Podcasts about ptonice

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. 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.

Osteoporosis- Diagnosis, Prognosis, Treatment So many of our patients are given a diagnosis of Osteoporosis without clarity of what that ACTUALLY means. We can address patients' concerns and questions and provide some clarity on what that diagnosis means for them. We'll dive into learning more about Osteoporosis, how to read DEXA scan reports, & using that info to inform your plan of care! — Want more helpful info to better serve older adults? Check out the Older Adult Specialist Certification at PTonICE.com

Dr. Jeff Musgrave, Doctor of Physical therapy shares a 3 step process to keep Older Adults moving in group fitness classes during a bout of care.  Symptoms Guardrails Modifications Upcoming Courses! MMOA L1: May 15th L1, MMOA L2: May 16th, MMOA Live this weekend: Raleigh, NC, Urbana, Illinois, Burlington, NJ & New Orleans, LA. Next weekend I'm back out on the Road Bellingham, WA. *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  

Cognitive Screening 101 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. Alex Germano // #GeriOnICE // www.ptonice.com  In today's episode of the PT on ICE Daily Show, join Modern Management of the Older Adult lead faculty Alex Germano as she discusses how rehab providers are incredibly positioned to screen cognition in older adults, what the current barriers are to cognitive screening, and which measures would be best to use to identify early signs of cognitive impairment. 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 ALEX GERMANOWelcome to the PT on Ice show brought to you or the daily show brought to you by the Institute of Clinical Excellence. Happy Wednesday and welcome to today's segment of Jerry on Ice. My name is Alex Germano. I'm a member in the older adult division. This weekend I was talking with our students out in Madison, Wisconsin about cognition being a risk factor for falls. And I really wanted to dive into a more complete conversation about our role as rehab providers in screening for cognition. I guess I'll be specifically talking to the physical therapists, but also occupational therapists. And I know speech language pathologists actually do a really great job at cognition and cognitive screening. So I'm kind of talking to more of that PTOT group of humans. Today, we're gonna highlight why we encourage cognitive screening on older patients, and especially older patients without a known diagnosis of cognitive decline, and which cognitive screens will give you the best information. All right, so preface the conversation. This is going to be really talking about those who do not have a known diagnosis that could cause the symptom of dementia. If our patient has a known diagnosis of Alzheimer's disease, I don't really need to be doing a cognitive screen telling me that there is a problem. We know that they have a known diagnosis. It would be more beneficial for me to do something like a global deterioration scale to kind of categorize their level of dementia. and deterioration and then track that over time. So remember, if they have a known diagnosis already, probably no really need to screen. HOW AND WHEN TO PERFORM A COGNITIVE SCREEN So we're talking about people who are telling you that they are cognitively normal, that they do not have a diagnosis that affects their cognition. So why would we recommend this for these patients? Can't you just tell that they're cognitively normal and won't people be offended if I just start screening their cognition and they believe that they're normal? This is probably a number, these are probably a number of the questions that you're wondering right now. So let's make sure we reach out to all of those. ESTABLISH A BASELINE So first we are recommending screening or labeling our patients with a known cause of dementia because we need to establish a baseline. It's also very important that we are identifying problems on the earlier end of the spectrum. Let's think about another problem where we encouraged to do, we encourage like an early screen. That would be for frailty. It's very important to identify people as early as possible because it is so much easier to treat and change the trajectory of a patient experiencing pre-frailty than it is to change the trajectory of the person who's already in the depths of frailty. The same thing goes for cognition. It's much easier to change the trajectory of the human with mild cognitive impairment than it is once they are already in the depths of Alzheimer's disease and dementia. Pre-frailty, just like mild cognitive impairment, are really hard to see, right? It can be really hard to see. There can be a community dwelling older adult who is going to the senior center and seems really active, but they could be experiencing clinical levels of pre-frailty. And it's just, it's hard to see based on maybe the activities they're telling you that they do, maybe their physical function. They walked in without a walker, so they're probably, you know, not pre-frail. But this stuff is really hard to see, and it's why it warrants us screening for it. People do a really good job masking, especially those early signs of cognitive impairment. And from my clinical experience, when if you're not working in the home with them, sometimes the home is where you see this person a little bit more raw, and you see a little bit more of their habits, and you can kind of pick up on some issues. But if you're not with them for some of those critical moments, and they're coming to you in a clinic, you're probably thinking, I just work with super high level outpatient older adults. This is silly, they're not cognitively impaired. Well, let's share some statistics. So the current prevalence for older adults experiencing mild cognitive impairment from age just 60 to 64 is already about 7%. That's a pretty significant chunk. And that increases progressively with each age range up to the ages of 80 to 84, where those 80 to 84-year-olds, 25% of that population, mild cognitive impairment has a prevalence of 25% within that age group, 80 to 84, a one out of four. That's a huge chunk of the population. And actually there was a study done that one out of five older adults that use outpatient physical therapy services are estimated to have a cognitive impairment. So to use a phrase from the spine division, You may not think you're seeing patients with cognitive impairment, but they are seeing you. It's critical to establish this cognitive baseline for our patients like we do their physical abilities. We have no problem taking a grip strength. We're not weird about it. We just say, Hey, let's see your grip strength. We say, Hey, let's do that five times sit to stand. And even if we know they're going to blow it out of the water, we still do it, right? We're establishing a baseline. It gives us a complete and holistic view of their health status. If somebody has a cognitive impairment, they're going to be less likely to stick, follow through and progress with physical therapy or occupational therapy. And there's so many conditions within older adults that cause acute changes to cognition or acute on chronic changes to cognition, including a urinary tract infection or normal pressure hydrocephalus. So having the baseline assessment of cognition could be really powerful in making us feel confident to make the call to the physician, to make the call to one of the medical providers to say, hey, something's going on and something's wrong with this person. We are uniquely positioned as therapists and rehab providers because we have so many touch points with patients, way more than the PCP does. So we are providers who are going to be able to catch something very, you know, something sinister very early. And we can prevent these downstream hospitalizations from sepsis or injurious falls. These things occur as a result of having something that seems simple, a urinary tract infection that often presents as a cognitive change first. So, We can save lives by screening cognition and being aware of the cognitive changes that our patients are experiencing. Now, just like we continue to test our one rat maxes and stay informed on the status of our blood markers and other physical health markers, why are we not comfortable doing the same for cognition? Wouldn't it be great information to know that you're experiencing cognitive decline early? Or do you want to know about it when you're already in the worst stages of it? Wouldn't most people want a fighting chance? Well, there's a ton of stigma around cognitive health and cognitive decline. And that is a big barrier to doing some of these screens. But I'm going to share a quote with you from a participant from a town hall from the Alzheimer's Association. They do these big town halls and they get people's subjective experiences. And this person said, an early diagnosis is vital. It's made all the difference in the world in my life. It gives us a purpose and allows us time to get our house in order. On a recent poll, about 54% of Americans would rather know that they had Alzheimer's disease at the earliest stages of mild cognitive impairment. Simultaneously, many Americans are very worried about getting this diagnosis. They're scared because they're worried they're going to learn something serious is going on. They're going to worry that They're going to be over prescribed pills or given the wrong diagnosis. They worry that the symptoms might just go away if they give it time. So we need to work on combating this stigma, right? First, we need to do cognitive screening on all of our patients, right? The ones who don't have a known neurological diagnosis that causes dementia. NORMALIZING COGNITIVE SCREENING We have to do these cognitive screenings on everyone. We make it a very normal part of the process. It's as normal as asking the patient, have you had a fall in the last three to six months? We need to explain why we're doing the test. There's going to be nuance to this conversation, and I'm sure we have all worked with a patient or two where we felt a little bit uncomfortable maybe doing the cognitive screen, because we could feel some tension. Maybe the patient did have a mild cognitive impairment, and we felt like they would get maybe a little bit aggressive. I don't want to say combative, but maybe a bit in denial, a bit defensive if we brought in some of this cognitive screening. But I think when we try to lie about what we're doing, we're just going to do like this quick little thing. Ha ha. I don't think that that's giving the patient the, um, the true reasoning behind what we're doing. And I think sometimes that that trickery can elicit some of these defensive behaviors and postures. So what we need to do is be very clear and kind about what we're doing. We are going to be doing a cognitive screen. I do this on everyone because your cognitive health is as important as your physical health. A SCREENING IS NOT A CONFIRMED DIAGNOSIS Now, when we get a result that maybe isn't perfect, we need to bring a high level of sensitivity and empathy to this screening process, especially while relaying results. Remember, we're not in the position to diagnose somebody. This is a screening test that maybe can tell us something's going on, but that's all I know, all right? I can't make a formal diagnosis of mild cognitive impairment or dementia with the person sitting in front of me. That's not my job, and that's important that the patient knows that too. So we get the results of the screen. We are very clear about the results that we find. And we say, you know what, this means we just have to connect with our provider. And we're gonna get you connected with them to make sure nothing else is going on or there's nothing else that we can treat here. And we want this whole medical team to come together and rally around the person. We are in the perfect position to provide a ton of hope for this person. to provide a ton of hope. Hey, you're doing exactly what you need to do. You're here with me. We're gonna exercise. We're gonna work on some of this cognition together. We're gonna get you to a medical provider and we're gonna come around you and support you. We can't leave the patient hanging with bad results or good results even, right? We need to educate on what the next steps are. We need to educate on cognitive health and what to do to maximize it. We cannot just leave them there without any of the information and just slap a label on them and move on. CHOOSING THE RIGHT SCREEN Now, choosing the right screen is also very important. Interestingly, only 32% of PTs when asked about performing a cognitive screen as a part of a falls risk assessment, only 32% of PTs were performing that cognitive screen. Only 53% of PTs in the home health setting felt like they actually had the skill set to do cognitive testing. And in a study looking at occupational therapists, only a third of the occupational therapists were, I mean, sorry, a third of the occupational therapists were using only clinical observation or ADL assessment in isolation to report that there was a problem. So we kind of have an issue within our profession when it comes to what we are screening for and these screens that we're actually using. Um, We know that a number of people are only screening very specific aspects of cognition, including alertness and orientation, or choosing measures that are only sensitive for dementia, but not sensitive enough for mild cognitive impairment. Think like mini mental state exam. So we are really trying to specifically capture people in this conversation who are experiencing mild cognitive impairment. We need to choose measures that are more sensitive for that condition. These measurements include, just to name a few, The Mocha, okay? Mini Cog. Mini Cog is super easy, very free. You can get it from the Alzheimer's Association right now. The Short Bless Test, the Slums, the Brief Alzheimer's Screen. These are all sensitive enough for mild cognitive impairment. Many of them you'll see have like overlapping qualities. There's a clock on them. They're going to ask to remember some different words. You're going to have to like count backwards, name the months of the year. A lot of them will feel very similar. So just find ones that you think you can fit into your clinical practice and start looking through them and get familiar with some of them to use and pull out with your patients. SUMMARY Okay, let's wrap this thing up. So one, we are uniquely positioned to be screening providers for cognitive decline, especially those who might appear normal for a while, but then have an acute change to their cognition. We can catch those people and get them medical help much earlier than if they were to wait to see their PCP again, right? It is incredibly important for us to find out who is starting their journey on cognitive decline, who's experiencing that mild cognitive impairment, so that we can triage our approach and make sure to get the medical team involved, the family involved, make sure we start talking a lot about cognitive health with these patients and get the patient motivated to fight back against this decline. We also need to work on reducing the stigma of cognitive testing. Do not make it weird. I have no other piece of advice than that. Don't make it weird. Be very clear about your intentions on what you're doing. Report the results in a very meaningful way. Give hope when something comes out badly, right? We have to be choosing the right tests and measures when it comes up to cognitive screening. We've got to be picking measurements sensitive enough for mild cognitive impairment. Now we have, if this stoked your fire like it does mine, we have an entire week in our online level two course dedicated to cognitive impairment. We are very proud to have taken a very deep dive into the variety of neurodegenerative conditions that causes the symptoms of dementia, as well as provide a very meaningful and hopeful clinical considerations and strategies for treatment in this population. Our next online level two starts May 16th. We also have a variety of live courses coming up in the next few weeks. For my east coasters, my east coasters, listen up. We are up and down the country until basically July for the east coast. We've got courses in Raleigh, North Carolina, Burlington, New Jersey, Aspinwall, Pennsylvania, Richmond, Virginia, and Virginia Beach from now until July. After that, our east coasting slows down significantly. So if that's your territory, please look at those courses now. and consider getting into one of those options. We would be so excited to see you out there. Head to the PTOnIce.com website to find out more about our online live courses. And I'm looking forward to seeing you guys soon. All right, bye now. 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.

Join Dustin Jones as he discusses the gap between someone given a diagnosis and then a prognosis. Whether it's a matter of seconds or decades, we'll discuss the huge opportunity in that gap to impact our patients as well as practical takeaways. --- 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. Alexis Morgan // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic Division Leader Alexis Morgan discusses what a pelvic floor exam looks like in light of updated practice patterns & research,. 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 ALEXIS MORGAN Good morning. Welcome to the PT on Ice daily show. My name is Dr. Alexis Morgan. I am one of the faculty with the pelvic division and happy Monday. I'm excited to be here this morning to talk to you all about the 2024 version of the pelvic floor assessment. We've been through so many iterations as a profession of the pelvic floor assessment. And I want to just take a few minutes today to talk with you all about the 2024 version, the updated version, the modern way to assess the pelvic floor. Thanks for joining me. Let's jump right in. HISTORY OF THE PELVIC FLOOR EXAM So when we think about the history of the pelvic floor exam, this goes way back, all the way to Dr. Kegel. I've actually done some podcast episodes on the history, and if history's not your jam, don't worry, I won't bore you with the history details today. But our pelvic floor exam does go way back decades, closing in on 100 years now. And over the last several decades, of course, we've had a lot more research come out and a lot more evidence, a lot more understanding of these muscles that are at the base of the pelvic floor. And so with, of course, new updates, new pieces of understanding, we're still gathering information, but of course, as we change in the way that we understand a group of muscles, of course we're gonna change in the way that we assess them clinically, right? We see this so frequently when we look at the evidence on strength. So strength is not necessarily indicative of problems or lack thereof problems. Yet we are so often talking about assessing strength and obsessing about what manual muscle test grade is there. And yes, if you're not familiar, we do have a manual muscle testing score for the pelvic floor. but realize that that is such a small piece of the entire picture. And we're starting to see this in the evidence as just described, and there's several studies that are making us go, hmm, maybe it's not all about strength. But how do we then take that into our clinical practice? FOCUS ON RANGE OF MOTION & MUSCLE COORDINATION First and foremost, we ourselves need to back off of obsessing about strength, right? We need to really get a full understanding of the person in front of us and really gather that information and not just talk about strength, but talk about the entire picture. So, here's the updated version of the way that we do our assessments. First, we're going to test their range of motion. I'll dive into each of these details, but I want to give you all the overall picture first. So first, we do a range of motion assessment. Then we go into coordination. And after coordination, then we might go into a strength assessment. We might go into a palpation assessment. or we might go into a prolapse assessment, depending on how that person shows up in front of us. We may take it a few different directions, our assessment, but we're going to start with the range of motion and coordination assessment. Range of motion and coordination are important for all people. No matter what we are assessing, no matter what problem, no matter what genitalia we are looking at, all of the people that we are assessing with the pelvic floor, we need to start with range of motion and coordination. So what is the range of motion of the pelvic floor? What do you mean by coordination? Well, range of motion of the pelvic floor, you've heard us talk about this a lot here at ICE, is squeezing up, we call it squeezing into the attic, going up towards the head, going to baseline, and then going into the basement. So in our A-frame analogy, we've got the attic, the first floor, and the basement. So we need to assess all of these areas. That is the range of motion. There are going to be problems if somebody can't raise it up. There's also gonna be problems if they can't push their pelvic floor down. There's problems when the full range of motion does not exist. So we need to A, assess it, and then B, help them find their full range of motion. That's beyond the scope of this podcast. Come to our live course where we talk more about this. But that is range of motion assessment. Very important as it is first. Then we go into coordination. So coordination is me assessing your pelvic floor with certain coordinated movements or certain movements that you do in the day. And I'm assessing to see what does your pelvic floor do and is it coordinated with the core muscles? How does that function? So we might would look at a cough We would definitely look at a brace, especially if the individual is having issues with some type of bracing mechanic. And you may do it in a lot of other different positions. I have clinically assessed pelvic floor coordination for a yogi who is having difficulty with downward facing dog. Yes, we got into that position to assess the coordination of her pelvic floor. That was where her primary complaints were. That's where we need to do that assessment. It's not a strength assessment at that point. It's a coordination. What is she doing with her core and pelvic floor in the problematic position? That is coordination. With these two important pieces of the assessment, There's a lot of different ways in which you might assess. Range of motion, coordination. That could be assessed just visually. Just externally, I am looking at maybe the rectum, maybe the vagina, male or female. Whatever it is, I might be just looking externally. Or I might do an internal assessment. vaginal or rectal. I might would do it in standing, a standing assessment. There's a lot of ways in which we're going to match the assessment with the problems that the person presents to us with. We're going to match them, but realize that they're going to start with a range of motion assessment and coordination. Then of course we can dive into our other three options, that strength assessment, that palpation assessment, and the pelvic organ prolapse assessment. So it's important for you to know that All of these options that exist, you may not use all of them in a client. You may not use them all in one day. It may take you several months or weeks, depending on the person in front of you, to go through all of these assessment tools. That doesn't matter as much as what matters is that you're testing the problems that they're presenting with, and of course, that you're making progress along the way. So that strength assessment is important. It is a piece of the puzzle. Someone needs to be able to generate enough force in their pelvic floor to squeeze off their holes. That way they do not have problems of a lack of force. That is important. But only when we know that they're coordinated enough to squeeze their pelvic floor. Right? Because if they can squeeze it on their own, but whenever they're bracing, they're not squeezing it, it doesn't really matter to work on strength. It matters to work on coordination. You see where I'm getting at? So once they get that, those first pieces, the range of motion and coordination, then we move on to strength. WHAT NEXT AFTER RANGE OF MOTION & COORDINATION? So with that strength assessment, we might do that in supine, we might do that in standing, testing their strength, their ability to squeeze the pelvic floor. With the palpation assessment, and again, we go into all the details. I'm skimming the surface here. We go into all the details in our live course. When we are doing a palpation assessment, that is purely to reproduce their pain. You hear us at ICE all the time talking about, and no matter which course you're taking, when we are doing a palpation exam, we are trying to reproduce their main complaint that they're coming in to see us for. So, same is true in the pelvic floor muscles, each of the layers, left side and right side. Does this reproduce their problem? Their problem might be urgency. When I gotta go pee or poop, I've got to go. Let's see if pressing on some of these muscles causes that urgency. or round ligament pain or adductor pain or might even look or sound like what the patient may come in with is sciatica, right? Or radicular pain. All of those could be caused by the pelvic floor muscles in which you would find in that palpatory exam. So that palpation exam is important to rule out the pelvic floor as a potential root cause of some of their symptoms that they are experiencing. And then lastly is pelvic organ prolapse. So we may not do this pelvic organ prolapse assessment. There's a lot of podcasts where we're talking about our thoughts on POP or prolapse, and I will have to guide you to those. I'm not gonna take all of your time talking about that this morning either, but it is a piece of the exam that you might would add in. We might would add in the prolapse exam if the person is coming in with their main complaint saying the word prolapse. Saying that I've been diagnosed with prolapse. Discussing some concerns about prolapse. Similar to the obsession about the strength scores, we can also see an obsession about a prolapse grade. Something about these numbers gives us this black and white, this very clear picture in our heads, but it's not exactly the full clinical picture. So really, do the pelvic floor assessment. If you need to do the prolapse assessment, absolutely do that. And again, you can do that in supine. You can also do it in standing and apply that to that individual. But just remember that 50% of individuals assessed objectively are going to have some sign of dissent, aka some sign of prolapse, so we don't need to be freaked out about it. Rather, what we need to do is focus on their range of motion, focus on their coordination. Those two pieces are so incredibly fundamental and important for everyone to be able to utilize their pelvic floor effectively. Whether that is in preparation for birth, whether that is performance under the barbell, or trying to reduce pain with sex, Whatever the topic is that the individual is coming to us for, we're going to start with that range of motion assessment. We're going to go into that coordination and we might hang out there for a while and work on the goals of pulling pelvic floor up, pushing down, feeling all of those differences of the pelvic floor, and then coordinating it. Coordinating it with diaphragmatic breathing, with bracing, with whatever problem they have, matching it to that. That right there added with it the three options of the strength, the palpation, and the prolapse assessment, that is the updated version of the pelvic floor assessment. That is what aligns with how we understand, as of today, the pelvic floor function. It matches what we see in the newest literature all the time, which is maybe it's not all about strength. Maybe there's some other aspect. And when you look at these studies, we recognize that individuals are assessing this, but it's not really been discussed about in this way. This is what we're doing. This is how you create change. This is how you have some organization in your assessment. This is how you get the patient on board. You tell them we're gonna do range of motion. We're gonna do coordination. We're gonna see how you do with each of these. This is gonna look a lot like this problem that you're experiencing. We're gonna match that up and we're gonna talk about what optimal is. Really focusing in on what matters to them helps them stay focused. SUMMARY So use this, let me know what you think, and if you are so excited to see us maybe in Greenville, South Carolina this coming weekend at the live course, we're excited too. Or we've got several courses coming up in Colorado, in Missouri, in Alaska, In New York, we're all over the place this year. So look for a course that's near you or near somewhere that you would like to travel to. We would love to have you at our course. We also are discussing these topics in a little bit different ways in our Online Level 1 and our Online Level 2. Our first cohort of the Level 2 is actually sold out. Our second cohort of the season of the year is in August. It will sell out. If you are interested in joining us, you should go ahead and purchase that ticket. We'll be talking about all of these aspects of what we just discussed today in both of those courses. head on over to PTOnIce.com, check us out, we would love to have you join us in the courses. Have a wonderful day, a wonderful week, and let me know what you think about the new way of doing the pelvic floor assessment. 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.

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. Jeff Musgrave PT, DPT, Cert. MMOA discusses how to use the SOC model of successful aging to help patients reach their adventure goals. Adventure for your patient could be walking outside for the first time or riding a horse on the beach for the first time in decades.  Baltes Theory Of Successful Aging Selection Optimize Compensate https://doi.org/10.1080/15427600802034827 Upcoming Courses! MMOA L1 8 wk online cohort is March 13th, Next MMOA Live courses are in Newton, Kansas 3/16-17 & Madison WI 3/23-24 *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. Paul Killoren // #ClinicalTuesday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Dry Needling division leader Paul Killoren discusses the safety, efficacy, and utilization of palpation when incorporating dry needling treatment into your 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 our live dry needling courses, check out our dry needling certification which consists of Upper Body Dry Needling, Lower Body Dry Needling, and Advanced Dry Needling. EPISODE TRANSCRIPTION PAUL KILLORENGood morning, crew. We've got YouTube, we've got Instagram. My name is Paul. I'm representing the dry needling division for ICE. My name is Paul and I would like to talk about palpation this morning. Pretty dry topic you might think, but depending on if you're trained in dry needling and how you're trained in dry needling, palpation may have been one of the key aspects to your course, your training, and then fill in the blank from there. I mean, our accuracy, our safety, and even our effectiveness for dry needling relies at least somewhat, high percentage, low percentage, on palpation. So we're talking palpation this morning, not even actual needles in, but this is heavily a dry needling topic on our clinical Tuesday. IS PALPATION-BASED DRY NEEDLING SAFE? First of all, to get it out of the way, there is actually quite a bit of research saying, is palpation-based dry needling enough? Enough being, is it safe? Is it consistently effective? And the answer is yes, most of the time. Meaning there's solid data that says if we're palpating rotator cuff muscles, so a 2023 publication last year said, if we're palpating infraspinatus, even teres and supraspinatus, compared to ultrasound, we're reliable. Maybe that's because it's accessible, we have a big spine of the scapula to rely on, but unfortunately we have data, a publication from 2021 that says if we're palpating ribs, especially posterior ribs, so deep to rhomboid and trap and all of that, unfortunately we're not very reliable. So first of all, to say, um, not the topic exclusively for this morning is can we rely exclusively on palpation for dry needling safety? The answer is yes. Most of the time. Um, I mean, one stance we do with ice, even on our advanced courses that we do not do rib blocking techniques, uh, meaning we don't palpate and rely on the rib as a bony backdrop for for like thoracic extensors, rhomboid, all of those muscles. So we can rely on it most of the time. There are certain regions where it's less, research says it's less consistent, less safe. And that's pretty obvious stuff. Can we palpate everywhere else in the body? Spinous processes for the spine, trochanter sacrum for the glutes. Can we palpate muscles for quads and all that? The answer is yes. HOW IMPORTANT IS PALPATION FOR DRY NEEDLING? So really the topic of this morning is how important is palpation for dry needling? And I'm gonna break this, the rest of the discussion into two topics. The first one is how important is dry needling as a diagnostic criteria? And the second one is how important is palpation, we have to put it in the palpation bucket, but I'll say how important is tissue control when we're dry needling? So let's tackle topic number one. How important is palpation as a diagnostic criterion for dry needling? And this is where we'll start to see a separation based on when you were trained and how you were trained. Meaning, if you were trained more than five or 10 years ago, or if you took a fairly exclusively trigger point dry needling course, then palpation is key. as a diagnostic aspect, meaning hopefully you're doing other assessment, but when it comes down to firm pressure in tissue, identifying trigger points or top bands or even muscular tissue that reproduces a patient's symptoms or refers into different patterns, very, very high on that diagnostic algorithm, the palpation is. For ice, we are drifting in almost every respect away from the trigger point paradigm. I mean at the highest level we're drifting away from trigger points being necessarily the singular explanation for pain, the direct dry needling target, and even the twitch response as not necessarily being deactivation of shortened sarcomeres, trigger points, all of those things. So the question is immediately asked, so does that mean that we don't palpate? Are we just randomly, generically floating needles into a muscle? The answer is no. We don't palpate trigger points, we palpate motor banding. This follows other philosophies, but motor banding being a slightly larger, slightly more macroscopic tone, I mean it is palpable, but it's not on that microscopic sarcomere level. If you have been needling for any period at all, or if you do any type of any soft tissue work, you know that you can find motor banding in almost everybody's glute medius, vastus lateralis, medial gastroc, tricep, deltoid, infraspinatus. These aren't trigger points, these are motor bands. And there is value to palpating that, and there's value to treating that tautness, that motor banding for dry needling. IS PALPATION DIAGNOSTIC? So back to the question at hand is like, how important is palpation as far as a diagnostic criteria? For ice, for us, it's a little less important than perhaps a purely trigger point based therapist, but it's not completely unimportant. It's just a lower, it's lower importance on our assessment, meaning Hopefully we had a full patient interview, a subjective, a full assessment. There was something that led us to treat vastus medialis for Gladys' knee pain or infraspinatus for Gladys' shoulder pain. So we're already approaching the patient, essentially knowing that we're going to treat these muscles. Then, and the narrative that we use on our courses is that, that very last piece of the puzzle, like if there are any puzzlers out there in the group, you know, depending on how challenging your puzzle is. It just took you a few hours, a few days, a few months. You did the edge first, maybe that's your patient interview. Then you fill in different colors, different objects. Maybe that's the rest of our assessment. But then there's that last puzzle piece. Almost always it's lost under the couch or something, but it's that last piece. And you're like, sweet, found it. I'm gonna put this in. That is our palpation. meaning everything else in our assessment, in our treatment model, interviewing the patient, led us to treat this muscle. That last puzzle piece before we put in a needle, so we've decided we're gonna use dry needling, we've decided we're gonna treat infraspinatus, that last puzzle piece is spending five to 10 seconds finding that motor banding, finding tautness, finding any tenderness, finding anything that reproduces symptoms. But the shift that I'm acknowledging is that that final puzzle piece was not the full puzzle. Depending on how you're trained and when you were trained, palpation was what created the whole puzzle. Meaning if you are a little bit more trigger point centric, we really rely on palpating a trigger point or palpating that banding and having it reproduce the patient's symptoms or at the very least be a familiar sensation. Or to say an extreme opposite of, If you're relying exclusively on trigger point identification and you palpate, you dig your fingers into a muscle and don't find tautness, that almost starts to sound like, okay, we're not gonna treat this muscle. So again, the paradigm shift we're talking about is that palpation is always a part of the equation, even for diagnosis, I'll say, or even when deciding where to place our needle for dry needling. But depending on how you were trained, depending on how much emphasis you put on that pain generating reproduction of palpation based tone, it is like what decides if you're gonna needle at all, or it really just decides where you're gonna put the needle in. So that's number one. If we're just talking palpation this morning, the first topic I wanted to tackle was how important it was diagnostically. and the TLDR there was that we're going to treat that muscle anyways, but there is that final puzzle piece, that final five seconds or so where we look for motor banding. That is where we want to put our needle. GREAT PALPATION IMPROVES PATIENT COMFORT Topic number two, I guess we're still going to call it palpation, but now it is about the technical aspects of controlling tissue while our needle is in. No matter what technique, no matter how you were taught to tap the needle in, set up a bracket window with compressed tensioning of tissue, or squeezing, or setting up the OK sign. Now we're saying, how important are the more nuanced aspects of tissue control? So again, we're not talking diagnostic criterion anymore. Here is where this tissue control, this tissue feel, this firmness of palpation separates novice needlers and more experienced needlers. Here we are saying that this is one of the primary aspects for making dry needling comfortable. You could probably argue this is part of making dry needling safe, but here is where palpation, quote unquote, becomes hugely important. very specifically the technical aspects of needling. Myself, when I'm on courses, every once in a while I get on the table for our faculty or just to get some free needles or just to volunteer my body. And when I'm on the table, this probably applies to all of you out there who have been needling for a while or work with someone who's needled for a while, you can tell pretty quickly, meaning before a needle is even tapped in, you can tell pretty quickly how confident that clinician is, how experienced they are based on how they palpate. And that is key. This tissue control, how we identify those motor bands that we just discussed for diagnostic or deciding where to put our needle, but really making the insertion comfortable, getting through some dense fascial planes or deeper into tissue, or just quickly, confidently, consistently getting into a muscle. There's kind of a clinical proficiency here as well. That is an expert art. Masters who do dry needling do this very well. So again, we've split the road. We're no longer talking about that being important for diagnosis. Now we're saying this is what separates expert clinicians from newer needlers is the tissue control. If you've ever taken a course for me or a course for me recently, when we leave the weekend, the last few slides, I kind of give you a few things to remember. And one of those things I hope was, Dry needling is a skill that you have to use, use it or lose it, unfortunately. That's tough in some states where you just learned, you just took your weekend course, you just learned how to dry needle, and you can't immediately go back and start needling every single patient in the clinic. But what you can do is start palpating your colleagues, your partners, your patients. You can work on that firmness of tissue pressure, you can work on tissue control, and really I'll say that is a primary aspect for dry needling. Again, not diagnosis necessarily, but making dry needling more comfortable, more effective, and clinically more efficient. SUMMARY And that's where I'm gonna drop off today. I mean, the emphasis today, I'm Paul, I'm one of our leads for the dry needling division, so this is kind of a dry needling topic, but really, didn't talk much about needles today. The question I wanted to answer is how important is palpation? And if you're just jumping on, thanks for joining. See a bunch of folks joining on Instagram. First of all, can we be safe with palpation only, meaning compared to ultrasound guided dry needling? The answer is yes, most of the time in most places. If we're palpating ribs posteriorly, maybe not. Number two, How important is palpation for guiding our diagnostic, our diagnosis, as a diagnostic criteria and how important is palpation? And the answer there is a little less if we're not talking trigger points, but it is that final piece of the puzzle. There is that final three to five seconds before we put the needle in that says, aha, motor banding, just palpated it, that's where I'm going. The third aspect of palpation is how important is it for dry needling, comfort, efficiency, all of that. And that's where we say very high. That is really what separates experts from novice or that's what separates a more efficient, proficient, confident clinician when it comes to dry needling. So the challenge this morning is if you have not really been waiting palpation as important for that pre-insertion with your needle. The challenge this morning is to spend two to three extra seconds. Add five more pounds of pressure through your fingertips. See if you can be a little more precise with identifying your motor banding before you put a needle in. And from there, once you've tapped the needle in, maintain that tissue control or that palpation focus for the entire time the needle is in. So this morning we won't talk about are we gonna piston a bunch, are we gonna twist it, are we gonna just leave it, are we gonna do e-stim. For now I'll just say for the entire time you're inserting the needle, you're moving the needle, you're repositioning the needle, focus on the palpation, the tissue control, maybe more than you were before. That is what separates the experts. So with that, I'm going to drop off. I held it to 15 minutes, which is always a victory for me. I apologize for the darkness this morning. I have my ring light on, but otherwise, kiddo is sleeping right next door. So we are dark and quiet here in the Killoran household. It is very early on the Pacific coast. So if you're jumping on, catch the recording, catch the first 10 to 15 minutes. How important do you feel palpation is? Or even to ask it another way, how do you feel your palpation, your tissue control, your confidence in palpating stuff has matured and improved from when you started dry needling to today? I'd love to hear, I'd love to have a poll, maybe I'll throw it up on Instagram, but I'd love to hear some comments on has it gotten better, has it stayed the same, more important, less important, where do you place palpation on your paradigm of importance, your pyramid of significance when it comes to dry needling.  Otherwise I'm dropping off, if you're trying to catch a dry needling course with us for ice, The next few months are key, meaning we've had a really busy February. We have a really busy March and April. Then things kind of slow down. May, we take Mother's Day off. We have Memorial Day off. We have a post-sampler rest. So things start to slow as we get into the summer. All of our faculty have kiddos and family, and we know you all do too. So the summer will be a little lighter for courses. So if you're trying to catch us before the summer, Check out March and April courses. Ellie will be in Bozeman, Montana this weekend. I'll be in Baton Rouge. And then we've got a handful of other ones coming up. Otherwise, we're setting up our fall calendar now. So keep your eye on the calendar if you're looking for something post-summer for dry needling. As always, at PTONICE.com or check us out Instagram at Ice Physio or DPT with Needles. Thanks for listening, folks. 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.

#PTonICE Daily Show: Kneeling After TKA Often the most neglected facet of the Total Knee Replacement recovery, yet maybe the most important. Join @dustinjones.dpt as he dives into why working on kneeling is not a matter of IF we should do it but WHEN. We'll cover kneeling progressions as well to help that hyper-sensitized patient. ---- Want more helpful #geri content? Head over to https://mmoa.online for Free Resources & info on our Certification!

It can be hard to change your habits. In health and in rehab.  But it doesn't have to be a drastic sudden change, we encourage you to just take the first step (and we give you a couple options of what that might be)  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!

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. Guillermo Contreras // #FitnessAthleteFriday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Fitness Athlete faculty member Guillermo Contreras discusses the role of the lat and its importance in functional fitness as well as his top three exercises to strengthen the lats. Take a listen to the episode or check out the show notes at www.ptonice.com/blog If you're looking to learn from our Clinical Management of the Fitness Athlete division, check out our live physical therapy courses or our online physical therapy courses. Check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION INTRODUCTION Hey 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. GUILLERMO CONTRERAS Good morning, PT on Ice, Daily Show. Welcome to the Best Day of the Week Fitness Athlete Friday. I am Guillermo Contreras on the teaching team within the fitness athlete division of the Institute of Clinical Excellence. My basement gym here. Today's topic at hand is lighting up the lats. One topic that we see most often discussed or looked at within the fitness athlete division, whether it be in the live course or the online course, is the idea of lat weakness. And also, right, we talk about very heavily how to cue engagement of the lats, right? We never wanna say engage the lats, but squeeze oranges between your armpits, pretend I'm not gonna tickle you, don't let me tickle you. And in essence, we want to be able to teach individuals how to better utilize, use, and strengthen their latissimus muscles. The best way we can do that is not only using the pull-up, which we teach in the live and online courses, but also giving some accessory movements. And the accessory movements are where most people tend to have the greatest amount of questions. What movements do we do? What can we actually use to strengthen it besides a standard lat pull-down machine or a seated row machine? Especially when in the fitness athlete realm, we don't have those pulley systems. We don't have a giant cable pulley machine. We don't have a big lat pulldown, seated lat pulldown, or a seated row machine. So being able to give really good accessory movements that individuals can utilize in the gym to improve that lat strength, that awareness of what their lats are doing, is really pivotal. in helping improve the quality of movement, the strength of movement, and the ability for our fitness athletes to complete what they want to be doing in and out of the CrossFit box. STRAIGHT ARM LAT PULLDOWNS So, quick anatomy review for you all, right? We know the lat originates right here on the front side of the shoulder, wraps down around into the low back, and then attaches itself through to the lumbar spine via the thoracolumbar fascia, which is why the pelvis can play a part in the position of the length of the latissimus as well. So with that, I'm gonna give three of my favorite or three of the best movements or exercises that I give, that I prescribe out for a home exercise program or within the clinic to help improve individual's lat strength and lat activation. Number one is a direct strengthener of the lat. It's just gonna target it, it's gonna help people feel it really, really well, and that is right here. It's a straight arm lat pulldown. And I'm gonna show two variations that this one can be performed, depending on, I would say like the level or the strength of the individual you're working with. We start simply by anchoring that band onto a pull-up bar or anything just above head height. We then take that band, we can hold it in both hands here, back away there so there's some tension. We get a nice forward lean, keeping that nice neutral spine. And then I simply keep my elbow straight and pull that band down to my hips. By keeping the arms straight, we ensure we are hitting that lat muscle by performing that shoulder flexion all the way to end range. And in this upward position, we are hitting that end range position of the lat overhead when it's fully lengthened like we would see at the bottom of a pull-up. A way that I progress this for individuals is by adding hip movement or combining that shoulder flexion with hip extension. Because as we extend the hips, we change the length of latissimus by letting the thoracolumbar fascia can relax a little bit more, contract a little bit more, and we get up to the top. This movement is called a lat prayer. Again, I don't know who named it, who comes up with the names of it. It's simply what I know it as, a lat prayer. And what that looks like is a very similar setup. I am here in this forward flexed position, hips back, arms at that end range. As I pull down on that band, I am bringing my hips up towards that band and come into a full contracted position of the lats. as I descend back down, I'm going to that fully lengthened position once again. So it's just a combination of movements. We can do this both as a smooth kind of movement, all occurring at once, or we can segment it as a pull to the hips with that straight arm pull down, and then a stand, return to the hinge, and then come back up. So that is your straight arm lat pull down. dosing that with some good amount of volume right this is just a a rogue blue band i think it's like a half inch or a quarter inch band, but it's got a nice amount of tension on it. I can do anywhere between like 15 to 20 reps, really feel that nice active muscular pump as I'm doing it, and it creates a lot of awareness in that shoulder. The lat is huge when we think of pull-ups. When we're doing kipping pull-ups, chest-to-bar pull-ups, butterfly pull-ups, whatever it is, we wanna have proficient strength in the lats to be able to maintain a stable shoulder and protect us from injury when we're dropping down to the bottom. So number one, again, straight arm pull down or lat prayer. However you want to do that, you can dose it out in different ways. BANDED KETTLEBELL ROW Number two is a unique one in which we use a kettlebell and then a band anchored to the rack or a rig. Here, we take that band and we put it around the handle of the kettlebell. It can also be around our wrist or something like that, or you can actually like attach it onto the kettlebell itself. Easiest way for me to set this up for my athletes is just to have it right around the handle there. And then we set up in the same way we would do a bent over row or a single arm row. So it can either be supported on a bench or a box. It can be in this kind of double leg hinge position here, or we can be in just our standard staggered stance position here. From here, forearm goes on the knee, take a hold of that kettlebell, pick it up. We then row back towards our hip. So I'm here and I'm pulling back to my hip and then letting it pull me forward. So the motion is more of a J. So I like to think of it that way. It's a J back up to the hip and then bringing it back down. So more of a curved motion of that row versus the standard kind of straight vertical row. or I guess you could say horizontal row. What this does is because it is now anchored, as I do that row, it's not a simple horizontal row where I'm just doing a little bit of an upright motion there. I am now getting a bit of a vertical pull force as well, where I have to actually pull against that band, up to my hip, and then back down. Up to my hip, and then back down. This is a really nice one because you can load it different ways. You can load it with a heavier kettlebell going 35, 45, 53, whatever weight you want to use for that weight. Or you can make it much tougher by going with a much heavier band. This is like the Rogue quarter inch band. This is I think like 15 pounds, 20 pounds of force, stress. But you can go much heavier attention on that band, make it much tougher. There, maybe you probably are bracing on something so you don't get pulled over. But this one, if you've never done it before, if you've never prescribed this for your athletes before, this works wonders. It hits that so much better than anything else you've seen. And it feels great. I think it feels really good. It's a very strong movement there. So that is a banded kettlebell row. Again, think of a curved pull towards the hip rather than a straight vertical row. And you're going to get much more of that lat activation as you come back. BANDED LAT SWEEPS The final movement, because we know that the lat is responsible for much more than just doing vertical pulling, It's also responsible for maintaining tension on the bar when we're doing deadlifts, Olympic lifts like the snatch and the clean. We want to make sure we're also training it to do those things. So this here is my favorite exercise for those athletes who struggle to find their lats, to find that armpit squeeze, that pinch, and we can cue it with something called a sweeping deadlift. This here is just a five pound kids bar, it's my daughter's, but we can also use a PVC pipe or a dowel, anything works fine. we take that bar or that PVC pipe, it goes in the band as well. So again, once again, it's anchored on a rack or a rig, something that's not gonna fall over on top of you. We move back away from that anchor point, so now we have some tension on that band. We then pull that bar towards our hips, and then we begin our movement. So here I'm going to bring my hips back, maintaining tension the whole time, bend at the knees, down to the bottom, And then as I come back up, I am maintaining tension, so I'm scraping my shins to my thighs, pulling through, and maintaining that tension there. And back up. We can obviously do this with different grips, right? So this would be more of like my deadlift or clean grip. I can go much wider, as wide as this bar lets me go, and go with more of a snatch grip, and then really focus on more of a snatch setup, or more upright torso, and really think, of going through that first and second pull as I come there, as I come here, getting tall with it, and continuing to use that tension to train how that should feel when I'm pulling that bar towards my body. So there it is, right? A nice recap. Three movements that I love to give my athletes who are struggling either with getting pull-ups or with shoulder pain because the lats might be weak and they're kind of dropping and crashing down in their kipping pull-ups or their butterfly pull-ups. One here, that straight arm pull-down, pulling down to the hips, keeping the elbow straight. Can I add in some hip motion to just really increase that tension and that full range of motion for it? that banded kettlebell row with a vertical and horizontal pull that's working together at the same time to really hit that lat musculature there. And then that sweeping deadlift for maybe my athlete that just really struggles to understand what it means to use their lat to be able to hold that bar close to their body to create more tension through their spine, through the thoracolumbar fascia to maintain a neutral spine when deadlifting, Olympic lifting with the clean, the snatch, et cetera. So there again, three movements that I love to prescribe out to my athletes for that there. SUMMARY If that was good, if you enjoyed learning those, or you're like, oh my gosh, I've never seen those before, never heard of those before, and you want to learn more, please join us on the road, please join us online. We have a number of courses coming up. We have our next course of Clinical Management with a Fitness Athlete, Level 1 course, or what used to be known as the Ascendant Foundations. That kicks off on January 29th. We would love to have you join us there. We do all things squat, front squat, back squat, deadlift, press, pull-ups. We learn how to program for CrossFit. We understand what it looks like to do a Metcon. It's a great experience, great course, especially if you're new to this area and you want to get more involved in the fitness athlete realm. And then our live courses, we have a handful coming up. Next week, we're going to be in Portland, Oregon, January 10th and 11th. We're going to be in Richmond, Virginia, February, I said February 10th and 11th, February 24th and 25th down in Charlotte, North Carolina, so hitting that East Coast. And then in March 23rd and 24th, we're going to be out West in Meridian, Idaho. So if any of those are near you, if you've been looking to take a live course, please head to PTOnIce.com, go to our live courses, check that out. And if you have taken these courses, and you're interested more in kind of just the exercise prescription realm, what do movements look like, these ones right here, there's a resource we have in our self-study courses section of the PT Honors website called the Clinical Management of the Fitness Athlete Exercise Library, over 150 exercises all different realms for deadlift, for squat, for pressing, for pull-ups, for gymnastics. Myself and Kelly Benfinger, the TA, worked really hard to send that out. We just came up with a new version 5.0, fully updated, that we'd love for you to use to help your athletes and have a really great resource for you. So gang, thank you so much for joining this Friday morning. Hope you have a wonderful weekend. And again, thank you for tuning in. We will catch you next week on the PT on ICE Daily Show. 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 // #FitnessAthleteFriday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Fitness Athlete division leader Alan Fredendall discusses assessing & treating for issues related to shoulder internal rotation & extension limitation with overhead movement in the fitness athlete. Take a listen to the episode or check out the show notes at www.ptonice.com/blog If you're looking to learn from our Clinical Management of the Fitness Athlete division, check out our live physical therapy courses or our online physical therapy courses. Check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION INTRODUCTION Hey 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, everybody. Welcome to the PT on ICE Daily Show. Happy Friday morning. I hope your morning's off to a great start. We're here at Fitness Athlete Friday. My name is Alan. I'm happy to be your host today. Currently, I have the pleasure of serving as the Chief Operating Officer here at ICE and the Division Leader in our Fitness Athlete Division. Fitness Athlete Friday, we talk all things fitness athlete, CrossFit, Olympic weightlifting, powerlifting, endurance athletes, and any recreationally active person. we talk about how to address those concerns. I have Dr. Haley with me here today. She's going to be my demo for some hands-on stuff. If you are listening to the podcast right now, I don't know why I pointed to my ear. If you're listening, you can't see me anyway. If you're listening, please switch over to our YouTube channel and watch the video because about halfway through, I'm going to show a lot of hands-on assessments and techniques, and you're not going to be able to see that if you are just listening on the podcast. SHOULDER INTERNAL ROTATION & EXTENSION: ANATOMY Today, what are we talking about? We're talking about the combined motions of shoulder internal rotation and extension in the shoulder, especially its relevance to the fitness athlete. So when we talk about these motions, we're primarily talking about the subscapularis muscle of the rotator cuff and the shoulder blade. So this muscle gets neglected a lot, mainly because most human beings no longer exercise, which means they are no longer vertically pulling and pushing above their head. So they're often not needing to use a lot of internal rotation and extension of the shoulder because they live their life with their arms relatively neutral. But if we look at the actual anatomy specifically of the subscap muscle, we know it is actually the largest and strongest rotator cuff muscle. It takes up the whole anterior portion of the shoulder blade on the anterior side of the scapula and is primarily responsible, yes, for internal rotation, but when the arm is elevated or out in front of the body, It also performs some combined motions of adduction and extension. It functions very similar to our lat muscle. So we have our subscapularis and our lat muscle counteracting all the other muscles of the shoulder and the rotator cuff that elevate our arm above and overhead. Most importantly, from the anatomy is knowing the attachment points. It attaches right on the anterior capsule of the shoulder. And when we see referral pattern, we can see anterior shoulder pain, folks point directly to a spot right on their anterior shoulder. But it also has referral into the posterior rotator cuff and into the medial scapular border. So a lot of times we can chase treating the posterior rotator cuff, especially in the fitness athlete when we actually need to be treating subscapularis. SHOULDER INTERNAL ROTATION & EXTENSION: ASSESSMENT Now how do we know this is a target for treatment? Well that's going to be revealed in our subjective and objective exam. So when someone comes in and I'm gauging their symptom behavior and I'm getting a list of their eggs and eases, especially with a fitness athlete, I'm looking to hear things like pain with dips, pain with bench, especially in the bottom position of a bench press, things like pain in the turnover, or what we call the catch of a bar or a ring muscle up, handstand push ups, again, especially the lowering the eccentric phase, where we're now going from an overhead, flexion, abduction, external rotation. And now we're lowering eccentrically into extension and internal rotation, very similar to the bottom position of a bench press. And then in that pull, that high pull motion that we have in our cleans and snatches with Olympic weightlifting. So when I hear aggs like that, my hypothesis list subscapularis jumps up. I'm looking to assess internal rotation and extension in that athlete, much more so than that sedentary person who comes in and complains of shoulder pain. I'm really not thinking this person is probably having a lot of issues with loaded internal rotation extension in the gym. because they don't go to the gym, right? That is a person where I'm probably going to look to the posterior rotator cuff and maybe the lats for strengthening and the delts for strengthening and just basically get that person's shoulders stronger versus specifically addressing a specific muscle like the subscapularis, which I would with a fitness athlete. So let's talk about how to actually assess the shoulder. So I have Haley here. We're going to demonstrate on her shoulder. You're all probably very familiar with this seated screen. It's something you learned in school. We're going to go through it really quickly. So having Haley lift her arm up and overhead and sitting to look at flexion, coming out to 90 degrees to look at abduction. We can meet in the middle and look at scaption at that 45 degree angle like that. We can put our arm at our side and now we can look at extension. And then we can hold our arm at a side and we can go across the stomach, internal rotation, and then out away to look at external rotation. Now what do we like about that screen? It's a screen, that's it. I hate almost all of that for the fitness athlete. Why? It's really not challenging a lot of true end range positions, especially of extension and internal rotation. The main thing to remember about internal rotation is if Haley's arm is at her side and she's internally rotating, she can palpate on herself. When the arm is at the side, the pec is the main mover there. It's not actually subscap or the deltoid at all. So when the arm is at the side, we're not even challenging actual internal rotation. We're using nothing about the subscap at all. Likewise, if we're seated and we're going through extension, I need to know how can I challenge sheer force to the shoulder like it might encounter in a bench press, a muscle up, a handstand pushup. I can't do that in sitting. SHOULDER INTERNAL ROTATION & EXTENSION: DITCH THE SEATED EXAM So for fitness athletes, we need to ditch the sitting exam and we need to go prone for the shoulder. So I'm gonna have Haley lay on her stomach here. We're gonna look at her left shoulder. We're going to look at internal rotation first. So I want her arm out at 90 degrees, about parallel with her shoulder, and I'm going to instruct her to bring her palm up towards the ceiling. And I want to look at that internal rotation. So we're cheating a little bit here, a little bit of abduction, but we have a really good assessment of internal rotation here. I can overpressure this as well. Haley, don't let me put your hand down. And I can look to see if that's symptom-provoking. So that is how I will assess internal rotation. Is the motion full? Is it provocative with an overpressure test? We can also look at extensions. I'm going to have her scooch a little bit to her right. She's going to bring her arm up at the table next to her side, and then she's going to lift her arm up in the air. And I'm looking to see, again, does she actually have full straight plane extension, or does she drift out into a lot of abduction? Good motion here. Same thing. I'm going to overpressure this. Don't let me push you down. And I'm going to see, is that symptom-provoking? So I'm going to challenge extension in a manner where gravity is providing sheer force through the labrum for me to see if that's provocative. And then I'm also going to overpressure the arm to see if I can overpressure and get any symptom provocation out of the shoulder. The last test that I will do is I'll have Haley stand up and then she's going to turn her back to the camera. We call this the liftoff test. It's also called Gerber's test. Very old test, almost 30 years old now. Tons of great research on it. So I'm going to ask her to pick a hand and I'm going to have her put it in the small of her back. And really I'm going to see how far up her back she can go with that hand. So can she go any higher? Good. Some of you might measure range of motion this way. That's great. I usually see what level of the spine can the thumb get to. Very functional for women, right? Somebody that can't even put their hand in the small of their back is probably going to have a lot of trouble with something like taking a bra on and off. But we get a good measure of range of motion. We know that if she can reach the small of her back, we're primarily now looking at subscap. A really good study by Greece and colleagues way back in 1996 found that if someone can get their hand in the small of their back versus down at their glutes, that just by getting it higher to the low back, we can get 33% more subscap activation. So I know if a person can achieve this position, they have really good range of motion out of that subscap muscle and that we're primarily now looking at subscap in isolation. What do we do now? We do the actual lift off. So I'm going to have Haley lift her hand away. She can lift her hand away and keep it approximately in the small of her back. And then if that's not pain provoking, at this point I am confident in ruling out subscap. Why? This test has 99% sensitivity. If that is negative, I can cross subscap off my hypothesis list and now I can look a little bit deeper into the shoulder. All of that has only taken us eight and a half minutes with a lot of talking. This is something you could probably do in a minute or less in the clinic and immediately rule out the subscap and be really confident that it's not the subscap. So, Haley, go ahead and have a seat. SHOULDER INTERNAL ROTATION & EXTENSION: TREATMENT So, what if it is a subscap, right? What if somebody like me walks in, my left shoulder looks okay, my right does not, Immediately I'm thinking I know which side I'm going to treat. I know which muscle I'm going to treat. We're going to talk about treatment next week. Zach Long is going to get on here. But the main thing is we need to restore that internal rotation range of motion, especially under load. Why? These folks are using this range of motion in the gym or they're trying to use it, which is maybe why they're bumping into symptoms with things like handstand pushups and Olympic lifting and muscle ups and that sort of thing. So we need to restore that full internal rotation range of motion. we need to increase its load tolerance, and we need to, in general, get the shoulders stronger, both delts and lats. But specifically, working on the subscap is going to give a lot of benefit to that athlete. So someone like me, I would needle my own right subscap, try to improve some of that range of motion, and then try to load that internal rotation. We'll talk more about treatment next week with Zach. He's gonna do a follow-up episode specifically on how to treat the subscap for the fitness athlete. So make sure you tune in next Friday. That's all we have for you today. I hope you have a fantastic weekend. Courses coming your way. Head on over to ptinex.com. Remember, all of our courses priced at $6.50 will become $6.95 on Monday. So if you have a course on your list, make sure you buy it over the next couple days and avoid that price increase. All of our courses from the fitness athlete division are on PTONICE.com. Hope you have a fantastic weekend. Have a wonderful new year. See you next week. 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.

A Framework for Rehab for Patients with Dementia 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!  

Join @jmusgravept today on the Daily Show as he discusses how to balance infusing patient care with hope with the reality of their recovery. Take a listen or check out the full transcript with show notes on our blog (www.ptonice.com/blog) or on your favorite podcast app. Psychol Sci.2007 Feb;18(2):165-71. doi: 10.1111/j.1467-9280.2007.01867.x. Mind-set matters: exercise and the placebo effect Alia J Crum 1, Ellen J Langer Affiliations expand PMID: 17425538 DOI: 10.1111/j.1467-9280.2007.01867.x *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

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.  

Guidelines for Exercise in People with MCI + Dementia 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. 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. Dustin Jones // #GeriOnICE // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Modern Management of the Older Adult division leader Dustin Jones discusses the difference between sarcopenia (the loss of muscle mass) and potentiapenia (the loss of muscular power). Dustin reminds listeners that performing functional outcome measures & then creating a treatment plan based on functional deficits uncovered during assessment is the most important thing in ensuring patients receive the individualized care they need: "Assess, don't assume." Dustin also discusses the utility of using functional outcomes to assess & track progress so that insurers like Medicare will continue to pay for treatment. Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 - DUSTIN JONES All right, welcome y'all. This is the PT on ICE Daily Show brought to you by the Institute of Clinical Excellence. My name is Dustin Jones, one of the lead faculty within the older adult division as we call MMOA. We're going to talk today about a really interesting topic. We're going to name the enemy and that is potentiopenia. We're going to name the enemy particularly when we're working with older adults and that is potentiopenia. This is brought to you by a listener question, a commentary that they wrote and I want to dive into the topic of power, strength, Sarcopenia as well. What should we really be focusing on? How can we screen? Before we get into the goods, I want to mention about some upcoming MMOA live courses. MMOA live is a part of the cert MMOA curriculum. Part of that curriculum is a live course. Also our MMOA level one online course, which was formerly called MMOA essential foundations. And then MMOA Level 2, which was formerly called Advanced Concepts. You complete all three, you get your cert MMOA. We have three upcoming weekends where you can go to that live course. We're gonna have Annapolis, Maryland and Central South Carolina. This upcoming weekend, November 11th, we're gonna be in Wappinger's Falls, New York. And then right before Thanksgiving, November 18th, that weekend, we're gonna be in Westmont, Illinois. So if you are looking to get some Con Ed before the end of the year, be sure to check us out. PTOnIce.com is where you can find all that. POTENTIAPENIA All right, so naming the enemy, potentiopenia. So this is a term you probably have never heard about because it's not been coined, it's not been researched, it's not been agreed upon in literature. This is a word that was made up by Dr. Ronald Michalak. So Dr. Michalak is an orthopedic surgeon that's been practicing for roughly 20 plus years that has quitting his surgical practice to go back and pursue his PhD in Rehabilitation Science. Dr. Michalak is an avid listener to the PT on ICE Daily Show, so I want to take the time to shout out to him, but also for all of y'all that listen to this show that aren't our typical physical therapy crowd, right? The OTs, the speech-language pathologists, the other healthcare providers. I know we have some PAs, some NPs in here, but we're really grateful for y'all tuning in because we're starting to see we have a fitness-forward army clinicians that are trying to solve the same problems. This is one example. So Dr. Mitchell like you know 20 plus years doing orthopedic surgery you start to see some patterns right? You start to see the issues with focusing on the tissue, right? Of focusing on, oh, that bone-on-bone, we should probably just go ahead and replace that whole joint, and that will solve all your problems, right? There's some issues to that, that when we focus so much on the anatomy, the structure, that we apply surgical interventions to non-surgical problems, that creates issues, right? And so over his career, he started to see, man, the biggest issue is not the quote-unquote bone-on-bone, it's the fact that these folks are deconditioned, they're weak, they're not able to do the things that they want to do and it leaves them susceptible to some of these medical situations that I'm often performing surgery on. What can I do to prevent them from even having surgery? And so we started to dig into the research and science and what he has come to the conclusion of is we are really missing the boat to where we're focusing on the wrong things and what we need to focus on particularly with this population is their lack of power. hence the term potentiopenia, the lack of muscular power. So, I want to give some context for this discussion because I think it's really interesting of how much progress has been made in this area, particularly in geriatrics and geriatric rehabilitation. SARCOPENIA So, sarcopenia, you've heard us talk about this so many times on the PT on ICE Daily Show. If you've taken any of the MMOA courses, you've heard this term. Sarcopenia was first coined in 1989 by Dr. Rosenberg, and at the time, the definition, the accepted definition of sarcopenia was age-related loss of muscle mass. That we thought, oh man, these folks are losing muscle mass, therefore, they are losing their strength, they are losing their ability to do what they need to do. This is a big issue. It's age-related, but we may be able to do something about it. As this was studied more and more, and just this whole concept, was being critically you know thought about that the term of sarcopenia or the definition of sarcopenia was missing a little bit right because you can have someone that is losing muscle mass but may still be really strong or you may have someone that does have a good bit of muscle mass that is rather weak or they're not able to produce their force quickly aka they have low power So, in 2008, Dr. Clark really started to push against this definition of sarcopenia and say, hey, this isn't the issue. The issue is the lack of strength, the age-related loss of muscular strength. And he coined the term dynopenia. That was a back and forth, back and forth. And now in terms of the term of sarcopenia, what we're seeing is that it's starting to incorporate some of the things that Dr. Clark really was pushing for. And now you're often going to see sarcopenia defined as the age-related loss of muscle mass and strength. That's what we speak to in the MMA course. And so a lot of the screens that you're seeing of being able to identify folks that have sarcopenia are mass related screens of actually measuring muscle mass and having cutoffs based on certain age groups and so on and so forth. But then there's also functional measures, right? Gait speed is one, grip strength is another one, the SPPB, the short physical performance battery test can indicate that someone is at risk of sarcopenia. Sarcopenia has changed a ton over the past few decades. Now, what's interesting is that the amount of research, which is so massive in this particular topic, that we have really good evidence to show, man, if this person scores below one meter per second, for example, on the gait speed, that this individual is at risk of sarcopenia, also a host of negative health outcomes. It's very predictive. We have a lot of data to show that poor performance on some of these outcome measures is a big issue and very predictive and warrants medical treatment or physical therapy, if you will, or occupational therapy, some of these rehabilitation-based services. Now, here's the issue. Here's what I think Dr. Michalak is going towards, is a lot of these screens that have been used to say, hey, this person has sarcopenia, age-related muscle mass and strength, that these screens may not actually be measuring what we think, right? If you think about gait speed, normal gait speed, for example, is that a measure of strength? Not really, right? Is it a measure of, let's say, power, the ability to produce that strength quickly? Potentially, right? Definitely, if it's a fast gait speed, or if we're looking at gait speed reserve, the difference between max gait speed and normal gait speed. Think about the 30 second sit to stand test, where we're standing up and sitting down 30 times. Is that a measure of strength? You can make a strong argument that, no, not necessarily, but it's more of a measure of how people can use that strength quickly to perform that transfer. Same thing could be said for the five times sit to stand. And so these outcome measures that are often tied to quote-unquote sarcopenia, the age-related loss of muscle mass and strength, isn't really measuring that. We can say that those tests are very predictive of some of these negative health outcomes. That's not what we're talking about. What we're talking about is do these tests actually measure, indicate what they're saying that they measure, right? Now, here's the, I think the important part about this is that if I am performing a five-time sit-to-stand test or a 30-second sit-to-stand test and think that, oh, this indicates that this person has impaired lower extremity strength and I focus on strength-based interventions, right, I'm just worried about getting them stronger, not necessarily trying to help them get stronger, produce force quicker, aka power. THE NEGLECT OF POWER-BASED TRAINING And so what Dr. Michalak is really proposing is that our focus on age-related loss of muscle mass and strength, the focus on strength has resulted in the neglect of power-based training. We need to really think differently about these terms and ultimately what they result in. I think we should have a new term, potentiapenia. That was his argument. This is all in a beautiful commentary that I loved reading that I'm going to link in the notes. So here's our take on this. I agree that… we have really dropped the ball on power-based training, right? That we often neglect that in this population for many reasons. One is just we haven't named the enemy as one. Two is that we often have ageist assumptions about what people can handle, right? That, oh, that's too intense for them or they will get hurt. It's not as well studied as strength-based training. There's a lot of reasons that go into that, but I do agree that we have really dropped the ball there. A new term, creating a new term, and everything that's associated with that, I don't know if that's the answer, but I do think we need to continue to be critical of the term sarcopenia and what that actually represents. It's already changed to age-related loss of muscle mass and strength, which is lovely, and I would love to see that conversation continue to include power as well. Clinically, here's what I think is really important for us when we think about some of these deficits that folks are undergoing and we're throwing around some of these terms. STRENGTH VS. POWER TRAINING I think the big thing that needs to be focused is we're diving into the weeds of strength versus power and you know reps and sets and volume and all that type of stuff that when first one is when we're working with individuals that are relatively sedentary or inactive and Movement is king. I don't care what they do. The fact that they are moving is ultimately important, right? We got to get people moving first and we need to be less picky of what that looks like, especially with sedentary and active individuals. That's the first thing. The second thing is we need to really think about our assessments and challenge our assumptions with this. This is why in our courses we always say assessments over assumptions. It's very easy for us as clinicians, when you're doing an assessment, you're doing the five-time sit-to-stand test, 30-second sit-to-stand test, to assume, oh, this person needs to do more lower extremity-based strength training, right? That's a very common thing for us to correlate. Now, that test may not be and probably isn't testing pure strength, right? There's other ways to do that. One rep max testing, estimated one rep max testing. We can use dynamometry as well. There's other methods to test strength. These functional and very practical outcome measures may be more a testament to someone's power ability. So when we use these tests, particularly the 30 seconds sit to stand, five times sit to stand, I think is a great example. that we need to be thinking probably about strength training, but we also need to be thinking about power training. Can they produce that force quickly? Because it ultimately is an indicator of power, the ability to produce that force quickly and do that transfer. So what your outcome measures tell you, we need to be very careful of how that informs the intervention, right? And ultimately what we're often going to find, I think this is not an or conversation, strength training or power training, in the realm of ice, you will hear this so often, it is and not or, right? Probably both, strength and power, we can do both. In reality, when we do get people stronger, you often see, especially in folks that are untrained, you are gonna see an improvement in power production. You could do specific power training, where you're doing force movements quickly, you're probably using lighter loads, and you're probably gonna see an improvement in strength, right? That's gonna happen with a lot of untrained individuals. But I think in the context of rehab, in the context especially of One Rep Max Living, that we probably want to do both. Heavy loads are really good. Heavy loads provide an amazing stimulus to promote muscle mass, our strength, but also the strength of our bones, also our soft tissue remodeling. It makes us more resilient individuals. But fast loads are really good too, right? They give us that type 2 muscle fiber stimulation to prevent some of that preferential decline. in those fibers. That quick speed is so practical for so many things that we do in the real world and also in high-risk situations. It's an and conversation. We want to do both. Now, Dr. Mitchell, I had two specific questions that I also wanted to hit on. Could referrals be written or phrased better from the physician end to encourage PTs to try to help get these individuals moving toward fitness? Now, I want everyone to listen here, and by and large, the PT on ICE Daily shows largely physical therapists, physical therapy assistants. Think about what this physician just asked. This physician is basically saying, where are my fitness forward clinicians, right? Where are my fitness forward clinicians? Where are the people that I can trust with my patients? I love this question. I think from our angle, from kind of the rehab fitness side of things, Let it be known. What are you about? Lock arms, lock shields with us, the ICE tribe, the ones that are really pushing this fitness forward message because there are healthcare providers looking for you. Now, Dr. Mitchell, from the physician's standpoint, I do think it is helpful to make it clear as a physician that you have that fitness forward approach. And oftentimes, we don't see that on referrals, right? It's the diagnosis and treat, which you love as a PT, to be honest, but if you do run a 30 second sit to stand and acknowledge that it is under or below a particular cutoff let it be known and let it be known what you are thinking about that it is a potential loss of power production potential right and let the PT do the job of assessing to determine is this a bigger power issue or a bigger issue of just producing force of strength. FUNCTION-FORWARD HEALTHCARE PROVIDERS But let it be known, I love it whenever I see another healthcare provider perform some type of screen, like a 30 second sit to stand, a timed up and go is another one, that tells me that this is a function focused healthcare provider. And we're speaking the same language, especially when we're coming from the MLA tribe. We speak function, we speak that fitness forward mindset, include some of that information and that's really going to get the point across particularly to the fitness for clinicians. I would also say Dr. Michalak is go to PTOnIce.com, look at the find an ice clinician map and build relationships with that person that is local. The second question that he asked was, are there any insights into Medicare billing or reimbursement that would allow them to do so and actually get paid for their expertise? So the question here is mainly looking at, he's interacted with some PTs where he sent the referral that was not pain based, where these clinicians said, I can't get this covered, right? I treat pain, I get paid to treat pain. That is not correct, right? So you can definitely get reimbursed to have the fitness forward approach when you use appropriate outcome measures. When you can demonstrate medical necessity through the performance of these validated outcome measures that we cover extensively in our MMOA level one online course, and a little bit as well in our MOA live course, when we're using those outcome measures to demonstrate, hey, this person has a score, which based on the literature is showing that they are at a higher risk of whatever, negative health outcome, usually it's a fall, that that warrants your services. It is medically necessary. So we can have fitness-forward physical therapy. This is what we often see in the context of home health. We treat more function than pain in the context of home health. Outpatient, not so much. It's more of a pain driver, but you can still have a fitness-forward approach in the context of outpatient. These outcome measures are absolutely key because they demonstrate medical necessity. Multiple outcome measures I should say great conversation. So what I want y'all to do if you like this topic I want you to come to Instagram and I'm gonna drop a couple links. You could also send me a direct message At Dustin Jones dot DPT and I'll send you the links as well because it's a really great conversation. I think by and large Yes, we need to get people stronger We're already really pushing forward with that and I love that but we may need to take it to the next level of power based training In terms of a new name, potentiopenia, I don't know. I'll let the really smart people debate that and discuss that, but I'm going to keep pushing the message that we need to build people's resilience. We need to end one rep max living and really show that people may be quote unquote old, but not weak. Also that they may be quote unquote old and not slow. Y'all have a good rest of your Wednesday. I'll talk to you soon. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Dr. Jessica Gingerich // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member Jessica Gingerich discusses simple, but often overlooked interventions for treating patients with symptoms of pelvic prolapse including the Kegel, unilateral hip strengthening, and proper breathing & bracing. Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter! EPISODE TRANSCRIPTION 00:00 - JESSICA GINGERICH Welcome to PT on Ice Daily Show. My name is Dr. Jessica Gingerich and I am on faculty here at Ice with the Pelvic Division, which means that it is Monday again. We are getting super close to Halloween. I'm really excited. I'm definitely a Halloween girly. Today we are going to talk about what may be missing during the plan of care when it comes to prolapse. So this is another hot and relatively scary topic for a lot of mamas, but also for a lot of clinicians in this space. So we're going to talk about a few housekeeping items before we get started. We are currently in our last cohort of the year for the online course. This is something we are gonna put the pedal down come January. We've got a lot of exciting things coming up. So if you have not signed up for this course, head over to ptonice.com, just sign up. We also have a few more courses, live courses, to round out the year. So, if you're looking to dial in your internal assessment with that kind of higher level population, that athletic population, head over to PTOnIce to sign up there as well. My hope after this podcast is that you guys want that. You want to sign up for that live course. You want to dial in your internal assessment, dial in your interventions, and just guns a-blazin' out in this population. For those of you in the ICE Students Facebook group, you will hear more about the revamped certifications from Jeff tonight. Otherwise, stay tuned to Hump Day Hustlin' emails for details. So if you haven't signed up for Hump Day Hustlin' emails, again, that's all on the website. It's free. We just want to get out as much information to you guys as we possibly can. So we have some really fun new certifications coming up that Jeff is gonna dive into later tonight. So as we begin our PT careers, a lot of us prefer a specific population, right? We want to treat the older adult, the pregnant person, et cetera. We want to dial in our skills. And we love to see that, right? Like that, I love that. I want to get really good at that one thing. I want to go to the provider that is that provider. I am the person that you want to see if you are experiencing X, Y, and Z. We hear that a lot as faculty, especially in the pelvic space is, you know, well, I only want to kind of treat this type, this, the urinary incontinence or, you know, low back pain. And as a faculty, we've all kind of experienced those same thoughts and feelings. Again, it's intimidating when you get into this space. Well, we quickly learned that you can't just pick and choose. If you have someone that's experiencing urinary incontinence, they also are likely experiencing something else as well. If you are in the pelvic space, you're going to see all things. PELVIC PROLAPSE The ones that are at the top of the list, at least that we hear about as faculty, are the ones that are scary are pelvic pain and prolapse. So today we're going to focus on treating prolapse and specifically what we may be missing in our plan of care. It is going to be outside of the scope of this podcast to talk about the assessment of, um, like the subjective or objective assessment of prolapse. So if you are unfamiliar or you feel like you're just kind of shaky on this, again, that live course is waiting for you. Once we know the pelvic floor is strong or weak, or that it's a timing issue, or that they may or may not be tender to palpation internally or externally. And when I say externally, I mean hips as well. And that they may or may not have objective signs of prolapse. we then get to develop our plan of care. Now notice that I said may or may not because these clinical patterns are not identical. You will see so many different clinical patterns when it comes to symptoms of prolapse. So let's just say your patient comes in with feelings of heaviness, pressure, or dragging, and it feels like they may be sitting on something. That's something how they're describing it. When they're in the shower, they feel, as they're bathing, they may feel something physically. The heaviness gets worse after they have a bowel movement, void, go to the gym, or have been on their feet all day. So what's your next plan of action? Well, first and foremost, we wanna encourage you guys to stop focusing on the biomechanical components of a prolapse. Of course, there is that person or that type of prolapse. We're maybe talking about surgery. That does happen, but it doesn't happen without needing that pre-physical therapy, the stuff that they're doing beforehand, getting stronger, learning how to poop and pee. learning how to brace. So all of this stuff is still happening, even if surgery is part of the discussion. So first and foremost, let's stop focusing on the biomechanical components. Let's start focusing on the symptoms. So understanding what makes the pressure heaviness better, what makes it worse. Can we, part of their plan of care, ramp up the things that make it feel better and ramp down the things that make it feel worse? That has to be followed with this is not gonna be your forever. This is not gonna be you never doing that thing because it ramps up your symptoms and always having to like sit and be immobile because it ramps down your symptoms. We have to think about this on an irritability scale just like we do with pain. We have to be able to bring down their irritability, so then we can make them better by loading them. So now that we know that, I'm gonna give you four points to go home with today that are great points to start with. When you have that person come in with a script that says pelvic organ prolapse, or doesn't say that, it says pelvic pain, but then you start asking them questions and you're like, hmm, they may have symptoms of pelvic organ prolapse. REMEMBER THE KEGEL We have to remember the Kegel. This is number one, the Kegel. It has gotten so much hate over the past few years, especially on social media. I don't think that was anyone's intent to just say never do Kegels, but it matters. Teach your client how to do a Kegel. Lift and squeeze, shut off the holes, come to the attic. But we have to remember the relaxation component to the Kegel. Teach them how. to relax. Have them focus on this. A lot of times people feel like they can multitask a cubicle. If they are new to this and they don't know and they didn't even know they had a pelvic floor, they need to go in a room where it's quiet with no kiddos running around and focus on the up and the down component of a cubicle. Something that I love to say in the clinic is the relaxation component of a Kegel is sometimes more important than the contraction. Everyone always thinks we need to go up, up, up, up, up. And when I say everyone, I mean typically our clients. And they forget that this actually has to happen as well. Or, not that they didn't forget, but they think that they may be in that relaxed position and they're not. and that's where that internal palpation can be golden. Again, people tend to focus on the contraction, so being constantly contracted can also lead to symptoms of heaviness. So maybe their symptoms of heaviness are coming from this versus actually symptoms of prolapse. UNILATERAL HIP STRENGTHENING Number two, single-sided hip strengthening. get their hips stronger, always, but even here, get their hips stronger. And I don't mean with a TheraBand. Throw it out. If you want to warm them up with it, great. But we've got so many options. Step downs, step ups, we've got single leg RDLs, we've got variations of that. We have Core stuff that we can do, like the options are endless. We can do side planks, we can do hip thrusters. Don't forget about strengthening their hips. INSTRUCTING THE BRACE Number three, teach them how to brace. Symptoms of heaviness can happen due to faulty bracing strategies. Bracing is not only for lifting heavy either. We need to prepare mom for the demand of life. And mom is holding Johnny who has a runny nose and she's trying to wipe his nose and he's flinging his head back. She's going to be bracing her core and she's not even gonna think about it. So let's prepare her for that. Number four is find and encourage frequent rest positions that ease or make their symptoms go away. This could be lying on their back. This could be seated, this could be laying on their stomach, it could be leaning over the counter, anything that makes their symptoms ease. Again, follow this up with this is not forever, this is a for now, we wanna get those symptoms, the symptom irritability down. And once we get those symptoms down, what can we do? Everything that we just talked about in one through three. So to recap, find the symptom aggravators, find the things that make their symptoms go away or ease. There may be multiple clinical patterns to prolapse-related symptoms. Prolapse can be scary to a lot of women. It is, if they've Googled it, they are gonna come in wide-eyed, or if the doctors told them that, there might be tears. But it can also be really scary to clinicians if we don't know how to treat this. You have four places to start. The Kegel. Gets a lot of hate, but we need to start using it. Don't forget about the hip. The hip muscles are gonna be supporting structures to the pelvic floor. Bracing is not only used for heavy lifting, and using positions that ease symptoms to lower irritability, which will increase our loading capacity. That is it. Start there. So team, I hope this helps. I hope you have a great week and enjoy your Halloween and 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.

Dr. Ellison Melrose // #TechniqueThursday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Dry Needling lead faculty Ellison Melrose discusses an alternate technique to dry needle the lumbar multifidus. Take a listen to the podcast episode, watch the video, or read the full transcription below. If you're looking to learn more about dry needling, especially dry needling with e-stim using the ITO ES-160 stim unit, take a look at our Upper Body Dry Needling course, our Lower Body Dry Needling course, or 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 - ELLISON MELROSE Good morning YouTube and good morning Instagram. This is PT on ice daily show. I am Dr. Ellison Melrose and I am currently lead faculty with the dry needling division of ICE. So we are going to go over a alternative approach for dry needling the lumbar multifidus today. Um, before we get into that, I want to go over our upcoming courses. So this, the remainder of 2023, we have, um, a handful of courses. This weekend, Paul's going to be out in Anchorage, Alaska, and I believe that is capped. After that, he will be down in Seattle, Washington on November 3rd through the 5th for the upper quarter. I will be out in Rochester, Minnesota for upper quarter dry needling on November 18th through the 19th. We will both be teaching the first weekend in December. So December 1st through the 3rd, Paul will be in Bellingham, Washington, and he will be hitting upper quarter then, and I will be out in Clearwater, Florida, so opposite sides of the states, doing lower quarter. So if you guys have a chance to find us out on the road, or want to join us for the remainder of 2023, those are the courses. We have one other one also in Fayetteville, Arkansas, the second weekend in December, where we'll be doing lower quarter. out there. So if you guys have any questions about those courses coming up, feel free to message us here or yeah, stay tuned for those courses. And then 2024 we'll be starting out pretty hot with some more courses and our advanced course as well. It will be, will be coming, um, in 2024. 02:10 - COMMON APPROACH TO DRY NEEDLING THE LUMBAR MULTIFIDUS So what I wanted to do today was to go over an alternative approach for, uh, dry needling the lumbar multifidus. So there, We are not gonna go over clinical reasons for needling the lumbar multifidus, but for those who have been taught how to needle the multifidus, there is one technique that is used fairly widespread across all educators, and that is the wrap-over technique. For demonstration purposes, I am going to be using my knuckle as the spinous process, and then we will be demonstrating it on a human body as well. For that wrap-over technique, so we have our spinous process here, Wrap over technique, we use two fingers to compress within a one centimeter gutter, just lateral to the spinous process. And we create a target window with our fingers and treating within that zone. In order to treat bilaterally, so both sides, you have to walk around the table to treat the contralateral side, which is fine, But when we're talking about clinical efficiency, it may be conducive to be able to treat or to needle staying on the same side of the patient. So we have an alternative approach for needling the multifidus where you are able to stay on the same side of the patient, and that will be your dominant side. So I am right-handed, so I'm going to be treating from the right side of the table treating the lumbar multifidus. I'll demonstrate first the wrap over technique and the alternative technique. 04:02 - ALTERNATIVE APPROACH TO DRY NEEDLING THE LUMBAR MULTIFIDUS For that alternative technique, so instead of using that spinous process, our palpation hand, two finger, stepping over that spinous process and compressing into the gutter, what we are going to be doing is we are going to be using our palpation hand, index and middle finger to orient us to where that lateral border of the spinous process is. In the lumbar spine, we have about a one centimeter gutter where we can feel fairly confident that we're going to be directing our needle towards the lamina with a directly posterior to anterior approach. From there, if we go outside that one centimeter gutter, we need to angle the needle medially to ensure that we have contact with the lamina as we need that laminal contact to ensure that we are at the depth of the multifidus. We are going to stay within that one centimeter gutter for today's demonstration, but we will start with that wrap over technique and then the alternative approach. The alternative approach, instead of using that two finger digital compression, we are going to be using the spinous process and either our middle or index finger to find that lateral border. So, first we want to find the spinous process and take the mid pad of our palpation finger and palpate that lateral border of the spinous process. From there, we're going to take our middle finger or our index finger, depending on which side we are treating, and compress tissue down within that one centimeter guide. From there, we're going to create a treatment window between our two fingers and treating directly posterior to anterior. towards laminal contact. 07:19 - ALTERNATIVE TECHNIQUE DEMONSTRATED So it'll make more sense when we're demonstrating it on the patient. So let's go ahead and do that. I'm just going to angle this camera down towards my patient. So here we have an exposed lumbar spine. I'm going to just orient myself to where we are. I am standing on my dominant hand side. From there, We'll just go over palpation. So spine is processed, we can palpate the lateral borders with our thumbs here. For that wrap over technique, we're going to take our pads of our palpation hand, stepping off, compressing tissue down, treating within that one centimeter gutter, okay? So let's start with that technique and then I'll show you the alternative approach after. So, palpating that lateral border of the spinous process, two fingers stepping off, compressing down into that gutter, keeping that needle angle directly posterior to anterior, so vertically, tapping, advancing the needle towards laminal contact. So in order to treat the ipsilateral side now, I would have to walk around the table and straddle that needle to do the same compression and same technique that we did on this side. So what I will demonstrate is the alternative approach and then we'll do another segment down below of the alternative approach just to show you how efficient this tool can be. So, instead of using those two fingers to hug the lateral border, I'm going to be using my middle finger on my palpation hand to palpate the posterior aspect of that spinous process. From there, I'm going to take the middle aspect of my pad and hug that lateral border of the spinous process. My index finger is then compressing into that gutter creating a nice treatment window. Again, we want to be aware of where that one centimeter gutter is and treating within that zone, directly posterior to anterior. So vertical, vertical needle approach here. So compressing down towards laminal contact. So there we have the alternative approach on that ipsilateral side. From there, thinking clinical efficiency, if we were going to set up multiple different segments in the lumbar spine, if we started proximally or superiorly and worked inferiorly, kind of like you're reading a book, that is going to be the easiest way to avoid some awkward hand positions with the needles. So we will needle the segment just distal to the ones that have needles in. So from there, Instead of using my middle finger to contact that lateral border, I'm gonna be using my index finger. We are treating the contralateral side from where I am standing. So again, we can appreciate the lateral borders of the spinous process. Take the pad of our index finger and hug that lateral border of the spinous process. Compress my middle finger now and create a treatment zone between my two fingers. Again, appreciate that we have a one centimeter gutter. Now we want to be treating directly posterior anterior to contact lamina. From there, I'm going to do a firm guide to compression, firm tap, advance the needle to laminal contact. And then we can do the same thing on the ipsilateral side. so middle finger palpating the posterior aspect of the spinous process wrapping to that lateral kind of hugging that lateral where it starts to curve creating a one centimeter gutter with my index and middle finger treating within that zone directly posterior to anterior towards laminal contact. So there we have, we went over the wrap-over technique and the alternative approach and just looking at the clinical efficiency that being able to stay on that ipsilateral side of the patient can do. I have a very small treatment room, so it allows me to not have to kind of wiggle my treatment table back and forth, and allows us to get a handful of segments within a couple minutes, which I think when we're thinking about using dry needling in the clinic, we want to save as much time as we have for using our electrical stimulation, as the new research is showing how beneficial that can be for treating pain, neuromuscular priming, also, um, recovery or hemodynamics, improving hemodynamics. So we want to get the needles in as efficient as possible as to allow for some optimal treatment time with the Eastern. So we, again, just to review with this technique, we are going to be using our index and middle finger. And instead of hugging the lateral border of that spinous process, we are going to be treating, um, with those fingers just off the lateral border, creating a one centimeter gutter between those two fingers, treating directly posterior to anterior and maintaining laminal contact to ensure we are at the depth of the multifidus. Thank you guys so much for joining me this morning, going over the alternative approach for dry needling the multifidus. And I hope to see you out on the road sometime this year or next year. 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.