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Healthy Wealthy & Smart

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The Healthy Wealthy & Smart podcast with Dr. Karen Litzy features top experts in health, wellness and business with a particular focus on physical therapy. We take evidence based medicine and break it down, making it easier to understand and immediately apply to your life. At Healthy Wealthy & Smart our goal is simple: to provide you with the best information so you can live a healthy and pain free life!

Read more

The Healthy Wealthy & Smart podcast with Dr. Karen Litzy features top experts in health, wellness and business with a particular focus on physical therapy. We take evidence based medicine and break it down, making it easier to understand and immediately apply to your life. At Healthy Wealthy & Smart our goal is simple: to provide you with the best information so you can live a healthy and pain free life!

iTunes Ratings

176 Ratings
Average Ratings
161
8
2
3
2

Applicable to Outpatient PT

By alkirklom - Nov 11 2019
Read more
Good information and topics that often translate to OP ortho PT setting.

Great podcast by a great host!

By Dr Feilgood - Feb 09 2018
Read more
Karen does a great job getting a wide array of interesting guests.

iTunes Ratings

176 Ratings
Average Ratings
161
8
2
3
2

Applicable to Outpatient PT

By alkirklom - Nov 11 2019
Read more
Good information and topics that often translate to OP ortho PT setting.

Great podcast by a great host!

By Dr Feilgood - Feb 09 2018
Read more
Karen does a great job getting a wide array of interesting guests.
Cover image of Healthy Wealthy & Smart

Healthy Wealthy & Smart

Latest release on Feb 19, 2020

The Best Episodes Ranked Using User Listens

Updated by OwlTail 3 days ago

Rank #1: 262: Prof. Peter O'Sullivan: Reconceptualizing Pain

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LIVE from Combined Sections Meeting, this episode of the Healthy Wealthy and Smart Podcast features Professor Peter O’Sullivan discussing elements of the biopsychosocial model for chronic pain management. Peter O’Sullivan is Professor of Musculoskeletal Physiotherapy at Curtin University, Perth, Australia. In addition to his teaching and research at Curtin University, he works in clinical practice as a Specialist Musculoskeletal Physiotherapist (as awarded by the Australian College of Physiotherapists in 2005) in Perth, Australia. He is recognized internationally as a leading clinician, researcher and educator in the management of complex musculoskeletal pain disorders.

In this episode, we discuss:

-Why you should validate your patient’s pain experience, understand their beliefs and fears, and disconfirm them through behavioral learning

-The link between a practitioner’s language and self-efficacy

-The informal and non-threatening art of Peter’s initial examination

-Maintaining professional boundaries with chronic pain patients and avoiding burn out

-And so much more!

One of the strongest influences to better treatment outcomes for chronic pain patients is trust in the therapeutic alliance. “You’ve got to build a strong therapeutic relationship,” Peter suggests if you want to see patient’s engage in their program and take more control over their pain.

Treating chronic pain patients can be challenging. With the right evaluation framework and understanding of neuroscience, Peter believes you can make instant impact for the patient. Peter stresses, “The nervous system is so damn plastic. If you can get to the heart of what someone is thinking and feeling. Validate it and take them on a journey—it can break that schema up.”

Peter is critical of therapeutic techniques in physical therapy when in fact a majority of patients would benefit from relaxation strategies and progressive loading. He suggests, “I think we undermine how smart the body is…someone who gets in trouble is someone who is too hyper vigilant and probably obsessed with their technique.”

For more information on Peter:

Peter is the Professor of Musculoskeletal Physiotherapy at Curtin University, West Australia and is a Specialist Musculoskeletal Physiotherapist (as awarded by the Australian College of Physiotherapists in 2005). His private clinic is Body Logic Physiotherapy in Perth www.bodylogicphysiotherapy.com.au. Peter has an international reputation for clinical research investigating the development, multi-dimensional assessment and targeted management of chronic spinal pain disorders. He has also developed a management approach for chronic low back pain – called ‘cognitive functional therapy’. He has published over 190 papers with his team in international peer review journals, has presented the findings of his research at more than 90 National and International conferences and has run clinical workshops in over 24 countries. Peter’s expertise is linking of clinical research to the clinical setting. (see www.pain-ed.com)

Resources discussed on this show:

Blink by Malcolm Gladwell

NOI Group

Body in Mind

Pain-Ed

Adriaan Louw

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!

Have a great week and stay Healthy Wealthy and Smart!

Xo Karen

P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!

Mar 13 2017

1hr

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Rank #2: 112: Adriaan Louw, PT explains central sensitization

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Adriaan and I discussed the ins and outs of central sensitization. Adriaan shares his knowledge on what central sensitization is, how it can be diagnosed and what the role of the physical therapist is in the treatment. Adriaan is a wealth of knowledge and has the ability to take these very complex ideas and break […]

Jun 10 2013

59mins

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Rank #3: 356: Tom Goom, PT: So, You Have a Pain in Your Ass?

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On this episode of the Healthy Wealthy and Smart Podcast, Tom Goom joins me to discuss a gluteal tendinopathy case study. Tom has gained the nickname ‘Running Physio’ after years of combining his passion for physio and love for running together to specialise in management of running injury. He’s written widely on the topic with over 200 evidence-based articles for his own site, running-physio.com as well as contributing to the BJSM Blog, Runner’s World and the Telegraph. In 2016 he published a masterclass on proximal hamstring tendinopathy in the Journal of Orthopaedic and Sports Physical Therapy. He presents his Running Repairs Course in the UK, internationally and online, covering a range of topics from training load management to bone stress injuries, strength and conditioning and more.

In this episode, we discuss:

-Crafting the subjective portion of your evaluation

-Objective measures at the impairment, activity and participation levels

-Multimodal treatment approaches to manage gluteal tendinopathy

-Intrinsic factors that affect tendon health

-And so much more!

Identifying what running really means to your patient will help guide your goals for therapy as Tom stresses, “I want to know about the impact the injury is having on them.”

Modifying activity levels is an important aspect for your exercise prescription and you have to convey to your patients that, “It’s this kind of balancing act of risk versus reward.”

It is important for clinicians to avoid iatrogenic language in their patient education and only, “Highlight the good things.“

Establish at the onset to, “Expect flair ups.” as managing patient expectations during their rehabilitation is key to long term success.

Treating gluteal tendinopathy is both challenging and rewarding and Tom believes, “There’s an art to it as well as a science.”

For more information on Tom:

Tom is a physiotherapist with over 10 years of experience and a very keen runner! He graduated with a BSc (Hons) degree in 2002 and since then has worked in clinics in the UK and overseas. His career started in Winchester where he worked in the NHS and developed a specific interest in lower limb rehab and joined the physio team at a semi-professional football club. Following the Tsunami in 2004 Tom travelled to Sri Lanka and did voluntary physiotherapy work in a hospital, teaching local staff, treating patients and fundraising for new equipment. Tom returned to the UK in 2006 and started working in Brighton as a senior physiotherapist. His interest in rehab continued to grow and he ran lower limb and spinal rehab groups as well a chronic pain programme.

Tom started RunningPhysio in March 2012 to help those training for marathons that spring, since then it’s developed into a resource used by runners all over the world. Tom has written for Running Fitness, Men’s Running UK, and the British Journal of Sports Medicine blog. His work has featured on Kinetic Revolution, Bartold Biomechanics and a host of online sports sites.

 A few words from Tom…

I’m learning about running all the time, one thing I’ve found is that there are a lot of opinions out there! No 2 people will give you the same advice and I respect that. My plan with this site is to share my view on injury prevention and management when running. I welcome different views and ideas so please feel free to comment. I don’t claim to have all the answers but I hope people will find this site helpful. I’ve got a few miles under my belt and a few good PB’s – 39:30 for 10km and a 1:28 half marathon. In April 2013 I did my first marathon and loved it! I finished in 3:12:28 – full story here.

I work at The Physio Rooms clinic in Brighton. For more information or to arrange an appointment see our Clinic Page.

If you have any questions feel free to leave a comment or chat to me on Twitter via @tomgoom. Please note that due to very high numbers of comments and questions we aren’t able to reply to everyone

Resources discussed on this show:

Running Physio Website

Running Physio Twitter

Running Physio Facebook

Tendon Health Questionnaire

Pain Catastrophizing Scale

Hudl Technique

Plinsinga et al 2018: Psychological factors not strength deficits are associated with severity of gluteal tendinopathy: A cross‐sectional study

Ganderton et al 2018: Gluteal Loading Versus Sham Exercises to Improve Pain and Dysfunction in Postmenopausal Women with Greater Trochanteric Pain Syndrome: A Randomized Controlled Trial.

Mellor et al 2018: Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!

Have a great week and stay Healthy Wealthy and Smart!

Xo Karen

Jun 11 2018

1hr 1min

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Rank #4: 287: Prof. Lorimer Moseley: The Pain Revolution

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On today’s episode of the Healthy Wealthy and Smart Podcast, I had the honor of welcoming Professor Lorimer Moseley onto the show to answer audience questions regarding persistent pain. Lorimer Moseley’s interests lie in the role of the brain and mind in chronic pain. He is Professor of Clinical Neurosciences at the University of South Australia and a Senior Principal Research Fellow at Neuroscience Research Australia.

In this episode, we discuss:

-The Pain Revolution: creating a public discourse about persistent pain

-Misconceptions surrounding the biopsychosocial model and pain

-Confronting medical providers who promote negative pain beliefs

-Is there merit in using placebo treatments for chronic pain?

-How does Lorimer stay critical of his own scientific work?

-And so much more!

Persistent pain needs to be understood not only by clinicians but the general public and policymakers. Lorimer believes, “It’s our most burdensome non-fatal condition facing our species.”

Clinicians need to understand what motivates their patients. Lorimer reminds us that, “When push comes to shove, in the raw moment, you ask a patient with persistent pain or anyone in pain, what do you want most right now? I think most of them would say pain relief.”

Medical providers hold a great deal of sway with patients. This influence can be used to validate what patients are feeling and aid the healing process. Lorimer states, “Nearly all health professionals have a natural tendency and a very slick skill set of legitimizing someone’s suffering.”

Although the biopsychosocial model differs in many ways from the biomedical model, there are many opportunities to share insights and practitioners of both frameworks should be self-critical. Lorimer advices, “It’s tempting for us to cast character judgments on those who are not like us. Actually, I think that people are trying to help their patients a lot of the time. They’re good people. I really think we need to collaborate and just keep open the possibility that we’re wrong. We have to be committed to try and prove ourselves wrong.”

For more information on Lorimer:

Professor Lorimer Moseley is a clinical scientist investigating pain in humans. After posts at The University of Oxford, UK, and the University of Sydney, Lorimer was appointed Foundation Professor of Neuroscience and Chair in Physiotherapy, The Sansom Institute for Health Research at the University of South Australia. He is also Senior Principal Research Fellow at NeuRA and an NHMRC Principal Research Fellow.

He has published over 200 papers, four books and numerous book chapters. He has given over 140 keynote or invited presentations at interdisciplinary meetings in 30 countries and has provided professional education in pain sciences to over 10,000 medical and health practitioners and public lectures to as many again. His YouTube and TEDx talks have been viewed over 200,000 times.

He consults to governmental and industry bodies in Europe and North America on pain-related issues. He was awarded the inaugural Ulf Lindblom Award for the outstanding mid-career clinical scientist working in a pain-related field by the International Association for the Study of Pain, was shortlisted for the 2011 and 2012 Australian Science Minister’s Prize for Life Sciences, and won the 2013 Marshall & Warren Award from the NHMRC, for the Best Innovative and Potentially Transformative Project. He was made Fellow of the Australian College of Physiotherapists in 2011, by original contribution, and an Honoured Member of the Australian Physiotherapy Association, their highest honour, in 2014.

Resources discussed on this show:

Pain Revolution

Pain Revolution Facebook

Explain Pain Supercharged

Body In Mind Twitter

Body In Mind

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!

Have a great week and stay Healthy Wealthy and Smart!

Xo Karen

P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!

Jul 24 2017

1hr 3mins

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Rank #5: 252: Dr. Joe Tatta: The Evolution of a Physical Therapy Career

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On today’s episode of the Healthy Wealthy and Smart Podcast, Dr. Joe Tatta joins me to discuss the evolution of his physical therapy career. Dr. Joe Tatta is a doctor of physical therapy, board certified nutrition specialist and functional medicine practitioner who specializes in treating persistent pain and lifestyle-related musculoskeletal, metabolic and autoimmune health issues. His mission is to create a new paradigm around treating persistent pain and reverse our global pain epidemic.

In this episode, we discuss:

-Why fresh PT’s should focus on honing their skills

-Why an onboarding process is crucial to educating, selecting and motivating a successful team

-The limits of scaling a cash pay practice and when it might be beneficial to sell

-New integrated health centers for chronic pain and how it impacts the global pain epidemic

-And so much more!

For new graduates, the physical therapy profession offers many different ways to grow and develop. Joe believes, “One of the great things about being a physical therapist is you have so many different aspects and avenues to really go. There are so many options.”

Joe recommends creating a consistent treatment methodology for chronic pain patients. Joe states, “It created continuity of care. It created almost one mind. When you came into the clinic, patients knew that there was a method going on here and they felt safe there.”

Joe has found performance tracking to be a useful tool for his employees to help asses their strengths and areas for improvement. Joe states, “[Metrics] can actually be a way to motivate people but they can be an indicator as to how interested someone is in their job.”

To reverse the global pain epidemic, more creative options are necessary and physical therapists are perfectly aligned to take on an integral role. Joe stresses, “We have to find solutions to help [chronic pain patients].”

For more information on Joe:

Dr. Joe Tatta is a doctor of physical therapy, board certified nutrition specialist and functional medicine practitioner who specializes in treating persistent pain and lifestyle-related musculoskeletal, metabolic and autoimmune health issues. His mission is to create a new paradigm around treating persistent pain and reverse our global pain epidemic. He is the creator of the Healing Pain Online Summit and The Healing Pain Podcast designed to broaden the conversation around natural strategies toward solving persistent pain. Dr. Tatta is the author of Heal Your Pain Now; A Revolutionary Program to Reset Your Brain and Body for a Pain-Free Life by Da Capo Press.

Resources discussed on this show:

Dr. Joe Tatta Twitter

Dr. Joe Tatta Website

Heal Your Pain Now Book

The Pain Quiz

Heal Your Pain Now Website

Healing Pain Podcast

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!

Have a great week and stay Healthy Wealthy and Smart!

Xo Karen

P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out the Final Blog Post of 2016: Advice You Need to Know!

Feb 06 2017

56mins

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Rank #6: 219: Dr. Greg Lehman: The Beauty of Simplicity

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Happy Independence Day to the American Healthy Wealthy and Smart family! On this week’s episode, Greg Lehman and I review the evidence and rethink effective treatment strategies. Greg is both a physiotherapist and chiropractor who treats musculoskeletal disorders within a biopsychosocial model and simplifies pain science for clinicians around the world.

In this episode, we discuss:

-Why explaining pain leads to better treatment outcomes

-The case for and against repeated spinal flexion

-Does glute activation or inhibition affect pain?

-Functional training and the carry-over effect

-And so much more!

Greg stresses that most physical therapists should rethink what is valuable to their patients. He states, “The technical mastery is less important…It probably has more to do with how your patient feels comfortable and how you respond to them rather than you being a good robot who knows lines of drive and the biomechanics. That isn’t what is valuable and isn’t supported in all the research that we have.”

Greg also questions the effectiveness of being so specific with our interventions and takes a broader approach in his treatment philosophy. “I don't think there is any treatment that ever has to occur… It’s actually a neat, big question for therapy I would like to see addressed more. Is there ever a treatment that is absolutely necessary for a specific condition or are there a number of things that can be helpful? I tend to believe there are a number of things—I have my biases—but I think most things aren't that specific.”

Greg builds patient self-awareness with education and believes it is his most effective treatment tool. “I go right into education for low back pain. I am not too worried about getting them super active right away. I want to encourage them to getting back to doing the things that are important. If they tell me they are afraid to do a number of things that they like doing and they are meaningful activities, my go to intervention is to convince them they can start doing those things again.”

Greg suggests shifting our focus as clinicians from a purely biomedical approach to treatment and instead developing our psychosocial expertise. “I really believe it is okay to be simple. We don't really need the complexity that we try to do, especially the biomechanics. The big point of that is if you simplify your biomechanics, your physical interventions, it can allow you to develop your skills in the other areas, the psychosocial stuff and start taking more classes outside our typical training—psychologists, social workers, that type of stuff. That’s where we can build our skill set. There's not a better manipulation, there’s not that special exercise technique that you need to learn. It’s fun but it’s not necessary for patients with pain.”

For more about Greg:

  1. GREG LEHMAN BKIN, MSC, DC, MSCPT

He is a physiotherapist and chiropractor treating musculoskeletal disorders within a biopsychosocial model.

Prior to his clinical career he was fortunate enough to receive a Natural Sciences and Engineering Research Council MSc graduate scholarship that permitted me to be one of only two yearly students to train with Professor Stuart McGill in his Occupational Biomechanics Laboratory subsequently publishing more than 20 peer reviewed papers in the manual therapy and exercise biomechanics field. Greg was an assistant professor at the Canadian Memorial Chiropractic College teaching a graduate level course in Spine Biomechanics and Instrumentation as well conducting more than 20 research experiments while supervising more than 50 students. He has lectured on a number of topics on reconciling treatment biomechanics with pain science, running injuries, golf biomechanics, occupational low back injuries and therapeutic neuroscience. His clinical musings can be seen on Medbridge Health CE and various web based podcasts. Greg is currently an instructor with therunningclinic.ca and with Reconciling Biomechanics with Pain Science.  Both are continuing education platforms that provide clinically relevant research that helps shape and refine clinical practice.

While he has a strong biomechanics background he was introduced to the field of neuroscience and the importance of psychosocial risk factors in pain and injury management almost two decades ago. Greg believes successful injury management and prevention can use simple techniques that still address the multifactorial and complex nature of musculoskeletal disorders. He is active on social media and consider the discussion and dissemination of knowledge an important component of responsible practice. Further in depth bio and history of my education, works and publications.

For more information on where Greg will be lecturing next, make sure to visit his website and keep up with Greg on twitter!

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!

Have a great week and stay Healthy Wealthy and Smart!

Xo Karen

P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on Managing Expectations: It Shouldn't be That Difficult!

Jul 04 2016

54mins

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Rank #7: 256: Andrew Vigotsky: Do Biomechanics Matter?

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On today’s episode of the Healthy Wealthy and Smart Podcast, Andrew Vigotsky joins me to answer audience questions and translate biomechanics literature to clinical practice. Andrew is currently a Master's student in Biomedical Engineering at Northwestern University in Evanston, IL, concentrating on musculoskeletal biomechanics. His thesis work aims to elucidate the relationship between the shear-wave velocity of muscle, as measured using Supersonic Shear Imaging, and muscle stiffness in vivo.

In this episode, Andrew answers:

-What is your biggest surprise on engaging clinical practitioners with research evidence?

-How much do you feel biomechanics matter when looking at injury and pain development across various exercises?

-If you were building your own program to maximize muscle hypertrophy what parameters would you use?

-What can we draw from EMG studies and what conclusions are fair to make?

-And so many more!

The goal of biomechanics research is to ultimately translate results to the clinic and enhance how clinicians treat their patients. Andrew states, “It’s only after you find those answers that you really understand what your results mean and how your question can affect society.”

Despite the large amount of research done each year in university labs, very little reaches practioners. Andrew notes, “There is a time lag from research to practice in the medical field of about 17 years.” Andrew believes clinicians can improve this transmission rate through a greater focus on science literacy and improved dissemination of new findings.

Best evidence based practice encompasses all elements of a biopsychosocial framework. Andrew believes, “Biomechanics still matters… It’s just in what context does it matter. From the people that are purely biomechanical, the neurophysiological and the pain science stuff matters a lot and we can’t ignore that.”

For more information on Andrew:

Andrew is currently a Master's student in Biomedical Engineering at Northwestern University in Evanston, IL, where he is concentrating on musculoskeletal biomechanics. His thesis work aims to elucidate the relationship between the shear-wave velocity of muscle, as measured using Supersonic Shear Imaging, and muscle stiffness in vivo. He is completing this work in two different labs: the Neuromuscular Biomechanics Laboratory and the Neurobionics Lab, under Drs. Sabrina Lee and Elliott Rouse, respectively.

Before attending Northwestern, Andrew graduated with a BS in Kinesiology from Arizona State University (ASU). It was during those undergraduate studies that he started getting involved in research; Erin Feser supervised him in ASU's Motion Analysis Laboratory, where he carried out two data collections that resulted in three publications. The studies investigated the effects of load on good morning kinematics and EMG amplitudethe acute effects of anterior thigh foam rolling, and the validity of the modified Thomas test. In addition to Erin's mentorship, I also grew close to Dr. Rick Hinrichs, who taught me a lot about biomechanics both inside and outside of the classroom.

 While at ASU, Andrew was also able to secure an internship under Dr. Bret Contreras while he was completing research for his Ph.D. Bret has had a profound impact on how he thinks about movement and sports science. Together, they have published over a dozen papers related to strength, muscle hypertrophy, and physical performance, and have much more in the pipeline. Moreover, he has introduced Andrew to other great minds and researchers, such as Chris Beardsley and Dr. Brad Schoenfeld.

After graduating from ASU, Andrew completed pre-requisites for graduate school (i.e., math, physics, and engineering courses) at a local community college while splitting time between two laboratories: the Leon Root, MD Motion Analysis Laboratory, at the Hospital for Special Surgery (HSS), and the Human Performance Laboratory, at CUNY Lehman. At HSS, he worked under Dr. Andrew Kraszewski to develop a 3D-mesh model of the gluteus maximus. At CUNY Lehman, he worked under Dr. Brad Schoenfeld to train participants and collect data for a training study, and also designed and carried out a cross-sectional study that investigated the determinants of squat strength, which is currently in peer-review.

If you are interested in learning more about what Andrew has done or reading works that he has published, you can check out it out at ResearchGateGoogle ScholarPubMed, or my CV.

Resources discussed on this show:

Andrew Vigotsky Twitter

Movement Science Blog

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!

Have a great week and stay Healthy Wealthy and Smart!

Xo Karen

P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!

Feb 21 2017

1hr 4mins

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Rank #8: 350: Dr. Josh Payne, PT, DPT: The Anatomy of a Cash-Based Physical Therapy Start Up

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On this episode of the Healthy Wealthy and Smart Podcast, Dr. Josh Payne joins me to discuss how he began his concierge physical therapy practice. Dr. Josh Payne is the owner of Freedom Physical Therapy, providing concierge services to his clients in Denver, CO. Josh started his practice after getting tired of the traditional physical therapy model in multiple outpatient clinics that he worked in. He is an advocate for the growth of the physical therapy profession, and for the trend towards more personalized care.

In this episode, we discuss:

-Why Josh decided he wanted to open his own private practice and how he laid the foundations for his business

-Josh’s top referral sources he used to build his patient case load

-Some mistakes made along the way while growing his practice

-What the future has in store for Freedom Physical Therapy

-And so much more!

Josh believes confidence in yourself as a therapist will go a long way in helping you grow your practice. Josh stresses, “The whole reason why I want to start a practice is to give my patients what they truly deserve.”

Entrepreneurs can invest an abundance of time in their business and setting boundaries at the beginning can be an important consideration. Josh found that, “I took away everything that wasn’t helping me go in the direction I wanted to go forward with.”

Job burnout is becoming more and more common in physical therapy. Find the right blend for your practice as Josh advises, “Don’t be afraid to be different in the world of PT.”

For more information on Josh:

Dr. Josh Payne is the owner of Freedom Physical Therapy, providing concierge services to his clients in Denver, CO. Josh started his practice after getting tired of the traditional physical therapy model in multiple outpatient clinics that he worked in. He is an advocate for the growth of the physical therapy profession, and for the trend towards more personalized care. Dr. Payne believes that a holistic approach is what is needed for truly effective care. In his free time, he enjoys mountain biking, camping, and hiking with his wife Shelby. Josh graduated with his Doctorate in physical therapy from Texas Tech University in 2013.

Resources discussed on this show:

Josh Payne Instagram

Josh Payne Facebook

Freedom PT Concierge Website

Email: drjosh@freedomptconcierge.com

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!

Have a great week and stay Healthy Wealthy and Smart!

Xo Karen

May 17 2018

33mins

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Rank #9: 442: Dr. Tamara Rial: What are Hypopressive Exercises?

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On this episode of the Healthy Wealthy and Smart Podcast, Shannon Sepulveda guest hosts and interviews Tamara Rial on hypopressive exercise.  Tamara Rial is the creator and co-founder of Low Pressure Fitness which is an exercise training program based on hypopressive, myofascial & neurodynamic techniques.

In this episode, we discuss:

-What are hypopressive exercises?

-Patient populations that would benefit from hypopressive exercises

-The latest research on the mechanisms and effects of hypopressive exercise

-Common criticisms of hypopressive exercise

-And so much more!

Resources:

Shannon Sepulveda Website

Shannon Sepulveda Facebook

Tamara Rial Website

Herman and Wallace Website

Pelvic Guru Website

Tamara Rial Instagram

Hypopressive Guru Instagram

Email: rialtamara@gmail.com

The Outcomes Summit:Use the discount code LITZY

For more information on Tamara:

Tamara Rial earned dual bachelor degrees in exercise science and physical education, a masters degree in exercise science and a doctorate with international distinction from the University of Vigo (Spain). Her dissertation focused on the effects of hypopressive exercise on women’s health. She is also a certified specialist in special populations (CSPS).

She is the creator and co-founder of Low Pressure Fitness which is an exercise training program based on hypopressive, myofascial & neurodynamic techniques. In 2016, this program was awarded the best exercise program by AGAXEDE, a leading sports management association in Galicia, Spain. Dr. Rial is the creative director and professional educator for Low Pressure Fitness. At present, over 2000 health and fitness professionals from around the world are certified Low Pressure Fitness trainers.

Dr. Rial is a professor of pelvic floor rehabilitation in the masters Degree at Fundació Universitaria del Bages in Barcelona, Spain. She is the author of several scientific articles and books about hypopressive exercise. She has also published numerous articles and videos about pelvic floor fitness, hypopressive exercise and women’s health. She is an internationally recognized speaker and has presented at conferences throughout Argentina, Canada, Mexico, Portugal and Spain. As an established researcher and practitioner, she continues to collaborate with colleagues at universities and health care settings to explore the effects of hypopressive exercise on health and wellbeing.

She lives with her husband and two dogs in the United States and Spain. Dr. Rial is available for consulting, speaking and freelance writing in Spanish, Galician, English and Portugues.

 For more information on Shannon:

Shannon Sepulveda, DPT, M.Ed., CSCS, WCS is the owner and Physical Therapist at Shannon Sepulveda, DPT, PLLC. She is an Orthopedic and Women's Health Physical Therapist and is currently the only Board-Certified Women's Health Physical Therapist (WCS) in Montana. Shannon received her undergraduate degree from Dartmouth College, Masters in Education from Harvard University (M.Ed.) and Doctorate of Physical Therapy (DPT) from the University of Montana. She is also a Certified Strength and Conditioning Specialist (CSCS). She has been a practicing Physical Therapist in Bozeman, Montana for over 6 years. In her free time, she enjoys running, biking, skiing, hunting and spending time with her husband, son and daughter.

 Read the full transcript below:

Shannon Sepulveda:      00:00                Hello and welcome to the healthy wealthy and smart podcast. I'm your guest host Shannon Sepulveda and I am here with Tamara Rial. Hi Tamara. Can you tell us a bit about who you are and what you do?

Tamara Rial:                                         Well, we're going to introduce a little bit how we met because Shannon came to our hypopressive course that we hosted in Portland with Bobby Grew, right. So I like to call myself a hypopressive expert. I been studying and practicing and teaching this technique for over 10 years and I did my PhD based on hypopressive and its effect on urinary incontinence. And then I began teaching this technique to professionals as also to practitioners. And well, I happened to live in Spain also almost all my life and they do my work there. And also I have been a professor in the University of Vigo in Spain.

Tamara Rial:                 01:13                But two years ago I came to United States because I married my husband who happens to be American and we moved into New Jersey and that's where I currently live.

Shannon Sepulveda:                              Well, can you tell us a bit about what hypopressives are and what low pressure fitness is because I would assume the majority of the audience has no idea what that is. I think some of us pelvic health PTs know and some other people in the world, but it's all the rage in Spain. So tell us about what it is.

Tamara Rial:                                         Yeah, I understand because there's this word hypopressive and some people kind of listen to this word for the first time. So if we look at the etymology of hyper pressure, really what it means, a hypo pressive, it's Hypo. Less pressure pressure of course. So it's an exercise that reduces pressure.

Tamara Rial:                 02:16                It's specifically a intraabdominal pressure intrabdominal pressure and intrathoracic pressure. So normally we call the hyper pressive exercise as a form of exercising with different postural cues and different poses throughout and a specific mechanism of breathing. And the general name of these exercises was named after that reduction in pressure that we have observed after doing these poses, combined with this specific hypopressive breathing technique. So yes, I know that sometimes it’s quite hard to understand, but they name and especially in some countries are for those people who are not familiar with it pelvic PT area. But, it will be the name given to a form of exercise.

Shannon Sepulveda:                              So can you talk a bit about what you mean by poses and then what you mean about the breathing technique?

Tamara Rial:                                         Well hypopressive exercises are also known as the hypopressive technique as I said, as a form of exercise that is mainly postural and breathing driven.

Tamara Rial:                 03:42                So I also like to say that it's a mind body kind of technique because it is based on low intensity poses that can resemble a little bit of the kind of poses we were doing pilates exercise or when in Yoga many yoga instructors will find that many of those poses and breathing techniques are very similar of the ones they also practice. So the postural technique of hypopressive is basically one that aims to do a postural correction, a postural correction in a more body awareness. Like how is our spine, how do we activate our pelvic girdle, how do we activate our pelvic, abdominal muscles or shoulder girdle? So we would focus a lot of body awareness as I said, and on posture reeducation, making the person aware of how they stabilize their spine, how they stabilize their body.

Tamara Rial:                 04:54                And from there we would progress the exercise from a more static poses. And then from there going to a dynamic postural position, and then the breathing exercise is mainly the technique made up of lateral costal breathing that is also practicing in pilates and also by a form of exercise that is also called the Ooda bandha technique. So this is a Pranayama, yoga Pranayama that we use in hypopressive and we call it the hypopressive breathing. So it's a very noticeable and visible technique. But you, because when you practice it, you see how they add them in draws in and the thorax expands and sometimes people confuse it with a hollowing, abdominal vacuum hollowing. Because when you're doing abdominal hollowing, you see how they belly button draws in and there is actual a little scoop in your abdomen, right?

Tamara Rial:                 06:10                But really when you're doing abdominal back q or a do the Anna Vanda or hypopressive breathing technique, what is happening is that you're actually opening your rib cage throughout a breath holding maneuvers. So that means you expel all the air or you expel the current volume of air you have in your lungs. And then after that you open your rib cage. And that will lead to a observable and very noticeable draw in of your abdomen. It is going to be even more noticeable that the actual abdominal Holloway maneuver. Why? Because their rib cage opens and lifts and that's gonna draw in the abdomen and in and create this vacuum that we call in yoga with the Yana Veranda, which is a Prana Yama. They are yoga teachers in some practitioners may be also aware of. And the combination of this type of breathing in a sequence with different poses that they instruct are not normally a progressive. The person through these form of exercise, the low pressure fitness technique.

Shannon Sepulveda:      07:31                That's awesome. So let's talk about who can benefit from this form of exercise because I think that it's become really popular in the pelvic organ prolapse community and the urinary incontinence community. But then we also had a bodybuilder in our class because she needs to learn these poses for her bodybuilding. And we also learned about other types of athletes in particular in Spain that use this technique to help with their sport. So could you talk about like who can benefit from this?

Tamara Rial:                 08:03                Right. That's a great question. Well, hypopressives at the beginning where as you a correctly said, we're especially aimed for the post natal woman. And so specially after giving birth woman began to have some urinary incontinence and many women develop some type of prolapse and also they want to rehab there mommy tummy. So the application of this type of exercises that reduce their waistline and also reduce pressure, especially at the first weeks after giving birth where especially in France and in Belgium, the exercise that they were doing and performing and in France and in Spain, these exercise became to get a more popular and I think almost all a postnatal woman do this kind of routine and pelvic floor physical therapist and also midwives and duolas recommending and teach this kind of exercises in the postnatal phase.

Tamara Rial:                 09:18                So that's why I think it got very popular. But it's true that many other people and at the beginning I wasn't very aware of it because I also began focusing a lot in urinary incontinence because I thought that we're dealing with pressure, right? So this thought of I want to reduce pressure so it will benefit those women or those people who have some type of issue related with increase or dynamic pressure. So the one that always can come to mind or what stress urinary incontinence and pelvic organ prolapse. But there are other pressure issues that can go that people can deal around. And in the woman's health community we are very aware of constipation because it could also lead to constipation in the way we breathe and we push when we go to the bathroom can also lead to some symptoms.

Tamara Rial:                 10:23                So we've seen that people who a incorporate hypopressive breathing and also hypopressive technique from a regular basics and have constipation issues can benefit. And also there has been some research done on pelvic who suffer nonspecific, lower back pain and who have shown good results doing a basic series of exercises because many people ask what are the exercises? Are they're doing a lot of a complex exercise or are they doing dynamic? No, the basic routine. For example, in the course we learned the basic normal static exercises and in the easiest vacuum, that means a vacuum that is performed with a low breathe breath holdings only between 6-10 seconds. And also very easy poses that almost anybody can do in a standing position in a sitting and a kneeling. So really you don't have to be at gym to perform it and even our elderly in our and people with any type of a movement issues or even people who are in wheelchairs can also perform it because really the exercise is very easy.

Tamara Rial:                 11:52                It's basically controlling your breathing and control your pose. So it's specifically, we began to see that not only the woman's health, a community could benefit from hypopressive, but also people suffering, as I said, with a constipation, low back pain. And then there has been an increasing application of this type of training from an aesthetic point of view. Why? Because doing this type of exercise, the transverse abdominis muscle gets quite activated and when you see the abdominal vacuum maneuver, you can see that really the transverse and all the abdominal muscles have this corset effect. There's a visible waistline reduction so that waistline reduction is visible during the exercise. But after two or three months of continuous practice, that means doing two or three sessions of 30 minutes over a period of three months. You can observe a statistical reduction.

Tamara Rial:                 13:07                Yeah, significant statistical reduction in waistline, we're talking about between two centimeters of average or 2.5 between 3.5 right? So that will be the average waistline reduction. So for people who really want to reduce their waistline because they want to look better or they're doing a competition for bodybuilding for example, they are really want to find exercise  that can achieve a waistline reduction without only thinking. Of course we all have to think about our food intake and our caloric expenditure. But when all those variables are taken into account and you also want to want to work on your natural corset that means your abdominal muscles. We all know that we have to train our core, but we can train our core in different ways. And one way that we have seen that also can be an alternative to normal or traditional core training methods is also the stomach vacuum or the abdominal vacuum or the hypopressive technique.

Tamara Rial:                 14:27                In fact, it's funny to observe that in the body building community they have a pose that they execute. That is called the stomach vacuum pose. And this stomach vacuum pose was a popularized by Arnold Schwarzenegger in 1970. There are many, there are some pictures of him that if you go to the Internet and you put an Internet Stomach vacuum pose, you can really see how he had a pose I think he's the king of the stomach vacuum pose. And he really popularized it because when he would go on stage, he will want to show his serratus. So a way to show the great development or the mass development of his serratus would be going into a big rib cage expansion, lifting his arms behind his head and just pulling in his stomach throughout this abdominal vacuum technique that is really hypopressives.

Tamara Rial:                 15:29                So he even wrote in his bodybuilding, he wrote that he usually trained this technique to achieve a waistline reduction. And if you see his body, it was amazing. He really had a very thin waistline and a big thorax. And now bodybuilder nowadays they're there. Well at least what they are seen as they're getting, they're having trouble in and getting a great lat spread and a great big thorax and in comparison have a very, very thin waistline. So that's why now we're recovering a little bit. This knowledge that he brought us in the 70’s it seemed that now more bodybuilders are being aware of doing this type of a stomach vacuum exercises. And even in Spain, the Federation of bodybuilding has a included the stomach vacuum pose again as compulsory for the male competition, which is kind of cool.

Tamara Rial:                 16:34                And that's why I think it was two years ago. And we begin to see a great demand of body builders to come to our classes to learn, only from aesthetic purpose is to learn the technique because it's not easy. It's not easy to be onstage, hold your breath, be smiling, and at the same time hold your breath for 10 seconds when you're already very tired and open, open your ribs and show that stomach vacuum so you really have to train it. And in our bodybuilders, that came to the course. She is amazing. Of course she was absolutely gorgeous, but she wanted to work a little bit more on her stomach vacuum pose.

Shannon Sepulveda:      17:20                Yeah, yeah, yeah. She told me that, that maybe the difference, like it like she's like, I need to learn this. And I was like, wow, that's, I didn't even think about that. And then when you showed us the pictures of Arnold Schwarzenegger I was like, oh yeah. I mean I remember seeing them as a kid, but I was like, oh, it totally is a stomach vacuum. And so I think it's really fun when you have all of people from different

Shannon Sepulveda:      17:50                backgrounds in the courses because it's just fun to talk to them and pick their brains and see like why they're here. So I thought that was, that was really cool.

Tamara Rial:                                         And how different people from different areas, from fitness professionals for women's health, from even massage therapists, it can have a common link. There was also the course, we had a several yoga instructors because I guess it also makes sense to incorporate a technique  that has so much in common with already yoga.

Shannon Sepulveda:                              Yeah. Can you tell us a bit about your research and your education and your PhD work?

Tamara Rial:                                         Okay. Yes. So as I said I was Spanish and I think some of our listeners have noticed that I have a little accent. Well say. I've grew up in Spain. I did my education, all of it over there.

Tamara Rial:                 18:54                I also did a semester in the University of Porto, part of my PhD and they laboratory of CNN, Tropo Matree with the professor. But my main focus was always a pilates, and some type of mind exercise. Mind body exercises a woman's health. So I began to get interested in this because I've seen at least in his Spain, it wasn't a woman's health wasn't a topic that was taught so much in the physical education and fitness community. We were talking about the benefits of exercise for health, but we were looking so much of the benefits of exercise also for Woman's health and how some type of techniques and pelvic floor muscle training could also benefit a lot. Mainly females and males who have some type of dysfunction.

Tamara Rial:                 20:00                And we really had to bring this knowledge into the physical education to the exercise science community and into the gyms. And I also think into the woman's community because sometimes there's that, well I really think there's this feel like great taboo talking about women's health issues. So maybe it will be easier if we begin to talk about it in a easy way from the gyms and bring this topic into the fitness instructors. So they would bring more awareness and also the coaches into the sports community and that way make aware to our woman and our males that there is option to, and there's options to take care of your pelvic floor and your health with exercising correct movements and how just by breathing you can affect immensely your pelvic floor health because we are not aware of how we breath, how we are standing now.

Tamara Rial:                 21:06                Now our listeners they’re maybe they're sitting in the car they're walking, but are we taking our time? Are we looking in was and are we feeling our brand that we fit in our body? So all those things I thought we, I had to bring it into the fitness community. And that's why I really wanted to focus on how some type of mind body techniques could impact urinary incontinence. And at that time hypothesis was not a very famous thing in Spain. I think it was not famous. Nothing. Maybe some pelvic floor PTs who had been taught in France. Know a little bit about it, but really it wasn't a big thing. So I learned about it from Marcel Frey, who was one of the main people and teachers who begin to get interested in this topic. So I thought, why don't I do a research study on this on urinary incontinence?

Tamara Rial:                 22:12                And I remember at the beginning it was hard because imagine telling your doctoral advisor that you want to do a study on woman that's kind of, okay, I'm focusing on women and then say I want to focus urinary incontinence. So I'm getting more specific. And then I say, I'm going to assess the effects of hypopressive exercise. When I said this word, he was like, what is this? And we went into the literature and there was nothing in the literature, nothing at that time. And right now there's still nothing. Okay. But at that time there was negative and it was kind of hard because what is the basis? There is almost no basis. And I know, I know I took a risk, but I began to apply it on myself and I begin to apply on some practitioners and I saw results very quickly and they were telling me even after three sessions that they already were feeling a decrease in their ordinary symptoms and they were, I was even shocked because I like time.

Tamara Rial:                 23:25                I didn't believe it. I was still one, I was one of the skeptic that's a little bit the reason why I said I want to study this to prove it's not working, but when people begin to already tell me, you know, I feel great and I begin to see how women were enthusiastic about it. I said, okay. I really had to give it a chance and that's how I got paid. I'm really passionate now about it and people say, you're very passionate. Why? I think that people who I work with made me passionate because whenever I see that somebody can benefit from what I'm teaching, that makes me happy. And that makes me really think that maybe I'm, if I'm making somebody better, I'm helping in some sort of way, I think that's how I've been driven to keep on in this path.

Tamara Rial:                 24:19                And also because I want it to make it more on evidence based or a technique that would have more support. Because at the beginning I would hear people say, hypopressives does this, or hypopressives does this, but there was no, there was no basis behind that. Even sometimes the physiological description of the exercise was wrong and people were very assertive. Like people would say, it does this to the body or you can achieve this, whatever. But what is the research like? What is the, what is the, even the physiological mechanism, which explains that. And, and there was very contradictory explanations in the literature because I guess nobody has really wanted dive into it and study to show that maybe it's correct or not as correct because I even at the beginning thought that maybe intraabdominal pressure doesn't increase or maybe decrease.

Tamara Rial:                 25:29                We still don't know. We still don't know what has happened at the thoracic level so we cannot just assume things if you really don't study it. I think that was the big mistake with hypopressives. People got excited and they began to say, there's no thing called hypopressives. It's fantastic and blah blah blah, but you cannot put something out in the market and say it is great without really having to first apply it with real people as it in a clinical way and then begin to do some short term studies or some physiological studies. That means, for example, if you argue that there is a decrease in pelvic pressure, you have to assess it. You cannot say it without even assessing, maybe not 200 people, but at least a group of people. And then from there, which we would have to see if there is some type of chronic effects.

Tamara Rial:                 26:39                We still don't have a research that really shows many claims that people say. So those are lacking in the literature. So we always have to be cautious and see, you know, we don't know. We don't know. People are getting some good benefits and they're claiming that they're feeling better. For example, they're feeling more posture rehabilitation or they feel there breathing capacity has increased. But that's anecdotal evidence and we have to prove that with more randomized trials. Right. So, that's a little bit how I started and I got interested in it and I'm still working with it and teaching. I came to United States and I did my first courses through Herman and Wallace, pelvic rehabilitation institute, and also through pelvic guru that we're the first people who trusted me in United States.

Tamara Rial:                 27:52                And they led their hand and they began also to hear from some pelvic floor practitioners who in United States who were already working with this. And I guess there was a little bit of spread of the word and that's why I think in the United States some people began to get interested in it and now let's just see how it works and hopefully more universities can open new lines of research on this topic because I think women's health and pelvic health, although if we focus a lot on urinary incontinence in pelvic organ, there are many other issue that have not been so much address like a hypertonicity, a topic for dysfunctions, pelvic pain. So there is still a lot of research that we can do. And I think also the area of alternative movement exercises, for example, Yoga and even pilates, there should be more, more interested in it because our woman and our people, our population, we need to move, we need to do exercise.

Tamara Rial:                 29:13                And we really, when there is a public condition, many women are afraid of moving and doing exercise. And I don't think it's good to tell a woman or to tell a postnatal mom, you know, you have to be careful, don't lift weights or don't do this exercise or don't do curl ups. So are I feel that sometimes we're frightening too much are woman and there and instead of going to the gym or maybe sometimes you can have a leakage and you say, Oh, I'm a little embarrassed because I'm leaking during my crossfit activity, but I love going to crossfit. So maybe I can also compliment my activity with other more pelvic floor friendly programs or with some programs that kind of counterbalance that high intensity activity. I kind of, I sometimes say that a low pressure of hypopressives are the best friends of high impact activities because we have the metabolic benefits of a high intensity interval training, which has a great background of research that shows that is one of the best type of training for many metabolic conditions for our cardiovascular health. So we want people and we need people to be doing their physical exercise. And on that note, we're going to take a quick break to hear from our sponsor and we'll be right back.

Shannon Sepulveda:      31:36                Okay, so we learned about some awesome new research in the course. So can you share that with us?

Tamara Rial:                                         Yes. Well, we still didn't know until some weeks ago what was happening in the diaphragm. Because it's true that when you do the abdominal breathing maneuver, the hypopressives maneuver, you're actually opening your rib cage in, you're holding your breath. So it was hypothesized that because you're using your inspiratory muscles to hold and expand your rib cage, that diaphragm what is happening it raises up, right? So imagine when you breathe in your diaphragm goes down, contracts and lowers the position and also the pelvic floor because the movement of the breathing and the synergy or the diaphrgm the pelvic floor diaphragm is synergistically, right? So then when you exhale, the diaphragm raises up and also the pelvic floor contracts and raises.

Tamara Rial:                 32:38                So when you're doing this hypopressive maneuver, what has happened is they're opening your rib cage in your allowing to your Diaphragm to raise up a little bit more. So that means that it achieves a little bit of higher position than when you're only exhaling because it's kind of a stretch of the diaphragm. But the question was, well, but what happens? Because we have some studies that have shown through ultrasounds and MRIs that when you're doing this hypopressive breathing, there is a pelvic lift, right? There's a raise of the pelvic floor and also the bladder and the uterus. So this is something you can actually see. And in the course we also see it in ultrasound measurements, but it's difficult to have an ultrasound measurement of the diaphragm and also it's difficult to see the pressure in your esophagus or in your abdomen.

Tamara Rial:                 33:40                Because that would have to be through a more difficult assessment that normally in the pelvic settings we don't have have. So normally if we want to assess in a pelvic floor or physical therapist setting the pressure, we can use intrarectal devices or intra vaginal devices. And that way when we're doing different types of maneuvers, we can assess what's happening, right? So when you're doing the maneuver, what happens with hypopressive is there's going to be a decrease of intrarectal pressure intracolon and also vagina, right? If you performing the exercise with the correct form, and I always like to say and this and make it a specific, that it's not something that you can achieve the first day of practice. You have to know how to correctly perform the technique as well as we teach how to correctly perform up pelvic floor muscle contraction to enable the pelvic floor muscle to really lift and contract and not to, for example, Bulge.

Tamara Rial:                 34:51                That can happen if the technique is not correctly performed or if they breathing phase doesn't accompany the contraction. So in the same way, when we're doing a hypopressive maneuver, what would happen is that we would exhale first and then after that exhalation we would hold their breath and we would only perform a voluntary muscle contraction of our rib cage muscles. So the question is the diaphragm what happens is a very relaxed is a very contracted, is it not? So Trista sin, which is my colleague and one of my friends who have, I been working also very closely and she teaches courses over there in Canada, she actually flew to Vancouver because there's a research group there who's going to access actually with the group of people who are going to do hypopressives and I can't recall right now his name, but he's a phd candidate who is a looking forward to do his phd on the effects of a hypopressive technique on the EMG activation of the diaphragm and also into the pressure management, intrathoracic pressure.

Tamara Rial:                 36:29                So we won't call it the pilot testing and because Trista is a very good practitioner, she already knows how to do the technique and I know that not everybody wants to introduce a catheter, it's not one of those research that a everybody would want to do. So she did it. And, we have the preliminary results that I can, I can read you some of them. And she also did different poses. So she did the analysis in the standing pose, which was more easier to assess also in kneeling. Because you don't have to move your face or you're not on a board where sometimes you can change the position of the catheter.

Tamara Rial:                 37:32                Yeah. And, also supine was an easy pose. So that's the assessment and there actually was electromyographic activity shown in the diaphragm from which would make sense because the diaphragm cannot relax. So there's a quite of lengthen in an activity going on even if you're doing the breath holding maneuver. So I guess that when they results on the group, they're going to test on the trial. We will get to know more of really what happens, not when you're doing actually that technique, but what would happen, what chronic effects would have your intercostal, your breathing muscles. And also your Diaphragm from when you're doing this kind of vacuum technique and also what happens into the pressures. So we would be able to show that there is a reduction, the reduction of thoracic pressure and intrabdominal pressure, which is kind of cool.

Tamara Rial:                 38:40                It's pretty cool because at least now you can say that it makes sense to call it hypopressives. So, well, that's the thing. And also when you're doing hypopressives, the thing is that you're lifting your rib cage and you're using your breathing muscles. So for example, they, SCM muscle increases his electromyographic activity because it's all it has, it enables their rib cage to lift, right? So whenever you're doing a hypopressive, you will really actually see the lift of the rib cage and also the widening of your intercostal rib cages. All the rib cage actually open. So also this serratus is a muscle that is also going to increase as is electromyographic activity. Right. And there has been another group from Brazil that actually did not a chronic study, but they did an acute study that they assessed the electromyographic activity of the abdominal muscles, so transverse, Oblique and internal oblique.

Tamara Rial:                 40:01                They did it through superficial electromyographic activity and it was with some female practitioners. They were healthy. There were no pelvic floor dysfunction. Just testing when you're doing the vacuum, what actually happens in the core muscles because some people think that when you're doing a hypopressive, maybe there's a high electromyographic activity, but really you're not doing an active contraction. For example, if you do a a crunch exercise or you actually contract forcefully your abdomen, you will have a very high electromyographic activity, but because what you're doing is just having a stabilizing pose that makes your spine grow and you're actually doing a low intensity postural activity and you're opening your rib cage in your muscles. There's not going to be such a high activity. There is an increase of activity but not so much on the rectus abdominis and the external oblique as much as there is in the transfers and in the obliques. So that's why it's especially indicated for people who need a rehabilitation of their deep inner unit and not so much of the outer unit. So especially in the first rehab phases for example, for those with lumbar pain and want to achieve

Tamara Rial:                 41:34                a greater mind body connection of your deep core muscles or we want to a connect that transverse and the pelvic floor. This could be a technique that we could use for example. So especially more indicated for our deep system. And then from there we can build on a more dynamic exercise that will recruit the larger muscles and the larger dynamic muscles.

Shannon Sepulveda:                              Cool. That's awesome. Thank you so much for that explanation of the new cutting edge research. I think that's awesome. In my experience, it seems like there's a little bit of controversy surrounding hypopressives and low pressure fitness where some women's health people are like, yes. And some women's health People are like, no. And in my opinion, not that it means anything, but my opinion about something like this is if it works for somebody and there's no harm in it, then why then what's the problem?

Shannon Sepulveda:      42:41                Because it's not like we're causing any harm with any of this. And so if it's a tool in your toolbox and it works for certain women, what's the harm? Yeah. Because really there is none. And so why not try it? But I just wanted to get your thoughts on, you know, what's going on in the, I mean, I feel like hypopressives are so hot right now. It's Kinda like diastasis is just so hot right now and it's the new buzz word I think in women's health, physical therapy. So, but there's been, you know, people are like, if people don't, I don't really know. But what's your take on all of that?

Tamara Rial:                                         There has actually been all a lot of controversy and even a lot of controversy in the scientific literature because I think it was last year there has been a discussion paper published by Carrie Bowen, a researcher from Spain, on hypopressives saying that there wasn't enough evidence to support that hyporessives could be an alternative exercise for women with pelvic organ prolapse.

Tamara Rial:                 43:54                So they based their discussion paper and their results on the articles that our group has published it on this topic. So I wrote a letter to the editor and it was published on the British journalist sports medicine blog. It's available and they had also a reply. So it's kind of funny when you get to have these replies. So there has been a lot of controversy even in this field because as I said before, it's true that there has not been a lot of research and there are studies that have been publishing from the Brazilian groups. They have done some studies on woman with prolapse. We can find a on pub med with the word hypopressive but my argument and my counter argument in the letter and the response to the letter to the editor that is available as you said in British Journal of sports medicine, you can read it is that the thing is when we are applying a technique and especially a technique as hypopressives, that is first difficult to teach, difficult to a specially properly perform if there's not a good instruction and supervision.

Tamara Rial:                 45:25                That means that first we have to assess if the person is correctly performing the exercise as well as anything as well as pelvic floor muscle training. We will teach first how to do a optimal pelvic floor muscle contraction before beginning the trial. We have to perform or assure that the person who is really doing that vacuum is actually doing a vacuum and if the form is correct that means does that person do a vacuum that is really lowering the pressure. Is that person really in the correct positioning or does that person need a little bit more of supervision of somebody who really knows how to correct and see if the pose is correct? Is the breathing so in the description and they papers and you can read the paper. They don't describe the exercise as a form of different postural exercises.

Tamara Rial:                 46:25                They only described that they performed on a technique where there is an abdominal contraction a transverse abdominal contraction. But that is that you don't really know. They have been doing the whole series of exercise as this has been described in the literature because hyporpressives are currently describe the technique as a postural base and a breathing base. So that was my critique that you're basing your argument on the low number of research that is still available and on research that doesn't describe quite maybe let's use the word accurately as all their manuals and other professionals and other also because we can see other research common from other groups that are already doing and describing the technique. And this happens a lot in exercise science and physical therapy. Whenever we're using exercise that involve a lot of supervision and technical instructions, we have to be very clear and describing that technique.

Tamara Rial:                 47:37                That means how many repetitions did you do, how many rest breaks, how many seconds did you rest between exercise and exercise? Because we know that changing one little variable can change the whole exercise. And, even when it comes to breathing exercise, we have to very accurate accurately describe the time that means, for example, you're breathing in how many seconds you're breathing out, what way you're really now doing a four, six inhalation, or you're breathing out doing a a more relaxed maneuver. Are you for example, doing a more intercostal breathing? Or are you doing a more diaphragmatic breathing using, you know, there's so many different aspects that if we really don't describe how is that technique, it's gonna be more difficult to replicate that and more. And it's going to create even more controversy between the readers or the listeners because we really don't know what the technique is about.

Tamara Rial:                 48:49                And many times we see a video on youtube. This is the worst thing to learn from youtube. I know that we all go to youtube many of our listeners are now, many people that are doing it, but you can see the person do the exercise. But how did you know if you're really doing what that person is doing it maybe you are contracting or you're trying to pull your shoulder up or it's Kinda hard and I would never I love watching those youtube videos and there are some yoga professionals that do amazing exercises, but it will be very hard for me to know if I'm doing the exercise correct if I don't have somebody that is telling me I think, I think you're doing the pose or even when I'm instructing pelvic floor muscle training, we really have to have somebody that is supervising that technique and giving us advice to progress in the technique.

Tamara Rial:                 49:56                So I think this has been the first controversy, the lack of research and the claims of some Gurus and like they is the best exercise for the pelvic floor. Well that's a huge claim. You can never do the say that and, or some people will have, I have also claim a hypopressives if you do hypopressive's is much better than Kegal Well, no, no, no, you can never have those because that's going to go against you and, and that's why maybe I think there has been such a bad reputation and also because maybe there has been a lot of marketing towards that waistline reduction. So if people say you're selling it as a tool that is only aesthetic, but it kind of sounds like a selling thing, right? Where we want to sell a product only because it Kinda is new, but why, what is it, how is it an other profession?

Tamara Rial:                 51:07                Is it professionally driven, technique driven, and that has been the big, I think, huge controversy in the literature and also between practitioners. Right. And I think also another controversy that I see from my point of view is, is that one of people trying to learn, learn it from professionals who learn it from youtube. If I'm not sure about it and I would rather not do it or if you really want to practice it. I always advise people even to exercise under the guidance of professionals and I know that sometimes hiring up a personal training or higher, you know, going to a physical therapist once in awhile people can say it's a waste of time. I think I'm good on my own. But no, even, even us as professionals, we should be instructed on the care of over there people because the eye of a professional is better than your own eyes and we need that supervision.

Tamara Rial:                 52:20                We need to a planification and we also need an assessment. So maybe when you're under the guidance of a pelvic floor physical therapist or a instructor, they would assess you and say, you know, maybe we should do other exercise or we should begin with this. But then progressed to other phases and talking about progression, the idea that hypopressives would be like the magic pill. No, I don't. I think that that's a very wrong message to tell our people because there's nothing that is magic pill there. It's a tool in your toolbox. So it can be something that you can do to help you in some part of your life, but then you're going to progress and then you're going to do more things. Because for example, hypopressive is a good maybe reputative tool kind of. Yeah, kind of reputation tool.

Tamara Rial:                 53:20                But I won't think that I'm going to get better improvements in my cardiovascular health doing hypopressives, for example, I'm not going to lose weight doing hypopressives it's not an aerobic driven kind of tool. So if you're beginning to sell a technique as something that is the best for everything, or maybe that thing of a reduces waists. So people say it's because it's because you're losing weight. No, no, no, it's maybe because you're getting a better posture so then you don't have such a bulge in your abdomen. We all know it. Right? If you have bad posture, your abdomen is going to bulge more so by again having a better posture or by having a better breathing habit, you're going to help you to have a better abdominal appearance. Right. And then if you tone your inner unit, that will also help, but we will never, never achieve a waistline reduction or a better appearance without a loss of weight because you almost don't use a lot of energy.

Tamara Rial:                 54:33                In fact the heart rate will even decrease a little so, so not not increase. Interesting. So we still have to do cardiovascular work. We can then counterbalance our running.

Shannon Sepulveda:                              I know. I was like I love to run and I was like okay, 20 minutes a day, 10 or 20 minutes a day. Like I can do this. And it actually felt really good because I'm so tight for running and I just like them. Then it was actually pretty awesome doing it in the class.

Tamara Rial:                                         Yeah. And many, many people who perform running or other type of high intensity activities or aerobic cardiovascular training, they use what he'd do this training, they could operate it after. So as a way of cool down. Yeah. So it's a set of doing other type of exercise or we can incorporate it into our cooling down or even our stretching because many poses are like our stretching houses lying on the floor, stretching and our arms stretching our legs.

Tamara Rial:                 55:41                So we just incorporate it and it's 10 minutes. You don't need much, you really don't need much. 10 minutes for those that need other 15 maybe 50 minutes and, and I think everybody can find 15 minutes in their day to have sum up some sort of mind, body practice. We really need it nowadays with so much going on. Social media.

Shannon Sepulveda:                              Yeah. Well, it actually, it was interesting, I was thinking about why it felt so good and why say I would stick to something like that instead of yoga. I've tried yoga before and I wasn't too into it. I think it's because never in my life have I stretched that area. Like it's so hard to stretch your thoracic area, right? Like I couldn't, there's no way. Or like even my rectus, right, your front abdominal muscles. Like it's, unless, I mean you could do up dog to stretch, but it's really hard to lengthen and stretch all of that. So it was like the first time in my life where like those muscles stretch and it feel really good.

Tamara Rial:                 56:39                Because we're stretching from the inside. You've seen our breath instead of pressing it down, we're pulling it inwards. So that's why maybe this sensation is different. I think also the concentration on the breathing in that now it gives you a kind of mindful sensation. So for many people, they only do it as a mindful practice. They're pressing because they're so focused in on their breathing. It takes you out of your daily worries.

Shannon Sepulveda:                              I think that's what I found too because it gave me something to like focus on, like I had an objective so I wasn't thinking about anything else because it's hard to do. And so it's also like a new challenge.

Tamara Rial:                                         Yes. Yeah. So it was really great. And to challenge your breath Holding and to only think as well as we count, we always tell people sometimes when they're breathing to count breath up to one, two, three.

Tamara Rial:                 57:41                So whenever you're counting, you're mindful in your present. And also we're gonna add they've beneficial effects of having us slow paced breathing. That's to add down train our nervous system. So we're also going to help us if we want to just do a mindful or a relaxation kind of technique.

Shannon Sepulveda:                              Well thank you so much for coming on the podcast. And so where can we find you? Email social media courses and you teach people like where can people find you if that.

Tamara Rial:                                         Thank you. My name is Tamara Rial So my website is tamararial.com but I'm very active in Instagram, so you can find me as Dr.tamararial and I also have another, another Instagram account that is a specific only, only for hypopressive that is called hypopressiveguru because I also teach other women's health programs, not only hypopressives.

Tamara Rial:                 58:53                So I focus also on the female athlete. Pelvic friendly exercises, so, so you can see all my programs and courses on my website, although in my social media, especially on Instagram and know the courses I'm hosting in United States are throughout Herman and Wallance and also pelvic guru. So if we'd go to the websites we would see their announce all the hypopressive or low pressure courses. And I think contact email is rialtamara@gmail.com.

Shannon Sepulveda:                              Great. Well thank you so much. We really appreciate it.

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on iTunes!

Jul 08 2019

1hr 5mins

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Rank #10: 392: Dr. Tim Gabbett: Debunking the Myths of Training Load

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On this episode of the Healthy Wealthy and Smart Podcast, I welcome Dr. Tim Gabbett on the show to debunk myths about training load, injury and performance. Tim holds a PhD in Human Physiology (2000) and has completed a second PhD in the Applied Science of Professional Football (2011) , with special reference to physical demands, injury prevention, and skill acquisition. Tim has published over 200 peer-reviewed articles and has presented at over 200 national and international conferences. He is committed to performing world-leading research that can be applied in the ‘real world’ to benefit high performance coaches and athletes.

In this episode, we discuss:

-The acute:chronic workload ratio and how it relates to risk of injury

-Is the 10% rule foolproof?

-Ways to quantify training loads

-Practical ways for practitioners to translate research into the clinic

-And so much more!

“Social media is great for sharing information but sometimes those myths get perpetuated on social media and they grow.”

“Risk doesn’t equal rate.”

“We don’t coach the number—we coach the athlete, we coach the patient.”

“Load is just part of the puzzle.”

“When you’re in the basement or when you’re in the ceiling, keep the percentage changes in load from week to week quite small but if you have moderate to high chronic loads then you can probably progress a little quicker.”

For more information on Tim:

Dr. Tim Gabbett has 20 years experience working as an applied sport scientist with athletes and coaches from a wide range of sports.

He holds a PhD in Human Physiology (2000) and has completed a second PhD in the Applied Science of Professional Football (2011) , with special reference to physical demands, injury prevention, and skill acquisition.

Tim has worked with elite international athletes over several Commonwealth Games (2002 and 2006) and Olympic Games (2000, 2004, and 2008) cycles. He continues to work as a sport science and coaching consultant for several high performance teams around the world.

Tim has published over 200 peer-reviewed articles and has presented at over 200 national and international conferences. He is committed to performing world-leading research that can be applied in the ‘real world’ to benefit high performance coaches and athletes.

Resources discussed on this show:

Gabbett TJ Debunking the myths about training load, injury and performance: empirical evidence, hot topics and recommendations for practitioners Br J Sports Med Published Online First: 26 October 2018. doi: 10.1136/bjsports-2018-099784

Gabbett Performance Website

Tim Gabbett Twitter

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!

Have a great week and stay Healthy Wealthy and Smart!

Xo Karen

Oct 29 2018

42mins

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Rank #11: 269: Dr. Bart Dingenen, ACL Rehab & Return to Play

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On this episode of the Healthy Wealthy and Smart Podcast, Dr. Bart Dingenen joins me to discuss rehabilitation following an ACL injury. Dr. Dingenen is currently both a sport physiotherapist at Motion To Balance in Genk, Belgium and a post-doctoral researcher and lecturer at Hasselt University.

In this episode, we discuss:

-Physiological and psychological considerations for return to sport following ACL reconstruction

-How to structure treatments to promote motor learning

-The fine line of early return to sport and the risk for re-injury

-Integration of sport prevention training at follow-up

-And so much more!

More traditional approaches to rehabilitation following ACL reconstruction are limited to the physiology of the athlete. Bart believes, “Knee focused outcomes can be valuable but probably don’t tell us enough about the big picture of that patient in front of you.” One outcome measure isn’t adequate enough to determine how an athlete is progressing through therapy and Bart stresses, “We don’t treat a structure, we really treat a person.”

Bart stresses that the most effective intervention addresses the sensory motor system considering the neuroplastic changes that occurred following injury. He states, “If we just continue to consider the ACL as a pure mechanical problem, I think you miss so much.”

The clinician’s role is to provide a rich environment that is sport specific, fun and challenging to ensure compliance and reduce risk of re-injury. Bart recommends, “People have no time to be consciously aware of their knee. They have to have fun and they have to move. These aspects have to be there in your training.”

Treatment sessions should seek to mimic an open and dynamic environment which challenges the athlete physically and cognitively. Bart warns, “If you do [ACL injury prevention training] the traditional way you see indeed the compliance rates are really low.”

For more information on Bart:

Dr. Bart Dingenen is a sport physical therapist from Belgium. He is currently working as a postdoctoral researcher and lecturer at the University of Hasselt, Belgium, in combination with his work as sport physical therapist in the private physical therapy practice Motion to Balance, Genk, Belgium.

He finished his PhD in 2015 at KU Leuven (Belgium) on postural control in relation to knee and ankle injuries. Bart published numerous papers in international peer-reviewed journals over the last 5 years on ACL injury, chronic ankle instability, athletic screening, injury prevention, postural control and jumping and running mechanics, and is a well-respected speaker at both national and international conferences, workshops and symposia.

Resources discussed on this show:

Bart Dingenen Twitter

Bart Dingenen Publications

Return to sport Video

International Knee Documentation Committee Questionnaire

Optimization of the Return-to-Sport Paradigm After Anterior Cruciate Ligament Reconstruction: A Critical Step Back to Move Forward

Tim Gabbett Publications

Email: bart.dingenen@uhasselt.be

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!

Have a great week and stay Healthy Wealthy and Smart!

Xo Karen

P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my blog post on the Top 10 Podcast Episodes of 2016!

May 01 2017

55mins

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Rank #12: 389: Steph Lagana: How Your Morning Routine can Change your Life & Biz

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On this episode of the Healthy Wealthy and Smart Podcast, I welcome Steph Lagana on the show to discuss morning routines. Steph Lagana is a Business Strategist and Spiritual Teacher. She leverages her background in national security to ground conversations on intuition and the energetics of business. Steph works with women to build their business and align with their strengths so they can market themselves naturally and powerfully in service of their calling.

In this episode, we discuss:

-Myths surrounding morning routines

-Practical strategies to implement your unique morning routine

-How long should I commit to develop a new habit?

-The benefits a morning routine can have on both your life and business

-And so much more!

“A morning routine can be anything that really you want to turn it into.”

“When you design your morning routine, you get to win your day.”

“You don’t have to do the same thing every day.”

“Be kind to yourself and honor that sometimes things happen.”

“If you allow yourself to set those boundaries, you can absolutely win your day.”

“The framework that works is the one that works for you.”

“You can revolutionize your life with tiny habits.”

“Your morning routine does not have to look like anyone else’s.”

For more information on Steph:

Steph Lagana is a Business Strategist and Spiritual Teacher. She leverages her background in national security to ground conversations on intuition and the energetics of business. Steph works with women to build their business and align with their strengths so they can market themselves naturally and powerfully in service of their calling.

Resources discussed on this show:

Steph Lagana Facebook

Steph Lagana Instagram

Mythical Enterprises Website

Miracle Morning Book

Tiny Habits Website

Your Sacred Craft Facebook Group

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!

Have a great week and stay Healthy Wealthy and Smart!

Xo Karen

Oct 15 2018

36mins

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Rank #13: 138: Dr. John Cryan, neuroscientist on the gut-brain connection

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John F. Cryan is Professor & Chair, Dept. of Anatomy & Neuroscience, University College Cork. He received a B.Sc. (Hons) and PhD from the National University of Ireland, Galway, Ireland. He was a visiting fellow at the Dept Psychiatry, University of Melbourne, Australia (1997-1998), which was followed by postdoctoral fellowships at the University of Pennsylvania, […]

Jan 18 2015

51mins

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Rank #14: 224: Sex!?! Part 2

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Thanks for tuning in to the Healthy Wealthy and Smart Podcast! Coming to you from Chicago, Drs. Sarah Haag, Sandy Hilton, and Jason Falvey join me for Part 2 on our discussion all about sex! You can check out Part 1 from CSM in Anaheim, California here in case you missed out!

In this episode, we discuss:

-Broaching the subject of sex with your patients

-Recalibrating sex after surgery and childbirth

-Rising rates of sexually transmitted diseases in the older adult population

-How a bladder diary can help those with persistent UTI

-And much, much more!

Sex has multiple health benefits outside what is commonly perceived and can be utilized as exercise. “There is so much that sex is good for cardiovascularly, musculoskeletally. It’s just awesome for so many reasons mentally. When we talk about population health and things that keep people moving and happy—that’s a good one.”

Sex is an important activity of daily living and can be a tool for clinicians to implement into their home exercise program. “Pleasurable movement is one of the things that help you get back to normal movement. So if you can make this make sense and feel good, it’s probably going to be one of the first and well motivated things you’re going to do in an exercise program.”

After patients have undergone surgery, surgical restrictions are not you’re only guiding tool for sex. “Always let pain be your guide, if it hurts, don’t do it. Sex is never supposed to hurt—it’s supposed to be amazing.”

We tend to forget about the vital functions our pelvic organs perform every day. “Peeing and pooping and sex, they are all very basic bodily functions and we can start to forget about it. If I ask any of you how often you peed today, you would have to think really hard and I betcha 10 bucks you’d be wrong with whatever you guessed. You can go pee mindlessly.”

Today's guests:

Sandy Hilton PT, DPT, MS: Sandy graduated from Pacific University (Oregon) in 1988 with a Master of Science in Physical Therapy and a Doctor of Physical Therapy degree from Des Moines University in December 2013. She has worked in multiple settings across the US with neurologic and orthopaedic emphasis combining these with a focus in pelvic rehabilitation for pain and dysfunction since 1995. Sandy has teaches Health Professionals and Community Education classes on returning to function following back and pelvic pain, assisted with Myofascial Release education, and co-teaches Advanced Level Male Pelvic Floor Evaluation and Treatment. Sandy’s clinical interest is chronic pain with a particular interest in complex pelvic pain disorders for men and women. Sandy is also pursuing opportunities for collaboration in research into the clinical treatment of pelvic pain conditions. Sandy brings science and common sense together beautifully to help people learn to help themselves.

Sarah Haag PT, DPT, MS, WCS Cert. MDT, RYT: Sarah graduated from Marquette University in 2002 with a Master’s of Physical Therapy. Sarah has pursued an interest in treating the spine, pelvis with a specialization in women’s and men’s health. Over the past 8 years, Sarah has seized every opportunity available to her in order to further her understanding of the human body, and the various ways it can seem to fall apart in order to sympathetically and efficiently facilitate a return to optimal function. Sarah was awarded the Certificate of Achievement in Pelvic Physical Therapy (CAPP) from the Section on Women’s Health. She went on to get her Doctorate of Physical Therapy and Masters of Science in Women’s Health from Rosalind Franklin University in 2008. In 2009 she was awarded a Board Certification as a specialist in women’s health (WCS). Sarah also completed a Certification in Mechanical Diagnosis Therapy from the Mckenzie Institute in 2010. Most recently, Sarah completed a 200 hour Yoga Instructor Training Program, and is now a Registered Yoga Instructor. Sarah plans to integrate yoga into her rehabilitation programs, as well as teach small, personalized classes. Sarah looks at education, and a better understanding of the latest evidence in the field of physical therapy, as the best way to help people learn about their conditions, and to help people learn to take care of themselves throughout the life span.

Jason Falvey PT, DPT, GCS: PhD Student Jason Falvey was awarded a Kendall Scholarship from the Foundation for Physical Therapy in 2014 and a Fellowship for Geriatric Research through the Academy of Geriatric Physical Therapy in 2015 to support his research examining the role of home physical therapy in enhancing function and reducing re-hospitalizations for medically complex older adults. He is also the primary investigator on a research grant from the American Physical Therapy Association, Section of Health Policy and Administration looking at the role of physical therapists in models of transitional care for older adults after acute hospitalization.

Resources discussed in this show:

Oswestry Disability Index

Finding a pelvic health PT

Holly Herman

Make sure to give Jason Falvey , Sarah Haag , and Sandy Hilton a follow on twitter!

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!

Have a great week and as always stay Healthy Wealthy and Smart!

Xo Karen

P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on Managing Expectations: It Shouldn't be That Difficult!

Aug 08 2016

58mins

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Rank #15: 409: Jamey Schrier, PT: Growing your PT Business in 2019

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On this episode of the Healthy Wealthy and Smart Podcast, I welcome Jamey Schrier back on the show to discuss business fundamentals.   Jamey is sharing his practice freedom methodology to practice owners all across the country who are looking for financial prosperity and a better quality of life. His book, The Practice Freedom Method: The Practice Owner’s Guide To Work Less, Earn More, And Live Your Passion, has been an Amazon #1 best seller.

In this episode, we discuss:

-How to establish a clear vision and find the why behind your goals

-Why comparisons to others will keep you small

-The importance of sharing the narrative behind your practice with your team

-Planning and budgeting for the bottom line that aligns with your goals

-And so much more!

“Measuring your progress, measuring your success compared to where you are now and where you’re going—when you do that—you stay in line with who you are.”

“When you put a pen to paper, it’s powerful.”

“Alignment is everything in our business.”

“Not knowing the answer isn’t the problem, it’s asking the right question.  The answer is out there.”

For more information on Jamey:

In 2004, Jamey Schrier was facing the soul-crushing struggles of private practice ownership. He couldn’t figure out how to grow his business without sacrificing family, income or time.

Armed with an insatiable curiosity, Jamey invested the next 9 years and over $300,000, to learn how to free himself from his practice. At the end of his journey, Jamey finally discovered the formula to creating a self-managed, profitable and stable practice that allowed more time with his family and more time to work “on” his business.

Jamey is sharing his practice freedom methodology to practice owners all across the country who are looking for financial prosperity and a better quality of life. His book, The Practice Freedom Method: The Practice Owner’s Guide To Work Less, Earn More, And Live Your Passion, has been an Amazon #1 best seller.

Resources discussed on this show:

Jamey's FREE training on howto generate referrals

The Practice Freedom Method Website

Jamey Schrier Twitter

The 7 Habits of Highly Effective People: Powerful Lessons in Personal Change

Start with Why

The Life-Changing Magic of Tidying Up: The Japanese Art of Decluttering and Organizing

Free online community for NetHealth

Email: jamey@jameyschrier.com

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on iTunes!

Have a great week and stay Healthy Wealthy and Smart! 

Xo Karen

Jan 14 2019

47mins

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Rank #16: 308: Dr. Christian Barton: Patellofemoral Pain

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On this episode of the Healthy Wealthy and Smart Podcast, I welcome Dr. Christian Barton on the show to talk about exercise for patellofemoral pain. Dr Christian Barton is a physiotherapist who graduated with first class Honours from Charles Sturt University in 2005, and completed his PhD focusing on Patellofemoral Pain, Biomechanics and Foot Orthoses in 2010. Dr Barton’s broad research disciplines are biomechanics, running-related injury, knee pathology, tendinopathy, and rehabilitation, with a particular focus on research translation. Dr Barton has published over 40 papers in Sports Medicine, Rehabilitation and Biomechanics journals, and he is an Associate Editor for the British Journal of Sports Medicine.

In this episode, we discuss:

-Why exercise is so important in treating patellofemoral pain

-Exercise prescription principles for optimizing therapeutic programs

-Muscle power and its role in absorbing load during activity

-Utilizing graded exposure to address fear around movement

-And so much more!

The current literature shows, “Exercise is the key intervention, along with education” for patellofemoral pain. Although uncertainty exists around specific exercise prescription parameters, Dr. Barton has found that, “The exercise that probably should be provided is primarily hip and knee based on current evidence.”

Dr. Barton is a proponent for conservative management over injections and surgical interventions for patellofemoral pain and encourages all clinicians to, “[make] sure that patients take this on board and you stop them from looking for quick fixes.”

While strength and power deficits will exist for individuals with patellofemoral pain, other factors such as recovery expectations and fear of movement can further impact clinical presentation and intervention. Dr. Barton stresses, “Ultimately, you need to treat the patient in front of you.”

For more information on Dr. Barton:

Dr Christian Barton, APAM, is both a researcher and clinician treating sports and musculoskeletal patients in Melbourne. He is a postdoctoral research fellow and the Communications Manager at the La Trobe Sport and Exercise Medicine Research Centre. Christian’s research is focussed on the knee, running injuries and knowledge translation including the use of digital technologies. He has written and contributed to a multitude of peer-reviewed publications and is a regular invited speaker both in Australia and internationally. He also runs courses on patellofermoral pain and running injury management in Australia, the United Kingdom and Scandinavia. He is on the board of the Victorian branch of the Musculoskeletal Physiotherapy Association, and a guest lecturer at La Trobe University and the University of Melbourne.

Christian is currently studying a Master of Communication, focussing on journalism innovation. He is an Associate Editor and Deputy Social Media Editor at the British Journal of Sports Medicine, as well as Associate Editor at Physical Therapy in Sport.

Resources discussed on this show:

Christian Barton Twitter

La Trobe University Sport and Exercise Medicine Research Blog

The International Patellofemoral Research Network

Proximal muscle rehabilitation is effective for patellofemoral pain: a systematic review with meta-analysis

How can we implement exercise therapy for patellofemoral pain if we don’t know what was prescribed? A systematic review

IPFRN Exercise Guide

2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 2: recommended physical interventions (exercise, taping, bracing, foot orthoses and combined interventions)

Hip rate of force development and strength are impaired in females with patellofemoral pain without signs of altered gluteus medius and maximus morphology

La Trobe University Blog: Hip muscle rate of force development is impaired in females with knee cap pain

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!

Have a great week and stay Healthy Wealthy and Smart!

Xo Karen

Nov 27 2017

23mins

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Rank #17: 241: Erin Jackson, J.D.: The Legal Side of Physical Therapy

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On this week’s episode of the Healthy Wealthy and Smart Podcast, Erin Jackson joins me to answer audience questions on healthcare law for physical therapists. Erin is a healthcare attorney, consultant, and health equity advocate. She also is a Managing Partner of Jackson LLP, a healthcare law firm in Chicago, and a Principal of Jackson & Co., a healthcare consultancy serving the compliance and business needs of providers and practices nationwide. 

In this episode, we discuss:

-Why every independent PT practice owner needs a Privacy Policies and Procedures manual

-How to know if your practice falls under HIPAA rules and regulations

-Can referrals and profit sharing be kickbacks?

-Creative solutions for pro-bono work

-What a good legal representative should know and how to find the right one for your practice

-Everything you need to know about treating Medicare patients if you’re an out of network provider

-And so much more!

Before committing to your first job, Erin encourages reading the fine print to ensure it is the right fit for you. She recommends to not, “take one that really isn’t going to allow you to treat in the way that you have spent all this time educating yourself to treat. You really deserve to be in an environment that advances your profession and professional existence in a way that matches your vision and all of your hard work for the past several years.“

There is a conflict of interest when incentivizing current patients to refer others to your clinic. Erin states the consequences are, “It potentially thwarts the accuracy of information about the quality of the services when people are getting financial benefit.”

Hiring a healthcare lawyer is essential when incorporating your practice to avoid unnecessary challenges. Erin states, “The number one mistake I see people making is they have had their accountants set up their businesses. Now most of the time this is okay if you're opening a widget store however different rules apply to opening healthcare practices.”

For out of network providers, the argument for treating Medicare patients has high risk. Erin stresses, “If you're not in trial and you haven't been caught or gotten in trouble for this stuff, I would say most people's risk tolerance is way too low to tolerate this sort of risk… If you want to see Medicare beneficiaries, then take Medicare.”

For more information about Erin:

Erin Jackson is a healthcare attorney, consultant, and health equity advocate. 

She is the Managing Partner of Jackson LLP, a healthcare law firm in Chicago, and a Principal of Jackson & Co., a healthcare consultancy serving the compliance and business needs of providers and practices nationwide. 

In addition to her healthcare practice, Erin serves as the President of the nonprofit organization Inspire Santé.  Using her healthcare knowledge and patient experience, she speaks to healthcare providers about the importance of maintaining a patient-centered practice. In the past year, she spoke at the APTA's Combined Sections Meeting, keynoted the Michigan Physical Therapy Association's conference, and appeared on podcasts like the APTA's MoveForward Radio.  In 2017, she will be speaking at physical therapy conferences around the country and expanding her reach as an educator, consultant, and advocate.

Websites:

Jackson & Co. Healthcare Consultancy

Jackson LLP Law Firm

You can get more great insight from Erin on twitter and from her persistent pain blog here and health law blog here!

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!

Have a great week and stay Healthy Wealthy and Smart!

Xo Karen

P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on The Do's and Don'ts of Social Media!

Dec 05 2016

1hr 15mins

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Rank #18: 377: Dr. Jarod Carter, DPT: Tips For Growing Cash Based PT Practice

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On this episode of the Healthy Wealthy and Smart Podcast, I welcome Jarod Carter on the show to discuss strategies for patient acquisition. Jarod Carter PT, DPT, MTC opened Carter Physiotherapy in Spring 2010, a 100% cash-based clinic where he provides an hour of one-on-one care in every treatment session. Via creative marketing and his reputation for producing fast results, his patient schedule was full within 6 months of opening his cash-based practice. In the fall of 2011, he released his first book My Cash-Based Practice and has been blogging, podcasting, and speaking on all aspects of the out-of-network practice model ever since.

In this episode, we discuss:

-Jarod’s top strategies for acquiring new patients and clients

-How to gain different referral sources in your area

-Why investing in video content has helped boost Jarod’s practice

-Investing time on the initial phone consultation for lead conversion

-And so much more!

“I don’t really promote the idea of physician marketing.”

“Video can be really, really powerful.”

“Giving them more than one option to connect with you and request information or start a conversation is huge.”

“Start developing your personal brand early on.”

“Start retirement investing right away.”

For more information on Jarod:

Jarod Carter PT, DPT, MTC opened Carter Physiotherapy in Spring 2010, a 100% cash-based clinic where he provides an hour of one-on-one care in every treatment session. Via creative marketing and his reputation for producing fast results, his patient schedule was full within 6 months of opening his cash-based practice. In the fall of 2011, he released his first book My Cash-Based Practice and has been blogging, podcasting, and speaking on all aspects of the out-of-network practice model ever since. After over 5 years of researching the subject and consulting with many legal and compliance experts along the way, he released his newest book: Medicare and Cash-Pay Physical Therapy

Jarod enjoys surfing, swimming, travel, and time with family. He married the girl of his dreams in April of 2015 and they welcomed twins into their life in January of 2018. They currently reside in Austin, TX with their golden retriever, Stella.

Resources discussed on this show:

The Cash-Based Practice Podcast

Cash-Based Practice Podcast iTunes

Jarod Carter Website

Carter Physiotherapy Website

Jarod Carter Twitter

Jarod Carter LinkedIn

Jarod Carter Facebook

Jarod Carter Youtube

Patient Sites

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!

Have a great week and stay Healthy Wealthy and Smart!

Xo Karen

Aug 30 2018

30mins

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Rank #19: 374: Dr. Susan C. Clinton PT, DScPT: Pelvic Pain in Pregnancy

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On this episode of the Healthy Wealthy and Smart Podcast, I welcome Susan Clinton on the show to discuss a pelvic health case study.

On this episode of the Healthy Wealthy and Smart Podcast, I welcome Susan Clinton on the show to discuss a pelvic health case study. Susan C. Clinton PT, DScPT, OCS, WCS, FAAOMPT, WHNC is an award winning physical therapist and the co-owner and founder of Embody Physiotherapy and Wellness. She is also an international instructor, mentor, and presenter of post-professional education in women’s health and orthopedic manual therapy. She has helped thousands of people with pelvic and orthopedic problems discover continence and health, reduce pain, and return to their activity goals.

In this episode, we discuss:

-The most important part of the evaluation: the subjective

-Assessing load and posture and the effect on the patient’s symptoms

-Designing a home exercise program to enhance and deemphasize different movement patterns

-How to progress your treatment and allow the patient to help strategize

-And so much more!

“If you ask the questions in the right way, you can get some deeper answers back.”

“It’s easy to take your eyes and go straight to the pelvis.”

“It’s so hard to evaluate and not treat.”

“There’s no such thing as a bad posture, it’s just a dominant one.”

“They just get into patterns.”

“Let’s stop trying to endure and start trying to make changes in the moment.”

“People hear about 10% of what we say.”

“There is no right or wrong.”

“If I lock her into one movement pattern, I’ve sunk her boat.”

“Having a family is a contact sport.”

For more information on Susan:

Susan C. Clinton PT, DScPT, OCS, WCS, FAAOMPT, WHNC is an award winning physical therapist and the co-owner and founder of Embody Physiotherapy and Wellness. She is also an international instructor, mentor, and presenter of post-professional education in women’s health and orthopedic manual therapy. She has helped thousands of people with pelvic and orthopedic problems discover continence and health, reduce pain, and return to their activity goals.

Susan is active in teaching and research as an adjunct instructor for the University of Pittsburgh, Chatham and Slippery Rock University. She is a published author in peer reviewed journals on topics such as chronic pelvic pain and clinical practice guidelines for pregnancy and pain. She is the co-host for “Tough to Treat – A Physical Therapist’s Guide to Treating Complex Patients”.

She is active with the American Physical Therapy Association, American Urogynecologic Society and the International Continence Foundation. She is the Co-founder and Board of Director for the Global Women’s Health Initiative.

Susan resides in western Pennsylvania with her husband and enjoys walking / hiking, ballroom and country line dance. She is an avid supporter of music, the performing arts and international objectives for women’s health.

Resources discussed on this show:

Embody PT Website

Susan Clinton Twitter

Susan Clinton Instagram

Susan Clinton Facebook

Email: susan@embody-pt.com

Clock Yourself App

Tough to Treat Podcast

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!

Have a great week and stay Healthy Wealthy and Smart!

Xo Karen

Aug 20 2018

1hr 9mins

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Rank #20: 366: Brianna Battles: Pregnancy and Postpartum Athleticism

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On this episode of the Healthy Wealthy and Smart Podcast, Shannon Sepulveda, DPT guest hosts and interviews Brianna Battles on training post­partum athletes. Brianna Battles is the CEO of Everyday Battles LLC. She specializes in coaching pregnant and postpartum athletes, as well as educating coaches on how to help athletes navigate the physical and mental considerations of athleticism during these chapters in a woman’s life. Brianna has online courses and resources for both fitness professionals and athletes and is the founder of the movement and online education, Pregnancy & Postpartum Athleticism. She has built an international team of coaches who are equipped to work with pregnant and postpartum athletes.

In this episode, we discuss:

-Common diagnoses following pregnancy that impact an athlete’s performance

-How trainers and physical therapists can collaborate for the postpartum athlete

-The good and bad of social media during the postpartum period

-Cultural expectations surrounding what postpartum should look like

-And so much more!

Adjusting a training regime during pregnancy and postpartum can be a huge psychological hurdle for athlete’s to overcome. Brianna has found that, “We have to make the most informed decisions possible without ego getting in the way.”

Shifting cultural expectations surrounding what you should look like or be able to do during postpartum is one of Brianna’s biggest goals. She stresses, “Birth is a big deal. Pregnancy changes your body. And postpartum is not just a six week timeline it’s an ongoing change.”

While social media can be full of inspiration, it may also only show us the highlight reel of how someone has been progressing through postpartum. Brianna reminds, “Never compare yourself to who you see on social media and what their story is.”

For more information on Brianna:

Brianna Battles is the CEO of Everyday Battles LLC. She specializes in coaching pregnant and postpartum athletes, as well as educating coaches on how to help athletes navigate the physical and mental considerations of athleticism during these chapters in a woman’s life. Brianna has online courses and resources for both fitness professionals and athletes and is the founder of the movement and online education, Pregnancy & Postpartum Athleticism. She has built an international team of coaches who are equipped to work with pregnant and postpartum athletes.

Brianna is an advocate for women who want train during pregnancy and make a sustainable return to performance, lifestyle, function, career and activity in the postpartum chapter. She has been able to accomplish this not just with her own coaching efforts, but by also educating coaches to do the same in their communities and online.

Brianna has a local strength and conditioning program, but has shifted her focus to working online and traveling for seminars in an effort to reach a broader audience.

She has experience in coaching in Division 1 collegiate athletics, corporate wellness management, personal training, strength and conditioning, presenting, remote coaching, mentoring and habits.

Brianna has her Master’s Degree in Coaching and Athletic Administration and her Bachelor’s degree in Kinesiology. She is an active member of the NSCA where she is a Certified Strength and Conditioning Specialist (CSCS), and a USAW Sports Performance Coach. She has completed multiple continuing education courses and mentorships in the women’s health and strength and conditioning realm.

She lives in Southern California with her husband, 2 sons (Cade and Chance) and 2 boxers.

For more information on Shannon:

Shannon Sepulveda, DPT, M.Ed., CSCS, WCS is the owner and Physical Therapist at Shannon Sepulveda, DPT, PLLC. She is an Orthopedic and Women’s Health Physical Therapist and is currently the only Board-Certified Women’s Health Physical Therapist (WCS) in Montana. Shannon received her undergraduate degree from Dartmouth College, Masters in Education from Harvard University (M.Ed.) and Doctorate of Physical Therapy (DPT) from the University of Montana. She is also a Certified Strength and Conditioning Specialist (CSCS). She has been a practicing Physical Therapist in Bozeman, Montana for over 6 years. In her free time, she enjoys running, biking, skiing, hunting and spending time with her husband, son and daughter.

Resources discussed on this show:

Email: briannabattles@everyday-battles.com

Brianna Battles Website

Pregnancy and Postpartum Athleticism Website

Brianna Battles Instagram

Brianna Battles Facebook

Women’s Health APTA

Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!

Have a great week and stay Healthy Wealthy and Smart!

Xo Karen

Jul 23 2018

59mins

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