How To Make The Most Out Of Physical Therapy with Jessica Cozine-Lehman | Koopcast Episode 99

trail and ultra runners what is going on what's happening welcome to another episode of the KoopCast as always i'm your humble host coach Jason Koop and this episode of the podcast kicks off a series of podcasts that is all about how to use and leverage physical therapy to keep you on the right side of the injury line those long-time listeners of the podcast will know and recognize that staying injury free is one of the most problematic aspects of running and trail runners are no exception to this and so over the course of my career i have gone to great lengths to develop a network of physical therapists and also have a mechanism to develop that network of physical therapists that i can lean on with my athletes and so starting this week october 21st i have three of the physical therapists that i have used the most personally and with my athletes to glean a little bit of insight into not only what it takes to be a good physical therapist but also what you can look for when you are when you are navigating this landscape and trying to find practitioners in your area starting this week october 21st we have jessica layman who happens to live here in

colorado springs colorado and then on october 28th we're going to bring on my good friend john chow and then finally on november 4th we're going to have nat collins come on in each of them what i appreciate about them the most is they bring not only a tremendous track record of success with patients and athletes alike but also the way that they think about how to treat patients and how they have set up their businesses in many cases to better serve patients is something that i think that we can all learn from so on the podcast today we have jessica layman who just happens to be a very good friend of mine she lives right around the corner in fact she came over to my house to record this podcast and you hear my dog in the background every once in a while you guys will have to forgive me for this but i'm not just bringing on jessica because she's proximate to me i'm bringing on jessica because she also is a partner in her own physical therapy clinic great moves here in colorado springs colorado which has been very successful over the course of the past i can't even remember how long it's been open since 2009 i believe but she also is a very well-rounded practitioner she's been a member of the american physical therapy association since 2001 she has also served on colorado's apta board and is also the co-chair of the professional development committee and serves on the colorado delegation at the national house of delegates in addition to that she has received the bob doctor service award in 2008 and was named

outstanding physical therapist of the year in 2014 by the colorado apta jessica is one of the people that i have leaned on the most not only to send my athletes to not only to get treatment myself but also how to network and go out into the space and navigate this really complicated world and try to find high quality physical therapists that can work with endurance athletes her insights are invaluable and i guarantee you you will pick up a ton of nuggets of wisdom for not only how to navigate this area yourself but also how to take advantage of these physical therapy visits once you get into the office so there we go there's the preamble i hope everybody sticks around for the next few podcasts i'm going to get right out of the way here it is my conversation with my good friend and one of the most outstanding physical therapists i've gotten to know over the years this is jessica layman so i was reminded when i came into the clinic yesterday that you guys have been there for a long time yeah we have been there for well we've been in business for 21 years that's a long time to have physical therapy clinic it is it is particularly in this day and age yes well it's so so much so i actually looked it up this morning do you know what the average length the average career length of a physical therapist is i don't what would you guess so what i do know is that it takes two to three years

is about what they stay at a particular practice which is also not what our therapists do luckily um but i don't know the length of the career i got between five and seven years wow when i was looking it up wow that's surprising to me actually that is that long it's that short that is that short because of the investment yeah it's a huge educational cost up front that's a little bit of what we're going to talk about yeah it it's a massive investment um and we're trying to shift that a little bit within the profession um trying to make it not such a burden uh but it is it's a big investment of time energy and money right now so let's start out with that because what ultimately what i want to come out of this conversation with is a little bit of a toolkit that athletes can use to kind of survey the landscape of physical therapists because you and i have a really similar view on physical therapy you know on physical therapy and me on coaching where we can look at the landscape we've been doing it for so long right i've been a coach for 20 years you've been physical therapist for about that same length of time as well right yes and that gives you perspective on not only how that landscape has changed but how other people who are trying to navigate it who aren't as savvy can can can come in and have a successful experience because we both have the experience me on coaching you and physical therapists that have had great experiences people come in they just happen to find a great physical

therapist or a great coach and then the opposite is true and if you're not if you don't have that kind of level of experience in the field and or in that particular industry it's it's really hard to like say ah you shouldn't go there but you should go over here i agree i hear you on that and i think that we take for granted until you just pointed that out we take for granted that base of knowledge to be able to quickly assess what is quality and what is not quality exactly so i've known you throughout almost the entirety of that educational journey is true which is which and i apologize for that no i don't apologize at all i can remember like you invite you and jim inviting me into your house sleeping in your basement when i was a knucklehead 21 year old and you going to you know night school and just trying to like figure out the whole deal so really quickly try to like try try go over that educational journey that a doctor of physical therapy will will have to go through if they if that's if that's what they choose to undertake so the traditional journey which is not what i took um is to go to four years of undergraduate school major in a form of science one particular science or another knowing going in that you have prerequisites that are specific to pt school which are unique they're a little different from what it would be for uh going to medical school or going to

some of the other health care professions so one thing that's unique is you need a background in psychology so there are psych classes that are mandatory if you're applying to pt programs um some require calculus some don't so you have your four-year degree with the specific prerequisites that must be included athletic trainers great background um that's a great four-year undergraduate degree to come into pt school with because you have so much hands-on experience yeah yeah and and you get a lot of the um just on the field experience that we don't necessarily get in pt school so you have that then you go to a doctoral program they're two and a half to three years and they are in their year round so you don't get summers off anymore probably remember no breaks complaining about that um but it's intense it's a lot it's a lot to go through and it is your full-time job so the only person in my pt class that quote unquote worked outside of pt school she was mountain bike racer a pro and she would just basically and she already had a master's degree in exercise uh physiology so she had a lot of the science background already and that caliber of graduate level academics so she could handle it uh she would just basically take off on a friday and go race and come back and most people didn't even know she was racing so that's about the only kind of work that you could manage while you were in pt school because it was

you know nine to five plus the hours afterwards is that intentionally designed to like weed out people that can't cut it i mean kind of like any other medical school right they intentionally designed it very in a very difficult fashion to like cut through a little bit of the duff 100 percent um in fact our first semester i'll never forget our anatomy professor dr cliff barnes he had us all sitting there and we're all nervous first years and he said okay here's the deal i already know because you guys are in this room i already know that you're accomplished and that you are successful academically and i know you're smart i said so you spent the last four years kind of clawing your way making sure you get the best grades making sure you get all a's because you wouldn't get in if you didn't have it there is a history of people applying to pt school multiple years in a row because it's hard to get into um so anyhow he said right now in our learning model is where you have to set that all aside and we all you can hear crickets you know what are you talking about no we're used to being competitive we're used to being you know got to get there got to do this the best and he said so if you don't settle down with the competitiveness you'll never make it you guys need each other to get through this program and if you don't he said this is not medical school and it's not law school you are not what we don't do is you're not graded you're not put in a system where you know you choose

your residencies or clinicals based on your rank he said we don't rank you he said and some of my b students are actually some of the best clinicians because they see the big picture they're not just academically strong which was just for all of us we're all like what are you telling us don't get we don't know what you're saying right now um so he just had this really common sense down to earth little talk for us that i think probably all of us remember so it is very competitive and and that being said you can't get below a b and stay in pt school so it's not like you know i've heard you know with medical school you what do you call someone who's not doing well you know in p in in uh their world you still call them doctor at the end of the day right so our world was not quite the same if you drop below a certain gpa you would get kicked out of the program or probation and then kicked out of the program so as much as they said you know you can't be competitive you can't be well you still had to be extremely on your game that's pretty tight but i mean the what was fascinating to me after talking to you a little bit about this is and i didn't appreciate this until more recently it's kind of the interdisciplinary approach that a physical therapist has to have it's not just all anatomy and physiology and working with your hands i mean you have to have a psychology degree as well you have to have some classes in psychology you have to have a background in it yeah yeah or at

least a background in it yeah yeah and i think that's part of what's unique it's such it's so focused on the human experience i mean really our job is to make people get through this world with movement and the best movement possible the best quality movement the least painful movement um not all not not just pain free the least painful i like the way that sometimes we have to say that right because we deal with people with chronic pain how are you going to manage it you know we know for one reason or another that this isn't going away but does that mean you do nothing that would be the worst thing for you how do we help you compensate and get through and live a life outside of your world pain um get you moving because movement is medicine at the end of the day that's how we see it so we also have to work in our profession when we're going through our clinicals even if you end up in an outpatient setting you in your clinicals had to work in a hospital setting and that means you had a team you had speech therapists occupational therapists physicians nurses you had everybody respiratory therapists and often we have to sort of be a quarterback with that oh i think we need this now we need that now in the military world pts are more like primary care we actually do a lot of the triage and um that's so that's how we're trained we have that capacity we just don't always use it or the setting doesn't

allow for us to use it and let's kind of shift i think that's a good transition point to shift over to the outfit that you've had now for 21 21 years great moves physical therapy here in colorado springs colorado i've been there myself i've sent athletes there our coaches have been there so we've got the trifecta of people that are there but it's not only athletes that are there i mean you see a really wide range of patients as i experienced just the other day in terms of abilities and age and background and on and on and on and on describe the practice though just to like paint paint the picture like who's working there what clinicians do you have there why do you have those people there so um we we start out small right we only had three of us and in back when i started there um and jackie corey started the clinic in 2001 on her own i was still in pt school and um she's also a regis grad and that's how i met her was through the regis connection so um we started small and then we moved into a bigger space in 2010 and that's when we expanded so now we have six physical therapists all with different backgrounds we have two massage therapists and we have two fitness trainers so our model is that we're a whole person type of facility and we're on we have a wellness focus very traditional physical therapy and we have a wellness focus and that blend i think is what

allowed us to stay in business so long um and very um the span the lifespan throughout the lifespan we do not treat young children pediatrics is its own entity i have a lot of respect for pediatric physical therapists so uh teenage athletes yes outside of that if i do see uh in the adult population orthopedic and neurological uh issues that's in my wheelhouse both of those for pediatrics it's a little bit different for neuro the neuro side of that so i really lean on my uh pediatric colleagues for that if somebody needs that kind of treatment so our practice um we have um a golf specialty um because it's badass by the way thank you it's totally badass thank you we have a golf simulator it's fun so it's cool when my business partner and i built this facility we actually toured spas and medical facilities and we wanted to blend that because we wanted to be a place where people felt like it wasn't too sterile and stiff that they could get better and feel comfortable and we feel like that sympathetic nervous system when you walk into a medical facility sometimes just goes up automatically people put their guard up and so we thought could we create this this blend a little bit so people walk in and feel like it's a little different it's a little bit more calming it's a little more fun it's a little it's just different so we wanted that to be um obvious when you walked

in the door so we we really built the inside of the facility we gutted it and we redid it and we really put it put that in mind like let's make the treatment so treatment room individual treatment rooms uh that's one of our focuses and we think that allows the person to speak freely we're often speaking people about really personal things i mean i treat uh pelvic health issues as well so that area for sure you want a quiet private space for that so we really designed it with healing and wellness in the forefront and and then um we lean on our medical background to create the rest i'm starting to see more and more physical therapy outfits that are like that just in the space i mean it used to be where you walked in and they had a cable cross machine and a little floor and some you know trinkets and toys and things like that but everything was open right they're just benches it almost resembled like uh my old college like athletic trainer rooms right where they're just benches and people and everything was just kind of open air yeah and it just seems like gradually they've been shifting to more i want to use the word interdisciplinary but it's not quite the right word where it's just they're bringing in more assets like more more people assets right the massage therapists the ptas the strength and conditioning people like to to try to create i'm going to use the cliche word holistic right yes it's like holistic experience with the uh with the with the patient

and it sounds like you guys did that deliberately over the course of years because you can't do all that at once unless you get like investor money venture capital money thrown at you which is really rare in this space that was not but you've got to do that gradually over time and it seems like that was at least at least partially deliberate on you and jackie's accord it was our vision this was our one place we wanted to build our dream pt clinic and that's what we set out to do so oh and i have an alter g that's my maybe i can't forget about that that was you know jackie got her golf simulator i got the alter g so that was it um so we both got something great out of it because i love working with endurance athletes so um and it's really great for many populations actually parkinson's folks with parkinson's it really helps a ton with that uh group of individuals so um and i should add in this is hot off the presses this is not public information yet but it's about to be breaking news breaking news um we we have had one or two ptas work with us in the past um because of our facility we really require just a certain level of experience and um we've just um gotten word that uh allison dunlap will be joining us oh nice and she's in the endurance world a little bit yeah you're gonna have to tell everybody who allison is this is a running crowd and they kind of get like too much tunnel vision we all do that cyclists do that too triathletes do that right you know the people in your world

uh her background is pretty fantastic she has an undergraduate degree in biology from color to college and and i think her story hopefully i'm not making it incorrect but i think this is pretty much it she tried out for the soccer team and they were about second in the nation so she didn't make it not because she's not great but because they're a great team and uh she decided to try riding your bike so she started riding her bike and riding it more and uh suffice it to say she did pretty well with it she's the uh she was a world champion the first world champion first women's mountain bike world champion i actually was there that day having no idea i was watching history yes i was there that day i was in pt school i came up and i was studying that weekend but i happened to come out so i was like oh allison i know her i'm gonna watch her race i had no idea what i was watching that's hilarious um that picture of her at the finish line with the american flag so so for the listeners it was right after 9 11 so the whole country is in a little bit of a shell shock mountain bike world championships the first women's mountain bike world championships was in vale colorado that year and allison dunlap who's kind of a hometown kid at this point right went to colorado college yeah ended up winning the race and i'm kind of tearing up about it right now because it's such an emotional thing she crossed the finish line with an american flag and it was just this spectacular moment so she's joining your clinic yeah and olympic athlete too i mean she went on to you know maybe go to the olympics and um and just a fantastic person i mean she her level of care i actually have a patient right now it was really

funny elderly woman so this is where we get that lifespan so i certainly see people in the geriatric population and she had had a fall and was in a rehab setting she said oh i had this student working with me at my um at the end of my stay at the hospital and she was just amazing and this this woman rides her bike to denver for thanksgiving and her son and her son is young and he rides his bike to denver for thanksgiving and i'm thinking this is sounding really familiar there are not many people in this world who will do this and said a couple more things and i said her name wouldn't happen to have been allison would it yes we're still in touch with her how do you know allison she's amazing but just this impact she had on this woman and it just speaks to her her gifts i think which which we are so excited to bring into our clinic yeah she's a great person as well yes she is okay so here's the here's the million dollar question though because people want to be able to like navigate this space yes and it's really easy for somebody to look at somebody like allison with her background former world champion olympian fantastic oh i want her to treat me because she has the street cred right i know you don't have that tight of a lens on things and so let's use that as as a little bit of a transition point to how do you evaluate people that are coming into your clinic as qualified physical

therapists and maybe use that as a little bit of a lesson for the audience out there to do the same when they're trying to navigate this space as well so i really feel strongly about their engagement with american physical therapy association the apta if they're a member of the apta that's a really good start uh only unfortunately i think it's 35 percent 40 percent of our profession are members and we're working to change that i've been a member apta since i was a student actually what's the limiting factor in that uh oh i don't want to be too um critical uh people say it costs a lot no it's cost yeah yeah it does that happens in any certifying body sure but it really for what you get it doesn't oh the and and they don't see what what the apta does for them they don't do anything for me oh got it well being part of i don't want to like go on a diatribe here but being part of the colorado apta i can tell you our practice act is unbelievable it's so open we have so many avenues you can treat animals in colorado we're the first state to do that really so licensed physical therapists who were working with animals and and vets had to be vet techs they couldn't say they were licensed doctor of physical therapy because we were only licensed to work on humans so when our sunset came up which is your practice act gets opened every seven years or so completely opened anything can change well we changed this um and allowed we said uh i believe this patient and we use that as a term as

opposed to person person or human that's opening that world for those people working on animals to come out as doctors of physical therapy so that's that's a part of it you know there's so much in the background legislatively in particular that we do but people who aren't involved i think just don't know so they don't see the benefit for the the cost they just don't understand how the profession works and keep can people look that up if their physical therapist is associated with that they can yeah are you an apta member so you go to uh the apta.org and you can find a physical therapist or find a pt okay just like you can the aumt one yeah we'll talk about that one too so that's a good start and then you can look for a an acronym ocs which means they're an orthopedic trained specialist i am not an ocs even though i've been trained that way but not i don't have the certification and have so that's a little bit tricky because some people won't have it even though they have a skill set but again if you're just shooting in the dark and you're going to new state and i do this right when i'm looking for therapists for people and i don't know anyone in that particular city i'll start there i'll just make sure they have these certain credentials that i know will narrow it down a little bit yeah so that's a way to start um looking for the pt side of it um and sometimes you can get amazing pts and they're in the wrong setting that's where we get to what type

of setting are you looking for um and i would obviously be a little biased towards the private practice side right because we have freedom to do what we want so we aren't owned by anybody it's pt owned and physical therapy owned practice is another thing to look for versus a hospital owned or owned by a physician owned physician owned yeah so and what's the in your in your estimation what's the advantage of being physical therapist owned so some of the advantages that i see as a physical therapist when i have a question i have a referral from a doctor or i or i have a patient who's just coming from surgery and i'm their pt so it doesn't matter who the doctor usually works with they'll come work with me that type of thing if something isn't going quite right i have i don't have any issues asking questions because they're not signing my paycheck oh interesting that can be tricky yeah yeah you sort of don't bite the hand that feeds you yeah technically in colorado it's on all states in colorado they're illegal they're called pops physical errors physical or physician-owned physical therapy services um there's a loophole which is what's used by um physicians that that have pt practices so they're legal entities i'm not trying to say they're not right now but the they're not staying within the ethics of the intent of that law but the so the the chain of events that you're gonna have to correct me if i'm wrong here on this because i don't know quite the organizational

structure as well as you do but the chain of events that a lot of people experience is is they go into a surgeon orthopedic setting they have rotator cuff surgery right from that surgeon they get assigned a physical therapist that's within that practice right that would be a physician-owned physical therapy type of clinic and what you're saying is and i never ever have thought about this like that that there is a little bit of a conflict between that physical therapist caring for that patient and their boss essentially being the person who did the surgery and coming back to the surgeon and saying dude or lady wtf like what do i do with this patient now that's so i've never i've never ever thought about that so it's it can be a really awkward and maybe not best for the patient situation so right who's signing your paycheck that's important okay so so and again i'm not trying to say that there aren't amazing physical therapists working in those settings and that those physicians aren't amazing that's not true they all are amazing it's the structure that i think can set you up for a decrease in questioning and conversation sometimes um on the flip side they know the surgeons really well so they're right down the hall maybe they can do that but what i have seen what that's how they always sell it too and what i have observed though is there's not a lot of questioning going on in those environments i never thought about it like that yeah it would be just it would be difficult i would be the same it'd be difficult for me to do right if i'm well it might not be for me to do

because of my personality be clear that's why i'm in private practice yeah exactly so how else would somebody get hired on at great moves we've already talked about they have to have good you know patient care they have to be involved in the physical therapy association you prefer a private practice what else is on the checklist if there is a checklist manual therapy they have to be manual therapists so they really need to work on people so i've had people show up for interviews saying i'm a manual therapist and i this is this might sound terrible but i'm just gonna say they have long long painted or fake nails jason i'm not gonna lie i don't know why they came to the interview uh you can't i mean minor you can see some white right now my nails which means they're this is really long for me i mean you can barely see the white but that's no you're not working with your hands on people so that's a red flag for me it sounds terrible but that is part of the process and it it maybe it sounds petty but as a manual therapist you can't do your job that way yeah so obvious red flag don't have long nails um so uh so that that's when i really look at their their backgrounds where they've worked how long they've worked there so for me the other piece is longevity we're going to invest in this person and i don't mean invest just in a fiscal manner i mean we're like a small little family like a team so we invest in them emotionally we want to support them and their family or where they have going on we

really like to have that as part of our clinic if they've been somewhere and they're the typical two to three years in a setting and then they moved on that's another flag i do the same thing with our coaches do you oh gosh whenever i see that on a resume it's a like a huge red flag yeah i'm asking a lot of questions the only out for that is if um because we're a military town here yeah so if they're a um if they've been the military themselves or if they're a military spouse that makes sense to me and it's not a red flag anymore but i have to ask questions around that so it'd be reasonable for the athletes out there that are trying to navigate this to just look at their resume and their bio because i mean most clinics have that and you can just see hey they graduated from xyz in this year and they have this certification and they've been doing this that and the other is is is that a reasonable way for somebody to try to figure out the landscape yeah i think it is and and just because they have alphabet soup as we call it behind their name does not mean they're fantastic all the time sometimes it's helpful sometimes it's not you have to know which alphabet letters you want in there uh but but it does indicate that they've been a lifelong learner right so it does indicate that they're passionate about about learning and i do love that because i mean that we all have to keep learning all the time so one of the tools that you gave me a while ago that i consistently use and i professed to know nothing about this other than it's coming from you as a recommendation

so i'll take it wholeheartedly is the find a fellow website whenever i have an athlete that is in another city and they're trying to and they're trying to navigate this area i do two things first i network and that's probably the least important to be honest with you because it's always based on people's subjective bias right sometimes they have great experiences with people that are not all that good and sometimes they have poor experiences with people that should be good but anyway i go on i network out try to get the landscape and then i cross-reference that with the find a fellow which is really picky is what i found out like i go there and like there's some cities where it's zero so we're gonna have to do we're gonna have to describe the listeners what is that first what is the alphabet soup that that that is contained in that and why is that so important the faompt the f-a-a-o-m-p-t and i'll put a link to the to to that website in the show notes for everybody that's listening right so that's american academy of orthopedic manual physical therapists that's why i made you do that because i would never remember of course nor should you um i would never expect anybody to so it is uh it's there it's a fellowship um just like you have in medicine for mds do's it's a fellowship program so they're going to be the highest trained manual physical therapists uh that really you can find um to a degree right as much as as much as we can tell on paper what we know is that they've gone through extensive training in manual therapy above and beyond their their physical therapy degree

so i go to their conferences my i was trained by fellows which is just fortunate for me um i am not a fellow so again i don't have the credentials i've just been fortunate to be in that world quite a bit um but if i'm looking for someone and i don't know anything about them if they have that credential it allows me to immediately know something about their background that i trust so i think that they will pull from a lot of different manual skills and be able to help this person and hopefully not just come so we have we have little pockets like a lot of professions do you can have people who are like this one therapist who had the long nails and she's like no i'm mckenzie trained which is an extension based therapy uh form of therapy and it is very helpful but boy that's the only tool in your toolbox toast i mean you can't that is not enough that is a component of what manual therapists do but that cannot be your only tool it's like if you again you had one hammer instead of a whole toolbox i want people with a whole toolbox that also now some the blind eye to this sometimes is with manual therapy i feel like sometimes that world doesn't tap into the neuro world the neuro side of what we do enough which is where we get to that neuro vestibular side vestibular being inner ear and balance those factor into how we move so much that i really want you know i appreciate some

background in that too but when i'm trying to find someone a new city don't know anyone there that's a credential if they have it that i'm going to start there it doesn't mean that's where i'll end but i'm going to start there because it's a as far as taking a shot in the dark that's a pretty good shot in the dark so what else is in your process because i've asked you this a lot hey i need a physical therapist in los angeles i need to find a physical therapist in stove vermont or like sometimes they're like really kind of obscure places other than going to the find a fellow website like what is your what would your process look like well for me it's a little different right because i have the inside track exactly so i'm also a delegate for colorado so i'm in something called the house of delegates which is just our internal body on how we make decisions for the profession so we have 10 delegates for example from colorado but we all get together once a year from around the nation so i've gotten to know delegates over the years from lots of different states so sometimes i will yeah so sometimes i'll be like you know well eric moen so cycling world would know that so he's a he's our you know bike fit guru uh teaches at apta national level um and he's fantastic so if i need someone in the northwest i'm going to go ahead and reach out to because he'll know the network in that region know it he's been and he's been the chapter president for the washington apta so so i go a little bit different route because i have that information so i can't really that's not i want to be helpful to your listeners and that's probably not the most helpful thing for

them no no but i think i don't know how to teach that i think the helpful thing is though is when you have the inside you can lean on people that have the inside track right and once again that's what i do as a coach is one of the things is i'll network and part of that network is i'll ask jessica i'll ask eric i'll ask other physical therapists that i trust that kind of know the space really well i won't ask so and so athlete that happens to live in this area that happens to get physical therapy from that person i won't because that's not an inside baseball track right that's an outside the ballpark type of track i'll always go inside the the community of people that i know and i don't know it as well as you do but i'll always go inside that community first before i have to like reach out to the far you know nether regions of networking right same way if i needed information about some kind of a running and coach who am i going to go to first yeah yeah i'm going to come to you and ask you questions about do you know this person do you what you know top or can we talk about shoes which we've done before um can we talk about uh packs can we talk i mean there are all kinds of we we have this great network and i think that's what it is being involved at in those networking situations and i'm and i know this is the same for you why do we go to conferences why do we go these things yes there is great education there but the conversations that happen in the hallway are oftentimes the game changers and that's how we get to know oh who is this person they're an

expert in that area great i have a name i have a name i have a person now i know my i can tag and so what are resources in the different areas and if i'm going to help patients if i'm going to help people i have to have resources and i think that's probably what you look for too 100 so you mentioned tools in the toolkit physical therapy is one of those uh it's one of those professions where there's a lot of stuff that you can do there's a lot of stuff there's a lot of modalities there's a lot of like trinkets that you can have one of the things i appreciate about your office in particular is that it's not barren but you don't see up on the walls a rack of theragons or you know a gazillion tens units you know on the on display somewhere and it never has really been like that and i go to some other physical therapy outfits and they seem to rotate right one time they've got the drug when dry needling became legal in colorado that wasn't that long ago was it eight ten years ago and we've had to fight for it several times since it seemed that every physical therapy outfit in the state of colorado automatically became an expert in dry needling and then something else gets hot and then something else gets hot and cupping yeah cupping gets hot or whatever and so you look at this through a patient lens right is this efficacious for the patient how do you evaluate bringing those modalities or not into your clinic because you probably get served them up because people are

trying to sell stuff right they are and so for an example is is you love the alter g yeah right that's something that you could have said it's a really expensive piece of equipment yes that's something that you could have said no to right whenever they were serving it up to you and i know you've had to go through that yeah as a business and as a physical therapist so what how does it pass through your filter when you're getting served serve these things up which seems like every six months you probably get hit up by somebody to buy something there are a lot of trends i've never been a trendy person i mean even in how i dress let's just be honest so uh i i've gotta i've got to see some research i really need to see some research so for example ultrasound okay this is something that i don't even know i haven't been in other pt clinics too much lately other than obviously my own but that that's something that was done and and probably still is in most pt clinics and i had it when i was 20 years old that was like de facto athletic trainer you get hurt it's ultrasound 1.5 watts per centimeter squared for 10 minutes okay that's what we do and then the research when i went to pt school this is back in the day now because i've been here a while uh even then the research was very clear it never gets to the depth of tissue that we think it does thus it is not really helping now if we're talking about hands by the way or feet where we have very surface joints this is different okay so i want to clarify that it can be helpful and phonophoresis where they use a little bit of it like an aspirin can be a little bit helpful for certain things um and so i'm not saying you throw it out completely

but for everybody to get it the vast majority of people to get it is an extra charge that doesn't help the patient so we just decided why have it our hands are better our exercises are better our you know let's get to the root of the problem and we can settle it down with you know other we can do other things to help it probably more and use their time better so research is the first layer research is the first layer so for the alter g for example did we have a ton of research because it was very new in fact when we got it the only other place that had it was the olympic training center in colorado springs so they don't have to have past the research bar because they can just bring stuff in they can and they're like oh we don't like this yeah exactly they just like very different for us very different huge investment right no no disrespect to the olympic training center they have fantastic people there but it's a different when they're evaluating things they in a lot of ways they have to be ahead of the research otherwise the athletes get behind 100 so they've got to try things out and sometimes we do that too i'm not saying we don't do that in my clinic and my business partner is much more apt to to try those things so sometimes you know get a little laser let's figure out how that works she will do that more than i will and i love that it's a good balance between the two of us is that she's more apt to just jump go for it um but i i like to see more research so alter g for example we have had years of research that this helps people with parkinson's if you can de-weight them they have two types of gait and this doesn't speak to the runners as much except we may have runners

who now have parkinson's and if you can find an alter g go get on one but you can de-weight them and they can actually tap into their old motor plan and they can run so like they used to with no hitch in their giddy up as we would call it technically um there are names for the way that they walk but that that that was one thing listen we can use for that population we can use it for our elite runners who want to de-weight a little bit and get that motor mapping of their legs moving faster we can do it with that so the the use for that machine was so vast we could really impact lots of people in all different areas of the population so so how many people will it help is there is there research behind it how many people will it help does it help folks coming to see us for what they need is there an alternate because that's something that you mentioned on the ultrasound is it's like well if we can treat this in a different way that we know works very true and so let me there's a caveat to that which is that i have generally speaking very motivated patients i do well this is a good motivated audience i know right so so if it's not working it's i need to change something and in many settings i mean this is privilege right here because i get people that really are going to use my tools they're going to do the program at home so they can do a lot at home so like ice massage in a little dixie cup it's worth its weight in gold it really is the ice massage is

key i can get a greater trochanteric bursitis to calm down if they're going to do you know ice massage three times a day for two minutes each time on their own and i can do the other stuff when they come see me so there's a component to this where i do have a benefit because i have people that i know are going to do what i ask them to do i mean within reason obviously people things happen but i so i so the flip side of that is i guess if you only had those couple of minutes to work on someone and you thought that was going to help if it was again surface okay let's use that and they're not going to do anything at home that's it might as well throw it at it right so there there's a time and a place and so my setting is very unique in that and i don't forget that because i work again in my delegation stuff we have people in all kinds of practice acute care really seeing emergency departments where they're seeing some of the most vulnerable folks in our community and that's not my setting right now and so i've been there i've seen it but it's not my setting right now what have you taken a flyer on that you eventually got rid of oh that's a great question i think we've used most of the things there is something though if i can think of it of course we got rid of it so let's out of sight out of the mind like what did we get rid of um you know what like did you ever have one of the vibration platforms or oh it's there right now oh you have a vibration platform you use it i i don't um right now your trainers use it yeah um so i would

use it for balance in fact i'd have different i'd have some pretty different purposes sometimes there are other they say that does a lot of things i might use it for some balance stuff um oh we've used the we we use the we which was actually kind of fun i've seen that a lot the we balance stuff yeah so we did use that for a little while um and but sometimes you kind of get to the point where okay what's the benefit what can i have them do at home is just you know doing some exercises at home going to do as much it just in the clinic it makes it fun well if you cut if you think of one send it to me afterwards i'll put it in the show notes and we'll see what people say about it that's great um the vibration thing actually originally came out with i remember the original one of the original intents of it was to help with muscle hypertrophy and power and strength and now it's being used more as a in a rehabilitative setting and bone density they've talked about that's a big that's a big push and that push was there probably 15 years ago for bone density in our in our world that was pushed um the i i don't know that i have enough conclusive research to tell me that it's going to help enough like there are other things that i might do okay so opposite question on that theme what do you use the most for our population yeah i mean alter g yeah you know especially there's an injury because you guys need you need endorphins need endorphins is it merely to satiate the need to train but it's important but that's not that that is not you know that is critical right that's a

mental health side number one number two if you have a race coming up i gotta keep you moving so it's a critical tool that i have to use um so outside of the alter g um what do i use see i don't use a lot of tools your hands my my hands a ton that's right when when you're in seeing me it's my hands because um that's what you can't do at home right and nailing what you need to be doing at home is critical so sometimes while i'm working on you i'm talking through this or that and little things that people tell me about their lives like their lifestyle that will end up sometimes being really critical information so as i'm questioning people i talk a lot in my sessions and i want to know about their lives i want to know this because if i can get this snapshot of what their life looks like i it i can put pieces together a lot better so i ask lots of questions in fact i had someone in secret service who told me i should be a spy oh my god i was like what are you talking about he goes you can just get tons of information out of people he's like i don't know how you do that and i just said but i'm a terrible liar i'd be a horrible spy he said oh we can train you for that oh wow um that actually that is another thing i wanted to talk to you about because since you see this huge range of patients what are the keys to a successful outcome from the patient side particularly in an athletic population so somebody like me comes in i want

physical therapy how do i make the most out of that visit in order to get whatever i'm trying to get treated treated write things down i don't do that start today start today um when we ask you things like okay i need you to for the next 24 hours i need you to really pay attention to how your body responded to this write it down life is busy we're not going to remember the details you do not need to write by the way uh matt huge essay don't do that just so it would be a few bullet points like this didn't hurt this hurt i did this better i did this and didn't even think about it you know whatever it is that that we're focused on write some feedback down or questions that you come up with write those down too and if you come in with that it's really helpful for us because when i give someone i'm going to give you a couple of exercises we've talked about this i don't like to give you 20 i like to give you a few because i want to know what's working and what's not working um and it will help me it's a little more scientific model i can say this is okay that's your key that's what you're going to stick with for the next two months i need you doing that x number of times a week um so your feedback is really important and our lives are so busy that we might forget oh was that the next day because sometimes someone will tell me oh i really hurt the next day and and then in conversation we talk about their week and what they did and it turns out that they went to a birthday party on friday and it was actually saturday that they started hurting oh yeah it was saturday when

i started hurting but that's important for me because i have to understand how they responded to the treatment and i have to put these puzzle pieces together so being a good historian at the end of the day is what helps us be better pts for you so write it down and come come to the office with it and then when you're in the office write down your bullet points leave with it put bullet points on those bullet points come back yeah tracking a little bit and it's intense for a short period of time but if during the short time of treatment that you can if you can do that for the couple of weeks that we're working together then i think your outcomes are going to be better because the more accurate feedback i have the more accurate diagnostic uh tools um and i might test something different in other words if one thing isn't working and i know i need to go down a different road also be honest listen if you didn't do any of your exercises it's okay i'm not i'm not offended i'm not gonna be offended i just need to know like just tell me you didn't do any for exercises and we all have lots of reasons for that and that's okay exercises okay this is the last point oh yeah a lot of people out there that have been to physical therapy have had this experience they leave with five pages of exercises and there's a whole i've used the software before there's a whole lot of pieces of software there's 30 things on them there's a 20 or 30 minute routine you know three by 10 four by 20 two minutes of this you know

five minutes of that and things like that i leave your clinic and i very rarely get anything more than you know i can put on a post-it note of things to do why is that generally your strategy that is my strategy because unless i'm dealing with a professional athlete who has their entire job is to rehabilitate for those folks they're going to get more okay they're going to get they're going to get they're going to get i shouldn't say that either because i still am going to be diligent about how i put that in there i don't want 10 exercises at once because i don't know what helped then i don't know if it was exercise five or exercise number eight so how do i know what to tell you to keep doing and i'm looking for long-term outcomes right first of all i want to diagnose it properly second of all i want to make sure that what i give you is really hitting the nail on the head so um i also need to know your life like you need to be honest with me i have 10 minutes a day to add in for exercises perfect i'll do that that's my job that's okay if you only have 10 minutes that's honest and it helps me to tailor your program to you so it's short because in most of my patients lives they're training they're working they might have a family and they've got to find balance it's not sustainable for me to give them 20 to 30 minutes extra on top of what they're already doing so i just have to be very precise in what i give them so i just think as a therapist i just

need to be better i've always felt that it's kind of like throwing shit against the wall yeah because i mean i've had that experience as well i've gone to a physical therapist and i'm like a none of these are synergistic b they're all different so like if you don't know just tell me i don't know like i would that's i would i would much rather appreciate that just say i don't know we're going to try all this stuff and then we're going to whittle it down but don't say we're going to do all this stuff and it's all going to work that's the issue that i've always had with the battery of things i agree with you so i have to have a hypothesis i have to say this is what i think is going on and i'm pretty honest with my patients about that i could be wrong i'm i don't mind being wrong i want to find the right path so i'm willing to say i'm having you try these couple of things because i think this is what's going on if you do them and you don't respond i know that we need to shift gears just a little bit we're probably not far off hopefully we're not far off then that's another problem but we might need to focus in on another thing and again sometimes it's those conversations where something just pops up where i go oh i know where we need to go right now because of something you just told me about when it hurts or why it hurts or how you move or i oh i did you know incidentally i do spend eight hours a day in bed long sitting with work good to know that is great information that i needed to do that because i'm always like what's the training load increase is it more than 10 okay then we'll just reduce training load

but you're like okay if you like the conversation we had the other day we're probably going to violate every hippo law by this uh no you can say as much as you want and if you tell me i can say it then i can say it you can totally say yes the conversation we had the other day i was on the pct for two months i was sitting in my van driving for six hours you're like oh yeah that's material to this to figuring out what's going on here i would have never thought about that because it's like i'm sitting down that's it nobody thinks about that except pts who geek out on static positioning static positioning is killing us it's a little dramatic and you said that you noticed that after covid right because everybody's working on their home offices and it's just a different deal right so we're no longer jumping up to go down the hallway or far in another building to a bathroom or go chat with someone in the in their office or go we just aren't getting up and moving as much and so even people that are endurance athletes they do their thing and some of them have even increased and and done it in a really really reasonable manner they're not increasing in a way that it would hurt them that's not what's hurting them they did it properly what's hurting them is what they do when they're not running riding cycling that type of thing is where we really get into trouble i love it yeah all right we're gonna leave it there jess thanks for coming by thanks for having me sorry my dog was so annoying it wasn't annoying yeah let's do that yeah i appreciate it keep keeping athletes on the right side of the injury line i'm gonna do my best thanks for having me all right folks there you have it there you go much thanks to jessica for coming on the podcast today

and enlightening us about how the whole thing works and how you can take better advantage of the physical therapy visits that you have and also help you navigate the space i'm also very appreciative of jessica and her handiwork and keeping me on the right side of the injury line for almost the entirety of my running career as i moved up here to colorado in addition to that she has a great track record with not only our athletes but our coaches who have gone and seen her or any of the other wonderful practitioners in her practice as i mentioned in the intro this is the first in a series of podcasts that are going to be dropping at in late october and early november all about how to navigate this world of physical therapy the next episode of the podcast is a really special one it is the 100th episode of the KoopCast and instead of doing something super cliche like coming up with the best of and the most salacious clips and wild things that everybody said i'm going to bring on my good friend john chow so you guys can learn something from him so stay tuned for that that will be dropping on october 28th he's got a lot of wisdom in this area as well appreciate the heck out of each and every one of the listeners and as always we will see you guys out on the trails video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video play video

Thank you.