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Dr. Megan Peach // #FitnessAthleteFriday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Endurance Athlete division leader Megan Peach discusses femoral neck bone stress injuries, including referral for diagnosis, potential treatment options, and rehabilitation & return to running. Take a listen to the episode or check out the full show notes on our blog at www.ptonice.com/blog If you're looking to learn from our Endurance 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 INTRODUCTIONHey everybody, Alan here. Currently I have the pleasure of serving as their Chief Operating Officer here at ICE. Before we jump into today's episode of the PT on ICE Daily Show, let's give a shout out to our sponsor Jane, a clinic management software and EMR. Whether you're just starting to do your research or you've been contemplating switching your software for a while now, the Jane team understands that this process can feel intimidating. That's why their goal is to provide you with the onboarding resources you need to make your switch as smooth as possible. Jane offers personalized calls to set up your account, a free date import, and a variety of online resources to get you up and running quickly once you switch. And if you need a helping hand along the way, you'll have access to unlimited phone, email, and chat support included in your Jane subscription. If you're interested in learning more, you want to book a one-on-one demo, you can head on over to jane.app slash switch. And if you decide to make the switch, don't forget to use the code ICEPT1MO at sign up to receive a one month free grace period on your new Jaina. MEGAN PEACH This is your PT on ICE, the daily show. brought to you by the Institute of Clinical Excellence. My name is Megan Peach. I am one of the lead faculty for Rehabilitation of the Injured Runner online and live. And today I'm gonna talk to you about, no surprises here, bone stress injuries. But specifically I wanna talk to you about femoral neck bone stress injuries and what to do once you expect that your patient has a possibility of even having a femoral neck bone stress injury. because sometimes that decision on what to do might be a little daunting. And so I'm going to present this information in a bit of an algorithm format. And I'm not the biggest fan of algorithms because our patients don't often fit perfectly into the algorithm boxes that we need them to fit in to in order to progress along that algorithm route. But this one I actually think makes a lot of sense and I think it's pretty straightforward so hopefully it will be helpful for you in your clinical decision-making process. So I'm also going to make some assumptions that you have already done your subjective exam, you've already done your objective exam as well, and you are ready to make some decisions and you've decided that your patient has potentially a femoral neck bone stress injury. Now that part is really important because if you are even suspecting a femoral neck bone stress injury, then you need to consider it a femoral neck bone stress injury until it's proven otherwise. And that's important because as physios, we can't tell if that's a high risk or a low risk femoral neck bone stress injury. All we know is that there's potential there and one, they're treated differently, but two, the high risk can progress on to be a more serious injury. And so it's really important that we treat them as femoral neck bone stress injuries until that condition is proven otherwise, or it's proven as a femoral neck bone stress injury, and then we can move on in that treatment algorithm. So once you have made that decision, this person sitting in front of me is potentially a femoral neck bone stress injury or has one. The first thing we're going to do is refer them out to an orthopedist. They need additional imaging. And again, that's because we really need to determine one, if this is a femoral neck bone stress injury, and two, if this is a high risk or low risk, because again, they're treated a little bit differently. And so that referral to the ortho is going to jumpstart that part of the process where they can then get additional imaging. MRI is the gold standard to diagnose bone stress injuries. You could also refer them to their primary care provider. Their primary care provider can certainly refer them for an MRI, but ultimately they're going to go and see an orthopedist. And so it's nice to just take out that middle appointment and you can always communicate this information to their primary care provider, especially if they were the ones that referred them to you in the first place. Okay, so all of the patients are going to start out with their referral to the ortho, and then hopefully go for an MRI. Now the results of the MRI are really important because they're going to dictate at what path in this algorithm they're going to take. So I'm gonna give you three different scenarios based on the results of this initial MRI. The first scenario is that the MRI is positive for only bone marrow edema. It is a femoral neck bone stress injury, but it's only bone marrow edema. There's no fracture line. So this patient is then going to do six weeks of non-weight-bearing. Kind of a bummer, a hard conversation to have, especially if there's no distinct fracture line, but they still need six weeks of non-weight-bearing to prevent further progression of this injury. After the six weeks, whether or not they get a follow-up MRI is really dictated by that orthopedist and their experiences. Typically they don't if it is bone marrow edema only, And so at this point, they would likely begin a weight-bearing progression. And that weight-bearing progression is going to be gradual, likely over the course of a couple of weeks. After they are able to weight-bear normally, they're going to then start into a normal walking program and a formal rehabilitation program. With that being said, during that six-week period of non-weight-bearing, certainly they could do formal physiotherapy, but you could also send them home with exercises they can do on their own to prevent atrophy, to maintain the strength that they do have and the muscle mass that they do have. That, of course, is a conversation between you and the patient and the orthopedist on where they want to spend their time, potentially money, potentially number of visits for physio, because you know they're going to need them once they start that weight-bearing progression. I'm not going to talk a lot about the details of that weight-bearing progression because I want to stick to this clinical decision algorithm, but in that weight-bearing progression, it would then work itself into also a return to sport progression as well, but that's where it starts. Okay, so to summarize that first scenario, you have your patient, You have differentially diagnosed them with a potential femoral neck bone stress injury. You referred them out to an orthopedist. They had an initial MRI, which was positive for bone marrow edema. Then they did six weeks of non-weight bearing, and then they progressed into a loading program to get them to load normally and walk normally, ultimately probably run normally, and get back into the sports and the activities that they want to do. Okay, so the second scenario, we're going back to that first MRI. They come in with their results. Their results say that they now have a stress fracture, okay? And so this is a totally different scenario than the first scenario with bone marrow edema only. Now, the location of a femoral neck stress fracture is really, really important because that's going to determine whether or not this is a high-risk or a low-risk bone stress injury. So if the fracture is on the underside of the femoral neck, it is deemed a compression-type fracture, and it is going to be more low-risk. If the fracture is on the superior aspect of the femoral neck, it is deemed a tension-type injury, and that is going to heal a lot more slowly with a lot more difficulty. It is deemed a high-risk bone stress injury, and it's treated very differently from the low-risk or compression type fracture. So the MRI is going to describe the location of that fracture as well as occasionally the severity. If that person presents with a compression type fracture, so on the underside of that femur, and it is 50% or less of the width of the femoral neck, they are going to then, surprise, do six weeks of non-weight bearing, okay? And so they have a fracture line, but we're still going to treat them conservatively in this scenario. After the six weeks of non-weight bearing, typically they will have a second MRI or follow-up imaging. Occasionally that can be x-ray if they were able to visualize the fracture line on an initial x-ray. So a follow-up image, and based on the results of the follow-up image, they're going to be filtered into basically three different paths again. And so if that follow-up image says that they are making good progress and healing, so maybe we don't see a line anymore, maybe there's callus, maybe there's less bony edema, then we're going to filter them back into that progressive weight-bearing approach. And so the same thing that we use for scenario one, they're going to do a progressive loading program into full weight-bearing and then walking and then running and then return to sport, et cetera. Okay, that is if they were asymptomatic and they demonstrate healing on that follow-up image. If the follow-up image does not show any progress, it doesn't show any regression, it's just kind of stagnant, or the patient is still symptomatic, they're still having symptoms in that hip. Now, granted, they haven't been weight-bearing for six weeks. they're going to restart that six weeks weight-bearing. It is a tough, tough conversation, and nobody likes it. Not you, not the orthopedist, certainly not the patient. They're going to start that process over again, and they're gonna start back at the top of that six weeks non-weight-bearing, and then they'll likely have a repeat image at the end of that second six weeks of non-weight-bearing. I should mention here that I keep saying six weeks non-weight-bearing It's a start and I think it's important to educate our patients on that. It is just a start very often they will go into Longer durations of time non weight-bearing in order to treat this condition Okay, so the third scenario after the second image the follow-up image is that there is a regression and so this is not based on symptoms it is only based on that second image and this now shows a progression in the injury, maybe the fracture line increased, maybe the edema increased, but there's been some basically like regression in the issue. And so, or progression in the injury, however you want to take it. And so with this situation, unfortunately, they've now become a surgical candidate and they will likely stay under the care of that orthopedist. Okay. So to summarize that second scenario, They have come into your clinic, you suspect a femoral neck bone stress injury, you refer them out to an orthopedist, they come back with a positive MRI for a fracture line, but that fracture line is less than 50% of the width of the femoral neck and it is on the compression side or the underside of that femoral neck. They then do six weeks of non-weight bearing. They get a follow-up image. Based on that follow-up image, they will either continue in a progressive loading program in formal rehabilitation, repeat the six weeks non-weight bearing, and then do another follow-up image, or go on to be a surgical candidate, depending on the results of that second image. Okay, our third scenario. They come back with their first MRI, and the results show, again, a fracture line. This fracture line, though, is one of two scenarios. It is either a fracture line on the superior aspect of that femoral neck, which is a high-risk, tension-tight bone stress injury, or that fracture line is on the compression side, or the underside of that femoral neck, and it is greater than 50% of the width of that femoral neck. Either of these two situations, unfortunately, are going to necessitate, likely, a surgical intervention. So an open reduction, internal fixation, to stabilize that fracture and make sure that it doesn't progress into a more severe injury. The type of that ORIF is obviously very dependent on that surgeon as is the weight-bearing status post-operatively. So some will do non-weight-bearing for an additional six weeks, Some will do partial weight-bearing and then some will do full weight-bearing immediately after surgery. It is obviously just up to that orthopedist. And so that third scenario is quite short compared to the others. Your patient came in, you suspect ephemeral neck bone stress injury, you refer them out to the orthopedist, they come back with the MRI results with a positive for either a fracture line on the underside of that femoral neck on the compression side that is greater than 50% of the width of that femoral neck, or they have a fracture line on the tension side, the superior aspect of that femoral neck. Either of those two situations are then going to necessitate some kind of surgical fixation for that injury. Obviously, that is always a discussion between you and that patient and the orthopedist and whatever team they have around them in terms of if surgery is the appropriate intervention for them. Obviously, this is just a basic algorithm and then to help guide some of these clinical decision-making processes. Okay, so the themes in this algorithm that I want to highlight are regardless of what that initial MRI says, basically all roads lead to six weeks non-weight bearing. It's kind of an unfortunate part of this injury is that we definitely don't want this to progress from a low risk to a high risk bone stress injury. That's the worst case scenario because if we can prevent that in any way, even if it means six weeks non-weight bearing, we have to do that. So any roads, maybe with the exception of that third scenario where it just leads to surgery, all of the other paths essentially lead to that six weeks non-weight-bearing. So just know that that might be in their future. The other thing is, is that any progression that we do formally as informal rehabilitation after they've done their six weeks non-weight-bearing and they've been basically released to physiotherapy or released to progress to walking or weight-bearing, all of the progression has to be asymptomatic. Any progression that is symptomatic, creating symptoms in that hip, it must be backtracked. And so if they are initiating weight bearing and they are symptomatic, they're likely going to have to backtrack into a few weeks of non-weight bearing again. Really hard conversation again, but it's necessary in order to really prevent progression of this injury for obvious reasons. So the two themes, six weeks non-wavering and any progression must be asymptomatic. SUMMARY All right, that is the content I have for you today. Just want to make a couple of mentions of our upcoming Rehab of the Injured on our online course. We are currently in the middle of our, our current cohort is right in the middle of this session and All of the online cohorts this year have been on our new ICE app, which has been fantastic. It is really generating a great online community of therapists that are interested in treating endurance athletes. And so we've had some good discussions on there and it's really just fostering a great community. So if you haven't already taken Rehab of the Injured Runner online, I would definitely encourage you to do so. Our next cohort starts, I believe, in June. We will see you there. I can't wait to see you there. And have a great Friday and a great weekend. OUTRO Hey, thanks for tuning in to the PT on ICE daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Dr. Christina Prevett // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic division leader Christina Prevett discusses the benefits of birth control and when we should be thinking more positively about these medications and methods 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 everybody, Alan here. Currently I have the pleasure of serving as their Chief Operating Officer here at ICE. Before we jump into today's episode of the PTI Nice Daily Show, let's give a shout out to our sponsor Jane, a clinic management software and EMR. Whether you're just starting to do your research or you've been contemplating switching your software for a while now, the Jane team understands that this process can feel intimidating. That's why their goal is to provide you with the onboarding resources you need to make your switch as smooth as possible. Jane offers personalized calls to set up your account, a free date import, and a variety of online resources to get you up and running quickly once you switch. And if you need a helping hand along the way, you'll have access to unlimited phone, email, and chat support included in your Jane subscription. If you're interested in learning more, you want to book a one-on-one demo, you can head on over to jane.app.switch. And if you decide to make the switch, don't forget to use the code ICEPT1MO at signup to receive a one-month free grace period on your new Jane account. CHRISTINA PREVETTHello, everyone, and welcome to the PT on Ice Daily Show. My name is Christina Prevett. I am one of the lead faculty in our pelvic divisions. And I am coming to you from a hotel room. I'm about to get back after teaching MMOA Live here this weekend. So you got my hotel version of today's podcast. Today we're going to be talking about advocating for birth control. And so this might be a bit of a hot take hot topic, because in the allied health or birth provider space, there has been a lot of anti birth control messaging. And so I want to kind of play devil's advocate a little bit. and speak to some of the potential pros of birth control, and then really try and loop this into why it is so important, especially as healthcare providers, that we become more nuanced in our approach, right? It is so easy with social media for us to be thinking in 30 to 60 second snippets. But one of the reasons why I love the podcast is that we're able to kind of dive into nuance a little bit more. So firstly, the development of the oral contraceptive pill was one of the big revolutionary medical marvels that allowed women to have reproductive choice in a lot of ways, right? The idea behind oral contraceptives was that females could have some, you know, obviously when they're having intercourse, but like they were able to prevent unwanted pregnancies and that gave them some sense of control in a lot of ways. So the development of oral contraceptives outside of barrier methods was truly such an amazing medical advancement that paved the way for a lot in reproductive healthcare. With the use of exogenous hormones, what we have also seen with the use of oral contraceptives is that it has been used in the management of different gynecological conditions. So here's where we get to messaging numero uno. When people take birth control, they aren't actually balancing their hormones. Something is doing it for them and it is a band-aid and it's making all your sex hormones go down. This is the messaging. So we shouldn't be giving people birth control because it's not fixing the problem. So let's talk about an argument where that works, and let's talk about an argument where it doesn't. Okay, so in our pelvic division, we talk a lot about relative energy deficiency in sport. This is for individuals with primary or secondary amenorrhea, where because they are not fueling their body appropriately, their body goes into battery saver mode, which means that they are not doing any bodily processes that require excesses of energy out like energy out because they don't have enough energy coming in, which can include pregnancy. And so we suppress the HPT access to prevent ourselves from ovulating because right now we're not taking in enough fuel for our body to function. We're definitely not taking in enough fuel to support a pregnancy. In those circumstances where individuals are not getting their period because of under fueling, sometimes birth control can be recommended and The argument can be made that. we're not getting at the root cause for the hormonal imbalance, because you need to have that fuel to the root cause, and we should see a hormonal re-regulation, and reds from the literature that we have right now is reversible, right? So that makes sense, right? If individuals are highly active, they're in low energy availability, and they're not screening for root causes of issues with hormone status, and we give birth control as a knee-jerk reaction without doing the proper investigations, I can see where that argument of it's exogenously balancing your hormones would work. But here's where it doesn't. Okay, here's where it doesn't. So birth control is also used as a frontline treatment for a lot of fertility-impacting conditions or gynecological conditions, such as PCOS, endometriosis, and fibroids, right? PCOS, is a androgen excess and it is a chronic disease. It is a chronic disease. It is a chronic disease that has no cure. So there is no cure to be able to balance your hormones naturally with PCOS. Does health promotion potentially help with becoming more regular with your menstrual cycle? Does it help with bringing you to a more regular cycle where you may be more ovulatory with PCOS? Yes. Are you going to change to a, within normal levels, your androgen access? Probably not. So guess what? The birth control pill is being used to bring androgen load down, right? And that is how we treat chronic diseases, right? I don't give a person, oh, I'm not, I'm not a physician, but physicians don't give a person a blood pressure med and we get mad at the physician for giving them a blood pressure med because they're treating the symptom of the high blood pressure, but they're not getting to the root cause of the issue, which is cardiovascular disease, right? These medications are given specifically to manage the symptoms. which is the exact same logic that we are seeing with individuals with gynecological conditions. We are not giving oral contraceptives in order to balance their hormones because they are chronic diseases, right? Outside of excision for endometriosis and fibroids, where we may see a reduction in symptoms, that is not a guarantee. And the only known cure for true 100% cure for endometriosis and fibroids is a hysterectomy. So if we have individuals with a high amount of symptom burden, heck yes, we are going to treat the symptoms, right? And so we can use oral contraceptives to treat those symptoms, right? If I wanted to pull this into our physiotherapy logic, that would be like saying, well, this person has a disc bulge on MRI. If we can't fix the disc bulge and get it back in that spinal alignment, then all of our interventions for pain don't matter because we're not fixing the root cause, right? So, but, PT we say you are not your image like we're not just going to treat you mechanically we're gonna treat how you're feeling within your own body and yet we flip that in our health care providers spaces when we talk about birth control and we make women with heavy menstrual bleeding with heavy periods with individuals who are suffering from fatigue and lethargy because they have anemia we have cyclical pain that could be treated with oral contraceptives and we make them feel bad that they're using it or make them feel fear that they shouldn't be using this because they should be able to balance their hormones regularly and so inadvertently in an attempt to help we're kind of gaslighting them, right? And, and I, I mean this in a very, like, I want to have a fruitful conversation about this because I have seen this messaging over and over and over again. And when individuals have gynecological conditions, birth control can be a management strategy. Should it be a knee-jerk reaction for everybody without the need for further investigation or evaluation? No. Are individuals oftentimes dismissed with birth control because they're not actively trying to get pregnant? Yes. Do some people not tolerate certain types of oral contraceptives or different types of birth control methods? Absolutely. But it is a trial of treatment that has some evidence to back it up. and it can be helpful in some circumstances with some individuals. So having this knee-jerk reaction and saying, well, it's not getting to the root cause or it's not balancing our hormones in the background of a chronic disease with no cure, we are missing the mark on our messaging. And so many of our clients come to us as pelvic PTs and they trust our opinions. And we are trying to lock shields with physicians, not battle with swords. And we need to be mindful of that, that by being very dismissive or not getting to the nuanced approach to contraceptive care or using birth control methods, we are not doing ourselves any favors and we're not helping our clients by not getting into the nuance of it. So the first argument that we see a lot is you aren't balancing your hormones, like it's doing something for you. It's taking your HPG access and bringing it down to nothing, right? That's not always the case and not always the method of oral contraceptives. It can blunt the HPG access, but it doesn't make it go down to zero. And then the secondary piece that individuals have fear on when thinking about oral contraceptives is future fertility. So, There was a cross-sectional study that said that almost 70% of females surveyed were worried about long-term fertility because of oral contraceptive use. We do not have evidence. We actually have multiple systematic reviews and meta-analyses that actually demonstrate that there are no changes in fertility upon cessation of long-term birth control utilization. All right, let me repeat. We do not have evidence that being on birth control negatively impacts future fertility. It does not. What we see is that using hormonal, non-hormonal IUDs, oral contraceptives and patches, the rates of live pregnancy or positive pregnancy rate for contraceptive versus non-contraceptive users in age-matched cohorts appears to be the same. where we can kind of get into this bias, this selection bias, is based on the reason for individuals going on birth control. So if you were a person who went on oral contraceptives in order to prevent pregnancy, but you did not have any fertility related concerns, and that wasn't a factor in your prescription, once you stop taking oral contraceptives, maybe after a couple months things will kind of re-regulate, you should have no future impacts on your fertility. Where you can have downstream fertility related issues is based on the reason for being on those oral contraceptives. So if you are on oral contraceptives for heavy bleeding or cyclical related pain, or hirsutism or clinical androgenism as a consequence of PCOS, we know that PCOS, endometriosis and fibroids can negatively impact your fertility and increase your chance of infertility. So in those situations, because we were treating the symptoms of your condition, we do not have the capacity outside of excision and endometriosis and fibroids to cure these conditions, that downstream fertility consequence is still going to be present upon removing your birth control method or upon removing oral contraceptive use. So it is not the pill itself, it is some of the reasons why you were on the pill that can negatively impact future fertility. And so I have now been talking for about 11 or 12 minutes on the nuance of birth control. The final thing that I will say is it is hysterical to me that the clinicians who are absolutely adamant against birth control for reproductive age individuals, are big advocates for using topical estrogens and hormone replacement therapies, menopausal hormone therapies, for individuals going through the menopausal window, because they are treating the symptoms of menopause, right? We are not trying to fix a person's hormones. We aren't gaslighting them and saying, oh, well, you know, this is your natural aging consequences, so you're just gonna deal with your menopausal symptoms. No, we're at the forefront advocating for topical estrogens and the use of exogenous hormones to be able to help individuals at the end of their reproductive window. So then why are we telling individuals with chronic diseases like PCOS that we can't or shouldn't use, that we should be fearful of using oral contraceptives in their reproductive window when they do not want to be pregnant? Right, and we know that it is a chronic disease that has no cure, and we make them feel bad for treating the symptoms with these exogenous hormones. So we just need to be so careful in our profession about how we are catching onto these trends. I always talk about the fact that I am scrunchy, not crunchy. I am a huge advocate in holistic care. And I think that holistic care can come alongside Western medicine in an evidence-informed way. All of my research is in health promotion, which means that I am in the science-based crunchy. So we just need to be mindful about not having this knee-jerk reaction and saying that birth control is bad. That is the messaging that I'm seeing. And that is absolutely not true. In the messaging, the logic in the messaging is flawed. When we're thinking about gynecological conditions, many of them are chronic conditions that do not have 100% curative rate. PCOS is a chronic disease with no cure. Endometriosis and fibroids can have excision, but the only thing that's going to guarantee that you are not gonna have another growth is a hysterectomy, which is not obviously a viable option for individuals who wanna get pregnant. And therefore, using oral contraceptives for managing signs and symptoms of those conditions is a evidence-informed utilization or medication that people can do. That does not mean that it is for everybody. That does not mean that people can self-select. It's okay for them to self-select away from it. We just wanna make sure that they're getting the right information about what it is and what it isn't. Birth control does not impact your future fertility. We now have multiple systematic reviews and meta-analyses that pending normal reproductive status, normal fertility rates, that we have no infertility-related conditions that there is no difference in conception rates once getting off birth control. And then we are huge advocates for the use of supplemental hormones through menopausal hormone therapy at the end of a person's reproductive window. All right, that was my rant for the day. I hope you guys found that helpful. I really just wanna get into the nuance of this, right? Like we wanna make sure that we are being mindful of our messaging and we are not, inadvertently shaming people or making them fearful or Gaslighting them and saying you don't need birth control you can use all these natural methods When we don't have the same effectiveness data in some of those health promotion technology or health promotion interventions SUMMARY All right You probably wonder why we're deep diving into this. This is because of level two, right? We have a huge role, right? We are doing level two right now for our pelvic course, and we are trying to do fitness-forward pelvic PT in a variety of different conditions. Fertility, baseline fertility, infertility-related conditions, and our role coming alongside those who are going through assisted reproductive technologies is in our curriculum. So we are in the weeds of that research and talking about the ways that we can be involved in rehab. And then if you guys are interested in seeing us live, we have two courses going June 1st and June 2nd. I am in Highland, Michigan, and Alexis is up in Alaska with Heather. And then June 8th and 9th, I'm in Mineola, New York. I'm near New York City at Garden City CrossFit. So if you are hoping to jump into a pelvic live course, I hope that I can see you at the beginning of June. Otherwise, have a really wonderful week, everybody. Hopefully I won't be so nasally and sick the next time I'm on the podcast. One can only hope. And have a really wonderful 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. Julie Brauer // #GeriOnICE // www.ptonice.com In today's episode of the PT on ICE Daily Show, join Modern Management of the Older Adult lead faculty Julie Brauer translates lessons learned from training for a 50k trail run into strategies to use when working with older adult clients to help them become the person they want to be as they journey through life. Take a listen to learn how to better serve this population of patients & athletes, or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION INTRODUCTIONHey everybody, Alan here. Currently I have the pleasure of serving as their Chief Operating Officer here at ICE. Before we jump into today's episode of the PTI Nice Daily Show, let's give a shout out to our sponsor Jane, a clinic management software and EMR. Whether you're just starting to do your research or you've been contemplating switching your software for a while now, the Jane team understands that this process can feel intimidating. That's why their goal is to provide you with the onboarding resources you need to make your switch as smooth as possible. Jane offers personalized calls to set up your account, a free date import, and a variety of online resources to get you up and running quickly once you switch. And if you need a helping hand along the way, you'll have access to unlimited phone, email, and chat support included in your Jane subscription. If you're interested in learning more, you want to book a one-on-one demo, you can head on over to jane.app slash switch. And if you decide to make the switch, don't forget to use the code IcePT1MO at signup to receive a one month free grace period on your new Jane. JULIE BRAUER Morning crew. Welcome to the PT on Ice daily show. My name is Julie Brower. I am a member of the older adult division, and I am going to be talking to you all this morning about my favorite thing in the world, running. So this morning I am going to share with you some lessons that I've learned from training and running a 50k that I just ran this past weekend and I'm going to translate some of the lessons I learned and give you all some advice on how you can use those lessons with your older adult patients. So This past weekend, I ran a 50K, that's 31 miles, in New River Gorge, West Virginia. It was absolutely beautiful, absolutely brutal, and I was out there for seven hours and 14 minutes. That gives you a lot of time to reflect and learn some life lessons. So I'm gonna share some things with you all, and hopefully you can translate these to be using with your patients this week. LESSON 1: THE TRUE FINISH LINE IS AT THE END OF YOUR LIFE Okay, so first lesson. The true finish line is at the end of our lives. The true finish line is at the end of our lives. This is a quote by Sally McRae. If you all have not heard of her, she is my absolute idol. She is a professional ultra mountain runner. She is known for her mental fortitude and crazy accomplishments throughout her career. She just did the Grand Slam of 200 mile races, which are four 200 mile races in the span of five to six months, which is absolutely insane. So she has a, her own podcast called the Choose Strong Podcast. And I started listening to her as I was starting to train. Um, when I first started trail running like a year plus ago, a little bit over a year ago, And I remember I'm running on the trail, I'm listening to her podcast, and she said that, quote, the true finish line is at the end of our lives. All of these start lines and finish lines and belt buckles and medals that we acquire, they're just adventures along the way. They're lessons learned along the way, the triumphs and the failures. What matters is the end of our lives. And it's a story that we get to tell. So I, as I was listening to this, I was thinking back to when I was younger and I ran track when I was younger. And when I was running in a race, it was first place or last place. My entire world hinged on me winning that race. If I didn't come in first place, I was gonna have a bad several days, my family was gonna have a bad several days because I was miserable. And so as I'm listening to Sally talk about this, and I'm training, I'm realizing that life is not a singular race or a singular goal to conquer, and then we're done. It's a journey. And it's not about winning, it's about becoming someone who endures. So that's my thought about this is a journey in our lives, that the end of our lives is the actual finish line. It's about, for me, becoming someone who endures. Developing the mindset and the habits and the lifestyle of someone who can go out and run 31 miles in the mountains. Okay? So when you're thinking about this with your patients, especially when we work with older adults, it's never just about their one episode of care with you. From day one, when you're sitting down and you're talking to your patient or your client, you want to be speaking to them as if this is a journey that you're going to go on together. This isn't, we're just creating goals for you to accomplish at the end of our eight week plan of care. This is about connecting with their life journey. Who do they want to become? How are you going to help them develop the habits and the lifestyles to become the person that they want to be so that the next several decades of their life are happy, purposeful years? Start that conversation early. Start talking about what's next. Again, it's not we are ending this relationship in eight weeks. What's going to be beyond that? Do you have a side gig that you do private wellness in folks' homes and you're going to then provide personal training for them? Are you going to refer them to a gym and you start that process early so you find the right fit for them so they can continue on with fitness? Start talking to your older adult clients as if this is a long-term relationship and this is a lifelong journey. Start talking to them about who is the person that they want to become and how you are going to help them get them there. Okay, that's number one. LESSON TWO: PAIN IS MORE EASILY ENDURED WITH FRIENDS Number two, pain is more easily endured with friends. Pain is more easily endured with friends. Team, I have never experienced pain like I have when I was out there on the trail this past weekend. There was about 5,000 feet total of elevation gain and loss. You're climbing up rock scrambles, like vertical rock scrambles, treading through water, slipping on mud, rocks and roots the whole entire time. The terrain was absolutely brutal. I've never felt this type of pain before. I mean, my ankles and my knees and my feet were just absolutely destroyed and screaming at me for a long time. I went out on that second 15.5 mile loop and I knew, I was like, this is gonna hurt the entire time. It was not my cardiovascular system holding me back. It was the pain in my joints. Every single step was grueling. And I started to think, as I'm in this much pain, I'm starting to think about our older adult clients who have aches and pains and arthritis, and I'm like, man, this may be a little bit of something that they feel on a daily basis, right? I know that this pain for me is temporary. When I finish this 31 miles, it's gonna be over, for the most part, until the DOMS sets in, which has definitely happened. But older adults, pain may be a part of their lives. Now, we know that we can get people strong and we can influence their environment and help with their diet and their stress management and their sleep. Like, we can do a lot of things that can help with pain that they feel, right? However, I don't think it's fair to come at someone with rainbows and butterflies and tell them, like, you're never gonna experience any pain. I don't think that's fair. Pain may be a very real experience for older adults, even amongst them doing all the right things and getting really strong. And we have to realize that. So this is what I want you to think about. Pain is better endured with friends. And I will tell you when I was out running and I was on that second 15.5 mile loop, just miserable and miserable amounts of pain. The one time that I wasn't feeling it as severe were the times when I was running alongside someone. When I was having a conversation with someone else on that trail who was experiencing the same thing as I was. When I was meeting people and hearing their journey of their training and why they signed up for this race, and who's waiting for them at the finish line, and what they were experiencing in that moment, and you're distracting each other, and you're learning about each other, you're making friends with strangers. I did not feel that pain as severe as when I was spending time with someone else on that trail. And I will tell you one moment in particular, I was running with this one guy pretty consistently at the last like five, six miles of the race. And I was telling him like, I ran a 20 miler and then I jumped to this 50K. So skip the marathon. And at one point, we're continuing on and he turned around and he says to me, hey, you just ran a marathon. And I was just so taken that this individual, who's trying to concentrate on his own footing and his own race, turned around to give me the benefit of, hey, you just ran a marathon. You just PR'd. And that right there, I didn't feel any pain. I was so grateful for this human. I didn't feel a darn thing. So when you are starting to work with your older adult clients, I want you as quickly as you can, starting day one, try and get them to be a part of a community. I said it before, how are we going to plant that seed early to get them to discharge to fitness, right? To go on to their second part of their journey, start getting them a part of a community as quickly as possible. The pain that many older adults experience throughout the day is because they're bored. They're bored. They're not doing anything. They're not spending time with anyone. Try and find them friends as quickly as possible, whether that is a fitness facility, a walking group, a church group. Find them community ASAP. Get them to be socially interacting with others more than just you for that one time in the week. Because their pain they're experiencing, I promise, is going to be able to be endured easier when they are spending time with others. LESSON 3: FORWARD IS FORWARD Okay, next one. Forward is forward. Alright? Forward is forward. I had to keep telling myself that. especially before I was heading out on that 15.5 mile loop, that second one, because there's no way I was like, I am in so much pain. There is no way I can be in this much pain for 15.5 miles, especially knowing how much climbing I was having to do for the last five and a half miles. I couldn't believe that it was possible. All right. But when I kept on going back to focusing on becoming someone who can endure, Focusing on that goal. It's not about winning this race. It's about becoming. I am focusing on becoming someone who can endure. I am having people along the trail who can distract me along the way. Even amongst insane amounts of pain, you can move forward. And I had not experienced that until this past weekend. It's incredible what the body can endure if you just focus on continuing to move forward. regardless of what that looks like. There is so much grace in forward. For me, it was, okay, running quick, like my first 15.5 miles, I was zooming, I was flying, it felt awesome. The second loop ate me alive. Running quickly became jogging, okay? Jogging slowly, my jogging slowly became hiking. all right my hiking became i am leaning up against a tree hunched over absolutely miserable and making deals with myself like julie count down from 10 and then keep moving and i out loud was counting down from 10 and then i would say go and then i would just continue moving forward it is insane how you can chip away at miles and chip away at time and chip away at pain if you just focus on forward but you give yourself grace as to what forward means so applying this to your patients especially when you are putting them through an emom or an amrap have options for them, especially those who are high achievers and they want to be able to do the level one, the highest level of the exercise you're giving them. So have options for them. So I have a fellow right now, he was just diagnosed with pulmonary fibrosis, idiopathic pulmonary fibrosis, incredibly sad diagnosis, but cardiovascularly he's very deconditioned, but also he just feels like there's an elephant on his chest that he can't get air in. And so he gets very tired very quickly when we start exercising. But I know that it's so important to build his capacity any way we can. So I will say, OK, I want you for two minutes. burpees, okay? That's the goal. When you can no longer do burpees, then I am going to have you do some jumping jacks. Take away that transitioning from up to down. When those jumping jacks become too hard, I want you to march in place. When marching in place becomes too challenging, I just want you to walk. I want you to walk down to the driveway and back up. The only thing I care about is that you continue to move forward. Give your patients options and make sure that you let them know that whatever type of forward it is or moving that it is, it has value. Continuing to move forward through discomfort, through pain, giving a lot of grace there, that's going to build a lot of confidence and mental fortitude with your patients. LESSON 4: SOMETHING>NOTHING AND DONE>PERFECT Okay, last one, last one. I could do this forever, but last one. We're getting close to where we're getting too long. Okay, so last one. Something over nothing and done over perfect. Something over nothing and done over perfect. So this is another quote by Sally McRae. Something that I have just had etched in my mind ever since I heard it on her podcast. Team, the consistency of chipping away at a goal every single day. and saying yes to yourself versus no is so much more important than hitting your A goal every single time that you go out to train or you go out to compete. I wrote myself a note. It's right here. I put it on my fridge so I could see it every single day. I'm going to read it to you. Hey Julie, remember last time you felt like shit before going on a run? Consider not going, but walked out the door and went for it anyway. Data shows that when that happens, you regret saying yes to yourself 0% of the time. Say yes, start moving. xoxo that's exactly what this says and i looked at it every single day every single day because no matter how bad you feel and how much you want to say no when you say yes and you do something something it doesn't have to be My goal was to do six miles, and if I don't do six miles, I'm throwing the day away. No, that could be I do two miles. That could be I stay and I do 20 minutes of strength in the garage. When you say yes, and you continue to build that consistency, you build resiliency. You are building reserve. Every single time you say yes, you are building mental fortitude. And 100%, You will feel better when you say yes. You will never feel bad for saying yes. You always feel better. So when you are working with an older adult, You're making sure that, again, you give them options. Maybe they don't do their entire HEP, and instead of them, well, I wasn't gonna do the HEP, so I just didn't do any exercise. Make sure they understand that saying yes is so important. It's the same thing. Forward is forward. Yes is yes. If they don't want to do their entire HEP, my goodness, just do five minutes of it. Five minutes. Guys, they said yes. And yes is so incredibly powerful. If we know that we wanted them to do that high intensity EMOM, we're trying to increase their aerobic capacity, but they just weren't feeling it that day, they can do yoga instead. It's still movement. We know with older adults, something is always better. than nothing. And the more you say yes, and what I did, I started to tally up the amount of times that I said yes versus no. And every single time, how did I feel afterwards? I felt so happy and proud that I said yes, and physically and mentally I felt better. Once you elicit that same feeling with your older adult clients, and maybe you write something for them too, you write them a note to put on their fridge, and they track the amount of times they said yes, it's momentum. It's going to be so much easier for them to continue to say yes every single time. SUMMARY All right, guys, that's it. We've been here for 20 minutes. I could talk about running and lessons learned forever, but let's recap. Number one, that true finish line is at the end of our lives. It is about the story we want to tell. It's about becoming someone who endures. becoming someone who endures. Make sure you're connecting with an older adult's life journey and who they want to become. Two, pain is more easily endured with friends. Make sure day one you are starting to figure out how to decrease social isolation and help your client find friends to work out with, to experience different sorts of pain and competition and training with. They're going to experience their pain at a lower severity, I promise. Next, forward is forward. There's so much grace. Make sure that they understand that they've got options and you are hammering in that if you can't do that level one goal, We've got options for you and as long as you're still moving, it's still forward progress. And lastly, something over nothing and done over perfect. If we're not going to reach that A goal, it doesn't matter. Just say yes to yourself consistently every single day. It's going to build resiliency and reserve and confidence moving forward and saying yes is going to become a lot easier. All right, y'all, I hope you have a wonderful rest of your Wednesday. The last thing I will leave you with are what courses we have coming up. We've got both of our online courses coming up in May on the 15th and the 16th. 15th, level one starts. 16th, level two starts. And then on the road between May and June, we are in North Dakota, Virginia, Arizona, and Texas. PT on ICE is where you find all that info. Hit us up if you want to talk about 50ks and running. I'm here for it. Have an awesome day, guys. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Dr. Megan Peach // #FitnessAthleteFriday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Endurance Athlete division leader Megan Peach discusses utilizing hill running as a gait drill for injured runners, explaining the changes in running mechanics between running flat, uphill, and downhill. Megan also explains when and why to recommend uphill or downhill running Take a listen to the episode or check out the full show notes on our blog at www.ptonice.com/blog If you're looking to learn from our Endurance Athlete division, check out our live physical therapy courses or our online physical therapy courses. Check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION INTRODUCTION Hey everybody, Alan here, 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. MEGAN PEACH I think both YouTube and Instagram are both live. Miracles. Good morning. Happy Friday. This is your PT on ICE Daily Show, and I'll be your host today. My name is Megan Peach, along with the Institute of Clinical Excellence, bring you this topic today of incorporating hills into your gait retraining toolbox. I am one of the lead faculty for our endurance division here at Institute of Clinical Excellence. and I teach both the live and the online versions of Rehab of the Injured Runner. So I'm super excited about this topic today. Let's get into it. So we have a lot of different tools in our gait retraining toolbox that we might use to keep injured runners running or return injured runners to a running program if they've had to take some time off. CHANGES IN RUNNING MECHANICS WITH UPHILL RUNNINGOne of the tools that we don't often use or that maybe we don't often think about as much of the others like cadence training or forward trunk flexion or maybe quiet running is incorporating hills into their current running program as a gait training tool to keep that injured runner running. And before we talk about specific injuries, I want to talk a little bit about the differences between running mechanics when we're running either uphill or downhill as compared to running over a level surface or a level ground. So when we're running uphill, a couple of things happen in terms of the sagittal plane gait mechanics that are different from running over ground on a level surface. One of those things is that our stride length So the distance from where the foot strikes the ground to a vertical line straight down from the center of mass, that's our stride length, that often will decrease when we are running uphill. And what goes along with that is also an increase in knee flexion at initial contact. So when we're running uphill, our knee flexion tends to be more than when we are running over a level surface. and it tends to be a little bit less in comparison. Also, another change that we typically see is a decrease in the angle of inclination from the foot to the ground when we're running uphill. And so what that means is that, or what that looks like, is that a runner running on a level surface who has a rear foot or a heel strike might look like they have less of a rear foot or a heel strike when they're running uphill. So maybe they look like they have a midfoot strike or they may even have a forefoot strike. It's going to be very, very dependent on the runner and that certainly doesn't happen in every single runner. We don't necessarily see a strike pattern change in every runner when they start to run uphill, but certainly that can happen and it does in many, many runners when we go from running on a level surface to uphill. So that's the third change. And then the other change that we commonly see in that sagittal plane is an increase in forward trunk flexion. So from going from a level surface to running uphill, we will often see that runner shift their trunk forward. And what that does is take a little bit of work off of the knee and transfer it to the hip. And so the glutes end up doing a little bit more work. The quads end up doing a little bit less work when we're running uphill. That has some advantages. but potentially some disadvantages as well, depending on the runner. So then when we talk about running downhill, all of those biomechanics changes that we saw, or that I talked about running uphill, are the opposite when we're running downhill. CHANGES IN RUNNING MECHANICS WITH DOWNHILL RUNNING So going from a level surface to running downhill, we often see that stride length increase. And so a runner will go from maybe landing with a little bit of knee flexion to nearly a straight knee at contact when they go from running on a level surface to running downhill. So we also see the knee flexion decrease or the knee extension increase depending on how you want to describe and look at that. What we'll also see is an increase in angle of initial angle of inclination at initial contact at the foot and ankle in relation to the ground. And so somebody who was a midfoot or a heel striker or a rear foot striker running on level surface is just going to shift that impact a little bit more posteriorly toward the heel. And it's going to be relative to how they hit the ground when they are on a level surface. So a midfoot striker may look more like a heel striker, or a rear foot striker may look more like a heel striker, depending on how they started out. Again, not in every single runner, but certainly there is that trend. The other thing we see with running downhill is a change in trunk position. And what we see when they're running downhill is more of an upright trunk posture. And even occasionally, we can see that runner almost lean backwards. And this happens for a couple of reasons. One, they're just trying to maintain their balance. It's a different body position running downhill versus running either uphill or over level ground, and so they're just trying to maintain their balance. And another, they're trying to control their speed. So often when a runner leans forward when they're running downhill, that can almost feel like they're gaining speed and it's a little bit uncontrolled, especially if that runner is more of a novice runner or just not used to running downhill. And so they'll lean back in an effort to just control their position and control their speed when running downhill. that has some obvious disadvantages, as it will increase the load on the knee and the lower extremity and decrease the load on the hip musculature. UTILIZING UPHILL OR DOWNHILL RUNNING FOR THE INJURED RUNNER So, in talking about specific injuries and running mechanics in an uphill or downhill, we want to take into consideration where those specific injuries are and what types of tissue we want to offload. So starting with patellofemoral pain, super common running related injury. It's one that a runner can typically continue running through, at least in some capacity, as long as there are some shifts and adjustments in their training program. They may not be able to do the same amount of mileage, but they certainly can, in most cases, continue running. So when we consider offloading the patellofemoral joint, We typically use gait retraining drills like cadence retraining or increasing the step frequency. So we reduce the stride length, increase the knee flexion angle at initial contact. We might also use something like a forward trunk flexion drill to shift that load from the knee more approximately to more of the hip. And those tend to work very, very well for people with patella femoral pain. I personally treat a lot of trail runners and so they're generally not running on a level surface and they're generally running uphill or downhill and that's just the terrain that they're running on. And so often when we're using other drills like cadence or like trunk control, then we're expecting that they're going to run on a level surface. And so if we have a drill like running uphill, they're very, very much appreciative of being able to incorporate their normal terrain into their current running training program while they rehab that injury. And so with runners with patella femoral pain, we will often incorporate running uphill. Now I know it sounds a little bit crazy and runners always give me a little bit of a weird look, but because of the biomechanics that go into running uphill, namely the reduction in stride length, the increase in knee flexion angle at initial contact, and the forward trunk flexion, all take a little bit of that load off of the patellofemoral joint and shift it up the chain, so it shifts to the hip, and they're often able to tolerate running uphill quite well, even in comparison to running over a level surface. It is important that you remind them that they need to walk downhill, and that's really important so that we don't actually increase the load on that patellofemoral joint. Now, when I talk about incorporating uphill running to an injured runners training program, I am not talking about incorporating this giant steep slope that I expect them to run up. I'm talking about a very low grade, like a three percent grade, which is generally what's cited in the literature as something that the authors or the researchers are looking into as does this create biomechanical changes. And even a low grade like 3% is enough to create some of those favorable biomechanic changes that are going to make a difference in that runner's ability to tolerate that running load. And a 3% grade is enough to reduce that patellofemoral joint stress by about 25%, and that's per step. And so when we think about that cumulatively over many, many, potentially thousands of steps, that's a lot of load reduction on a single joint that is going to allow that runner to continue running as they rehab that injured tissue. So moving down the chain and thinking about Achilles tendinopathy, very different injury, obviously, different types of structures, different types of tissue injured. And we think about the biomechanics of hill training. And when we think about biomechanics of running uphill, like I mentioned, we have that reduction in angle of inclination as one hits the ground or as one impacts going uphill. that reduction of angle of inclination or the shift toward landing on a midfoot or a forefoot is going to also result in an increase in load or stress on that posterior lower leg musculature. So the gastroc soleus complex, as well as the Achilles tendon and some of the forefoot structures. And so with an injured runner, with Achilles tendinopathy, they're actually going to accumulate more stress while running uphill than they would running on a level surface or downhill. So much so, in fact, it's about a 25% increase in stress on the Achilles tendon while running uphill as compared to that level ground. And so with a runner with Achilles tendinopathy, we actually want to discourage them from running uphill. We do not want them running uphill. obviously while they're still symptomatic later on in the program. That might be something that we incorporate as they're able to tolerate more and more load, but certainly not while they're still symptomatic. And so when an injured runner with Achilles tendinopathy, we actually want to encourage running downhill because of some of those biomechanical changes, those runners are going to tolerate downhill running much, much better than maybe even overground running. And often in those, Runners with Achilles tendinopathy, they've stopped running for a period of time in an effort to rest the injured tissue and resolve the symptoms, they're not always sure how to get back to running. And so downhill running can be a good start with less load on that injured tissue than overground or level running or uphill running. Certainly we want to incorporate those later on as they tolerate more and more load. Okay, so the last one I want to talk about and It's been 12 minutes already and I haven't talked about bone stress injuries, so it's probably, it's a little unusual, probably a record. I do want to talk about tibial bone stress injuries. And so with bone stress, it's a little different than other types of soft tissue stress because with bone stress, we get stress from a couple of different inputs. One is an external input, meaning the ground reaction forces. Two are the internal inputs, which comes from the muscles that are attached to that specific bone. So in this case of the tibia, the gastroxilia is complex. And both of those external and internal inputs are going to have an effect on the amount of stress that that bone is accumulating. The internal load or the internal stress being much, much more of a contributing factor to bone stress than the external ground reaction forces. Although it does contribute a little, so it still needs to be considered. Okay, so when we run uphill, we know that there is going to be an increased load on that gastrocnemius complex. And so therefore, there's going to be a significantly increased load as well on the tibia because of that internal load from the gastrocnemius complex. When we run downhill, then we see an increase in ground reaction forces, which is also going to increase the load on the tibia. So we can talk about uphill or downhill, but they're both essentially going to increase the load on the tibia specifically. And so while somebody, although they will likely have some time off of running after they've had a diagnosis of a bone stress injury, while they are returning to running, we want them to run on level ground. We do not want them to incorporate any hills up or down early on in their program until we are absolutely sure they are tolerating level ground running without any symptoms or exacerbation of symptoms. And then we can start to incorporate the downhills, which are going to be less problematic and less provocative than the uphills because that internal load with the uphills and the gastroc soleus is going to contribute much more stress and load to that tibial bone than the downhills with the increased ground reaction forces. Okay, so a couple of other things to add. One is that if you are working with novice runners, hills often have to be trained. So they're not intuitive in terms of how we can most efficiently run downhills, uphills a little bit more so, but certainly not downhills. And because of some of those maladaptive mechanics that I talked about with running downhill, specifically like the upright trunk posture and the increase in the stride length or the over striding, those we tend to just do when running downhill if we're not trained how to run downhill. So if it's in your toolbox and you know how to kind of instruct or coach a runner to have better mechanics running downhill, meaning lean into the hill just a little bit. You don't have to have so much forward trunk flexion that it's making you uncomfortable, but lean into it just a little bit, or to maybe just be conscious of not extending the trunk posture or having a very rigid upright trunk posture. And then maintaining the stride length. So trying not to reach out as one goes down can really help to reduce some of that stress on the patella femoral joint, and the lower extremity as well. And so training or coaching a runner to be able to run downhill can also have really positive benefits in their ability to tolerate some of those hills, especially if they either currently are injured or have that running related history, especially if it's something like a patella femoral pain. And then the other thing to mention with using uphill and downhill as gait retraining tools is that The biomechanical changes are not independent of changes in stride frequency or our cadence or changes in speed. And so just like any other gateway training drill that we might use, so cadence for example, it's really, really important that we maintain some of the other variables that go into running. So speed for example if somebody's running on a treadmill and we manipulate their cadence we're really really sure to maintain that speed otherwise we may be changing too much at one time or we may not be getting the desired effect that we want from that gait retraining tool if we are changing more than one variable. So if you are recommending like an uphill run for example try to maintain some of those other variables specifically like stride frequency or cadence and speed. So obviously easier said than done, much easier on a treadmill than it is outdoors like on a trail, but just something to be aware of. Okay, so to recap, running uphill or downhill can be a really effective tool for runners with specific injuries, such as patella femoral pain or Achilles tendinopathy, that we can definitely put into our running gait retraining toolbox. As long as we keep some of those biomechanics in mind, and as long as we understand how uphill or downhill running can shift some of that load from one structure to another, And then also taking into consideration that there are instances when we do want runners to run on a flat surface, for example, in tibial bone stress injuries, when they are returning to run, it's really important to keep them on that flat surface so that they are not inducing excessive stress on that injured or healing tissue. SUMMARY All right. So before I let you go today, I do want to mention a couple of upcoming courses. We have, let's see, Rehab of the Injured Runner Online. We are just about to start a new cohort. It is in May, the very beginning of May, so you've got a couple of weeks to sign up, but it's filling up. Sign up now. We have just revamped Rehab of the Injured Runner Online for 2024 and so far it's been really, really fun. We've had a lot of great engagement from current participants and previous participants. in our courses this year. Great questions. It's been really fun so far. So make sure you get into that if that's something you've been meaning to do. We also have Rehab of the Injured Runner live. We have June in Wisconsin and then we have September in Maryland and then Certainly the bike fit course is part of our endurance division and so we have a course this weekend in North Carolina. We've got one in May, mid-May in Minnesota and then up with our friends in Bellingham, Washington in June. All right, so that's it for me today. Hopefully you can add in hill training, uphills and downhills into your toolbox for rehabbing injured runners and just hit the ground running with that and use it right away. That's my goal for you for today. Feel free to ask any questions and hope you have a great Friday. All right, have a great weekend as well. OUTRO Hey, thanks for tuning in to the PT on ICE daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Dr. Christina Prevett // #GeriOnICE // www.ptonice.com  In today's episode of the PT on ICE Daily Show, join Modern Management of the Older Adult division leader Christina Prevett discusses how it can feel very overwhelming when your practice looks very different then what you are exposed to in a course like Modern Management of the Older Adult. You don't need to change drastically overnight (though you can!) but we encourage you to take the first step. In today's episode, Christina takes you through 4 steps you can take TODAY, to level up Take a listen to learn how to better serve this population of patients & athletes, or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION INTRODUCTION Hey everyone, this is Alan. Chief Operating Officer here at ICE. Before we get started with today's episode, I want to talk to you about VersaLifts. Today's episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of h drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today's show notes to get your VersaLifts today. CHRISTINA PREVETT Hello everybody and welcome to the PT on ICE daily show. My name is Christina Prevett. I am one of the lead faculty within our geriatric division. And today I wanted to talk to you about something that we see a lot as we talk to clinicians across the country, across North America, sometimes internationally, about some of the barriers to implementing some of these exercise interventions that we know are so, so relevant and helpful to get our older adults as strong as possible, to give them as much reserve as possible. So when we go into different live courses, we have our two-day online, or we have our eight-week online course, we have our two-day live course. We talk to clinicians in the geriatric space who are in a lot of different practice settings, right? It's really great and really unique that one, we oftentimes have a multidisciplinary group. So we're seeing OTs, PTs, CODAs, PTAs. But then we also have a lot of people in the room who are in different practice settings. So in any course, we can have some people who are in acute care, in home health, in skilled nursing facilities, long-term care facilities, outpatient clinics, fitness. We kind of see this spectrum, right? And we know that with our older adults, that there is a spectrum. And in our courses, we try to speak to that spectrum. So we try to speak to the clinician who is working with really sick folks in the hospital, to the, person who's in fitness and is keeping older adults who are doing fairly well as active as they can into hopefully their 90s and 100s. But sometimes there can be these barriers that are maybe not to do with the client that you're seeing, but the clinician and the space at which the clinician is at in order for it to feel like an overwhelming barrier to get individuals to or to see some of the changes we know are going to lead to better outcomes. And this is not to cast any blame on the clinician, but to acknowledge that it is not just you working with the client, it's you working with the client within the system that is medicine and the system that is your employer. And it's something that we want to acknowledge. So I was at a course recently and I had a person come up to me and I just, I loved the vulnerability, but she said to me, you know, I am a worse clinician than I was five years ago. And she was, she's about five, six years out. And you know, I'm going to talk about what you can do today, but I want to acknowledge this first. And she said, I'm just so tired. And she wasn't saying it for, you know, sympathy. She was just wanting an acknowledgement that she knew that all of the things that we were talking about in this course were exactly what she needed to be doing. And yet all of the other stuff around the system that she was experiencing was making it so that she was exhausted and it made it hard to do the better thing, right? Because Seated Therax is not as cognitively demanding on us as clinicians. The safety profile is oftentimes a lot lower, is a lot lower, even if the returns are not as good. And I first, before we start talking about ways that we can start leveling up our therapy practice, like what is the next step that we can take? If this story is resonating with you, what I want you to do is know that we see you. We see how hard clinicians are working. We see how hard it can be to push back against a narrative that has been, you know, kind of placed into our system that makes it so that there are barriers that are systems and administrative barriers that make, you know, leveling up in geriatrics be difficult to do. It is especially difficult if you are the one trying to push against this and everybody else in your practice is not. And so I first want to just acknowledge you and say, you know, I'm going to start trying to give some practical tips around ways that you can take that next step. But if your biggest barrier is where you are at from a headspace perspective or where you are at from a cultural perspective, just know that I acknowledge that where you are. and maybe some of that reflection will help work towards, you know, I don't know what that next step is for you to try and help get you out of that burnout or out of that exhaustion state, but it may be your biggest hurdle when it comes to leveling up in the geriatric space. So I wanted to acknowledge that first. "WHERE DO I START?" Okay, so the next step is I have no idea where to start. and I have no idea what to do. And so where I want all of you to start, and this is gonna be my challenge for you for the rest of the week, is do one thing different. level up in one thing. So when people come and take our course, they think, okay, now everything that I do has to be different. And that would be like taking you and you eat fast food six times a day or six times a week and you don't exercise at all and you're not sleeping and you're over caffeinated and you don't know what water is. And then you say, okay, I'm going to go and I'm going to eat super clean. I'm never going to have any fast food ever again. I'm just going to drink water. I'm going to kick out caffeine and I'm going to exercise 150 minutes. of aerobic and two times a week of strength training. I love that goal for you, but we wanna make it so that it makes what seems impossible possible. And we're gonna start taking these little steps, right? So we talk a lot in MMA about graded exposure and acknowledging that process when it comes to our patients, but we acknowledge that that practice change also takes time. And if this is not an area where you are focusing with respect to intensity, and this is particularly true in the resistance training space, just know that we don't need to drastically change. LAYER IN STANDING EXERCISES We need to take the next step. And so what can that be? Let's go through three examples of what that can look like. So you have a patient who is coming in and you have been doing predominantly seated exercise. and this is no shame at all. This is where you are at with this person. They are tired, their joints are irritable, and you know that you're gonna have to do a lot of pressing to get that session to be mostly in standing. Great. I want you to get them standing for one. If that's one exercise, that's one set. If you are doing long arc quad, change that to a standing terminal knee extension with a band around the rig or around a doorknob or around the high-low table that allows them to do that exercise in standing. So the one next step can be is to choose one person on your caseload where the easier choice was to do the seated option, but you're going to get them to do the standing option. So that's taking the step Here, that was number one. START USING AMRAP SETS Number two, if you are a person who has had trouble finding a quantifiable baseline assessment of strength. And this is so many people in our profession, like we ask all the time, like how many people take a kind of estimated strength measurement before they prescribe strength exercise? And most people are saying, well, shoot, I don't really do that. And it was a big growth area for me too. So the first opportunity for leveling up, today in your geriatric practice is to get a person who you would have chose a seated option, but you're going to try and get them into standing for at least one set. The second one is going to be to pick one exercise for one person and do an AMRAP set. So we talk about using estimated 100 maxes. So an AMRAP set is as many repetitions as possible. We can use it for a quantifiable baseline amount of strength, You're going to choose a weight that you think individuals can do for 10 repetitions or less because there's a cardiovascular component if we're over 10, if you've ever lifted heavy weights for more than 10 reps, you know what I'm talking about. And I want you to put an AMRAP set in today. So that's number two. Number three is you take one person's session and you get an objective measure for every set. So this is my number three. So one is get a person in standing if we want to have them sitting even though we know they can stand. Number two is getting an AMRAP set to try and find a quantifiable baseline amount of strength. BEGIN TO OBJECTIVELY QUANTITY EFFORT WITH RPE And three is to find a rate using a rating of perceived exertion, an RPE, for each exercise. and try and get individuals in that moderate sweet spot between five and seven. Hey, if you want to push them up to 10, I'm here for it. But if we are trying to take the first step to level up, what we want to make sure is that we are asking our patients, how hard do you think this is? And some people are going to say it's hard because they're tired. Some people are going to say it's hard because of pain. or some people are going to say it's hard because it's effortful, and effort is the name of the game, right? Effort when we're bumping up against pain can be that we're kind of toggling in this wiggle room between this increase in pain and how long it takes for their pain to come down to baseline. It can be exertional effort, but effort is the currency that we are looking at when it comes to all of our rehab interventions. And so the step that I want you all to take is to take a rate of perceived exertion for every exercise. So if they are doing clams, if they are doing bed mobility, I wanna say how hard do you think that was on a scale of one to 10? Or was it easy, medium, or hard? And you want them at least in the medium. There are so many times where I think that I am hitting the right mark when it comes to intensity for my older adults, and then I ask them, and they're like, oh, it's like a three. And I was like, well, dang. Linda, I'm going to switch this weight for you." And we end up taking the weight and putting it higher. Of course, your clients learn that and they'll look at you and you'll ask and they'll say, eight. And I was like, I don't believe you. That's not an eight. And you switch that exercise out. But giving you a rating of perceived exertion, one, that's something that you can document to make sure that you're getting that intensity, is a great way for you to be able to level up your Jerry game today. Okay, I know I said three, but I'm gonna give you four. BEGIN TO MEASURE REST INTERVALS The fourth one that you can do, and then I'll kind of go through all of them again, is to record your rest. Oftentimes we do our sets and then we kind of wait and we wave a little bit and we think, oh, well, I'm getting bored or they're getting bored or they're finished with the story. Okay, we'll start the next set. And we have no idea what that intensity looks like if they are resting for 30 seconds versus 90. If you are working with an individual with a high enough amount of load, they should need that full minute to recover. And so if we don't Check how much rest they're getting it can be really difficult for us to know if we're hitting the mark again with intensity So I gave you a bonus one So I'll do three plus bonus that I didn't lie to you at the beginning of this session About or this podcast about what our ways for us to level up our Jerry game So let's bring this around full circle the first thing is I want to acknowledge you if the hardest part about leveling up your Jerry game is because of the mental state that you are in right now if that is because of your job if that is because of family stress if that has become because of work culture expectations that make it difficult. I want to first acknowledge that and where you are. And know that sometimes if you are sitting at a 40% baseline, your cognitive reserve, and you're giving 40%, then you're giving 100% of the effort that you have available right now. And I want that acknowledged. And I know that it's not just simple as like, let's just change these one things for individuals who are kind of in the throes of some of those difficulties. If you are able to get through and try one thing different today, I gave four options, right? So doing that AMRAP set, getting a person doing an exercise in standing that we probably would have biased towards sitting, taking a rating of perceived exertion for every exercise in a session, or measuring rest, putting a clock on in the background and having it roll up and just kind of getting an idea of how much rest individuals are taking. You'd be surprised how much of our exercises, our interventions are gone because of us taking longer rest intervals than are probably necessary. SUMMARY All right, if you want to learn more of these level up steps, you can hit us up at MMOA Live. In two weeks on the 17th, 18th, I'm in Oklahoma City, Oklahoma with Sam. It's going to be such a fun course. On the 23rd, 24th, We are in Gales Ferry, Connecticut. We actually also have a sold out course right now in Rochester on that same weekend, which is super exciting. I love when we see these big crowds. But Alex is going to be in Gales Ferry. And then March 2nd and 3rd, we are in Rome, Georgia and Sparks Glencoe, Maryland. So if you are looking to find us on the road, if you want to figure out all these level up techniques, That is the place to do it. It is two days. It is so fun. You get to hang out with us and our crew. Maybe we can give you that little boost of motivation that you need to take that first step forward. And we would love to be that little bit of a motivation boost and a culture for you if you are struggling right now with different aspects that are outside of your control and your patient's control. within our healthcare system. So I encourage you to see us on the road if you haven't yet. Have a wonderful rest of your week, everybody, and hopefully I will see you all eyeball to eyeball at a course soon. Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

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

Summary:   “All the best people have bad chests and bone diseases. It's all frightfully romantic.” This week we talk about an infamous murder and intense teenage friendship in the film Heavenly Creatures. Also discussed: malls as retirement villas, Alex Cuba, and the clothing label Esprit.   Show notes:   "I was guilty. I did my time': Anne Perry, the novelist whose past caught up with her (The Guardian)   Recommendations: Andrea G.:  The Boy and The Heron (film) Andrea W.: Alex Cuba Tiny Desk concert (music) Lisa: The Lost City (movie)     Music credits "Electrodoodle" by Kevin MacLeod From: incompetech.com Licensed under Creative Commons: By Attribution 3.0 License   Theme song "Pyro Flow" by Kevin Macleod From: incompetech.com Licensed under Creative Commons: By Attribution 3.0 License   "Flutterbee" by Podington Bear From:  Free Music Archive Licensed under Creative Commons: By Attribution 3.0 License     Pop This! Links: Pop This! on TumblrPop This! on iTunes (please consider reviewing and rating us!) Pop This! on Stitcher (please consider reviewing and rating us!) Pop This! on Google PlayPop This! on TuneIn radioPop This! on TwitterPop This! on Instagram Logo design by Samantha Smith Intro voiced by Morgan Brayton Pop This! is a podcast featuring three women talking about pop culture. Lisa Christiansen is a broadcaster, journalist and longtime metal head. Andrea Warner is a music critic, author and former horoscopes columnist. Andrea Gin is a producer and an avid figure skating fan. Press play and come hang out with your new best friends. Pop This! podcast is produced by Andrea Gin.  

SUMMARY: All eyes are on the Fed as the FOMC will announce a likely 25 basis point increase to the federal funds rate, home prices climb for the fourth straight month despite home prices falling year-over-year, consumer confidence rises to a two-year high, and mortgage demand falls for the first time in three weeks...NOTES:Home Prices Continue to Fall in MayConsumer Confidence Jumps to Two-Year HighMortgage Demand Falls as Rates Stay ElevatedBLOOMBERG: Who Wants to Keep Hiking Rates and Who Doesn't? Breaking Down the Fed's ViewsDISCLAIMER: TowneBank Mortgage, NMLS #512138, is an equal housing lender. This podcast is for informational purposes only. Hosted by Tyler Cralle #2028201

Pills, such as pain relievers, may be swallowed in Pesah. Even if they have Hametz ingredients, these ingredients do not impart a taste, and the pills are swallowed, not chewed or sucked, and they are therefore permissible on Pesah. Moreover, the vast majority of medications nowadays do not contain Hametz. Therefore, even if one does not have a serious medical condition, he may swallow pills which he requires during Pesah. One who is prescribed such medication by a doctor must take the medication during Pesah and should not refrain from doing so out of the concern of Hametz. It goes without saying that one must continue taking medication if his health would otherwise be endangered. However, medications that have a flavor, which the patient drinks, chews or sucks, require certification for use on Pesah.Some cosmetics include ingredients made from Hametz. However, these ingredients are inedible, and are not even "Ra'ui La'achilat Keleb" – suitable as food for dogs. The Shulhan Aruch (Orah Haim 442) rules that any Hametz product which is not suitable as food for a dog already before Pesah is entirely permissible, and may be kept and used on Pesah. Therefore, all cosmetic products may be used on Pesah.Hacham Yitzhak Yosef (contemporary) writes in Yalkut Yosef that all housecleaning products, soaps and shampoos may be used on Pesah, and do not require certification for use on Pesah, since these products are not "Ra'ui La'achilat Keleb." Although some required these products to be certified kosher for Pesah, Rav Shlomo Zalman Auerbach (Jerusalem, 1910-1995) considered it a "joke" to certify such products kosher for Pesah, since they are inedible even for dogs, and thus are entirely permissible for use on Pesah.Summary: All pills and tablets which have no taste, and are swallowed whole, may be used on Pesah, even if one's condition is not serious, and they do not require certification for use on Pesah. Medications that have a flavor, which the patient drinks, chews or sucks, require certification for use on Pesah. All cosmetic products, soaps, shampoos, detergents and housecleaning products may be used on Pesah, and do not require "kosher for Pesah" certification.

Summary: All successful leaders have one thing in common: a Great Aunt Edna. Mac McNeil— an author, former Military Intelligence Analyst, and leader in business—appears in this episode to talk about the ‘E.D.N.A.' philosophy and why it is foundational to leadership. Mac was, in fact, inspired by his real Aunt Edna, but the acronym symbolizes a Leadership culture of Excellence, Doing Things the Right Way, No Shortcuts, and Accountability. The purpose of EDNA is to make people think about the culture they are fostering when managing others. As a leader, you may have moments where you are “in the wilderness,” or alone in your pursuit, but these moments can help you solidify your ‘why' and grow stronger. Mac highlights how it looks to have an opportunity mindset—positioning clients for a successful future—and discusses the spirit of excellence that himself and his colleagues uphold. Tune in for more amazing insight from a key thought leader, and use the link below to pre-order Mac's book.  Useful Links: Financial Survival Network My Great Aunt Edna Book

Summary:All the unaccountability and separation from reality that make government healthcare a failure help produce foreign policy disasters like the Iraq and Ukraine Wars as well. Additional Reading:The Culture of Entitlement in MedicineIs Russia Really the Aggressor in Ukraine?Free Gift from Tom:Download a free copy of Tom's new e-book, It's the Fed, Stupid, at itsthefedstupid.com. It's also available in paperback here.It's priced at a pre-hyperinflation level so grab a few copies for friends if you can.It makes a great introduction to the government's most economically damaging institution for liberals, conservatives, libertarians, socialists, and independents alike.Get even more great content by becoming a Tom Mullen Talks Freedom Supporter at tommullentalksfreedom.com/support. You can sign up there for either my Patreon or my Substack. Like the music on Tom Mullen Talks Freedom? You can hear more at tommullensings.com!

Summary: All pangolins have tails, but each species' tail is unique. Join Kiersten and a special guest co-host as they discuss pangolin tails.   For my hearing impaired listeners, a complete transcript of this podcast follows the show notes on Podbean.   Show Notes: Pangolin ID Guide: https://www.usaidrdw.org//resources/pangolin-species-identification-guide/pangolin-id-guide-rast-english.pdf pangolins.org https://arkansasresearch.uark.edu/researcherss-discover-fossil-of-new-species-of-pangolin-in-europe/ Pangolin Conservation Organizations:  Rare and Endangered Species Trust - www.restnamibia.org Save Vietnam's Wildlife - www.svw.vn     Transcript (Piano music plays) Kiersten - This is Ten Things I Like About…a ten minute, ten episode podcast about unknown or misunderstood wildlife. (Piano music stops)   Kiersten - Welcome to Ten Things I Like About… I'm Kiersten, your host, and this is a podcast about misunderstood or unknown creatures in nature. Some we'll find right outside our doors and some are continents away but all are fascinating.    This podcast will focus ten, ten minute episodes on different animals and their amazing characteristics. Please join me on this extraordinary journey, you won't regret it.   This episode continues pangolins and my ninth favorite thing about pangolins is their tails. Today I have a special guest co-host, my friend Cheryl! Cheryl and I co-host another podcast together called The Feathered Desert and it's all about bird feeding in the Southwest region of the United States. Thanks for joining me Cheryl!   Cheryl: Thank you for having me Kiersten! I'm very excited to be here and pangolins are one of my favorite animals.   Kiersten: I know you are as intrigued by pangolins as I am, so I'm glad you could join me for the penultimate episode of my pangolin series! Today we're going to talk about tails! I know that seems like a strange thing to focus on, but all pangolins have tails. It's a very important part of their body structure, but each species tail is a little bit different!   As always, let's start off with our Asian pangolins and Cheryl's going to kick it off with the Chinese pangolin.   Cheryl:  The Chinese pangolin's tail is 25-40 cm long or 10-16 inches in length. It has 16-19 scales along the edge of the tail. This pangolin's tail is semi-prehensile which means it can curl the end of its tail around an object to hold or grasp it. They use this adaptation to hold onto branches when they are in trees and to steady themselves when walking over rugged terrain.   Okay, I have a question.    Kiersten: Yes!   Cheryl: The scales on the tail, do they start of larger and get smaller?   Kiersten: That depends on the species, but in general, yes. The scales at the base of the tail will be larger than the scales at the tip.   The Sunda pangolin's tail is a little bit longer than the Chinese pangolin's at 35-57 cm or 14-22 inches. They have 21-29 scales along the edge of the tail and it is more slender than the Chinese or pangolin's tail. The Sunda pangolin's tail is fully prehensile which means they are able to manipulate items with their tail like a human hand.   Cheryl: Do they do that?   Kiersten: I have not seen any evidence that they pick up things and carry them around or move things because they eat ants, so its not like they need to collect fruit or anything but they certainly have the ability to do it if they need to.   Cheryl: Our third Asian species is the Philippine pangolin. Their tail is 35-52 cm long or 14-20 inches long. They have 28-32 scales along the edge of the tail. Like the Sunda pangolin's tail, the Philippine pangolin's tail is fully prehensile which comes in very handy since this pangolin spends most of its time in the trees. They are able to wrap their tail around tree branches as they tear open ant nests (I didn't even know ants would be in trees! How interesting.)    and even hang their entire body weight from their tail. The Philippine pangolin's tail is the longest in proportion to their body of all the Asian species.   Kiersten: Our last Asian pangolin is the Indian pangolin. Their tails are 40-45 cm in length or 16-18 inches. They have only 14-15 scales along the edge of the tail because their scales are larger in size than our other asian pangolins. Their tails are semi-prehensile and help balance them as they walk along the ground, but can also anchor them if they climb into tree, which they only occasionally. They have the thickest tail of all the Asian species.   Okay. I'm going to continue and take us into our four African species. Let's start with the Tree or White-bellied pangolin. This is one of my very favorite tails.    Cheryl: (laughs)   Kiersten: I know its a weird thing to say, but it's true!    This pangolin's tail is 30-52 cm or 12-20 inches long. They have 34-37 scales along the edge of the tail. Like the Philippine and Sunda pangolin, the Tree pangolin's tail is fully prehensile, but it has another very cool adaptation at the end of their tail, a scale-free pad at the tip of the tail. This gives them a better grasping ability which allows them to pick up things with their tail like a human hand and gives them an even tighter, more secure hold on tree branches.      Cheryl: That is very interesting. Cool little guys!   Next is the Giant ground pangolin. This is the largest of all the pangolin species and its tail holds true to their size with a length of 50-65 cm or 20-26 inches.  Wow! That's a long tail.   Kiersten: It is!   Cheryl: They have 15-19 scales along the edge of the tail and their tails are only partially prehensile. They generally use their tails mainly as a counterbalance  while walking and digging.   So, prehensile is just so it gives them more flexibility when they need balance.   Kiersten:  Yes, I believe so. They could if they ever needed to hold onto a bush or something they could give themselves a little curvature. But mainly theirs is for counterbalance.   Our third African pangolin is the Cape pangolin. They have a tail length of 31-50 cm or 12-20 inches. They have 11-13 scales along the edge. Like the Giant ground pangolin, the Cape pangolin's tail is partially prehensile. The Cape pangolin is the pangolin species that walks bipedal most often, which mean they only use two feet as they walk. The Cape pangolin will use its tail to counter balance with the front of the body so they don't tip over as they walk.    Cheryl: (laughs)   Kiersten: They look very cute. They look like little dinosaurs.   Cheryl: I'm sure they do.    Our final African pangolin is the Black-bellied Tree pangolin, ( I like to say that! Black-bellied tree  pangolin) also known as the Long-tailed pangolin. As their names implies, they have a very long tail with a length of 50-60cm or 20-24 inches. They have 42-44 scales along the edge of the tail. It is fully prehensile with the same unscaled pad at the tip that the White-bellied pangolin has, which is especially useful to them because the Black-bellied pangolin spends their entire lives in trees. They have the longest tail of all the pangolin species. Wow! Their entire life in trees.   Kiersten: I discovered a fun fact while researching this podcast and I want to share it with you. The Long-tailed pangolin has more vertebrae in the tail than we have in our entire body! Humans have 33 vertebrae from head to tail bone and the long-tailed pangolin has 47 vertebrae just in their tail! They have 75 vertebrae in total! That's a lot of vertebrae!   Cheryl: That IS a lot of vertebrae. Speaking of vertebrae, did you hear about the pangolin fossil they found in Europe? How often do you get to say that sentence!?   Kiersten: Right! I know!   I did! Researchers found a bone fossil that dates back to the early Pleistocene era in Europe. It's just one bone, the humerus or upper arm bone, but its accepted proof that pangolins used to roam the landscape of Europe. It was 2.2 million years ago but they were there! (Laughs)   Well, that's it for pangolin tails. Thank you Cheryl for joining me as co-host.   Cheryl: Well, thank you again for having me. It was fun and I love pangolins too!   Kiersten: I hope you all enjoyed learning about pangolin tails because it is my ninth favorite thing about pangolins.   Please visit savepangolins.org to find out even more about pangolins and discover what you can do to save this unique animal. To help the African Cape Pangolin visit the Rare and Endangered Species Trust at restnamibia.org and to learn more about Asian pangolins and help the Sunda and Chinese pangolin visit Save Vietnam's Wildlife at svw.vn.    Join me next week for the last ten-minute podcast focusing on pangolins.    (Piano Music plays)    This has been an episode of Ten Things I like About with Kiersten and Company. Original music written and performed by Katherine Camp, piano extraordinaire.

Start overcoming overwhelm TODAY and join the waitlist for the Leadership On The Rocks: The Survival Guide Course, CONTACT US: Visit our website at https://www.leadershipontherocks.com/ Follow us online at: Facebook: Leadership on the Rocks Instagram: @leadership_onthe_rocks Linked In: Bethany Rees Twitter: @Leadontherocks Email us at contact@bressentialservices.com Summary: All people need structure. They will thrive when there are clear processes and priorities. This includes your children and grandchildren, your co-workers, and your employees. Without structure and clarity, chaos is created, and chaos breeds conflict. Essential Rock # 3 Systems and Processes create the clarity and structure needed to not only kill chaos but create forward progress towards the mission. However, systems and processes are typically the weak link in every business, organization, and family. In order to accomplish your mission, make sure you are not playing the victim to your circumstances but be the hero that provides clarity and establishes structure to overcome chaos and conflict by building your life and leadership on essential rock #3 systems and processes. Application: In order to implement essential rock #3, you need to do 4 things: Identify the gaps you, your family, and your organization have within the 5 domains of impact. Without paying attention to growing yourself, building relationships, and developing a positive culture, no strategy for clarity and structure will work. Define your systems or critical elements that explain HOW you will accomplish your mission Develop simple standardized processes that are sustainable so there is a clear structure around what the day to day work is that moves the organization towards progress. Train your people on the processes and allow them to refine those processes. Being the hero that starts with one step of action to provide clarity and structure through systems and processes is always better than a victim that complains about the status quo and doesn't take action at all. If your organization, team, or family is a hot mess and you have no idea where to start in developing systems and processes then your first step is to find the hot spots. Make a full list of all the pain points that are causing the chaos and prioritize them. Remember the only way to eat an elephant is one bite at a time, so take action on the one hotspot that will burn your figurative house down if you don't put out the flames. References: “Status quo.” Merriam-Webster.com Dictionary, Merriam-Webster, https://www.merriam-webster.com/dictionary/status%20quo. Accessed 16 Jun. 2022. Jocko Motivation “GOOD” (From Jocko Podcast) https://www.youtube.com/watch?v=IdTMDpizis8 The Holy Bible, English Standard Version. ESV® Text Edition: 2016. Copyright © 2001 by Crossway Bibles, a publishing ministry of Good News Publishers.

Summary: All publications go through a harsh process of editing. Think of the best magazines and newspapers. All have teams of editors. Why? Because if you want something amazing to come out of your life, it usually requires you to take away the unnecessary. To put away the distractions. Hebrews 12:1-3 says it this way, "...let us throw off everything that hinders and the sin that so easily entangles us. And let us run with perseverance, the race marked out for us, fixing our eyes on Jesus, the author and perfecter of our faith..." If you want to run with perseverance, it's time to let go of the unnecessary. Today we're talking about how to edit your life for success. Resources Mentioned: How to Create More Time Workshop: https://ashleyvarner.com/time

Growing a successful online business as an entrepreneur can feel daunting and overwhelming. But if you follow these 5 tips you can grow an online business, with more ease and less stress. You can start and grow an online business without feeling so overwhelmed The online world is inundated with people sharing tips on how to grow an online business. But a lot of times, those tips aren't applicable to everyone, they aren't accessible to everyone starting out, or, they are confusing and hard to do alone. By the way, no one is meant to grow a successful business alone. We all need someone to help us and guide us and hold us accountable for intentional action. But, even before hiring a business coach, you can take steps to grow an online business without feeling like you are climbing a mountain with no lifeline. Let's take a look at how my 5 C's of personal branding can be applied to help you grow an online business Clarity is the first step to take to successfully grow an online business If you want to start and grow an online business, you must have clarity. When you have clarity, you have more confidence. And when you have more confidence you also trust yourself more. Likewise, when you have clarity and confidence and trust yourself, your soulmate clients are going to have clarity be confident, and trust you. So where do you begin to discover clarity? Purpose It starts with knowing your purpose and what you can do to truly make an impact and serve others. If you make a list of your values, visions, and passions you will see overlap in the three. Where that overlap occurs, you will discover your purpose. That thing that you can do to feel fulfilled, but also make an impact and serve others. Soulmate client Once you have clarity around your purpose, it's time to discover who your soulmate client is. Who are the people you feel called to serve? What specifically do the people need from you? Know exactly what the problem is that people have and how you can help them with it. How you can help If you are struggling to identify how you can help people, look at what your purpose is and all of the experiences that have led you to where you are today. Your soulmate client is 10 steps behind you. That may look like 10 years, 5 years, 3 years, or a few months, but all of the experiences that you've grown through are what they are going through at this moment. Clarity means aligning with your values The key to clarity is aligning all you do with your values. Your purpose involves your values and therefore, if you want to connect with your soulmate clients to grow an online business, you must stay aligned with your values, your visions, and your passions. You must have clarity around your purpose, the impact you want to make, the service you can and want to provide, who you want to serve, how you will serve them, where and when you will serve them, and your mission for serving them, in other words, your why. Keep in mind that it is challenging to achieve clarity if you are struggling with mindset barriers. Similarly, if you aren't aligned with your values, you may feel more fear and anxiety which will result in procrastination. I can't emphasize enough how important having a positive mindset is to achieve clarity. Being Cohesive is the second thing you need to grow an online business When I talk about being cohesive, I am referring to your brand identity and your branding. Your personal brand is what others think, say, and feel about you. Branding is how you communicate what makes you unique from all others in your area of expertise. And your brand identity is your color palette, typography, and logo, identifying factors, but now what truly differentiates you. Click here to read more about the differences between a personal brand, branding, and brand identity. Become recognizable, memorable, and sharable to build trust to grow your online business In order to stand out and become recognizable, memorable, and sharable, you need to use all of these things cohesively from your website to your social media platforms. In order to grow an online business, you must have trust. Trust determines buying practices. The more recognizable, memorable, and sharable you are, the more people will trust you. Think about stopping the scroll on social media. You want people to see your content and immediately think, that's Jane, I love her and know she provides value so I don't want to miss this post. They stop and consume your content, and their trust in you grows. The third thing you need to grow an online business is consistency Consistency doesn't refer to the thickness of cake batter when talking about how to grow an online business but rather being consistent. Consistent messaging to grow an online business When talking about being cohesive I didn't mention your copy or messaging. These are very important and they do need to be cohesive, but they also need to be consistent. Every piece of content you create should be clear and consistent about what you do, who you serve, how you serve them, and why you serve them. You never what to confuse your audience. Confusion will break trust. And we know that confused people never buy. The more consistent you are with the content you create on your website and all other platforms, the more trust you will build. Consistently showing up for your audience helps grow an online business You also want to be present consistently. The best part about being present is that you get to choose what works best for you. Do you want to write a blog post once a month or once a week? How many times a week do you want to post on social media? What about emailing your subscribers? How often do you want to show up in their email inbox? You get to decide so that you can be consistent, showing up in a way that works for you. Following recommendations of people online is not necessarily going to work for you. Some people show up on social media multiple times a day. If that doesn't work for you and you can only show up 3 times a week, make that choice but stay consistent so that your audience knows when to expect you and can see that you are consistently showing up for them. The more consistent you are, the more trust you will build. In addition, the more consistent you are with your messaging, the more people will see you as an expert. The fourth tip to help you grow an online business is content. Your content will become the deal-breaker for your audience getting to know you, understanding what makes you unique from all others in your space, and building relationships. At the end of the day, your goal is to build trust. You build trust by building relationships. Your content from your website copy, blog posts, email marketing campaigns, and social media post is what will help you emotionally connect with your audience to build relationships and trust. People often dislike social media and the demand for creating content. However, if you look at creating content as an opportunity for developing relationships and building trust so that you can grow your online business it won't seem so daunting. Ultimately, your content is your branding. It is your effort to differentiate yourself, create an emotional connection with your audience, build relationships and community, and convert them to soulmate clients because they trust you. Repurposing content to make your life easier while you grow your online business In addition, repurposing content makes content creation easier. You can begin with a blog and repurpose the blog into multiple social media posts and an email to your audience. It takes people 7 to 20 times to see or hear something and remember it. This statistic is justification for repurposing your content to ensure that your audience gets to know you as the expert you are. Lastly, you need a community to grow an online business Your community begins with your family and friends. You might think they will get sick of hearing your messages or seeing you on social media, but they love you and want to support you, and will share you with their friends, neighbors, and extended family. Your community is not only a referral source but an opportunity for collaboration. The more you create opportunities for collaboration, the more your community will grow. For example, when you are a guest in someone's Facebook group, when you collaborate for an event when you collaborate for a social media post or guest on a podcast or blog, you are reaching a larger audience. The collaborator's audience will immediately trust you because the collaborator trusts you. As you develop relationships on social media and through networking, build your community and extend invitations for collaborations and joint referrals. Summary All of the Cs are connected and result in trust. Clarity builds confidence which builds trust. Being cohesive helps you become recognizable and memorable, which in turn helps people trust you. Consistency in messaging and presence builds also helps you become recognizable and memorable and is the key to meaningful content. Content is your gateway to developing relationships, differentiating yourself from all others in your space, and building trust and community. Your community is your fan base will who ultimately shares about you and hires you. Click here to learn more about my Purpose to Results™ Method for building a strong foundation for long-term business success.  

Summary:  All life is sacred. God instructs us in His Word to “Choose Life.” What does that look like in our society today where so many are divided? Join Doug Stringer as he, Kevin McGary and Arnold Culbreath discuss how to have civil discourse in the midst of strong disagreements and yet stand for the truth. You'll learn about proven strategies that will equip you to impact your church and community too! Share this message with a friend and subscribe for weekly encouragement and inspiration! Download a free 30-day devotional at  AWordInSeasonPodcast.org; and subscribe to this podcast on your favorite streaming service.   And, you can let others know that Somebody Cares with a donation to support this ministry as well as disaster response efforts at  SomebodyCares.org.  That is also where you can get ministry updates. Learn more about the ministry at SomebodyCares.org, or by following us on Facebook, YouTube, Rumble or Twitter.   You can also receive weekly Provoke-a-Thought emails, monthly teaching emails, periodic ministry updates, or join our prayer team by signing up here!

Summary: All of Shanghai under lockdown despite majority of asymptomatic cases,; President Biden comments on atrocities in Bucha; seizure of a Russian oligarch's $90mm Yacht by Spanish police.

Summary:All the jobs and ideas (6:13)What does true PR entail? (8:52)PR is like online dating (9:30)It's okay to not be okay (17:50)Being a conscious creative agency (25:32)Going green in shipping (31:07)Brands, people, and networks (37:01)Being Fearlessly YOU (49:22)On this episode of The Finding Fearless Podcast, Madeline is sitting down to chat with one of the amazing agency owners of the world, CEO of clover PR, Heather Lovato! Heather has nurtured her brand baby to be a multi-million dollar PR firm representing game-changers in beauty, health and fitness, wellness, and motherhood. When she's not slinging press you can find her on her podcast, A Space for Sōl, and connecting with other mommas.She's a professional toddler juggler, repeat entrepreneur, and nap connoisseur. Basically, she wears a lot of hats—her favorite, mom!Links Mentioned:clover PRFollow on social - Instagram, Facebook, Twitter, LinkedIn, Pinterest A Space for Sōl PodcastFollow on social - Instagram Know a Female Founder you'd love to hear on the podcast? Shoot us an email to hello@fearlessfoundry.com to submit their info! Finding Fearless Community - Join Today! Use code “PODCAST” to get your first month free.The Finding Fearless Podcasts primary purpose is to highlight female entrepreneurs' voices. This has been a Fearless Foundry production. All audio is recorded and owned by Fearless Foundry.

Welcome to Finance and Fury. In this episode, we will be looking at investing using a moat. Moats are an effective tool for defence historically – you would put one up around a fortified structures – such as a castle or town – can be filled with water or not, many different types and variations – but the whole aim is to make a location more defensive from attacks – so what does a moat have to do with investing? Well – in this episode we aren't talking about defending your castle from some medieval invaders – we are talking about moats that can be identified to provide some defence for your investments – in particular – we will focus on Economic Moats - What is an economic moat? An economic moat – simply put – is the ability of a business to maintain a competitive advantages over its competitors This – like a moat around a castle - helps a company to protect its long-term profits and market share from competing firms – which in this analogy would be the attackers a competitive advantage is essentially any factor that allows a company to produce goods or services better, or more cheaply than its competitors – this means that this company is likely to outperform its competitors due to capturing a larger market share and therefore, generating better profits Castles also had competitive advantages – you could place one on top of a hill – or have a drawbridge across a moat – making it harder to breach the gates – no two castles were exactly the same, as the landscape and designs of the time all vary from location to location This is the same when looking at shares in a company - When talking about companies – a competitive advantage is evident if the company has been able to maintain a market share due to a combination of different competitive advantages – essentially putting it in a monopolistic or oligopolistic environment Different types of economic moats – There are several ways in which a company creates an economic moat that allows it to have a significant advantage over its competitors – we will go through 6 types – But by no means are these all-inclusive - Cost Advantage - a cost advantage that competitors cannot replicate can be a very effective economic moat. Companies with significant cost advantages can undercut the prices of any competitor that attempts to move into their industry, either forcing the competitor to leave the industry or at least impeding its growth. Companies with sustainable cost advantages can maintain a very large market share of their industry by squeezing out any new competitors who try to move in. Successful Resource companies often have a cost advantage over their competitors – when you look at this industry – the price of the materials can vary – but if you have the lowest costs – you can weather the storm BHP – has a cost base of just under $12 per tonne for iron ore – this is the cheapest in the industry – when prices plummet to $40 – they are still making $28 – a good margin – when the prices are around $125 – they are making a killing The next best is Fortescue with $15 per tonne – but that $3 is still a large difference – 25% more in costs This comes with economies of scale – which leads into the second competitive advantage Size Advantage - Being big can sometimes, in itself, create an economic moat for a company At a certain size, a firm achieves economies of scale where there can be synergies between businesses – or they can control the supply chains as well This is when more units of a good or service can be produced on a larger scale with lower input costs. This reduces overhead costs in areas such as financing, advertising, production, etc. Large companies that compete in a given industry tend to dominate the core market share of that industry, while smaller players are forced to either leave the industry or occupy smaller "niche" roles. High Switching Costs – This is a tricky tool that companies can use – increase the costs to switch between them and their competitors products Thinking about Apple and Android for a second – I have had a Samsung phone for about 13 years now – after having an iphone for about 2 years prior – I made the switch, but I remember the difficulty in not only switching IOS – but also the transfer of contacts and data – it is almost like starting from scratch This is where the size advantage can also come into benefit - When a company is able to establish itself in an industry, suppliers and customers can be subject to high switching costs should they choose to do business with a new competitor. Competitors have a very difficult time taking market share away from the industry leader because of these cumbersome switching costs. Intangibles - Another type of economic moat can be created through a firm's intangible assets, which includes items such as patents, its brand, government licenses and other factors which give it the edge over competitors – such as loyalty Strong brand name recognition allows these types of companies to charge a premium for their products over other competitors' goods – generic brands versus the house hold names - Patents or IP can also block any competitors from entering your industry Barriers to entry – This can either be in the form of legislative restrictions or a high cost of capital to enter the industry Airlines are an example – as well as other highly regulated entities – can have not only legislative hurdles to overcome, but also upfront capital – Which can be hard to raise – either need wealthy investors, or banks to lend – which they are not that likely to do unless it is a low risk enterprise for them – smaller loans of $1m are not too great a risk – but loans in the hundreds of millions to start a larger company are almost impossible for a start up to come by Soft Moats - Some of the reasons a company might have an economic moat are those factors which are harder to quantify – this might be from exceptional management or a unique corporate culture – this is because a unique leadership and corporate environment can contribute to a company's ability to generate a competitive advantage, adding to their success and profits    Economic moats are generally difficult to pinpoint at the time they are being created. Their effects are much more easily observed in hindsight once a company has risen to great heights. From an investor's view, it is ideal to invest in growing companies just as they begin to reap the benefits of a wide and sustainable economic moat. In this case, the most important factor is the longevity of the moat. The longer a company can harvest profits, the greater the benefits for itself and its shareholders.   Many of the best businesses often encompass more than one of these economic moats – let us look at a hypothetical example - Say there is company A – and they have sent all of their production overseas, whilst there competitors are domestic – this has reduced their labour costs and costs of production by around 40% - this allows them to undercut the prices of competing companies producing the same product This low prices lead to an increase in the number of customers buying your good, as you are now – lets say 20% than the next competitors for the same product – from this - you see an increase in profits But - it probably wouldn't take very long for your competitors to notice that you have offshored and follow suit – therefore, now their cost decreases can match yours – and they can likely drop prices by around 20% more – or lets say they go to 25% decrease – which would eat into their profits by still make an additional profit of 15% instead of 20% - These other produces would start to lower this companies market share and profit – in response they may need to lower their prices as well However – lets say that you have been using your profits and investing in R&D – you develop a new technology that allows you to get 30% more efficiency out of your product – making it 30% better for the same price Over this time, your competitors will have no way of duplicating your methods – therefore, your competitive advantage is protected by your patent So in the end – your economic moat is the patent that you hold – not that you started producing overseas at a lower price In the end - a company's economic moat represents its ability to keep the competing companies at bay for a longer period of time – in a way that is not easily replicable As the strategy of offshoring was replicable – but the patent isn't The interesting thing about moats is that they have no obvious dollar value Real world examples – Amazon – Cost – Amazon have developed a low cost offering – often delivery is nothing, or lower cost than something like Aus post – the goods prices are also often the lowest in the market – due to supply chains that are straight to the producers Size – due to size, they have a massive distribution network – can get you anything, and in the quickest time Intangibles – have a major brand name – would have to go to some Amazonian tribe to find someone who doesn't know amazon – ironically talking about the company here soft moats – the soft moats relate amazons ability to lobby and have a legal department in every state to petition the local politicians for lower taxes and some subsidies to take business to the state – many other businesses don't have the clout of amazon to negotiate such deals These moats are all well and good – but how do they stand up over time - One of the basics of competitive market theory - is that, given time, competitors will adopt and adapt your practices – this can erode any competitive advantages enjoyed by a firm This is more likely to occur in nations with relatively free markets – where firms are allowed to competing for competitive advantages – if any company innovates and adopts a superior model – at a lower cost or better product – then other companies will copy as soon as possible – in a truly free market – there is nothing to stop these companies – therefore in the long term – it would be almost impossible for any company to maintain a long term competitive advantage – it would be gone, and better for us – we get better goods and lower prices But when it comes to a monetarily and politically controlled economy we live in – where do you look for competitive advantages – as they do exist – and are actually easier to pick than in a truly free market Frist – look for any companies with superior operations – this can mean that have the market share of sales, or excess profits in their industry, or the brand name recognition – The reason these two are important is that they are outside of normal market competition – existing larger companies have a competitive advantage over other companies that don't have the same political or economic influences that they do – this does disrupt what would occur in a theoretical free market – so reality does need to be accounted for It is important to identify what moats of the business are likely to last – and which can be replicated – i.e. is it a shift in business practice which can be easily replicated – or is it some form of competitive advantage that allows this company to stand alone Things like businesses practices can be replicated – but the political connections and lifeline protections are harder -   This leads into the application of identifying moats and selecting shares Say you have identified a company with a moat – does this mean that you rush in and buy? Technically not – the second part of moat investing is all about the fair value of the company – This is where this style of investing does require some degree of value investing applied to it – so if you identify a moat company that is priced at $40, but has a fair value based around future cash flows of $30, you may not purchase this company This is for one major reason – back the concept of a moat – for defensive purposes – therefore, being more defensive, investors would purchase at a below fair value – or at the very least, not at a 30% increase in value In the end - The goal is to not just find businesses that have moats, but undervalued businesses that have moats – this is easier said than done - This strategy does sound great – but how well has it actually performed – due to being a value-based approach of undervalued businesses who possess a moat – a moat value investment strategy has underperformed other strategies Over the past few decades – when measuring purely based on return - index or a growth approach would have performed better This is where if a company has a real moat around it – it likely isn't trading below fair value – other investors would have identified the moat and purchased around this – an important factor may be ignoring the fair value approach – but at the same time not blowing it out of the water – Traditionally – fair value is paying a sum less than the fair value – but what about purchasing at the fair value – or 10% above? This is the real problem with this strategy – unless this is your fulltime job – the market will likely notice the moat before the individual investor So how do you apply the use of moats when it comes to investing – Individual shares – You can spend some time understanding the individual shares, or there are also some researchers that provide a moat rating – like Morningstar and you can get an idea of a company's potential from sites like simply wall street – these can be a useful tool Active managed funds – You can look at some fund managers who use moats and value approaches – or at the very least a moat approach – especially in the large to mid-cap of the market this strategy has historically worked well to protect a downside ETFs – There are a few ETFs that tilt a portfolio to focus on certain factors, like moats through the quality of the companies Summary - All businesses have some sort of competitive advantage – especially once they get to the size of being listed on the market   So, it can be side to assume that once a business has grown and survived long enough to get listed on a share market – there is some advantage – but is it a long-term competitive advantage? Or can competitors catch up and perhaps even overtake it? The idea of moat investing is to identify companies with competitive advantages that can persist long term and then invest if the price is attractive This can help a portfolio limit risks where the underlying investments can maintain their market share and continue to deliver performances Thank you for listening to today's episode. If you want to get in contact you can do so here: http://financeandfury.com.au/contact/

Summary: All of the madness is coming to a head in the housing market, so today, Wolf Richter and I get on the podcast to discuss what exactly is happening with buying and selling homes as a result of the current economy. San Francisco in particular is experiencing an interesting circumstance: seasonality is returning, which has been absent for most of the pandemic. We are seeing a rising market as well as individuals eagerly spending more money, which is stimulus driven. Tune in to hear about the interesting dichotomy between the economy and housing market, and what is to come in this industry. Highlights: -All of the madness is coming to a head in the housing market -People are reducing their asking prices—how can this be? -Every local market is different. In San Francisco, it is dominated by condos and has not gone anywhere in three years in terms of price. House prices have sky rocketed with a medium price at $2 million, dropping by 8% in July -Seasonality is returning, which we have not seen throughout the pandemic -Medium price dipped for single family houses, and for condos it jumped -The volume fell quite a bit; prices dipped a bit from the peak -There are very elevated prices at the moment, and this poses an issue as incomes do not match -Drops in prices bring buyers out -A lot of supply is coming on the market — this is the most new houses we've seen on the market since 2008 -Mortgage rates are still extremely low by historical standards. If mortgage rates go up, what will happen to the market? -The Fed is already talking about tapering its asset purchases, which will likely happen this fall. This affects mortgage rates and long term interest rates -The trend now is buying rental homes close together, which is more efficient than having single family homes scattered -In a rising market, foreclosures are extremely rare -We don't have the situation of short sales -Does the shadow inventory still exist?, or have banks flushed this out This is pretty much gone, according to Wolf. -The carrying costs of vacant homes are very high, so this will probably bring more properties to the market -What does the housing market tell us about the broader economy? Every time there is a shortage within the economy, we see prices rise. -People are still eagerly spending money, which is stimulus driven -States are sitting on a lot of money they haven't spent yet, which will be put to use soon -We are in an overstimulated economy - red-hot demand with supply constraints Useful Links: Financial Survival Network Wolf Street

Broken  Pie  Chart  |  Episode 116 With  Derek  Moore How is Inflation Measured? Sticky CPI vs Flexible CPI Show  Summary: All you hear these days on CNBC is inflation. How high will inflation go? What is causing inflation? But how is the CPI constructed to measure inflation? What are the weightings of CPI components? And, what is the PCE Inflation Index which is preferred by the Fed? • What is the CPI Consumer Price Index? • What is the PCE Personal Consumption Expenditures? • What is Trimmed Mean PCE Inflation? • Owners’ equivalent rent • How often do components of the CPI index change? • Difference between CPI and PCE • Sticky CPI vs Flexible CPI • Headline Inflation vs Core Inflation • Where to find inflation data • Difference between YOY Year over Year and MOM Month over Month data   Mentioned  in  this  Episode:   Broken Pie Chart Book by Derek Moore https://amzn.to/2MibTSk   PCE Trimmed Mean Inflation https://www.dallasfed.org/research/pce.aspx   CPI BLS Bureau of Labor Statistics latest inflation data https://www.bls.gov/cpi/   Sticky CPI and Flexible CPI Atlanta Fed https://www.atlantafed.org/research/inflationproject/stickyprice

Today's learning sponsored by: Dedicated to Leslie Simpson, Paul Simpson, my dear Bubbles, and most of all to HaShem Sponsor a day's learning (thousands of minutes!) for only $72 click here https://www.flipcause.com/secure/cause_pdetails/ODUwOTU= A stolen sukkah or one built on the street: Rabbi Eliezer: It's possul. Chachomim: It's kosher. Summary All agree that if wood was stolen and used as schach, the sukkah is kosher and he merely owes the value of the stolen wood*. We know this, because the law of “a stolen sukkah” is taught together with the law of “a sukkah built on the street”. A sukkah built in the street is not on his land, so too a stolen sukkah is not one built on his land with stolen materials but a case where someone else's sukkah is actually seized. An old woman came before Rav Nachman with a complaint, she said that the Reish Galusa and all the rabbonim of his household were using a stolen sukkah, because the Reish Galusa's slaves had taken wood from her fields and built the sukkah with it. She cried out but Rav Nachman paid no attention to her. She said “I'm a woman whose father [Avraham Avinu] had 318 servants, and you daon't pay attention to me?” Rav Nachman: She's just a loudmouth, she's only entitled to the value of the wood. Ravina (he came after Rav Nachman): A stolen wooden beam that was built into the sukkah is included in the takanah of Marish. We might think that since a beam is hard to find and the sukkah is not permanent, the takanah shouldn't apply, so we learn that during the seven days of sukkos it is included in the takanah. But after yom tov the beam must be returned. But if it was attached with clay, he may pay with money and keep the beam. Click here to listen to the shiur with Tosfos https://drive.google.com/file/d/1P3E_aASEngSTGybV_osnFgHIfnpHaAqv/view?usp=sharing * Rashi: Here there is yiush, shinui maaseh - shinui shem as well as takanas hashavim, and so the wood must not be returned, only its value. When we learned above (22.5) that a stolen sukkah cannot be used, it was referring to a portable sukkah in which the entire sukkah was stolen. Tosfos: A stolen sukkah that is disqualified d'orayso may be referring to a sukkah made of stolen wood since it's not an actual shinui and is only considered as belonging to the thief because of takanas hashavim. There is another case where a sukkah can be considered stolen, when someone builds a sukkah on his neighbor's lot, when the neighbor uses it, he is considered a thief.

Series ISAIAH with Pastor Kurt Piesslinger, M.A. 12.DESIRE OF NATIONS Jesus has got all the answers for all problems for all peoples on this planet. Memory Text: Isaiah 60:3 - The Gentiles shall come to your light, and kings to the brightness of your rising. 12.6 Summary All peoples on earth have the possibility of getting forgiveness through Jesus and life in eternity. Whoever comes to Jesus in faith will receive a rich reward. We would like to thank the artist Maximilian Jantscher for his permission to use his paintings for the series ISAIAH. Contact: Email: artgallery3000@gmx.at Website: akm777.at My God bless you today and always. For video recording: vimeo.com/523338277

Summary All the way from Denver Colorado we have Chad Sanderson giving us the lowdown on what “sales” really means. He’s been leading successful sales and marketing teams for over 20 years, and although he his very charismatic and insightful, he’ll tell you that good sales is about so much more than good talking. He goes into more detail about Proven Predictable Value selling and debunks some of the common myths that are tripping up business owners when they build their sales teams. See some of Chad’s top tips below: ** [5:15 - 5:25] Chad was trained in the value selling framework 18 years ago and it totally transformed his career. ** [6:20 - 6:35] Value isn’t what I think value is. Value is what the other individual I’m talking to thinks. ** [14:45] - [15:10] If you can’t step back then you’ll never get a new perspective. You must make the effort to disengage. ** [16:05] - [16:20] Sales people are always looking for a silver bullet. There isn’t one! The sooner you realise this, the sooner you will create an effective process. ** [36:40] - [37:30] When planning the direction of your business, it should always go back to “why?”. If you don’t know the “why” of what you’re doing, you shouldn’t be doing it. Get out of the way of your own assumptions! ** [40:20] - [41:00] Educate yourselves about what sales really means. You want people who solve problems, rather than push benefits. In this episode of Business Brain Food you will learn: ** The battle of marketing people V sales people ** How do people end up in sales? ** Commission V permission ** How to plan ahead in a post-COVID world ** Proven predictable value explained ** Where businesses get their sales training wrong Resources mentioned in this episode: ** If you’re a business coach, business adviser or would like to become one, go to: https://maxmyprofit.com.au/business-exceleration.html ** All previous BBF episodes & show notes can be found at http://www.businessbrainfood.com.au ** Join the Business Brain Food Facebook Group: https://www.facebook.com/groups/BusinessBrainFood/ ** Twitter: https://twitter.com/bfewtrell Call to action: Remember that sales is a long-term thing, not just a short-term sales pitch. Also, if you are enjoying these Business Brain Food podcasts, then make sure to share them via social media sites or email the links to family and friends. A lot of time and effort goes into producing each of these podcasts with the goal in mind of the more people we can inspire about business the better. You can help us do just that! Until next time, have a profitable day! Cheers, Ben Fewtrell 02 8808 5500

Summary- All first time, long term or considering investors are going to enjoy today's episode. Before the guys dive into today's topic, Ben and Seth go over Money in the News. They review how Warren Buffet is changing his rules, examine movements of the Dow and discuss the effects this quarantine has had on the economy. The main topic of today's episode is about tax loss harvesting. What is it really, is it even worth it and how can it benefit your investment portfolio? Join us for Money on Tap!

REVIEW. “What did you take away from last time?” [Refer to last week’s responses.] “How did that go?” READ. Summary: All personal problems are solved by gospel solutions. Discussion Questions: Read Romans 8:3-4 1. Why can’t we keep the law? When you have tension with others, in what kind of laws or rules do you put your trust? For Paul, where does he tell us to place our trust? 2. How do our human relationships reveal the condition of our relationship with God? 3. Where do you feel distant from someone? What does that reveal about your relationship with God? How then, would you define “success” in that human relationship? RESPOND. “Ask God, how can today’s discussion further your relationship with God, one another, and the world? Pray together. [Record responses and prayer requests.]

ASMR reading of Sorrow of the Dragon Gods by Pam McElprang. Listen with headphones for the best experience. I wrote this novel during my senior year of college, in 2006. It follows the journey of a young witch in a land of dragon gods and demons as she fights against tradition and law to gain control over her powers. Summary: All she wants is love, all the dragon gods want is her sacrifice. In a world torn asunder by the wars of demon gods and dragon gods for control over the realms, one girl must find her path among the seraphim of legends or risk destroying everything she loves. For millennia, mortals have been bound by the covenant of the dragon gods, worshiping the creatures to gain access to the fount of magic deep within the realm. Journey through the kingdoms of light and dark as Cauri discovers the truth about her past and struggles to save the land of Solace from the encroaching darkness. Buy the Book: https://www.amazon.com/dp/1500818356 Support me: https://paypal.me/TomeByTome Support me on Anchor: https://anchor.fm/tome-by-tome-asmr YouTube: http://bit.ly/youtubeTomebyTomeASMR Twitter: http://twitter.com/PamMcElprang More Horror: https://anchor.fm/asylumasmr/ --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/tome-by-tome-asmr/message Support this podcast: https://anchor.fm/tome-by-tome-asmr/support

In this episode: -The common entrepreneurial challenges that led to the birth of Story Hacking -The book that saved my life -Sales funnels vs Websites. -Why entrepreneurs must focus on "The Who" not "The How". -The only two books an entrepreneur needs to read.. -The excuses entrepreneurs use for not telling their story and how to break through them. -The question to ask yourself when you don't know what to do next in your business. -Why Successful Entrepreneurs Must Become Story Hackers: Only story talks to the part of the brain that makes buying decisions. So hacking the formulas for perfect storytelling is the most important part of sales and marketing. Who This Is For: If you're and entrepreneur who thinks you don't have a compelling story to tell or maybe you think you're just not successful enough yet then this podcast will help you destroy that false belief, start telling your story, and building your own audience of buyers TODAY! Summary: All of the above and more!.. Your questions help me create the content you want to hear and need more explanation on. That means this show can only reach it's full potential with your participation! So think of a question from the podcast content you'd like to have played on the show and click the link to leave me a message: http://www.storyhackinghero.com/askme I can't wait to hear from you! Dave Anderson      

Emotions are an essential part of our lives. One minute we are happy and laughing, the next frustrated or the next discouraged. Our emotions whether good or bad, high or low they have a tremendous impact on our physical, mental, and emotional health.   How can you control the damaging emotions like anger, temper or resentment?   In general, emotional control is not something that is taught to us. As we get older, it really starts to affect our decisions and it affects all every aspect of our lives including our business. If we don't understand how to get a handle our emotions, then we end up being ridden by them.   In this episode, we'll be discussing three techniques to teach you how to gain control of your emotions. We're going to learn how to get out of the road and onto the sidewalk with your emotions.   Imagination Time Imagine standing in the middle of the road and there are several cars and trucks headed your way. These trucks and cars represent your emotions. If you don't know how to get to the sidewalk, then you are in serious trouble.   Usually, we’ll let those trucks and cars run us over, leaving us desperate to make any quick decision that will get us out of harm's way, the quickest. Even if it is not the best decision, no one has time for rational thinking while standing in the middle of speeding traffic.   Now, imagine yourself standing on the sidewalk looking at those passing cars and trucks. It's a different point of view. Notice that the cars and trucks or your emotions have not stopped their travel. They're still going to happen.   Now you're observing the traffic instead of being in the middle of it and you can make better decisions based on that traffic that is passing by.   How do you learn how to do that? We're going to be discussing the 3 techniques that I was taught is still used today to keep me on the sidewalk and not in the road.   Three Techniques on How to Gain Control of Your Emotions   Breathing We’ve all heard about deep breathing. But sometimes we need a reminder and sometimes we need to actually do it instead of just saying in our heads, “Yeah. We already know this” You already know it, but do you actually do it? Make note of how you feel -- your physical awareness. How's your heart? Where's your mind at? Do you feel heavy? Do you feel right? Do you feel happy or sad? Then take three deep breaths. Now make note of how you feel. More than likely there is a difference. Maybe you feel calmer. Your heart slows down. Maybe your mind quiets a little. Maybe your shoulders relax. Breathing is an amazing technique and it's best used when you're in the middle of an emotional situation in which you need to gain back control. Deep breathing, you can do it anytime. And no. You don't have to do 10 deep breaths. You should take three deep breaths or one huge breath. That's enough to stop the physical reactions that are happening in you. That's what deep breathing is good at. It stops the physical response. If you're a woman, more than likely, you have this wonderful skill of crying when you are frigging angry. This helps slow down or stop the crying. When you feel that big old ball of emotion coming up, take a deep breath and it will slow it all down.   Grounding When people hear grounding, they think of, “Take your shoes off and go stand out in the grass,” or, “Go for a long walk in the nature.” But when you're in the middle of something that's causing you to be emotional, more than likely, you don’t have time to take off the shoes and go stand underneath the tree. That's not to say that those aren't good ideas, but they're not the best ideas when you need something to work now. These techniques are meant to teach you how to deal with things now.   What to Do For Grounding Wiggle your toes and feel the sensation of your toes wiggling together. Once you've honed in on the sensation of your toes wriggling together, that skin to skin contact, now try to feel the solid ground underneath you. This is a very good way to ground yourself when you don't have time to take a walk. So, take a deep breath and then start wriggling your toes. While breathing stops the physical emotions, grounding stops the mental reactions. When you start becoming energetic in your head, you start to leave your center. You start to go off into another place. It's hard for you to concentrate on what's happening now and in a calm manner if your mind is going 100 miles an hour and floating off into different areas, because you want to be prepared to defend or you’re having a bad memory, or whatever the case may be. Grounding takes you from all over the place and brings you back to you again. It brings you back to center and back to the present. It's a wonderful way to come back to yourself and not be drugged around by your emotions.   Physical Awareness Physical awareness is all about learning how to feel your emotions. That means when you are feeling anything, actually describe how it feels. Does it feel like a hard knot at the bottom of your stomach? Does it feel like a heavy weight upon your chest? Is it large? Is it small? Is it a hairy ball that's stuck in your throat? They can't seem to get out of the way. Is it warm? Is it cold? Is it dark? Is it light? Is it sharp? Is it smooth? Really get into what that emotion feels like. What happens when you do that, it teaches you to understand what is really happening versus just assuming you know what is happening. For example, every emotion has a spectrum, but most of the times you won't ever hear anybody talk within the spectrum. A lot of times we hear people speak in the vague. Like, “I'm angry, I'm sad. I'm happy.” Most of the time we don't hear people talk about their emotions in a defined manner. Like, “I'm disheartened, dismayed, displeased, disquieted, edgy, concerned. I feel dejected, detached, or I'm feeling interested, intrigued, invigorated, involved, gratified, hopeful, inquisitive and I’m feeling pleased and pleasant and perky and peaceful, overjoyed enlivened, engrossed, amused, alert, affectionate, adventurous, absorbed, confident, contented, cool, curious, and dazzled, and delighted, eager…” the list goes on and on. Each spot on that spectrum has a different way it feels, but you can't understand the differences and how an emotion feels on the spectrum, if you can't even identify how the base or the overall emotion feels. Physical awareness gives you that skill. It gives you the skill to start to define what's actually happening. Are you actually angry or you just nettled? Are you happy or do you just feel content? These are all important. When you understand what's actually happening on inside, you're able to make better decisions. Summary All of these things will help you remove yourself from the road and put you onto the sidewalk. Emotions, they're going to happen. Feelings, they're temporary, but they're going to roll through like those cars and trucks. When you stand at the sidewalk, you can get a good idea about what's coming, and what to expect, and how to best prepare for it, and how to cross the street if we need to. We can't know these things if we don't understand how to slow our physical reaction with breathing, how to slow our mental reaction with grounding, and how to truly identify what is going on the inside. When we do those things, we can make better decisions in life and in our business. Fear is a great example of this. Fear, for most of us, is a big old, scary monster. A lot of times we don't know how to move through it. Through these techniques, you can learn how to identify fear and the different types of fears and know what to expect when they come. Instead of running and hiding, because you’re being eaten up with fear, because you’re standing in the middle of the road getting hit by the cars and trucks, you’ll be able to see the path through. Always take time to really hone in on what's going on inside of you because you are going to know best about what's happening and how to handle it. Resources:   Free Resource Library Course: Mindset Matters Looking to create your own course: Membervault Looking to collaborate and take some useful classes: Eclectic Entrepreneur    *Disclosure: Some of the links above are affiliate links, meaning, at no additional cost to you, I will earn a commission if you click through and make a purchase.    **Rich in Differences Podcast is not intended to diagnose, prescribe, treat, or cure any disease, physical or mental. Any advice given on the Rich in Differences Podcast should not be construed as a prescription, a promise of benefits, claims of cures, or a guarantee of results to be achieved. The information, instruction or advice given by Rich in Differences Podcast is not intended to be a substitute for competent professional medical or psychological diagnosis and care. You should not discontinue or modify any medication presently being taken pursuant to medical advice without obtaining approval from your healthcare professional. As a listener/reader, you must take complete responsibility for your own physical health and emotional well-being.   TRANSCRIPT BELOW   Hey, everyone, welcome to Rich in Differences, I'm your hostess with the mostess, Brooke, welcome. This is our first full episode so I'm excited to get started. Actually, this episode is going to be one of three. I figured I would start with a three-part series because these first three episodes are what I teach anybody I coach. And these three things were taught to my, by my own coaches and therapists. Believe it or not, we coaches, get coached too, all right. So, what I'm going to be talking about in this three-part series is emotional control. I don't believe this is something that is taught to us, in general and as we get older, it really starts to affect our decisions, especially in our business, it affects all of our lives. I don't mean to be like, especially in business, but this is a business podcast. However, that being said, this is totally valid for everyone because our emotions follow us through every aspect of life. If we don't understand how to get a handle on them, then we end up being ridden by our emotions. So, in this episode, we'll be discussing three techniques to teach you how to gain control of your emotions. Now this will be part one of a three-part series and in this episode, we're going to learn how to get out of the road and onto the sidewalk with your emotions. All right, imagination time, don't roll your eyes. Most of you are probably driving right now so you have all the time in the world to picture in your mind's eye when I'm about to describe to you. Now, imagine standing in the middle of the road and there are several cars and trucks headed your way. Now these trucks and cars, they represent your emotions, and if you don't know how to get to the sidewalk, then you are in serious trouble. As we usually are with our emotions, we'll let those trucks and cars run us over, leaving us desperate to make any quick decision that will get us out of harm's way, the quickest, even if it isn't the best decision. No one has time for rational thinking while standing in the middle of speeding traffic. Now, I want you to imagine yourself standing on the sidewalk, looking at those passing cars and trucks. It's a different point of view. Notice that the cars and trucks or your emotions have not stopped their travel, they're still going to happen. But now you're observing the traffic instead of being in the middle of it, now you can make better decisions based on that traffic that is passing by. So, how do you learn how to do that? Next, we're going to be discussing the three techniques that I was taught, is still used today to keep me on the sidewalk and not in the road. Alright, pop tarts, we're going to be discussing our first technique, breathing. Now, don't roll your eyes, right, because we all know we've all heard breathing, breathe, deep breath, it's all good for you. But sometimes we need a reminder and sometimes we need to actually do it, instead of just saying in our heads “Yeah, we already know this.” Yeah, you already know it, but do you actually do it? So, right now, I want you to make note of how you feel, your physical awareness. How's your heart? Where's your mind at? Do you feel heavy? Do you feel light? Do you feel happy, sad, like, where are you at? And then I want you to take three deep breaths with me. All right, you ready? Here we go. In. Out. In. Out. One more time, in and out. Now make note of how you feel. More than likely there is a difference. Even I feel calmer, your heart slows down, maybe your mind quiets a little, maybe your shoulders relax some. Breathing is an amazing technique, and it's best used when you're in the middle of an emotional situation in which you need to gain back control. Deep breathing, you can do it anytime. And no, you don't have to do 10 deep breaths, I do not do 10 deep breaths and I can't imagine what I would look like if I was in the middle of a heated discussion be like, we got to hold on a second, I need to take 10 deep breaths. I mean, I usually do one to three, usually is one, huge one, if I'm being honest. And that's enough to stop the physical reactions that are happening in me. And that's what deep breathing is good at, it stops the physical response. So, if you're a woman, more than likely you have this wonderful skill of crying when you are frigging angry. This, this keeps me from crying. When I feel that big old ball of emotion coming up. I take that deep breath and it slows it all down. The next one is grounding. Now when people hear grounding, they think of, take your shoes off and go stand out in the grass, or go for a long walk in nature. But when you're in the middle of something that's causing you to be emotional, more than likely, you don't got time to take off the shoes and go stand underneath the tree. Now, that's not to say that those aren't good ideas, but they're not the best ideas when you need something to work now. And these techniques are meant to teach you how to deal with things now. So, what can you do for grounding? Wiggle your toes, and I want you to feel the sensation of your toes wiggling together, and once you've, kind of honed in, on their wiggling, or not really so much the movement but the sensation of them wiggling together, that skin to skin contact. Now, I want you to try to feel for the ground underneath you. Can you feel the solid ground beneath you? This is a very good way to ground yourself when you don't have time to take a walk. So, sometimes we don't have time to take that walk. So, take a deep breath and then start wiggling some toes. Grounding is good because it stops the mental reactions. While breathing stops the physical, grounding stops the mental. So, what does that mean? When you start becoming energetic in your head, you start to leave your center, you start to go off into like another place and it's hard for you to concentrate on what's happening now and in a calm manner. If your mind is going 100 miles an hour and floating off into different areas, because you want to be prepared to defend or you're having a bad memory or whatever the case may be. So, grounding takes you from all over the place and brings you back to you again, brings it back to center, brings you back to present. So, it's a wonderful way to come back to yourself and not be drugged around by your emotions. Next up we will be discussing physical awareness. Alright, so we just finished discussing grounding, but this last one I bet you've never even thought of. And you're probably thinking I'm crazy, God knows I thought I was crazy when I first did it. Physical awareness is all about learning how to feel your emotions. Now, what does that mean? That means when you are feeling anything, actually describe how it feels. Literally. Does it feel like a hard knot at the bottom of your stomach? Does it feel like a heavy weight upon your chest? Is it large? Is it small? Is it a hairy ball that's stuck in your throat? That can't seem to get out of the way. I know some of you just laughed at that, because God knows I just laughed at that in my head. Is it warm? Is it cold? Is it dark? Is it light? Is it sharp? Is it smooth? Like really get into what that emotion feels like because what happens when you do that, it teaches us to understand what is really happening versus just assuming you know what is happening. For example, every emotion has a spectrum but most of the times you won't ever hear anybody talk within the spectrum. A lot of times we hear people speak in the vague, so like, I'm angry, I'm sad, I'm happy. Most of the time we don't hear people talk about their emotions in a very defined manner. Like I'm disheartened, dismayed, displeased, disquieted, edgy, concerned. I feel dejected, detached or I'm feeling interested, intrigued, invigorated, involved, gratified, hopeful, inquisitive and feeling pleased and pleasant and perky and peaceful, overjoyed, enlivened, engrossed, amused, alert, affectionate, adventurous, absorbed, confident, contented, cool, curious and dazzled and delighted, eager, the list goes on and on. But each spot on that spectrum has a different way it feels, but you can't understand the differences and how an emotion feels on the spectrum if you can't even identify how the base or the overall emotion feels. Physical awareness gives you that skill. It gives you the skill to start truly identifying what's actually happening. Are you actually angry or are you just nettled? Are you happy or do you just feel content? These are all important. And when you understand what's actually happening on inside, you're able to make better decisions. So, all of these things will help you remove yourself from the road and put you onto the sidewalk. Emotions, they're going to happen, feelings, they're temporary, but they're going to roll through like those cars and trucks. But if when you stand at the sidewalk, we can get a good idea about what's coming and what to expect and how to best prepare for it, and how to cross the street if we need to. But we can't know these things if we don't understand how to slow our physical reaction with breathing, how to slow our mental reaction with grounding and how to truly identify what is going on the inside. When we can do those things, we can make better decisions, in life and in our business. Fear is a great example of this, fear, for most of us is a big old, scary monster. And a lot of times we don't know how to move through it. But through these techniques, you can learn how to identify fear, the different types of fears and know what to expect when they come. I used to be, I would get so nervous about doing anything regarding asking someone who I thought was a mentor, instead of a peer, to help me on something. And I would have these fears of like, “this person is going to think I'm stupid. They're going to hate my idea. Oh, my God, what are they say? No.” And I would talk myself out of it. Like, I'm pretty sure there's a lot of people who do this. I'm not the only one. But when I learned how to use these techniques, I saw fear coming a mile away. So I needed to ask someone for help regarding one of my programs, and I was hoping that she would be willing to give me some advice, though, she definitely did not have to. And as I sat in the chair waiting to speak to her in her office, I started, I had started to have those thoughts. But then it was interesting. So, instead of letting those thoughts just sit around in my head, beating me up, it literally was like I had stepped onto a sidewalk. I was like, “Oh, look, there's fear.” Then fear come to say what it needs to say. So I tell fear “You know what fear? I think we got this. I don't think this is going to be the end of the world, and even if they do say no we're going to go ahead and do this.” And I just went ahead and did it, regardless of the fact that fear had come rolling on through. So, I made a better decision, instead of running and hiding, because I was being eaten up with fear because I was standing in the middle of the road getting hit by the cars and trucks. I was able to say, I see you, but I think I can see the path through, and I think we're going to make it so I'm going to go for it, you know, and I did, and I got the yes. So, always take the time if you can to really hone in on what's going on inside of you, because you are going to know best about what's happening and how to handle it. In the next part of the series, we're going to be discussing how to take back control of the bus. A lot of times our emotions are the ones driving that bus instead of the bus driver i.e. you. So in the next part of this series, we will be talking about, taking back the bus. Be sure to subscribe and join our Facebook group, Rich in Differences, where we will collaborate to see what works best for you and your business. Have any questions you would like to be answered in an episode, be sure to email me or ask in the Facebook group. Alright, pop tarts. At the end of each episode, I'm going to leave a special message to my dad, my biggest fan. So, here goes “Hey, Dad, call me if you want to go to lunch sometime this week. Love you.”  

Learn the difference between will of the mind vs. surrendered will and how surrendered will can be more effective, more productive and provide more opportunities than will from the mind. SUMMARY: - All the possibilities are amazing if you’re not attached to what the outcome is. - Will of the mind can be effective but it’s limited because it can only take in a small percentage of the millions of data points happening at any moment in time. Surrendered will (i.e. surrendered to Pure Source, only) opens up new and many more possibilities because it’s not constrained by the limited data that the mind can absorb and process, nor what we think we want which is informed by the distortion patterns running through us. - Without doing frequency work to remove them, distortion patterns are what form our thoughts, emotions and what we think we want. - Surrendered will allows us to enter into more creative thought, have different emotions, different ideas, allow for more opportunities and more magic comes in because we let go of and aren't limited by what we think we want. - Surrender from strength is when we are so complete, we know with absolutely certainty that we can transcend whatever obstacles we are experiencing, so there’s nothing to fear. Whatever shows up in your path will be an opportunity to grow or learn from.

Today's Scripture Reading:Ephesians 4:26-31 26 “In your anger do not sin": Do not let the sun go down while you are still angry,27 and do not give the devil a foothold. 28 Anyone who has been stealing must steal no longer, but must work, doing something useful with their own hands, that they may have something to share with those in need. 29 Do not let any unwholesome talk come out of your mouths, but only what is helpful for building others upaccording to their needs, that it may benefit those who listen. 30 And do not grieve the Holy Spirit of God,with whom you were sealed for the day of redemption. 31 Get rid of all bitterness, rage and anger, brawling and slander, along with every form of malice. 32 Be kind and compassionate to one another, forgiving each other, just as in Christ God forgave you. Summary: All of us get angry at some point in our lives. Whether it is as injustice that you watch or hear about, or whether it is because your neighbor has said or done something wrong to you. For some of us, the emotion of Anger is a frequent occasion. We have a short fuse, and it doesn’t take much for us to get mad at something that we don’t feel happy about. Some of us store it deep inside, so our anger is stuff away deeper and deeper until one day it manifests itself in an explosive manner. Some of us pretend like we aren’t angry at all, and deal with it in a passive aggressive way. Some of us will burn the bridge by walking away and avoiding the people involved altogether – severing relationships and ties and never speaking to them anymore, or at least for a certain amount of time until it has cooled off.

Continuing the conversation about combat, the panel of Dungeon Masters expand the discussion to cover more specific tips for DM's.  The main talking points in this episode tackle the differences between Theater of the Mind and using Maps and Minis, how to balance combat encounters, and whether or not to help players when things go awry. SUMMARY: All three DM's weigh in on the pros and cons of the Theater of the Mind style of play, looking at the concepts of player engagement, trust at the table, and cinematic moments in combat.  Dan then shifts the topic to cover how to balance encounters and difficulty levels, and the various strengths and techniques of the different dungeon masters begin to reveal themselves.  After moving through conversations about battle escalation and session pacing, the group goes off topic to analyze how to give environmental clues and reminisces about previous characters in their campaigns that have died.  When the discussion turns to whether or not to help the players, Adam reveals some of his techniques to keep some players alive longer by attacking other things besides their Hit Points, and Terry talks about the most sentimental item he’s ever owned as a player and what happened when it was in danger. Shout Outs: The Original Die Available On: iTunes | Spotify | Podbean | YouTube | www.itsamimic.com Don’t forget to Like/Follow/Subscribe/Whatever when you listen! Links: Facebook | Instagram | Twitter Email: info@itsamimic.com Intro/Outro Music by: Cory WiebeShout Out Music by: Isaac CallenderLogo by: Kate Skidmore

Chapter 11: 'Yes Has a Number' In this chapter Blount tells us that sales is governed by numbers. Our main issue is that we don't get why he included this in a book about objections. Chapter 12: 'Red Herrings' We had a lot more to say about this chapter. We thought that he explained red herring objections badly. After reading this we went beck to the start and put the note 'he didn't actually tell us how to identify a red herring'. Jonny said to me years ago when I put the phone down - 'how much was that phone call worth?' and this has stuck in my head ever since. Blount says that when somebody gives you an objection you need to test the validity of whether or not that's a real objection His first rule is to ignore, which I agree with to an extent BUT also think that's dangerous because an unhandled objection grows like a piece of mould - you're often sat there thinking 'will that come back?' when you could've nipped it in the bud instead. The line I often use for red herring objections is 'go on' I'm quite negative about this chapter because I think red herrings are so important - often they're a silent killer and Blount misses this point Ignoring a red herring can also be synonymous with bullying - it's going to come back and bite you later on. Especially if you're having a conversation with somebody who's a little bit quieter - they're going to hate you for your ignorance. You've got to judge the situation with one where you're in front of the client - if you're a huge personality and your client isn't and they throw a quiet objection in the works - do not ignore this - if you do, don't be surprised if they never speak to you again. Chapter 13 'Micro-Commitment Objections' 'The human mind abhors the unknown' Agreed. We always say when we're on the phone, this is a canvas call, we state our intention. Blount's 100% right about being clear with your intention, objective and micro-commitment at the end of the call. 'When you indicate that you are unattached to the outcome, that you're willing to walk away if working together might not be a fit, you are saying right up front that you are not going to chase - this activates the scarcity effect, people want what they can't have' - We thought this is beautifully elegant - you've got to be careful because you still have to sell to them a little bit, but I agree. The way the guy puts together his scripts is amazing - the script on p.142 is blinding. He's missing those little shades of grey around what do you and don't you ignore - I'm very nervous about the concept of ignoring an objection because a lot of salespeople will misconstrue that as walking over the top of it. A lot of this book, Blount's got me thinking and he's got me to realise that my trainings not outdated. Micro-commitments - he's saying that A. you get your customer to say yes then B. you get them to do stuff for you - he's saying that call me back next January is not a micro-commitment - call me back on January the 5th at 2pm is. Blount isn't too realistic with some of the points he makes. Micro-commitment chapter in general is excellent - it's something I already do but if you don't then you should be doing it! read the chapter listen to our advice and change your game Summary All in all, we enjoyed these chapters, they've been a good refresher course for us and they've got us thinking about our game.

Time Stamps: Map Mastery: Temple of Anubis 00:15:35 Mercy & Junkrat Nerf Discussion 00:50:30 In the Lab this week we’ve got another entry into our Map Mastery series. This time around we bring back a returning guest Skyline to talk about Junkertown! So buckle up as we talk all about this map and a few of the meta changes at the end of the show! Heads Update: Game Night -- Feb 23rd? Omnic Meta: (Homepage) OWL Recap now up on it’s own feed! Twitter Main Feed Special Thanks to Diamond Sponsors & New Patrons: Chrisdaplaya, Good Apollo, GoldenSoldierA, GreatRootBear, Kippppp, Lisome, Magic, JanJinkle, RickyTicky, Shazear, & TopScore Solutions, TragicZac General strategy for Payload & Junkertown Key Map elements to look at Team composition considerations Point A: Attackers Defenders Point B: Attackers Defenders Point C: Attackers Defenders Blue Posts & News: Mercy & Junkrat changes are now LIVE. Notes from OmnicMeta MERCY- Win rates have fallen -6% on average across all tiers, putting her below 50% win rate at each tier. She is now in the same "winrate dumpster tier" as Ana (Ana winrate haven't changed) Healing and deaths per game is exactly the same as before patch.  This means her bread and butter base kit has not been impacted. Resurrects per game have fallen 40% on average across all tiers - the ability appears to have been nerfed into the ground. Support Pickrates? Ana (30% usage average) Lucio (30% usage average) Moira (60% usage average) All see play bumps. Mercy now around 50% usage at Bronze, declining to 20% usage at Grandmaster. Summary: While Mercy is still the easy-to-pick up healer, without Resurrect being a strong ability (through Valkyrie) she just isn't the same hero. However, we may find that people learn how to get the most out of her new kit. It's still very early. JUNKRAT Only change was to Concussive Mine. Eliminations down -7% though damage is only down -2%. (Both moved a little). Win rates have gone down about -2% (to 51% average) Pick rates are down -4% (to 28% usage average). (Both moved a little.) Summary: All of this data indicates that the nerf was really minor.  Junkrat remains a strong hero with some of the highest win rates in the game.  His plat continues to center around his base grenade damage and quick-to-charge Rip-tire. Blizzard World Map now in Quickplay and Arcade. Will not come to Competitive play until Season 9. Year of the Dog launches Feb. 8th Omnic Lab Links: Omnic Lab is now a Twitch Affiliate! Sub now with Twitch/Amazon Prime! Twitter, Facebook, Patreon Twitch, Youtube, MERCH Discord: discord.me/omniclab Email: omniclabpodcast@gmail.com Website: http://www.omniclab.com iTunes, Google Play Music, RSS -->Full Extended Show Notes

What Is This Episode: 70 Air Date: 12/22/17 Duration:161:05 Size: 156mb Summary: * All the cool kids are now ‘Squonking’ like hipsters. * Remembering Joey Boots for the great asshole he was. * Eminem has become an SJW and his new anti-Trump mainstream ‘Revival’ album. * Russell Simmons sexual assault allegations and why we shouldn’t […] The post Episode 70 – Tribute to Tribulation appeared first on Podtrash.

What Is This Episode: 70 Air Date: 12/22/17 Duration:161:05 Size: 156mb Summary: * All the cool kids are now ‘Squonking’ like hipsters. * Remembering Joey Boots for the great asshole he was. * Eminem has become an SJW and his new anti-Trump mainstream ‘Revival’ album. * Russell Simmons sexual assault allegations and why we shouldn’t […] The post Episode 70 – Tribute to Tribulation appeared first on Podtrash.

Pork Chop Express Episode: 43 Air Date: 12/04/17 Duration: 180:05 Size: 259mb Summary: All right all right alt-right! Max & Ted are back with The fastest 2 hours on Podtrash.com. Every Monday the boys discuss the past week of affairs and talk your calls. Zero fucks are given to political correctness or fragile liberal sensibilities. […] The post Episode 43 – Maxwellvania: Population 1488 appeared first on Podtrash.

sermon transcript Holy Ground When Moses was 80 years old, and at that point had become a very obscure person. He was raised in power and prosperity, but he fled after he murdered an Egyptian, and was at that point, at 80 years old, tending his father-in-law's sheep on the back side of the desert; an obscure man tending another man's sheep. He was trying to find pasture and water for the sheep. And at one point, he saw a sight he'd never seen before. He saw a bush that was burning, and it was a kind of a fire. I don't know if it gave off any heat, maybe it did, but he saw the light, the dancing flames, perhaps heard the crackle of it, but the bush wasn't consumed and he'd never seen anything like it. And so he turned aside and said, "I'm gonna go over and see this sight. I've never seen anything like this before." And as he approached, he heard, from the flames of the burning bush, he heard a voice that changed his life, and the first thing that that voice said is, "Do not come any closer, for the ground on which you're standing is holy ground." And then the voice identified himself, "I am the God of your fathers, I'm the God of Abraham, the God of Isaac, and the God of Jacob." And Moses trembled with fear and did not dare to look upon God. And this is how God called Moses away from tending his father-in-law's sheep to being the human instrument for leading the Jews out of bondage in Egypt into the Promised Land. Amazingly, however, though the Exodus journey from slavery through the Red Sea, through 40 years in the desert, crossing eventually the Jordan River into the Promised Land is worthy of eternal consideration. Nothing is more important than the personal encounter of a sinner with a holy God exemplified in that burning bush. And many of the Jews who made that physical journey never had that encounter by faith. They were not believers, and their bodies were scattered all over the desert. They did not know the God who was physically saving them out of slavery. They did not encounter the God who said, "The ground on which you're standing is holy ground." They didn't have an encounter with God. So what does that mean? "The ground on which you're standing is holy ground." How can each of us come to a personal experience of that God who lives today? He is not the God of the dead, but the living, he is still our God, how can we stand in the presence of the Creator of the universe and not be consumed by the fire of his holiness? It's a great mystery. We are taught theologically in the Scripture that God, the God of the Bible is omnipresent, that means he is everywhere at once. And he's, in one sense, we could say no more in one place than he is in another. There is nowhere in the universe in which God does not fully exist with all of his attributes. The psalmist in Psalm 139 teaches this plainly, he says, "Where can I go from your spirit? Where can I flee from your presence? If I go up to the heavens, you are there. If I make my bed in the depths, you are there. If I rise on the wings of the dawn, if I sat on the far side of the sea, even there, your hand will guide me, your right hand will hold me fast." It clearly teaches the omnipresence of God; he is everywhere that we could go in the universe. Jesus Christ made this even more plain in his conversation with the Samaritan woman at the well. The Jews and Samaritans were divided and debated for centuries over the proper place of worship, where people should make pilgrimages and make their offerings, their animal sacrificial offerings. The Jews said the place was Jerusalem, the Samaritan said it was Mt. Gerizim in Samaria. And so they debated, and this woman wanted Jesus to weigh in on that. But Jesus revealed to her on an amazing level, way beyond I think anyone else's understanding of what he was coming to do. He told this Samaritan woman what was going to happen in the new covenant. There would no longer be any one designated place for worship. He said in John 4:21 and following, "Believe me, woman, a time is coming when you will worship the Father, neither on this mountain nor in Jerusalem. The time is coming and has now come when the true worshipers will worship the Father in spirit and truth, for they are the kind of worshipers the Father seeks. God is spirit and those who worship him must worship in spirit and in truth." But God has always been omnipresent. And so even in the days of the old covenant, when there was a designated place for worship, even in the days before that of Moses, when Moses was standing there in front of the burning bush, what did it mean that there was a holy place or a most holy place? What did it mean that there was holy ground on which Moses was standing? Why was that ground holy and a quarter of a mile away wasn't holy ground? We could ask the same thing of Jacob, when he was fleeing from his brother Esau, Esau wanted to kill him, so Jacob ran for his life and he came to a certain patch of ground, exhausted as he was from all of the exertions and his sorrow and running away from his home, he laid down with a rock for his pillow. I think how hard-headed do you have to be to need a rock for your pillow? Which is harder, his head or the rock? I'm not sure. But God had a lot of work to do in Jacob's heart and he desired to do some of that work that very night, for as he slept with that rock as a pillow, his mind was aflame with light and with a vision, with a dream. And in that dream, he saw a stairway going all the way up to heaven with angels ascending and descending. And there above the stairway stood the Lord, and he said, "I am the Lord, I am the God of your father, Abraham, and the God of your father, Isaac." And God promised to give Jacob and his descendants the land on which he was lying, and to greatly multiply his descendants so that they would spread out to the west and east and north and south. And he promised him, all peoples on earth will be blessed through you and through your offspring. And he promised to be with him and to watch over him wherever he went. And when Jacob woke up from his dream, he was filled with awe. And he thought, "Surely, God, the Lord is in this place and I was not aware of it.” The Lord is in this place and I was not aware of it. He was afraid, and he said, "How awesome is this place? This is none other than the house of God, this is the gateway of heaven." And he set up a pillar there, poured oil on it. So what is holy ground if God is omnipresent? Well, I think it must be tied to our sense of God in the place, our relationship with the God of the universe in that place, our experience of God. And it comes at his initiative, he is choosing to reach out and draw us close in that place. He's choosing to reveal himself and to bring us closer and to pour his goodness into our souls. It's relational language, the relational distance, it's relational. It's not got to do with God being omnipresent, it has to do with his relationship with each of us. So it says in Psalm 138:6, "Though the Lord is on high, he looks upon the lowly, but the proud, he knows from afar." So there's a distance between God and the proud. So what does that mean, from afar? It's similar to Jesus' terrifying statement in Matthew 7:23. "Many will say to me, 'Lord, Lord on that day, and he says, 'Then I will tell them plainly, I never knew you. Away from me, you evildoers." What does that mean, I never knew you? There, and we're not talking about omnipresence, but omniscience. What's he saying when he says, "I never knew you"? Is he saying, "I don't know anything about you, I don't know your name"? No, he actually, in the verse, he knows that they are evildoers. And another verse says, "He knows every careless word they've ever spoken.” He knows the thoughts and inclinations of their heart when they spoke those careless words, he knows everything about them. What does he mean then when he says, "I never knew you"? He said, I didn't come into an intimate covenant relationship, a love relationship with you. That's what he's saying. So it is, I think with holy ground, God is everywhere, but especially and immediately and powerfully found in places he chooses, and there he reveals Himself directly to faith-filled hearers of his word, whose tied to his word and to faith and to the power of the Holy Spirit; he reveals himself in a memorable way there. Now, Jesus was not saying to the Samaritan woman that there will never again be holy ground, he didn't say that. Instead, he's saying that God who is spirit can and will choose to reveal himself any place he wants to, any time he wants to. Anywhere on the planet could become holy ground now. Now in the new covenant, so in the new covenant, there's no longer a physical temple, there's no longer a physical tabernacle, but there's a new holy place or even most holy place, or like the KJV used to say, "Holy of Holies" and that is the body of Jesus Christ; that's the new temple. So at the beginning of his public ministry in John 2, Jesus was there with a whip, cleansing the temple. He would do it again at the end of his public ministry, cleansing the temple. But there in John 2 at the beginning of his ministry, the Jews demanded of him, "What miraculous sign can you show us to prove your authority to do all this?" Jesus answered, "Destroy this temple, and in three days, I will raise it up." The Jews replied, "It's taken 46 years to build this temple. You're gonna raise it up in three days? But the temple he had spoken of was his body.” John 2:21. And so when Jesus cried out in a loud voice on the cross and gave up his Spirit, the curtain in the temple was torn in two from top to bottom. And that was a physical symbol of a new and living way open for us into the Holy of Holies, into the presence of God. That time was over. The physical temple time was done, it was fulfilled in Jesus, fulfilled. But now the author of Hebrews tells us in Hebrews 10:19-22, "Therefore brothers, since we have confidence to enter the most holy place by the blood of Jesus, by a new and living way, open for us through the curtain, that is his body." Do you hear? Blood, body. By the blood, by the body, we have a new and living way into the presence of God. And since we have a great high priest over the house of God, let us draw near to God with a sincere heart and full assurance of faith, having our hearts sprinkled to cleanse us from a guilty conscience and having our bodies washed with pure water. So, brothers and sisters, that is precisely where the Lord's Supper comes in for me. Done properly, it's holy ground. It's encounter with the living God. We draw near to God. He draws us near to him by faith in the Word, by understanding the significance of the once for all body and blood sacrifice that was made for us, we can today, right now, draw close to God and he draw near to us. It can become for us an experience of Almighty God. It can be holy ground. Now, in order to do that, we're gonna turn briefly to 1 Corinthians 11, and just walk through it. Just setting the context, the Corinthian church was a talented, gifted, but fractious and divided church, lots of sin problems in that church, lots of carnality, immaturity, sin going on, all kinds of doctrinal issues Paul had to walk through with them. But he comes at last to this practical issue of the Lord's Supper. Reading the lines and reading between the lines, we can see some of the problems that are going on with the Lord's Supper. It seems that the Corinthians were acting very irreverently toward the Lord's Supper, didn't take it seriously. They were behaving carnally, they were even getting drunk on the wine served at the Lord's Supper. Incredible. So Paul drops a theological bombshell on them concerning the significance of what was actually going on for them that they didn't even realize probably, didn't know why certain things were happening. So look at verses 27-30, he says, "Therefore, whoever eats the bread or drinks the cup of the Lord in an unworthy manner will be guilty of sinning against the body and blood of the Lord." Verse 28, "A man ought to examine himself before he eats of the bread and drinks of the cup. For anyone who eats and drinks without recognizing the body of the Lord, eats and drinks judgment on himself. Verse 30, look at it. "That is why many among you are weak and sick and a number of you have fallen asleep." That's New Testament language for dead. They've died because of their unworthy observance of the Lord's Supper. That's incredible. The Lord takes this ordinance so seriously that he was willing to afflict some of his own people with illness and weakness, and even with death, because they had eaten and they had been drinking in a manner unworthy of the Lord. So Paul moved with compassion for them, moved by zeal for the Lord, moved by the Spirit of the Lord himself, he wrote these verses to warn them of danger concerning the Lord's Supper, but that's only part of it, that's not even the greater part of it. Speaking positively, he wanted them to come into the fullness of blessing the Lord intended in the Lord's Supper. He wanted them to richly experience the beauty of the Lord's Supper with the sin removed, that's what he wanted. And so it is also for us today, the Lord's Supper. This ordinance was meant to be a river of blessing for us as Christians, but it has also been throughout 20 centuries of church history, a source of division in the body of Christ, sadly. Right from the very beginning it is here in the Corinthian context, but it continued. Historical Context It's good to understand some history, I was raised personally Roman Catholic. I was an altar boy, so I took part in the Mass, and the center piece of the Mass is the offering, so they believe, of the actual body and blood of Christ, they...I wasn't taught all this theology, I learned it after my conversion, but they believed in the doctrine of transubstantiation, which is a complex Greek philosophical basis for how it could actually be the body and blood of Jesus. And so they argued from Aristotle that the substance had changed and had become actually the body and blood of Jesus, even though it still tasted like bread and wine. I didn't know all that, I was just told to ring the bell at a certain point, and when the priest offered up the host, I rang the bell. I'd been a Christian for 10 years before I figured out that that was the moment they thought transubstantiation happened, and the bell was rung so you would know that it had happened. Martin Luther, the great Reformer of the 16th century, was first a Roman Catholic priest, trembled so violently at the moment that he performed his first Mass, "I'm actually holding the blood, the cup of the blood of Jesus," that he spilled it on the tablecloth there. Even after his evangelical conversion and understood the Gospel, he never gave up on the concept of real presence, that the body and blood were actually there in the Lord's Supper, though not by transubstantiation, he rejected that, he said, "I don't have an explanation, I just believe it's true." Now, Ulrich Zwingli, who also began as a Catholic priest, he was in Zurich, he was a Swiss Reformer, he had a whole different take on it. Every bit as much born again, strong, powerful Reformer in the Swiss context, he minimized the Lord's Supper rather completely, just maximized the preaching of the Word and said, "It's just a memorial, it's just a way to help us remember, that's all," what some called the bare memorial view of the Lord's Supper. Many evangelical churches follow that bare memorial view. They denigrate the Lord's Supper or diminish it, have it on Sunday evening service quarterly, something like that and to minimize it, not everyone, but many. Now, Luther and Zwingli, these two powerful Reformers met at a colloquium, meeting together in Marburg in 1529 to try to reconcile their differences on the Lord's Supper. But it only made them worse enemies. Very sad, very bad moment in church history, when they couldn't get along over the Lord's Supper, a meal that should have united them. Half a generation later, John Calvin, a Reformer in Geneva, came along and had a different view. And it's a view that I hold and I want to espouse to you. It’s what I call the spiritual presence view, the “we're standing on holy ground” view. In that way, it's just bread, it's just juice, it's all it is. It does not change, but it's not a bare memorial, not at all. If you take this seriously, if exegetically, you read through 1 Corinthians 11 and you understand how seriously the Lord takes it, and then think positively, 'cause a meal of thanksgiving, you come expecting a spiritual blessing, you come expecting to be fed by it based on your faith in the Word of God. Modern Context So what I wanna do here is, I wanna just walk through some things. And this outline I got years ago, from Mark Dever, and I preached it once here in this church about six years ago, and it has to do with the word, "look". And what I want us to do is, I want us to, based on the text, look in different directions, it's gonna come right up off the text. We're gonna look in different directions, and this has always stuck with me, six different directions of looking. Ultimately, we're gonna look to Jesus, we're gonna look to him by faith, we're gonna try to see Jesus spiritually in the Lord's Supper. So the idea of looking to Jesus, we get that from Hebrews 12, it says, "Since we're surrounded by such a great cloud of witnesses, let us lay aside everything that hinders and the sin that so easily entangles. And let us run with endurance the race marked out before us, looking to Jesus, the author and perfect or of our faith.”nThe same book of Hebrews says, "We see Jesus at the right hand of God." We don't see him except by faith. That's why there's a whole chapter on faith in that book. So by faith, we're looking to Jesus, that's what we're gonna try to do, and so we're gonna look in different direction, we're gonna look back in the Lord's Supper, we're going to look up, we're going to look within, we're gonna look down, look around and then look forward. All of these flow right from the text. So we're gonna look back at history, at key things in redemptive history, at the time of the Lord's Supper, we're gonna look up to God with thankful hearts, it's a meal of Thanksgiving, we're gonna look within, we're going to examine ourselves like the text tells us to do and see if there's any sin in us, and we're gonna do business with God, looking inward. We're gonna look down at the actual elements and realize how physical they are. And there was a time that Jesus was physical, too, for us dying on the cross, we're gonna see the physicality of it and embrace that. We're gonna look around, maybe even literally in the sanctuary to other brothers and sisters in Christ who are partaking. But then in our minds, look around the world, and know that we're part of a body of Christ, we're part of a church, worldwide movement of Christians, we're not alone, we're not islands, but we're part of a body. And we're gonna look forward to the Second Coming of Christ and to the new heaven, new earth, all of these just flow from the Lord's Supper. Looking Back So let's begin. First, let's look back. First and foremost, this was a Passover, that Last Supper was a Passover, and so the Jews had built into their calendar a once-a-year remembrance of the Passover deliverance, and the Passover was part of the final trial, the final plague that God brought on Egypt for their enslavement of his people. And so at that time, the Angel of Death moved through Egypt and everywhere that did not have the blood of the Passover lamb sacrifice and painted on the doorpost and lintels, he would go down and kill the first born in that house. But if he saw the blood, he would pass over. And so the Jews were instructed to sacrifice the Passover Lamb and apply the blood, but then they were commanded that this would be a lasting ordinance, and that every year they would go through and remember what God did that night. Passover. In the same way, the Lord's Supper is a time of remembrance. Look at verse 23-26. Jesus said, "This is my body, which is for you, do this in remembrance of me." In the same way after supper, he took the cup, saying, "This cup is the new covenant in my blood. Do this whenever you drink it, in remembrance of me. For whenever you eat this bread and drink this cup, you proclaim the Lord's death until he comes." It's a meal of remembrance, so we're looking back, we're gonna look back to the Passover and how Jesus is the fulfillment of that Passover. We don't do the Passover anymore as Christians, we do the Lord's Supper. We also look back, historically, to the night that Jesus was betrayed. Look at verse 23, "The Lord Jesus on the night he was betrayed, took bread." So this obviously reminds us of Judas Iscariot, who sat with him at the table and no one knew that he was a devil except Jesus, and how he betrayed Jesus, you can only betray a friend, and so there had been an intimate love relationship between Jesus and all his apostles, and Judas was one of them, but Jesus knew who he was, he knew that he was a devil. But they, he had extended friendship, and so he was betrayed, and so we think about that, and just the events recorded in Matthew, Mark, Luke and John, the events that led to Jesus' dying for us, we remember them, we look back, but then especially friends, we look back to the cross. We look back to the giving of the body and the blood of Jesus for us as sinners. The bread symbolizes Christ's physical body. The wine symbolize symbolizes Christ's literal physical blood, and the body and the blood were given for our redemption, and so we think about that, it's a clear recognition. I'm gonna talk more about the physicality of it in a minute, but Romans 6:23 says, “the wages of sin is death.” The soul that sins will die. We deserve to die, the death penalty for our sins. And so Jesus' identification of the bread with his body and of the wine with his blood, focuses our attention on the need for a substitute who would sacrifice himself in our place to pay the penalty for our sins. So we look back and we look back to the new covenant. The Passover was an old covenant animal sacrifice. Leviticus 17 says that the life of the animal is in the blood and is to be poured out, a life given in death for atonement of sins in the old covenant pattern. But the blood of bulls and goats never took away sin. It couldn't do that, it was just a foreshadowing of the actual blood that could take away sin, and that's the blood of the Son of God. And so, look at verse 25, Jesus institutes a new covenant in his blood, thus ending forever the need for animal sacrifice. In the same way, after supper, he took the cup, saying, "This cup is the new covenant in my blood. Do this whenever you drink it in remembrance of me." So there's the new covenant. So by this new covenant in Christ's blood, the wrath of God is totally satisfied. We are actually forgiven, not just symbolically forgiven, like animal blood, but actually forgiven by the blood of Jesus; it's a new covenant. And then we look back to our personal faith in Jesus. Look back to your own story. Remember how you came to Christ. Examine yourself to see if you're in the faith, and if you are, thank God that you're in the faith. Remember what Jesus did to bring you to himself, remember your own story. And look at how he has sustained and protected your faith from the moment you believe until this day. Think about that. Looking Up Secondly, we look up to God the Father. Whenever Jesus gave thanks for food, he looked up to his Heavenly Father, like in Matthew 14:19, when he fed the 5000, he took the five loaves and the two fish, and then he looked up and gave thanks. We look up. The Last Supper, Jesus took the cup, gave thanks and offered it to them, saying, "Drink from it." So as we look up in our hearts, we think God the Father crafted before the foundation of the world, a salvation plan for a sinner like me. This whole thing comes from God the Father, so you look up with a heart of thankfulness to God for your salvation, and you look up and you see Jesus, like the author of Hebrew says, "At the right hand of God, your great high priest, interceding continually for you, pleading the merits of his blood shed once for all." We don't believe like the Catholics do, that we're repeating the sacrifice here. No, no, know once for all it was offered, and Jesus is pleading the merits of his blood on your behalf at the right hand of God, see him there, he's praying for you, if you're a child of God. And look up and see the activity of the Holy Spirit, that the spirit is delivering, administering grace to his people all over the world in the name of Jesus, the activity of the Triune God. And as you do, as you look up to Jesus, you're going to do a kind of spiritual eating and drinking. Now, this is a hard concept, but this is what John Calvin taught, there's a spiritual eating and a spiritual drinking. What does that mean? It says in John 6, Jesus taught that he, his flesh is bread. And he says, "I tell you the truth. Unless you eat the flesh of the Son of man and drink his blood, you have no life in you. Whoever eats my flesh and drinks my blood has eternal life, and I will raise him up at the last day, for my flesh is real food and my blood is real drink. Whoever eats my flesh and drinks my blood remains in me and I in him." So I do not believe that the bread and the juice will actually be changed into the body and blood of Jesus, I don't think we need that. But there is a spiritual partaking, or a spiritual eating, or a spiritual nourishment that comes mentally in your soul by recognizing the body and blood of Jesus given for you, in a sense that you need ongoing ministry from the cross to continue you to feed your soul. You're not ever gonna be independent. He's the vine, you're the branch, a different image with the same teaching. So you're gonna be spiritually eating of Jesus. I know it's a hard teaching, it was hard back then, but we can embrace it. And you say, as I eat this and chew this and swallow it, as I drink this and swallow it, it's a symbol to me of a need for ongoing ministry from Jesus to myself. I'm never gonna be independent. Looking Within Thirdly, we're gonna look within, we look within to our own sinfulness first and foremost, look at the ugly sinfulness of that Corinthian church. Look at their factions and divisions. Look at them getting drunk. Look at them selfishly rushing ahead and eating more bread than they should have, and others who go without, and feel a sense of shame and guilt that we all share. Don't think, "Oh, I would have been better than those Corinthians. I'm a better man, better woman," I wouldn't do that. Instead, we have to look inward to our own sinfulness. We complain. We murmur. We fail to thank God for his many blessings. We just assume them. We go into patterns of idolatry and lust that are shameful and addictive. We are selfish toward people that we love. We bicker and argue with them. We are not zealous for the kingdom of God. We don't lay down our lives for lost people. We’re not generous with our money toward the poor and needy like we should be. There's so many sins of omission and commission that we should be confessing to God, and this is a good time to do that, to look inward and confess, and we're going to have an opportunity to do that in a moment. We should do it in light of the seriousness of sin. Look at verses 27- 29, "Therefore, whoever eats the bread or drinks the cup of the Lord in an unworthy manner will be guilty of sinning against the body and blood of the Lord. Look at verse 28, "A man, a person ought to examine himself before he eats of the bread and drinks of the cup." I'm just saying, look inward and examine. "For anyone who eats and drinks without recognizing the body of the Lord eats and drinks judgment on himself." So we don't eat flippant or lightly, we bow in our hearts and search our hearts for sinfulness, and we bring out those sins and allow Christ's all-sufficient blood to cover everyone. We're told in this text, "Judge ourselves so that God won't have to do it." You should take that seriously. If we judge ourselves, then the Lord won't have to do it. So Paul says in another place, in the same epistle, "I beat my body and make it my slave so after preaching to others, I won't be disqualified." So get serious about whatever sin is in your life and judge yourself in reference, and God won't have to discipline you. You won't have to become weak or sick or fall asleep. We also look inward to repentance and faith, which are graces of God. If you are a repentant sinner, that's a grace that God's worked in you, so thank God for that spirit of repentance and that faith that you know that Jesus is the Son of God, and he died for you. Find that repentance in faith. Look to the testimony of the Spirit that you actually are a child of God, the Spirit testifying with your Spirit that you are a child of God. So therefore, we're looking inwardly to ensure that we are eating in a manner worthy of the Lord. This is especially true of a gospel hypocrite, an unconverted church member able to play the game and deceive elders and other people, but you're not really converted, going through the motions, and you live it out through the week. Pastor needs to warn people about gospel hypocrisy. Let this be an opportunity to look inward and say, "Am I genuinely in the faith?" And certainly true of unbelievers. Unbelievers are not welcome at the Lord's table. You'd be eating, drinking judgment on yourself. Instead, what I want you to do, hear the Gospel, God sent his Son for sinners like you and me. We're all sinners. “All have sinned and fall short of the glory of God,” we are sinners. God sent a Savior, trust in him. Don't partake of the bread and the juice, but just believe in Jesus, look to him for the forgiveness of your sins, and then testify to it by water baptism, and then next time partake. Looking Down Fourth, we look down, you're gonna have in your hand, bread and a cup, these physical elements tell you that you needed a physical savior. We're not like the Greek philosophers that think, "Body is evil, spirit is good." “The Word became flesh.” And Colossians 1 says plainly, "Once you were alienated from God and were enemies in your minds because of your evil behavior, but now he has reconciled you by Christ's physical body, through death to present you holy in his sight, without blemish and free from accusation." Now, that physical body and blood, the flesh and blood, was given once for all, never to be repeated. The author to Hebrews is so clear about this. But it did happen once. And as you eat the physical bread, chew it and swallow it, and you drink the juice and you swallow it, you should think of the physicality of your Savior and how he once for all died for you, went through agony for you, shed real blood for you. And with your physical hands, look at your own hands, some day God's going to give you resurrection hands, a resurrection body. You're gonna actually be in a resurrected physical world, in a resurrected physical body, seeing a resurrected physical Savior someday. Looking Around Fifth, look around to the body of Christ. You're not the only person God is saving. He is working in brothers and sisters. And isn't that beautiful? There won't be any loners or hermits in heaven. We are part of a beautiful mass body of Christ around the world, and this local church is a physical, visible sign of that. So sneak a peek at someone in the pew. Look down, look left, look right, they might be looking at you. All right? Looking left, looking right, we're surrounded by people. It says in verse 33, “So then my brothers, when you come together to eat, wait for each other.” First time I as a new convert in Christ partook in a Protestant Lord's Supper as a Catholic, you eat it right away, as soon as you get it, you eat it, so I did that. I was so embarrassed, I was the only one who ate in the entire sanctuary. I didn't know this verse, verse 33, "Wait for each other." But there's a reason we wait till everybody has... We try to harmonize it and synchronize, so we look, give nods to the deacons, they come and when we're all ready, then we eat together. And it's just a symbol of, like it says in 1 Corinthians 10, "We partake of one loaf, so there's one body." So there's that sense of unity that we have, look around, and look around to the fellowship that we have with each other. If you're aware of any sin going on your life, any dis-fellowship, anything going on, make it right. We're also aware, as we look around to an unbelieving, watching world, we are proclaiming the Lord's death until he comes by this, but also by the Gospel. We've got a responsibility to the watching, unbelieving world to proclaim the Lord's death. Looking Forward And then finally, looking forward to the future coming of Christ. Look again at verse 26, "For whenever you eat this bread and drink this cup, you proclaim the Lord's death until he comes." Now, we're learning all about that in the book of Revelation. I intend, God willing, to resume that study next week, but we know Jesus is coming back, and this homely symbolic feast saturated with powerful ministry of the Spirit will someday give way to the reality of a returning king and a banquet in heaven, and we're gonna feast in the kingdom. "Many," Matthew 8:11, "are gonna come from the east and the west and will take their place at the feast with Abraham, Isaac and Jacob in the kingdom of heaven. We're gonna sit and feast. I don't think that's all we're gonna be doing, but I just think... I see regular feasting in our future. All right, we're gonna come back together, the new Jerusalem, and then go back out to the new earth and work, and then come back and feast some more, and we won't get fat, we don't get... That'll be really good. Well, just feast and feast, and we won't have to work it off. It'll be wonderful. Ultimately, we're looking ahead to our own resurrection, to the feast of our resurrection, as it says in Isaiah 25, "On this mountain, the Lord Almighty will prepare a feast of rich food for all peoples, a banquet of aged wine, the best of meats and the finest of wines. On this mountain, he will destroy the shroud that unfolds all peoples, the sheet that covers all nations, he will swallow up death forever." So the destruction of death and the resurrection is portrayed in Isaiah 25:6-8 as a banquet, and we're gonna feast. Summary All right, summary. I desire that your experience by faith in the Word of God would be like on holy ground now. I've invited you to look back to the history of the Passover and Christ. I've invited you to look up in thankfulness to God and to see the activity of Christ, your mediator. I've urged you to look inward to your own sins, to deal honestly with your sins, and to be certain that you're born again, but if you are to be thankful for that, and to know that the Spirit is in you; to look down in an understanding way to the actual bread and actual juice, knowing that a body was broken for you, blood was shed for you; to look around to the body of Christ, the fact that you are part of a worldwide movement of Christians; and look ahead to the second coming of Christ. So what we're gonna do now is have a time of prayer that I'm gonna lead in three parts, briefly, just 30 seconds, 45 seconds in each one, of silent prayer, and then I'll end that time and go to the next one, and then we'll partake in the Lord's Supper. So let's pray together. First, I'd like to call on you to worship God, so this is like looking upward, I want you to be mindful of the greatness of the Triune God and pray, worship prayer first and foremost, so quietly in your heart, reverence and worship God. Prayer of Worship Almighty God, we recognize that you are holy, holy, holy, and that 100 million angels stand in your presence and they cover their faces, and they cry out about your holiness. Oh God, you are a great God, you are a consuming fire, and you are also the father of the prodigal, who comes back broken and sinful. We thank you for your infinite greatness and majesty and your infinite kindness and grace to us. We worship you, God, and praise you and thank you. Now we're gonna go to a time of confession of sin. Look first and foremost toward your conscience, if there's anything that you've been doing, any habit, any pattern, any addiction, anything that you've done, anything that conscience is saying to you that needs to be dealt with, and also look horizontally, if there's anyone that might have anything against you, if there's any brokenness in a relationship, confess it now and resolve to repent and to make things right. Let's confess our sins quietly to God. Prayer of Confession Father, we acknowledge that we have sinned in what we have said and done and what we have should have done and didn't do, and we are mindful of the depth of our brokenness and our sinfulness. We ask your forgiveness, we confess our sin to you, O Lord, knowing that you are faithful and just and will forgive us our sins and cleanse us from all unrighteousness. Oh God, wash us and cleanse us. Father, if there's any unforgiveness or broken relationships in our family or in the church or any others that we're aware of, God give us the determination to leave our gift at the altar and go, be reconciled. Oh God, I pray that you would help us, help us oh Lord, to be pure and to fight sin by the power of the Spirit in Jesus' name. And now thirdly, finally, we want to lift up our hearts in thankfulness. Think first and foremost of the fact that every spiritual blessing in the heavenly realms is yours in Christ. Thank God for your forgiveness, thank God for Jesus, thank God for your adoption as a son or daughter of the living God, and then be thankful for lesser blessings. Prayer of Thanksgiving Father, we know that Scripture teaches us that every good and perfect gift is from you, every gift we've ever received, but we also acknowledge some gifts are infinitely greater than others, you give them all, but some are unspeakably valuable and precious. You are the God who did not spare your own son, but gave him up for us all; there is no greater gift. Thank you for sending Jesus. Thank you, Lord, for dying for us. Thank you, Spirit, for taking the blood of Jesus and applying it to us for the forgiveness of our sins, and thank you now for the chance we will have to partake in the Lord's Supper, in your name, we pray. Amen. I'd like to invite the deacons to come now and help serve the table.