Burnout in Physical Therapy | Where Passion Collides With Reality

Burnout in Physical Therapy | Where Passion Collides With Reality

It’s become clear a good chunk of physical therapists have become disenchanted with the profession and are suffering burnout.

Can’t imagine it has anything to do with the insurmountable levels of debt and pressure from employers who lack core values and prioritize patient churn out.

How can this already be happening,” you think to yourself as I’ve only been practicing for a couple of years?

I must confess the situation has me distraught to the point where it’s brought me to tears.

Is what I’m experiencing normal or are these unjustified fears?

I went into this field to help others reclaim a life of movement and get back to the things they love.

I thought this was gonna be rewarding but I’m starting to feel like I’ve had enough.

Every day I run around a clinic throwing tips and tricks at complex, volatile situations.

Then I have no choice but to stay long after my shift writing notes, which are nothing more than overexplaining.

How in Sam Hill am I ever going to pay off $100k+ in loans and where does starting a family, enjoying some leisure reading, and pursuing my hobbies fit in.

Please throw me a lifesaver because I’m drowning in all these nonsensical explanations patients are given about why they’re in pain…what a sin!

Before I forget, do you know how I can get out of a non-compete?

Is it something I’m locked into because I’m on the verge of conceding?

I don’t know bout’ you but I can’t sit through one more compliance meeting.

If you haven’t figured it out yet, I feel like it’s time to switch professions or jump ship.

And don’t get me started over the fact some states still require a PT script?!

Why is it that when we know there’s a leak in the ship we sit there and watch it sink (thanks Johnny!)?

I don’t know about you but if we stay on the current trajectory, I’m genuinely concerned the physical therapy profession could go extinct.

Now more than ever physical therapists are looking for purpose and patients desperately need individualized care.

Unfortunately, clinicians are having their passion(s) crushed thanks to a soul-sucking system and employers who’ve created a sense of despair.

It’s time we stop feeling sorry for ourselves, reclaim our profession, and get back to the things which matter most?

What happened to creating an unparalleled patient experience, clinical excellence, and simply being a gracious host.

Let’s take a moment to revisit the wise words of George Patton, who once said, “Courage is fear holding on one minute longer.”

I’m sure you probably feel like things are going bonkers.

Now’s the time to double down on your situation so you can position yourself to break through and conquer.

Do your best to put your fears and worries aside while getting crystal clear on your core values then rework your narrative as a person and clinician.

I’m excited for you to discover the opportunities that await and look forward to following your mission.

Remember to immerse yourself in and connect with your local community while pouring your hands, heart, and mind into your craft.

Only then will you get established as a trusted resource at which point there’ll be no looking back.

Please stop worrying about all these new-age marketing platforms characterized by suspect strategies and tactics.

At day’s end, they’re nothing more than a racket!

Rather, focus on doing the best job you absolutely can day in and day out.

Remember in case you forgot…the best marketing is still word of mouth.

By no means will this be an easy journey as you’ll surely encounter some obstacles along the way so remain patient and revel in the process.

A final reminder…YOU GOT THIS!

The Runner’s Despair

The Runner’s Despair

One of the greatest challenges I face in working with runners is what I refer to as “Runner’s Despair.” So, I decided to write a poem about it…

“Why me?”

“Will I ever run again?”

“This isn’t fair!”

Please don’t fret as this is a classic case of “Runner’s Despair.”

You’ve likely tried pulling back on training and resting without any luck.

Maybe you’ve resorted to pulls, injectables, and/or surgery while having parted with several hundred bucks.

Please put your mind at ease and try your best not to freak out or worry.

Look…as much as I wish we could rush biology it often creates a strike against us to be in such a hurry.

This situation has arisen for reasons you’ll likely never fully know though it demands some reflection.

And believe me…I’m well aware of your running predilection.

Take this time to pick up a book, phone a friend, or tend to things that you’ve put on the back burner and need your attention.

Appreciate that perhaps you’ll have to confront some challenging issues and face adversity so it’s normal to have some apprehension.

Do know that you WILL get on the other side of this turmoil and once again take flight.

This will not be an easy process and could very well take all your might.

And never forget that you’re best running lies ahead.

So chill out and power off as it’s time to get to bed.

I’ll see you bright and early and be ready to get to work.

For the record, let it be known that you’ve been put on alert.

Never forget that you’re only as good as your last injury and the extent to which you rehabbed it.

And please don’t gimme this shit that you’re gonna quit.

It’s time to saddle up…are you ready to commit?

How to Apply the Science of Step Rate to Your Running Using the RunCadence & Spotify App

How to Apply the Science of Step Rate to Your Running Using the RunCadence & Spotify App

Over the past several years, a wealth of research has emerged pertaining to the myriad of benefits of step rate (AKA cadence) manipulation when addressing various running related injuries (RRIs) and lower extremity pain.

The fundamental principle behind step rate manipulation is that by keeping running velocity/speed constant and taking more steps per minute, one is able to effectively reduce their stride length, and in turn the magnitude of each individual loading cycles at the expense of taking more loading cycles. This is readily apparent when stopping to consider the following equation.

Speed= Stride length X Stride frequency

Furthermore, research shows that music serves as a great external auditory cue, especially for endurance athletes, as it results in spontaneous entrainment to the tempo or beat with a greater effect noted in women. One approach to help you apply step rate manipulation to your running involves making use of the RunCadence and Spotify App.
Below I will take you through how to use the combination of these Apps to reduce the magnitude of loading of each individual gait cycle if that is indeed the desired goal. Research has shown that as little as a five percent increase in step rate while keeping running velocity constant can reduce shock absorption at the level of the knee by upwards of 20 percent. That’s astronomical!!!

It should be noted, however, that the information presented in this post should not suffice nor serve as a substitute for professional medical advice in the event you are dealing with pain and/or functional limitations. In such instances, we advise you to seek consultation with a trusted medical provider, who specializes in the rehabilitation of runners.

Equipment Requirements:

  1. Calibrated Treadmill
  2. Iphone with the RunCadence App
  3. Spotify App

Let’s Get Started

The first item of business it to determine your step rate or cadence for a given running velocity. To do this, you will have to complete a one-minute test. We suggest conducting this on a treadmill to obtain the most accurate results provided that you are comfortable running on a rotating belt. This is where the RunCadence app comes into play. Prior to completing the test we encourage folks to start with a 5′ brisk walk followed by a 6′ run to get familiarized with the treadmill. From there, stand on the runners of the treadmill and open up the RunCadence App (assuming it’s already been downloaded) on your smartphone and click “TEST.” You will be given a 5s countdown before the test officially starts though we encourage folks to start running once the countdown ensues to settle into your running gait. You will have to hold the phone in your hand for the duration of the test. To avoid compromising the accuracy of the test, we encourage you to avoid looking at the timer on the App. Rather, simply use the treadmill timer and make a note of when you start the test and plan for 70-75s of continuous running to ensure that you fully capture your foot contacts for the entire minute.


How to Determine Your Step Rate for a Given Speed Using The RunCadence App:

Tap the RunCadence App

Select “Test”

Tap Ready & Start Running

Run for 1′ w/ phone in hand

Once you have finished the one-minute test, this screen will appear which shows your average step rate as well as +2.5, +5, +7.5, and +10% above your avg step rate. We generally recommend starting with +5% when it comes to gait retraining. This is the value that you will plug in to the Spotify app when prompted. We’ll cover this in more detail below. In the event that you are able to readily adopt the +5% step rate, feel free to increase it to +7.5% if not +10%. While you can increase your step rate above 10%, apppreciate that doing so occurs at a great metabolic cost.

How to Use the Running Feature on Spotify and Plugging in Your Step Rate:

Step 1:

Once you have downloaded Spotify from the app store, simply tap the icon to open it.

Step 2:

When the homescreen of the Spotify app appears, tap the search button centrally located at the bottom of the screen.

Step 3:

In the searchbox, type in “running” then click the search button at the bottom of the screen.

Step 4:

Scroll down until you see “Genres & Moods.” Tap the icon with the running man.

Step 5:

You will have the option to select various types of music so pick the one that suits your fancy 🙂 We often encourage folks to select a style of music with a distinct beat as it lends to better sychronization in terms of your foot contacts.

Step 6:

When you arrive at this screen and are prompted to start running, simply click the “skip” button at the bottom of the screeen and plug in the value obtained from using the RunCadence Test. Consider starting with the “+5%” value.

Step 7:

You are ready to roll/run! Aside from periodic advertisements, you will now have a continuous playlist based on the beat frequency you plugged in. Bear in mind that maintaining a consistent/steady step rate for a given running speed is most easily accomplished on level ground. Hills and softer surfaces may cause you to deviate from the target.

Wishing you HAPPY, HEALTHY, & STRONG Training. Please reach out if you have any additional questions regarding how step rate can be applied to your training. Onward!!!

Disclosure: RunCadence is a for profit IOS App that I developed along with my good friend and business partner, Ben Wobker. It is currently priced at $2.99 and can be found on the App store.

How to Create a Pain Problem & Opioid Addiction

How to Create a Pain Problem & Opioid Addiction

I recently received a call from a young guy (late twenties), who was recommended by his friend to contact me as he was in need of acute post-operative rehabilitation following a recent knee menisectomy. Upon asking him, “What instructions were you given to manage your situation until your first follow-up appointment with the doc?” He responded by listing off the following recommendations given by the physician’s assistant (PA)…

  • Take pain pills as needed (prescription for 40 percocet)
  • Don’t do anything that hurts or causes pain
  • Don’t bend your knee past 90 degrees

This represents a microcosm of our current state of affairs in relation to pain management and opioid addiction. The potential societal repercussions of this situation are disconcerting. I’m hopeful we can do better!

A Guide to Treadmill Running Analysis for Clinicians & Health Professionals

A Guide to Treadmill Running Analysis for Clinicians & Health Professionals

“The S’s of Treadmill Running Analysis”

Perhaps one of the biggest mistakes I made during my early years as a physical therapist was not taking the time watch runners run. Invariably, this led to a short-sighted perspective, hasty decision making, and suboptimal outcomes for those runners seeking my care. While I was generally effective in helping runners reduce their pain and symptoms and get them back to their usual activities in the short term, they seemed to consistently experience pushback when attemtping to return to consistent training. Needless to say, I was obviously missing something, and quickly realized that my affinity to run had little to do with my ability to help runners aside from perhaps getting buy in from looking the part. Ultimately, this put me on a quest to demystify the performance demands of running so I could be in the best possible position to help runners seeking my services. After spending countless hours reading and contemplating the available literature, it became readily apparent that running is a hierarchical skill relative to most activities meaning that taking the time to watch someone run is critical before discharging them from your care. There also seems to be a set of common denominators or factors that deserve particular attention when conducting a running analysis. I like to refer to these as “The S’s of Treadmill Analysis.” 
  • Strike – footstrike
  • Sound – sound of ground contact
  • Step Rate – AKA cadence
  • Speed – running velocity
  • Shoes – impact of footwear
  • Slope – incline or decline
  • Swing – arm & leg swing
The purpose of this guide to provide clinicians and health professionals with a simple and practical framework to approach conducting a TM running analysis while learning how to interpret and apply the results in real time. By enhancing one’s understanding of running and gait retraining, loads can effectively be shifted away from sensitized or pathologic tissue while demonstrating to patients that their running related pain is malleable, and can be lessened by manipulating specific aspects of their gait. Having runners experience a rapid improvement in their symptoms through simple gait retraining has the potential to enhance a runner’s expectations and confidence with treatment, which ultimately lends to a better outcome. While one might argue that certain characteristics are missing from this list, I feel that clinicians can effectively intervene through these variables. I hope that this guide proves invaluable in helping you demystify TM running analysis and gait retraining in an effort to assist with migrating runners out of the medical system and back to STRONG, HEALTHY, and CONSISTENT running. Onward!!! To leaern more and to purchase this guide, follow this LINK. Thanks in advance for your support and hope this proves to be an invaluable resource. Happy Holidays!


Metronome Marching & Return to Running

Metronome Marching & Return to Running

  One of the many mantras that I recite in working with runners is that “Running is about rhythm and timing.” Along these lines, If there was only one exercise that I could give to a runner following a running related injury (RRI) to safely return them to training, it would most likely be metronome marching. Having spent considerable time practicing this drill, I can say that it is arguably the ultimate form of graded exposure while taking advantage of the use of an external auditory cue (silent in the vid). The slower beat frequencies effectively serve to mitigate threat and demand the runner to load through each leg while forcing them to audit their motion. As the speed of movement increases so do the coordination requirements. Additionally, as you start to work above 100+ bpm, the runner must also naturally contact the ground with greater force. Lastly, and most importantly, every runner will hit a point at which they invariably start to adopt a float phase, which is what differentiates running from walking. So, have a practice and let me know what you think. Also, take note of the fact that when I go to contact the ground I do so with the forefoot before gently kissing the heel to the floor. This is not because I think forefoot striking is superior, but rather because it automatically reduces one’s step length, which has been shown to yield distinct benefits in addressing common RRIs. In retrospect, this drill blends pain science fundamentals, gait retraining, and cueing with the performance demands of running. If you are looking to enjoy improved outcomes in working with runners, remember that I will also be launching “The Runner’s Zone on Tues, November 15th. I am determined to make this the premier online learning platform related to running. Click HERE to reserve your spot now!

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