Podcast appearances and mentions of Jeff Moore

As President and Chief Acquisitions Officer for ATI, Jeff Moore drives the company's growth and spearheads key initiatives that focus on the future of the organization. His current role involves overseeing mergers and acquisitions and ensuring ATI's continued expansion. In his current role, Jeff leverages his industry expertise to identify growth opportunities, forge strategic partnerships, and expand ATI's footprint across the United States. By focusing on acquisitions and fostering a culture of innovation, Jeff propels ATI forward, consistently exceeding industry expectations. With his extensive experience and deep understanding of the industry, Jeff has successfully led ATI's steady growth through more than 15 acquisitions, positioning the company for continued success.

Send us a textJoin us on a quiet night of summer rain as we listen to rooks and explore the beauty and ambiguities of two liminal places with a lot in common. We learn about the web-footed fenmen and are guided by Luke Sherlock to a ruined church under haunting skies.   Journal entry:6th June, Friday“We walk through the sheep field As the rain pours down. My boot socks still wet from last night. The rooks muster noisily at the One Oak.Even the magpies' cackles cannot wake The lambs still asleep Nestled beneath the blackthorn hedge.” Episode Information:In this episode I read Edward Storey's ‘You walk the roof of the world here' and Jeff Moore's ‘The worked land.' I also read an extract from Luke Sherlock's Forgotten Churches published by Quarto and refer to Adam Porter's podcast ‘The Water Road'More information about the campaign for a flag for the fens can be found here: Flag of the Fens.With special thanks to our lock-wheelers:Susan BakerMind Shambles Clare Hollingsworth Kevin B. Fleur and David Mcloughlin Lois Raphael Tania Yorgey Andrea Hansen Chris Hinds David Dirom Chris and Alan on NB Land of Green Ginger Captain Arlo Rebecca Russell Allison on the narrowboat Mukka Derek and Pauline Watts Anna V. Orange Cookie Mary Keane. Tony Rutherford. Arabella Holzapfel. Rory with MJ and Kayla. Narrowboat Precious Jet. Linda Reynolds Burkins. Richard Noble. Carol Ferguson. Tracie Thomas Mark and Tricia Stowe Madeleine SmithGeneral DetailsThe intro and the outro music is ‘Crying Cello' by Oleksii_Kalyna (2024) licensed for free-use by Pixabay (189988). Narrowboat engine recorded by 'James2nd' on the River Weaver, Cheshire. Uploaded to Freesound.org on 23rd June 2018. Creative CSupport the showBecome a 'Lock-Wheeler'Would you like to support this podcast by becoming a 'lock-wheeler' for Nighttime on Still Waters? Find out more: 'Lock-wheeling' for Nighttime on Still Waters.Contact Facebook at https://www.facebook.com/noswpod Instagram: https://www.instagram.com/nighttimeonstillwaters/ Bluesky: https://bsky.app/profile/noswpod.bsky.social Mastodon: https://mastodon.world/@nosw I would love to hear from you. You can email me at nighttimeonstillwaters@gmail.com or drop me a line by going to the nowspod website and using either the contact form or, if you prefer, record your message by clicking on the microphone icon. For more information about Nighttime on Still Waters You can find more information and photographs about the podcasts and life aboard the Erica on our website at noswpod.com.

In this episode, I sat down with a man who needs no introduction, but Ill give him one anyways! Join us as we talk shop with Jeff Moore, a 2nd generation Restorer, the President of the largest family run Restoration Companies in the world, ATI Restoration, and, the newly appointed President of the RIA. We will be talking about all things Restoration and about Jeff's journey from a youngster in the industry and into where he stands today, as a serious powerhouse who is advocating for big changes aimed to positively move the Restoration Industry forward.

On this episode of Ask The Expert, the RIA leadership team including President Jeff Moore and other top officers. They dove into the future of the restoration industry and several of RIA's initiatives.

In this episode of 'Modern Chiropractic Mastery', Dr. Kevin Christie interviews Jeff Moore, a physical therapist from the Institute of Clinical Excellence and founder of Onward Physical Therapy Clinics. They discuss the nuances of leadership in private practice, the importance of mentorship, and how to cultivate conviction in clinical skills. Jeff shares insights into a fitness-forward approach to physical therapy, the structure of his cash-based clinic model, and the role of interpersonal skills in successful practice management. The conversation also delves into strategies to prevent burnout and the importance of skill stacking for career advancement. This episode offers valuable advice for chiropractors and physical therapists looking to enhance their leadership capabilities and practice efficiency. https://ptonice.com/https://onwardphysicaltherapy.com/

On this episode, host Fred Burton interviews Dr. Jeff Moore, a globally recognized hotel threat analyst and creator of the Secure Hotel Threat Portal. Dr. Moore shares insights into global trends in hotel violence, key safety strategies for travelers, and the strategic importance of understanding threat patterns to enhance security measures. From analyzing data on incidents to providing practical advice for corporate security and travelers, Dr. Moore offers a comprehensive exploration of safety in the hotel industry.You'll Learn:The surprising trends and patterns in hotel violence worldwide, including the most affected regions and types of incidentsActionable advice on how to stay safe in hotels, with strategies for choosing rooms, securing doors, and avoiding potential threatsHow the Secure Hotel Threat Portal collects and analyzes thousands of cases to uncover critical insights for creating safer environments in the hotel industrySign up for our newsletter here.

Dr. Jeff Moore // www.ptonice.com  In today's episode of the PT on ICE Daily Show, ICE CEO Jeff Moore delves into the crucial topic of mentorship, addressing the common questions surrounding how to secure great mentors. He emphasizes the significant impact a strong mentor can have on one's career trajectory, providing insights on navigating real-world clinical practices and business aspects that aren't always covered in formal education. Jeff aims to clarify the key principles involved in obtaining mentorship, sharing his expertise and experiences to help listeners understand the path to finding someone who can invest in their professional growth. 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.

In this week's episode of The Guerrilla Social Work Podcast, your favorite irreverent duo, Jeff Moore and Mace Warren, dive headfirst into the legislative deep end. We're talking about Congresswoman Anna Paulina Luna's latest triple threat of bills aimed at giving child sexual predators the ultimate timeout—permanently. 

Dr. Cody Gingerich // #ClinicalTuesday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Extremity Division lead faculty member Cody Gingerich discusses the importance of technique in manual therapy, specifically focusing on joint mobilizations and manipulations. Cody shares a valuable principle he learned from Jeff Moore, ICE's CEO; the idea of having "iron fists in velvet gloves." He emphasizes the need for clinicians to use a broad contact area with their hands to enhance patient comfort while effectively directing force through body positioning rather than relying solely on hand strength. Cody identifies common faults in techniques and offers simple corrections to improve manual therapy practices. Take a listen to the episode or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about our Extremity 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.

On the 225th episode of the GreatBase Tennis podcast Steve Smith and Ivan Ozerets interview Jeff Moore. To make an understatement, their humble and honest guest has oodles of wisdom to share. We are confident that the session should be classified as a master class for anyone and everyone hungry for improvement; no matter what the endeavor.As an athlete, he played college tennis for the incomparable Jim Verdieck. As a coach, he led the University of Texas women's tennis team to two national championships. As a consultant, he has successfully impacted a wide assortment of teams, athletic departments, and companies.We highly recommend reading his book, Strive Together. One may contact Jeff via his website (www.mooreleadership.com).

We connect with portfolio manager Jeff Moore to get his thoughts on the US elections, the impending rate cute announcement by the Fed and how both events could potentially affect the markets. Jeff says the market stability hinges on timely election results in the bond and stock markets. He says investors should maintain existing trades and add the main stabilizer of the bond markets will depend on if there are clear cut election results. Jeff says there is a high likelihood that the current government debt will prompt higher taxes, cause spending cuts, and potentially both higher taxes and spending cuts could occur. No matter the result, the election is expected to bring stability as markets revert to usual trends post-certification. Jeff says it's important to continue to focus on inflation, employment, and GDP growth, and shaping monetary policy and rates. Recorded on November 4, 2024. At Fidelity, our mission is to build a better future for Canadian investors and help them stay ahead. We offer investors and institutions a range of innovative and trusted investment portfolios to help them reach their financial and life goals. Fidelity mutual funds and ETFs are available by working with a financial advisor or through an online brokerage account. Visit fidelity.ca/howtobuy for more information. For a fourth year in a row, FidelityConnects by Fidelity Investments Canada was ranked #1 podcast by Canadian financial advisors in the 2024 Environics' Advisor Digital Experience Study.

On Wednesday October 23, Fidelity Canada hosted VISION 2024 in Toronto, connecting our portfolio managers and experts with advisors. Fixed income portfolio managers Jeff Moore and Michael Plage sat down at the event with moderator Kelly Creelman, Senior Vice President, Products and Marketing. This session from VISION is today's podcast. Jeff and Michael reflect on fixed income investing in today's market environment, as 2024 winds down and '25 is on the horizon. Among other topics we'll hear about the team-based approach to fixed income investing at Fidelity's Merrimack, New Hampshire, fixed income headquarters, how the various team members contribute to Fidelity Canada's funds, and what may be next from the Federal Reserve and other central banks. Also, the potential impacts of the upcoming U.S. elections on markets. Recorded on October 23, 2024. At Fidelity, our mission is to build a better future for Canadian investors and help them stay ahead. We offer investors and institutions a range of innovative and trusted investment portfolios to help them reach their financial and life goals. Fidelity mutual funds and ETFs are available by working with a financial advisor or through an online brokerage account. Visit fidelity.ca/howtobuy for more information. For a fourth year in a row, FidelityConnects by Fidelity Investments Canada was ranked #1 podcast by Canadian financial advisors in the 2024 Environics' Advisor Digital Experience Study.

In this episode, I'm joined by Jeff to discuss his long battle with mental health challenges. Jeff shares how his depression stems from childhood, living in a chaotic home environment, and how it revisited him regularly throughout his life. He describes how, after many years of struggle, he found solace in both medication and exercise, specifically running and cycling. Jeff talks about how his depression was also linked to seasonal affective disorder (SAD) and how discovering the positive impact of exercise, especially in the winter months, helped him manage his symptoms. A key part of Jeff's journey has been setting what he calls "big, hairy-ass, audacious goals." He explains how one such goal, learning to play the slide guitar and performing in a blues band, and another, cycling across the U.S. from Florida to California, were transformational experiences that gave him a new sense of purpose and control over his mental health. However, in his sixties, Jeff was completely caught unawares when he suffered a stroke, and the impact it had on him mentally and physically, plunged him back into depression. Jeff then shares how he has adapted to live after the stroke up until today. He also discusses techniques he uses to help manage his mental health, for example, journalling daily has helped him reflect and manage his emotions. This episode is an inspiring look into how audacious personal goals and self-care can help manage mental health, especially in middle age.Jeff referenced the Stroke Association in the UK (https://www.stroke.org.uk) or in the US, there's the American Stroke Association (https://www.stroke.org). If you or someone you know is struggling with depression, then general advice is to contact your doctor.  

Today we welcome Portfolio Managers Jeff Moore and Michael Plage as they discuss the fixed income landscape.  Jeff and Michael touch on topics such as the positive correlation between stocks and bonds, the sustainability of the 60/40 portfolio, and what steeper unwinds mean for the U.S. treasury curve.  With strong bond market flows, there have been significant returns, leading to an increased demand for treasuries in this sector. Jeff and Michael also touch on what geopolitical tensions could mean for fixed income. They explain how these escalations could accelerate Fed rate cuts and benefit bonds, but could also negatively impact equities. Recorded on August 20, 2024. For a fourth year in a row, FidelityConnects by Fidelity Investments Canada was ranked #1 podcast by Canadian financial advisors in the 2024 Environics' Advisor Digital Experience Study.

Dr. Jeff Musgrave // #GeriOnICE // www.ptonice.com  In today's episode of the PT on ICE Daily Show, join Modern Management of the Older Adult lead faculty Jeff Musgrave shares shares how by being too quick to limit risk for our patients we can expedite deconditioning, worsen social isolation and mortality of our patients. Take a listen to learn how to better serve this population of patients & athletes, or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION JEFF MUSGRAVEWelcome to the PT on ICE Daily Show brought to you by the Institute of Clinical Excellence. My name is Dr. Jeff Musgrave, doctor of physical therapy. Super excited to be talking to you about everyone dies, not everyone lives. So I am fresh off an epic motorcycle adventure with the CEO Jeff Moore and Matt in the bike fit division of our company. And it was an epic trip. And a great way to summarize this trip is a quote from a motorcycle brand that I've started following recently. We don't promote this brand in any way, I just thought the quote was great, which is, everyone dies, not everyone lives. So just to kind of set the stage a little bit, I'm new to motorcycling, brand new thing, it's something just recently I decided was Important to me a risk that I wanted to take Lots of people in my life very well-meaning that care about me deeply Wanted to just share all the worst case scenarios. They wanted to instill enough fear in me To maybe prevent me from going or to make sure that I'm super safe and and I get that right there is some inherent risk Taking a motorcycle up a cliff face lots of things can happen Some injuries occurred, there were some wrecks, but most importantly, there was the opportunity to really live life. in a very deep, meaningful way to accept some risk, to have a lot of fun, to have some fun stories, to make some fun memories that are gonna last me, I hope, the rest of my life. And I think this is very relevant whether we're talking about older adults or even younger adults. But I think we come in contact with this type of problem with older adults most common. So commonly with older adults, In that same vein, we're trying to help our patients be safe. We want them to make decisions that are going to prevent injuries, prevent falls, and for a lot of our older adults, a fall can be a very serious thing. I'm not making light of that in any way. We know that lots of our older adults are living with low reserve. and low physical resiliency and reserve, so they have very little margin. So if they fall and they have decades of deconditioning, their bones are weak, their body systems are not prepared to help them recover quickly, and this can have a huge impact on their life. So I want to say I recognize that, and we preach this fitness forward approach to try to help build that reserve and build that resiliency, but still what I tend to see when I interact with clinicians, working with older adults, is we treat older adults with kid gloves and we don't want them to be put at any level of risk. But I think the thing that we forget is what they're missing out on. What are the things that they want to do that are risky and how meaningful may they be to their life? So I'd like to give you a few tips just from my clinical experience to help patients live until they die. We want them to live their life as fully as possible, and I think sometimes we don't think about, when we limit our patients, what the downstream effect is for their life. So I've got a few tips here that I think will be helpful, and then we'll go through an example of what this could look like. So, you know, many of our patients, they're maybe not trying to take a motorcycle adventure into the Rocky Mountains. Maybe it's something like walking without an assisted device, or maybe they really need a walker but they're only willing to use a cane. So I think the first thing that we have to do is we have to have an objective assessment here. We can't just make assumptions. We don't want to look at their past medical history, their diagnoses, and decide for them, or heaven forbid, just their age. We know that people age at different rates and have different functional levels. Their age doesn't dictate their treatment. There are clinical findings should, very accurate clinical findings that meet them where they're at. So the first thing I would advocate for is to get an objective assessment of the risk. So how risky is this activity? Say it's some type of walking or balance activity and we're worried that their balance isn't good enough. Well, first thing we should do is say, hold the phone. We need to do a good assessment here, so we need to match up the patient's physical ability to the objective measure and make sure that the activity is represented in our objective measure. One that we really like to use, it's pretty comprehensive, is a mini best test. The mini best test is a great way to look at dynamic balance, looking at reactive components, as well as anticipatory. as well as a vestibular system, and reactive, like how are they gonna react if they do catch their toe? Do they have the ability to react? So if it's a balance activity, we'll wanna make sure that that activity is represented in our assessment. So we can have a very clear picture of how much risk is this. Maybe it sounds really risky, and we have them do the assessment, and it's like, meh, it's maybe not the best, but it doesn't look like it's that serious, On the other hand, it could be that it is very risky. They can't even do the task at all safely in the assessment. So either way, we need to know objectively what's their physical ability to do this task, whether we're doing the task directly or we're trying to replicate it. We need to get an idea of what's required and get an objective measure for that. The second thing we need to know is how meaningful would this activity be to our patients? How risky is this? But how much reward is there for our patient as well? So there's two sides to this. So if we're thinking about, we've got our assessment, then we've got a good idea how much risk is this based on say like their fall risk. It looks like they're having trouble walking and carrying something. So them wanting to carry in their own groceries without their hands would be a pretty risky task. But maybe that task allows them to be independent in their home. Or maybe they don't have the financial resources to pay someone to bring their groceries to them or for some type of grocery delivery service. So that could change their living arrangement. So we don't want to just make these big blanket statements based on risk. So we've got to figure out how much risk is there based on an objective assessment. We also need to know how much reward is there for our patient on the other end of that. Or what are the downstream effects of them not doing that task anymore. Will there be more deconditioning? Will there be lack of social connection? Social isolation, especially if someone is pre-frail, increases their mortality risk by over 25%. So if we, our choices for safety, take away the social reward, and we reduce the value of their life, we may also hasten their death. which is kind of a wild thing to think about, but our trying to play it safe could actually lead to them dying sooner, which is pretty awful, and I know that's not anyone, what anyone wants to happen that's listening to this. And then the final thing is you have to come to some type of agreement that you can work with, that they can work with, that you can work with, right? So that this therapeutic relationship can continue. So I'll give you an example, I'll kind of work through this, and I think this will help make this a little more clear, So an objective assessment of someone's risk. Say we've got a patient who's an independent community-dwelling older adult who has had some deconditioning, they've got some balance deficits on board. They say, I've got a cat, I'm widowed, I live alone, I need to be able to take care of Fluffy, but my balance, I'm really struggling to be able to get the cat food in from my car up the steps into the house, and I've actually had some falls recently, and I'm at the end of the bag of cat food, now what do I do? So the first thing we're gonna do is based on that task, pick an objective measure that's gonna be helpful. So for a community dwelling older adult, we'll probably do some type of quick screen to get an idea of strength and balance, so something like the short physical performance battery. And then based on that, if it looks like there's some serious balance deficits, we may wanna do a deep dive with a mini best test to get an idea of her dynamic balance, her ability to recover if she catches her toe, while she is carrying, it'll also take away her visual field during parts of the test to get an idea of what's her proprioception like, how well is her vestibular system functioning, and then from there, we can get an idea of what is the objective level of risk. So say we run the mini BEST test, and it looks like she is at risk for having a fall. And then the third thing is, we know, based on this patient, maybe she doesn't have a whole lot of social outlets, and this is one of the only times she gets out of the house for a medical appointment. So we need to really go through this filter of, yes, she could fall. If she continues to do this task, she could fall. But if we take away this trip out of the house, we take away a lot of activity from her daily life. So if she's not able to, if she's not lifting, carrying, working on her dynamic balance through this task, even if it's once every couple weeks, that is still a huge reduction in her overall physical outlet in her physical health. I mean it's built into her life so taking that away from her will actually probably expedite her lack of reserve, resiliency, expedite her deconditioning, as well as potentially isolate her from her pets. So if she's trying to take care of Fluffy, she doesn't have a whole lot of social outlets, that may reduce her willingness or desire to even live moving forward if she doesn't have that outlet with her pet. the lack of reward or the loss that that would represent to just say, no, not safe for you to do that. Let's have someone else bring the food, which she loses the physical attributes or the physical activity that is keeping her strong, at least at some level. But then the second piece is, maybe if we went to the extremes like, you know what, you're just gonna continue to get older and more deconditioned, you should probably just give the cat away. which is probably the worst thing we could say if there's any hope of her getting her strength back. She'll have the social isolation, probably some depression, as well as not being able to have that at least low level of physical activity. A way that I would come at this, if this was my patient, is I would describe the risk. Hey Betty, you know what? You are at risk for falling. You do have some deficits on your balance, but I realize this connection with Fluffy is really important for you, and I think we can work together to find some solutions. So some things I would be thinking about is if she needs some upper extremity support, maybe she's not using an assistive device, or she's not using the right one, which also happens pretty often, Maybe we can meet in the middle. Maybe we can say, you know what? I think if you get a smaller bag of cat food, you can put it in a backpack. And if you can get it, if I can teach you how to put this in a backpack and put it on your back, you're gonna have your hands free. And maybe until we get you stronger, just till then, we can use a walker to get you from your car to the steps, and then if you've got enough support or you've got your cane you usually use in the house, maybe we can get you to use the cane for a very short distance. Or maybe even let her set the backpack down and drag the thing into the kitchen. There's so many ways we could get the job done, but we may have to change what it looks like for a short time. And I would almost guarantee you, if that example was your patient, that they would 100% be okay with buying a smaller bag of cat food, which may get them out more often, which may help us reduce their sedentary behavior, improve their activity frequency, how often they're doing that, could be really good, as well as keep the cat, which I think is the ultimate goal. If they get to keep the cat, keep doing the task, maintain their independence, and we can limit their fall risk by giving them some extra support, but the task gets done and it's temporary, I bet they're gonna be on board. So I hope that helps. So I would really advocate before we just give blanket statements for safety for any patient, but especially for older adults. We want to make sure that they have the opportunity to live their life. We need to consider the risk, absolutely. We need to get an objective measure on that, but we need to consider what we're taking away or what their life will look like and the downstream effects of telling them no. With the heart of safety, we may expedite someone's death or reducing the quality of their life. The final phase, after you figure that out, is we've gotta come to an agreement. We've gotta continue that relationship, do what we can to reduce the risk for them, but maybe we have to meet in the middle. And maybe we can make some agreement that it's like, hey, until we get you to this point, would you agree to use this extra support? Or do this task a little bit differently? And almost 99% of the time that I've come at this type of conversation with a client this way, it has always gone well. Team, I hope that you go out there and you help your patients live. I hope that you're careful assessing risk. I would love, if anyone has any examples or stories they'd love to share, please drop it in the comments. If there's a cool story where you've been able to meet in the middle, help someone continue to do something like that, or just have some thoughts. I would love to hear your thoughts on that. If you're interested in learning more from the older adult crew, We've got our level one is kicking off in less than a week. It's crazy. It's time to sharpen those mental muscles, get back into L1. So if you just came off live and you're wanting to get your specialty in older adult, we would love for you to hop in there. If you've already had L1, I'd recommend you hop into L2. The last cohort sold out. The next one of those is gonna be October 17th. As far as live courses, myself and Ellen Sepe, The woman, the myth, the legend is going to be with me in Anchorage, Alaska. We're going to have a great time. That's going to be August 17th and 18th. Great opportunity for some awesome continuing education. Meet us live, work on your skills, and also take in a beautiful state at a great time of the year. We also have live courses on September 7th and 8th in Minnesota and Alabama. Team, that's what I've got for you for today. Go help those patients live. Have a great day. Catch you next time. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

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 healthcare & rehab as an industry, who the big players are, what (if anything) is being done to change things, and how individual therapists can begin to affect meaningful change 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 ALAN FREDENDALLGood morning, everybody. Welcome to the PT on ICE Daily Show. Happy Thursday morning. We hope your day is off to a great start. My name is Alan, the pleasure of being our Chief Operating Officer here at ICE and a faculty member in our Fitness Athlete and Practice Management Divisions. It is Leadership Thursday. We talk all things practice, ownership, business management. Leadership Thursday also means it is Gut Check Thursday. This week's Gut Check Thursday comes directly from ICE's CEO, Jeff Moore. sent this to me last week said hey I was just goofing off in the gym trying to get some lifting and cardio in together and so he sent me a workout of 100 bench press with the weights on the barbell 135 for guys 95 for ladies and a hundred calories on a fan bike for guys 80 for ladies with the caveat that you can break up that work however you like you can Do 100 bench press straight through, 100 calories on the bike straight through. You can break it up into 10 rounds of 10 and 10, 20 rounds of 5, 5, 5. Whatever rep scheme suits your fancy, you are allowed to do that as long as you get all of those bench press and all of those calories done. that bench press weight should be light to moderate for you enough that you could potentially do five to ten reps unbroken. If it's so heavy that you could only do maybe singles or doubles or triples it's going to take you a long time to work through a hundred so keep that in mind. Other than that just pace yourself on the bike. There is no use racing that bike to finish a couple seconds maybe faster than normal only to lay on that bench for 30 seconds before you feel like getting some reps in. So just treat it a moderate approach on that bike and hammer out that bench press as able. So that is Gut Check Thursday. Today we're talking about changing the status quo. What does that mean? We're talking about the status quo as it is across healthcare in general, but of course specifically to rehab today on PT on ICE. So we're gonna talk about what is business as usual in rehab, who are the major players, We're going to talk about what is currently being done to address some of the issues across the rehab professions and again in particular physical therapy. And then are there more effective ways to try to change things. WHAT IS BUSINESS AS USUAL IN REHAB? So let's get started first by talking about what is business as usual. And in the rehab industry, the healthcare industry in general, we have what is really going on across pretty much every industry in the country of a slow merger acquisition consolidation of small to moderate companies being bought out by larger companies and slowly paring down the amount of organizations who really offer the same or similar service. A good representation of this is the airline industry. We only have four major airlines left. Southwest, Delta, American, and United. 20 or 30 years ago, there were over a dozen. And in the wake of some of the IT issues we had last week, we may even see that Delta and American could be going away soon if they don't fix their IT infrastructure and get their feet back on board. And so we see that there are just a handful of major players in the industry. And we would label those too big to fail kind of organizations. We have the same phenomenon going on in physical therapy and again in healthcare in general. When we look at healthcare, when we look in particular at rehab, we really have four major players. We have health insurance companies that control the care that patients are able to receive. and the amount of time providers have to spend paperwork wise on providing that care and also the amount of money that providers get. We know that almost every American has health insurance and so that health insurance for the foreseeable future is going to be part of the equation and therefore these health insurance companies are a big player in this industry. We have just a handful of health insurance companies, about 10, that generate $1.3 trillion collectively and employ over half a million people, with an average profit increase every year of about 9% year over year. And these 10 companies insure about three-fourths of Americans. So again, a very consolidated, condensed industry. where if any of those companies were to go out of business or something, it would have a lot of ramifications for the economy, for patients, and for providers. And so health insurance companies stand as one of those too big to fail type of organizations in this equation. Right after health insurance companies are health care companies. Large, national, across state lines, corporate, health care clinics, whether they are primary care clinics, dental clinics, urgent cares, physical therapy clinics, whatever, we see the same issue across all health care professions is that over time we are slowly paring down that the vast majority of clinics are owned by a large corporation and that usually as we get near the top of these organizations, Nobody involved in the leadership or management of the company is actually a healthcare provider. And so these are large, for-profit clinics that provide some sort of healthcare treatment. In the rehab industry and physical therapy in specific, just eight companies are closing in on owning 75% of all outpatient physical therapy clinics. And so that's very similar to health insurance, right? A small amount of companies own the vast majority the organizations and clinics within the industry. We have universities as our third player in the equation. They are responsible for educating entry-level students and getting them prepared to become new clinicians. They certainly have a stake in the equation here. And then finally we have the government itself. That can be kind of vague when we say the United States government. We're kind of really referring to enforcement organizations, Medicare, IRS, who are trying their darndest to try to regulate the other three organizations, big players in the industry. And what we find when we look at the intersection of all these giant, large, too-big-to-fail organizations is that we find that Over time, they have become intertwined. They have developed a symbiotic relationship with each other such that it would be really hard to affect significant change on one piece of the puzzle without it affecting everything else downstream. We see that universities have grown their cohort sizes so much that they are now graduating hundreds. Hybrid programs with multiple cohorts starting per year are getting close to graduating thousands of physical therapists per year. And all of those students need clinical placements. Those large corporate health care clinics are happy to take those students and put them to work for some free labor. I think we've probably all experienced that. at one point or another in our student career. And when those universities grow these cohort sizes, they begin to need those large clinics to have places to send their students to. And those clinics rely on those students, again, as part of their labor force alongside their staff therapists as well. We see that health insurance companies need, at some level, some providers to take their insurance so that they can offer to their customers, our patients, that there are some providers who take your insurance. If we get to a level where no one is taking insurance, health insurance companies are gonna be in a lot of trouble, and so we see that they are trying to hang on and kind of fight back against a shift across healthcare towards cash-based physical therapy and trying to go around the insurance system. And then finally we see that the United States government hasn't necessarily quit trying to enforce curb all the fraud waste and abuse in Rehab in health care in general what we see is they've kind of changed their policy over the years instead of throwing people in jail or busting up companies or that sort of thing that they have shifted their strategy to just collect fines right if they can't and stop it, then they will collect a piece of the revenue that all these different organizations are making. And so you see that fines are becoming much more popular than actual legal action when the government tries to get involved in significant issues with fraud, waste, and abuse in healthcare. So that's business as usual currently. Universities pumping out students, big corporate clinics taking students, offering students a job, health insurance companies playing both sides against the middle and then the government just trying to come in and take a little bit off the top at the end of the day. And really what we see happening is at the end of the day, there's really no impetus to change business as usual, the status quo among those four groups. It is working well enough that there is no significant push to really change things. WHAT IS BEING DONE TO CHANGE THINGS? What is being done to change things? You may have noticed what we did not mention in one of those big players was an organization like the American Physical Therapy Association. Not much is being done here because not much can be done. If we take a second, and please don't hear that this episode is just an episode designed to dump on the American Physical Therapy Association, but structurally it is not designed to hang on and try to enforce or weigh in or make any sort of decisions or affect really a lot of long-term change on any of the issues we see among the big players in our industry. That when we look at what is the APTA, really it is a non-profit member organization. It's not a charity. It's not a church. It's a member organization, it's a non-profit, it doesn't pay taxes, and so at the national level it really can't affect change. Nothing about our profession is regulated on the national level, it is all regulated on the state level. Your scope of practice, whether you can manipulate the spine, dry needle, whether who can prescribe exercise, who can do cupping, who can do blood flow restriction, all those different scope of practice issues are all handled by individual state legislations. And because of that, the APTA cannot really weigh in. They can also not weigh in because they can't legally weigh in. When we look at how the APTA is structured, it's structured as a non-profit corporation. It is forbidden by law, as is every non-profit company, every church, every anything, from engaging in political activities. So what the APTA has is a secondary organization called the PT PAC, the Political Action Committee. That is an entirely different organization. It's an entirely different pool of money. And that is the group that can try to lobby for things like mitigating Medicare reimbursement cuts. But that in general, on the national level, by design, it can't be effective. And just being an APTA member without donating any extra money to the PT PAC itself doesn't really allow us as individual clinicians to help the APTA effect change either. HOW DO THINGS ACTUALLY GET DONE? So, how do things actually get done then? Things really get done in our profession at the state level. State legislation, changing scope of practice, doing things like expanding direct access, opening up the ability to dry needle. We saw Washington just get access to dry needling a couple months ago. That was a state-led initiative from the clinicians in that state, from the state physical therapy chapter, and from the state legislature in Washington. That is how things actually begin to move around in our profession. And the unfortunate thing is you cannot join, just join your state chapter. You have to join the APTA and then also join your state chapter at the same time. So you can't be a part of just your state without being a part of the national organization, which I personally believe is a little bit unfortunate because I'd rather see my time and money go towards the organization that's going to affect the most change, which is going to be my state chapter. A really good example right now, we're close to completely removing direct access restrictions here in Michigan, and that is led on the state level. A guy over on the west side of the state, Dustin Karlich, he is pushing that initiative with the Michigan State Physical Therapy Association through the Michigan State Legislature, and we're hoping that that gets heard in the fall meeting of the state legislature. and that we have direct access restrictions completely removed here in Michigan. And again, that is all done at the state level, not at the national level. So what can we do? What can be done? If that is the status quo, if that is what is currently being done, and most of it is being done at the state level, What can we do to try to change the status quo? We hear a lot here at ICE, you know, what is being done about this issue? What is being done about that issue? And the truth is, not a lot, right? We're not expecting to see reimbursement probably go up ever again. We've talked about why that is. The math just doesn't math with that. And so if we can't meaningfully affect the change that we want to see, especially at the level that we want to see it, what can we do as individuals and what can be done to try to change things in our profession? The first is to recognize, like, hey, we're in a Cold War event, kind of, right? These big organizations that don't really want to change things are pitting themselves against each other, and again, they don't really have an impetus to change. We see a lot of proxy fighting going on, arguing back and forth about who and who cannot dry needle or use cupping or blood flow restriction or whatever. We kind of have these proxy fights across the country. We go back and forth constantly. And the truth is, we need to recognize, hey, how did we actually win the real Cold War? We've significantly changed our strategy, right? How did we do that? We stopped expecting that doing the same thing over and over again would create meaningful change, right? We stopped going into small countries and propping up a government to fight against the Soviet Union. We recognized after 50 years of that, that that wouldn't work. What we did instead was we shifted to focus on our economy, we shifted to focus on being self-sufficient with natural resources, and we went an economy-driven strategy instead of a military-driven strategy, and that's what actually ended the Cold War. We see a very similar recommendation here inside the PT profession. What is the strategy? Literally anything except what we're trying to do, which has not worked in decades. This is one of my favorite books of all time. This is a hefty book. None of you are probably going to read this. That's okay. This is Army FM 7-8, Field Manual 7-8. It is infantry tactics. What I love about this book is probably a thousand pages of how to fight a war. What I love is that almost every section starts with, if what you're currently doing is not working, stop trying to expect a lot of change by doing the same exact thing over and over again. Change your strategy, right? Do the unexpected. There is a whole page in here on how to react to an ambush and the first sentence is, if ambushed, attack back immediately. Why? It is the unexpected thing to do. We have to do the same thing in physical therapy. Do the unexpected strategy because the expected strategy, the thing we've been trying, for the past 50 years or so has not really changed anything and we should not expect that doing the same thing over and over again will affect any sort of meaningful change. If we just stick our head in the sand and say, certainly someone is going to fix all of these issues soon, we should not expect that those issues will be fixed anytime soon. So, what are our recommendations? Support your local state PT association. You can't join it directly, but you can support your state PT PAC, your political action committee, which means that you can give money to your state physical therapy association that they can use to pass meaningful legislation in your state. So if you're in a state and you want access to dry needling, you want access to spinal manipulation, cupping, blood flow restriction, you want better direct access, you want whatever, it's going to change most likely at the state level and so support your state level association. As an industry, as a profession, we need to recognize that slowly over time, we're moving towards a state where it is not going to be possible to accept every single insurance and run a sustainable and profitable practice that lets us pay our therapists what they need to make to make a decent living while working at a reasonable volume, right? We have moved over the years from 40 patients a week to 60 patients a week to 80 to the average now is climbing towards a hundred patients a week that is Unsustainable and the again the idea that we can just do the same thing over and over again and expect change is not going to happen we're not going to to really make any meaningful change by trying to see a hundred patients a week or 120 patients a week and to try to generate more money to be able to pay more people. There are limits to how much you can get, how much you can work, and we need to recognize that over time, if things don't change with insurance, we need to let that ship sail. That is a tough transition, that is a hard transition, but it is a transition that is going to have to happen to some degree at some point in time for almost every physical therapy clinic in the country. unless things meaningfully change. How can those things change? There are systems in place for us to report our outcomes and increase our reimbursement from insurance. Almost nobody does that because it takes time, but it is possible. We're going to see our reimbursement here at our clinic here in Michigan go up 20% in 2025 because we are reporting our outcomes and And we are getting rewarded with more reimbursement. So there are systems in place, but if you don't want to use those systems or do those tasks, you need to recognize that you need to let that insurance ship sail. And it means that you're not going to be on it. And then over time, we'll need to probably pare down our insurances and potentially be cash only across the majority of the profession. And then as individuals, what can we do? Yes, we can support our state physical therapy association and state PT pack, but we can also stick up for ourselves. Every time you go to work for somebody that overworks you and underpays you, you confirm to the leadership of that organization that there is another sucker out there who is willing to accept that, right? And we just perpetuate the cycle that we have been trapped in for many decades. And again, what is the best strategy? Anything different than what we're already doing. So when you are given that quote unquote opportunity from that organization, and it looks terrible, don't take it. There are 34,000 physical therapy clinics across the country. Find a different one. There is a clinic for you that is going to pay you well and respect your time and autonomy. I guarantee it. It just might not be three minutes from your house, right? We sometimes need to choose a little bit of discomfort to make a meaningful bump in our own individual practice and our own individual work inside of the bigger profession. SUMMARY So changing the status quo, recognizing we're kind of stuck in a cold war with several organizations that are too big to fail, that don't really have an impetus to change what they're doing because it's working well enough for all of them. What is being done currently? Not a lot on the national level because it can't. We have to stop expecting that black helicopters with agents in suits from the American Physical Therapy Association are going to drop out of helicopters and just fix things. There are only 160 people that work at the APTA. Almost all of them are administrative roles. There are very few people there that are doing a lot of of groundwork because the groundwork of our profession happens at the state level. So what can we do to support that? Support your state physical therapy association. If you're like me and you don't want to join the American Physical Therapy Association just to support your state association, you can still support your state's physical therapy political action committee PAC PAC by donating money. If you go to that website I think you'll be surprised by how few people donate and in reality how much gets done at the state level with a relatively small amount of manpower and money and that if we all just gave a hundred bucks to those organizations I think we'd be really surprised at how much more change we see affected if only in our individual states, but how effective and how large that change could be across our profession. So, when in doubt, if your courage strategy is not working, literally do anything else, right? Write from the Army Field Manual. If you are being ambushed, attack back because that is the strategy that is least expected. Do something different. Go around insurance companies, support your state political action committee, and stop working for employers who don't respect your autonomy and who don't respect your livelihood, who are trying to overwork you and underpay you. That's all we have for today's episode. I hope you found this helpful. I'd love to hear any discussion you all have about this. You can leave a comment here. I'll be back tomorrow. We're gonna talk about Fitness Athlete Friday, how to develop really brutal strength in a way that translates to improvements in your Olympic weightlifting. So we'll see you again tomorrow morning. Have a great Thursday. Have fun with Gut Check Thursday. Bye, everybody. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.  

Dr. Jeff Musgrave // #LeadershipThursday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Older Adult lead faculty member Jeff Musgrave discusses how choosing pain now can help you avoid pain of regret later in your career. 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 Welcome to the PT on ICE Daily Show. My name is Dr. Jeff Musgrave, Doctor of Physical Therapy, currently serving in the Institute of Clinical Excellence in the Older Adult Division. It is Thursday, so it is Leadership Thursday. Super excited to be bringing to you a message that I think a lot of people are going to relate to. Pain now or pain later? When thinking about this topic, it really came very organically out of a class that I was coaching. So I get to coach people 55 and up, we're all about pushing high intensity, we celebrate sweating, we celebrate heavy weights, and really pushing things in a business called Stronger Life. But we were finishing up class, it was a really tough workout, and I was talking to our members and I said, you know, the reality is, team, you can have a little bit of pain, a little bit at a time, or you can have some uncontrolled pain later in life, maybe years from now, maybe decades from now, but that pain, you're unlikely to get to choose. And we all know this, if you're listening to this podcast, you know that we're all about being fitness forward. We're all about choosing that little incremental consistent pain to avoid greater pain later, right? Whether we're talking about building reserve for not even just older adults, but all people, right? The stronger we are, the fitter we are, the less likely we're going to have those uncontrollable pains through health complications, whether we're thinking about heart attacks, type 2 diabetes and amputation, strokes, Those type of things, for the most part, are very avoidable by choosing a little bit of pain, a little bit at a time. So this really just resonated with me, and as I was reflecting on it, not that I have that many great quotes, but this one, I was like, this one kind of lands. It connects a little bit. And then it made me think about my career. It made me think about people that, in scenarios that I've been through, as a clinician, and my journey in my career. So I think this not only relates to us from a physical standpoint, but thinking about our career, where we're headed, having big dreams, like what do you want out of your life? Who do you want to serve? And how are you going to get there? And the reality is, I truly believe you've got to choose some discomfort. You've got to choose a little bit of pain if you want to reach your goals. Likely, if they're worthwhile at all, they're going to be hard to obtain. They're not going to be easy to get to, and you're going to have to push yourself. And you're going to have to seek some pain. If you're choosing comfort in your career, you're unlikely to reach any big, meaningful goals. That's just the reality of it. So I'm gonna give you some examples, thinking about the perspective if you're an employee and if you're a business owner, if you're an entrepreneur. So for these, really we're just gonna talk about two scenarios. So the first trap that can lead to you not choosing pain is really just seeking comfort, career comfort. And it can be a career comfort as an employee and as an entrepreneur. So the way I see this is if you're early in your career or maybe you're later in your career, it doesn't really matter. But if you were choosing comfort as an employee, it could look like choosing prioritizing a paycheck over growth. right? And I've been there too, right? Student loans, debt, paying the bills, that's a reality. We all have to pay the bills, right? And the more financial margin we have, the easier our life is from that perspective. But that's not always the path to a meaningful career. Those two things can coincide. You can make great money and you can be serving your life's passion, the mission, the thing that you are here as a clinician to do, you can get both. But oftentimes, there are so many more opportunities to choose a paycheck and comfort over growth, over meaningful growth. Some signs, because I've worked at these places before, I've been there, team. Some signs that you are in the wrong place and you're choosing career comfort over growth or that small incremental pain is you're working with a bunch of burned out clinicians. They've been there for a long time. Their interventions are ancient, right? They're not up on the research. They're the ones doing shake and bake with heat and e-stem. They're using the ultrasound machine, whether it's plugged in or not, right? We know it's going to work. Not to say we won't do that to meet a patient's expectations. If they believe that's what they need, we'll do that and then we'll get after it later, right? Another sign you're in a place of just comfort, seeking a paycheck, is all of your clinicians or maybe you have gotten into the habit of using handouts. There's like, here's my older adult knee program. Here's my shoulder program. Here's my hip program. Team, we know if it works for everyone, it works for nobody. Right? Care has got to be individualized. We've got to meet people where they are, do an individualized assessment, and then we can dive in and really bring them the goods. But there's a good chance if you're in a work environment where everyone's super burned out, they're there for the paycheck, it's probably a pretty good one. and the expectations are probably pretty low. No one cares what the quality of care is. All they typically care about is billing units. If billing units is more important than quality, if you're not getting your sword sharpened by the people you're working around, you may be choosing career comfort over growth. I think another area where people can fall into a trap, there are lots of different companies that are gonna offer mentorship. This happened to me. I was switching settings early in my career. I was promised mentorship. What I got? Super full schedule, no help, no supervision. I wasn't even treating during the time my mentor was supposed to be there. No conversations about mentorship happened until I told them I was ready to leave and put in my 30-day notice after I'd been there for five months. No mentoring, didn't execute on the schedule they said they would give me to slowly on-ramp and sharpen my skills. Look around. If your mentor is not available, if your mentor is not someone you want to emulate, that's at the cutting edge, that's constantly growing, that hasn't reached the peak of their career, if you've peaked and stopped, you're done. You're learning or you're growing. So that's another trap that I typically see. So if that is you and that is what your situation is like, you need to run. If you're interested in growth, you're interested in being the best, you can't hang around in a work environment for very long with people that are burned out, that aren't trying, that are doing the minimum, that are there for the paycheck, it will crush you eventually. You can swim upstream for a while, but you need people to go with you. And if you're in that scenario and you can't change your scenario right now, stay connected with us. Listen to the podcast, go to good content courses, and we can help you get through that period. But long-term, if you want solid growth, you've got to find a solid mentor. You need to be surrounded by like-minded clinicians that are going to push you You want people that are gonna point out the things that you're doing poorly. You need a mentor that's gonna say, you know what? I think you can do better. I know what your capacity is. You're smarter than this. You're better than this. Let's get better. Let me show you how. And that person better be someone you're ready to follow. Okay, so that's if you're an employee seeking career comfort. If you're an entrepreneur or a business owner, one of the traps that I see with seeking comfort is you probably busted your tail to get started. I hear Jeff Moore talk about this all the time and it's so true. Getting that boulder, pushing that boulder at the beginning to get some momentum is so hard. It's so challenging to do that. Once you get it going and get some momentum, it's easy to just be like, oh man, I did it, like this is good, I'm making money, I like this, and it's easy to get comfortable there. When really, there's so much more that you could do and I think Sometimes that is not bringing on someone else to help you. You're seeking comfort through just doing it all yourself. Not trusting someone else with things maybe you're not great at. relying completely on yourself. And basically you've turned yourself into an employee for yourself. You don't have time to work on the business. You don't have time to expand. You don't have time to bring on more business or new employees that are smarter than you or better than you in a certain area to really grow your business, to have a big impact. If you're really good, bring more good people with you. Serve your community well. Push yourself, push your business. If you are seeking comfort and you're an entrepreneur, this is my challenge to you, to grow your team. Find something that you suck at and find someone better than you at it. Offload some of those things, a little bit of time if you can. You don't have to go all in. I'm not saying cancel your schedule. What I'm saying is bring someone on that can help take on a little bit of the burden that's better than you in a certain area. That can help shake off the comfort. That'll make you feel a little uncomfortable. It'll be a little harder to teach someone else. It's gonna take some time investment, but it'll pay huge dividends. So that's one of the main ways that I see that happen. But you've got to free up enough time that you can work on the business, not just in the business. That quote I pulled from the EMF Great Book. If you're an entrepreneur, you've never read it. That's a trap that I fall into. I wanna do the work myself, but I've gotta get comfortable giving other people tasks that I'm just not that great at. We can't be good at everything. We can be good at a lot of things, but if we're gonna grow a business, we're gonna have a big impact. We've got to share the load. We've got to share that burden. The other, on that same note with hiring someone, another thing that we see, is if you get too disconnected. So the one extreme that I see with entrepreneurs that you can fall into this trap and I tend to fall into is I want to do too much work and not delegate or let other people do things I'm not good at. The other extreme that I tend to see is we have people that then continue to micromanage really talented people. You give them a job, you give them tasks, but you're upping their grill all the time. You're checking up on everything. You're not giving them the space to be creative. You're not giving them the space to spread their wings and do their thing, to let them fly out of the nest. You're hovering over them, micromanaging everything. You've got to find smart people. You've got to set some clear expectations. You've got to give them good support. Be clear. Just as a side note, when you think you're being clear, you're not being clear. I fall into this trap all the time with not having enough clarity. But the biggest key, once you get someone talented on board, is get out of the way. There's a reason you hired them. Give them the space to do their thing. Okay, so that's part one, career comfort. The second piece, risk little, gain little. If you risk little, you're likely to gain little over time. So if you're interested in growth, being the best in your area, being the go-to in anything, you gotta risk a little bit. You've gotta throw some money at your skills in an efficient way. You've gotta go through the discomfort of getting real feedback. If you're not getting real feedback on your skills, whether you're in the clinical or you're doing some type of mentorship or you're continuing education courses, people should tell you when you do something wrong. They should be bold enough to tell you, hey, that's not great. You can do that better. Here, let me show you and have a trusted source for that. But you're going to have to see some incremental pain and discomfort of being told that's not great. The other thing is if you are one of those people that were like me, you're in a career, you're ready to make a jump, you want to do your own thing, you're gonna have to suffer some pain. You're gonna be on the bubble for a while. You're gonna have to have some revenue streams to help support that jump as you're getting things going, and you gotta be prepared to not make money for a while. For most scenarios, there are very few scenarios where you can just hop straight over, go completely from being an employee into being an entrepreneur. So you need to have a period of time to build an on-ramp for yourself, and this is going to be uncomfortable. You're going to have to have revenue streams that are going to help support you through the period of time that you're working on building a business or building up your referrals so that you can make enough money to sustain things. That period of time will not last forever, but you need to have a solid plan. and you need to have a long runway. The longer the runway you can create financially, the more reserve financially you can create before you start doing a second thing or a third thing. Whatever it takes to be able to build your dream, build your business, you gotta do it. There's no path forward without some pain, without some discomfort, without some extra hours. I've just never seen that happen. If you've been able to do it, please share in the comments. I'd love to know how you pulled that off. So that is the second piece if you're an employee and you're trying to move forward. and you want to start your own thing. If you're an entrepreneur, I think another big mistake through being comfortable and not not risking enough is not risking to make yourself an expert in one area. I see this a lot too where clinicians are well-rounded. They can do a lot of things and that's great. You need to be able to treat all of the things that you want to treat, but eventually, after you become successful, you've got to niche down. You've got to find that specialty area. You want to be the go-to for this. When their friend says, oh, I've got someone that's got pelvic floor dysfunction, you need to go see Amy. Amy is the best at it. No one's going to do a job for you like Amy will. That's who you want to see. That is so clear. The message to your customer is so clear. You need to niche down. And maybe you've got a couple different areas. That's great. Crush it with those. You'll still get word of mouth referrals, but you want your clinic to be known for something in particular. This is great for getting people active. Maybe you're the older adult go-to. If you're over 55, you really want to go see Sally. Sally is the best in the world. She gets it. She understands what's going on. She's going to treat you with respect by challenging you as you're ready. I've got a friend who did X, Y, or Z, or those are the type of stories you want to hear. But you can't be too broad. If you want to grow, eventually you've got to niche down. You've got to be the best at things. Or maybe you're growing your team so that you've got a team of people that are the best at things. The only exceptions I can think of here is if you're in a super rural area, you kind of have to be a jack of all trades, but you want to hit those things that are the most common. And then people are going to trust you by proxy too, right? If you crushed it in this, it's like, well, I'll trust them with that too. And that can be helpful as well. SUMMARY Team, I hope this was helpful. This is something that I'm really passionate about. I found in my own life. personally, professionally, in the gym, seeking some discomfort early is going to help avoid pain later, uncontrollable pain later. So seek that little bit of pain for the growth, for your dreams, the things that you really want to do in life, and you will be much better off for it. Team, if you've got thoughts or questions here, I would love to hear your thoughts. I hope this was helpful. So we want to avoid seeking career comfort and if you risk little, you will gain little. Team, enjoy the rest of your Thursday. We'll see you next time. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning 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.  

Host Craig Larsen talks with Jeff Moore from the Challis Idaho Youth Bird Dog Association about upcoming shotgun clinics.

What up, doe!!! Welcome to another episode of the Woke•ish Podcast!!! In this episode, me and my brotha Jeff Moore talk about when racism and journalism mix, when the 2520s can let us have anything and how much money you would turn down for true love. Join in, check in and sit down a spell with us in the Woke•ish Podcast community!!! Follow us on Facebook: ⁠www.facebook.com/Wokeish19/⁠ Follow us on Instagram: @⁠Wokeish_podcast Gotta question? Email us: ⁠wokeishpodcast19@gmail.com⁠ Wanna support our self-funded podcast?: Hit up the CashApp: $Wokeish2019. We appreciate all the love and support!!! LISTEN, RATE, REVIEW, SUBSCRIBE!!!

What up, doe!!! Welcome to another episode of the Woke•ish Podcast!!! In this episode, me and my brotha Jeff Moore discuss the trials and tribulations of Black financial literacy (from a small business standpoint and legitimate home ownership) in the Black community. I think it's very informative and entertaining so listen in on this!!! Building Black wealth...something I know for a fact that we all need to brush up on!!! Follow us on Facebook: ⁠www.facebook.com/Wokeish19/⁠ Follow us on Instagram: @⁠Wokeish_podcast Gotta question? Email us: ⁠wokeishpodcast19@gmail.com⁠ Wanna support our self-funded podcast?: Hit up the CashApp: $Wokeish2019. We appreciate all the love and support!!! LISTEN, RATE, REVIEW, SUBSCRIBE!!!

It was a two part Voice today.  In part one, host Craig Larsen talked with Jeff Moore with the Challis Idaho Youth Birddog Association,  He was talking about the free youth shotgun clinic and pheasant hunt.  In part two, Craig talks with Joyce Scott, Paul Fisher, Steve Drippon and Keats Conley from the Whitewater Theraputic Recreation Riding Association.   They talk about the T-Mobile grant of $50,000.

Dr. Jeff Moore // #LeadershipThursday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, ICE Chief Executive Officer Jeff Moore discusses three fundamentals to working with individuals new to a fitness routine who encounter their first injury: avoid medical imaging, stay in the gym & modify around the injury, and be goal-driven to maintain motivation to continue to create a fitness habit. 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 everybody, Alan here, Chief Operating Officer at ICE. Thanks for listening to the P-10 ICE Daily Show. Before we jump into today's episode, let's give a big shout out to our show sponsor, Jane. in online clinic management software and EMR. The Jane team understands that getting started with new software can be overwhelming, but they want you to know that you're not alone. To ensure the onboarding process goes smoothly, Jane offers free data imports, personalized calls to set up your account, and unlimited phone, email, and chat support. With a transparent monthly subscription, you'll never be locked into a contract with Jane. If you're interested in learning more about Jane or you want to book a personalized demo, head on over to jane.app.switch. And if you do decide to make the switch, don't forget to use our code ICEPT1MO at sign up to receive a one month free grace period on your new Jane account. JEFF MOOREAlright crew, what's up? Welcome back to the P.T. on Ice Daily Show. I am Dr. Jeff Moore, currently serving as the CEO of Ice and always thrilled to be here on a Leadership Thursday, which is always a Gut Check Thursday. So first things first, let's hit the workout. Gut Check Thursday this week is going to be a bit of a partner WOD. So we've got four times, relatively simple. It's going to be 100 deadlifts, 100 power cleans, 100 power snatches. The weight is going to be 225-155 on the deadlifts, 135-105 on the power cleans, and then 95-65 on those power snatches. Essentially, you're going to decrease load with each movement, but obviously increasing complexity, and maybe more importantly, increasing grip fatigue. I'm looking at that workout thinking, boy, that's a lot of pulling on that barbell, but it's in teams of two, so break it up however you want, maybe five, maybe 10 reps on some of those things, and then pass it over to your partner, bang all of that out for time, and then post it so we can see how you did. Tag Ice Physio, hashtag Ice Train. I'm gonna do this at three o'clock with Say over at CrossFit Endure, our marketing director. We're gonna challenge this workout. I will make sure to post my time. so you have something to try and smash later on today or tomorrow whenever you have a chance to get to the workout. So that is Gut Check Thursday. Let's move on to the episode. THE ROAD TO FITNESS RUNS THROUGH MUSCULOSKELETAL PAIN We are talking about the fact that their life is in your hands. It sounds a little dramatic. I don't think it is, okay? We're gonna start off with the fact that whether we like it or not, we have to acknowledge it's true and that is the fact that the road to fitness runs through musculoskeletal pain. The road to fitness runs through musculoskeletal pain. We don't have to like that to acknowledge the reality of that. Meaning, if you're gonna take somebody who's relatively sedentary, is not on the path yet, and you're gonna bring them all the way to fitness, right? So through wellness, all the way to fitness, that journey, requires a lot of loading, and a lot of challenging, and a lot of recovering, and a lot of programming, and a lot of strain, and stress, and rebuilding, and remodeling. It is a journey, right, that involves a lot of stress to the organism, right, to be able to get it to adapt, to get to a point where you achieve fitness. You don't get there, first of all, quickly, and second of all, without ever experiencing any kind of symptoms, right? That's a lot of stress to the system. You're going to have some bumps and bruises and strains. I'm not talking about major injuries, but you're going to be working through some stuff, right? How we manage that stuff, especially acutely. And when I say we, I mean the entire team, right? Coaches, trainers, physios, chiros, fitness forward physicians, right? Everybody who these individuals are beginning to trust to guide them along this journey, how we all swoop in and manage the acute response to someone developing symptoms is going to dictate whether or not they stay on the path. And from our perspective, if they stay on the path, is a huge variable in the quality of their life. MANAGING THE INITIAL RESPONSE TO ACUTE INJURY DICTATES LONG-TERM OUTCOMES So when I say life is in your hands, what I mean is managing the initial response to someone's acute injury onset dictates probably the longevity, probably the level of thriving, probably the health span. That's why I'm saying life is in your hands because the way you respond to this will dictate those things. And those things really are the quality of this person's life. So let me tell you the three things specifically. that when someone develops symptoms in the gym, that our response kind of hangs in the balance whether or not this person continues along this path that we believe drives so many of the important metrics of the quality of someone's existence. Okay, so if an athlete develops symptoms, right, you're not going to get into a case study of how or why. It happens all the time. Somebody tweaks something, they develop symptoms. Here's the three things. AVOID MEDICAL IMAGING Number one, they avoid medical imaging, advanced medical imaging. If we want this person to stay on the path to fitness and they've recently developed symptoms, the number one most important thing is that they avoid advanced medical imaging, okay? We now know the problem, right? That most asymptomatic people have abnormal findings on imaging that can be really scary and knock someone off the path. I am not gonna get in to the myriad of studies here. Nobody reasonably well-read is gonna push back on this podcast and say that isn't true, right? We have now known for well over a decade, you think back to 2012 when the American Journal of Sports Medicine, right, took that cohort of folks, average age of 38. How many had abnormalities in their hips, asymptomatic people? 73%. How many had labral tears? 69%. No hip pain whatsoever, asymptomatic people. You think about that classic Brzezinski article, right? Not article, but systematic review paper. Took a bunch of different publications, bundled them all together, looked at the data, what did we see? Your average asymptomatic person, meaning no low back pain whatsoever, in their 50s. 80% disc degeneration, 60% disc bulges. We now know the average asymptomatic person has all of these findings on their imaging that can be concerning. This is why we focus on tissue health, not tissue shape. What we now all acknowledge is that your connective tissue changes over time in your face, inside your body, your spine, your labrum, right? It changes over time. It doesn't tend to correlate well to symptoms. The problem is if someone just got hurt, If they just started experiencing pain and they're nervous, right? And they're vulnerable and they get that image and they see something that looks kind of scary, it sticks with them. It bumps them off the path. They have a hard time letting it go. They say, well, yeah, I might be able to get healthier, but I saw that cartilage. It was torn. We're not going to fix that unless we go in there and fix that, right? And they get extremely fixated on this. They begin to lose confidence. in the rehab or strength and conditioning process. It really, really sticks. What we know is when that person develops symptoms, we could have sent the other 10 people in that class to get an image and we would have seen the same stuff, but it doesn't matter. We can say that until we're blue in the face. We have said that until we're blue in the face. When the person's injured, when they feel vulnerable, when they're in pain, when they're in that decision-making process and they get that image and they see something that looks scary and maybe somebody in the medical industrialized complex made it sound scary, Those things make it very, very difficult to keep that person on the path. So getting them to avoid that unnecessary image is a massive part of the acute triage process if we want to keep this person moving towards fitness. Now, it always is worth saying, But certainly there are some times when they should get an image. Of course there are. And that is why physios, chiros, physicians, I'm challenging you all to make sure you're available to these gym owners and these coaches that when something does happen, you've got that direct access training and license where you can come in and make that tough call. And it's a tough call on either side. Because if you do send them, we're risking this thought virus we're talking about here. If you don't send them and they needed it, you're possibly putting that person at significant risk. So don't make gym owners make that call. Don't make coaches make that call. This is what you're trained for. Get in there and make that call. And make sure that the gym owners know you're available that day for a quick consult to get that person's mind off of that possibility when that's appropriate, which usually it is, or doing the appropriate triage if it's necessary. Get that part accomplished, okay? Alright, number one, if you want to keep them on the path, avoid advanced medical imaging unless it's absolutely necessary. Have somebody qualified to make that tough call so that you can get over that hurdle quickly and efficiently. DON'T LEAVE THE GYM; USE THE GYM Number two, if you don't want them to fall off the path, You've got to convince them they don't need to leave the gym, they need to use the gym. People when injured, when in pain, are going to make a very broad assumption that they shouldn't be in the gym. It's the first thing they're going to say, right? They're going to go to put that membership on hold. Your job on the same day of injury is to help them realize that everything they need is actually in that gym. All the tools to rehab the injury that occurred are right there in that gym. The ability to regress the skill that maybe they were inefficient with is why they wound up straining something. are right in that jam. You can regress everything and build a better foundation so next time you get up to that PR or that new movement, you're more ready for it, you're doing it more efficiently, and you've done the accessory work so that you're not stressing different structures at an unnecessary rate, and now you're having a lot more success with these movements. All of those abilities, whether it's to rehab the area, to work on the skill that you struggled with, to build a better foundation, Those tools only exist in the gym. The number one place you should be after injury is in the gym. So don't let them leave, right? So help them understand that you might not do exactly what you just did, you will in a few months, but everything around here is what we're gonna use to make sure you can if you want to. Helping them realize, whoa, whoa, whoa, whoa, you don't need to be leaving the gym, you're gonna use this place, right? That's a critical part of the acute triage process. GET OBSESSED WITH GOALS And finally, number three, Get them obsessed with new goals or at least new angles at the same ones. What I mean by this? is that motivation is fleeting, especially in people that don't have well-formed habits yet, right? Something, some confluence of factors happened in their life where all of a sudden they became someone who goes to the gym, okay? That is a pretty fragile ecosystem early on. We know how tough habit formation is, you're learning new skills. Motivation can be fleeting and fragile. You gotta shift it, don't lose it. shift it, don't lose it. Get inside that person's brain quickly and figure out why they were coming to the gym and show them that they can achieve that while working around the injured area. If that person says, well, I'm here because I've been listening to so many podcasts and it sounds like Cardiorespiratory fitness is a massive predictor of longevity and healthspan and decreasing all-cause mortality. All the things, right? Like, I'm in, but I hurt my knee. So now I can't do the bike and run, etc. So I'm going to call it quits for a bit. You sure are not going to do that. You are going to be on the ski erg, right? Because those things don't involve high or low to those areas, but we can still challenge your cardiorespiratory fitness. We are going to get them obsessed with a different goal, right? If they had a gymnastics goal and right now their shoulders tweaked, we're going to help them realize there's nine other similar goals that don't involve that area that we have a very specific program to move towards. And we're going to get them obsessed with getting that goal. And then we're going to swoop right back around and get on the same path and grab the other one. We're just going to show them. There are so many amazing things that we can do in here. to keep chasing your original goal, add on new goals, work around the injuries, and still achieve everything you set out to do, we understand that motivation is fleeting and fragile. We are going to help them take that motivation they've got right now, and we're going to shift it a little bit. We are not going to let them lose it. And you've got to be convincing in that acute phase, because they're going to make some heavy-handed decisions with all that emotional energy, with pain on board, and you've got to be there to guide that process. SUMMARY Team… Whether people choose to chase fitness during their lives is going to be a huge predictor of the quality of their lives. As they chase fitness, they are going to have soreness. They are going to tweak things. We are not going to load the system for years and years and never bump into any of this stuff. How we as a support system come alongside that person in that acute emotional time when they're having pain is going to dictate if they stay on the path. If we can get them to avoid advanced medical imaging when unnecessary, if we can get them to stay in the gym and use it versus leaving it, and if we can take that motivation they have and shift it as opposed to getting rid of it, we can get this person staying on the path. and we can change the entire rest of their lives, their family's lives, everybody they interact with, their life is in your hands. Be a great resource. Think about those three things in that acute management phase. I hope it helps, team. Thanks for being here on Leadership Thursday. As far as courses coming up, We've got a bunch of them. Ice Sampler is coming up at the end of this month in just a couple weeks in Carson City. We're actually going to put a limited amount of tickets on sale for 2025 because we know this event is hard to get into. It sold out in one day last year so we're trying to make tickets available at different times to give folks an opportunity to be a part of the event in 2025. But before then, we've got a bunch of courses. We had 12 last weekend. I think we have another dozen coming up over the next weekend or two before Sampler. So get on PTNICE.com, check those out. A lot of online courses start on April 29th, which is only a few weeks away, and some of them only have a handful of seats. So get over to the website, check it out, have an awesome Thursday, do gut check. We'll see you next week, 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.  

Dr. 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 relationship between value & price, how to arrive at a potential price, avoiding assuming the value that patients perceive from our services, and understanding that not all physical therapy is created equal. 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 ALAN FREDENDALLAll right, good morning, PT on ICE Daily Show. Happy Thursday morning, hope your day is off to a great start. My name is Alan, currently have the pleasure of serving as our Chief Operating Officer here at ICE and a faculty member in our Fitness, Athlete, and Practice Management divisions. We're here, Leadership Thursday, talking all things clinic ownership, management, personal development here on Thursdays. Leadership Thursday also means it is Gut Check Thursday. Gut Check Thursday is back, the CrossFit Open is over. We have kind of a You're going to row 2,000 meters or 1,600 meters on the rower. That time domain is normally around the same time domain as a one mile run, about a seven to maybe 10 minute effort. But of course, we're going to make it a little bit more difficult. Every two minutes, but not the start of the workout, you're going to stop and do two rounds of three wall walks. six hang power cleans at 115.75 and then 12 ab mat sit-ups. The challenge there is when that clock beeps on the two minutes to get off, race through those wall walks unbroken, race through those hang power cleans unbroken, move through the sit-ups very fast, trying to get that work done in ideally a minute so that you have a minute or possibly even more to jump on that rower and chip away 200, 250, maybe 300 meters at a time. Extend that normal 7 to 10 minute 2k 1600 meter row out to maybe a 15 to 20 minute workout. Scale appropriately. Make sure your wall walk option you can do unbroken. Make sure your hang power clean option you can do unbroken. Make sure your sit-up option you can do unbroken. You don't want to have to stop and rest anywhere in there, or you're taking away from your time to do the real work of the workout, which is to move the distance on that rowing machine. So be careful you don't trap yourself where you're just doing wall walks, hang power cleans, and sit-ups, and you never actually get back to the rower. Scale that appropriately so that you have at least a minute, maybe a little bit more, each round back on the rower to chip away at that distance. VALUE VS. PRICE So today, sorry, Leadership Thursday, what are we talking about? We're talking about value and price. So we had an interesting conversation. The last cohort of our Brick by Brick Practice Management course just ended a couple of weeks ago. And one of the big themes of that course is folks deciding, especially those folks who may decide to be 100% cash-based, how do I know how to price my services? A lot of folks don't know where to start. A lot of folks look to maybe competitors in the area. They look to maybe national clinics that have different prices listed online to try to get an idea of what they should price their physical therapy visits at. And insurance providers are very similar of what is good payment for physical therapy quote-unquote good and so I want to talk today about Discussing what is value? Discussing what is price? Discussing how they can sometimes be the same but how usually especially if we're doing it, right? They are very different and some tips and tricks for you out there on to hopefully understand that the services we offer, at least as we teach them here at ICE, are probably much more valuable than what your competition is offering, and therefore worth a lot more when you're considering charging your rates, especially if you're going to be a cash-based physical therapist. WHAT IS PRICE? So understanding price is maybe the best and easiest way to start. If we talk about what is literally the definition of price, it is the arrival at the amount of money we'd like to make after we've accounted for the expenses of whatever it is we're selling. The physical cost, the expenses of making a thing to sell it, or the costs that go into what we might price a service for. So understanding that we're in the service industry, our expenses might not be as high as maybe a company that sells furniture or cars or something like that, but that our services do have a cost. We do need to pay ourselves or pay those individuals who work with us. And we also need to account, we do have some supply costs. We have to pay for power and heating and cooling and internet and needles and linen and all the sort of stuff that goes into keeping a physical therapy clinic running. And that comes at a cost. And so factoring in cost of expense, otherwise better understanding, especially on a patient by patient basis, What does it actually cost you to see that patient? So if you're already in practice, having an idea of what that number is, is really, really important because it lets us better come to an educated arrival on what our price could be. At the end of the day, though, we need to recognize that that is really just a guess. It is yes, assuming costs. Yes, it is assuming what we need to pay ourselves or pay someone else. and then having some sort of idea of ideal profit, but that it is a guess at what the perceived value of what we're offering is to our patients, to our customers for the sake of argument today. A calculation of ideal potential profit. How can we better understand the value that we're offering people? THE SWOT ANALYSIS I highly recommend, if you've never done it, even if you don't think that you would ever own your own practice or manage a practice or anything like that, I recommend that you do a little thought experiment called a SWOT analysis. S-W-O-T SWOT. Strengths, weaknesses, opportunities, and threats. This can be very in-depth, this can be very short, it's kind of an experiment that it's what you make of it, but sitting down and thinking what are the strengths of myself if I'm an individual practice owner, what are the strengths of my clinic if I have maybe one clinic with multiple providers, maybe multiple clinics with many providers, What are our strengths? What services can we offer? What are the strengths of the clinicians that I have on staff? What are the strengths of essentially the value of the product that we can offer? The inverse of that, what are the weaknesses? What are areas maybe of practice that we don't have somebody who could treat it? Maybe we don't have anybody who could work with pregnant and postpartum patients. Maybe we don't have somebody that's very keen on treating the vestibular system, treating folks maybe with falling or dizziness or balance issues. Maybe we don't have anybody who's comfortable working with older adults, youth athletes, so on and so forth. So understanding where are the weaknesses in your practice. And then O is the opportunities. What opportunities are there, not only in shoring up those weaknesses, but what opportunities exist outside of our clinic? Do we live in a town that's really big on running, right? Maybe we live out in Asheville, North Carolina, or we live in Johnson City, Tennessee, and we have a big mountain bike or trail running population. Are we able to target that population? If not, we know that's a weakness, yes, for a clinic, but also an opportunity to provide value to a new pool of potential patients. And then threats. Threats can be, yes, direct competition, but threats can also be external things. We can label things like inflation under threats. We can label higher than normal cost of commercial real estate under threats. But going through that SWOT analysis and saying, do I have any chinks in my armor? If yes, then I know the value of what I'm offering is probably a little bit lower than I'd like it to be. If I go through this analysis and I think, gosh, especially compared to the competition, I think we're doing really well. Then now you have an idea of actually I think what we offer here is more valuable than the competition. And that will overall let you better arrive at how to price your services. TAKING A GUESS AT PRICE And at the end of the day, when we're thinking about price, I love what our CEO here at ICE, Jeff Moore, says of thinking about what you need to charge per hour is really working in reverse. A question of what does it take to make a certain amount of money for a year, whatever that is for you or your clinicians or both, to treat five to eight patients per day, three to five days per week, 48 to 50 weeks per year, right? Having two to four weeks off for vacation, seeing maybe 30 to 40 patients one-on-one. What volume do you need to treat at and what do you need to charge as far as your price goes to achieve the amount of money that you would like to make each year? And now we need to understand, back to the threats portion of the SWOT analysis, that there are always going to be forces we can't control that are going to affect that, right? If we live in a really big city and with a really high cost of living, then we know we're either going to need to be happy taking less money home, or that we're going to need to charge maybe more than we're sure is going to be an appropriate price to offset some of those expenses. So at the end of the day, setting a price but not being so locked into it that it can't go up, ideally it won't go down, you won't continually lower your price over time, Ideally, your price will continue to increase as more folks find your services valuable, but at the end of the day, picking a price and starting there and then seeing how expenses, seeing how external threats, market forces, inflation, that sort of thing, change your price over time. And if you're doing it right, and this is maybe a personal belief, I don't have research to support this, but if you're doing it right, if people truly find your services valuable, you should find yourself slowly getting busier over time such that you can begin to charge more because you will end up in a position where you have more people that want to see you than you have time to see. And of course, that's where we can discuss growing beyond yourself into multiple clinicians, but that is a really good point to be at. It's not great to start with a full caseload and need to slowly decrease your price to try to hang on to it over time. It's a race to the bottom and that never ends well regardless of what industry that you're working in. So that's a conversation on price. WHAT IS VALUE? Talking about value, I love the quote by George Westinghouse. If you don't know the story of George Westinghouse, his company eventually defeated Thomas Edison in the race to electrify America, essentially in the late 1880s. He said, the value of something isn't what someone's willing to pay, but what it contributes, right? And that kind of says that the customer drives the bus on value. We can certainly set our price, But the folks who are buying our service, paying for physical therapy, buying our widgets, whatever, they ultimately dictate the value that they perceive from what we're offering and that that's going to be different from person to person. Some folks are going to find more or less value even if our price is flat and never changes. And we need to accept that just like we need to accept that price is never permanent. There's no business that's selling stuff for the same amount of money 50 years ago as they were today, for example, except maybe Costco with their $1.50 hot dog. But for most businesses, things tend to get more expensive over time to adjust for inflation and that sort of thing. So value is kind of in the eye of the beholder. A lot like price is not really a fixed thing for us on the other side of the equation. DO NOT ASSUME PATIENT'S VALUES In most businesses, and I think especially in physical therapy, we do way too much assuming about how our customers, our patients, our clients, what have you, perceive the value of our services. We see a lot in brick by brick. We see a lot on social media. We see a lot of conversations. that I'm worried about charging too much. I'm worried that my patients won't find value with the price that I'm charging. We are assuming way too much about how much money people have to spend, but also again, that value is this fluctuating thing. and that folks place different levels of value on different products and services in their life in ways that are, yes, in line with the price, but sometimes that are not in line with the price, right? A good example is cell phones. Almost every human being on the planet has a cell phone. In the United States, 94% of all Americans have at least one cell phone that connects to high-speed internet. In particular, they have a smartphone. What does that tell us? At least as Americans, we highly value having a smartphone, right? We're willing to pay $1,000 to $2,000 out of pocket to initially buy it. We're willing to spend $100 or $200 a month on the subscription so that that cell phone has access to the cellular network and can text and email and look at apps and all that sort of stuff. So there's a high value on something like a cell phone. What we're really talking about in the conversation between price and value is that we need to show folks the value of physical therapy such that they don't even consider the price of what it is. Of yes, of course, if we try to charge $1,000 a visit, we're probably not gonna get too many takers, but also we shouldn't feel like we need to undercut our competition and perform visits for $50 or take insurance payments for $40 because we're uncomfortable asking for too much money. Again, do not assume what your patient values. If they find your services valuable, trust me, they will find a way to pay for what you're charging, just like they find a way to pay for their cell phone and all the other stuff in their life that they truly find value at, even if they think, gosh, that's high. If their perceived value is high enough, they will find a way to pay for it. I think of myself as an example, across the week, most days I work about 16 hours, most weeks I work seven days a week, and most months I work most weeks. On average, I make about $28 an hour across everything that I do. An incorrect assumption is that an hour of my time then is therefore worth exactly $28. And that is a misunderstanding between the relationship between price and value. There are hours of my time that you cannot pay me a million dollars to take that hour away from me, right? You cannot offer me $28 to not exercise an hour a day. You cannot offer me $28 to skip the mornings that I have with my son where I get to get him out of bed and get him ready for school or the days where I get to pick him up and bring him home and play with him and put him to bed. That has a value on it that really has no price that can be associated with it and I hold on to those hours very, very much. Likewise, when I myself am injured and need physical therapy, I place a high value on the physical therapy that I obtain because I find that it helps me a lot, right? The manual therapy helps me a lot. The guided home exercise program helps me a lot. I tore my meniscus two weeks ago tomorrow, just finished a workout. I'm back to lunging. I'm back to light impact. I'm back to light squatting in just two weeks. An injury that might put some folks out for three, six months might cause them to seek surgery. I'm already modifying around it and slowly getting back to full activity, probably realistically within a month. That has an extreme level of value that I would argue is more than the cost of what I pay for the physical therapy with the price that it holds. So do not assume what folks value, how much they value things, or that relationship between value and price. Because it's not always exactly equal, even though in our heads we tend to think value equals price, that is simply not the case. WHAT IS THE VALUE OF TIME WITH A HIGH-QUALITY HEALTHCARE PROVIDER? I will challenge you before we sign off for today to really step back and ask yourself the question, especially if you're in this scenario right now where you're thinking, what should I charge for my services? Should I increase my price? What are people around me charging? What is the value of a high quality healthcare provider? who can keep you from otherwise consuming tens of thousands of dollars and hours and hours of your time otherwise in the healthcare system to usually ultimately not get any better than you were doing nothing on your own. I would argue the value there is really high. The value is high to the patient. The value is high to the healthcare system in general as well. And the question then becomes, what is ethical? What is too much? What is too cheap? What is an ethical amount of money to be paid? And the answer to that, unfortunately, that we don't want to hear is that it depends. Well, what does it depend on? It depends on the perceived value of the patient for our services. Sure, you can charge $500 for an hour of physical therapy, but that probably needs to come with a really high quality level of care. That's probably more concierge care, direct access to your provider at all times, evening visits, weekend visits, visits at the office, visits at the home, whatever. That's kind of a more high caliber level service versus what is the value of a visit of physical therapy that costs $33. Well, we might assume that's so cheap, it might not be really valuable, but at the end of the day, we don't know that either, do we? There are a lot of folks accepting insurances that pay almost nothing who are providing high quality care, or at least trying to, in a way that their patients perceive value. So don't assume what the value of our care is, and certainly never assume the value of the care a competitor is providing until you know what they are offering their patients. that we can say, wow, they're charging $500. The default assumption there might be it's really high quality of care. It must be. It's $500, right? The natural association in our brain is higher price equals higher value. but that is not always the case. There are a lot of people charging a lot of money cash for patients to walk in and lay in a circle on treatment tables and just get dry needles for an hour. And I would argue that's probably not really valuable care to the long-term health and fitness of that patient. Yet they are charging and receiving that money, which again kind of shows us the asymmetry between price and value. If those patients perceive value, they will find a way to pay that amount of money, and that is true for you as well. So at the end of the day, don't shortchange yourself. Don't set your prices just because it's what somebody else is charging. Don't set them lower. Don't set them a little bit higher. Step back and ask yourself, What is an ethical payment for an hour of my time given the value that at least I believe I'm providing to my patients? Set that price and then adjust fire as needed later on. We say here at ICE, ready, fire, aim, right? Set it up, lock in the price, see what happens. Your patients will determine your value. Do not assume it for them. Do not assume someone does not have the money or cannot find the money to come see you once a month for a cash-based physical therapy treatment. Again, if those patients truly find value, they will find a way to come pay you. So price versus value. They're not always related. Sometimes they are, but usually not. We often see an asymmetry where the value that folks perceive can often be significantly higher than the price they're paying. We hear that a lot in physical therapy. I would have paid double what I paid. This was such great service, you erased a decade of back pain, I'm back to playing with my grandkids, I'm back to walking without a walker, whatever. We hear all of those things in the clinic. We hear that folks are significantly happier with the value they receive from our services than the price they were charged, so keep that in the back of your mind. What price is sustainable? What price is sustainable for you to believe that you're making enough money to do the work that you're doing? And what price is sustainable for your patients? Demographics, socioeconomics, market forces, inflation, commercial real estate, all those things that are really out of our control do play a factor in our price. What price targets your ideal customer the best? Do you want to provide a high level of elite concierge service? If so, you can probably charge a little bit more as long as you're comfortable knowing that that patient is probably going to demand a lot more out of you than if you charged less. Again, keeping in mind at least your perceived value of what you're providing to somebody, what price is ethical? I guarantee you an ethical price is not the $43 flat rate payment from an insurance that's an HMO that requires a 30 minute authorization before you can treat that patient. I don't know what an ethical amount of money on average across the United States is for a physical therapy visit, but I know it's not that for sure. And then what is a fair market value for a similar service? Again, do not assume the value that your competitors are providing until you know exactly how they treat and the value that they at least are attempting to provide to their patients. It's easy to look on someone's website and see what they're charging and just make your price $5 more or $5 less, but that doesn't really understand the whole picture of the value they're providing, the value you're hoping to provide, and what the difference between those two services might be. I think of it a lot of getting a haircut, right? Yes, I can get a $10 haircut at Bo Rick's or Fantastic Sam's or whatever. My hair is not going to look the greatest. What is the price at a barbershop? It's a little bit more. What is the price at a high-end salon? It's a little bit more. And what am I getting along the way? Well, with those services, quality tends to go up and the value tends to go up, right? The haircut tends to be a little bit better. You tend to get a little bit more time with the person providing the service as you go up each tier. And that can be the case in business, but it's not always. SUMMARY So remember, Price isn't firm. It can change. You're the one responsible for changing it and do not assume the value of what you're providing. Let your patience dictate that. If you set a price and you have a full caseload and you have a two or three month waitlist, guess what? Your price is probably too cheap compared to the value that your patients are perceiving, and you're okay to bump that price up at the beginning of the year. So don't assume that. Don't assume people can't or won't find the money to come see you if you truly believe in the value of the product you're providing. If you want to learn more about this stuff, our next cohort of Brick by Brick starts April 2nd. We take you all the way through from having no idea how to run a business to finishing the course in eight weeks, having all of the legal documentation you need to formally start a business, to have a better idea if you're going to take insurance, take cash, take a mix of both, and to be able to open your doors potentially at the end of that eight-week class. So we'd love to have you. More information at PeteDenise.com. That's it for me. Have a wonderful Thursday. Enjoy Gut Check Thursday. I'm going to be out in Rochester, New York this weekend watching Lindsey Huey teach extremity management. So I'm going to be at that course. I'm looking forward to hanging out with you. And I imagine we'll probably hit Gut Check at lunch on Saturday or Sunday. So have a great Thursday. 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.  

This is one of FIVE Meet the Candidate interviews featuring the five RIA Board of Directors candidates for the 2024 elections. Please take a moment to watch each video! Voting is open to RIA members March 18 through March 25; links to vote will be sent via email. Election results will be announced on March 27, with the new board members installed at the RIA Convention in Dallas April 8-10. To register for the RIA convention, visit convention.restorationindustry.org. --- Send in a voice message: https://podcasters.spotify.com/pod/show/michelle-blevins/message

This is one of FIVE Meet the Candidate interviews featuring the five RIA Board of Directors candidates for the 2024 elections. Please take a moment to watch each video! Voting is open to RIA members March 18 through March 25; links to vote will be sent via email. Election results will be announced on March 27, with the new board members installed at the RIA Convention in Dallas April 8-10. To register for the RIA convention, visit convention.restorationindustry.org. --- Send in a voice message: https://podcasters.spotify.com/pod/show/michelle-blevins/message

Dr. Jeff Musgrave // #GeriOnICE // www.ptonice.com  In today's episode of the PT on ICE Daily Show, join Modern Management of the Older Adult lead faculty Jeff Musgrave discusses the theory of selective optimization & customization, including how to help patients select goals, optimizing treatment around goals, and being OK with compensation as needed. Take a listen to learn how to better serve this population of patients & athletes, or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION JEFF MUSGRAVEWelcome to the PT on Ice Daily Show. I'm going to be your host today, Dr. Jeff Musgrave, Doctor of Physical Therapy. It is Wednesday. That means it is all things geriatrics today. So excited to be sharing with you a topic fresh off a really exciting trip, Preparing for Adventure and the SOC Model. Now, don't get sick to your stomach if you're a home health clinician. We're not talking about start of care, okay? We're talking about a theory for successful aging. THE STRONGER LIFE RETREAT So I'm gonna give you a little bit of background on how I got to this topic and why I'm excited to share it with you. just came off a trip out of the country with 20 members that are 55 and older. So we took an adventure retreat. Stronger Life members joined us out of the country to seek adventure and this was a really incredible experience. If I was preparing one of these members from a formal PT standpoint, what would I want to be thinking about? How would I select the goal? How would I optimize? When do we compensate for these patients? So if you're preparing someone for adventure, we need to be thinking about all these things. BALT's successful theory on aging has been a really helpful framework we use very frequently in our division, the older adult division. And what we want to do is, Adventure is relative, right? So we're taking 20 members from Stronger Life to the Dominican Republic where they're going to go snorkeling, where they're going to go horseback riding, where they're going to be walking or running on the beach, they're going to be swimming in the ocean, they're going to be kayaking in the ocean, all these exciting things. But adventure is relative. So maybe the patient in front of you, adventure for them is going to their grandson's baseball game. that may be a big overwhelming task that you need to break down. Or maybe it's just going for a walk outside. Maybe you've got a primarily homebound population and going outside feels like a big adventure. So I am going to use this higher level adventure example because it's fun, interesting, and fresh for me coming off this trip, which was so much fun. But for you, know that all of these things are scalable and this framework is going to be relative regardless. of the functional level of the client in front of you. SELECTIVE OPTIMIZATION AND COMPENSATION So just a little bit more on this SOC model. So Selection Optimization and Compensation. So this has been a tenet of Lifespan Psychology and the process of development that entails Losses and gains of our patients over time. We know that in general, our patients who are not seeking fitness, who are going through this period of time where they're in a decline, if we can't interact with some fitness and get them active, we know it's gonna look like this. But for many of our clients that we're taking this fitness forward approach, there's gonna be gains and losses over time. And what we wanna do is we wanna learn how to partner with them in this aging process, knowing that there are some changes, despite our best efforts, things we can't change. We're really comfortable with things we know we can change, but we have a little more trouble when we bump into barriers and things we can't move forward. So this model, SOC, Selection, Optimization, Compensation, looking at the full lifespan and learning how to use these three tools. SELECTION So the first tool is selection. So when we're talking about selection and we're thinking about older adults and their goals and successful aging for them, we're talking about goals that matter to them, not these BS goals like get better, get out of the hospital, feel better. Those things are things our patients may report to us, but it's our job to dig deeper and figure out why and why they feel that way and what specifically that means to them. So finding that meaningful goal and what they want to accomplish, we've got to break it down and get as specific as possible. The more effort we can put on the front end with selecting a meaningful goal and really understanding what that means, it makes the rest of our job so much easier. When it's time to select exercises, we're trying to figure out what tests and measures we need to be looking at. It becomes so much more clear. So a good start, I'll give you an example. We had lots of members who were planning to go horseback riding for the first time, or first time since they were in their teens. And if I had that client in the clinic, I'm seeing them in the fitness realm currently, but if I was seeing them in the clinic, the questions I would ask based on this framework of selection are, when is this gonna occur? When's our goal need to be accomplished? I would also want to know what's amounting, you know, excuse me. So when's this going to occur? How long are you going to ride? How big is the horse you're getting on? How frequently do you want to ride while you're gone? What gate is this horse going to going to experience? Is this member going to just be doing a slow walk? Are they going to be trotting where they're going to be oscillating up and down which may stimulate the vestibular system? Are they going to be cantering? How much dynamic balance do they need? How much strength do they need to be able to hold their position on the horse? So based on the frequency, the duration, the size of the horse, how often they want to do this, this is really going to help us break down what our patient needs specifically to reach this goal. And reminder, we're going to go through this same process if someone needs to carry their groceries in. We want to select a meaningful goal for them, then we need to break it down. We need to have all the specifics possible at our fingertips. So we want to know the strength, the range of motion requirements, the endurance requirements, the balance requirements, the vestibular requirements, which in this case are very relevant. When you think about the movement of someone on a horse, they're going to be going up and down. That's going to be stimulating the inner ear system, the utricle and the saccule as they accelerate, decelerate. There's going to be head turning. They're on a beautiful beach riding a horse. They're going to be turning their head, looking at stuff or trying to talk to their friends or get some selfies going. during that time. So we want to be as specific as possible to figure out what in the world they are going to need to be able to accomplish this goal. So selection is the first piece. We want to select a meaningful goal to them and we want to get as much information as possible. OPTIMIZATION Once we have all the specifics nailed down, We're going to go on to the next step. And this is where most of us shine is optimization. So the first piece is selection. The second is optimization. Based on where this patient is starting, And the goal, we now have a start and a finish line. We've got to get accurate measurements at the beginning. Our CEO, Jeff Moore, is very famous for saying you can't make good decisions with bad data. We want to be specific of the conditions we're testing. We want to be accurate so we can actually see if we're making change in the future. Otherwise, we might as well not measure, by and large. So we want to be very specific with those measurements. But now we know This person wants to go horseback riding once. It's going to last about 45 minutes. They want to walk. They don't care if they canter or trot. They're going to be on the beach, so they're going to have to walk across the beach to be able to get there. So we now, we're going to say those are the specifics that the patient gave us. So now we're going to be looking at the range of motion of their hips. We're going to say, oh, these are going to be small island horses. There's not as much hip abduction required. We know that we don't have to get them stable in a seated position for a canter or a gallop. We just got to be steady in this seated position for 30, 45 minutes one time. And then we're going to, you know, hopefully the mounting situation we've asked about as well. Are they going to be able to go up steps unsupported to get on this horse? Or are they going to need, in the equestrian world, a leg up? Is someone going to come over and help boost them into position? So once we've got all that information, we've checked the range of motion, strength, balance, vestibular requirements, then we're going to go to work, right? We're going to challenge all of these different systems to reach this big, meaningful goal. range of motion that they need to really make this happen. We want to make sure that we're, you know, not laying on the table, kicking our legs, sitting, or outside of these positions that aren't relative to the goal. We want to make sure that these are big functional movements. We want to make sure that it mimics this movement and this activity as much as possible. Being in a seated position, can they go up and down, accelerate back and forth? There are lots of creative ways to do this on Swiss falls or if you're on, on a rolling chair going back and forth and adding some head turns. There's lots of ways we can replicate this. Even the mounting situation where we can use a high-low table and get really creative and maybe we're getting them onto a bolster or a Bosu ball, something like that. But during this optimization, we've got to make it as much like the actual goal as possible, as quickly as possible. That's going to help us with buy-in, And we know from motor learning, just in general, the more it replicates the actual activity and the conditions. I mean, heck, we can play some seagulls and some ocean music. We could do these things outside with distractions. There's lots of ways to layer in all the specifics that we gained from the first piece of selecting the goal. But once we know the optimization period, we've got to replicate that as much as possible. COMPENSATION Once it's time for the third piece is compensation. This is the part that we get really uncomfortable. Most of us in the rehab world, we want to restore function as much as possible, and that's not a bad thing. We want to do that, but sometimes we don't have enough runway. The patient doesn't come to us in enough time. We can't help them change quickly enough to meet that goal on time. And if we want the goal to be accomplished, we're going to have to compensate. Oftentimes, our OT colleagues are much better at this. They're like, hey, just use the tool. Let's make this thing happen. Most of us that are physical therapists, fitness pros, we want to see people get stronger and we get really uncomfortable when it's time to compensate. but there are simple ways, little on-ramps, like getting a leg up, practicing having someone help them get on the horse, versus saying, you know what, you just can't mount on your own, so I don't think it's a good idea for you to do this, or you don't have quite enough range of motion to be able to throw your leg up behind the horse, for example, so this is really out of the question, versus saying, hey, can we have someone support you? Is someone else going on this trip? Can you bring someone into the office and we can replicate this mounting situation to give them a leg up, swing their leg around the horse, and help them be stable. Heck, even sometimes we can have someone walk alongside them to help keep them steady. If the goal is meaningful enough, we can accomplish it with some compensation. So whether it's an adventure retreat, whether it's a patient that needs to walk outside, get thrown groceries, go to a kid's baseball game for the first time, adventure is relative to the person in front of you. Regardless of that, a great framework, keeping in mind that compensation and changes in capacity happen over time, our BALT's theory of successful aging. So we wanna make sure that we're selecting meaningful goals to the patient, We're optimizing all the systems, getting good baseline data, and then if all else fails, we need to compensate to make those goals happen. SUMMARY Team, I hope this was interesting. I hope this was helpful for you. If you're looking to catch us out on the road, We're gonna be in Newton, Kansas. I'll be there on the 16th and 17th, and then Madison, Wisconsin, we'll be there March 23rd and 24th. If you're trying to hop into one of our online courses, lucky for you, level one course is going to open up on March 13th, and then not long after that, we'll have level two. So I hope you enjoyed this. If you have any questions, comments, please drop them for me. I hope you have a wonderful day, and that's it for now, 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 CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Dr. 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 concept of viewing the human body as a vehicle or mechanical system versus recognizing the underlying physiological systems in place that make the human body adaptable & changeable. Zac encourages listeners to adopt loading a primary intervention as a way to cause physiological change in the body in a manner that could not be done with a vehicle. Take a listen or check out our full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about our Lumbar Spine Management course, our Cervical 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 ZAC MORGANGood morning, PT on Ice Daily Show. I'm Zac Morgan. I'm a lead faculty here at the Institute with Cervical and Lumbar Spine Management, bringing to you all this morning some concepts on physiology versus physics. And I would say physiology greater than physics is the title of this episode. Before we dive into the actual episode, I kind of wanted to talk through some of the definitions of these two sciences. Do you think it'd be helpful to frame our conversation this morning? And before we even do that, I want to start out by saying that really using physics to describe why someone develops symptoms or why someone gets hurt, I think it could be maybe one of the most unhelpful things we've ever done as a profession. So let's start out with definitions, and then I want to unpack that big statement that I just gave you. So from the physics perspective, let's start there. Physics is a natural science. Its studies matter. It's foundational constituents. and its motion and behavior through space and time. So that's the definition of physics. When you think about physiology, it has a different definition. Physiology's definition, it's a branch of biology. It deals with the normal functions of living organisms and their parts. It's the science of how the body and its parts work and function. Physiology covers a multitude of systems within the living organism, how cells, organs, and tissues work together and interact. The point here isn't that physics are completely irrelevant when it comes to why someone develops symptoms. There is certainly a part of the puzzle. But the unipolar commitment to physics from whether it's us as therapists actually understanding why someone develops symptoms or when we're actually describing to someone why they develop symptoms, that unipolar commitment to physics, it's devastating in the clinic. AN OVERCOMMITMENT TO PHYSICS So let's start with why I think as therapists we tend to overcommit to physics. Physics, while on the particle level, are very challenging to understand, when you think of physics on the big picture level, they're actually not all that challenging to understand. Humans, we tend to believe the things that we can actually lay our eyes on. When we can see something happen, when we can interact with it, we tend to believe those things as humans, and it makes sense because we can actually see them. And when things happen right there in front of us, it's just so much easier to believe them. We can observe the physical universe. We can test these things on ourselves. You think about things like gravity. Gravity is a physics concept. It's really easy to test gravity. You can take basically any object, drop it, and you can observe that object fall towards the center of the earth at a specific time or a specific speed. It doesn't really matter the object. They all move towards the center of the earth at that same speed. we can observe that, we can interact with it. So it's really easy to believe in gravity and it's really rare that you would interact with someone who doesn't believe in gravity. From a physics perspective that's easy to observe. Now let's extrapolate that more towards what we see clinically. I think a lot of times people will use these examples of things like vehicles. That's a very common example for the body. People will compare the body to a vehicle or tires to joints. And you think about like tires, that's a physical object and every mile that you drive on your tires, that tread wears out a little bit more over time. You can watch that happen. You look at the tread on your tires and you can see that it's wearing out with each mile that you drive. Really the only way to avoid your tires wearing out is to not drive as much. So we know that that stuff happens because we can watch it happen, and so we tend to believe in that. So it's so tempting clinically when you look at something like an imaging study that one of our clients comes to us with, and you can look at whether it's an x-ray, CT, MRI, ultrasound, you name it, really any type of imaging, and we can observe those tissue shapes on that image. And when we look at those shapes, we can attribute pathology to the shape of those tissues. It's really easy for us to observe that and say, hey, I bet if that gnarly looking intervertebral frame and that gnarly looking joint were to move through space, it would be painful because it looks really, you know, disrupted. It's not smooth. There's a lot of pressure or a lot of compression in that area. We can observe these things on imaging and then kind of extrapolate that out to the symptom presentation in front of us. And this is what's so devastating in the clinic. While it is a piece of the pie in a lot of our clinical cases, it's certainly not the whole pie. It's only one small slice. PHYSIOLOGY IS THE TICKET When you think about what the rest of that pie is, it's physiology. What environment that those tissues are living in. That's really where the ticket is. I think because it is so easy to wrap our heads around this concept of physics, it's so easy for us to observe it. We have tools that make it easy to observe. It's easy to make a lot of attribution of symptoms to those concepts. And so this is really challenging to our patients. Like you think about what that does to a patient's psychology, like it's devastating. for those people. People don't understand much about their bodies and so when we give them these descriptions they often catastrophize the symptoms or they catastrophize the physics. They worry that it's going to be like what they've seen in their tires where every mile they run their knee ends up with a little bit more osteoarthritis but yet we know that recreational runners have less prevalence of knee osteoarthritis than sedentary folks. So it's clearly not the same as our tires. That's not a physical object, it's a physiological object. It's much, much different. So again, physiology deals more with the ecosystem that these tissues live in and that's where we want to put our attention moving forward as a profession if we really want to have a chance at helping people conceptualize their body and and helping people feel stronger within their body and helping people understand the benefits of exercise. OUR BODY IS AN ECOSYSTEM So let's talk a little bit about that. When you think of those examples like a tire or a vehicle, the big thing that those things lack that our body has are things like a vascular system. Like your vehicle doesn't have a vascular system. It's simply just built by engineers. And like I said, each mile that you drive is one less mile that you can drive in that vehicle. Sure, you can maintain the vehicle. You can rotate your tires, and that will make them last longer. You can change your oil, and that will make your engine last longer. But at the end of the day, shy of not doing anything in that vehicle, it's going to break down over time. Our body is completely different. It has a vascular system. It has intra and extracellular fluid that are full of nutrients that are built to help your body adapt to the stimulus in front of it. It has an immune system that creates specific responses to stimuli that create a more robust underlying system. That can't be said for a vehicle. So when we compare our body to a vehicle, our clients often don't have that understanding that our body is actually full of a lot of adaptations that we've developed over a long period of time that are inherently built within us that help us continue to move forward. They help us build a more robust vehicle. That would be awesome if when you bought a car and you used it and you maintained it well, if it actually It actually lasted longer for every mile that you drove. That would be great. We would all want that car. But over time, cars break down. Over time, if our body has the right ecosystem underlying it, it builds more resilience. You think about like our MMOA crew, so Modern Management of the Older Adult, and you see some of these stories that they share where older adults start to put on so much capacity, so much strength, so much cardiovascular endurance over time. It doesn't make sense. If our vehicle was an actual vehicle made of physical objects that we could interact with, it should break down over time, but we know the physiology drives function. And so when we put it in the right ecosystem, and when we allow it to adapt over time, we get way more out of it. I mean, think about it. Your tire, it doesn't get nutrients from the fenders. The rims don't provide it nutrients. The air within those tires don't allow it to build more tread over time. Again, I would love it if that was the case, because we wouldn't have to replace these things, But our bodies, they do have those things. The vascular system is built for that. The immune system is built for that. Our bodies are so much different than vehicles and when our clients leave our interactions and they have in their head that they're going to break down over time, they end up opting out of activity and that's exactly what we want to avoid. Like you think about if someone feels the that every mile that they run is one less mile that they can run on their knees, or every deadlift that they do is one less time they could pick their grandkid up, think about what that does to them psychologically. It makes them avoid those activities, and so they wind up missing out on all these physiological adaptations that would extend their quality of life and lifespan. That's a huge mistake as a profession, and we need to move dramatically away from that over time. It's easy to observe problems in people's bodies. We can make attributions of the way someone moves with pain. You can look at those imaging studies and say, well, if that nerve root's that compressed, then this person's probably gonna be in a tough spot. But team, it's not like that in the body. The body is so well built to adapt over time. I'll never forget the first time I heard Jeff Moore say, back pain is not a tissue shape issue, it's a tissue health issue. And it just hit so hard in my head when I heard him say that for the first time, because it is that. I mean, you can look at the Brzezinski study, you can look at the Nakashima study, that's lumbar and neck kind of respectively, and you can see that people with no symptoms whatsoever have all sorts of physical deformities in their spines and yet they have no symptoms whatsoever. Over time, we're seeing the same concept throughout the rest of the body. Like I said, the extremity crew does a great job of pointing out the inadequacies often of imaging studies throughout the rest of the body. And team, seeing that over time, it is becoming more and more clear that these physics examples, while they're easy to understand both for us as clinicians, but also for our clients that we're teaching these concepts to, while they're easy to understand, they're such a small piece of the pie, but they have catastrophic responses within people's psychology. People tend to catastrophize those things. So we have to focus on physiology. LOADING CHANGES THE UNDERLYING PHYSIOLOGY And team, I think our treatments, what we choose to do with clients reflect this. When you think about, if you haven't taken the extremity course, you have to because they do such a wonderful job of framing things like tendinopathy. From a physics perspective, sure, you could look at a painful tendon, you could look at a histological study, you could look at an ultrasound sometimes, and you can see that those collagen fibers are disrupted from a physics perspective. But going in and physically stimulating those things isn't what creates adaptation. It's not cross friction massage, it's not those things, it's load. And why does load work? You take a relatively poor vascular supply, but still a vascular supply, and you force angiogenesis to that region, you get that tendon to adapt over time. You change that underlying physics. Vehicles don't do that. So we have to get our heads wrapped around how these things are different so that we can start to push our patients forward and help them work through a little bit of discomfort, which is a big part of tendinopathy management. People need to know that they're going to be okay and that their body is built for these stimuli and it responds in a way that is tremendously different from a lot of the other things that we can observe in the universe. It's so cool that our body is built for that. You think about spine management. We talk a lot about this on the weekend. Often a nerve root is in a really unhelpful environment. There's a lot of concentrated inflammation in the region and the person's reporting a lot of distal symptoms when that's going on. We do things like repeated motions or spinal manipulation or some sort of treatment to intervene on that region and we draw a lot of fluid in there and drop that concentration. Team, that is so amazing that our body can do that and that the person can leave feeling centralized and feeling so much better. But we didn't push the jelly back in the donut. It wasn't a physics issue. It was a chemical soup bathing that region. And when we draw fluid into that region, it feels better. The person feels dramatically better. ENGINEERING VS. BIOLOGY Team, We have to change our perspective. We can't keep comparing our body to a vehicle. Vehicles are built by engineers, and they're really well built, and they're built out of physical materials that we can all observe in the universe put together, and they all have specific wear rates. There are things you can do that might slow that wear rate down, but at the end of the day, they do wear out over time. Our bodies are biological. They're physiological vehicles, and within those, they are well built. They've been built over thousands of years. to heal, to move forward. They've been built for the one specific purpose of survival. It's what makes us so different from everything else in the universe and it's why a huge part of what we do is address this underlying physiology. It's about the ecosystem that the tissues live in. We have to move forward as a profession and this is why things like fitness forward care make so much sense. Because it goes so much far beyond that local tissue, like you think of the environment and you think of when you do address this fitness forward method of care, now you're improving metabolic systems, cardiorespiratory systems, you're improving all systems team. And at the end of the day, that is a huge deal for us. SUMMARY I just want to point you all in the closing moments here towards a couple of upcoming lumbar and cervical spine courses if you are looking for them. A few here in March for cervical, we've got Kuna, Idaho. That one's filling up pretty quick. And then same deal for so that one's March 9th and 10th over and that's close to Boise, Idaho. March 23rd and 24th Longmont Colorado also filling up so if those are on your list make sure you jump in those pretty soon. Casper Wyoming has a few seats left as well. If you're looking for lumbar spine management Brookfield Wisconsin that's right outside of Milwaukee at Onward Milwaukee. to see you on the road. We love having these conversations in a lot more depth on the road, a lot built into those spine courses, but have a good rest of your Tuesday. We'd love to interact with you all here on this thread if you have any questions or thoughts to add to today's podcast. Thanks. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Dr. Jeff Moore // #LeadershipThursday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, ICE Chief Executive Officer Jeff Moore discusses the mindset behind how we respond to news & change: do we respond positively or negatively? Jeff challenges listeners to consider the many positive benefits to responding to change with a growth mindset, looking for the benefits to change rather than catastrophizing the downsides. Take a listen to the podcast episode or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about courses designed to start your own practice, check out our Brick by Brick practice management course or our online physical therapy courses, check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION JEFF MOOREWhat's up, everybody? Welcome back to the PT on Ice Daily Show. I am Dr. Jeff Moore, currently serving as the CEO of Ice, and always thrilled to be here on Leadership Thursday, which is also a Gut Check Thursday. Remember, this is gonna be the last Gut Check Thursday that we have, because now the Open's gonna fire back up, so the workout for every week, of course, is going to be the Open. But if you wanna get in one more, it's relatively simple, starting from 500, 400 on the row, or it's just gonna be one time through for time. You're looking at 500-400 rower into 30 box jumps and 20 hang power cleans, 135-95. Then you're going to take down those reps across three rounds. So should be a relatively lighter load, pretty approachable. Good one to kind of keep moving as we get into some of the very challenging open workouts. I don't know about you all, I'm going to be doing mine today at 245, kind of right out of the gate. So mountain time, the announcement I think is noon. So I'm going to go right over to the gym at two o'clock. get warmed up and give it a go at 245. So I can't wait to see everybody's open adventures. Hopefully most of you got signed up and are going to see how you kind of stack up. Always important, right, to not run away when the measuring stick comes out. Get out there, do your best, see where you fall, and then look at over time if your consistency can't move you up in those rankings. So let us know, tag us, enjoy the journey. I will be starting mine here in a few short hours. ALTER YOUR REACTION TO NEW I have wanted to chat about this topic for months because of everything you can do in your growth and business interjectory. I think this one might be the most shockingly rapid as far as ensuring that your upward trajectory with whoever you're working for makes the steepest kind of hockey stick sort of climb. So let me explain. The episode is titled change this reflex and change your life. What it revolves around is altering your reaction to new. To new news specifically. altering the way that you compare to everybody else reacts to it. So I am in business, I am obsessed with asymmetry, okay? Where do you have it and where can you demonstrate it? The reason I'm obsessed with it is because it gets attention. And oftentimes, 90% of the battle is who can get somebody's attention. We are wired as creatures, we are wired to look for unexpected differences. That's what stops us in our tracks and makes us pay attention to something, right? I thought this was going to happen, but this happened. That generally speaking, is what gets a consumer's attention, it's what gets your boss's attention, it's what gets anybody's attention, because that's how human beings are wired. I thought this was going to happen, but this happened. Obviously, looking back evolutionarily, it's because that makes you safe, right? Things that aren't expected, things that are unusual, are usually worth paying attention to for survival. But for whatever, However, it came to be that can now be leveraged in the way that you move forward in both your career and your life What we're going to talk about specifically today is your response to change. YOUR RESPONSE TO CHANGE: GROWTH VS. SCARCITY So if you think about the importance of demonstrating asymmetry and you think about where you could demonstrate that that would matter, the number one spot that you could demonstrate asymmetry that would move the meter in the right direction would be your response to change. And the reason for that is because it's the one where it is so unusual to see a difference from a leadership perspective. Most people's response to change, and this is widely and universally known, right? Most, it's why they don't like it. Most people's response to change, the reflexive response is what am I losing? And that is deeply rooted in scarcity mindset, which most people have, which is why most people don't like change. It is relatively universally held that most people don't like change. And the reason for that is because their brains are rooted for scarcity. And so when something is changing, they always fear the worst. If you make an intentional habit to do the exact opposite, you will stand out in a way that I don't think that you could stand out more profoundly by making any other shift in your life or business. If you respond with what's the upside here. it will have massive downstream effects. THREE BENEFITS TO RESPONDING TO CHANGE POSITIVELY Let me just talk about the three biggest ones that will be immediate. If you can get your reflex response to change, to be positive, as opposed to, oh my gosh, what am I losing? Right off the bat, the first one is it will have a profound mental health uptick if you focus first on finding the positives, okay? Because, Wherever you start in anything, one of my favorite sayings in physical therapy is, wherever you start is where you wind up. Meaning, when you look at a lot of the big studies in PT, when people begin with a medical industrialized complex move, i.e. getting an MRI, getting higher level scans done, they tend to kind of stay stuck in the medical industrialized complex. But when they go to a provider that doesn't do those images, that doesn't offer those quote-unquote solutions, they tend to never go in that direction because they get moving and keep moving, things seem to resolve, and they stay in that lane. Because inertia drives so much about life. So wherever you start is where you tend to wind up. So why not start positive? Why not? I assure you, you'll figure out some of the downsides. Those won't escape anybody. We're wired to look for that. But why not start positive? Because now it's life's job to reveal enough to you to pull you away from that position. But it has work to do. So if every time a new thing or a change comes up, your reflex is, ooh, what's the upside here, right? What can I do with this? This could be really good. Now life needs to prove the opposite, to pull you away from that position, which is challenging because you've got momentum in that direction. Most people do the exact opposite, right? They start low, oh my gosh, oh no, what's gonna happen now? And now there has to be a lot of proof to pull them out of that negativity. If you start high, life has to prove to you that you should get pulled down, and oftentimes it can't. So right away, just by having a reflex where you're looking for the positive, the mental health trajectory is very real. Okay, number two, and probably now talking more about business, it will absolutely shock the person who's delivering the news in the best way. If your response, right, because leaders are always dreading sharing any news about change because most people being rooted in a scarcity mindset are going to begin peppering you about what they're losing or why things are going in the wrong before they've even thought it out. They're scared. They're nervous. Their reflex is negative. It's a lot of tough energy that comes at you when you're delivering change news to a group of people. If you're the person in that group that throws their hand up right away and says, Oh sweet. Does that mean that we can blank? If you don't think you've got the attention of that leader, you're crazy. First of all, you're the only person doing that. So already you are the asymmetry. And it's such a positive thing when the leader was expecting a negative response. And now you said, oh cool, does that open up this possibility? Or could we now do this? It will be as shocking as it is positive. So now you've got the attention of that leader and you've got them in an incredibly positive space. There is so much positive work that you can do from that position. And finally, third, and it usually builds off of number two, Looking for the positive reflexively and immediately places you in the best position to find it. With every single change comes new opportunity. Does not matter if it is at first perceived as a calamity, right? You think about big financial crashes. There are massive opportunities in every one of those calamities, right? But you have to be looking for it. If when things are moving and shaking and changing and the ground is shifting, if you're the person who's looking for in this new terrain, how can I now capitalize on variables that weren't present before? You have positioned yourself to find them first. Everyone's going to figure out the downside, but most people see the upside too late because they were consumed by the downside. So if you're the person who, when change is coming, you're looking for the upside, you're going to find it first. And now you've got the attention of leadership on you while you find the early opportunity and you are going to be on a trajectory that is so much quicker and faster than everybody else that when you telescope that out months or years, you obtain that position and thrive in it when other people are still figuring out why some of the change was good. Crew, things happen so fast in business and life. If you're the person who can gain positive attention from decision makers when change is happening, and you're the person that can see the opportunity that arises through change, and you put those two things together, you will move forward relative to your contemporaries at a staggering speed. Because the greatest asymmetry that you could ever demonstrate is being a person who has a reflexively positive response to change. When the entire world is rooted in scarcity mindset and thus has an immediately negative response to change. Enjoy better mental health and enjoy way more business success by making that one simple reflex change. SUMMARY PTOnIce.com, team. It's where all the courses live. Have an amazing Thursday. Enjoy the Open. I will certainly be reporting back on how it goes for me. It never goes overly well, but I will give it my absolute best. Enjoy, team. Have a great Thursday, great Friday, great weekend. Cheers. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.  

Dr. April Dominick // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member April Dominick shares some insights and a “big win” from a coffee marketing meetup with a physician. She cites 5 clinical pearls for how to approach challenging the status quo of practice patterns with the providers in your community. Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter! EPISODE TRANSCRIPTION INTRODUCTION Good morning, everyone. This is Dr. April Dominick. I am on faculty with the Ice Pelvic Division. And today I wanted to discuss a recent marketing win that I had with a physician and some insights regarding how to challenge the status quo of practice patterns within providers in your community. One concern that we often get with our ICE courses and especially in the pelvic division is someone will say, hey, I love all of this incredible research that you all are sharing that is completely different from the way that I practice and I'm so stoked and I'm so behind it. But how do I recommend or how do you recommend that I bring this back to a community of providers who are pretty steadfast in their practice patterns? So today I'll share that recent interaction. And again, it was a marketing meetup with a physician and I want to share how it went from an invite for a latte to an invite for a lecture that I could give And all of that happened in just under 35 minutes. So I met with an OB who I have a pretty solid referral relationship with. She refers folks to me, I refer folks to her, and we were just catching up over some mutual patients that we had. And the conversation ended up turning towards how she counsels patients in the pregnant and postpartum space in regards to exercise. And she absolutely encourages people to continue moving, keep exercising, working out. But she says, you know, I caution them against doing planks and I don't really support twisting and turning because I don't want to make that diastasis recti worsen or that thinning of the linea alba. And she also says that she cautions individuals with any sort of impact because she doesn't want to further any sort of urinary incontinence. In my head, I was like, ooh, gosh, there's so much research that has come out, especially in the past six to 10 years, that doesn't support that line of thinking. But how do I share that with her without, you know, stepping on her toes and interrupting this beautiful relationship that I've developed with her? So I asked, I said, would you mind if I shared some updated evidence that we have regarding all of those topics? And she was totally game. She was like, fire away. Yes. So I shared the benefits and the protective mechanisms that we know about as far as core strengthening during pregnancy and early postpartum. I relayed to her the reality of the situation regarding diastasis recti is we don't even really have a consensus in the literature for defining it. And I also quoted some studies that we also talk about in our live courses and our online courses about when it comes to someone who is one year postpartum, they are likely still, some of them still have a diastasis recti and that those with a persistent diastasis recti tend to have a weaker rectus and oblique strength score compared to those without a DRA about a year postpartum. I also anecdotally, I mean, I had to squeeze this in somehow, but I anecdotally shared that since I started loading the core more during pregnancy and early postpartum, that some of our mutual clients, I did some name drops, have actually had relatively quicker recoveries on the back end, on the PT side. And they've returned to their functional activities seemingly with more ease. And that was, of course, all things considered and just an anecdote, but it's something that a trend that I've noticed. And that's all for folks who have prioritize course strength training as opposed to those who have not or those who continued some sort of resistance training of some sort. We also talked about other topics and I threw in that we have a lot of evidence regarding the benefits of resistance training and lifting heavy during pregnancy and some preliminary evidence that says hey, exercise and heavy strength training may support the role of lowering some pregnancy complications, including gestational diabetes, gestational hypertension, and even some perinatal mood disorders. And then of course, I let her know, you know what, I am there to help support someone in their endurance training, their impact training, Um, and I help address that pelvic floor dysfunction. So I actually will come alongside someone, um, with those goals. And if there is any sort of pelvic floor dysfunction or urinary leakage, um, I got them. And, and that's not something that I discourage. Her mind was blown. Like she was glued to me as I was just rattling off all of this new information to her that differed from her current practice patterns and likely what she had been trained under when she went to school or in the last continuing education class that she went to. Or maybe she just hasn't really been to any of this because that's not necessarily her expertise. So she was just mind blown and she was so excited to learn this new information. And I said, you know what, this line of practice that I just shared with you, all of these recent updates and literature, this is more of a recent shift even for me. When I first started practicing in pelvic health, up until three to four years ago, I had many of the same practice patterns that you just shared with me. And in fact, many PTs, many other pelvic PTs are still currently practicing with those similar philosophies because that's how we were trained. And not everyone is caught up in respect to the latest evidence. So we talked about different concerns also that we hear in our clinic rooms. And that was fascinating, a whole nother podcast episode, but it was just really fascinating to hear that some of the concerns that her clients have, that our clients have, what they tell her in the clinic room is very different from what the conversations I have. And of course I shared with her, you know, a lot of the folks who are pregnant and postpartum, They have so much fear on board regarding getting a diastasis recti during pregnancy. By the way, it's 100% normal. And how they often pay for generic programs to get flat abs from Instagram influencers and they don't work and then they're frustrated. Or they share with me how they're just terrified about getting a perineal tear during delivery. or they're just determined not to have their organs fall on the ground after pregnancy. And it was so interesting because she, she was like, April, that is, those are not the main concerns in my sessions. And she was like, this is so informative to hear what's happening over there. She also doesn't have Instagram. So I feel like that may influence what it is that she sees and hears. But again, we were talking about in our clinic spaces. So I also got curious because I had some questions that were more on topics about her expertise, like perimenopause, menopause, and hormone replacement therapy, which all of those topics are being discussed way more in the pelvic PT space now. So at the end of the conversation, she thanked me so much for sharing the recent literature. She said, I am so much more confident now promoting whole body strength, including the core, like I feel comfortable because of what you shared with me, promoting people doing planks and promoting impact exercise throughout pregnancy and postpartum. She wanted those articles emailed to her immediately. And the most surprising and probably the best part of this entire meetup was that she asked if I would like to give a presentation at Grand Rounds of the do's and don'ts of exercise during pregnancy and postpartum. She was like, my colleagues would 100% benefit from hearing what you have to say. It'll be a tough crowd because she said many of her fellow nurses and physicians assistants and doctors practice from what they learned, uh, 20 to 30 years ago and are even way further behind than how she practices. She's like, some of them are still promoting bed rest. Um, even when the client doesn't meet that criteria. And she said that she often will come behind providers as she's rounding up the hospital and say to the clients, no, I want you to get up and move. Moving is good, exercise is good. Because I guess some of her other colleagues have said, no, no, no, just stay in the bed, stay in the bed, that's gonna be better for recovery. So I was of course ecstatic when she asked me to do a Grand Rounds lecture. I told her, you know what, it would even be very helpful from my perspective if clients heard about the benefits of continuing resistance training and core work and impact exercise from the medical community because Clients have so much respect for the medical community. So if they are hearing about it first from them and then they get to see me later, if that's the order that happens, even better that we are reinforcing that strength is queen and that can help knock down a lot of those fear-based messaging that our clients get. So, In a matter of 30 minutes, I went from coffee grounds to grand rounds. I want to identify just five things or themes that I came up with from that interaction that may help you cultivate a relationship with a provider, whether it's an OB, an orthopedic surgeon, or a chiropractor, massage therapist, whatever. Use these when you are going to market. LEVERAGE THE LITERATURE Number one, leverage the literature. and thoughtfully ask if it's okay for you to share that recent literature has overturned some of those old tiny beliefs. So reference some of the amazing evidence-based pearls that you've gotten from your ICE courses or from some of our posts. It's all about being respectful for that delivery in the question. So I'd recommend that you just be honest and say, would it be okay if I shared some of the recent literature with you that I have found incredibly helpful for my practice in bettering client outcomes? VALIDATE THE OTHER PERSON Number two, validate them. Share that it wasn't long ago that you were practicing in a different way that maybe didn't align with some of the recent clinical practice guidelines. Sometimes the oldest techniques don't necessarily stand the test of time and they may not be the most effective. SHARE CLINICAL OUTCOMES Number three, share some stellar clinical outcomes. Use wins from mutual patients if that's an already established referral source. ASK FOR ADVICE Number four, ask them for advice. When it comes to a topic that is in their expertise that you may be curious about, or maybe you have an uptick in this particular diagnosis on your caseload. There is nothing that people love more than talking about themselves. Exhibit A, just kidding. Um, but they love talking about how they treat their philosophy. And when you ask someone for insight that shows, you know what, that shows that you're curious and you're wanting to learn from them. So it becomes more of a two way street. LEAN INTO YOUR PERSONALITY & PASSION And then finally, number five, lean into your unique personality and passion. When people get a sense of how incredibly passionate you are about changing lives and how you practice being about it day in and day out, they listen. Think about the first time you tuned into a PTA on Ice podcast episode with Jeff Moore or Christina Prevett blasting their truths from behind the mic. how you can feel their excitement through your speaker as they rap about getting that PT version 2.0 going, about how we need to remove barriers to exercise in the older adult, the pregnant and postpartum space. So lean into your personality, whether it's loud and proud or quiet confidence, and let that drive your passion behind changing the status quo in your community. I hope you found this marketing one of mine and those insights helpful for your next marketing meeting. Remember, leverage recent literature, validate the provider and how you may have just recently shifted to using these more evidence-based interventions and strategies, share recent client wins and trends, get curious about their expertise, and then lean into your personality and let that elevate your passion for providing Fitness Forward, evidence-informed care in the PT space. SUMMARY If you're feeling like you need to brush up on some of the latest research and treatment strategies in regards to fitness, guidelines, and any sort of pelvic health issue, join us in our Ice Pelvic Courses. We have some live courses coming to you. Alexis and Rachel will be in Newark, California. the first weekend of March, and then Alexis and I will be in Bismarck, North Dakota the second weekend of March. There's still time to sign up for those. And then from an online perspective, our next level one cohort starts March 5th, and we only have a few seats away from being sold out for that cohort. So hop on in. Thank you so much for joining and remember to bring that Be About It attitude not just to your workouts but to your marketing meetings and coffee meetups as well. Cheers y'all! OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Dr. Jeff Moore // #LeadershipThursday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, ICE Chief Executive Officer Jeff Moore discusses the differences in how regret can present from overworking an unrewarding job, but also from underworking in a career with a lot of potential for both personal & professional impact. Take a listen to the podcast episode or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about courses designed to start your own practice, check out our Brick by Brick practice management course or our online physical therapy courses, check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION JEFF MOOREAlright team, what's up? Welcome back to the PT on Ice Daily Show. Thrilled to be here on Leadership Thursday. I am Dr. Jeff Moore, currently serving as the CEO of ICE and always pumped to be here on Leadership Thursday, which always pairs as a Gut Check Thursday. Let's get right into it and talk about the workout. So what we've got is the CSM workout. Both Alan Fredendahl and Paul Kalorin of Ice and iDryNeedle, the combo, are going to be there to lead you all through a workout Saturday morning. Anybody at CSM who wants to get some movement in, please join us. 5 a.m. CrossFit Southie. You've got to sign up on the form. So go to the Ice Students page. The form is on there. It's here on Instagram. It's on the pinned post for the CSM WOD. I think we have like 20 signups and I want to say they're taking in 30 or 40 so as we get very near to Saturday morning make sure you jump on there if you indeed want to work out. It's going to look like this should you choose to attend. It is going to be an AMRAP 25 minutes. Now mind you, anybody not at CSM should still do this. Teams of 2. We've got a 100 calorie row. We've got 80 alternating hang dumbbell snatches at the usual 50-35. You've got 60 box jump overs at 24-20. You've got 40 toes to bar, and then finishing off with 20 burpees over a dumbbell, and then going back up to the top, should you have more time in your 25 minutes. Should be a really nice chipper running through that. Gonna get kind of a one-to-one work-rest ratio. Should be able to keep moving. Should be an awesome workout. If you go to the CSM workout, please make sure to tag us. I won't be there, so I'd love to see photos and videos of all of you getting after it. Let's jump into Leadership Thursday. DEATHBED REGRETS The topic is deathbed regret. Will you have them? I think perhaps not. Let me explain. So the usual story goes something like this, and I think we've got to respectfully counter it. The usual story goes something like this. Your grandfather or your grandparents in their twilight years are regretting spending too much time at the office. right, saying, you know, oh, I wish I would have pursued more of my hobbies, done more things that I really cared about, et cetera, et cetera, et cetera. And the cautionary tale here that we're supposed to pull away from this constantly heard story is that you shouldn't overwork, okay? This is the concern, this is the moral of the story, if you will. REGRET FROM OVERWORKING Okay, I don't know about you all, but my grandfather worked in paint factories in downtown Detroit, Michigan. Tough gig, tough city, right? But he did what he had to do. I have no doubt, given the option, he would look back and say, I never asked him, but I'm sure he would have looked back and said, I wish I could have done a bit more of that. Or I wish I would have chose to, if there were sufficient resources, do a little bit less of that and spend less time there. I have no doubt about that. That's fair. If your job feels like that, like it's tough, it's grindy, it's not necessarily one that you're super passionate about it. You're kind of doing it because you have to, but you can't change that because you're doing what you have to do. That's the job that's available to you and you're getting it done because that's your responsibility. Not only is that noble, but it's totally understandable to do what you need to do, but I would agree, maybe don't do a ton extra. And I can totally appreciate how regret at end of life could come should you choose to do a ton extra of something you don't necessarily love. I will cough that up. I will agree with that. I can appreciate why that's been the narrative for a lot of years. That being said, It is much more likely that you are doing something that you chose and that you are passionate about and that you love. Particularly if you're sitting here on Thursday morning, taking in leadership Thursday, the odds are really good that you chose your career amongst a variety of options and you chose one that you believe in, right? You probably didn't choose the paint factory in downtown Detroit. It's a tough gig, right? That probably isn't one you were drawn to. And again, if you're in this ethos, where you're taking in this kind of content, you're probably in a position where you chose something you loved. Now, if you started a company, or you joined a company that you really believe in, regret is unlikely going to be the byproduct of your hard work in that space. So what I'm saying is that we need to advocate, or I wanna advocate, for a shift from people on their deathbed say to or towards people on their deathbed used to say. Because I don't foresee myself or any of you saying in your twilight years, I really wish I wouldn't have fought so hard for something I believed so much in. I just don't see that coming. I totally see it from the paint factory, right? I don't see it when you chose your passion that you feel most aligned with, where you want to be of some use. I don't see that statement on the horizon. For me, the thing that I believe I'm fighting for is freedom for everybody from dependence on the medical industrialized complex. From the pharmacy, from the surgery, right? Instead, a belief in a utilization of one's own physical resilience, right? The belief that changing the narrative and educating the public that if they train and fuel well, and they don't have a bad accident, that you can maximize and enjoy an incredible health span. And unfortunately, the narrative in this country is solely the opposite. The amount of people who are unbelievably dependent on a ridiculous amount of prescriptions, that are so quick to surgery, that leave anything healthy once they're injured, that we have so much to fight against. But I believe in this fight. And I don't believe that when I'm 80, I'm gonna say I wish I would have fought it less. I don't believe that. The principle runs too deep. REGRET CAN ALSO COME FROM UNDERWORKING Instead, and to close off the episode, a bit of real talk perhaps, I think that our regret risk in this generation, now that that shift where choice is kind of the driver of career has been made, the risk more lies in the following items. I feel like I never made a difference. I feel like I didn't fulfill my potential. I didn't go hard enough. I never found my limits. I don't know what I was capable of doing in the good fight. I never generated sufficient resources to be able to support myself and others. I think this is probably the list of regrets that is more common and they come from underworking, not overworking when you've chosen something that you believe in. And many of us get to make that choice. So my message to you on this Leadership Thursday is first of all, make sure you're doing that if you're able to. I do not mean to put anybody in a bad mental spot if they're like, dude, I'd love to, but my cards don't allow it. My situation, maybe right now and future, totally respect that. Do what you have to do. There's so much honor in that. If you get to choose, if those are your cards, choose something that you believe in and go all in. If you are a part of a team that achieves something that you believe to be deeply meaningful, you are not going to look back and wish you spent more time on yourself on vacation. That isn't how it's gonna shake out. You're gonna look back and say, I'm so glad that I was of some use. I'm so glad that I figured out the maximum that I was able to contribute in an area that I believe needed my efforts. That isn't something you regret. That is something you celebrate. It's time to push back against the narrative. Things have changed. Let's acknowledge it and let's stop scaring people into not working enough to find their potential because of things being different 30, 40, 50, 60 years ago. Give it some thought. Thanks for being here on leadership Thursday. We've got a million courses coming up. It's our busiest time of year. I think this weekend alone, we have 12 to 15 live courses. Make sure you jump on ptonice.com and check out that schedule. Get those skills, get out there and help some people y'all. Cheers. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.  

Dr. Dustin Jones // #GeriOnICE // www.ptonice.com  In today's episode of the PT on ICE Daily Show, join Modern Management of the Older Adult division leader Dustin Jones as he discusses what it looks like to discharge as a fitness-forward clinician. In this episode, we'll cover the do's & don'ts to discharging and even challenge the whole notion of discharge itself. Take a listen to learn how to better serve this population of patients & athletes, or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION DUSTIN JONESWelcome y'all to the PT on Ice daily show. My name is Dustin Jones, one of the lead faculty within the older adult division. And today we are gonna be talking about the fitness forward discharge, the fitness forward discharge, how we can set our patients up for that fitness forward lifestyle once they leave our doors, all right? So before we dive into this conversation, I wanna start by really saying that the whole concept or notion of the discharge as we know it, traditionally, really needs to be challenged, right? The whole concept of, I'm gonna see this person for six to eight weeks, and then I'm gonna have no contact with that person whatsoever, and then cross my fingers and hope that that person will hopefully come back if they do have issues down the road, right? Hopefully, we see some of the issues with that. Hopefully, we can see the problem with bragging about how few visits it takes for you to get particular results, right? It's like we've created this badge of honor for how little that we're seeing people. And if you spend any time around the Institute of Clinical Excellence at any of our courses, you start to see what you have to offer people. Why in the world would someone like you, a fitness-forward trained clinician, want to be around someone less. You have so many valuable skills. You have such an amazing influence. Your be a valid approach, this fitness for lifestyle that you lead and can ultimately give to your patients. Why would you not want to rub shoulders with these folks that you can absolutely change their lives, right? So the whole notion of discharge, I really want to challenge. I think the Onward Physical Therapy crew is doing such a good job with this with their Restore and Perform program where they will have patients and they will transition to more of a maintenance type situation. I know many of you all watching have similar services where they may come off of quote-unquote physical therapy but you're still getting those touch points to change their lives. That is really, really good. What I want to speak to today in terms of the Fitness Forward Challenge is for many folks that are working with individuals and patients that do not partake in fitness, that these folks are not a part of a fitness community and you're going to work with this person and we need to set them up for success after your course of care. How do we handle those situations? I know for The vast majority of you all watching and listening, that is the case. I can say that for myself, definitely in the context of home health where I've spent most of my time. clinically, but now I'm on the other end of the equation where I am mainly in the fitness space at Stronger Life Fitness in Lexington, Kentucky. So I've really enjoyed experiencing what it's like to get people into our fitness community from different clinicians and what clinicians have done really well to set them up for success, but also what they've done really poorly that's made our job really difficult. And I think about all the folks that even come into our doors because of something that happened in that course of care. All right, so the fitness forward discharge for you clinicians that are working with folks that do not partake in fitness right now. We're gonna dive into some practical things. I want you to think of this in three steps. All right, number one is that we start with the end in mind. Number two is we prepare for what's ahead. And number three, we test the plan. All right, I'm gonna dive into some specifics. within those three chunks. START WITH THE END IN MIND So number one, starting with the end in mind. Many of us will hear this saying all the time, especially when you are in a more acute setting like acute care clinicians, right? As soon as they do their eval, they're planning their discharge, right? That is For many of them, the goal is that, all right, what's the discharge disposition so we can get this person to a place where they can receive care? And I think that's a good mindset for us to have across the continuum of healthcare. Discharge planning starts day one. Where is this person headed? where are we taking this individual? Now, for you all, the fitness forward clinician, the question that we often ask ourselves, but ultimately ask the patient or the client, is how fit will you let me get you, right? Betty comes to you for her back, her back pain, and we're gonna take care of that back pain for sure, but ultimately we don't wanna stop there, right? We change lives, not just pain. We're gonna see how fit we can get Betty ultimately in her one rep max living and help her live the fullest life that she can imagine right that goes beyond pain reduction techniques right so how fit will you let me get you now what is really important when we start thinking about the next step after our course of care when we're discharge planning and starting on day one we need to consider what this person is going to be willing to start and but then also sustain in terms of a fitness routine. What they're willing to start and then sustain. And I would say the latter is more important. It's easy to start something, it's tough to sustain it for months, years on end. So this is where we really need to spend a lot of time understanding this person's goals, their desires, their deep desires of what they want to be able to do. What keeps them up the night? What would they want to be doing if they had no pain whatsoever? And then match the fitness regimen that could ultimately make that happen, right? And with that, we have to consider so many factors, like personal preferences. past experiences, their perceptions of certain communities or fitness modalities. What's their financial situation? What do they have available to them to help offset some of the financial barriers? If someone is on Medicare or have a Medicare Advantage plan, there's lots of things available to help reduce the cost of fitness services. Where are they located, right? Location is such a huge variable in the adherence and consistency of an exercise program when someone is leaving their home to partake in fitness. It's a lot easier for someone to go around the corner as opposed to driving across town, right? And what social support, what resources does this person have? We need to take all of these into consideration and that is going to form our recommendation of where we are headed and we can set that out very early on in the process. So for the outpatient clinician, many of you all watching, many of you all are probably a part of some type of CrossFit community or CrossFit box, right? And you may be treating some patients in the outpatient setting where that transition may make a lot of sense. They may be familiar with it. They may not have a lot of baggage associated with that brand or that gym, that CrossFit box. And that transition can be relatively easy for you. And that's a no-brainer for many of you all. But for a lot of folks watching and listening, they have patients that are likely never going to step foot in a CrossFit gym. And I would go as far to say that CrossFit gym is not the best place to serve some folks, right? I know that's blasphemous on this podcast, but the local CrossFit box may not be suitable for every single person that you're working with as a physical therapist. So we need to understand, are there communities out there that can meet this person where they're at and help them make this a sustainable long-term fitness routine? and for the home health clinicians watching. Is there something that could be done for someone that is currently a homebound status? Is there some type of online community? Is there some type of online service or some type of YouTube channel, for example, that someone could partake in and consume that's going to be suitable for their situation? You cannot make these recommendations without truly understanding the person sitting in front of you. So we have to dig in. What are they willing to start and then what are they willing to sustain? Now, this is going to require some work, right? You need to know the communities out in your area, of the differences of them, of how some may be more suitable or welcoming to other groups of people. there's gonna be big differences there. You need to understand what services are available online to folks that may not be able to get out, what services are available that are willing to accept some of these Medicare Advantage plans or Silver Sneakers or Renew Active if they're on United Advantage, for example. So we need to do some work so you can make some of those recommendations. If you're like, what in the hell is he talking about? Hit me up or join the MMoA community where we have a lot of these discussions and we have a really helpful resource of where clinicians threw in some of their favorite YouTube channels, for example, and different resources that they help encourage that fitness-forward lifestyle beyond discharge. But there's options out there. We can do the hard work for you. Hit me up, DM me, and I'd love to share some of those resources. So that's the first one. Start with the end in mind. PREPARE FOR WHAT'S AHEAD Two, we prepare for what's ahead. So we start with the end in mind and then we prepare for what's ahead. When we start with the end in mind, we get a good idea of maybe what type of fitness regimen, what type of fitness community is gonna be good for this person so they can sustain and continue their health journey, right? If we understand what that community and that regimen is about, we can prepare that person for said regimen in our course of care. And I view this kind of like graded exposure. or gradual exposure, where we're gradually exposing people to elements of that fitness community or fitness regimen. Let's take CrossFit, for example. Let's say you have a patient that has never done CrossFit and they have agreed, yeah, I'm going to join that community down the street once we're done. That's really interesting to me. You can do that person a solid by exposing them to some of the CrossFit movements, of some of the movements that you're commonly going to see in the programming. getting a barbell in their hand, teaching them some of the basics of a squat, a deadlift, a press, and then maybe even getting to Olympic lifting. Expose them to those movements to reduce that new member suck, right? We've all experienced it. There are some benefits to the suckiness of being new and not knowing a lot about what's going on in the community. I do want to acknowledge that, but man, it's really nice if you come into a community having a little bit of familiarity with some of these movements and jargon and so on and so forth. So we want to gradually expose them to the movements that are going to be coming down the pike. We also want to expose them to the intensity that they're going to see. This can also be new for a lot of individuals, particularly going into something like a CrossFit gym or some high intensity interval training bootcamps type fitness community, that if these folks have not experienced true intensity, we can do that in the course of our care and expose them to that so they're not blindsided when they join this fitness community. We would also argue within the MOA division that you want to do that regardless to get better outcomes, keep in mind. But when we also think about that fitness forward discharge, this is really, really helpful to do. So gradual exposure to that intensity that they're likely going to experience and then gradual exposure to the movements that they're likely going to see. The beautiful thing about this is it reduces that new member suck when you're partaking of something for the first time. But for a lot of our folks, it often gives them trust in their bodies, that they can trust their body again. Think of what so many of these folks have been through, especially the older adult population that I particularly work with. We're talking decades of different healthcare interactions, maybe a dozen courses of care in the context of physical therapy, who knows how many surgeries, who knows how many diagnoses that were given without context, who knows how many damaging words have been said to this person where they believe that they are weak, fragile, slow, that they are broken pieces. We have the opportunity to show them that is not the case. That is not the case whatsoever. You can trust your body again and you can push your body again and your body can improve and get better and you can do things that you thought were absolutely impossible. You can show people that through this gradual exposure. So that's how we wanna prepare, that gradual exposure to intensity and movements. Number two, we also want to give people a plan to troubleshoot the difficult scenarios that are going to come up, right? Jeff Moore always says this, and I love this, where he will talk about the path to fitness is always gonna run through some musculoskeletal issues, right? And this is where we are such a huge service for individuals, that we, throughout our course of care, can give people a plan to be able to troubleshoot what is ahead, what is common, the question of hurt versus harm. When am I doing damage versus when a little bit of discomfort is okay? Maybe giving them something like the traffic light analogy where, you know, that zero to three out of 10 is kind of that green light. Still send it, you're good. But if that lingers on to, you know, that four, five, six range, that's kind of in the yellow. We need to start thinking about modifying. We're still moving, right? And then, you know, that seven, eight, nine, 10, where we're in kind of that red light, where we're thinking, still need to keep moving but I may need to go come back and see you physical therapist or PTA or whoever you are so that strategy of if this than that so they understand the difference between hurt versus harm and when they need to come back to see you can be very very helpful another one particularly in a population that's not used to exercising is DOMPS. For many of you all you don't even remember what it was like the first time you felt delayed onset muscle soreness if you've been exercising regularly but for someone new it's a very frightening thing when they do something that they perceive is going to be beneficial and helpful for them and then they try to get out of bed the next day or the day after and they're absolutely miserable. a lot of things can go in your head of what may not be helpful or beneficial about what you did that caused so much discomfort and so you can give them context. I've made this mistake way too often where I did not give context to delayed onset muscle soreness and it really comes back to bite you. You can lose that that clip that trust of the patient but ultimately we want to give them the ability to handle kind of the ups and the downs to understand hurt versus harm, to understand DOMS and what to actually do about it, and ultimately, when they really need to come back to you versus continuing on in their fitness regimen or community. Alright? So, number one, start with the end in mind. Number two, prepare for what's ahead. TEST THE PLAN And then last but not least, and where most people really drop the ball, is we test the plan. we test the plan during our course of care. So as the course of care is winding down, we may be kind of reducing some of the focus on pain reduction and thinking more about building physical capacity. We're starting to stress test this person, of how they're handling what we know they're gonna experience down the road, right? This is where Alex Germano, she's watching here, but she has said before that we need to make PT sweaty again. And I absolutely love that phrase, and I feel like that is very, very pertinent throughout the whole course of GARE, but particularly for this phase. That last few weeks where we're stress testing our plan of care, where we're getting people sweaty in PT, seeing how they respond. These folks, we also, during that transition, want some overlap where they're actually partaking in that fitness regimen or a part of that fitness community. When we still have those regular touch points and we're able to handle some of the ups and the downs and what may come and answer some questions and just make sure this person is well prepared while they're under our care, that makes it very, very easy for them to continue and make this a sustainable effort. So we want to test the plan. stress test them in your session. Make PT sweaty again. And there's usually kind of a turning point that you'll see, particularly in Jerry PT, Jerry OT. And sometimes it happens sooner, right? If you really push intensity and your sessions are very challenging and it kind of catches them by surprise. But at the latest, this should happen. during this test the plan phase and what typically happens you got bob that's been coming in bob good old boy wearing his wranglers tucked in button up got a big old leather belt probably has some 30 year old fry cowboy boots rolling in here He's getting after it, just sweating his rear end off during your sessions. Then the next session comes around. What's Bob wearing? Bob's probably still wearing his boots, his fry boots. He's probably still wearing his button up, but he swapped out the Wranglers for some Fruit of the Loom sweatpants. still tucking the shirt in, the hem's probably right around his belly button, you know, that waistline area for them. He has seen, oh my gosh, this is not, quote unquote, physical therapy or occupational therapy. I'm going here to work out. We're getting sweaty, right? We're stress testing Bob, and he changed his outfit as a result. I cannot tell you how many times this has happened in the context of even home health, but then outpatient, and we definitely see this in the context of fitness. as well, but we want to try and see that. We want to stress test for if something bad happens, if they have some type of flare-up, for example, if they have some type of questions, we can handle it within our course of care. And ultimately, you're allowing a little bit of overlap where you're still seeing this person, but they're transitioning to that fitness community. That is what a fitness forward discharge looks like. We start with the end in mind. We're thinking about where this person is going. How fit are you going to let me get you and where are you going to end up? Whether it's a fitness community, whether they're doing something at home, whatever fits their particular needs, we start there. Number two, we prepare them for what is ahead. We make them familiar with the intensity, the movements that they're going to experience and we help them troubleshoot the challenging scenarios that are going to happen. DOMS, hurt versus harm. When should I seek care? when is it okay, when do I need to modify what I'm doing, right? Then number three, we test the plan. We stress test them while we have them in our course of care, while we're regularly seeing them. They may even already be starting that fitness program or fitness regimen. We're able to handle the bumps that come with that and really set them up for success as they continue forward. The fitness forward discharge. I appreciate y'all listening. SUMMARY Before you go, I want to mention MMOA courses. We've got a bunch of stuff lined up for 2024. If you want to see us on the road, I want to highlight a few weekends that are coming up. February 17th, 18th, this upcoming weekend we're in Oklahoma City, so catch that if you're in that area. March 2nd and 3rd, we've got Tripleheader. We're going to be in Rome, Georgia, Halifax, Canada, Glencoe, Maryland. We also have our Level 1 and Level 2 online courses. Our Level 1 course is going to be starting March 13th. We'd love to see you on that. Appreciate y'all. Have a lovely rest of your Wednesday. Go Crutchets! OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Alan Fredendall // #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.  

Dr. Owen Strachan is joined by Professor of New Testament at Grace Theological Seminary, Jeff Moore and they're discussing the important Biblical theme of being "outside the city gates" and what that means for Christians today.See omnystudio.com/listener for privacy information.

Dr. Rachel Moore // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member Rachel Moore discusses how to get patients performing more fitness in their plan of care, as well as suggestions on how to help patients transition to becoming "everyday athletes" with a wide variety of home & community fitness programs. Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter! EPISODE TRANSCRIPTION 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 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.RACHEL MOORE Good morning, PT on Ice Daily Show. It is 8 a.m. on a Monday morning, which means we are here tuning in for our ice pelvic. We are hanging out here today. We are gonna be talking about building the bridge to fitness in the pelvic floor PT space. So we talk a lot at Ice about being fitness forward. We've had Jeff Moore on the podcast a few weeks ago talking about what fitness forward means. and we really pride ourselves on being fitness forward right sometimes that can create this like mindset of if i'm not seeing athletes quote unquote how can i bring this fitness forward um style of therapy into pelvic floor pt WHAT DOES BEING AN ATHLETE MEAN? And first I want to talk about what athlete means, like define what that means in this space and kind of dive in from there. So when we talk about like athletes, quote unquote, in our space, that's anybody that's like intentionally moving their body for exercise. That doesn't mean that they're CrossFit Games athletes. That doesn't mean that they're super competitive. It just means that they are moving their body intentionally to get some effect. I would argue that every parent that is chasing after kiddos is an athlete in that case. And so if we take this term of athlete and broaden it out, we can apply that concept to everybody that walks into our clinic. This is a really huge key point in the pelvic space because there are so many people that are coming into pelvic floor PT that maybe have not ever exercised before or maybe exercise like back in high school played sports and since they graduated high school haven't done anything in the gym intentionally or haven't done any sport. So this season of life of pregnancy and even postpartum is a fabulous reintroduction into potentially the world of exercise. And that's where we come in. So when we have people coming in that are pregnant that want to get out of pain, maybe their goal isn't even anything to do with staying in the gym or getting back into the gym and their entire goal is to get rid of their back pain in pregnancy or get rid of their pelvic girdle pain in pregnancy. We can help not only accomplish that, like we know that. We talk about it in all of our courses, in our live course and in our online course, how we can use resistance training to mitigate pain and get rid of pain in these populations. But we have a fabulous opportunity here to literally change somebody's life. We can help them fall in love with fitness and fall in love with that feeling of being strong. a lot of times people are coming in and again maybe they haven't resistance trained ever and we put a barbell or a dumbbell in their hands and they kind of look at you like I'm not really sure who you think I am but there's no chance I can do this and so having conversations with them about like look this is a 20 pound dumbbell and your toddler weighs 30 so yeah you can and I know this looks scary because it is this little metal handle with two big old heads on the side But in reality, you're already lifting more than this. Let's just build your capacity by doing it intentionally at a higher volume. And then they start feeling those effects of that. We can have so many downstream effects from resistance training, not just getting them out of pain, not just giving them a new hobby. We can shift the trajectory of their life and impact things like metabolic diseases in their future. So this really is a powerful thing that we can do. And we have to recognize that every time somebody comes into our clinic, whether or not they've exercised before, we have a lot of opportunity to help build this capacity for them, not only physically, but also emotionally and mentally. In our PT sessions, we do a lot to help build confidence and rapport, right? Like we're in there with them. We're going over form. We're talking to them about like, okay, this is how you do a deadlift. This is how I want you to brace. This is what a brace means. Now we're going to practice it. Let's go apply it. Like let's actually lift heavy things while bracing. And when they're in the clinic with us, that can be incredibly empowering and amazing. And we love that, but sometimes that doesn't translate over into the next step. So great. WHAT TO DO AFTER FORMAL PT HAS ENDED? When I'm in the clinic and you're watching me do the things, I feel awesome and I feel like I can knock that out of the park, but I'm just not really sure what to do when I leave here. A lot of the times the way that I'll program HEPs is I'll do like our rehab EMOM style and I'll give them two or three workouts, if you will, and they cycle through them. But I think we all can agree that if you're just doing the same thing like three times in a week, so like A day, B day, C day, and do that for a few weeks, it can kind of start getting stale. And we kind of like crave that variety, right? Especially as people are starting to get a little bit more confident. So there's kind of this like gap between I'm done with PT, informal PT sessions. A lot of clinics are now coming out with like once a month or like once every other month kind of like check-in style appointments where you come in, you get a progression of your exercises, you get maybe some updated programming, and then you go off for another month or so on your own again. And those are really the two big things that we see. And then the third option is like, okay, you discharge and you're done. I'm here to talk today about another option, right? So when we have our person who's coming in and they've been coming to us for several weeks, they're feeling really great or maybe a couple months and they want to continue working out, but they want something a little bit more than once a month. and they don't really want to do like a full blown PT session. Like they just want to come in and work hard. We've got two options. We can create a program within ourselves and within our clinics, or we can get really, really good at helping find a home gym or a home space for them. If we're talking about the creating a program route, this is something we're about to roll out in my clinic. We're calling it like the bridge. Feel free to take that same concept. But the whole idea is when you're done with PT, quote unquote, like you're not in pain anymore, all your symptoms are gone. You're feeling really solid. You want to work out, but you're just not sure where to go and you're not sure if you feel like you can confidently take the things that we've done in our sessions. and apply them across the board, this is the spot for you. So we're doing it as a couple times a week and obviously this depends on what the capacity is within your clinics. We're rolling it out starting out two times a week and these are group HIIT style classes, where we're going to have a cardio component, we're going to have a strength component, we're going to take them through different movements, and so there will be a variety of movements that they can increase their comfort and their confidence in while they're in our classes. They're also building community here. They're meeting other people that are in a similar stage of life as they are. Not only are they maybe pregnant or postpartum just like they are, but they're people that are wanting to get into exercise and wanting a little bit more, but maybe haven't really known how to do that up until this point. So we're taking these people and we're bringing them together and then we're lifting heavy things together. So powerful. If you've ever set foot in a CrossFit gym or any type of like group fitness setting, you know how powerful these connections are that get built in under like shared suffering, if you will. This class, though, isn't meant to be forever. Like, its whole goal or the whole purpose is to build capacity, increase confidence, so that these people can go from working out a couple times a week, doing their PT exercises, and then coming to these bridge classes. But I want you getting to the point where you're like, let's send it five days a week, or whatever that looks like in your schedule. And truthfully, I want you to have more variety. Like I want you to get out and do different things and try new sports. BUILDING A NETWORK OF FITNESS PROFESSIONALS And so that's where option two comes in, where we as professionals need to have a really reliable, strong network of fitness providers. So we need to know not only the CrossFit gyms in our area, Because truthfully, not everybody vibes with CrossFit. That's OK. There's the whole phrase, like, CrossFit is for everybody, but it's not for everybody. So CrossFit gyms in your area, knowing those coaches, being comfortable with, like, if I send you there as a newbie, I know that you're going to be in really solid hands and be taken care of. But also the other types of workout spaces, too. So we're thinking things like F45 or burn boot camp, maybe having some options for, like, Pilates studios, where you've taken some classes there you understand how they teach the bracing piece of it and if it isn't maybe what the way that you've taught them you kind of have that conversation beforehand or you have an opportunity to educate those Pilates instructors on like hey this is how we do things from a pelvic floor PT side you've got somebody coming in that's postpartum or pregnant So this is kind of the messaging that we have. We also really love things like PureBar. We've got actually evidence for PureBar helping reduce stress urinary incontinence, not even full-blown pelvic floor PT, but just going to PureBar classes. So having a variety, knowing who these people are, knowing what these spaces are like, and knowing what the environment is like. It is powerful to be able to have your hands directly on give the people the thing that they need as far as improving their fitness and improving their form. But it's also powerful to then watch them take that and go off into the world and utilize it. And then you're seeing them maybe on Instagram months later, or you run into them at a workshop, and they've been going to these gym classes for like a year. And now maybe they're competing at different things that they're in CrossFit. And you can see this like spark ignite. And we have the opportunity to start that spark at our very first visit, our very first appointment when somebody comes waddling into our office because they're in so much pain, they can't even take a full length step because their pubic bone pain is so bad. We can be the ones that not only knock that pain out, because I know we can, but also create this bridge into a completely different life for this person. Increasing their capacity, increasing their confidence, helping them find community and support, and having that far reach outside of the realm of what our typical plan of care is. This is huge. This is a massive piece of the puzzle in the pelvic floor PT space. So if you are not somebody who has the ability or desire, totally understand, to create a group class within your own setting, whether it's in your clinic or your gym or whatever, start reaching out and start making those connections with providers, fitness providers in your area. Meet those gyms, take those classes, get out there and build that network. Have some cards on hand when your patients are talking about, hey, I just really think I'm ready to get out there and do more. Lay them all out. Here's everything we know about all the gyms in the area. Let's talk about all your options and help you find the perfect home for you. I hope that kind of lights a fire under you guys if you have an eval coming in this afternoon on the ways that you can really implement all of these strength training principles to change their lives and also to get out there and make some connections in your community. SUMMARY If you are looking to join any of our pelvic classes, we've got our live courses. We actually have a ton coming up in the next couple months. We've got one in February, February 3rd and 4th in Bellingham, Washington. And then we've got three rolling out in March. Our first two are gonna be March 2nd and 3rd in Newark, California, and March 9th and 10th in Bismarck, North Dakota. Our next online cohort comes on March 5th. If you're interested in that L1 online cohort, hop into it, because we are, man, we're getting full. So grab your spot before there's not one, because if so, you've gotta wait another nine weeks after that March 5th cohort to hop into the next one. I hope you guys have a great Monday morning. Absolutely crush it. Thanks for joining. 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.

Good Day and welcome to IAQ Radio+ episode 720 this week we welcome Jeff, Ryan and Gary Moore of ATI Restoration for a Fireside Chat about the Moore Family's Restoration Journey. It's a rags to riches story about the largest independent owned company in the industry. Gary Moore, founder and Chairman of ATI, is committed to ensuring that the ATI family legacy and entrepreneurial spirit continues to serve its employees and clients in meaningful ways. As an accomplished entrepreneur and industry pioneer, Gary followed his passion and established his own restoration and reconstruction services company in 1989 after working in the insurance restoration industry for 15 years. Business plan in hand, Gary met with several banks to secure a loan to fund his new venture. Unsuccessful yet undeterred, he took out an equity line of credit on his home, and ATI was born. As President and Chief Acquisitions Officer for ATI, Jeff Moore drives the company's growth and spearheads key initiatives that focus on the future of the organization. His current role involves overseeing mergers and acquisitions and ensuring ATI's continued expansion. In his current role, Jeff leverages his industry expertise to identify growth opportunities, forge strategic partnerships, and expand ATI's footprint across the United States. By focusing on acquisitions and fostering a culture of innovation, Jeff propels ATI forward, consistently exceeding industry expectations. With his extensive experience and deep understanding of the industry, Jeff has successfully led ATI's steady growth through more than 15 acquisitions, positioning the company for continued success. Ryan Moore is the President and Chief Growth Officer of ATI Restoration, where he has driven remarkable success and growth for the Company. Starting from the warehouse, Ryan's career journey exemplifies his dedication and deep understanding of the business. Under his leadership, ATI has become a premier workplace through his work in establishing the Company's values program, ATI CARES, and a culture of excellence. With a degree in Business and Communication from Arizona State University, Ryan holds over 45 trade licenses for the Company, ensuring compliance and building trust with clients. Ryan's commitment to continuous learning led to the creation of ATI University, which empowers employees to excel in their careers. Overseeing national sales, Ryan's strategic vision drives revenue and expands ATI's market presence.

In today's episode of the PT on ICE Daily Show, ICE Chief Executive Officer Jeff Moore discusses how friction opposes the momentum of starting a business but offers different solutions on how to overcome the initial friction encountered when starting.  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. JEFF MOORE All right, team, what is up? Welcome back to the PT on ICE Daily Show. My name is Dr. Jeff Moore, currently serving as the CEO of Ice, and always thrilled to be on the Daily Show, Mike, and always happy to be here on a Leadership Thursday that is a Gut Check Thursday. As always, let's start with the workout. It's gonna be a little bit rough. We got five rounds for time. It's just a simple couplet, but there's no rest to be found. The workout is five rounds for time, you are gonna do 30 calories for the gents, 25 calories for the gals on the rower, and then you're gonna do 15 burpees over that same rower. and you're simply going to, I say simply, but ouch, going to repeat that for five rounds, okay? So thinking a little bit about time domain as always, you got to think about maybe that row is going to take you what? Maybe up on two minutes and then a little bit over a minute for those burpees. So a great target would be 15 minutes. Try to keep it inside of 20. I think that would be a reasonable goal for the workout. It was a qualifier workout. It's gonna hurt. The heart rate's gonna be peaked. There's just nowhere to hide during those five rounds. So enjoy that. Make sure you're tagging Ice Physio. Make sure you hit Gut Check Thursday with that hashtag. It's so fun for us to be able to follow along with you. So enjoy that workout today. "IS IT WORTH IT?"Let's talk about friction in your business. Specifically, Let's talk about friction coefficients and how it relates to your business. So I get to talk to a lot of people who are in the process of starting up their companies, kind of in that early phase, okay? And many of them engage with me when they're in the harder part of that phase, right? Where they're starting to wonder, is this worth it? Like maybe the excitement of starting something new and all the fervor that comes along with that has legitimately turned into the daily grind and some real questions about, is this going to turn over? Is this going to catch some momentum? Is this gonna work? Are really starting to come to the forefront? Is the ROI there? The first thing I want to say is don't shame yourself. If you're in these shoes, don't shame yourself for asking that question. I think that this latest generation of business gurus, this mantra of everything is going to work as long as you keep going is the most ridiculous mantra of all time. That makes absolutely no sense. I can list off an innumerable people who have hit dead ends and pivoted and had drastic levels of success because they were willing to say, this route, the way I went about it, this approach, this area doesn't make as much sense. Now that I've seen around the corner a bit, that does not make sense. I'm going to pivot. I'm going to pull back. I'm going to redirect. And those people have a huge amount of success. So don't feel like It's not logical or you're less than because you're asking the question, is it gonna be worth it? It isn't always. That being said, if you've hit that spot and you've thought, is it worth it? Do I really wanna be in this space? And the answer is a hell yes. You say, I love serving these people. I know it's what I'm called to do. I know I bring some unique value to this area. I know that I've got something to share in this space. I wanna keep going. I want this to work. If that's you, then I want to share with you what I think is both an accurate and helpful analogy from physics that correlates beautifully with the business journey. OVERCOMING FRICTION So, in physics, If we can get you to think way back, right? When an object is stationary and you want to move it, to do so, you have to overcome static friction, right? And this is really hard. You know this because you've encountered it in plenty of places on a daily basis, maybe even in your workout. So if you're in the gym and you're trying to push a box, right, you're trying to do box pushes across the floor. You can all picture how agonizing that is. You know the worst part is getting the box started, right? It's that initial setting into motion. Once the box is sliding across the ground, I'm not saying it's easier, but it's certainly better, right? The same is true for plate pushes. Like when the 45 pound plate is on the ground and you're trying to push it across the floor, it's getting it started that's the absolute worst. Keeping it moving isn't nearly as hard. Mathematically, The reason for that is that the coefficient of static friction is larger than the coefficient of kinetic friction, right? When you're doing equations, the thing you multiply the forces against is larger when you're talking about static friction, things that are not yet in motion. Now, you don't have to, if you're not a math person, you don't need to gravitate towards that part of the conversation. It's best illustrated visually probably that, let's imagine that you had two hand saws, okay? We're talking about like the saw that you would cut a Christmas tree down with, right? Let's say this is one hand saw. These are all the teeth of the hand saw. This is the other hand saw, okay? So you're putting teeth to teeth on these two hand saws, yeah? Like this, okay. If they're sitting stationary, the one on the top, settles into the one at the bottom, right? And they've been sitting there for a while. And now you wanna move the top saw relative to the bottom saw. This is gonna be tough, right? Because you've gotta break all of that and get things moving. However, once the top saw is moving across the bottom saw, as long as there's decent speed here, there's not enough time for the top saw to sink and settle into the bottom saw. Thus, you kind of click across the top significantly easier than it was to break that original static bond. Once something is in motion, it's not settled into the other object. Keeping it in motion is not nearly as hard. Team getting a company going and keeping a company going is the exact same scenario. BUSINESS IS PHYSICSThe business rules follow the physical world. It's why we use all the same terminology all the time, right? How often do we say, oh, it's an uphill battle, right? I've got the wind at my back. We've got momentum, right? Momentum. We're talking physics all the time because the same mechanics happen. They're in different environments, but the same terminology, the same laws apply. Okay, so if what we're saying is, you gotta get some speed going, because that is significantly easier once built up to keep it going, well, what do we mean by the speed of our business? We gotta break that down, because that's where the action item lives for today. So, the speed of your business, getting the saw moving over the other saw, is best looked at as a compilation or an aggregate or a sum of the speed of all the different parts of your business. And this is where it can get actionable. First of all, appreciate that at the beginning, they all start at zero. They are settled into one another. Each part of your business has to break the static friction to get things into motion. For example, idea or concept generation, right? The hardest thing is thinking of that first original concept that's paradigm shifting. It's got static friction. It's hard to create that first great idea. But once you do it, once a unique and valuable concept has been created, building off of it seems effortless, right? Then it's like, once you've done that, you're like, oh, now we should do this, and now this opportunity becomes available. Once you get that first great original idea, Building off of it seems effortless. Team building has significant static friction. Think about it. People want to join a great culture. Well, you need a team to have a culture. So in the beginning, there is no culture, which is why there's so much static friction to team building. But once you get a couple great people on board, they naturally attract a bunch of other great people. Once the saw is moving, it's really easy to keep it moving. You just got to get it moving. It's all about finding those first couple people that will then attract other great people almost effortlessly. ATTRACTING BUSINESS IS OVERCOMING STATIC FRICTION Attracting consumers or customers has significant static friction. Think about when you walk by a restaurant and there's nobody in there. Do you want to be the first people to go in, especially if you're not familiar with the area? Absolutely not. But once there's a few people in there and they seem to be having a good time, other people just naturally come in. Why do you think happy hour is always so discounted, right? People want their restaurants to look full and bustling, so people will come in and actually have dinner. That's what draws them in. Consumers attracting them has significant static friction. When there's none, it's hard to get one. But once you have a few, it's easy to keep the saw blades moving. This is how I want you to think about your business. And your action item is to realize that you can get each of these going, or any of these going, and the beauty of getting them going is you can use them to nudge the other one. This is where you got to get clinical with it, right? So when you've got that box for that box push that you know is going to be tough to get moving, right? The best, the hack would be, could there be another moving box that you could slam into this one just to break that static friction? So then you could then push it from there once it's already in motion. The answer in business is yes. You could choose any of those boxes if you will. Idea generation, team building, attracting consumers. Those are all individual physics scenarios that you could focus on and get one of those in motion and I promise you it'll ram into the next one. If you break the static friction of team building and you get a couple of great people, I promise you, you'll get more great ideas, right? So that one box that's now moving will slam into the other box and you won't have to do quite so much work to break the static friction of the other one. So you can use success or momentum in any of these individual areas to nudge into the other one and make it easier to get it into motion. FINDING THE LOWEST BARRIER TO ENTRY IN BUSINESS TO BUILD MOMENTUM The key then is to figure out which one for your business has the lowest barrier of entry. Which box, if you will, can you get moving the easiest? Is it team building? Is it attracting consumers and getting social proof? What area in your business can you get moving so it can slam into the other boxes and get them moving for you without quite as heavy of a lift? That's what I want you to really think on today. Before I let you go though, there's a couple other thoughts that go along with this topic that I've got to share, especially because I think they give you a lot of hope. And the first one is, you only do this once, in most cases. There's exceptions, things happen. But in most cases, you only get it going, if you will. You only get the box moving or the saw blades rubbing. You only do it once. Once you've got momentum, once you've got speed, once you're only dealing with kinetic friction, you just keep it moving, right? You don't have to start and stop again. So realize that if you're feeling like, my gosh, this is a heavy lift, it gets lighter, because the boxes, once moving, are easier, but they also slam into each other, and overall, the momentum builds and it does get easier. You don't have to keep facing that your entire career. So if that's you and you're in that spot, hold onto that. And number two, to get even more exciting, to think a little bit bigger this morning, soon, it's not that one component of your business bumps into the next one. A couple of years down the road, what begins to happen is your businesses begin to bump into each other, right? If you're playing this game right, if you've got one business that's really humming, Oftentimes, that can help to create an offshoot business that doesn't have nearly as much labor required to break the bonds of static friction because you have so many resources from the first one. So pretty soon, what you realize in the game of business is that every time you create, it's a little bit less effort and a little bit more impact. If you're watching this and resonating, you're probably at the hardest part right now. But if you can think about how to use one box to bang into the other, you can get this thing moving. If you can realize that you only have to do it once, hopefully that can help you have the effort you need to build the speed. If you can really dream and realize that soon one of these lifts can make all the other ones happen almost for free, you can realize this game becomes, you never want to say effortless, but you do want to say a return on investment that you probably never imagined. when you were first starting off and maybe sitting right now in a bit of a tough trough looking at a big mountain, right? The top is brighter than you could ever imagine. So think a little bit about how the physics of friction in your business work together and think about the upside of that, not just how hard it is to get that damn box started to begin with. I hope that gives you a little bit of hope this morning on Leadership Thursday. Team, There are so many courses going on. I'm in Reno, Nevada right now. I'm doing all the logistics for Ice Sampler. Ice Sampler is sold out for this year. It's been sold out for a long time. Those of you coming to the event, this is going to be an absolute banger. Carson City is so beautiful. The gym is so beautiful. Carson City CrossFit. So if you're coming to Sampler, get excited for that. Other than that, we have some online courses that are almost sold out. Essential Foundations Level 1 only has a handful of seats left. We are more than half sold out for Pelvic Level 1, which starts in March. Point is, a lot of these online courses, especially, are selling out like crazy. So get on ptinex.com, jump in, grab what you need, get it done, break that static friction. Cheers, team. Have an awesome day. 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.  

Money, money, money! It's the thing that makes the world go 'round, yet it's also the source of stress, anxiety, and conflict for so many people. How should we think about money in a healthy way? What money beliefs are limiting us from reaching our full financial potential? in this episode of Money You Should Ask, recorded at FinCon 2023 in New Orleans, I roamed the halls of the nation's biggest personal finance conference, getting up close and personal with attendees and speakers to uncover their deepest money beliefs, biggest money mistakes, and most insightful money lessons learned. You'll discover practical tips and thought-provoking perspectives that will help you shift your relationship with money and ignite your financial potential. Get ready for an eye-opening and ear bending episode of Money You Should Ask that will shake up how you think about your money.  A huge thank you to all of the generous attendees who opened up and shared their stories, wins, failures and lessons learned when it comes to personal finances. In order: Clifton Corbin, Diedre Tshien, Lauren Cobello, Robert Croak, Austin Hankwitz, Amy Smith, Steve Chou, Brenton Harrison, Scott Carson, Sean Pan, Jeff Underwood, Joe Saul Sehy, Khadijha Stewart, Philip Taylor (aka PT), Nathan Barry, Lily Vittayarukskul, Jeff Moore, Gordon Firemark, Jay Narvaez, Zinnia Adams, Ericka Young, Paula Pant, Sebastian Guerra, Wendie Veloz & Steven Jarvis.  To learn more about this episode and our guests visit: https://go2.money/fincon23

Alan Fredendall // #LeadershipThursday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, ICE Chief Operating Office Alan Fredendall discusses how and why behind more carefully curating the digital & social media content you consume on the internet.   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. ALAN FREDENDALL Team, what's up? Welcome to the PT on ICE Daily Show. Happy Thursday morning. I hope your day's off to a great start. Glad to have you here on the PT on ICE Daily Show. My name is Alan. I'm happy to be your host. Currently, I have the pleasure of serving as the Chief Operating Officer here at ICE and a lead faculty member in our Fitness Athlete Division. Leadership Thursdays, we talk all things practice management, small business ownership, and general leadership tips for all of you out there who are leaders in your own way. Leadership Thursday also means it is Gut Check Thursday. This week's Gut Check Thursday couldn't be more challenging but also simpler than getting out there and hitting a 5k run or if you can't run hit a 5k row. Great aerobic test. As I get more into endurance running, I would argue I've been learning to hate 5Ks the most if it's a really uncomfortable distance to settle into kind of a longer, slower pace of, you know, you're setting a good pace on the first mile. Dang, I'm almost a third of the way done. Second mile, third mile. can be quite an aggressive distance. It's the most commonly programmed CrossFit workout if that surprises you. I've posted some benchmark times as far as percentiles for both the 5k row and the 5k run to kind of compare yourself to where I stack up against the general population. So have fun with that one. It's good to test that at least once a year and see how your 5k has changed, especially if it's a goal for you to get your aerobic, your longer energy system a little bit more efficient, and specifically to get better at maybe 5k runs. Some courses coming your way. Before we talk about these courses coming up before the end of the year, I want to challenge you that if you are in the market for an ice course, and you're able to purchase a course before the end of this year, you should do that. Wink, wink, wink, right? There might be a change being announced soon that would make you regret not purchasing now. So you'll see that maybe an announcement coming soon. courses before the end of the year we're almost done we have some courses this weekend but that's probably too late for you we'll be off next weekend for Thanksgiving and then we have just three weekends left of live courses in 2023 December 1st through the 3rd that weekend you can catch Paul up in Bellingham Washington for dry needling upper body You can catch Zach down at his home base at Onward Tennessee for cervical management. Christina will be up in Halifax, Nova Scotia, A for Pelvic Live. Ellison will be down in Tampa, Florida for dry needling lower body. Cody will be on the road for extremity management out in California in the Bay Area in Newark, California. Brian Melrose will be in Helena, Montana for lumbar management. and Julie Brower will be on the road in Candler, North Carolina for Older Adult Live. That's right outside of Asheville. The weekend of December 9th and 10th, we have Fitness Athlete Live. That's your last chance to catch that course this year. That'll be with Mitch Babcock out in Colorado Springs, Colorado. You can catch Extremity on the road again, this time with Lindsey Huey in Fort Collins, Colorado. And Older Adult Live, your last chance this year will be in Portland, Maine with Alex Germano. And then our very last course of the year, of course, we expect nothing less than a person of Paul's caliber to be the last person working this year. He will be in Salt Lake City for dry needling his upper body. That'll be the weekend of December 15th, 16th and 17th. That's a three-day course. So if you're in a state that needs a lot of hours like Washington, or Maryland, that'll be a chance to catch a three-day version of that course. A course is coming your way from us here at ICE. YOUR TRIBE DICTATES YOUR VIBE Okay, let's talk about today's topic. Your tribe dictates your vibe. You've often maybe heard the other way around. Your vibe attracts your tribe. How you carry yourself, your personality, your values, kind of attract the people around you that are maybe in your friend group, your colleagues at work, that sort of thing. I want to talk about it from the other angle your tribe dictates your vibe, of the people you choose to follow, whether they're actual in-person people or specifically today's topic, of the people you follow on social media can really dictate not only how you feel about yourself, care yourself, but of what you might begin to spend your time and money on for the worse or for the better. So I really, really, really want to stress that social media, I think, is destroying our society for the worse. Certainly, it has value in things like this and sharing information and education. from one person to a large group of people. But I think overall, we can begin to follow people who appear really relevant to our lives. But actually, if we do a really deep dive, we understand they actually have very little in common with us. And then ultimately, at the end of the day, we're in charge of who we follow. Many of us are not on social media against our will. And so that the emails you subscribe to, the social media accounts you follow, all of this digital content that you consume can have positive or negative effects on you. And to really stress, if you take nothing else away from this episode, to be really diligent in the streams and feeds that you begin to curate as you begin to follow email newsletters, social media accounts, and the like. THE PITFALLS OF THE INTERNET: TALKING TOUGH & SOUNDING SMART The first point I want to make today is The pitfall of the internet, as it's always been since its inception of consumer-based communication, is that it's super easy to talk tough and sound smart on social media. We live in a very impatient, rapid-fire, fire-and-forget type of world now. You may not know, but certainly, if you work at all in customer service, you experience, that the average expected response time to an email or social media message is now 10 minutes or less by the average customer. That's a study from Forbes from this year in 2023. I could say a whole bunch of crazy stuff right now on this podcast. I could say it in a social media post and I would have almost no side effects come to me because our society now is so rapid-fire, so fast, so consumable that you would consume this. Maybe what I'd say you would resonate with, maybe it would make you upset. It doesn't matter because you will forget about it in three minutes when you scroll on to the next piece of content. on your social media feed or the next podcast episode that you queue up. The only regulation on what we say is from you all, from the consumers. What's noticeable on social media is that the people who tend to be the most aggressive and make the largest blanket statements are often those who do so without any sort of evidence or support. They're also not the people who tend to engage in the stuff that they create, right? They're very aggressive. They fire something out there. They know it might make you upset. You might actually make a comment. And that's kind of their goal, right? That drives their engagement up. That shows their post to more people. Maybe it further upsets people. It gets more comments. And what we need to realize is that cycle is kind of what fuels those people to have large follower bases, to be able to advertise different things to you. Hashtag, you know, ice barrel, try out your hashtag toe spacers, right? Those people are trying to strike a nerve on purpose to get more engagement, more followers, more followers, engagement equals I can make more money selling sponsored things to you. So we need to be aware of that trap that is out there for us on social media and be aware of the pitfall of the internet and social media itself of this very consumable temporary transient content and recognize if you're falling for that trap of if you are getting upset and making comment or if you're following people who make kind of outlandish, unsupported statements. If that makes you upset, again, the whole theme of this episode is why are you following accounts like that. YOU HAVE NOTHING IN COMMON WITH THE MAJORITY OF PEOPLE YOU FOLLOW The second point I want to make of why are you following accounts like that is that you have nothing in common with the majority of people that you follow and obtain content from. You're making less money than you want to. You're working more hours than you want to. You're not feeling as physically well or as fit as you want to. You're not happy with how your body looks. Maybe you're not happy with how your marriage is going how you're raising your kids how your sex life is going, and how your postpartum recovery is going. You name it, you're being told that whatever is wrong with you, X is Y with you. Y is the solution, right? You are not having a good life because you don't wake up at 4 a.m. and do a 6-hour morning routine. You're not having a good life because you don't wake up and do a gratitude journal, use toe spacers, do yoga, meditate, do a cold plunge, or a sauna, or any of these other things that you're told are the difference between this apparently very successful person and you. But often when you do your research, when you look behind who are these social media influencers, you're often being sold solutions by people that are usually millionaires and who are usually millionaires, not because of the stuff they're telling you that they do, but because they're convincing people like you to buy the stuff that they're selling. And that's how either they are making their money or they're maintaining the level of income that they already have, right? Or maybe they started out in life and mom and dad footed the bill for college and for grad school and for their first house and they don't have a lot of debt and so they have a lot of extra time, they don't need to work as much to become this social media influencer and begin to sell you supplements and Toast Facers and all this kind of stuff. And the more you listen to those folks about what's wrong with you is that you're not consuming this stuff, the more money they actually make and the bigger that asymmetry actually comes. What's not said is that a lot of those folks have made their money by living what they're doing right now, which is a very imbalanced life of working more than you want to in order to try to pull yourself up the socioeconomic ladder. You're told that you're burned out or whatever and really the cause of their success is doing what you're doing right now and eventually getting to the point where their success comes to a level where they no longer need to work as much and maybe now they have more time to show you a video of them working out on the beach in Bali. And by the way, use my promo code Stephen10 for 10% off, whatever. And again, the more you consume that, the richer that person becomes. But at the end of the day, you do not have a lot in common with that person, yet you are trying to model your life after them, even though that's not how they currently live their life. And maybe that's not how they ever lived your life. These people are happy, healthy, and fit because they don't have to go to work anymore. Or maybe they never had to go to work. They can wake up and do their morning routine and go surfing because they're able to afford a full-time nanny to take care of their kids. Or maybe they don't even have kids and they get 12 hours of sleep because they have a night nurse. Or again, maybe they don't even have kids. And you get my point that they are living a very different life than you and maybe they never lived the life that you did. So it doesn't make sense for you to spend a lot of your time consuming their content and buying the stuff they're selling to somehow try to fix your life. Follow people who represent you, who represent your values, who are honest about where they made their money or how they got to the level they are at. I tend to follow people who are very upfront about how they got where they're at by pulling themselves up from being very, very, very, very poor, working a ton, and pulling themselves up the socioeconomic ladder. Is that ideal? No, but sometimes that is life, as true as it can be. And I resonate a lot more with those people who say like, look like this was the way that worked for me. It may not work for you. And I appreciate those people who are honest that look, it was a lot of years of 100-hour work weeks, working multiple jobs to pay off my debt to afford a house, to raise kids, and kind of get to where I'm at now. And I really, really appreciate that transparency, especially more as life goes on. So, what can we do about this of recognizing that Social media is meant to be fire and forget, instantaneous, consumable? It's meant to sell you things. It's meant to show people who maybe have nothing in common with you that you want to see yourself become only if you buy these products. If that's the way it's designed, what is the solution? CUT THE CORD The solution is to cut that cord, right? Take a serious examination of the accounts you're following, of the newsletters you subscribe to, of in general the content you consume digitally via social media, email, whatever, and stop following stuff from people who make it seem like the only reason you're not obtaining the fulfillment you want is that you aren't buying enough of the stuff that they're selling. Stop following accounts that tend to speak on best practices, but speak so dogmatically. Manual therapy sucks, it has no value. On the other side of the continuum, manual therapy cures diabetes, right? Stop following that stuff if you don't actually believe that stuff. Some of us follow that stuff just to watch the comments and watch people argue, or maybe you're even that person, spending your time that could be spent better elsewhere, arguing with people on the internet. I'll be very honest, I used to be that person. If you knew me a decade ago, I was that person. I was that person yelling at people on Twitter. and Instagram and all the other social media platforms, and I've talked about this before, one of the biggest shifts in my life was meeting Jeff Moore, our CEO, who one day sent me a screenshot of all these comments I was making, all this time I was spending on the internet, on social media, and just said, is this the best use of your time to advance the field of physical therapy? And of course, if you really ask yourself that question, then the answer truly is no. So stop following that stuff. Stop following those accounts. Stop following people who tell you that the way you're treating patients is wrong. If they are people who maybe don't currently treat patients or have not treated patients in a long time, five years, 10 years, 20 years, or maybe people who have never treated a patient ever, right, that person who went from PT school, maybe right to a Ph.D., or a consulting job, or to work for an insurance company as an adjuster, and has no actual real-world experience. Why are you following content like that? Knock that off. Follow people who are in the clinic every day, who are trying to make it all happen, who are trying to blend manual therapy, patient expectations and beliefs, and fitness-forward lifestyle, getting people loaded, getting people addressing their sleep and diet. Follow people who put out content like that, not content that maybe just makes you upset at the end of the day. Follow accounts that make your life easier. Follow accounts that give you resources that you can provide your patients so you don't have to work as much making that stuff yourself, right? Follow, obviously, I'm biased. I can't not have any bias here. Follow us, right? Go to PTonICE.com, click the resources tab, and look at literally an endless list of ebooks, workshops, of patient resources already created for you to make your job in the clinic easier so that hopefully you don't have to spend as much time making the money that you're currently doing. You don't have to work as hard doing it. Follow people in a manner that sees you working less and making more and not just buying more gadgets and $10,000 mentorship programs. THERE'S NOTHING WRONG WITH YOU And I think finally, what I want you to resonate from today's episode is to recognize deep down that there's nothing wrong with you. If you work more than you want to and get paid less than you think you should, you are not damaged. You are a normal American, right? 77% of Americans live paycheck to paycheck. Half of all Americans work two or more jobs. It is totally common to work more than you want to, to try to get ahead. Again, some of us are trying to pull ourselves up a huge deficit, right? We're trying to close a large asymmetry. We're trying to go from the poor person who grew up in a trailer park to maybe the first person in your family to finish middle school or high school or undergrad and grad school and be the first person to own your own home and be the first person to maybe have a retirement account and actually be able to think about retiring. We're trying to pull ourselves up multiple rungs. And I think for most of us, we believe that working a bunch is not how we get there. And I think when, again, we follow people who are more transparent in how they have their success. You'll find that's how they also got there, right? They didn't toe space and cold plunge their way from the trailer park to owning their own home starting a family paying off their debt and being comfortable in retirement. So recognize that there's nothing wrong with you. CHALLENGE YOURSELF TO CURATE BETTER CONTENT Okay, challenge you. If you look at my social media account, if you look at my Instagram, you'll see I have tens of thousands of followers. I don't know who most of those people are or why they follow me. Yet, look at that ratio. When you look at the ratio of people who follow to followers, it is my belief that you should only follow people that you want to see content from. What you'll see when you look at my account is that I only follow a couple hundred people, right? I follow close friends and family members. and people that I want to see content from. Again, my goal with social media is to curate a feed that makes my life easier with different tips and tricks about physical therapy, coaching, leadership, business, about all the different spheres I'm involved in. That's how I curate my social media feed. I don't follow people back who follow me if I don't think they post any content, that's certainly possible, or content directly relevant to me. And I think it's okay if you have to unfollow those people. Some people may think that means they follow you. Well, hopefully, they follow me because they find value in what I post and I think it's okay to not reciprocate if you don't feel the same way. I'm sure the people who follow me that I don't follow are nice upstanding people who treat their spouses and their children well hold the door for people to pay their taxes on time and leave a nice tip at the restaurant for the waitstaff, right? Not saying there's anything wrong with them. It's just I don't believe that the content they create is beneficial to me, and otherwise, it just becomes an endless blob of noise that maybe as you start to follow and compare yourselves to, you start to feel bad about yourself. So take a step back. Why am I following these people? Is it beneficial to me? It's okay to unfollow people, I promise you. I'm giving you permission, I'm giving you the blessing to do so. Cut that cord, recognize that you don't have as much in common with most of the people that you follow, as you think you do, and recognize that a lot of those people are relying on showing you this grandiose awesome life in order to sell you stuff so that they can continue to live that awesome life of working out on the beach in the Caribbean and living in their mansion in Costa Rica and using dye-free detergent and eating organ meat and all the stuff you're told is the reason that you're not doing as well as you need to. Consider, that your tribe dictates your vibe. Who you follow can really make your day or ruin your day. It can make you feel bad about yourself. You could get caught comparing yourself. So just knock it off. Cut that cord. Hope you have a fantastic Thursday. Have fun with Gut Check Thursday. We're going to be at a live course this weekend. Enjoy yourselves. I'll be back here on Thanksgiving Day. So I'll see you all on Thanksgiving Day. If you won't be joining us, I hope you have a wonderful Thanksgiving. Have a great Thursday. Have a great weekend. Bye, everybody. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.  

Dr. Jeff Moore // #LeadershipThursday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, ICE CEO Jeff Moore discusses the idea that moving into a leadership role requires a shift in mindset from focusing on individual accomplishments and deliverables to prioritizing the building of culture and guiding the team. Jeff emphasizes that one of the hardest things about transitioning into a leadership role is separating your sense of worth from the tangible outcomes of projects. Instead, leaders need to concentrate on steering the team in the right direction and creating an environment that fosters productivity and engagement. Jeff describes that a true leader's job is not to solve every problem or complete every project themselves. Instead, their role is to provide guidance and support to the team, ensuring that they stay on track and between the "buoys." This means constantly having touch points to build culture and considering where the team should go, as well as where they should not go. Jeff also highlights the importance of reframing what being productive looks like in a leadership role. It suggests that leaders should focus their energy on three main areas: culture building, organizing and strategizing, and problem-solving. Culture building is described as the leader's top priority, as they need to create an environment that people want to be a part of. Organizing and strategizing involves evaluating when to intervene and when to let capable team members come to their own conclusions. And problem-solving requires knowing when to provide guidance, but not getting caught up in completing the task oneself. Overall, Jeff suggests that moving into a leadership role requires a shift in mindset from individual achievement to team success. 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 JEFF MOORE All right team, what's up? Welcome to the PT on Ice Daily Show. My name is Dr. Jeff Moore, currently serving as a CEO of ICE, and always thrilled to be here on Leadership Thursday, which is always Gut Check Thursday. Let's get right to brass tacks. What's the workout this week? It is ascending squats, but of decreasing challenge, and then the reverse for our gymnastics. So it's gonna look like this, kind of an interesting workout. So it is for time, You're gonna open up with nine overhead squats. That barbell prescribed weight's gonna be 135, 95, so scale accordingly. Paired with 21 pull-ups. Then you're gonna increase your squat number 15, but moving to front squat, same barbell weight. gymnastics going to 15 chest-to-bars and then 21 back squats and then 9 muscle-ups. So you got kind of this 9, 15, 21 climbing a number of a decreasing complexity on the squats and then the opposite 21, 15, 9 as your gymnastics get more challenging. So should be a very interesting workout. Just one time through that for time. All right, regarding upcoming courses, it is all about the certifications this week. So if you have not heard, we launched our entire brand new suite of new and renovated certifications over on ice. So we've got our brand new pelvic certification. We've got our dry needling certification now. The group has launched that advanced course. We have our brand new ortho certification, the endurance athlete certification. on top of a tremendous amount of renovation and facelift on all the other ones. So if you have not browsed our new certification offerings, go to PTOnIce.com. That certification tab is right on the top. Jump in there and look at all those different search. Remember, One thing that separates ice certs from everybody else is live testing is involved in every single one of them. So regardless of which one of those you jump into, there is live testing. We believe that is really what holds the standard. So just know that you will be examined in person to make sure you indeed have the goods before we throw that stamp of approval on your work. So that is what's basically, involving all of our worlds this week is getting all the certifications launched. Hope those really improve not only your skill set next year, but your ability to market effectively that you're a specialist in these areas and really take over your geography and serve your community. So enjoy those certifications, check them out. All right, it is Leadership Thursday. BREAKING UP WITH DELIVERABLES We are talking about breaking up with deliverables. A challenging but necessary conversation. Challenging because… There's very few things, especially for really high performers, that is more satisfying than completing a really big project, right? Something you've been working on and chipping away on, very few things feel better than putting a bow on something like that, crossing that off that to-do list that you've been looking at for months as you kind of worked your way through the project, not to mention just delivering a beautiful deliverable. Nothing feels better. The bigger leader you become, the better leader you become, the less you will get to experience this. If your leadership trajectory really takes off, you will literally never, again, get to experience that wonderful feeling of wrapping up a project. The reason for this is it almost never makes sense For you to finish anything, right? Once your job is getting the train on the tracks, your job is approving the project. Your job is saying, you know what? That makes sense to put resources towards that. Considering all the other options available, your job. is figuring out the right combination of people that will maximally effectively take over that job and really bring it to completion as fast as possible and be able to scale it. So is it the right gig? Who are the right people to do it? What resources do they need? How can I collect those in the most cost and time effective manner? Those are your jobs. But once that train is on the tracks, proper delegation should always bring it to the finish line. It would be very rare, very rare, that a task needs your personal involvement end to end. Just because you want it to, doesn't mean it does. In almost every case, your job is going to be saying, yep, that's the right thing that we should do with our resources. These are the right people to make that happen. And here are all the resources they need to be freed up and made available so they can execute properly. Those are all of your jobs. The actual doing of it, the execution, the part you want to do, right? Cause it just, again, feel so wonderful to be a part of creating and finishing something like that is something you should almost always hold yourself back from. Now, I know what you're saying. You're saying, but that's what makes it feel like I've accomplished something. Like getting something to the finish line is what feels rewarding. You have got to reframe if you're truly moving into a leadership role. Like you're going to be organizing and strategizing a number of people that are in your circle and your job is kind of commander in chief. If you're heading in that space in whatever your division might be, you've got to reframe what being productive looks and feels like. You gotta reframe this, and you gotta think about three big buckets where your energy is gonna be going, and none of them are gonna be about bringing a project to execution. CULTURE BUILDING The first one is culture building. Your number one job, right, is that glue that keeps everything together, that makes the energy of the organization feel like something that people who are a part of it want to be a part of. Number one is culture building. In every single touchpoint, with another individual in the group is culture building. It doesn't need to accomplish anything, right? These touch points, these little moments of interaction don't need to finish anything. They don't need to accomplish anything. What they accomplish is you understanding each other just a little bit better. What they accomplish is you seeing where the other person's coming from, is a little bit of trust building because you had that moment of connection. They accomplish that. No, it's not finishing anything. This is an infinite game. Culture never has an end point. You never win culture, right? You nurture culture. And it's with every single touch point that you do so. So one of your biggest buckets as a leader is gonna be culture building. And culture building has no conclusion. So you'll never get that feeling of finishing. INNOVATING Number two, energy bucket number two is innovation. Time spent pondering solutions is one of your most important jobs. And here's the rub, here's the really uncomfortable part. 90% of your time will be considering solutions that you don't move forward with. You certainly can't finish anything you never start. And 90% of your time is going to be exploring options that don't wind up being the right call. But that is a critical part of your job. There's no way that you can rule down where your resources should go if you don't consider all the options and say no to most of them. So because so much of your time is going to be spent evaluating possibilities that literally never get off the ground because you decide they shouldn't, obviously you won't have any sense of completion there. But yet, if you're not in that role, you will never allocate your resources properly in a way that allows the company to move forward efficiently. Innovation, and namely deciding what shouldn't get off the ground, is a huge spend of your time and has no completion. PROBLEM SOLVING And finally, number three is problem solving. One of your key roles as a leader is evaluating when should you intervene. Oftentimes, my number one recommendation there is to restrain yourself, right? To let very capable, high-performing people come to their own conclusions, but be evaluating it from a 30,000 foot view. But you do need to sometimes say, you know what? I'm gonna jump in here. A little bit of restraint is always a good thing, right? But knowing when to jump in is very important. Now, here's the key. When you jump in, you jump in with a couple pieces of information or a little bit of guidance, again, to get the train back on the tracks. What you don't do is follow the train. Right, that's falling right back into that temptation of wanting to get something to completion. That's not your job anymore. Your job is, ooh, this isn't going in the right direction. Watch it, study it, think about it, find your moment, and then jump in and say, team, can I ask that we look at one thing a little bit differently? What are your thoughts here? Okay, now you jump in, you change the energy of that environment, of that project, you get people chiming in as a group, you decide, Oh, this is the one change we've got to make. And then very importantly, you get back out because you've got to go do that somewhere else. If you stay on that ride, you're not getting back over and solving that same problem in seven other spots. The people can handle it. Your job is just to steer, just to get them back in between the buoys and then get out of there. One of the hardest things about truly moving into a leadership role is you've got to divorce your sense of perceived worth from deliverables that you're a part of. Your energy needs to be in constantly having touch points to build culture. Your energy needs to be spent thinking about where should we go and maybe more importantly, where should we not go? Your energy needs to be in and out of different projects when you see an area that your experience or wisdom can nudge people in the right direction and get their momentum built back up before you remove your energy from the scenario. These things never feel done because they never are done. None of those buckets even move closer to a perceived finish line. You just keep nurturing and spinning those plates at all times and never ride any of them to the end. DIVORCE YOURSELF FROM DELIVERABLES TO IMPROVE THE EFFICIENCY OF YOUR BUSINESS You have to divorce yourself from deliverables, otherwise you're never going to take the true position of an effective leader. Give that some thought. I know you're high performers. I know you love finishing projects. I know for many, many, many years that has filled your cup, but it's killing your team. Try to reframe it. Let me know if you have any thoughts. PTOnIce.com. Thanks for being your team. We'll see you next week. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning 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. Mark Gallant // #ClinicalTuesday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Extremity Division Leader Mark Gallant emphasizes the importance of having a well-coached and appropriately dosed set of exercises for patients. He stresses that these exercises should be ones that the therapist is extremely familiar with and knows exactly how to prescribe. By having a clear understanding of these exercises, the therapist can confidently explain to the patient the objective criteria and expectations for progression. Mark acknowledges that sometimes our egos can hinder us, leading us to believe that we can come up with a better plan for each individual patient based on the information we have at that moment. However, he argues that research has shown that the human brain is a sensitive instrument that responds quickly to changes. Therefore, having a preset plan of exercises allows for consistency and efficiency in treatment. Additionally, Marj suggests that having a set of exercises that can be progressed by increasing work volume, range of motion, load, or speed, while keeping the exercises relatively similar, can be beneficial. This approach allows the patient to become more efficient with the exercises and increases their buy-in. It also reduces stress for the physical therapist and ensures that enough time is given for each intervention to make a meaningful impact. Take a listen or check out the episode transcription below. If you're looking to learn more about our Extremity 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 - MARK GALLANT What's up PT on ice crew we got Instagram here YouTube over here. I'm Dr. Mark Lantz coming at you here on Clinical Tuesday, lead faculty in the ice extremity management division, alongside Lindsey Hughey, Eric Chaconas, and Cody Gingerich. Happy to be here this Tuesday. Before we get rolling, a couple of housekeeping things. We've got a few more courses for the extremity division coming up here for 2023. I'll be in Woodstock, Georgia, second weekend of November. and then Cody and Lindsey each have opportunities early December, so check that out on the ICE website. More importantly, if you've been looking to get a certification through ICE and the overall ICE cert seemed like a bit much to chew off right now at this stage of your career, we are happy to announce that we've launched the Ortho cert. If you take the two spine management courses, cervical management, lumbar management, the extremity management course and total spine thrust manipulation, take a short test at the end of whichever the last of those four that you take, you can become ortho certified. So that is officially launched and on the website. So definitely head over there and check that out and we hope to see you on the road soon. 01:39 - INDIVIDUALIZED CARE So today what I want to talk about is individualized care. your ego is killing our profession. And what I mean by that, or what we mean by that, is that when we go around the country and we mentor folks, or we help out and talk through cases with individuals, watch people treat, one thing that we're starting to see as a trend is that folks are jumping around quite a bit in their plan of care. So that patient comes in for one visit, they're given a certain set of manual therapy techniques, a certain grouping of exercises at a specific dosage, and then each subsequent visit that person comes in, the plan dramatically changes. They're given a new set of exercises, there's different manual therapy techniques done. They are getting a completely unique plan of care each visit. And what we're recommending is that there needs to be a plan, that for any given pathology, you have a plan of what this is typically gonna go like. With that individualized care of jumping around from place to place, visit to visit, what we believe is that it is a reaction to old school physical therapy, what we like to call physical therapy 1.0, where a person would walk into a clinic, they would be put on a new step or a bike for five to 10 minutes, the physical therapist would wave the ultrasound wand on wherever their area of pain is, and then they would be given an exercise sheet. And it would be very specific to, here is the foot and ankle exercise sheet. Doesn't matter what you have going on, here is your foot and ankle exercise sheet. Here's our shoulder sheet. And if you were lucky, you would have a tech that would take you through that. If you were not one of the lucky few, you would either be given that to go run through in the clinic on your own, or even worse, just sent home with this exercise sheet. 04:17 - INDIVIDUALIZED PLANS OF CARE So we swung the pendulum hard to everyone gets an individualized plan depending on what they show up with the clinic that day. So if their pain has changed, if what the exercise is looking has changed, then we ditch the entire plan and then we're going to go to this very individualized thing each visit. The problem with this is it's hard for the patient to buy in if everything changes each visit. They're not sure what the plan is. Humans love to have a target in a bullseye. So if that person knows like, ooh, here's the plan that we laid out during the first couple visits. And here's where I am along that plan. It allows them to be more bought in. They're going to comply with the plan more. They're going to be more adherent to the plan because they can see the target they're shooting for. And they can very clearly see where they currently sit on that plan. In addition to that, if we're jumping from thing to thing all the time, we're actually likely not giving any one intervention enough time to do its thing. So we know with exercise, the research is fairly clear now that exercise for musculoskeletal pain is the most bang for your buck intervention from a cost perspective and from a getting the job done perspective. It takes time. If we're jumping from thing to thing every visit, then we're likely not giving those interventions enough time to actually make changes. And in addition, it takes people time to get used to doing an exercise. So if we switch to exercise each visit, we're not allowing that person to become efficient with that exercise. And then finally for us, if we're seeing anywhere, depending on what type of setting you're in, between six and 20 individuals a day, creating six to 20 unique plans of care. Every single visit for every single person becomes wildly exhausting. I've lived it. Everything that I'm saying here, I have personally done for many years. That type of physical therapy becomes exhausting. And it's likely part of the reason why we have such a high burnout rate in our profession. If the expectation is a unique individualized plan of care for every individual, every day. That becomes a lot for any one given physical therapist. Whereas if you know, for X pathology, for my rotator cuff related shoulder pain folks, I know that I can modulate their pain, decrease their symptoms with these three to four manual therapy techniques. I know that my bread and butter early on exercises are gonna be these four to five exercises that I can coach extremely well, that I know exactly how I want to dose, and that I have an expectation of when the person can do these, what the next group of exercises that I'm gonna move on to, and I can clearly explain the objective criteria to the patient of what that's gonna be. Now, our egos often get in the way of this, because many of us, myself included, I'm speaking to myself more than anyone, believe that for any given person that comes in, that we're going to be able to give them a better plan based on the information that's coming that day than the preset plan before that may seem more cookie cutter that we're afraid of. What we know about the human brain, now having a lot of research over the years, it is a very sensitive instrument and it's going to respond quickly and rapidly to what's changing in the moment. So therefore your plan or what that person is coming in can be highly deviated by anything that's happened to you that morning or that day. If you had a stressful interaction with your boss, if the kids were having a hard time getting ready for school, if someone called you right before the patient came in and gave you some bad news, that is all going to very dramatically sway what happens in that session and how you go about what you're going to do in that session. Even more dramatically, our patients are in pain. which means that their nervous systems are gonna be all over the place. And so their drama and their brains are gonna be very sensitive and that is also gonna shape those interactions. So we're leaving a lot of interpretation to that interaction. Whereas if we have a plan that we know if this is looking like this, I'm gonna go this way, if this is looking like this, this is how I go based on the plan for this pathology, we are far less likely to succumb to the sways of any given day. When we look at other professions, professions that have higher stakes than physical therapy typically, we see that they use systems and plans to deviate from those in the moment sways. Pilots are the easiest example to talk about. When you have a pilot, it doesn't matter if that pilot is on his second day of the job or if they have 36 years of experience. That pilot has a checklist for almost everything that could possibly happen on a plane. If the weather looks like this, this is our checklist of what we're going to do. If the wind changes this way before we land, this is what we're going to do. And that pilot follows the checklist, not what they're feeling in the moment based on their experience. So much so to the point where there's a second person there, the co-pilot. whose primary job is literally to say, hey, why aren't you following the checklist? We got to go back to the checklist. We know this works. 99.9% of the time go to the checklist. 09:30 - RECIPE REPETITION  For those of you who have been following ICE for a long time, our CEO, Jeff Moore, spent a lot of time working in restaurants and kitchens. And if you were lucky enough to take a class with Jeff or got to spend some time with Jeff, we used to always get all these stories about his time in the kitchen. And a lot of those things I still think about to this day, the stories he told as far as patient care. And one of the main ones that stuck with me was a chef that he worked with, who now has a Michelin star, by the way, told Jeff that for any given recipe, you need to cook this 1,000 times before you start to deviate from the plan. Doesn't matter if you're the greatest chef in the world, you don't add salt, you don't add fat, you don't add any flavor profiles until you have cooked that recipe 1,000 times. Because that 1,000 times is going to allow you to see how this thing really responds, what could possibly go wrong, what could happen, how you really get the full breath by committing that much. That's the same with our plan of care. There is no way that we can confidently say to the human in front of us, for most people what we see, if you follow this plan, this is where we get to. If we're changing the plan all the time, we never get to experience that to show the patient and to say confidently. So we want to have the plan for any given pathology that we're going to give most people. Another example, is the 12-step plan in recovery. I am not in recovery myself, so if I'm butchering this, I apologize to anyone who is in recovery. But with the 12-step program, it's 12 steps. You run the steps, and people who have addictions all over the country have been using this 12-step program to help deal with their said addiction. And when you look at that plan, it's a simple, not easy plan, and you follow those steps to a T. Again, same as the co-pilot, they have a mentor or a sponsor who helps them work those steps. If that person is struggling or deviating, what that mentor's job is to do is say, hey, make sure you go back and are following these steps and are not deviating. So lots of examples of really solid professions and organizations that use a plan to get the job done. 12:07 - STICK WITH THE PLAN: MODULATE PAIN, INTRODUCE MOVEMENT, PROGRESS MOVEMENT So what should the plan look like for us, for any given patient? When you have a pathology, rotator cuff related shoulder pain, plantar fasciitis, things that you need to know. Early on, what are the manual therapy techniques or exercises that you know can modulate pain and decrease symptoms for most people? Have a few of these that you know you can do effectively and work for most folks as part of your plan. Then have your bread and butter exercises. What are the exercises that are gonna be the main, let me back up for a second. Before you have your bread and butter exercises, what are the few exercises that you're gonna have that are for that irritable patient that you know before they can tolerate a lot of load that we're gonna give them? So your pain modulation techniques, your lower level exercises that are not gonna overstress the tissue while we're trying to calm this down. Part two, what are your bread and butter exercises? What are the handful of exercises that you know tend to work best for any given pathology that you can coach really well, that you can dose really well, that you can manage workload really well? And then finally, what is the criteria that that person needs to demonstrate to move on to their more advanced exercises? And then a final piece to have in your mind is what does this look like If the person does have a flare up or relapse, how do we coach them? What point in the program do they go back to if they are indeed not ready to progress? So again, what are the things that can modulate pain and that can calm symptoms down or exercises that are not going to require a lot of stress to the tissue while things are calming down? What are your bread and butter exercises for any given pathology? What are the most common things that you're going to give in most people's plans? And then finally, what are you going to have as your criteria to progress these people on and having a game plan if they do flare up or regress? What this is going to allow, it's going to allow the person to go, ooh, I know exactly where I am on Mark's plan of care at this time and where I need to go to take the steps to move forward. It's also going to allow you to not have to switch exercises so much. You're not going to have to get overly creative with your exercise prescription. And by doing this, what you're typically going to be changing is same exercises, but you're going to be increasing the work volume. You're going to be increasing the range of motion. You're going to increase the load on the exercise and you're going to increase the speed on the exercise while keeping the exercises relatively similar or the same so that the person can become more efficient with that exercise. It's going to allow the patient to buy in way more. It's going to take our stress way down as a physical therapist. And if there is that small percentage of folks who do indeed need a more nuanced program because they are actually not responding over time, or they're having a lot of trouble adhering to the plan, it's only a small percentage of the folks, which takes a lot off of the mental stress for us as physical therapists. Love to hear what you all think about this in the chat. Definitely hit us up. Love to see you on the road in Woodstock, Georgia next month. Cody and Lindsey have courses early December. Check out the ortho cert on the website. Have a great day in clinic today. Hope you all crush it. See you soon. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Dr. Paul Killoren // #LeadershipThursday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Dry Needling division leader Paul Killoren emphasizes the importance of using e-stim in conjunction with dry needling. This combination provides validation and helps the practitioner determine if the needle is in the muscle. Furthermore, using e-stim with needles can reduce post-treatment soreness, making it more approachable for patients. Paul also highlights research supporting the use of e-stim in various treatment goals, such as pain modulation, neuromuscular changes, tissue nourishment, nervous system accommodation, and somatosensory reorganization. Paul always recommends using e-stim after inserting the needle, as it offers multiple benefits for both the practitioner and the patient. Take a listen to the podcast episode or read the full transcription below. If you're looking to learn more about courses designed to start your own practice, check out our Brick by Brick practice management course or our online physical therapy courses, check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 PAUL KILLOREN Good morning. PT on Ice daily show streaming worldwide on Instagram and YouTube. I'm your host for the day, Paul Killoren, of the dry needling division for ice, and I'm hijacking the mic. Normally on Thursday for the PT on ICE Daily Show, we have practice management, we have leadership stuff, really inspiring messages from Jeff Moore, from Alan himself. I'm hijacking the mic and calling this Technique Thursday. We're talking needles on a Thursday. dry needling division. Before I dive in, some pretty exciting updates. Our very first advanced dry needling course is going down January 12th to 14th. And we actually have a registration page up and live that has a little work to do. But the course is going to be ready and the very first advanced dry needling course for ice will be in Washington in Bellingham in January. And then having the upper, lower, and advanced course that will form the ICE dry needling certification. So again, our division's not even a year old. We have had our upper and lower dry needling courses running across the country for almost 12 months. And this will be that final piece. So really exciting stuff coming out of the dry needling division. But I'm going to dive in, dive right in today. 01:58 - THE NEEDLE IS IN, NOW WHAT? And the title of today's episode is my needle is in, now what? And honestly, when I framed this topic, when I started to prep and form this discussion, in my mind, I pictured that novice clinician, I mean, you're on your first dry needling course, you're doing vastus medialis, vastus lateralis, glute medius multifidus, you learn the technique, the palpation, the anatomy, you're looking for a bony contact, you get super excited, just like, oh, sweet. There's the bone. That's what I was looking for. Now what? So really, this is a question I've answered consistently on level one or kind of first dry needling courses for the last decade. But again, when I started to prep for this episode, there's layers to this. And really, whether you're a novice, an intermediate, or even an experienced dry needler, Sometimes it's worth having this discussion of, our needle is in. Like first we learn how to do it safely, how to do it specifically, but our needle is in, now what? And to fully acknowledge, depending on who you listen to, how you were trained, the answer of, now what, will be very different. Because first of all, there's that technical spectrum of, well, now we piston the needle, or now we twist the needle. Now we use e-stim. But even there, let's say there's a dosage spectrum of, okay, if I piston how many times? If I twist it for how long? If I just leave it there, what duration? If I use e-stim, what parameters? So again, I thought this would be a pretty easy, a pretty short, quick-hitting topic, but there's layers to it. And first of all, let's say that there is significant value to my needle is in a very specific target. Again, safety always comes first when you learn dry needling, but I think we also can acknowledge one of the benefits, one of the advantages of the needle as a clinical tool is we can be sniper precise. We can put a needle in semi-membranosis, in multifidus. You know, this is not necessarily a technique of broad stroking manual therapy of like, we're doing the lateral hip, we're doing the low back, we're doing the SI region. To some degree, even a manipulation, we're saying, you know, we're not joint specific necessarily. We're kind of giving input neurophysiologically to joint receptors and there's more of a regional and global response to that. With a needle, I think we can just say, first of all, I have a needle in semimembranosus. 04:46 - THE BLESSING & THE CURSE OF NEEDLING I mean, The blessing and the curse of needling is it keeps us honest, especially if we use e-stim. When you get that motor response, the needle's telling you, it's like, you know what, Paul? You're not in semi-membranosis. You missed. You're either like, you drifted subcutaneously or you missed superficially in tendinosis, you missed deep in adductor magnus. So first of all, I don't wanna just like completely glaze over the fact that your needle is in a very specific target is a big part of the equation. I mean, for ice, for our dry needling, we teach safety for sure, but you as like highly educated, skilled clinicians, teaching you all how to be safe with a needle happens pretty quick. So our, our goals, our mantra with dry needling are be safe, be specific. Again, that's, that's a big part of using this needle as a tool and then be strategic. And that's what I want to go to today, because again, the topic here is, my needle is in, now what? And again, let's acknowledge that it depends, not just on how you're trained, it depends on that patient on the table, on what is your goal for that session, what is the acuteness or the chronicity of the condition. So by no means do I want to make this sound easy, but I am going to give a very specific answer to this question. And again, I have previous training, I know the narratives out there of the needle is in, now we twist it for two minutes. Or the needle is in, now we just let it sit there. Or we pissed in it. And again, there are narratives, there is research, and there is benefit to each of those approaches. But I'm telling you that those aren't the answers. Again, I have a pretty specific answer that I'm going to get to But I think I'll torture you just a little bit longer by setting the stage. And really, I'm going to flashback, not even talking needling, I'm going to flashback to my DPT education. I went to Regis University, graduated in 2010. So what attracted me to Regist was Dr. Tim Flynn, Julie Whitman, Jim Elliott. I mean, big manual therapy specialists, but researchers of our day. So we finally, you know, you're year one, year two, you finally get to that musculoskeletal management, you finally get to learn some manipulations from Tim Flynn and Julie Whitman. And you know, if you don't remember how you started with manipulations, it wasn't good. The hands were not skilled, like it wasn't crispy right out of the gate. So you spend a half day, you practice on your classmates at home, and finally you're like, man, I'm starting to feel like my hands have some skill. So imagine you are there, you're learning manipulations, your hands are feeling more skilled. Imagine how disheartening it was for me, and I remember this day, when Dr. Tim Flynn stands up and says, you know what, you can teach a monkey how to manip. And I mean, He's overgeneralizing, but the point is still true. He's like, you can teach a monkey how to manipulate. It's really how, like when to manipulate. Um, I guess how to apply it. There is skill there. We'll acknowledge that. But then it's what you do afterwards. So, I mean, that, that hit for me. And first of all, it's like, Oh man, there are manipulating chimps out there that are doing this better than I am. And again, that wasn't his point, but. But the point remains knowing when to use it, how to use it to some degree, but then the dosage and the follow through, the aftermath is really the true magic. That applies for dry needling as well. Again, can we teach a monkey how to put a needle randomly into tissue? For sure. Like there is not much needle skill to getting a needle interstitially, into muscle tissue. There is a skill to being more specific, and there is a skill to answering the dosage question, now what? And I'll tell you now, without further ado, we have our needle or needles in. The answer to now what is e-stim. And you know, I don't, you know, I kind of do the, you know, I was trained previously, I know the research, the narrative and the benefit to all the other approaches, but the answer today is eSTEM. And honestly, what makes me so confident in that is first of all, I have my own empirical anecdotal, like I was not using eSTEM, now I am. I have that sample size to make me confident. But what makes me more confident And it's not even just the research, I'll touch on that in a minute. But what makes me more confident is knowing or hearing that some of the other dry needling educators or other dry needling institutions in the US and worldwide that previously were saying there's no additional value to e-stim with dry needling, or we're essentially just doing tens through a needle, they're now starting to use e-stim. And whether they use it the same way we do with ice, whether they explain it the same way, what they're saying is there's value to e-stim. And here's what the research says, is our needles are in, now what? E-stim is the answer for almost any treatment intent. First of all, I mean, if you haven't taken one of our upper or lower courses, we teach e-stim right out of the gate. I mean, day one, we learn how to use the unit, we get muscles to pump, Again, there's high value when you first learn dry needling to using e-stim because it keeps you honest. Are you in that muscle? Are you not? But that immediately gives you some, I guess some validation, like I'm saying, but some grace. Because first of all, what we know is that if we use e-stim with our needles versus not, any sort of post-treatment, post-needle soreness will be much less. So there's a very, um, a very real like patient approachability aspect to using e-stim. And there's research to support that. 12:33 - E-STIM DOES IT BETTER But beyond that, what if our treatment goal is not pain modulation? What if it's neuromuscular changes? E-stim does it better. What if our goal is, tissue nourishment, blood flow, maybe venous return, lymphatic activation, edema evacuation. What if our goal is that? ESTIM does it better. What if our goal is nervous system accommodation? Or what if it's getting the biggest, baddest neuropeptide or enkephalin, endorphin, but our pain modulating up top cortical response. What if that's our goal? eSTIM does it better. What if we're talking pain science and there's some somatosensory reorganization, there's some homuncular smudging that we would like to remap. We'd like to give a very profound and precise input to that homunculus, to that somatosensory cortex. eSTIM does it better. So again, these are, these are research based answers. Very real research that says group A just got needles, whether that was pistoning or placing or what have you, and then group B got e-stim. What was the difference? At this point, e-stim does it better. And really, that is the long and short of this episode. And again, I think to not minimize the impact of you have to learn how to put a needle in safely, There is significant value, especially with the needle, to say, my needle is in, very precisely, fill in the blank. My needle is in peroneus brevis. My needle is in extensor hallucis longus. My needle's in glute minimus. There is significant value to the precision of that tool. But that's only half the battle. My needle is in, excellent. That took some training, that took some some skill honestly that took some three years of doctorate level like anatomical training and education and awareness that took a lot to say my needle just contacted I guess the external ileum like we are at the depth and the location of glute minimus that's awesome that you checked the box that is step one but if we don't fill in the then what you're leaving a lot on the table clinically And if you just logged on, the answer is eSTEM. So again, I know I see some of the names jumping on. Thanks for joining. I'm preaching to the choir, to some of you, because you've taken our upper or lower courses. We immediately talk about how to use eSTEM, the research behind eSTEM, and then we use it all weekend on the course. And it's a different experience. I think eSTEM makes dry needling a little bit classier. We can be a little bit more classy with our needles when we use E-Stim. We can also be a little bit more dialed, a little more tactical with our treatment intent. Again, is your goal pain modulation? Is it neuromuscular changes? Is it blood flow? Is it just fluid dynamics of moving fluid? Excuse me. So that's the answer for today. Again, jumping on on a Thursday for a Technique Thursday. We're talking dry needling. And the question was, needle is in, now what? And the answer was Easton. Excuse me. So if that prompts any questions, again, this is a big piece of our curriculum. Drop some comments in the thread. Hit us up on Instagram. This is on YouTube as well, so you can throw some comments there. Again, my name is Paul Killoren of the dry kneeling division for ice. If you hopped on late, We are launching our advanced dry needling course in January. That'll be the final piece of our upper dry needling, lower dry needling, and then advanced for the certification. If you're in Washington State, that'll be the third course of the series to allow us to dry needle as far as getting 75 hours. But if there's anyone out there who is trained in needling, who is uncertain about using eStim or the benefit of eStim, first of all, I'll just encourage you to try it. Like, there's value there to hearing your patients explain the difference of using eStim or not. Otherwise, we have an online course if you already have the needle skills, you know how to put your needle in, but then what? If you don't know how to use the eStim, there is an online course through ICE as well, eStim plus needles. That's all I've got for today. Thanks for logging on. I'm incredibly proud of myself. This is my most concise, my most brief podcast topic, but it's an easy one for me. So if you're out there saying, what do we do after we put the needle in? I'm not saying there's not value in twisting or pistoning or just static needling. There's blood flow changes. There's neuromuscular changes. There's tissue disruptive like inflammatory cascade responses to all of that but the answer is e-stim and With that I'm logging off folks. Thanks for joining PT on ice daily show. See you next time OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Dr. Jeff Moore // #LeadershipThursday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, ICE CEO Jeff Moore emphasizes emphasizes the importance of trusting a proven process for success, particularly in the later stages of a business or any endeavor when uncertainty arises. He cautions against blindly trusting any process and encourage listeners to thoroughly evaluate its merits before putting their trust in it. Jeff acknowledges the prevalence of outrageous claims and self-proclaimed experts in today's era. He cautions against falling into this trap and emphasizes the need to dig deep and evaluate a process before trusting it. He suggests spending ample time observing and studying someone who has achieved desired outcomes through their process before fully committing to it. This advice applies to various domains, including clinical practice. If someone is considering adopting a specific treatment approach or following a mentor's guidance, they should first spend a substantial amount of time observing the mentor's success with a wide range of patients. Only after extensive evaluation and proof of the process's effectiveness should one trust and implement it. Overall, Jeff emphasizes the importance of trusting a proven process but stresses the need for thorough evaluation and proof. Blindly trusting any process without proper evaluation may not lead to the desired outcomes. Take a listen to the podcast episode or read the full transcription below. If you're looking to learn more about courses designed to start your own practice, check out our Brick by Brick practice management course or our online physical therapy courses, check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 JEFF MOORE Okay team, what's up? Welcome to Thursday. Welcome to Leadership Thursday. And welcome back to the PT on Ice Daily Show. Thrilled to have you here. I am Dr. Jeff Moore, currently serving as a CEO of Ice, and always happy to be here on Leadership Thursday, which, as always, is Gut Check Thursday. Let's start off every Thursday how we always do. Let's talk about the workout of the week. Here's what we've got cooked up for you. We've got 21-15-9. Couldn't be a more classic rep scheme. We've got thrusters and bar-facing burpees. So hopefully the first thing you're thinking is it looks a lot like Fran, right? We've got two movements, we've got that classic rep scheme, but I'm going to argue it's going to be a bit worse. With Fran, we've got push-pull, right? So at least you're pushing that thruster and then you're pulling up on that rig. Now we've kind of got push-push, right? So we're going to go thruster and then hitting that push-up motion during that burpee. It's probably going to be a little more painful. Additionally, you're probably not going to be able to sprint through quite as fast, looking at how long a burpee takes compared to a pull-up. So in Fran, you might be able to out sprint the darkness, right? You might be able to get done with the workout before that darkness really catches up to you. Here, I think you might be living in it for a while. So just let us know how it goes. Make sure you tag us, Ice Physio, hashtag Ice Trained. Let's have some fun with the workout over the next couple of days. As far as upcoming courses, the thing I want to highlight this week, is that virtual ICE is open. So as you all know, our virtual mentorship, we only open it every quarter for a couple days, bring in a new group, add into the crew, and then launch, close those doors and launch for the next quarter. We are trying to hold that price steady. It's been 29 bucks a month forever. It's still 29 bucks a month. Yes, it's CEU eligible, but more importantly, it's a great way as you're going through ICE courses to be able to be in that group, hold you accountable. Every Tuesday we meet, going over case studies, new thoughts that aren't built into our courses. It's a way to deepen your knowledge and really make it more clinically implementable, if you will, by every week revisiting and expanding on some of our concepts. So if you want to jump in, go to Virtual Ice on the website. PTOnIce.com, as always, is where everything lives. 02:37 TRUSTING THE PROCESS Let's talk about trusting the process. So trust the process, absolutely, right? You should totally trust the process. But I wanna unpack a couple things around this conversation that aren't talked about enough. So number one, trust the process. Everyone speaks of this in the early stages. Okay, so kind of a classic conversation around this topic is, hey, when you're just getting started, you might not see gains right away, don't worry, trust the process, it'll show up in time. That's clearly very relevant. And certainly when you think about areas like fitness where we often talk about this, yes, you're not gonna stack on a ton of muscle in the first couple weeks of training. You've gotta trust the process and those gains do show up down the road. There are certain areas where that early phase This concept is the most important, but I'm going to argue today that in the world of business, it's really in the later phases where I think this concept becomes significantly more important. 05:29 LOSING CLARITY ON CAUSE & EFFECT So let me, let me build the argument. So early on in business. The connections are very, very clear, right? You don't need nearly as much trust that what you're doing is reaping a reward simply because cause and effect are much clearer early on. For example, If you're building a practice and you form a new relationship and you see an increase in customers, it's pretty obvious that those increased customers came from that relationship because you don't have a ton of relationships yet. And any increase in customers is really obvious because you don't have a ton of customers yet either. Additionally, it's really easy when you run an ad or something of that nature to see again that swell of business following that ad is quite noticeable and it's very clear where it came from. Following up with your customers is a lot easier. Number one, there aren't as many of them, so it's easier to dive in and figure out, hey, how did you wind up here? Where'd you come from? and there aren't as many people delivering your service. So you don't have to bring everyone together and try to kind of coagulate the data and see, hey, where's everybody coming from? The connections are simply clearer. There's not as much noise, little changes make very obvious results, and it's not as hard to collect or aggregate the data, because there aren't quite as many people delivering the service. Early on, you don't need as much trust. Five years down the road, it's much harder, right? It's much more challenging. You often find yourself saying things like, I have no idea where that person came from, right? There's so many more things going on. There's so much more noise that it's much, much harder to prove. Did this action result in a certain effect? Now we fight this valiantly, right? Everybody, and you should, is trying to track everything, right? Whether it's where a customer landed on your website, or if you're running an ad, you're putting a tag on there so you can see, hey, when that person came to the website, if we track them through to the commerce side, did they actually convert? You're doing your absolute best to track everything. But the larger you get, the more mature the organization, it becomes significantly more challenging to definitively prove that any individual action resulted in any significant outcome. There's simply too many variables. You don't know, did it come from word of mouth? You really can't track that all that well. There's so many things going on that it's tough to have that clarity that you had early on. The reality is growth results in necessarily losing some clarity on cause and effect. The more mature the business, the more true this is. So what's the answer? The answer is to very much embrace and trust the process. In the absence of proof, You're just gonna need to check the boxes of what's known to work. I would argue the earlier that you can do this, the earlier that you can stop wasting your time demanding proof of every single action that you did having a reward or a response, the more efficient you're gonna be and the faster you're gonna succeed. The earlier that you can say, I no longer need to see proof that this thing that I'm doing is reaping a reward, I'm just gonna do all of these things with absolutely ruthless consistency, and I'm going to trust that by doing so, the end result is going to be additional growth and more progress. The earlier you can trust the process, the more efficient and more successful you're gonna be. But there is a catch here. It's got to be a proven process. And this is what I want us to really think about this morning. 07:39 OUTRAGEOUS CLAIMS & TRUST Team, we are living in an era of outrageous claims, right? We are living in an area where A huge amount of people that can't do are claiming to be able to teach, right? They're claiming to be able to get you unbelievable outcomes, even though they themselves don't really have a track record of being able to do so. That is the era in which we live. Heavily marketed, thinly veiled, outrageous claims. That is really where we are. Because of that reality, you need to dig deeper. The passion behind this topic is coming from having seen so many people over the years come to me and say, here's where I'm at. And me thinking, dude, how did you fall for that? Like that person, there was no reason to believe that those claims were being backed up by any significant track record of proof. The person simply did not dig deep enough. And that's what I wanna say to you today. 12:50 SHOULD YOU TRUST THE PROCESS? Should you trust the process? Yes. after you have went through extensive lengths to prove that that process actually results in the real world, in the outcomes that you're seeking. This is across every domain. Clinically, if you're gonna choose a mentor, if you're gonna lock into somebody and say, I am going to treat the way that person treats, I'm gonna ask that person what the big rocks are, and darn it, I am gonna implement those in every patient that I see. If you're gonna do that, You better have spent a solid year around that person, watching them day in and day out succeed with patients. A wide variety of patients, a wide range of complexity of patients, until you get to a point where you're like, look, that person gets it done. Better than everybody else I've seen, almost regardless of who shows up in front of them, the methods that person's utilizing month after month after month after month consistently work. I buy it. That person can actually get it done. I am going to trust their process. In Con Ed, at ICE, I hope you never sign up for a certification until you've taken one of our courses and went back into the clinic and implemented and decided for yourself, do the tools that I learned in that weekend course or that online course when I went back in my clinic, was I demonstrably better? Was I more efficient? Was I having more fun? Did it actually work? Until we prove that to you, I don't want you to sign up for some long series of courses. I want you to test us, and I want you to go and see, does it actually work? That's the kind of level I want you digging in on everything. In business, you don't buy that someone can grow your business until you have talked to a bunch of people who aren't affiliated, who maybe have done some of their mentorship, but are not actively in their program, and you reach out in your private circle and say, hey, has anybody worked with so-and-so? I want to have some conversations. And you dive in and say, is it really as good as they say it is? Were the principles that they taught able to grow you? Anybody can put that on an Instagram ad. Did it actually work for you? Is your business three times bigger now than it was a year and a half ago like they said it would be? Dive deep and ask the hard questions. I love it when people reach out to me. And they're thinking about opening it onward, right? And they say, look, I want to talk to a couple other owners. I love it. They want to hear from the people. Did they actually deliver? I love when people who are getting coached up to become faculty at ICE, I hear them reaching out to other lead faculty. They're not offending division leaders by doing that. They're just going out and saying, hey, here's kind of what I'm being sold. Did it actually shake out like this? In looking for multiple sources. Business leaders, I hope you all are never offended by that. People are not second guessing you. Yeah, they are, but they're not disrespecting you. They're just doing the work. They're saying, look, I heard you, but now I'm gonna go see across multiple sources if what you're saying historically has added up. Are you actually able to get the job done? Have you proven that? Or are you just saying that because you want your business enterprise to grow? Do you have the goods? Team, in fitness, to me, with CrossFit, I had never heard of it before 2013, 14, but as I got into it, I looked around for proof. In the first thing I saw, in the second thing, in the third month, in the second year, is that everybody who just consistently did what was on the whiteboard and showed up five days a week had what I wanted, meaning tremendously well-rounded fitness. I was shocked by where they wound up. They had tremendous cardio engines. They were strong as all get-out. They had tremendous skills in gymnastics and mobility. The people who did the whiteboard, as written, five days a week, as hard as they could, and used that process, wound up exactly where I wanted to be. You can only watch that so many times until you're ready to say, okay, I believe it. I buy it and I'm all in. So yes, right, trust the process. And yes, put your head down and check the boxes. But after you've established certainty. Now I want to finish by saying here's why this is so critical. Here's why doing the legwork to prove to yourself to be fully committed that this person can actually get it done and that it should thus be transferable to your success. The reason it's so important is two things. Number one, once you do put your head down, and I am totally advocating for you to put your head down, right? Head down, stop looking for proof of every single thing, and just check the boxes with absolute rigor. I'm encouraging that. But once you do that, there aren't a lot of checkpoints. So once you've committed and you've said, I'm just gonna keep checking these boxes and I'm gonna trust the process, you're not really looking for proof, right? Because we've just established it gets harder and harder to gain any, so you've just simply gotta trust. The problem is if you're wrong, there aren't a lot of checkpoints to reveal to you that you're wrong. So you're gonna go a long ways down that trail. There is gonna be a tremendous investment until you realize, oh man, that system or that person or whatever didn't actually have the goods. I should have done more front-end homework. The second reason is because if you've done the work to truly prove it to yourself, if you've watched that clinician for a year and become absolutely certain their method works, if you've taken a couple courses and become absolutely certain that when you implement it, you're better for it, if you've done the work to be positive or as close to it as you can be, you're much less likely to quit. Once you put your head down and say, I'm just gonna check these boxes, I know what's gonna work, you are much more likely to go the distance to a point where you actually begin to reap very serious rewards because you won't be second guessing yourself because you've got certainty in your corner. But if you didn't do the work, you're gonna be saying much earlier than you should, am I sure this is the right path? And now you're gonna need proof and validation, which as we've just talked about, is hard to come by. So now you're gonna quit early, and if anything abbreviates success, it's early cessation of effort. Because there are a lot of checkboxes or checkpoints along the way to tell you whether or not you're on the right path, And because going the distance is so critical to success, you have to do the work to increase your certainty that that person's process or that system is gonna work for you. Do that work and then trust the process. Understand it's probably more important late in the game, at least in business, when things get cloudy and murky, than it is early on. I hope that spins the idea of trust the process, maybe a little bit different way in your brain, and certainly encourages you to go one step further on drilling down to be certain the process you're about to trust has actually proven merits historically. Have a wonderful Thursday, team. We'll see you next week. Enjoy that Gut Check Thursday workout. Cheers. 16:16 OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

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

Alan Fredendall // #LeadershipThursday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, ICE COO Alan Fredendall discusses the different avenues to find out if a potential hire is right for your clinic: screening the resume, conducting a series of interviews, and getting to know the person outside of work. In addition, he reinforces to listeners the importance of utilizing employment contracts. Take a listen to the podcast episode or read the full transcription below. If you're looking to learn more about courses designed to start your own practice, check out our Brick by Brick practice management course or our online physical therapy courses, check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 ALAN FREDENDALL Team, good morning. Welcome to the PT on ICE Daily Show. Happy Thursday morning. Hope your morning is off to a great start. My name is Alan. I'm happy to be your host today here on Leadership Thursday. We talk all things practice, management, and ownership. Leadership Thursday also means it is Gut Check Thursday. Gut Check Thursday this week is a workout called Gut Check. Kind of going back to our roots of a really kind of low skill, high work workout. We have four time, 180 calories on the fan bike, a one mile run, and then 100 bar facing burpees. So nothing complex here, just some good old fashioned grunt work. Each of those elements you're thinking is going to take you maybe 8 to 12 minutes and that you're going to get done maybe depending on your run speed, on your biking ability, on your ability to ignore the pain during the burpees. You might get done somewhere between 20 to 25 minutes. So that's a great workout to do in the garage, in the basement. Great workout in the clinic to scale and modify for patients. Very easy to modify the volume there, modify the movement, so on and so forth. So try Gut Check Thursday this week called Gut Check. Course is coming your way. I want to highlight our online courses. We have a bunch beginning related specifically to Leadership Thursday and Practice Management Brick by Brick. Our next cohort starts September 12th. That's next Tuesday with yours truly. All things related to getting your practice off the ground, all of the legal things you need to do to establish and incorporate your business, and then finishing talking a little bit of strategy depending on if you want to open a brick and mortar clinic, a mobile clinic, a dock in the box style clinic, whether you want to deal with insurance, be 100% cash, or maybe meet in the middle with a hybrid practice. Whatever your goals are for starting your practice, that is the course for you. Eight weeks online. That starts September 12th. Other online courses starting next week, Clinical Management Fitness Athlete Essential Foundations begins Monday, September 11th. Myself, Mitch Babcock, Guillermo Contreras, and Kelly Benfey. All things related to helping the recreational fitness athlete, the crossfitter, the boot camper, the orange theorist, the powerlifter, Olympic weightlifter, you name it. That class is for you. Clinical Management Fitness Athlete Advanced Concepts, the level two course of Clinical Management Fitness Athlete. That cohort begins September 17th. You need to have taken Essential Foundations first. That course is taught only twice a year, spring and fall, and it has two seats left. So if you've been thinking about rounding out your Clinical Management Fitness Athlete certification, you'll want to jump in that class this fall. Otherwise, you'll need to wait until the spring. Other online courses, Rehab of the Injured Runner online. That also begins September 12th. Modern Management Older Adult Essential Foundations kicks back off October 11th, and then Persistent Pain Management begins again October 31st. So today we're kind of building on last week's topic. If you were here last week, you know that we talked about really being intelligent and diligent and intentional about growing and scaling your practice, about how to add new practitioners to your practice, about how to do it the right way in a way that facilitates long-term growth, but also quality of the product that you're offering. So go back and listen to last week's episode if you have not yet. We used the example of McDonald's, of how they've grown and scaled to be one of the largest, most successful businesses in the world in all of history, and how they've done that. They've done that by having that shared foundation of training and a common belief system in all of their leadership and ownership to help maintain that company culture as they grow. Today we're going to build on that. As I said, we're going to talk about how to find that person. We talked about how McDonald's has Hamburg University, but how can you, maybe is the individual practitioner right now, solo practitioner, how can you find practitioner number two? How can you find maybe practitioner number one for location number two, so on and so forth. 04:15 FILTERING CANDIDATES So we're going to talk about the different ways that you can really get to know somebody, and then we're going to talk about something that's really undervalued and not really discussed in physical therapy at all. The legalese of bringing somebody on board, of getting everything that you are promising them, everything that maybe if you're on the other side of the table, everything you're looking for in a position that you get that stuff in writing. You get it written down, everything that you are offering, everything that you are wanting to see out of the position, get that stuff in writing. So let's start first about talking, what are the three avenues where we can get to know somebody better? They are the resume, very familiar with resumes, they are the interview, most of us are very familiar with at least participating interviews, maybe not conducting interviews, and some other maybe non-traditional ways to get to know somebody else. So the thing to understand about finding that next practitioner, about maintaining that clinical culture, that standard of quality and excellence that you want to maintain, is that you can teach some of the stuff, but some of the stuff that's really important to be a physical therapist unfortunately cannot be taught. If I can teach anybody a clinical reasoning algorithm to rule in or rule out the lumbar spine if somebody comes in with low back pain, or comes in with maybe what we're suspecting to be, radicular type pain. I can teach the clinical reasoning to help that person find out if it's actually that patient's low back or if it's something else. I can teach somebody manual therapy skills, I can teach somebody spinal manipulation, I can teach somebody dry needling, I can teach somebody exercises, go-to exercises for different conditions, I can teach them about dosing for tendinopathy, I can teach them a lot of different things related to clinical practice, but what I cannot teach anybody is how to be a nice person, an interesting person, or a hard-working person. So we talk about these three different avenues of filtering people in and out of kind of sitting in what we might think of as a potential pool of candidates for a position. How do we find that stuff out? Because that's ultimately some of the most important stuff and it's stuff that you cannot teach somebody to do and you cannot make somebody good at. They have to kind of come on board with it naturally or at least show a passion at getting better in those areas. 08:30 THE RESUME So the first way we're probably familiar with is the resume. If you have not gotten to this point yet in your clinic ownership or business ownership career, you will eventually, where you receive pretty much an endless stream of usually unsolicited resumes, of they come via fax, they come via email, sometimes they come via email and there's no message, it's just an attached resume. Sometimes people give you a long story about why they think they're the perfect fit and why you should hire them and they are a little bit forceful and they say things like, let me know when I can start. Sometimes they come in person and they drop a resume off. So we talk about a resume, you as the person evaluating a resume, what should you be really looking for? And when I look at a resume, I really just think it is a box check to get to the next step, which would be the interview of when someone gives me a resume, if I have an open position and I want to look at it, what am I looking for? I'm really looking to see is this person a licensed physical therapist because sometimes they're not and that's really important to be a physical therapist that you have successfully finished school and passed the board exam and you have a license. And then the only other thing I really care about on the resume is previous work experience besides school. My question in my brain is has this person done anything remarkable other than go to school for 25 to 30 years? Because when you look at a lot of resumes, when you evaluate new graduates who are coming out of school, what you'll find is that not everyone has experience besides going to school. And yes, I don't want to poo poo getting a doctor of physical therapy degree. Yes, work went into that. Yes, it is an advanced education. It is a remarkable achievement for that individual, but across our profession, it is not. Most of us are DPTs or we're working on our DPT or a transitional DPT. It is now the entry level of education for our profession. So just having that doesn't make somebody stand out. I'm saying, okay, this person has their DPT and their license, but what else? When I think about other things in life, hey, if you can run 10 miles in 90 minutes, that's kind of fast. You're faster than people who can't run that far, run that fast, but it's not that impressive to people who can run faster and or further, right? It's a remarkable achievement for you in the moment, but overall not remarkable. And that's how I look at the long list of education that you might see on someone's resume. Of the question in my mind is, does this person have experience outside of just going to school that would translate into being a good physical therapist? And again, those are the elements we're looking for. Is this person a nice person? Is this person interesting and are they hardworking? So when I see resume experience that maybe somebody worked in the restaurant industry or they worked in a retail position, I know, well, this person probably knows how to wake up to an alarm clock and be to work on time. I know they probably have some experience working with human beings, which is a very important part of being a physical therapist. And they're probably used to working relatively hard. So I learned a lot by looking at somebody's job experience on the resume. So that's my first filter of what else has this person done besides go to school to be a physical therapist. And in some cases, the answer is nothing. They have gone to high school, to undergraduate and to graduate school. And that's it. And that's okay. But that's not the person that I want to bring into my business. Again, the idea of having that shared foundation of training, having that common belief system of having things that I can't teach on board already. That's really going to facilitate that person getting into a good position in the business that I'm operating. 10:14 THE INTERVIEW So that resume is just a filter for the next step, which is the interview. In the interview, I'm really trying to figure out where does this person lie with their passions and do those passions and interests line up with a position I currently have or that maybe I'm looking to provide, right? Is this person really passionate about vestibular physical therapy? That's fantastic because we don't have a vestibular physical therapist. That is an entirely new demographic of patients that we could attract and treat here at the clinic. If somebody had experience in it, maybe clinical experience in school, but also had a passion for that area. A lot of people in an interview, interviews tend to be very redundant and basically just a, a live action version of a resume of explaining what has been done. We often hear things like, I'm really passionate about physical therapy, just like a resume. Cool. You've gone to physical therapy school. What else you're passionate about physical therapy. Okay. Tell me more, right? I think many, many years ago, when I came to Jeff Moore, the CEO here at ice, when it was just the Jeff Moore road show, ice was just Jeff Moore and had taken a couple of his courses. I had not received my certificates, which I needed for school to prove I had taken the credits. And I said, Hey, I need those certificates. And he told me how long it takes. And I said, Hey, tell me your process. And his process was, as you can imagine, terrible. If you know, Jeff, not very logistically minded. And what I came to him with was a better process about a passion for logistics, about a passion of creating a system that streamlines things like issuing CU certificates. So that's kind of the same passion we're looking for in that interview. Does this person already have an idea in their mind of what they want to do? Do they want to run older adult, small group fitness classes? Do they want to treat vestibular or concussion type style presentations with their patients? That is something that in your mind, you're thinking, Ooh, that's something we don't offer, but I would love to offer. And finding more about that person's passions kind of again, checks another box of resume. Yes. Got them to an interview, interview, interesting person. It's obviously hard to learn everything you can about a person in a 30 minute or 60 minute job interview, even across maybe multiple interviews. But you're looking to uncover where does that person's passions lie? And is that something that can be put to use here at my clinic? And something that's almost never discussed in an interview is what is that person's longterm plans? I don't need to know where you see yourself in 20 years or 50 years, but I do need to know if you're planning to move out of state in a year, right? Because that's probably going to affect my decision to hire you. I'm looking to bring longterm people on board. I'm looking to train them, help them become a better clinician, but also give them a really stable, a well-paying job that really offers a lot of benefits as far as schedule flexibility and treatment, kind of freedom and how they want to almost run their own practice within a practice. So if somebody says, well, I'm thinking about moving to Colorado in six months, then again, that's in my check, check box in my head as I'm going through it thinking, well, that's probably not going to work out just as we kind of train you and bring you on board, you're going to be leaving. So that doesn't really work out. So don't forget to really kind of dig deeper of what are your longterm plans of if you see yourself settling down and having a bunch of kids and maybe leaving the workforce altogether, that's okay. But when is that again? Is that three months from now? If so, that's probably going to affect my hiring decision versus somebody who says, I do want to have a family, but I'm 24 or I'm 25 and that's maybe five to 10 years away. Okay. We can cross that bridge when we get to it. Again, that's a box check in my head. 14:52 EVALUATING SWEAT EQUITY So the resume builds, get somebody to interview, interview, get some more boxes checked, maybe, or maybe it doesn't. But what else? How do you really start to learn those things about a person? We've talked here before on the podcast of watching that person practice in your clinic. That's great to do. If you're hiring somebody that's maybe currently or previously was a student, you can certainly go watch somebody practice. It's really kind of hard and awkward to have somebody come to your clinic and treat your patients while you watch them to get an idea. But there are other ways we can look at those characteristics of a person and get a good idea of is this person a nice person? Is this person an interesting person? And is this person a hard working person? And that's to get outside of the clinic entirely of, hey, come to my gym. Let's work out a couple of times. I can learn a lot about a person outside of the clinic. I can learn, are they punctual? If I say, hey, come to CrossFit class at 8 a.m. or meet me at 6 a.m. for a run, are they punctual? Are they reliable? Are they showing up late? Are they showing up not at all? Are they snoozing that alarm? How do they handle stress? If CrossFit is brand new to them or running is brand new to them or whatever you're doing is brand new to them, how do they handle that stress? Is that the person that trips on a couple of dumbbells and throws their jump rope out into the parking lot? Or is that a person who goes, hey, they're not in the cards today and just scales to single unders and keeps working out? How does that person handle pressure and stress? And ultimately what we're learning when we kind of use sweat equity as an interview is how is that person with being coachable and open-minded of are they open to feedback on improving their performance in the gym, running, rock climbing, whatever you all decide to go and do together, are they open or do they believe they've already learned everything and they have mastered it and they can't be taught anything? Because that is a red flag for somebody, right? Of somebody who shows up late to the whiteboard because they think they already know how to do CrossFit really well and they think they have nothing to learn from the coach. They don't listen to any sort of coaching. Those are all kind of red flags for you of if this is how this person behaves outside of the clinic, how is this person going to behave at my clinic? Are they going to be late to treat patients? Are they going to be somebody that calls in a lot? Are they somebody who believes they can't get better as far as the clinical practice goes? If their clinical reasoning is already at an expert level and they have nothing to learn? Those are all red flags for you of maybe this is not the right person for my job. This person does not seem to have our shared foundation of training and our common belief system. 18:36 GET IT IN WRITING So moving through those three avenues, resume, interview, sweat equity call it. What if then you fall upon somebody you think this is the person that I want to hire for this position? What should you do? You should always, always, always get everything in writing of you can be the best friends with somebody. You can have known them since you were kids. It can be your brother-in-law or your sister-in-law. It doesn't matter of when we're talking about dealing with professional employment, we should have employment agreements on board. We have these here at ICE with all of the faculty who teach for us. They don't have to be this complex 50 page document. It just needs to lay out what we're offering and what we are expecting for essentially work in return. And all that stuff, no matter how small, should be listed out. Obviously pay should be described of how a person is going to be paid. Things like time off should be described. Things like payment for continued education benefits or health benefits. Anything you can possibly think of that you are giving in exchange for work should be written down. Anything that person is wanting to receive in place for their work should also be written down in that agreement. And these things do not have to be set in stone. You can set a three month, a six month, a one year, a three year expiration agreement on these agreements. You're not forcing somebody into chains, but you should have that stuff in writing. I will tell you as Jeff and I sit at the head of ICE over the years, what we see not daily, but definitely weekly are really unfortunate emails from you all who follow us at ICE, who take our courses of, Hey, I was promised this, but then this happened. I was promised X, but because Y happened, now I'm stuck with Z. And it all comes down to the question we always ask of is that in writing somewhere? And universally the answer is no, it was promised verbally. It was promised in passing. It was promised maybe at a meeting or maybe at my first job interview five years ago, eight years ago, 10 years ago. And I kind of just expected that that person would keep their word. And certainly things change with the economy or whatever excuse we want to use on the employer side, but at the end of the day, it's not in writing, which means it doesn't really count. Right. And so getting stuff in writing, it doesn't matter how you're going to be paid. If you're going to be a W-2 employee, a 1099 contractor, it doesn't matter. Get all that stuff in writing, get time off in writing, get benefits in writing, get scheduled pay increases. If you agree upon those in writing, this is just another friendly reminder that if you don't get a pay raise that matches or beats inflation every year, you have taken a pay cut. And if you don't have that in writing, you probably didn't get it. Right. So having all that stuff in writing, when you're accepting a new position, putting it in writing, when you're bringing somebody on board is later on going to save a lot of time, money, hardship, bad feelings by having that stuff in writing. And if everything related to what's expected at the job, productivity, you clean your own room, somebody cleans your room for you when you're done, whatever, no thing too small can go in that employment agreement. And once you've both read it, reviewed it and agree, sign it. And that's how you bring that person on board. We have all been in that position where maybe we were told, Hey, it's one-on-one for an hour. And maybe it became, Hey, could you see a double book this hour? And one patient per hour became two, two became four. And all of a sudden you find yourself, how am I seeing 20 or 30 patients a day? And you go back and none of that was in writing, right? It was all verbally promised in your initial interview or your onboarding training. And none of it was in writing. And ultimately at the end of the day, there's not much that can be done. So whether you're hiring, whether you're being hired, get all of that in writing. And that should be a red flag to you on either side of the table. If one party to the other does not want to put anything hard and fast into writing, that should be a big red flag in your mind that you push the chair back and you step away from that table. That should already be enough of a red flag that you shouldn't even consider bringing that person on board or being brought on board if you're the person being hired. So get it in writing, find those people, figure out that we have a shared foundation of training, a common belief system, use a filtering system of resume into interview, into maybe sweat equity interview to filter those people out, really ensure that they are the fit of the person that you see working for you at your clinic. And then get as much of that stuff in writing as you can get done. So I hope this little mini-series was helpful. Again, if you have not listened to last week's episode, listen to that one, get some context, and then maybe revisit this one. If you're going to be on a live course this weekend, I hope you have a fantastic time. We hope to see you in our online courses starting next week. Other than that, have a great Thursday, have a great weekend. Bye everybody. 20:35 OUTRO Hey, thanks for tuning in to the PT on ICE Daily Show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ICE content on a weekly basis while earning CUs from home, check out our virtual ICE online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.  

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

International duck hunts are great ways to extend hunting season, see more world, put your hands on new waterfowl species.  Whether collecting experiences, trophies, or both, most traveling hunters want to bring home beautiful specimens. While it's mostly "just paperwork and protocols," it's still kind of a big deal---necessarily way, way more involved than bringing home a sombrero or gift shop coffee mug. Long-time US Fish and Wildlife Inspector, Jeff Moore, works several ports of entry along the Arizona border. Covering many need-to-know topics, he walks us through properly importing trophy birds across United States borders.      Related Links: Wildlife Inspection Offices https://www.fws.gov/media/wildlife-trade-wildlife-inspection-offices (PDF)     Podcast Sponsors: BOSS Shotshells https://bossshotshells.com/ Benelli Shotguns https://www.benelliusa.com/shotguns/waterfowl-shotguns Tetra Hearing https://tetrahearing.com/ Ducks Unlimited https://www.ducks.org Mojo Outdoors https://www.mojooutdoors.com/p Tom Beckbe https://tombeckbe.com/ Flash Back Decoys https://www.duckcreekdecoys.com/ Voormi https://voormi.com/ GetDucks.com USHuntList.com     It really is duck season somewhere for 365 days per year. Follow Ramsey Russell's worldwide duck hunting adventures as he chases real duck hunting experiences year-round: Instagram @ramseyrussellgetducks YouTube @GetDucks Facebook @GetDucks.com     Please subscribe, rate and review Duck Season Somewhere podcast. Share your favorite episodes with friends! Business inquiries and comments contact Ramsey Russell ramsey@getducks.com

Alan Fredendall // #LeadershipThursday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, ICE COO Alan Fredendall discusses average arrival rates in physical therapy, what the research says about how to improve arrival rates, leveraging technology to improve arrival rates, and creating policies & systems that ensure your clinic still gets paid for missed appointments. Take a listen to the podcast episode or read the full transcription below. If you're looking to learn more about courses designed to start your own practice, check out our Brick by Brick practice management course or our online physical therapy courses, check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 ALAN FREDENDALL Good morning, everybody. Welcome to the PT on ICE daily show. Happy Thursday morning. Hope your morning is off to a great start. My name is Alan. I'm happy to be your host today. Currently have the pleasure of serving as the chief operating officer here at ICE and the faculty member on our fitness athlete division. We're here on Thursdays. We talk all things leadership Thursday, small business ownership, practice management, that sort of thing. Leadership Thursday also means it is gut check Thursday. This week we have a 17 minute AMRAP, as many rounds and reps as possible in 17 minutes of the following 21 plate ground to overhead. Our Rx weight there for guys 45 for ladies 25. So grabbing a bumper plate, hinging down, tapping one side of the plate between your feet and then up and over overhead, almost like a snatch. Moving into 15 cows on the rower for guys 12 for ladies and then finishing with a small dose nine burpees to plate. So looking for somewhere between three to five rounds of that great workout for home, the garage, the basement, the clinic. Just need a rower and a bumper plate. Great to maybe take out to the park as well and sub the row for some running or something like that. So that is gut check Thursday. Course is coming your way. We have so many about to enter a very, very busy season for ICE here as we get into the fall, get away from the summer, school starts back up, that sort of thing. We have a couple hundred courses coming your way between now and the end of the year. So if you're looking for live courses, head on over to p10ice.com, click on our courses and check out our map to see what's coming to your neck of the woods. Some online courses I want to highlight. Pretty much all of our entire catalog of eight week online courses are starting back up after Labor Day. So if you don't know about our online courses, they are eight weeks online. They are synchronous, which means that you meet with us every week. They are not completely self study, a mixture of lecture, of reading, of homework and of live meetups. They're meant to simulate the feeling of a two day live course, but stretched across eight weeks to make it a little bit more accessible, save you a little bit of money on travel. So online courses, pretty much like I said, all of them are starting after Labor Day. We have ICE Pelvic Online. That's our entry level online pregnancy and postpartum course. That's going to start September 4th. We have Fitness Athlete Essential Foundations taught by yours truly Mitch Babcock, Kelly Benfee and Guillermo Contreras. That's going to start September 11th. The very next day, September 12th, Brick by Brick is going to start very relevant course to this day of the week to Thursdays. We talk all things practice, startup and ownership and management in that course. Injured Runner Online also starts September 12th and then Virtual ICE will open back up September 26th for our next quarter of enrollment. So let's get into today's topic. Let's talk about how do we handle, how do we get better at when a patient reschedules, cancels or no shows. I want to talk today about three main topics. I'm going to talk about what are the average no show cancellation rates, what we would call an arrival rate across the country, across physical therapy, what's normal, what's abnormal. I want to talk about how to improve those arrival rates. And then I want to talk about how to get paid when somebody does not show up for those appointments. 05:46 ARRIVAL RATES IN PHYSICAL THERAPY So let's start at the beginning and let's talk about what is a normal rate. If you have been practicing physical therapy for a while, if you have been practicing in a traditional clinic, you may have heard that the common recommendation for the maximum arrival rate is about 93%. That is to say that 93% of your appointments show up for their appointment that day. That there's some margin of error. We recognize that 100% of people probably won't make it, but pretty typical. 93% is the standard that's set and sometimes enforced by the clinic that you work for. Maybe if you fall below that, maybe you get a warning, maybe you get a talking to, or maybe they actually dock your pay for visits underneath that 93%. What's awesome about this topic is that we actually have a lot of research, surprisingly, supporting the numbers that I'm about to tell you. So we have a great survey back from 2015 of about 7,000 outpatient physical therapists. This is from Bo Kinski and colleagues, sorry if I mispronounced this, of 7,000 outpatient PT's looking at a couple of different things. Looking at finding the average cancellation no-show rate, but also finding what things seem to help fix that. So across the country, we see an average no-show cancellation rate of actually about 10 to 14%. So thinking you may have been told 93% is the gold standard, in reality, somewhere between 85 to 90% is actually probably more realistic. If you had 10 patients scheduled for the day, you could expect maybe eight of them to show up for the appointment. You could expect maybe one to two appointments to be unfilled. I like this survey because it goes a couple levels deeper. It asks why. Now knowing that rate, knowing that 10 to 14% rate, why do people not show up for the appointment? What is the number one cause? The number one reason why patients do not attend their appointment is not that they can't afford it, not that they don't like you, it's that they forgot and that the clinic that they went to physical therapy to had no reminder system. So that's a huge error, that's a very easy fix. When we delineate outpatient physical therapy from hospital-based outpatient physical therapy, so private practice versus hospital-based, we see that hospital-based clinics actually the no-show cancellation rate of a private practice clinic. Why is that? I would imagine it's probably due to having a modern reminder system, but again, that number of 93% isn't the gold standard that we think it is. In private practice, we can expect maybe 85 to 90% arrival rate, a little bit lower in hospital-based, maybe 75 to 80% arrival rate. Now this survey looked at the concept of a multi-method reminder system. What does that mean? That means that the patient received multiple reminders across multiple communication methods. That they usually received some sort of automated phone call reminding them of their appointment. They received probably a text message and then maybe also an email message. So they received two to three different reminders ahead of their appointment across different modalities, basically reminding the patient as much as possible of their upcoming appointment. Now they found that those clinics that used a multi-method reminder system had a significant reduction in no-show cancellation rates, about a 50% reduction. So they cut their no-show cancellation rate in half just by having a reminder system. And we're going to talk about how to set that up at your clinic here in a minute. The second reason that clinics did better with no-show cancellation rate was those clinics who had a 24-hour appointment change policy. That is inside of 24 hours, you will be penalized if you cancel or reschedule or no-show your appointment versus if you give more than a 24-hour notice that you need to reschedule your appointment or otherwise cancel it. So those clinics which had a 24-hour policy and enforced that policy on their patients also had a reduction in their no-show cancellation rate. So that brings us to the question of if 10 to 14% is the mean of the average of no-show cancellation rates across the country, then how realistic is 7%? The answer is not very, right? Even if you are treating one-on-one for an hour and you maybe only have eight patients on your caseload for the day, it's probably unrealistic to expect 100% of those people to show up every day. That we have to recognize at some level that the reason we see so much overbooking in traditional physical therapy clinics is it's just that leadership strategy to limit the impact of those inevitable no-show cancellation rates. That if you see eight patients in a day and 10 to 15% don't make it, you may see five to seven patients. So kind of the aggressive leadership solution here is just to make you see more patients. That if you see twice as many patients and you still have that 10 to 15% no-show cancellation rate, then you'll still see more patients than originally intended and scheduled to and the clinic won't lose as much profit. But that being said, that is an aggressive way. That is a way that puts all of the burden of the work on the therapist and none of it on the ownership, none of it on the leadership and none of it kind of on the backend logistical side of the clinic. Instead of making you see more patients, why don't we just have a 24-hour policy that we enforce? And if we're not using a reminder system, why don't we start using one? Why don't we do some more conservative approaches to reduce that no-show cancellation rate, especially now knowing that we have research that supports, does those actually improve our no-show cancellation rates? So let's talk about that. 08:48 IMPROVING ARRIVAL RATES Let's talk about aside from having a reminder system, aside from strategies to remind patients to get to the clinic and aside from having a policy, how can we approve improve those arrival rates? You know us here at ICE, if you've been listening to us for a while, Jeff Moore, our CEO says it best. The first thing you can do to make patients show up to physical therapy more is make sure that you're focused on getting good and not getting busy. That when people see results, when they begin to associate value with their physical therapy appointment, they come to their appointment more often. I think this is so overlooked, especially in a higher volume clinic where a therapist may be expected to see multiple patients per hour. By providing lower quality care, patients aren't able to get results or they're not able to get results as fast as maybe they want to. They don't really associate physical therapy as a valuable use of their time and it makes sense that they find better stuff to do and that you get that message at 4.55 p.m. that your 5 p.m. patient is not going to make it in today. So really focus on getting good, not getting busy. We also need to recognize that people are not stupid. When they show up to PT and they see that you are working with three other people at the same time and you have forgotten about them in the corner at the TheraBand station or on the recumbent bike or the pulleys, again, that really begins to lower the value proposition that patients have with physical therapy and it's not surprising again that they begin to find better stuff to do with that hour of their time. The counter argument here is that you can get so good as a physical therapist, I'm good enough that I can see multiple patients at once or patients aren't as fragile as we think. We don't need to give them one-on-one care, but we need to recognize that at some level, patients are paying for it, especially if they're paying cash for a one-on-one visit. They are expecting one-on-one treatment. Even if you are an insurance-based clinic and using a patient's insurance, that insurance is still paying you based on one-on-one care. And not only that, but the patient expectation is that you are going to give them the care that they need. And I often relate this to other professions of you would lose your mind if you had a therapy appointment with a psychologist, a mental therapy appointment, if you showed up and there were three other people getting mental health therapy at the same time as you. No one would put up with that, but for some reason, it's just expected and normalized that that's the kind of care that we give in physical therapy. So then it's no wonder that patients, again, find something better to do with their time for the hour. So really focus on getting good and not getting busy, of taking really quality care of that patient that you have on your schedule for that hour. And you'll be surprised how much they come back to physical therapy when they see their range of motion improving, when they see their balance improving, when they feel stronger, when their pain is getting better, whatever their goals are, as they can see progress towards their goals, it's much more likely that they're going to come back to physical therapy. And I think that is often overlooked. My second point with improving arrival rates is to leverage technology, implement that multi-method reminder system. It's 2023. There is no reason why your clinic does not have automated reminders, text, email, phone, whatever. It's all built in to a modern EMR. If your EMR does not do this, you need to get an EMR that does this. If your front desk person is still calling people by hand to remind them of their appointment, you're a little bit behind the curve, right? to do the work for you so that you can focus on treating your patients while the technology sends out those reminders for you. We need to recognize that people are busy and that the more we can be prominent in front of mind with reminders, the more likely people are to attend their appointments. We have research that supports this, right? We can cut these no-show cancellation rates in half with a multi-method reminder system, but also it gives the patient a chance to reschedule if they know they already can't make it, right? That text reminder, when they get that phone call, when they get that email, it gives them multiple chances to reschedule. And if they don't, it also kind of builds the case for you against them that you gave them plenty of chances to reschedule and they still did not. And that makes it a little bit easier to charge them money, which we'll talk about in a few seconds here. So remember, we can cut that rate in half, that no-show cancellation rate in half with a multi-method reminder system. So if you're still using Google Drive as your EMR, if you're still using paper documentation and scanning it into a computer, consider getting a modern EMR. They're not that expensive. EMRs, we're big fans of Jane here, obviously, at ICE, other EMRs, Prompt, PT Everywhere, pretty much all the modern web-based EMRs are going to offer reminders and more often than not, they're free for you to use. So why not use them, right? It's one more push of a button when you're building out that patient chart for them to get reminders. In addition to reminders, leverage technology to create an online booking and waitlist system so that when you do send that reminder, it should come with a link where it says, hey, if you can't keep this appointment, please click here, right? So that your appointment comes off my schedule and that you get a little link to rebook at a time that works better for you. So we still keep that visit on the schedule, but we also open up that visit to maybe somebody else who can use it so that we don't have a missed slot on our schedule. Pretty much just like reminders, modern EMRs are very good at having automation with waitlists of where when a patient reschedules and a slot opens up, usually automatically or with the push of a button, you can pull people in from your waitlist and make sure that that slot stays filled without having that patient get charged for cancellation or no-show because they were able to go in on their own and reschedule their own appointment. So make sure we're leveraging technology whenever possible to do this work for us. My last point here on improving arrival rates is probably something that we don't consider very often of making sure in that initial evaluation that the patient actually has the time and or money to come to their physical therapy appointments. I feel like a lot of time patients feel beholden to maybe a referral they had from a doctor or what you tell them of some sort of verbal contract of the doctor said I have to come here three times a week for six weeks or maybe that's what you wrote on your documentation is the physical therapist and they feel like they have to come no matter what, even if they know they do not have the time or money. I feel like this is something that should be discussed as we're wrapping up our initial evaluations that just doesn't get done. As we're building the bike for that patient, we're explaining our findings, we're demonstrating that we can help that person reach their goals by showing them some improvement in that first visit and as we begin to discuss what that plan of care might look like, also making sure that the patient is on board, right, including the patient that conversation of hey, Diane, this seems to be a pretty irritable tendinopathy. You know, I think I would like to see you here in the clinic twice a week, probably for at least the next four weeks. And instead of stopping there, take it one step further. How do you feel about that? Right? What do you think about my plan for your care? And we don't necessarily have to ask, hey, can you afford this? Or do you have the time for this? But that's what we're hinting at of how do you feel about coming here twice a week for four weeks? How do you feel about coming here once a week for the next four weeks and getting the patient's input because that's a great time for them to say, that's going to be tough with my schedule. You know, I have 17 kids or I work 30 jobs. I won't be able to do that, right? That's a great time to make sure that person does not get put on your schedule for a bunch of visits that they're not going to attend. And then making sure we're following the law, right? No surprises act that was passed last year that were very transparent with how long we think the plan of care is going to take and what that's going to cost that patient. Whether you're charging cash, whether you're billing insurance, you need to provide that information upfront to the patient. I would argue you should be doing it even if it's not the law, just so you don't have people on your schedule who are not going to show up. But being very forthright and how long you think it's going to take and what's that going to cost and get that patient's input on it before we talk about scheduling out for their visits. 19:05 GETTING PAID FOR MISSED APPOINTMENTS My last point here of talking about what average arrival rates are, what improves arrival rates is how do we get paid when somebody does not show up to the clinic? This is another area where I think physical therapists are very uncomfortable with asking people for money to come to rather not come to their appointment. And it's an area where again, when we look at the research, what improves arrival rates, multi-method reminder system and having a rescheduled cancellation policy that is enforced. If you don't enforce it, you can't get paid for these missed visits. And if you try to enforce it like halfway through the plan of care, the patient is probably going to be upset versus if you're straightforward from the start in your intake paperwork and with your expectations before they begin physical therapy, it's not as jarring to that patient when you charge them for that canceled or rescheduled appointment. So remember, combination of a reminder system and a clearly stated 24-hour rescheduling policy that's enforced are the keys to reducing your no-show cancellation rate by as much as 50%. So first things first, create a policy. What do you want your policy to be? Make sure that policy is very clear, very transparent and that patients see it before they actually come to the clinic. So for us here at Health HQ, this is the first thing that patients see when they go through their intake paperwork. They see our cancellation no-show policy. They see our rates. They know what they're going to be charged. They know the maximum they can be expected to pay out of pocket if they do have insurance and they're going to see what they can be expected to be charged if they cancel or reschedule appointment within 24 hours. So ensure you have a policy, make sure it's actually written out, make sure that it gets in front of patients before they commit to a plan of care and then decide on what you want to charge that person. Decide on what your rate will be. I would argue it should be what you would want to get paid for that hour even if the patient had come. A lot of clinics will have what I would call a dinky, kind of a really lackluster enforcement policy where maybe if you don't show up to your appointment, you're charged $10 or $15. That's really not enough for people to have skin in the game. Being charged $10 or $15, especially if you don't actually enforce it, is really not going to set the expectations for your patients the way you want it. For us, we want to be sure the patient, sorry, the therapist gets paid as if they had seen that patient even if the patient no shows or cancels. So we charge $75 and we enforce it. Right? How do we enforce it? Well, you should probably start obtaining payment methods before the plan of care begins. So again, somewhere in your intake, transparent, clear, laid out should be what you charge for cancellation, a no show, a reschedule, the amount, and that you should take a payment method and have that payment method on file even before the initial evaluation happens so that even if they don't show up to the evaluation, your therapists are able to get paid for that hour. And then actually enforce it. You have to enforce it. You have to rip the bandaid off and actually do it. If you don't do it until somebody has done this to you 19 times, it's going to be difficult to actually start enforcing it because you've let them get away with it so many times. Maybe your personal policy in your mind is that everybody gets one freebie. Whatever that is, stick to that and then start actually enforcing it. What you'll find is that when you enforce it, guess what? The first time that patient gets charged that money, guess what they never miss again? Physical therapy. Or they reschedule so that they don't leave an empty spot on your calendar book. So recognize that we have to enforce this. Yes, it's uncomfortable, but the more you do it, the sooner you do it in the plan of care, the more you'll find patients will either adhere to it or they might decide therapy with you is not for them and that's okay too because the end result is we want people on our schedule who are actually going to come to physical therapy. We need to recognize that this is not unusual. Oftentimes we said, well, this isn't something physical therapists do. They don't charge people for not coming to appointments. Literally every other industry on the planet does this. When you make an appointment to get your haircut or whatever personal beauty grooming thing you do, they have a reschedule cancel no show policy where if you don't show up to your appointment for whatever reason, you're probably going to get charged a little bit of money. Massage therapists do this. Lawyers do this a lot. You have to pay money upfront to even talk to a lawyer, right? You have to have that retainer money on file. Dentists do this. Other healthcare providers do this. This is very, very common across a wide range of industries except for physical therapy. People often ask me, why do you think that is? I think it's because we spend a lot of time with our patients and we begin to almost view some of our patients maybe as friends or at least acquaintances, which makes it that much harder to begin to charge that person for missing a physical therapy appointment. So we need to recognize that yes, it is difficult, but again, every other business does this. Every other industry does this. The sooner and more comfortable you get with enforcing this, the less awkward it's going to feel. And remember, leverage technology to fill those missed appointment slots so that ideally the therapist still gets paid for that person not showing up, but maybe they can also fit another patient into that spot still. I love when I pull up our schedule and I see that somebody has canceled, they've been charged for it, and we've been able to pull another patient from the wait list to fill that same slot. That therapist went to work, came to work here that day thinking, I'm going to see seven people and they actually got paid as if they had seen nine. That's fantastic, right? That's way better than systems where you may be expected to clock out if a patient doesn't show up and not get paid at all for your time, or you may be expected to clean the toilets or something like that in that missed time versus actually getting paid for that time and either being able to use that time for whatever you want or trying to fit another patient into that slot. So remember, it's really important here. This is all an end, not or situation that there are different components to this that we need to implement. It's not just we need to charge people for not showing up. It's not just we need to have a reminder system that we need to understand that at some level, having 100% arrival rate is unlikely. People not showing up is unavoidable, whether kids, family emergencies, that sort of thing. But there are things that can be done to reduce those rates. They're not unavoidable that we can deliver great outcomes to patients so that they do not find other reasons and other things to do instead of coming to physical therapy. We absolutely have to get with the program and begin to leverage technology, begin to send these reminders out if we're not doing it already, begin to use technology to have a waitlist system so that we can fill empty slots quickly, create and actually enforce a policy, get credit cards on file, begin to actually charge people for not coming to those appointments, hold them accountable, hold their feet to the fire, but also recognize and have that conversation early on of what is realistic for that patient. Do they actually have the time and money to come to therapy two or three times a week? Or do we need to look at maybe, hey, I can see you once every other week, but you're going to have to be really judicious at home with your homework because you're not coming here as much. So having those conversations early and often in the plan of care so they don't come back to bite us later on and then utilize technology to get paid for those visits and fill those empty slots. So reschedules, cancels, no shows, not to the end of the world, things we can do better to get better at them, I should say. Leverage technology, enforce a policy. So I hope this was helpful. I hope you all have a fantastic Thursday. Have fun with Gut Check Thursday. If you're going to be on a live course this weekend, have a wonderful weekend with our faculty on the road. We'll see you all next time. Bye everybody. 24:17 OUTRO Hey, thanks for tuning in to the PT on ICE Daily Show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ICE content on a weekly basis while earning CEUs from home, check out our virtual ICE online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Dr. Jeff Moore // #LeadershipThursday // www.ptonice.com In today's episode of the PT on ICE Daily Show, ICE CEO Jeff Moore challenges the common belief that vacations and time off are necessary to decrease stress levels. He argues that the expectations around time off may not align with reality, often leading to discontentment. Jeff suggests reconceptualizing the idea of time off and vacations to have better trajectories and lower stress levels. Jeff then discusses what creates low stress levels and a healthy ecosystem. He addresses the issue of returning from vacations to a chronically disorganized routine. Jeff explains that when our day-to-day lives lack discipline and organization, we often find ourselves in a cycle of feeling like we need a vacation, being disappointed by its inability to meet our expectations, and feeling worse off as a result. Jeff emphasizes the importance of taking ownership of our day-to-day routines and reorganizing them to break free from this cycle. Take a listen to the podcast episode or read the full transcription below. If you're looking to learn more about courses designed to start your own practice, check out our Brick by Brick practice management course or our online physical therapy courses, check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 JEFF MOORE Alright team, what is up? Welcome to the PT on ICE Daily Show. Welcome to Leadership Thursday. I am Dr. Jeff Moore, currently serving as the CEO of Ice. Thrilled to have you here live via Instagram or YouTube. Thrilled to have you on the recording if that's the way you're taking in the show. It is Gut Check Thursday. Let's get right down to business. What is the workout that all of the Ice Train folks are going to be taking on this week? It is as follows. 35, 25, 15, 5. So we have 4 rounds descending in volume. They are going to be double dumbbell push press but not real heavy, 35 and 20. And then ab mat sit ups are going to be paired with that. Okay, so you've got your 35 dumbbell push press drop down. You get your 35 ab mat sit ups. In between each round, you're going to run 200 meters and the rounds are going to be 35, 25, 15, 5. Okay so you should be able to keep a pretty high intensity up because the volume on those rounds are dropping. Make sure you get a snippet of that. Put it on Instagram. Let us know what's up. Hashtag Ice Train. We love seeing everybody throwing down on those Gut Check Thursday workouts. Real quick, courses coming up. I want to highlight cervical spine. If you want to be out there solving neck pain, radiculopathy, headaches, all the things that come with that upper quarter region, get to this class. We've got 3 options coming up. August 26, 7. It's going to be at Onward Charlotte. September 9, 10. It's going to be at Onward Atlanta. In October 14, 15. Going to be at Onward Greenville. So going to be in North Carolina, going to be in Georgia, going to be in South Carolina. So belt there and hit that course. Learn those skills. Serve those patients well. Okay, welcome back to Leadership Thursday. 02:01 VACATON & WORK-LIFE BALANCE We are going to have a conversation about why I think we've gotten vacations wrong. And I want to talk a little bit about the origin of this episode. So the other day I posted on Instagram some of the best advice I've ever received. It was from a friend. It was many, many years ago. And he said to me, if you play between the ages of 25 and 35, you will work hard for the rest of your life. If you work hard between the ages of 25 and 35, you will play for the rest of your life. And as I've watched now coming up on wrapping up the second decade of my career, I've seen a lot of people finish off their careers, seen a lot of people start them, myself going through my own. A lot of observation and the amount of truth embedded in that quote has been nothing short of shocking. When you get in the right lane early, and you get to you get with the right people early, you wind up doing what you love and excelling at it. And of course, just like investing, the earlier you do that, the more it compounds. And it really creates a scenario where the back two thirds of your career not only are more of what you love, but really decompress the stress. On the other hand, if you kind of get yourself into a financial hole and you're not in the right lane, and you're nearing the halfway point of your career, it really becomes a tough thing to dig out of. And it just sets you up for a bit more of a grind on the back end. Now we could have a whole episode about that quote alone, but that quote got a lot of feedback. And anytime you talk about working hard, you tend to get a lot of DMs and messages about the need for people to avoid burnout. And specifically that people need vacations and time off to decrease their stress levels. 03:46 EXPECTATIONS AROUND TIME OFF That's what I want to zone in on because I think that our expectations around time off are really, really aired, if you will. And the problem with your expectations not being aligned with reality is that discontent is the inevitable result of that. So let's see if we can't reconceptualize this a bit and wind up with better trajectories. So think about what creates low stress levels. So if we're going to talk about stress levels, what creates low stress levels? What creates a healthy ecosystem? The answer is the following. Now we could put nine bullets here, but let's go with the really, really big rocks. That when you have them dialed in, your stress levels tend to be low, your nervous system tends to be really under wraps, you tend to feel really dialed. Probably the biggest one we'd all agree on is sleep quality. The consistency of it we know is the primary driver. But the other small things, having it cold in the room, having it dark when you're eating food, not having those late meals, sleep consistency is probably, or sleep quality, driven primarily by consistency, is one of the biggest drivers to day to day having low stress, having more energy. Number two is a regular fitness routine. You're getting to the gym at the same time that you're engaging in quality fitness. Number three is nutrition, that you're eating a quality, clean, well-balanced diet. Sufficient in protein, void, hopefully, of a lot of nonsense and processed foods, that you're eating quality nutrition. When you're doing these things that we preach about all the time, your ecosystem tends to be optimal, your stress levels tend to be low, you tend to feel your best when those variables are dialed in. Now think about how those variables fare when you're on vacation. And I think we would all agree the answer is poorly. You're sleeping in a totally foreign environment, your consistency of your sleep is all over the map, you're trying to get some fitness in but it's random, it's not nearly as structured as usual, and your nutrition, let's be honest, leaves a lot to be desired. It's usually very fun food, you're usually trying a lot of new things, but you tend to be eating late at night, it affects your sleep quality, all of the primary metrics that create that really well-defined healthy, low-stress human are significantly disrupted, specifically when you're on vacation. Now does this mean, right, and I think it's worth saying that if that's not the case, if those things, if your sleep quality, your gym routine, your nutrition, if those things are better when you're on vacation, your day-to-day routine needs a serious second look. So if you don't have those things dialed in better on your day-to-day and your usual environment compared to when you are out in some random state or country where you've got no control of the other variables, if you do better on those things out there, you need a serious look at your level of discipline and organization on your day-to-day life. But I think for the vast majority, as we would agree, those things are pretty dialed when we're at home and they are very erratic when we're on vacation. Now does this mean that we shouldn't take vacations? And the answer to that is of course not, right? A lot of the coolest memories in your life, right? The things that you're going to do that you're going to look back on and say, gosh, that was crazy or do you remember that? And the stories that fill your life, a lot of those things are going to be formed when you're on vacation. Your perspective will expand, right? You're going to be in new environments. You're going to be seeing new people. You're going to be looking at things differently because you're outside of your usual routine. Your relationships with those that you go on will often deepen, whether it's your partner or your family or your friends, right? You rarely spend that kind of concentrated time and it creates incredible opportunity for those relationships to deepen. All of these incredible things are going to happen when you're on vacation. What will not happen though is usually that your stress level will drop because the things that drive that are generally disrupted. So then what's the secret sauce? 08:18 DEVELOPING A ROUTINE FOR VACATION The secret sauce is developing a routine that allows you to look forward to, but never need a vacation. That's the most important thing, right? You can't wait to do it. It's going to be a blast. You know those memories are going to be formed, but you don't need it because your routine day to day is so dialed that you feel outstanding, even under the presence of high workload because you've dialed in those metrics. So developing a routine that allows you to look forward to it, but not be desperate for it, not require it. And number two enables you to bounce back upon your return because if you do vacations right, a lot of that stuff is probably disrupted and you're probably coming home, hopefully thinking the classic quote, I can't wait to get back into my routine. That is a very healthy thing to be thinking, right? Like, hey, we went out there, we collected incredible memories, we got new perspective, we deepened relationships, we did all of the enriching things that vacation can bring. But now I'm pumped to get back into my dialed in routine because that's what's going to drop back down my stress level. That's what's going to allow me to perform optimally. So hopefully you're coming back to a routine that's dialed that not only did you not even need the vacation in the first place, you're bouncing back in two to three days, as opposed to having that post vacation hangover for weeks on end where you can't get your act together, which only increases your stress, which makes you need to step away again. And now you're in this vicious cycle of trying to survive when you're there and always wanting to be gone. The exact opposite should be true. You should love when you're gone and be taking a ton from that, but you should be strengthening while you're home to be able to enable that. Not weakening while you're home, hoping that it can do something that it can't when you step away. That's the challenge. The bottom line is people need more disciplined lives to decrease their stress levels. And people need vacations to enrich their existence. Unfortunately, a lack of discipline in our day to day lives requires a need and a desire for vacations chronically and a hope that they can do something that they usually won't. Simply because the organization of them doesn't tend to organize our nervous system. It tends to disrupt it, which in the right amount, when you've already got it balanced, is an amazing stimulus to get you to think differently, to get you to freshen up, if you will. 11:14 TAKING OWNERSHIP OF ROUTINE But if you are coming back to a routine that's chronically disorganized, you're going to be in that vicious cycle of, I feel like I need a vacation. The vacation didn't do what I wanted it to do. Now I'm a little bit worse off. And we go back and forth and back and forth. And there's really no getting out of that wheel until we reorganize and take ownership of what we're doing on the day to day. Then we can enjoy the vacations and be strengthened by our routine. So just want to put that out there because so often people are saying that people need vacations to decrease stress. I think we can live in a way that we don't need that at all. And yet we do get great things from those breaks and can certainly take them as opportunity allows. Hope that makes some sense. Had some great conversations this week. Feel free to continue those in the comments. Everybody have a wonderful Thursday. Thanks for being here on Leadership Thursday.

Dr. Jeff Moore // #LeadershipThursday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, ICE CEO Jeff Moore emphasizes the importance of considering individual circumstances and not allowing blanket statements to hinder progress. While the general principle of "do less better" is often advocated for efficiency and clarity, Jeff acknowledges that there are exceptions to this approach. Jeff encourages listeners to think about situations where a person may come into the clinic with psychological barriers or feeling overwhelmed. In these cases, Jeffg suggests that overwhelming the individual with multiple interventions or exercises may actually be beneficial. By providing a variety of options and allowing the person to choose one or two to focus on, it can help shift their psychology and get them on board with the treatment plan. Jeff also mentions that this concept applies not only to exercise but also to other aspects of healthcare, such as sleep hygiene and diet. Instead of overwhelming individuals with a long list of changes to make, it is more effective to start with one or two manageable changes. This approach makes it more approachable and minimizes barriers to compliance. Overall, the episode highlights the importance of considering individual circumstances and being flexible in treatment approaches. While the general principle of "do less better" is valuable, it is essential to recognize that there are times when overwhelming individuals with options or interventions can be beneficial in getting them on board and moving in the right direction. Take a listen to the podcast episode or read the full transcription below. If you're looking to learn more about courses designed to start your own practice, check out our Brick by Brick practice management course or our online physical therapy courses, check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 JEFF MOORE Alright team, what's up? Welcome to the PT on Ice Daily show. I am Dr. Jeff Moore, currently serving as the CEO of Ice and thrilled to be here on a Leadership Thursday. Always wonderful to have you on Instagram, on YouTube if you're live streaming or over on the podcast. Thank you so much for carving out a few minutes for us today. It is Thursday, it means it's Gut Check Thursday, and it is a doozy. So many of you are at the CrossFit Games, you're probably going to be throwing this workout down together. I know it comes from our friends at Mayhem, they're probably going to be doing it as well. But the workout is, and it would be simple if it was just the first part, it is a hundred for time at a relatively manageable weight. Okay, so we've got 75-55 on the bar. Many of you probably remember the 100 clean and jerks for time that we've done I think twice now. The problem is you also have an EMOM of 15 air squats, and that's going to make it a different kind of stimulus, and that includes starting at zero. The first thing you're going to do when the timer goes off or Gut Check Thursday is you're going to bang out 15 air squats, then you're going to grab your bar and start rocking your power snatches. You're going to keep doing this every minute, 15 air squats, as many power snatches as you can until you've accumulated 100 power snatches at 75 or 55 pounds. Can't wait to see some of the post commit, I already saw one this morning, somebody said their low back was on fire, I'm sure that's the case, I can't wait to try it. Probably going to knock that out here on Saturday afternoon. Alright, as far as upcoming courses go, I want to highlight, speaking of power snatches, I want to highlight our Fitness Athlete Live courses because the ones that are coming up, I see those courses swelling. So Mitch is going to be in Bismarck, and that is going to be on 9-9. So that's in four weeks, a little over four weeks. That class is already pushing 30 people, we're about at capacity, so if you want to jump into Bismarck, you're going to need to probably do that in the next week or so. Similar story for Newark, California, Zach is going to be down there on October 7th, and again, I'm seeing that course edge towards capacity, so if you want to jump in Fitness Athlete Live, you're going to want to make that move pretty quick. We do have Linwood, Virginia following that, so it goes Bismarck, 9-9, it goes Newark, 9-30, it goes Linwood, Virginia, 10-7. If you want to jump into one of those courses, try to make it happen in the next week or so to make sure you get your seat. Alright, it is Leadership Thursday, but this one's a little bit more clinical, but I do think that it really revolves around leading people, so I think it's appropriate for this day of the week. 02:56 "DO MORE, BETTER" I want to talk about doing it more, better sometimes. Now the obvious caveat we have to open with is the fact that we have preached do less better on this show, in this company, for the better part of a decade almost constantly, and there are good reasons for that because the majority of times, doing less better is what makes it work, is what makes for an efficient avail, is what allows you to know which intervention you did actually have the effect. If you're doing a million things with a small dosage, you have no clue what moved the needle. More importantly, your patient doesn't know, so they don't know what to focus on, they don't know what to attach their outcome to. If you're doing a ton of things, it gets messy, it lacks clarity, and it's very hard to get treatment effect. Additionally, it's very hard to give sufficient dose of anything if you're doing everything. Do less better is a hallmark statement and should generally be observed. The challenge I want to make for all of us, including myself this morning, is it always the case though? Is there sometimes, and there should be exceptions to all of this stuff, are there sometimes where overwhelm is exactly what the doctor ordered? Are there times we have to go big? Right now, what's very in vogue, and I generally like this, is things like don't do more than three exercises. There's actually a bit of research showing from a compliance perspective that statement makes sense. If you give somebody a whole laundry list of things to do, they're not going to do any of them. But it's not just exercise. We're hearing these comments around things like sleep hygiene. Don't try to make a bunch of changes, just make one. We hear it around diet. Don't change a ton of things, just start with one or two. I myself preach this all the time. Make it approachable, try to minimize barriers, just choose one or two. But I want us to pause for a second to make sure we don't just make this our default And think about when the opposite might make more sense. 06:30 MANAGING RELUCTANT PATIENTS I want us to think about that reluctant encounter. What I mean is that person who comes into your clinic and you can tell they are really suspect, they're suspicious about whether or not this is really going to work. And you know this person. This is not the person who gets rehab consistently. It's not the person who's already bought into this being the primary treatment choice. It's the person who's like, I don't know about this. My doctor said come so I'm here, but I just don't know about this. Think about that person who's really reluctant. For some people, for that person in particular, this might be the only time that they're going to be in this stage where they're even considering this route. It's not the route they've used in the past. They're really unsure about it, but they've heard some good things. They were told to be here. It's a small window of opportunity. You might only get one at bat with this patient. You can all picture this person. You've got him on your caseload right now. You can just feel what their energy is. I don't know about this. I don't think this is going to get the job done. You might only get one shot at this person. And I want to make a two-part argument about how we manage this individual, especially at that first encounter, which might be the only encounter if things go wrong. The absolute worst outcome with that person is nothing. The absolute worst outcome is no change because it's kind of what they think is going to happen. This is a waste of my time. This isn't going to work. Getting no change is the worst possible outcome. The second argument I'll make is that while I totally agree, especially this person, won't do a bunch of things for a long period of time, they will not do the long litany of exercises, they won't make a million changes, they won't do those things for a long time, but I think they will do it for four or five days. I think they will make a really aggressive change because they're wondering if their time is being well spent. They almost want to prove it wrong sometimes. Like, see, it didn't work. While I don't think a long list of massive lifestyle or exercise changes is sustainable for that person long term, I do think they'll do it for a few days, especially if we tell them, hey, listen, this is not sustainable for a long period of time. What we're trying to see is if we can move this needle. So let's figure it out once and for all and right out of the gates. What if we go this route where we tell them, you don't have to do this for a long time, we're going to put all the guns on early, we're going to see if anything changes. If nothing changes with a high dose, we can both agree that this isn't going to work. But if something does change, what we can then do is begin to look at what you've got on the board and we can tease that down to the things that were the most manageable for you to alter. And that's the stuff that we can ride out into the sunset. Right. Then we can pare down the program. What I'm saying is, should we be asking a ton upfront, prove that change will happen with the highest dose that they can tolerate and then refine and make it sustainable? Should we be telling them, I'm going to ask you never to continue this, but I want to know if we can make a difference and then we'll choose the things that were the easiest for you to stay with. And that's going to be our long term program. It's not for everyone. It's not even for most. 08:38 SWING FOR THE FENCES But on those people who are particularly doubtful that PT will work, I think we need to swing for the fences. And I'm bringing this episode to you because I've had numerous conversations recently with people who did the less better thing, right? Small changes that were easy for the patient that didn't do anything. Where the patient was like, I don't really think I felt a difference. That's fine. In someone who's committed to rehab being the solution, that is not fine. In someone who's testing you out to see whether or not they're wasting their time. On that second person, we need to identify them and say, look, they're only going to give us one chance. We don't need to make it sustainable. We need to make it noticeable. I want to say that one more time. In the highly speculative person, we don't need to make it sustainable. We can worry about sustainability later. We need to make it noticeable. We need to tell them what I'm about to ask is you're going to eliminate a bunch of stuff from your diet. You're going to change a bunch of things about your sleep environment. You are not going to have to maintain these long term. This is going to tell both of us if you're in the right spot. Once that person comes back and you've all had the person who's made really drastic diet changes, think about fasting or total sugar elimination. What do they come back and say? They say really drastic things like, my gosh, I feel less swollen all over my body. I had carpal tunnel as well and that feels better. I used to have headaches and now I don't. They tend to see things happen because they made such a drastic change to the ecosystem. In the unsure speculative patient, that is exactly what the doctor ordered because the number one goal with them is psychological. We've got to get them to believe, oh my gosh, this stuff can actually have an effect on my condition. Now the moment they realize that these are the things that I should be tweaking to make a change, now we alter that program to make it sustainable and do less better. 11:29 OVERCOMING PSYCHOLOGICAL BARRIERS But I am making a call to action on this episode that for the reluctant individual, for the person with the psychological barrier, doing more in the very short term to show them that what won't happen is nothing is the most important thing to get that initial piece of traction that allows you to then refine, pare down and make sustainable a program they now believe in. Give it some thought. Is there a place to go with overdoses, overwhelm, to shift psychology, to get that goal in mind and get that patient on board? I hope it makes sense. In general, I'm always going to believe in do less better but there are always exceptions and let's make sure that we're not letting a blanket statement prevent those people from moving in the right direction. Cheers everybody, PT on ICE.com, you know where the goods live. All of you at the CrossFit Games, good luck. Kelly Benfey, especially good luck. I hope the 64 Army crushes it this weekend. I will certainly be watching from right here. Cheers everybody, take care. 12:20 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 Check out our virtual ICE online mentorship program at PT on ICE.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to PT on ICE.com and scroll to the bottom of the page to sign up.

Today you're going to hear Robert's attorney, Jeff Moore's, closing. He takes an interesting approach in his closing argument. Listen ad-free on Patreon. See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.