Podcasts about ptonice

Want to level up your group fitness in Memory Care? Join Trisa as she reviews considerations for set up, maintaining attention to task, and specific cues for exercise and safety. https://music.apple.com/us/playlist/exercise-class/pl.u-XkD04X0UDYkKkKp If you found this content helpful, go to https://PTonICE.com to check out our collection of Free Resources like the MMOA Digest our Bi-Weekly Research Email that goes out to thousands of clinicians.

Are you working hard to help your patients with dementia build strength and mobility? And then faced with caregivers concerned with the mobility causing a potential safety risk? Have you been asked to refrain from helping your patient become "too mobile"? In this episode we address this conversation from all angles to help you navigate the conversation with the caregiver while supporting your patient's well-being. If you found this content helpful, go to https://PTonICE.com to check out our collection of Free Resources like the MMOA Digest our Bi-Weekly Research Email that goes out to thousands of clinicians.

In this heartfelt conversation, Christina Prevett reflects on her mother's journey through terminal illness, emphasizing the importance of dying with dignity and the lessons learned about life, family, and the value of living boldly in the face of mortality. She shares personal anecdotes and insights on how her mother's diagnosis transformed their relationship and prompted a deeper appreciation for life. 00:00 Reflecting on Life and Death 08:08 Navigating the Journey of Dying with Dignity 11:48 The Importance of Dignified Death Planning 16:10 Living Boldly in the Face of Mortality   Original Publishing: December 31 2025

In this episode of the MMOA podcast, Ellen Csepe discusses the concept of Inflammaging, its implications for aging populations, and practical strategies for managing inflammation through lifestyle changes, including exercise and diet. She emphasizes the importance of understanding the role of obesity in inflammation and highlights the potential benefits of new medications in reducing inflammation. The conversation aims to equip healthcare professionals with knowledge to better support their patients in managing inflammation and improving overall health. If you found this content helpful, go to https://PTonICE.com to check out our collection of Free Resources like the MMOA Digest our Bi-Weekly Research Email that goes out to thousands of clinicians.

Trisa Hutchinson, Doctor of Occupational Therapy reviews 3 tips for navigating the conversation of when an older adult should stop driving. Here you learn about what to look for in the clinic, who to refer to for a concrete answer, and how to support your older adults with community mobility if they are no longer safe with driving. If you found this content helpful, go to https://PTonICE.com to check out our collection of Free Resources like the MMOA Digest our Bi-Weekly Research Email that goes out to thousands of clinicians.

Join @theradork to discuss 5 clinical presentations of patients who were able to benefit from AFOs and LITERALLY climb mountains with the right selection! Using an AFO might feel like you're allowing weakness to win, but in reality, the right AFO can make a huge difference in endurance and fall prevention!  If you found this content helpful, go to https://PTonICE.com to check out our collection of Free Resources like the MMOA Digest our Bi-Weekly Research Email that goes out to thousands of clinicians.

Join @coach.noush_dpt as she dive's into the article "Exploration of combined physical activity and music for patients with Alzheimer's disease: A systematic review".  If you found this content helpful, go to https://PTonICE.com to check out our collection of Free Resources like the MMOA Digest our Bi-Weekly Research Email that goes out to thousands of clinicians.

Dive into a reframe on using hobbies as a gateway to fitness with @macybolt! If you found this content helpful, go to https://PTonICE.com to check out our collection of Free Resources like the MMOA Digest our Bi-Weekly Research Email that goes out to thousands of clinicians.

Join @trisaleehutch as she explains why Occupational Therapists need to be using deadlifts in session to help changes their patient's lives. If you found this content helpful, go to https://PTonICE.com to check out our collection of Free Resources like the MMOA Digest our Bi-Weekly Research Email that goes out to thousands of clinicians.

Join Dr. Macy Bolt as she talks about how to use genuine curiosity to improve your patient's experience with rehab! If you found this content helpful, go to https://PTonICE.com to check out our collection of Free Resources like the MMOA Digest our Bi-Weekly Research Email that goes out to thousands of clinicians.

In this episode of the MMOA podcast, host Dustin Jones interviews Dr. Betsy Spieler, a physical therapist and business owner, about her experiences at the National Senior Games and her journey in the fitness and therapy space. Betsy shares her observations from competing and supporting other athletes, the impact of her experiences on her clinical practice, and the importance of engagement and motivation in health. She discusses her business, Stay Strong Omaha, which aims to bridge the gap between therapy and fitness for older adults, and highlights the opportunities for physical therapists in this growing field. If you're curious about the Senior Games or starting your own Fitness/PT Hybrid practice, this episode is for you! Mentioned Links: Betsy Spieler Instagram Stay Strong Omaha - Facebook Page --- Want to learn how to better serve Senior and Masters Athletes? Check out our ICE Certified Older Adult Specialist Certification at https://PTonICE.com/mmoa

Go the extra mile and join @trisaleehutch to learn about the 3A's to support an increase in hydration for your geriatric patients.  If you found this content helpful, go to https://PTonICE.com to check out our collection of Free Resources like the MMOA Digest our Bi-Weekly Research Email that goes out to thousands of clinicians.

Join Dr. Kay Mayordomo, PT, DPT as she reflects on a trip to Sardinia and what it taught her about how striving for longevity doesn't have to be complicated. If you found this content helpful, go to https://PTonICE.com to check out our collection of Free Resources like the MMOA Digest our Bi-Weekly Research Email that goes out to thousands of clinicians.

Find YOUR super set of exercises to streamline your ability to prescribe a general exercise program for ALL your patients! Our patients need CONFIDENT exercise prescription to face sarcopenia, falls, and loss of independence. Make sure you have a routine in exercise prescription so that NOBODY leaves your practice without knowing what they are capable of!! If you found this content helpful, go to https://PTonICE.com to check out our collection of Free Resources like the MMOA Digest our Bi-Weekly Research Email that goes out to thousands of clinicians.

Join @trisaleehutch as she discusses how grip strength can be a predictor of health outcomes and what this means as a guide for interventions.   If you found this content helpful, go to https://PTonICE.com to check out our collection of Free Resources like the MMOA Digest our Bi-Weekly Research Email that goes out to thousands of clinicians.

Join Kay Mayordomo, PT, DPT as she goes over the other important aspects of osteoporosis management that play a role besides the T-score.   If you found this content helpful, go to https://PTonICE.com to check out our collection of Free Resources like the MMOA Digest our Bi-Weekly Research Email that goes out to thousands of clinicians.

Join @coach.noush_dpt as she discusses rosk factors of osteoarthritis-especially how we can address the genetic component of it with patients! If you found this content helpful, go to https://PTonICE.com to check out our collection of Free Resources like the MMOA Digest our Bi-Weekly Research Email that goes out to thousands of clinicians.  

Join @theradork aka Dr. Ellen Csepe as we discuss the obesity paradox and our role as clinicians in addressing this global health crisis while aligning with new medical Interventions    If you found this content helpful, go to https://PTonICE.com to check out our collection of Free Resources like the MMOA Digest our Bi-Weekly Research Email that goes out to thousands of clinicians.

Join @macybolt as she unpacks 5 tips to help optimize care for patients after head injury!   If you found this content helpful, go to https://PTonICE.com to check out our collection of Free Resources like the MMOA Digest our Bi-Weekly Research Email that goes out to thousands of clinicians.

Lighten your load without lowering your intensity!  @trisaleehutch brings the heat with 5 must-have tools for your home health care kit. These game-changing essentials help you level up your care—without weighing you down. Smarter tools, stronger support. If you found this content helpful, go to https://PTonICE.com to check out our collection of Free Resources like the MMOA Digest our Bi-Weekly Research Email that goes out to thousands of clinicians.

Do you have a patient on your caseload that you're scratching your head about because they've been told they don't have Parkinson's and you're not quite sure what it may be? Join Kay Mayordomo, PT, DPT (@kaym23) as she reviews normal pressure hydrocephalus (NPH).   If you found this content helpful, go to https://PTonICE.com to check out our collection of Free Resources like the MMOA Digest our Bi-Weekly Research Email that goes out to thousands of clinicians.

This week @sbship8_dpt chats about the importance of electrolytes to prevent and limit effects of osteoporosis and education that can help guide you and your patients to optimal bone health.   Check out these articles for more info:

Join @coach.noush_dpt as she shares components (outside of traditional balance training) that are helpful when training for falls with people with Parkinson's disease. If you found this content helpful, go to https://PTonICE.com to check out our collection of Free Resources like the MMOA Digest our Bi-Weekly Research Email that goes out to thousands of clinicians.

Wondering if a bidet could be helpful for you or your patients? Check out our latest podcast with@theradork @laurlova talking all things bidets and their benefits!!! #olderadult #bidet #tushybidet #biobidet   If you found this content helpful, go to https://PTonICE.com to check out our collection of Free Resources like the MMOA Digest our Bi-Weekly Research Email that goes out to thousands of clinicians

Join Macy Bolt as she unpacks reactive balance training and how to push your patients to improve their balance! https://doi.org/10.3390/jcm13195790 If you found this content helpful, go to https://PTonICE.com to check out our collection of Free Resources like the MMOA Digest our Bi-Weekly Research Email that goes out to thousands of clinicians.

Join Kay Mayordomo, PT, DPT (@kaym23) as she reviews a study on predictors of emergency preparedness among older adults and how rehab providers can help. If you found this content helpful, go to https://PTonICE.com to check out our collection of Free Resources like the MMOA Digest our Bi-Weekly Research Email that goes out to thousands of clinicians.

Join @jmusgravePT as he discusses a recent international scoping review of different types of exercise modalities and their impact on improving cognition in those with Mild Cognitive Impairment!  Dig in here: DOI: 10.7759/cureus.80895 *If you want more helpful content to better serve older adults, sign up for our MMOA Digest = Free Bi-Weekly Email packed with helpful links, posts, & research relevant to your work. Link In Bio or PTonICE.com **Looking for CEU's & courses that will change your practice? Check out our MMOA Course Offerings (Online & Live) Link In Bio or PTonICE.com #physicaltherapy #geript #homehealthpt #pt #dpt #dptstudent #physiotherapy #physicaltherapist #physiotherapist #physicaltherapystudent #newgradpt #physiotherapystudent #physicaltherapyassistant #physicaltherapyassistantstudent #geript #geriot #OTs #OTA #occupationaltherapist #ottreatmentideas #otstudent #otastudent #occupationaltherapyassistant #oldnotweak #ptonice #icetrained  

Are stimulating foot orthoses all hype or actually helpful for balance? Join @dustinjones.dpt as he discusses what you need to know about this new study looking at the impact of stimulating foot orthoses on balance in older adults. Referenced article (closed-access): https://doi.org/10.1016/j.gaitpost.2025.03.016 ----- Check out more info from the Older Adult Division and our Certification at https://PTonICE.com

Dr. Jeff Moore // ICE CEO // www.ptonice.com 

Join @jmusgravept as he discusses a recent randomized control trial, comparing aerobic & cognitive outcomes for high-intensity interval training (HIIT) compared to moderate-intensity interval training (MIIT) for older adult adults with no training history. Aerobic outcomes were similar measured by peak VO2 max, however working memory & peak knee extensor strength was slightly better for the HIIT group & they achieved this in 1/2 the training time! doi: 10.1093/gerona/glad070 *If you want more helpful content to better serve older adults, sign up for our MMOA Digest = Free Bi-Weekly Email packed with helpful links, posts, & research relevant to your work. Link In Bio or PTonICE.com **Looking for CEU's & courses that will change your practice? Check out our MMOA Course Offerings (Online & Live) Link In Bio or PTonICE.com #physicaltherapy #geript #homehealthpt #pt #dpt #dptstudent #physiotherapy #physicaltherapist #physiotherapist #physicaltherapystudent #newgradpt #physiotherapystudent #physicaltherapyassistant #physicaltherapyassistantstudent #geript #geriot #OTs #OTA #occupationaltherapist #ottreatmentideas #otstudent #otastudent #occupationaltherapyassistant #oldnotweak #ptonice #icetrained

@jmusgravept discusses the role of gut microbiome in nutrient absorption, inflammatory processes and how this shifts with aging as well as the role of exercise in making positive shifts to promote healthy aging & fight chronic disease. “Systematic Review of the Effects of Exercise and Physical Activity on the Gut Microbiome of Older Adults” DOI: https://deoi.org/10.3390/nu14030674 *If you want more helpful content to better serve older adults, sign up for our MMOA Digest = Free Bi-Weekly Email packed with helpful links, posts, & research relevant to your work. Link In Bio or PTonICE.com **Looking for CEU's & courses that will change your practice? Check out our MMOA Course Offerings (Online & Live) Link In Bio or PTonICE.com #physicaltherapy #geript #homehealthpt #pt #dpt #dptstudent #physiotherapy #physicaltherapist #physiotherapist #physicaltherapystudent #newgradpt #physiotherapystudent #physicaltherapyassistant #physicaltherapyassistantstudent #geript #geriot #OTs #OTA #occupationaltherapist #ottreatmentideas #otstudent #otastudent #occupationaltherapyassistant #oldnotweak

Protein supplementation is all the rage currently - LOTS of benefits being claimed and LOTS of marketing $$$.

If not already, you're likely going to be confronted with questions from your clients in terms of its benefits and how much is appropriate. Join @dustinjones.dpt in this episode as he discusses those questions and explores the recent evidence for protein's influence on bone health. Good reads related to this topic: -DOI: 10.1007/s00198-023-06709-7 -DOI: 10.1007/s00198-025-07393-5 Learn about the ICE Older Adult Specialist Certification - https://PTonICE.com

How to fight the #1 killer of older adults Join @jmusgravept today on the Daily Show as he discusses a recently published research study comparing the effects of aerobic training versus strength training on hypertension in healthy older adults. Jeff highlights the importance of strength training in long-term wellness programs for older adults, particularly in managing hypertension. Differential Effects of the Type of Physical Exercise on Blood Pressure in Independent Older Adults DOI: 10.1177/19417381241303706 STRENGTHOLD Program: : doi: 10.3390/ijerph18063253 High-intensity interval training in cardiac rehabilitation: a multi-centre randomized controlled trial doi: DOI: 10.1093/eurjpc/zwad039 Effects of High-Intensity Interval Training on Muscle Strength for the Prevention and Treatment of Sarcopenia in Older Adults: A Systematic Review of the Literature. doi: 10.3390/jcm13051299 *If you want more helpful content to better serve older adults, sign up for our MMOA Digest = Free Bi-Weekly Email packed with helpful links, posts, & research relevant to your work. Link In Bio or PTonICE.com **Looking for CEU's & courses that will change your practice? Check out our MMOA Course Offerings (Online & Live) Link In Bio or PTonICE.com #physicaltherapy #geript #homehealthpt #pt #dpt #dptstudent #physiotherapy #physicaltherapist #physiotherapist #physicaltherapystudent #newgradpt #physiotherapystudent #physicaltherapyassistant #physicaltherapyassistantstudent #geript #geriot #OTs #OTA #occupationaltherapist #ottreatmentideas #otstudent #otastudent #occupationaltherapyassistant #oldnotweak #ptonice #icetrained

Join @jmusgravept as he reviews an observational study completed in the acute setting looking at the impact of the ability or inability to walk on health outcomes & effect of progressive resistance training on non-ambulatory acute care patients. “The impact of mobility limitations on geriatric rehabilitation outcomes: Positive effects of resistance exercise training (RESORT)” published 9/5/24. Link To Article: https://doi.org/10.1002/jcsm.13557 Link to FAC : https://www.sralab.org/rehabilitation-measures/functional-ambulation-category *If you want more helpful content to better serve older adults, sign up for our MMOA Digest = Free Bi-Weekly Email packed with helpful links, posts, & research relevant to your work. Link In Bio or PTonICE.com **Looking for CEU's & courses that will change your practice? Check out our MMOA Course Offerings (Online & Live) Link In Bio or PTonICE.com #physicaltherapy #geript #homehealthpt #pt #dpt #dptstudent #physiotherapy #physicaltherapist #physiotherapist #physicaltherapystudent #newgradpt #physiotherapystudent #physicaltherapyassistant #physicaltherapyassistantstudent #geript #geriot #OTs #OTA #occupationaltherapist #ottreatmentideas #otstudent #otastudent #occupationaltherapyassistant #oldnotweak #ptonice #icetrained

@jmusgravept shares a case of an older adult having back pain with deadlifting. He covers the process of using : 1. Show, Tell, Touch 2. Progressive Loading 3. Monitoring Symptom Irritability *If you want more helpful content to better serve older adults, sign up for our MMOA Digest = Free Bi-Weekly Email packed with helpful links, posts, & research relevant to your work. Link In Bio or PTonICE.com **Looking for CEU's & courses that will change your practice? Check out our MMOA Course Offerings (Online & Live) Link In Bio or PTonICE.com #physicaltherapy #geript #homehealthpt #pt #dpt #dptstudent #physiotherapy #physicaltherapist #physiotherapist #physicaltherapystudent #newgradpt #physiotherapystudent #physicaltherapyassistant #physicaltherapyassistantstudent #geript #geriot #OTs #OTA #occupationaltherapist #ottreatmentideas #otstudent #otastudent #occupationaltherapyassistant #oldnotweak #ptonice #icetrained

@jmusgravept shares a case of an older adult having back pain with deadlifting. He covers the process of using : 1. Show, Tell, Touch 2. Progressive Loading 3. Monitoring Symptom Irritability *If you want more helpful content to better serve older adults, sign up for our MMOA Digest = Free Bi-Weekly Email packed with helpful links, posts, & research relevant to your work. Link In Bio or PTonICE.com **Looking for CEU's & courses that will change your practice? Check out our MMOA Course Offerings (Online & Live) Link In Bio or PTonICE.com #physicaltherapy #geript #homehealthpt #pt #dpt #dptstudent #physiotherapy #physicaltherapist #physiotherapist #physicaltherapystudent #newgradpt #physiotherapystudent #physicaltherapyassistant #physicaltherapyassistantstudent #geript #geriot #OTs #OTA #occupationaltherapist #ottreatmentideas #otstudent #otastudent #occupationaltherapyassistant #oldnotweak #ptonice #icetrained

Transforming Lives With Group Fitness: Considerations for Rehabilitation Professionals. @jmusgravept shares the keys from a newly published article he co-wrote with @dustinjones.dpt. The article focuses being providing tips to for Rehab Professionals to have a smooth transition of their patients into group fitness based on their combined experience across settings as physical therapists & helping members @strongerlifehq start their group fitness journey! 3 Keys: 1. Start with the end in mind 2. Set (positive)expectations 3. Test the plan *If you want more helpful content to better serve older adults, sign up for our MMOA Digest = Free Bi-Weekly Email packed with helpful links, posts, & research relevant to your work. Link In Bio or PTonICE.com **Looking for CEU's & courses that will change your practice? Check out our MMOA Course Offerings (Online & Live) Link In Bio or PTonICE.com

Join @jmusgravept  as he breaks down the S.M.A.A.R.T. goal acronym & gives an example of what it would look like to apply this to a patient receiving home health. Credit to: George T. Doran 1981 for S.M.A.R.T. Credit to: Smith D. K. 1999, “Make Success Measurable: A mind book for setting goals and taking action (pp. 45-52) New York, NY: John Wiley & Sons *If you want more helpful content to better serve older adults, sign up for our MMOA Digest = Free Bi-Weekly Email packed with helpful links, posts, & research relevant to your work. Link In Bio or PTonICE.com **Looking for CEU's & courses that will change your practice? Check out our MMOA Course Offerings (Online & Live) Link In Bio or PTonICE.com #physicaltherapy #geript #homehealthpt #pt #dpt #dptstudent #physiotherapy #physicaltherapist #physiotherapist #physicaltherapystudent #newgradpt #physiotherapystudent #physicaltherapyassistant #physicaltherapyassistantstudent #geript #geriot #OTs #OTA #occupationaltherapist #ottreatmentideas #otstudent #otastudent #occupationaltherapyassistant #oldnotweak #ptonice #icetrained

Dr. Rachel Moore // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, ICE Pelvic faculty member Rachel Moore breaks down how purity culture and pelvic floor dysfunction are linked, and ways we can empower and educate women to reduce dyspareunia 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 RACHEL MOOREGood morning, guys. What is up? Happy Monday morning. My name is Dr. Rachel Moore, and I'm hopping on this morning representing our pelvic crew to dive in and talk about a topic that's pretty near and dear to my heart in the area that I live in in Texas. We're going to be diving into purity culture and the pelvic floor. So if you're not familiar with what purity culture is, it is a set of beliefs that really focuses on promoting abstinence for sexual health and well-being and kind of involves a lot of feelings of shame or guilt or even fear focused around sexual functions and sex as a whole. So we know that sexuality in and of itself is biologic and it's instinctual. But there are a lot of overtones and a lot of components of sexuality and the development of sexuality that come from culture. Culturally embedded meanings are just kind of rampant in this space. And we see that one really large cultural component that can lead to issues with the pelvic floor, like dyspernia or vaginismus, is this topic of purity culture. We have studies that have looked at this in a lot of different countries. And what we see is that countries that really emphasize sexual purity hone in on and focus in on male sexual satisfaction over female cultures that emphasize like virgin brides and have a lot of societal contracts or context in place to eliminate or reduce premarital sexual relations have higher rates of vaginismus and dyspareunia. We know that societies that suppress female sexuality have higher rates of pelvic floor dysfunction that are associated with pain with intercourse. In order to understand all of this, we really need to understand purity culture in and of itself and understand kind of the component pieces and things that go into dyspareunia and vaginismus. So we already honed in on what purity culture is just a little bit. A lot of times purity culture is in theory linked with religiosity. And I see that in my area of Texas. I'm in a very conservative part of Texas and I've seen a lot of patients with vaginismus and with dyspareunia that were raised in a very religious household and have a lot of certain feelings and ideals and beliefs around sex and sexuality that are went kind of hand in hand with that is the common thought. However, we actually have a case study that looked at the link between religiosity and dyspareunia and vaginismus. And it was a 2020 case study that sent out a survey to 901 women. 19% of them had pain with intercourse. So dyspareunia or pain with intercourse And what they found is that religiosity was actually not linked with the presence of dyspareunia or vaginismus, whether it was current religiosity or previous religiosity, the way they were raised. But what they found is that the attitudes and connotations around sex and sexuality in and of itself is actually what was linked with that presence of pain with intercourse. So really kind of debunking this idea that religiosity and pain with penetration and intercourse go hand in hand. I think purity culture in and of itself gets linked a lot with the religiosity or that highly conservative group, but it's not necessarily because of the religion aspect. It really boils down to the education that we provide women about their bodies and the attitudes and beliefs about intercourse and sexuality in and of itself. There's actually another study that was done. It was another study that surveyed women that had vaginismus and they asked them, like, what are the reasons or what are the things that kind of led up to this happening? And what they found is that the number two reason for vaginismus was a negative attitude or a negative connotation around sex and sexuality as they were raised. And the number one reason was fear of pain with penetration. So that's pretty powerful that the way that we are taught about our bodies and the way that we are taught about sex and sexuality can have long lasting effects on the rest of our lives as females. It's really interesting because we used to think back in the day before women's health was really studied that vaginismus was just a purely motor response, right? Like with the penetration, these muscles tense up and they spasm and therefore penetration is painful and uncomfortable. and women are not able to have intercourse or are not able to enjoy intercourse. But just like every other realm of physical therapy, we're really diving into all of these different subsets of this diagnosis as a whole. And what we're finding is that the biopsychosocial piece of this is massive. The way that we are taught about our bodies, the way that we are taught about intercourse, the way that we are taught to feel about our natural desires and sexual urges can lead to a physiologic response that is outside of our control. So our pelvic floor has a protective reflexive mechanism when we are stressed or scared, and that protective reflexive mechanism can be maladaptive. But if we're taught from a young age that sex is shameful and that our bodies are something to be ashamed of, or maybe they only serve one purpose and that is only for reproduction and you're not trying to have sex to reproduce, then that can cause this reflexive reaction to kick in, where those muscles tighten and tense up. Even if you do all of the relaxation work in the world, and even if you do all of the things to stop it, that ideal is really deeply ingrained. And so that really leans into a lot more psychological work that needs to be done, not necessarily the physical work. so with that being said kind of segue into how can we help because we can't obviously go back in time and change the way that somebody was raised or change the way that somebody feels about sex and sexuality necessarily from their childhood or from the way that their parents raised them so as pts when we see this diagnosis walk in we see somebody come in who Has pain with intercourse and has or has dyspnea has vaginismus any other sexual condition? That is linked with pain or the inability to have or enjoy intercourse We want to start thinking about this in the back of our mind like this needs to be a way a topic that we come across maybe not necessarily directly asking like how were you raised to view sex and but it's something that we want to kind of keep in our back burner because if this is on board, then it's going to require a lot more collaborative care and it's a great opportunity for us to partner up with a mental health therapist in our area and really refer out and make sure that we're hitting this from all angles. One of the biggest things that we can do as pelvic PTs is educate. It is insane how many people are not educated about their bodies and especially in this purity culture realm, There's a lot of misinformation and miseducation and wrong education that is done that is really kind of focused or driven out of fear. And there's a lot of just lack of education. Women aren't taught about their bodies at all. And if we think about that, if you knew nothing about this area at all and something was going wrong, you would probably start panicking a little bit. It seems silly to reference it to our shoulder because we all obviously see our shoulders and know about our shoulders and For the most part, even if you have no anatomical knowledge, kind of get a sense of like, it does this, it does this, it needs to do all these things. But that's not true about our pelvic floor. Especially in cultures where purity is really honed in on, nobody is talking to women about the proper way to clean their vulvas. people aren't talking to women about the number of holes. Most of these cultures are not, absolutely not teaching about clitoral stimulation and female orgasm. And so keeping that in mind, like not knowing something can lead to a lot of confusion and fear when we do start having sensations of discomfort or pain. So educating in and of itself can be huge. Educating about the anatomy, we have three holes down there in a female pelvis. There are a lot of adult women that do not know that they have three holes. That in and of itself is a large piece of education. Educating them about how our pelvic floor works, what its functions are, how it aids in sex and sexuality, and the ways that we can really kind of lean into that and make sex or make the pelvis in and of itself not even sex, but the pelvis demystified. so that they're not looking at this area as a big black box with a question mark over it. And they have an understanding of the functions and the basic ways and inner workings of their own bodies. The other thing that we can really hone in on is working on parasympathetic drive work. So working on relaxation work, helping them get out of this fight or flight response. This is something that we can start in pelvic floor PT for sure and is a great way to partner with a local therapist or counselor or somebody that is trained in working with people with Sexual dysfunctions because a lot of this comes down to like taking a lot of steps back So we're not even talking about like let's relax while you're about to have intercourse we're talking about like let's lay in bed next to your partner and Hold hands and practice relaxing and then let's talk about maintaining that as your partner touches your leg and just kind of working in on these component pieces and Sometimes it's even like, let's go all the way backwards, just you. Like your partner is not even a piece of this puzzle. Let's talk about ways that you can get comfortable with your own body so that you can go into this partnership and this relationship with a degree of comfort and understanding, and it's not about this other person at all. finding a counselor or a therapist in your area, or maybe not in your area, but virtually, that is somebody that you trust, that can help guide this path. We can absolutely help. We can be a facilitator of that. But the great thing about having that mental health component is they can really kind of go back a little bit farther and more in depth than we can, because they're trained in that, to really break down those beliefs and talk about ways to rebuild that from a psychological level. And then we can go in, with that happening and align that with the physical piece. So kind of bridging those two pieces together so that we're getting this complete rehab component. A lot of the times in this population, the assumption is like, oh, we just need to work on strengthening other areas or whatever. But I think that in the sense of vaginismus, absolutely, we always are promoting strength training our hips and strength training our core and making sure that the muscles around our pelvis are strong and supporting the pelvic floor. So the pelvic floor isn't becoming the hero and becoming super tense and tight in a response to that. But especially when we're thinking about vaginismus, we're really looking at like the attitudes and core beliefs and the situation around the intercourse or the act that is causing that vaginismus to occur in and of itself. So we always can layer those things in. We love that, but really focusing in on that relaxation and finding ways to promote that relaxation paired with education and partnering with a provider that we trust that can help address the psychological component. We know, we have surveys that show that women that are raised in households where the mother had negative views about sex or negative beliefs about sex or talked negatively about it, have higher rates of vaginismus and dyspnea, which is wild to me. It makes sense when we think about it. You know, we always talk about how our kiddos are really mirroring the things that we say and we do in the way that we act. So as adults in and of ourselves, not necessarily even in the PT realm, But making sure that the way we talk about these functions is in a way that is not promoting shame or fear. I think that again purity culture is often linked with religion and so you have kind of these two sides and this can be a really polarized topic. And I think no matter what you believe, the big goal is that at the end of the day, our young women need to understand how their bodies work, they need to understand the functions of their bodies, and then they need to understand what sexuality means. In whatever way it is that we believe that, making sure that sexuality isn't seen as something that is really driven in shame or driven in fear, but it's something that is celebrated because at the end of the day, it is one of our basic biologic functions that we all need in our lives. And so making sure that we are setting our future generations up for not having these pelvic floor dysfunctions down the line. providing education at a community level in any way that you're able to can also be really wonderful. We've set up before like a mom and daughter workshop where we literally just talked about like, this is the pelvic floor, and this is the way the menstrual cycle works, and this is the way the pelvic floor functions, not diving into this is how you have sex, but base knowledge. That base knowledge can be so powerful in a community that doesn't have that knowledge. i hope you guys enjoyed this i hope that this hit a chord with you maybe especially if you're in an area where you're seeing a lot of patients that come in that are raised in cultures where sex is seen as shameful and seen as something that is not to be celebrated and is um maybe fear-based so um SUMMARY If you guys are interested in hopping into one of our courses in the pelvic division we talk a lot about pelvic pain in our l2 cohort which we have seats available for that october cohort coming up we just started our second cohort of the year so that one is kicked off We've got one more cohort of L2 coming up at the end of the year, so if you want to hop into that, look at that online. We've got L1 coming up in two weeks, and then we've got a lot of courses coming up in the end of the year. We are rounding out quarter four with tons of courses. We're on the road a lot. We're all over the United States, so if you are interested in hopping into one of our Pelvic Live courses, go to the website, PTOnIce.com, get into one of those courses. We can't wait to see you on the road. Have a great rest of your Monday, and I'll see you guys around. 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.

Everyone dies; not everyone lives - #GeriOnICE @jmusgravept shares how by being too quick to limit risk for our patients we can expedite deconditioning, worsen social isolation and mortality of our patients. *If you want more helpful content to better serve older adults, sign up for our MMOA Digest = Free Bi-Weekly Email packed with helpful links, posts, & research relevant to your work. Link In Bio or PTonICE.com **Looking for CEU's & courses that will change your practice? Check out our MMOA Course Offerings (Online & Live) Link In Bio or PTonICE.com #physicaltherapy #geript #homehealthpt #pt #dpt #dptstudent #physiotherapy #physicaltherapist #physiotherapist #physicaltherapystudent #newgradpt #physiotherapystudent #physicaltherapyassistant #physicaltherapyassistantstudent #geript #geriot #OTs #OTA #occupationaltherapist #ottreatmentideas #otstudent #otastudent #occupationaltherapyassistant #oldnotweak #ptonice #icetrained

@jmusgravept shares how choosing pain now can help you avoid pain of regret later in your career. *If you want more helpful content to better serve older adults, sign up for our MMOA Digest = Free Bi-Weekly Email packed with helpful links, posts, & research relevant to your work. Link In Bio or PTonICE.com **Looking for CEU's & courses that will change your practice? Check out our MMOA Course Offerings (Online & Live) Link In Bio or PTonICE.com #physicaltherapy #geript #homehealthpt #pt #dpt #dptstudent #physiotherapy #physicaltherapist #physiotherapist #physicaltherapystudent #newgradpt #physiotherapystudent #physicaltherapyassistant #physicaltherapyassistantstudent #geript #geriot #OTs #OTA #occupationaltherapist #ottreatmentideas #otstudent #otastudent #occupationaltherapyassistant #oldnotweak #ptonice #icetrained

Join @jmusgravept today on the Daily Show as he discusses how to help older adults understand the value in practicing falling as well as tips for increasing confidence & helping older adults set positive expectations for a meaningful experience. https://doi.org/10.1016/j.jbiomech.2018.12.002 *If you want more helpful content to better serve older adults, sign up for our MMOA Digest = Free Bi-Weekly Email packed with helpful links, posts, & research relevant to your work. Link In Bio or PTonICE.com

We hear that High-Intensity Interval Training (HIIT) is good for so many complex conditions, but HOW do we use it clinically? Join @dustinjones.dpt today on the Daily Show as he shares tips to make HIIT more objective, being diligent with monitoring vital signs, and underdosing high-intensity with medically complex patients when needed.   https://PTonICE.com

Join Dr. Kay Mayordomo, PT, DPT (@kaym23) as she discusses wellness class logistics, the unsexy, but completely necessary part of running a workout class (specifically what she's learned from bone health bootcamp)!   Want to make sure you stay on top of all things geriatrics? Go to https://MMOA.online to check out our Free eBooks, Lectures, & the MMOA Digest! Schedule at your designated date PTonICE's - Every Mon 6a est MMOA's - Every Th 6a est  

Dr. Jessica Gingerich // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member Jess Gingerich discusses the role of the deltoid and upper extremity strength in pregnant & postpartum moms. 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 INTRODUCTIONHey everyone, Alan here, Chief Operating Officer here at ICE. Before we get into today's episode, I'd like to introduce our sponsor, Jane, a clinic management software and EMR with a human touch. Whether you're switching your software or going paperless for the first time ever, the Jane team knows that the onboarding process can feel a little overwhelming. That's why with Jane, you don't just get software, you get a whole team. Including in every Jane subscription is their new award-winning customer support available by phone, email, or chat whenever you need it, even on Saturdays. You can also book a free account setup consultation to review your account and ensure that you feel confident about going live with your switch. And if you'd like some extra advice along the way, you can tap into a lovely community of practitioners, clinic owners, and front desk staff through Jane's community Facebook group. If you're interested in making the switch to Jane, head on over to jane.app.switch to book a one-on-one demo with a member of Jane's support team. Don't forget to mention code IcePT1MO at the time of sign up for a one month free grace period on your new Jane account. JESSICA GINGERICH Good morning, PT on ICE daily show. My name is Dr. Jessica Gingrich and I am here to kick off deltoid week. So if you are wondering what that is, the faculty have come together and we are going to take this week and we are going to talk about the deltoid. This is gonna be a really fun week. We are going to learn just how to assess it better, how to use better pain management strategies, and really ultimately how to load the deltoid better and just treat shoulder pain differently. Now, we are coming hot off of semifinals over in Knoxville. We had wonderful, also Monday, here's my dog again, if you can hear. Olive with the trash guy We are coming hot off of semifinals where we watched Tia Claire to me dominate That was really cool You know, there are other athletes out there Haley Adams. I'm wearing her shirt today I mean coming back and just in just doing such a phenomenal job, but Tia crushed it and that was really cool to see her coming back postpartum So we're going to take today and we're going to talk about the deltoid and the pelvic floor. I know you guys are probably like, I'm sorry, what? How are you going to put that together? And you know, I a little bit thought that as well because we're not going to palpate the deltoid and then bring on pelvic floor symptoms likely. So the deltoid, we know abducts the arm. It's going to flex and internally rotate with those anterior fibers and it's going to externally rotate and extend with the posterior fibers. We want to make sure that we can take this muscle and maximize it for motherhood. So we are going to further break down the pelvic space with the deltoid, and we are going to bring this into the pregnant and postpartum space. Motherhood is a journey. I'm not yet a mother, but I treat moms every single day, and I see the different pieces that they have to do, the challenges that come with it. We have new tasks, right? Like tasks that look different than when we were before a mom. Getting back to exercise, a lot of the times is a massive goal of a lot of people. We're starting to see pregnant and postpartum people just infiltrate exercise, like the exercise space. And that's so fun to watch. So we are gonna first break down and talk about pregnancy. PREGNANCY: A PERFECT TIME TO BUILD STRENGTH So pregnancy is a wonderful time to build strength. A lot of times we have moms who don't feel great all the time, especially further into their pregnancy, getting their heart rates up. In doing these metabolic conditioning pieces, going on long runs, they don't necessarily feel great all the time. Some moms do. But we can take that time and we can bodybuild. and we can hit a strength piece and then we can sit down and rest for three minutes and maybe that rest for three minutes is also the same time as giving our baby some attention. So things that we can do in the pregnant time is work on things like push-ups, bench, elevate the bench if you have to, go down to your knees for your push-up, elevate the push-up. overhead press, variations of overhead press, whether we're doing a push jerk, a strict press, a Z press, a bent over row, hitting those posterior delts, and then even doing things like a front rack hold or a front rack carry. These movements are going to mimic a lot of the movements that they're going to have to do postpartum or they may already be doing if they have another kiddo at home. So in pregnancy, focus on setting the foundation for upper extremity strength. Breastfeeding, bottle feeding takes up so much time. Sometimes that time is valued and sometimes it's not and that's okay. Sometimes that's very frustrating. Let's prepare mom so when she's breastfeeding or bottle feeding every two to three hours that she doesn't come in and she's like oh my neck and my back hurt because we're building that strength. So now we're going to switch and go into the postpartum space. The postpartum, we have this with a zero to two weeks is our healing timeframe, right? We aren't doing a push jerk at 70%. So maybe we're doing things like stretching the posterior delt with a sleeper stretch. loading the delts with banded I's T's and Y's, stretching the anterior delts and the pecs with a doorway stretch, and then doing some banded pull aparts. And maybe we can incorporate that after every feed, or maybe if that's too much, can we do it at least once a day to help utilize these muscles to decrease back pain and decrease neck pain? So, we're gonna dive further into this week with other divisions, so extremity, dry needling, where they're gonna talk about pain management strategies. So using dry needling techniques, soft tissue, cupping, joint manipulation, and other loading strategies to help load the deltoid, make the deltoid feel really good, and incorporate this into your moms, into your pregnant women. help them. You look at them as a whole body, not just pelvic floor because that's rarely what it is. So, if you are thinking about taking pelvic courses, head over to PTOnIce.com. We've got our live course, our L1 online course, and then we've actually recently added a third L2 at the end of the year due to high demand. So if that is something that you are or that is on your list, head on over and check it out and we will see you at 9am tomorrow. 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. Jordan Berry // #TechniqueThursday // www.ptonice.com    In today's episode of the PT on ICE Daily Show, Spine Division lead faculty Jordan Berry discusses three different variations to load the lateral shift: side plank variations, RNT side bends, and unilateral carries. 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 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. JORDAN BERRY All right, what is up PT on Ice Daily Show? This is Dr. Jordan Berry, Lead Faculty for Cervical Management and Lumbar Spine Management. And today we are continuing our theme of the lateral shift. So we've had a few episodes over the last few weeks. For the first episode, we were chatting about how do you actually recognize the lateral shift? Like from a subjective, from an objective standpoint, how do you pick up a lateral shift in the clinic so you're not gonna miss it? Second, we went over what are our lateral shift correction variations. Besides the standard one, then standing, what are some other ways that we could correct the lateral shift based on the patient irritability? Today, we're talking about loading the lateral shift. So this is something that comes up in courses quite often for our lumbar management courses when we're talking about the lateral shift and we have some different ways to reduce symptoms and to correct the shift or reduce the person's pain, decrease the irritability, but then what do you follow that with? Like in the session, right? We're not oftentimes just doing 40 or 45 minutes of a shift correction. We want to try to apply load to the person's system as well. And if we can start to load that person, the shift correction is going to quote-unquote stick more or be more effective during the session, between sessions. As long as the irritability allows for us to start to apply some load, we want to be able to. So we're going to go over three exercises that we commonly use in the clinic to start to load the lateral shift. So I've got Jenna again with me. Jenna is part of our fitness athlete division. She's going to be demoing some of the exercises while I'm talking through it. So let's get the camera set so we can see the ground a little bit better right here. Okay, perfect. SIDE PLANK VARIATIONS The first way that we're going to talk about that we load for the lateral shift is a side plank variation. So I want you to think about really just loading unilaterally. Whether it be the midline, core, whether it be the lateral hip, we're just trying to load that side to get the person to load that part of the spine. So for example, let's say Jenna had left-sided symptoms. Left-sided symptoms. So we said in a previous episode, almost always the lateral shift is going to be away from the side of symptoms. So, it might be slightly backwards depending on what platform that you're watching with the camera, but we are shifting away from the side of symptoms. So again, we're saying this side here, and if you're listening on the podcast on whatever platform that you're on, be sure to hop on either Instagram or YouTube and watch this episode as well so you can see the exercises in real time. Okay, so the first exercise. So we're going to say again that left side is painful and we are shifted towards the right. So we are going to do a side plank variation in order to load in to the painful side. So we're going to start with our standard side plank variation. The painful side is going to be down. So again, the side towards the floor would be the symptomatic side. And you can appreciate as Jenna comes up and squeezes the glute, squeezes the midline here, she is loading this bottom side that is towards the floor. Now, we could of course go through our same variations with the side plank that we would if we were loading the lateral hip to increase or decrease the difficulty, right? We could have the feet together, we could have knees together, we could also have that top leg floating that makes the bottom side work even harder. How would we regress that? if the person can't tolerate that full version. So Jenna, you can come up here. We would go to an elevated surface. So you could use a bench or you could use a box or you could use a table. But what Jenna is going to do is mimic the exact same position. only now she's at an angle, right? So she's not fully on the ground and we've taken out some of the load. So now it's likely only about half of her body weight that she's having to hold up. And again, the painful side is still down. You can appreciate if this is the painful side and we went here, that's basically the way that Jenna would be shifted. But when she contracts, that is the same thing as a shift correction. Only now we're applying load. instead of regressing it, how would we progress it? We could just add some resistance to the side plank. So we've got a band right here around the rig here. And what you would do, I'm gonna lift this up, Jenna would do the exact same side plank, only she's got this resistance band right around the hip. Much more challenging. When she comes up, she has to press into the resistance band and now she's getting way more load and working way harder to correct that shift or load that shift after we have done the lateral shift correction. You can come out of that, Jenna. So that's number one, a side plank variation. There's a million different ways. You just have to respect the irritability. RNT SIDE BENDS Number two is essentially an RNT side bend. So RNT meaning reactive neuromuscular training. So we're going to take a band and put it around Jenna's torso. And the band is just essentially pulling her in the direction that we don't want to go so that she has to fight against it and go in the opposite direction. So we're going to take this band, Jenna's going to wrap it around, and then bring your arm over top. Perfect. So we've got the band here, okay? So we are saying again that the left side, side here, is the symptomatic side. So if we had a lateral shift, she would be going this way. Well now, in order to stand in midline and keep herself centered, she now has to push in to that resistance band. So again, the band is pulling her more in the direction that we don't want her to go, right? There would be more in the direction of going away from the symptoms. So the more that resistance band or the more resistance the band has and the heavier, thicker that band is, the more she's going to have to fight against it to self-correct into that position. essentially a standing version of the side plank that we just demonstrated. Okay, so that's number two. UNILATERAL CARRY Number three is going to be a unilateral carry. Unilateral carry. So you could use dumbbell, you can use kettlebell. We typically will load it with a kettlebell. But again, just to stick with the same theme, saying the left side would be the symptomatic side. So Jenna would almost always be shifted away towards the right. we are going to put the weight on the right side. So we are putting the weight on the side opposite of symptoms so that she has to fight against the weight and correct back to midline. So again, the weight is pulling her in the direction that she's already going, avoiding the symptoms. And the heavier the weight is, she's going to have to work that much harder to pull herself back to midline. So you could start with just the static hold with the kettlebell. We could also add in a march to make it more challenging. And she's just lifting one foot at a time, going nice and slow and again, trying to just make sure that her midline is really engaged and active and holding her in this neutral position, fighting against the direction that she would typically be going to avoid the side of symptoms. SUMMARY So those are our three variations. We've got the side plank, very similar to how we would typically load the lateral hip. We've got progressions and regressions, just based on the patient irritability, find something that they can tolerate that does not increase symptoms. We also have that RNT, that banded side bend, where the band is pulling more in the direction that we don't want the person to go, so they have to fight against it. And the exact same thing with the unilateral carry. Whatever side the symptoms are on, the weight is on the opposite side, so they have to self-correct and pull themselves back towards midline. Three ways that you can start to load a lateral shift in the clinic. So again, we've got three parts now in this series that we're doing on the lateral shift. Part one, how to actually recognize it in the clinic. Part two, what are the lateral shifts? And three, how do we actually start to load the lateral shift? All right, that's all I've got. Have a great day in the clinic. And we have a few lumbar management courses coming up this month. We've got Anchorage, Alaska, and we've got Paoli, Pennsylvania. So check out PTOnIce.com for tickets. All the other dates coming up. Have a great day in the clinic. 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.

So many of our patients need better balance…but HOW do we go about giving them the intervention/s they need? Unfortunately, generic “Balance Programs” may not get the job done. We need an individualized approach to get the job done. Join @dustinjones.dpt as he discusses a framework to assess balance then intervene. Learn more about MMOA at https://PTonICE.com

  Want to make sure you stay on top of all things geriatrics? Go to http://PTonICE.com/resources to check out our Free eBooks, Lectures, & the MMOA Digest!

Dr. April Dominick // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member April Dominick shares a case of an OBGYN client with lumbar radiculopathy and the unique approach to core training that increased the client's tolerance to sustained positions with less pain in the OR. 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 INTROHey everyone, Alan here, Chief Operating Officer here at ICE. Before we get into today's episode, I'd like to introduce our sponsor, Jane, a clinic management software and EMR with a human touch. Whether you're switching your software or going paperless for the first time ever, the Jane team knows that the onboarding process can feel a little overwhelming. That's why with Jane, you don't just get software, you get a whole team. Including in every Jane subscription is their new award-winning customer support available by phone, email, or chat whenever you need it, even on Saturdays. You can also book a free account setup consultation to review your account and ensure that you feel confident about going live with your switch. And if you'd like some extra advice along the way, you can tap into a lovely community of practitioners, clinic owners, and front desk staff through Jane's community Facebook group. If you're interested in making the switch to Jane, head on over to jane.app.switch to book a one-on-one demo with a member of Jane's support team. Don't forget to mention code IcePT1MO at the time of sign up for a one month free grace period on your new Jane account. APRIL DOMINICK Good morning, PT on Ice Daily Show. My name is Dr. April Dominick and I am here with the Ice Pelvic Division to talk to you about a current client case I have on cutting to the core, a case of the low back pain in the OR. So today I'll talk to you about a doctor with lumbar radiculopathy. radiculopathy that I've been treating, and the unique approach we took to core training that increased her tolerance to sustained positions in the OR and reduced her pain. a bit about my client. She is a cheerful female obstetrician in her early 30s who lives a very healthy, active lifestyle. She is strong. She loves to ski, hike, lift. She also lifts really heavy, which we love. And she came to me with a myriad of complaints of TMJ pain, headaches, cervical thoracic pain, and reports about 80 to 90% improvement with those issues. And then for the purposes of this podcast, we will just focus on her hip and low back pain. So she described it as aching, stabbing, and she, that was for the low back pain, as well as her right-sided hip pain. It was a six out of 10 at worst and three out of 10 at best. that intermittently worsens. And her pain originally started after she had to sit for a prolonged period of time in order to study for her boards for residency, something that we all are very familiar with. And she sought PT care with me about six months after when the pain had been steadily worsening. And then the final straw was she had 10 consecutive days of pain in her hip and back after a really long shift in the OR. So things that made it worse, exacerbating factors, prolonged sitting, prolonged standing, so any sort of prolonged positioning, sometimes heavy lifting days at the gym, especially leg day, and work days. And then easing factors, stretching, changing positions, supportive shoe wear at work, or sometimes exercise would help it, So after her subjective and objective exams, signs and symptoms pointed towards lumbar radiculopathy, coupled with some right hip labral pathology, and she had moderate irritability. So I took her through the typical lumbar radiculopathy and intraarticular hip treatment, including manual therapy like manipulation, dry needling plus stem, I dialed in some back and hip strengthening and mobility. And then she also responded really well to a little EMOM that I gave her for when she had acute severe flare-ups in between our sessions, which included some cardiovascular bike intervelling to address her chronic inflammatory state, nerve glides, and isometrics. So after a few sessions, she made really awesome improvement in, she had improved in neurodynamics testing. Her weekly frequency went from having pain daily to every couple of days, which was great. And then her intensity and duration of those pain cycles also reduced. Love it. And then her progress stalled, and she continued to have some low-level symptoms that would flare. And the culprits seemed to be work. Particularly, we narrowed it down to her labor and delivery shifts, where she had to hold sustained positions, as opposed to when she was working in the clinic and she was getting up and down from her stool or moving between patients' rooms. THE HIP & PELVIS SHARE MUSCLES So it wasn't until we unpacked two key pearls that we began to make another difference. So during initial eval, she had, when I asked her, she had denied any bladder, bowel, or sexual dysfunction. And given that I was able to reproduce her pains, why she came in, with specific exam of the lumbar spine and her right hip capsule and surrounding musculature, Pelvic floor dysfunction wasn't high on my hypothesis list, but given our roadblock in progress, I decided to go ahead and screen the pelvic floor externally. And when I palpated her obturator internus externally, and then we did some further testing internally, it reproduced her lingering secondary hip pain on the right lower extremity. So she had like a major hip pain. And then we found out she had, um, another hip pain that she hadn't really noticed as much, um, because of the other pains had kind of been so overpowering. So, um, she also had some difficulty, um, from the pelvic floor side of things and in relaxing, she had some hypertonicity throughout and then, um, some coordination issues. So we treated the pelvic floor, did manual therapy, dry needling to the obturator internus, along with some circuits with her low back and hip. And that seems to have really helped her quite a bit as well. So that was the first thing that helped us in this stalled progress was lesson number one, don't forget that there are bits and pieces of the hips that share a wall with the pelvic floor. and that the OI lives in that pelvic bowl and it's a direct connector over to the hip via the greater trochanter that it inserts on and it influences hip stability, hip rotation, and that was one of our key pieces in helping her get some more improvement. ADDRESSING JOB-SPECIFIC DEMANDS The Second piece that really helped move the needle and address those lingering back and hip symptoms was getting more specific about her job demands and environment. So specifically when she is working in the OR, our operating room, if we can't change her job duties, like she has to deliver babies, that is her job, what can we affect? Can we set her environment up for success, specifically as it relates to VOR. So in the clinic, we set up her operating room using what we could, and we went through things like, what is the table width and the height? We positioned her tools. I asked her where her coworkers stand in relation to her. We talked about the amount and direction that she's leaning over the OR table. She ended up describing a really common position that she ends up in, which is a right side bend and rotation. And that is, if you remember, her hip pain is on the right side. So that was really helpful. And then we also looked at the percent of or we kind of labeled it in an RPE way of the isometric pull during retraction of the abdominal tissue for her C-sections. So I basically had her try out different percentages of pulling and and she kind of landed on, okay, this is about how much I have to pull when I am either using my own strength to do that retraction, or if I'm using tools to do that retraction. So we then, after I got her table set up in my brain, I also asked about detailed information of the surgeries itself. So of the C-sections in particular, about how, With the C-section itself, how is time split up? You have to do a lot of retraction. That seems like the thing that she's doing in a sustained position. When does that happen? And come to find out for her, it happens in two-thirds of the time that she's in the C-section. So there's like a first retraction and then there's some other things and then there's a second retraction. So that was helpful to know that there were some breaks, so to speak. And, um, then we, uh, we talked about her, uh, average time it takes to have her symptoms come on during the C-section. And, um, she has to do multiple C-sections a day, uh, intermixed with some vaginal deliveries. So we, we talked about, is it within the C-section if it's a particularly long one for some reason, about when does your symptoms come on or after about how many. So all of that was really helpful information. And then we, we did some treatment. So we brainstormed strategies that she could use in the OR. Can she Use the retractor tool instead of her actual hands or her own strength to help reduce some of that burden on her body. And then can she use tools like a step stool to increase her height or get closer to the table, redistribute her weight, use the step stool to put one leg up on top, or even the bottom of the table sometimes has that. And then an anti-fatigue mat or supportive shoe wear. And then I asked her if she would be able to sneak in some lumbar extensions or side bending just in the OR when she's not actively assisting with the retractions just to give her body a break from that sustained position. And then increasing reliance on the other staff on her residence to give her a break prior to her reaching that symptom threshold of more than five or six out of 10. So that was super helpful for what she could do in the OR. And then we talked about what she could do before her surgeries. And this is where the core piece comes in. So she sometimes is able to return back to her office or back to the floor between her C-sections and vaginal deliveries for her shift. which led us to creating a quick core rehab EMOM, every minute on the minute, that focuses on multi-planar core strengthening and endurance for those long duration positions. It's that duration piece that seemed to really exacerbate her symptoms. So the core remom we came up with includes neutral and extended trunk work, side bending and rotation of the trunk. And we threw in some isometrics as well as mobilizations just to help with both the pain from an analgesic effect with the isometrics and then some mobilization given that she is just in that sustained position for so long. So for the core remom, I gave her basically three to four categories that she could choose one exercise for to do for a minute. And she could do anywhere from a three to four minute remom all the way up to 12 to 16 minutes, depending on what time she had. So for the core remom, in the neutral slash extension category, she could do a reverse plank for a 45 second hold. And then we talked about having a tote bag filled with a bunch of the medical textbooks that are just collecting dust in her office, two tote bags actually, and that was going to be her load for some of these exercises. So she could put the tote bag on top of her for that reverse plank to add load. We also did a side plank plus a top leg raise hold. She could use her loop band that she brought if she wanted. And a loaded windmill. So that was the, sorry, the loaded windmill is actually in the side bending category. So for the neutral extension, she had the reverse plank for about 45 seconds. as well as prone press-ups. And we found out that the prone press-ups tended to make her feel better from the discogenic symptoms she would have after the surgery itself. From a side bending category, so next category side bending, we had her do standing heavy farmer's carry with a band on her feet. So she'd have to work her hip flexors during that time and anterior core. and obliques. And then she had the side plank with the leg raise and then the loaded windmill. And then from the rotation category, we had her pick, or actually we just had her do a banded doorway. She could either do diagonal chopping, so that P and F pattern, or lifting. And that was really helpful because it really mimicked the retraction kind of pull that she had to do. And so I had her do it in different positions, tall kneeling, all upright, tall kneeling, half lunging, and then standing. And I had her match the percentage of pull or the RPE that we talked about, I had her either match it or go a little bit higher that she has to use her own body weight or the retractor tools in surgery. So we could kind of get her used to practicing that pull with good breathing mechanics and then also good awareness of her core. And then a bonus, was some hip and back mobility, like banded long axis distraction, quadruped rocks, or thread the needle. So that's a bonus if she wanted as well. So all that, she only needed a long band, a loop band, and then her tote bags filled with the medicine textbooks. And with that, She's been able to incorporate that into, um, before some of her C-sections or at least before the first couple, as well as, um, in between. And she has had some really awesome results in terms of reducing her low back pain, hip pain, and being able to tolerate standing in the OR and working on these individuals as much as she could. Um, so love that. And it was really cool to be able to, brainstorm and put ourselves in her actual environmental situation as best as best that we could to figure out what it was that she was doing with her body and how we could use her core to better support her so that her hips and low back didn't have to do all the work as well. SUMMARY So Our pearls from today don't underestimate the power of a 30 second external pelvic floor objective screen, even in the absence of bowel, bladder, sexual dysfunction, when there's hip involvement on the table. Even me as a pelvic floor PT, I missed that in this particular case, she did have a lot of other things going on, but it was interesting to find just a little bit of that secondary hip pain that we hadn't uncovered initially. And then taking that deeper dive into understanding the nuts and bolts of someone's job duties and environment to paint a clearer picture. And then with this case in particular, OI-focused obturator internist-focused treatment, as well as brainstorming strategies to alter the environment during the case itself, as well as priming the anterior core and hip with that focused multi-planar remom, helped her diminish some of her lingering hip and back symptoms. And we were able to raise the threshold that she could tolerate in terms of the number of C-sections that she could complete. So, success all around. If y'all want to dive deeper into the latest research on the core as it relates to pelvic health and some examples of actually some of these remoms that you can practice with early core management or advanced core management, then join us live. You can grab a seat on PTOnIce.com. Our next courses are in Kearney, Missouri this coming weekend, May 18th and 19th, and a double header June 1st and 2nd will be in Anchorage, Alaska and Highland, Michigan. Everyone have a wonderful week and I hope that helped you out with some of your cases. 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. 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