Career Advice Article Archives

Check out all my career advice articles. There’s something for everyone, from students, to new grads, to the more experienced.  Explore the archives below or click the button to subscribe and never miss another post.

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What is Evidence Based Practice?

One of the most important things for any healthcare or fitness professional to understand is that it is our professional duty to our clients to be sure we are staying current and following the evidence as our professions continue to grow. That is what many people believe is evidence-based practice.

I believe this is one of the most important qualities you need to master to truly become an expert in our fields.

We should always be learning and staying on top of the latest research, while keeping an open mind and growth mindset.

Continuing to follow outdated concepts that have been proven to be ineffective or disadvantageous is a disservice to our clients and ultimately our professions.

However, it is very common for students and new graduates to take this concept too far. This is not a criticism, just a statement that without clinical experience it is often difficult to follow evidence based practice as best as possible.

Paralysis by a Lack of Evidence

Here’s one thing that I wish people understood: a lack of evidence does not mean a lack of efficacy.

Research is hard. We’re humans. It’s difficult to have quality randomized control trials with adequate methodology to determine exactly what to do at all times. It’s the expert people that I know that grasp this concept the best.

It’s more common for the inexperienced to have what I call “paralysis by a lack of evidence.” They often state that without clear evidence we should not be performing certain interventions.

This couldn’t be further from the truth in my mind.

What is Evidence Based Practice?

Evidence based practice is defined by Sackett et al as the integration of the current best research evidence with clinical expertise and patient values.

This is super important to grasp. It’s not just the research, it’s also clinical experience and patient values. My friend Phil Page did an excellent job breaking this down in a recent presentation for my Inner Circle Online Mentorship program. Here’s a quick clip from that presentation where Phil defines evidence-based practice, which I thought was brilliant:

I also really liked the iceberg image, representing that EBP isn’t just the best available evidence, but that experience and patient values also lie under the surface.

How to Follow Evidence Based Practice

In order to follow evidence based practice as best as we can, we need to understand that EBP is a combination of these three things. No one piece of this is stronger than another.

When I am trying to determine if an intervention I would like to do is appropriate based on evidence-based practice, I’ll consider what I call the Evidence-Based Practice Light System.

  • Red Light = Stop.  If there is strong evidence by quality randomized controlled trials suggesting a safety concern or lack of efficacy, then you should find an alternative approach that may be more advantageous.
  • Yellow Light = Proceed, but with caution.  When there is conflicting information, or there aren’t enough quality studies examining the effect you are assessing, then you must proceed with caution.  In this scenario, perhaps there are some low-quality studies (like a case study or publication without strong methodology) that show efficacy, or maybe even some conflicting results in the literature without an overwhelming trend towards efficacy or lack of efficacy.
  • Green Light = Go.  If there is strong evidence by quality randomized controlled trials suggesting efficacy, then you can comfortably use this approach with evidence-based justification.

We also recently discussed how we do this in a podcast episode on Using Physical Therapy Interventions with No Evidence of Efficacy

If you want to learn more about evidence based practice, you can watch this full presentation and many many more in my Inner Circle Online Mentorship program.

Starting Your Physical Therapy Career Off Right

On this episode of the #AskMikeReinold show, I join the DPT class of McMaster University in Canada to talk about starting your physical therapy career off right. I answered a lot of great questions from this group that I think would be very beneficial for all to hear! To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.

#AskMikeReinold Episode 210: Starting Your Physical Therapy Career Off Right

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Show Notes



Transcript

Mike Reinold: On this episode of the Ask Mike Reinold Show, I am joined by the physical therapy students of McMaster University in Canada to talk about some of my best tips and career advice for starting your physical therapy career off in the right direction.

Dianna Moulden: So I have three questions to start that the group has asked me throughout our time, and I thought I’d get your opinion on it. And then Brianna has some questions, and then we can kind of open it up to you guys using the raise your hand button. Okay. So the first question, in I think the first session I did with the group I had talked about saying yes to opportunities that came my way professionally. And so often now we hear, “You got to get better at saying no and protect your time and always say no.” But I mean, so much of my sport experience and my experience with teams was in exchange for a free meal and a tee-shirt.

Dianna Moulden: “So looking back in your experience, do you think of one opportunity that you said yes to that kind of changed the trajectory of your career?”

Mike Reinold: Wow, that’s a deep question too. That was actually a well-written question. That was really good. Yeah, it’s actually funny. We usually think about this from the flip side where we should say no more often, right? One of the probably most impactful books that I read in the last few years on that kind of topic was Ego Is the Enemy. Ego’s not necessarily a bad thing. Everybody thinks the word ego means bad, like the egotistical and the negative sense like that, but it’s about just why we do things. One of the big things I got from that is that we probably should say no more because oftentimes you’re saying yes for ego. So you could argue right now I should’ve said no to you when you were like, “Hey Mike, can you talk to my students for a half hour, right?

Dianna Moulden: Yeah.

Mike Reinold: But I don’t why I said yes. I just always say yes to things like this. It’s easy to give back and do little things like this. So we’re all home. We all have some spare time, so this is the type of thing that is helpful to do. But you’re supposed to say no more often, I think, is the key to life. So in terms of saying yes, I mean that’s I don’t know, that’s kind of interesting. It’s amazing as you go through your careers and you guys get a little bit more advanced how things layer on top of one another and a decision you make turns into a sequence of events. Actually, I sought out to work in baseball as a physical therapist because that was my passion at the time. I know Brianna has some questions about passion and stuff, but I wanted to do that.

Mike Reinold: I got lucky. I got my dream job. I got my dream job in my 20s, which is crazy. It’s sad that now it’s not my dream job anymore, but you never want to lose that dream. I got my dream job in the 20s and I think you could argue there, I remember specifically what happened, it’s again a sequence of events. But I put myself in a position where the Red Sox were looking for somebody like me. I remember I was speaking at the APTA Combined Sections Meeting. It was in Boston. It’s currently in Birmingham, Alabama, if you’re working at ASMI.

Mike Reinold: I remember I agreed to speak at CSM. You guys all know APTA. You’re all in Canada, right? But you know, APTA is still cool to you guys. I don’t know. But so the APTA, CSM’s a big meeting. There’s like 10,000 people at some of these meetings, but it’s funny, they don’t reimburse you for anything. You still have to pay. I’m not complaining here, but literally when I go to APTA CSM, they put me to work. I’m doing two talks a day. I’m jumping all around, and I have to completely pay all that out of your pocket. So sometimes you start to get annoyed at that process, but I said yes because it was like, all right, this is a good opportunity. It was free trip home, let’s be honest, going back to Boston.

Mike Reinold: It was a weird opportunity, but I gave a presentation. And in the audience was somebody that was affiliated with Mass General Hospital and they’d just started working with the Red Sox. They grabbed me afterwards and they were saying, “Hey, we want to talk to you.” So if I didn’t do that and I didn’t say yes to that opportunity, I think I may not have had the sequence of events that happened. To give you a good lesson from all this here, I think is it’s okay if you don’t know your master plan and your dream job right now. You’re not supposed to know that.

Mike Reinold: It’s okay if you don’t, but you try to have as much of a plan in place as you can. And when you have a decision come in front of you, should I do this or not, you just think, will this help me get to my endgame goal? I think that’s an important concept right there and that’s how you can make some decisions. That’s what I learned from that book, Ego Is the Enemy. As you can tell Dianna, I’m a terrible question answerer.

Dianna Moulden: No, that was great.

Mike Reinold: Go off on tangents a little bit, but hopefully that helped.

Dianna Moulden: No, that was great. Okay, next question. Depending on the specialty of physiotherapy you want to work in, there can be lots of gaps in knowledge within the educational program. Overall, I think exercise rehabilitation is very poorly done in our program and even just surrounding building programs and even exercises to give and prescription and that type of thing. It’s something that’s not discussed.

Dianna Moulden: “What do you think is important to know about programming and periodization of programming when you’re building a rehabilitation program for someone and do you think this is where your CSCS filled that knowledge gap for you?”

Mike Reinold: Yeah, good question. I feel like our brains as individuals have surpassed what is in a PT curriculum nowadays. If you flash back 20, 30 years ago and you said, what’s physical therapy, I think most people think of it as the acute and subacute type things. And everything in our world’s based off insurance and stuff like that, so most people get discharged before they get to advanced phases. So it was like our profession just didn’t really care about that end. It’s like once you get your range of motion back, once you could take a bath, once you can walk, you’re discharged; you’re out, and the physical therapy is over.

Mike Reinold: I think that was physical therapy maybe in the 70s, the 80s, something like that back in the day as our profession’s evolved, but now as we’re working with more active people, especially when you talk about even athletes trying to get back to sport or something like that, they’re nowhere near ready for sport by the time they meet discharge criteria all the time. So I feel like our curriculums and our college educations aren’t really there to get us to that level, and you probably do need to seek some outside education to get yourself better at that.

Mike Reinold: Trust me. So yeah, I’m a couple of different societies of other physical therapists and we meet every year and we talk about things. One of our big meetings that we do every year is probably about 40 of us in this group. It’s called ICUS. ICUS was the first athletic trainer in the Greek Olympic games I guess or whatever, but anyway. We meet every year and we talk about things. Tim Hewitt, big ACL researcher, is in this group and stuff. We talk about different trends in our field. The big one right now is return to sport after, let’s say, ACLs. Everybody looks like crap at six months and we’re still letting them go back to sports. Then we’re wondering why we’re getting some of these failures.

Mike Reinold: When we ask our group and we look around and be like, “Hey, are your guys weak? Is your quad weak in your athletes after surgery?” Everyone in that room says no. But if you look at the systematic review that’s published that looks at things, everybody looks poor quality. I think what happens is certain groups of people that work with athletes have gone above and beyond their basic curriculum to learn advanced strength and conditioning and periodization schemes. To make a long story longer, you have to seek that outside right now because I don’t think our PT curriculums are getting us past three sets of 10 phase and talking about advanced periodization.

Mike Reinold: I would say your first step in this education process is probably a CSCS through the NSCA, which is just becoming a certified strength and conditioning coach. But trust me, that in no way is going to really make you that good of a coach. You can’t call yourself a coach or be a coach with that because you have to experience it. You have to actually train people and work with people. If you find yourself in a generic outpatient setting where you only work with people for six weeks after surgery, just realistically, you’re probably never going to get good at that because you don’t get to practice it every day.

Mike Reinold: If you’re not in that environment, then what you need to do is you need to get some friends that are in that environment. So maybe you know some personal trainers down the street or strength coaches at a gym nearby and you collaborate back and forth and you try to work with them a little bit. CSCS is like your book smart version of that, but then you still need a practical application. Ironically, we have a strength and conditioning internship at our place at Champion, which is mostly for strength coaches. I can’t tell you how many PT students or new grads we actually get that come and work with us for three, four months, depending on the season, as a strength coach. They’re not doing PT with us. They’re doing it as a strength coach. I think that makes you a more powerful physical therapist as well.

Dianna Moulden: Definitely. Okay, last question. So one theme we’ve discussed every week with this group is the importance of watching people move. And irregardless of the injury they came in with, just watching how they move and looking for compensation strategies within this movement. I’ve told the group the shift in my own practice when I first graduated. If you came in with a shoulder injury, I treated the shoulder and then injury was over and they left. I was getting referrals from a strength and conditioning coach for asymptomatic athletes and I was like, “You don’t have any pain? You’re fine. Get out of here. I’m too busy with people who have pain.” So I’ve talked about in part in taking your course as well, but the shift in my thought and treatment over the last 10 years.

Dianna Moulden: “In your own practice, are you seeing a lot more asymptomatic people seek out treatment, and do you think this is what’s going to be what we see going forward in private practice?”

Mike Reinold: I mean, I hope so. I mean that’s what we’re doing. I would say I don’t even know the percentage, but maybe half of probably the clients that we see are probably what you would deem healthy. So we’d like to call them suboptimal, but that means they’re not in pain. They’re not injured. They’re not postoperative, but they want to get better at something. Maybe they want to improve their mobility or their strength or whatever it may be, especially in the athletic world.

Mike Reinold: I worked for a lot of baseball players, obviously. Every time you pitch, you kind of hurt yourself. So it’s like you have a micro-injury every time you pitch because that’s just the nature of the sport. Our job is to mini-rehab you back because you’ve got to throw again in five days, that sort of thing. I think it’s the future. We talk about this in the spectrum of our healthcare models. Different states, different countries have different probably scopes of what they have here, but oftentimes the therapy, if this is the baseline, I can never tell in Zoom which is left and right, if this is a mirror or not a mirror, so I don’t know.

Mike Reinold: Let’s say this is baseline in the middle and let’s say this is the bad way. You have somebody injured. Our job in physical therapy is to restore them to their baseline. Well, what if their baseline’s crappy? Great, we just restored them back to their crappy selves and they’re probably going to get back to where they were before. So we got to go past baseline. Did that work left or right or was I backwards? I don’t know exactly where it was.

Dianna Moulden: No, that was good.

Mike Reinold: So our goal is to get people better than baseline because oftentimes their baseline is poor and that’s why they’re probably having symptoms over time. That’s how we start talking about performance-based stuff and optimizing things is we want to make sure that we’re not just getting people out of pain, but we’re optimizing them. We teach our students this at Champion. It’s a couple things. When somebody comes in with an injury for an evaluation, we’re going to do two things. This is how I talk to the client too. I say, “We’re going to do two things.”

Mike Reinold: First thing, I’m going to look to see what’s broke, and then I’m going to say, “What’s suboptimal?” You’re coming in with shoulder pain, so the first thing I want to do is okay, is there anything structurally wrong with you. Is there a pathology I want to find? We’re going to do a specific evaluation for that, but then I’m also going to look to see what’s suboptimal. Many times people come in with shoulder pain and I’m like, “Hey, good news. Your shoulder looks fine. Calm down. You’re going to be okay. There’s nothing structurally wrong with it. You’re just a little overwhelmed.” But boom, I’ve got these four things that are suboptimal on our checklist and we’re going to start working on those. And then we’ll see what happens to your pain as that gets a little bit better.

Mike Reinold: I think that’s the future. Now, Blue Cross Blue Shield and insurance companies disagree with me. I also think part of the future of our profession, this is probably going to be more towards cash-based models as well. And not necessarily exclusively cash based, but just realizing that look, some things are covered by insurance and some things aren’t. When you go get your car worked on, if you have a major issue with your car, it’s probably under warranty. It’s covered, you’re fine. But stuff like an oil change isn’t covered. Rotating your tires isn’t covered, stuff like that. I think we have to get out of that mode where people think physical therapy or physiotherapy is just when you’re broke or injured or post-surgical and that’s the only time you can go see a physio.

Mike Reinold: That’s going to take a while. That’s going to take years of reform for us to get that across, but I think you can make that difference in your community when you settle down and you guys graduate and you get jobs because you can start to just get the word out there. Seriously guys, you have to live and breathe that. That has to be your motto. That has to be your byline for your business when you’re in there and that’s what we do at Champion. We help optimize people. That’s what we say. We’re trying to help optimize people. Then you become known for that.

Mike Reinold: Trust me, everybody goes through physio and they all think it stinks. You go four weeks straight leg raises. You work with the therapist for five to 10 minutes and then you beat it. We see that all the time, so it’s very underwhelming. They come to you and all of a sudden you’re looking at them more globally. Then you’re working on this, you’re working on that. Boom, they tell everyone, especially if you’re in sports or something like that. A golfer comes to us and their shoulder hurts. And then all of a sudden we increase their rotation and then they can hit the ball further. They’re telling all their friends and that’s how the snowball happens over time. You have to breathe that a little bit.

Dianna Moulden: Awesome. Go ahead, Brianna.

Brianna Bethune: Yeah, okay. You actually touched on a couple of my questions, so that was perfect. We’re on the same page there. One question I really wanted to ask, and I’ve asked other people it as well because I really like getting their input, but the question, the way I worded it was would you encourage a new grad to specialize in their area of passion right out of school or do you think it’s more beneficial to get exposure to generalized, say, ortho for maybe a few years first to get that foundation?

Brianna Bethune: And just to add a bit of a personal touch on it, for me, I feel like I’m starting to really find my niche and I’m excited by it, but I have that anxiety of jumping right into it out of school just because I’ve loved all my clinical placements. I’ve loved being in ortho, sports, the hospital, so I don’t know. I’m not sure if I want to take that leap right away. You know?

Mike Reinold: Yeah, no. I agree. And if anybody else’s name rhymes, like we have a Susanna or a Joanna or anything, they should all just jump in and ask questions. My opinion on that question has changed over the years. When I first got started, especially when I started my website, I started my website well over 10 years now. I’ll be honest with you, I got lucky. Dianna gave me some good praise with her introduction, but I got lucky.

Mike Reinold: I was just first to market with being a prolific PT online with social media and a blog and stuff like that, so I kind of got lucky. But when I first started that, I definitely got criticism from people that are just like, “That guys not a good physical therapist.” I’m like, “What do you mean?” It’s like, “Well, you’re not good at spine.” I’m like, “Yeah, no. I’m terrible at spine.” They’re like, “You’re not good at geriatrics.” I’m like, “Yeah, no. Yeah, I hate old people.” No, just kidding. Yeah. No, I’m not. So somebody would actually call me a bad physical therapist. It’s kind of funny, as I grasped that concept and I said, “I don’t want to be generic at everything. I want to be really good at a couple things.”

Mike Reinold: If you even just look at my website, I don’t teach things that I don’t feel like I’m really good at. There is no articles on my website about foot and ankle. Feet stink. It’s not a big passion of mine, so you’re not going to find some articles about foot and ankle because that’s not me. It’s shoulder and knee performance, basically. That’s what I do. I think you should do that. That being said, Brianna, though, you do have to learn some of the basics.

Mike Reinold: What I often tell people to do, you guys are probably too new at this. This is too big of a topic for you, too big of a scope, but maybe when you get three, four or five years into your practice, here’s what I want you to do. I want you to take a step back and I want you to do an audit of yourself. You’ll want to do your audit of your skills and your knowledge base and then figure out where you want to go from there, okay. I think that’s really important. The first thing you can do is you can look at joint-specific stuff. You say, I’m going to go through all the joints. What am I comfortable with? What am I not comfortable with? Then figure out if you even care.

Mike Reinold: For me, I actually, same thing with me. About 10 years ago, I thought to myself, I’m not good enough at spine. I’m not comfortable with spine, so I went to every freaking course I could go to on spine. You know what I found out? I was probably pretty good at spine. Nobody’s good at spine. There’s no magic that you’re like, wow, I mean am I missing something? It’s not that. It’s more of a confidence thing. But go through each of the joints and say, what do I need to get better at? But if you’re in a practice where you never, ever, ever treat a spine, then you don’t have to focus on that. That’s your mode you’re in. That’s number one.

Mike Reinold: Then two is you go to activities. Maybe that’s sport. Maybe that’s like I want to work with football, soccer, baseball, whatever it be, that activity. I think you can do that. Then the third audit is skill. So it’s like hey, I want to get better with manipulations. I want to get better with soft tissue work. I want to get better with exercise prescription. So I want you to do a self-audit at some point at time and say, what’s your comfort level with joints, activities, and skills. That’s where you can find out where you want to go with your continuing education, but make it specific to the population in front of you.

Mike Reinold: To answer your question about passion and getting back with that here, I think you have to get to a point where you feel comfortable with your basic skillsets. And if you’re there and you’re comfortable and you want to stick to your passion, then I would definitely say, do that. I do not think we’re going to do any of ourselves or our profession justice if we continue to be generic physios and we can do a little bit of everything. I want you guys to be awesome at something or some things and roll with it. That’s fine. Let your coworker deal with all the spines, or let your weird PT friend that likes feet, let him work with that. You don’t want to deal with that, right? Think of it that way.

Mike Reinold: I think that’s how you want to get there. You may not be ready day one because it’s overwhelming that you have very little self-confidence probably that you’re going to be able to get people better, but once you start getting there, I definitely think we should niche out and we should be a little bit more passionate about where we go. Otherwise, life gets really boring, to be honest with you.

Brianna Bethune: Thank you. That was a really good answer. I have more questions, but I know Will has a really good question that I think he should ask. I’m going to pass it.

Mike Reinold: Nice.

Student: Put me on the spot. I like it.

Mike Reinold: What’s up, Will? This better be good or you’re going to be in trouble.

Student: Yeah, really. Well, I have a couple questions. I don’t know which one Brianna’s talking about, but I’ll ask one. One thing that I find a little bit tricky just on clinical placements is patients are often looking for a specific diagnosis and sometimes can’t really pinpoint what that might be. It’s more of a generic kind of issue. I was just wondering if you could touch on the role of patient education when there is not really that x-ray that says this is the cause or anything like that really?

Mike Reinold: Yeah, no. Good question, Will. You’re going to find that probably more often than you think. It’s really, I don’t want to say it’s rare because that’s not fair, but it’s not every day you’re going to say, “Oh, boom. It’s your meniscus. Your meniscus is the cause of all your trouble.” Because especially too, if you do, let’s say you come in and you diagnose it is a meniscus, well, what do you do? You’re going to do the same thing you were going to do anyway even if you didn’t have that meniscus diagnosis. It’s the same kind of concept.

Mike Reinold: What I always tell people, again, this goes back to what I was answering with that other one. You do two things. What’s broke? What’s suboptimal? And you educate them with that. You say, okay, let’s look pathological and be like, “You know what?” All right, let’s say a shoulder pain, person like that. “You know what? Looks like your cuff’s a little inflamed, but it doesn’t look like you have a rotator cuff tear. It doesn’t look like blah, blah, blah,” all those things. It looks like maybe you just overloaded. Your workload increased too much. You’re suboptimal in these areas. Let’s just focus on that. You don’t have to give them a diagnosis.

Mike Reinold: Now, if somebody does have a diagnosis and when you go to that what’s broke, what’s suboptimal, and you do have a what’s broke, like, “Ooh, your anterior capsule looks torn. You had that dislocation episode.” Then that’s different. You can have that, but I would say the vast majority of non-operative people are going to be nonspecific pain. So your goal is to get them just again that suboptimal checklist more than anything else. You just have to educate them with that. But trust me, from my experience, they may come in wanting a diagnosis, but you’re going to give them a plan, not a diagnosis. You know what I mean? You’re going to give them a, oh crap, that was awesome. Will just said that my shoulder hurts, but it’s because of A, B, C and D, and we’re going to work on all four of those things. And they’re going to be ecstatic.

Student: Awesome. Thank you.

Mike Reinold: What’d you think, Brianna? Was that the one?

Brianna Bethune: Yeah. That’s good.

Student: No. She just texted me and it wasn’t really the one she was asking, so can I ask it?

Mike Reinold: Yeah. What’s your other one, Will? Let’s get that one.

Student: Okay. Just as soon-to-be new grads, a lot of job descriptions or whatever say two, three years experience and so forth. How do you navigate going about that? Obviously, we don’t have experience applying for jobs, so what kind of… I don’t know. How could we sell ourselves to those types of job offers?

Mike Reinold: I think you’re giving the employers too much credit. They’re all probably googling a physical therapy job description template and just throwing it on a website. I think you’re giving them too much credit. I think everybody knows as a new grad, there’s going to be some work with you. There’s going to have to be some mentoring. There’s going to have to be some con ed that you get through. Most physical therapy clinics I know of tend to embrace that, probably more just because you’re cheaper labor, but they know it’s an investment in you over time. I would say don’t be intimidated by that.

Mike Reinold: I think what you can do for yourself is talk a little bit more about what you’ve done yourself to make yourself better than the other new grads. Does that make sense? You can say, “Hey, I’m… ” Especially if you’re finding a job that is in a realm that you’re really passionate about, like a clinic that works with, let’s say, a lot of high school athletes. You’re like, I love that. I just went to this seminar, or I’ve learned from these three people online. That’s how you set yourself apart with that. I wouldn’t be too worried about that little clause in the job description, Will.

Student: Nice answer. Thanks.

Mike Reinold: Yeah.

Student: All right, I’m done. I’m done.

Mike Reinold: That’s awesome. Well, we kind of said it before, but if you have a question, I think you can raise your hand, right? I’m always the host, so I don’t know. Is there a button to raise your hand? They’re like, “Raise your hand and then we’ll unmute you and you can ask a question.” Love to get some more. If nobody has any, maybe I know Brianna may have another one or two up her sleeve. You guys are quiet. This is your time to shine, right. Usually, what happens, somebody will nervously jump in and be like, “Mike, what do you think about the shoulder?” You’re like, “You didn’t prepare well for this meeting, did you?” Too broad, too broad.

Student: I have one.

Mike Reinold: Yeah.

Student: When you started, and Dianna already went through your long list of accolades, how did you really work to prioritize and balance trying to do everything and achieve your goals?

Mike Reinold: To be honest with you, my goal was always to work in baseball at the beginning, so that was my primary focus. I was trying to put myself in a position to do that. The first thing I did was… How many of you guys have heard of the American Sports Medicine Institute? I see a couple of nods in there. This was in the early 90s. This is before the internet, so I’m older than I look. I’m just really short, so I look youthful. At the time, they were the leaders in baseball sports medicine, so I said, “I got to figure out, how do I get in with that group?”

Mike Reinold: At the time, you literally just called people on a landline. So I called up Dr. Glenn Fleisig. He’s the research coordinator. He’s probably the number one expert in baseball pitching biomechanics. I just called him up and I didn’t know what to expect. Called him up and he’s just like, “Hi, this is Glenn.” I’m like, “Uh.” I was like, “Whoa, I didn’t think you were going to pick up.” I wasn’t prepared for that and I was just like, “Hey, I’m a physical therapist student. I’m from Boston. I really admire you guys.” I just put myself out there. So he’s like, “Come on down. You can do a research project with us. You can do an internship with us.” Great. Then yada, yada, yada.

Mike Reinold: That escalated. I remember, I did that and they’re like, “Hey, when you graduate school, do you want to move down to Alabama and work here?” I’m like, “Hell no.” I don’t want to live in Alabama. That’s a big difference from Boston. So I said no, but then they’re like, “Well, how about a fellowship with Kevin Wilk and Dr. Andrews?” I’m like, “Okay. All right. That’s pretty good. I’ll do it for one year.” And then again, yada, yada, yada. I’m there almost 10 years as it was just a good experience over time.

Mike Reinold: So yeah, for me, I sought out the people that I wanted to learn from and who I wanted to be a part with. I put that together. I’m getting off topic here again, Paula, but here’s a good nother funny story you guys can make fun of me about. I did the same thing with the doctor of the Red Sox, the Boston Red Sox. Again, I’m just an idiot student like you guys. I literally did the same thing. I called up. This is the 90s. He answered the phone. It was crazy. It was like, why is this guy answering the phone? He was so taken aback that I just called out of the blue to try to say, “Hey, I’d love to learn from you and meet you.” He’s like, “Tell you what, I want to bring you to a Red Sox game. Friday night, come with me. Come sit in my seats and we’ll talk.”

Mike Reinold: Here’s the mistake I made. This was later in my college career. I already had tickets to that game with all my friends and it was going to be a party. So I actually said, “Oh… ” I made up an excuse where I couldn’t do it because I wanted to go to the game with my friends. And then I called him back next week, never answered the phone ever again, so I lost that opportunity. Total side thing right there, but it’s like try to grasp your opportunity, but pick opportunity over your friends, maybe. I don’t know the life lesson from that, but hopefully you can learn from my mistake there.

Mike Reinold: All right, I promise I’ll have more specific answers going forward. They’ll not be so vague. Who else? Anybody else want to raise their hand? I don’t know if I can see anybody with raised hands. I don’t know if you want… Is that Benjamin’s got a thumb up? We’ll do that. Here, I’ll unmute you there. I think I’m unmuting you. Awesome. What’s up, Benjamin?

Student: Not much. A lot of people talk about walking and gait analysis as a really good way to functionally assess. Obviously, that’s something that takes a lot of practice. You focus a little bit more on the upper extremity. What’s a good functional test that you like to use and, obviously with your expertise, to try and see what might be going on with around the shoulder or upper spine? If someone comes to you with nonspecific pain or even to try and find how to optimize them?

Mike Reinold: Yeah. I would say in my background when I was probably where you guys were, I got really into biomechanical stuff, especially with my interaction with ASMI and stuff like that. So I’m a big fan of biomechanics and how that works, but the more I learned, the more I realized that there are so many variations in the way people do things that it’s really hard to say, “Oh, you’re walking wrong,” or “You’re not walking right,” or whatever it may be. I’m trying to think of obvious examples in sports, but like a baseball pitcher, even a golf swing. There’s so many different ways people do that and they’re all successful. So it’s super hard to say what’s the best way to do things.

Mike Reinold: I’ve seen a lot of new grads also go through this assessment. Somebody’s like three weeks out of ACL reconstruction. They try to do a gait assessment. They’re like, “Yeah, you’re limping.” And the other person’s like, “Yeah, no crap, I’m limping. I just had ACL surgery three weeks ago. I know I’m limping. That’s not why I came to see you.” I look at those things, but what I started to do, Benjamin, I started to do it a little bit different. I started to say, “What do I want to look at in terms of a mechanical assessment or a movement assessment that will directly impact the way I treat somebody?” So not just look at somebody to look at somebody, but what will I do?

Mike Reinold: We took a big step back and we reverse hacked that thought process. We said, “Okay. When we write somebody a program, let’s say a comprehensive program.” So this is blending into performance therapy now too and performance training. We say, what do we do for exercises? We categorize things by movements. We don’t train muscles. We train movements. We broke it down. We have hinge, a squat, a forward lunge, a lateral lunge, a step, multi-segmental rotation, overhead reach, push and pull. That’s how we program.

Mike Reinold: If that’s how we’re going to program and that’s how we’re going to write your program, I want to assess how well you do in each of those categories. We came up with just our own little movement screen, and we did that in our Champion Performance Specialist program that we put together. This is how we look at those movement patterns and then if it doesn’t go well, this is exactly how I program. This isn’t a negative of some of the other systems like FMS and stuff like that. Those do a good job at looking at movement, but I don’t think they do as good of a job at telling you what to do if somebody’s not moving well.

Mike Reinold: So we tried to come up with an exact system. We say, “All right, if you can’t hinge, we’re going to do this manual therapy, these corrective drills, yada, yada, yada. Here’s how we’re going to load you, that type of thing.” I would say take a giant step back and there’s two things, gross movements like we just outlined, and then when you get past that, you can get specific. I don’t know if I’d go gait necessarily, but maybe running mechanics, throwing mechanics, hitting mechanics, sports-specific mechanics. That’s upper level stuff. That makes sense?

Student: Yeah.

Mike Reinold: I mean hopefully that wasn’t too vague, but I would say is take a big step back first and before you start nitpicking how somebody walks, for example, why don’t you nitpick how they move first and then see if any of that correlates to their out… Walking to me is the outcome. You have to look at their capacity to be able to walk before you even get there.

Student: Yeah. Thank you.

Mike Reinold: Then remember, you see somebody walking weird, you’re going to be like, “Yeah. Definitely not walking right.”

Student: Yeah.

Mike Reinold: And then have no idea what to do. So still, you have to figure out what you need to do. Awesome. Good question. Nice. Let me see. Oh, I see Brett. We have some thumbs up. Let’s go, is that Mara? Did I say that well, Mara? Nice.

Student: Yeah.

Mike Reinold: What’s up, Mara?

Student: So my question is, are there any major mistakes in programming that either new grads or PTs make that we should avoid?

Mike Reinold: That’s a good question. I’d say one of the biggest mistakes I see new grads make is we tend to under-load. I think that’s our bigger thing. Not that you want to go crazy and break people down, but I think we tend to under-load and not emphasize strength development enough. That’s again going back to what we talked about earlier with some of the questions. It’s like understanding different loading schemes and periodization schemes to try to get more strength out of people. You can’t just do three sets of 10 forever.

Mike Reinold: I think that’s the biggest programming mistake we tend to see is we just don’t get advanced enough. We’ve had athletes come to us from other facilities that are three months after ACL and they’re still doing straight leg raises. I mean I’m sure their hip flexor is ridiculously strong now, but there’s more to life than straight leg raises.

Student: Great. Thank you.

Mike Reinold: That sounds like a tweet. Should we tweet that, there’s more to life than straight leg raises?

Dianna Moulden: Sounds like a tee-shirt.

Mike Reinold: Yeah, exactly. We can do that. All right, who else? Anybody else? Maybe we’ll take a couple more. You guys got anything more exciting you want to talk about?

Student: I have a question. I just unmuted myself. I hope that’s okay.

Mike Reinold: That’s aggressive. I like it. That’s good.

Student: Sorry. I’m wondering, if you were interviewing someone for a job, what’s one thing that they could say in the interview that would make you want to hire them on the spot versus one thing that they would say and you would send them out the door?

Mike Reinold: Trust me, there’s a lot you can say that I would send you out the door for. Well, when we see students, I predominantly look at one category. It’s their growth mindset. That’s a buzzword now. That’s up there with change the narrative. Trying to think of all the other cool things I see on Instagram. This growth mindset concept here is believe it or not, I’ve seen a lot of students that have come in with opinions. That blows my mind. For example, we’re at Champion. I do ultrasounds sometimes. How many of you people think ultrasound’s awful? Right. Right. Most of you are just preconceived to think ultrasound’s awful because 20 years ago Blue Cross said it was awful, so now everybody says it’s awful because they don’t reimburse for it.

Mike Reinold: But there’s studies that show that if you can tweak the settings and you can do an ultrasound on a ligament, and it may promote healing. So if I have a baseball player, he has a partial Tommy John sprain and we’re trying to get him back, I want to throw the freaking kitchen sink at him. Why wouldn’t I do an ultrasound on his ligament if I can show in a rat that their MCLs healed faster if I did a pulse ultrasound on their ligament?

Mike Reinold: We have a justification for why we do it. We’re a little bit different because we don’t really care about the insurance model, but we’ll have a student come in and just be like, “I can’t believe you’re ultra-sounding them. You can’t do that. That’s stupid.” And we’re like, “All right, you’re fired.” But no, they come in with preconceived opinions that they have because social media right now is super influential. A lot of you guys are learning from social media, which blows my mind. It’s just not a good place to learn. It’s more like edutainment than education, but they come in with those preconceived things.

Mike Reinold: So if you come to me with a growth mindset and say, “Look, in the last six months here’s the two, three things I’ve done to grow and I can’t wait to grow more. I want to learn how you guys do things. I want to be mentored by your staff. I can’t wait to grow.” But with confidence. Not like, “Ooh, I’m afraid. I’m scared. I don’t have self-confidence in myself. I need to learn more.” It’s more like a, “No, I’m excited to learn. I want to grow.” That’s the key to me. If you come in with a fixed mindset where you actually think with your one, two, three years experience that the last 80 years of our profession was all wrong, that’s not going to fly. That’s not going to go very well, so be careful with that mindset when you go in there.

Mike Reinold: I find too if you have two strong of an opinion too early in your career, you tend to try to justify that opinion in your future thoughts rather than having an open mind about whether or not you were right or not because you don’t want to be proven wrong. So keep that in mind. To answer your question, growth mindset I think is the way to do it, but an excited growth mindset. If you look at our staff at Champion, you look at our people here, I think we’re all studs. Everybody there is an exceptional person at their job because they choose to. Nobody’s a nine to fiver. Nobody’s just trying to get in and out. They want to be the best they can.

Mike Reinold: You guys know Dave Tilley, shiftmovementscience.com? He’s one of our PTs, a big gymnastics guy. You should see the crap this guy is reading. It’s insane. He’s like chemical reactions in brains. This is during his lunch break. It’s insane. We all just laugh at him, but he’s just such a leaner that he wants to do that at all times. That is what we’re looking for in our young hires.

Student: Thank you. That was a really good answer.

Mike Reinold: You guys are going to think, wow, this guy is really not professional. I’m too casual.

Dianna Moulden: They’ve heard me every Friday, so they know.

Mike Reinold: For me it’s trying to help. It’s trying to help, right? This is the reality of what’s real out there. Even the little things you learn in school like special tests and stuff you learn in school, half of them don’t work the way that you think they do because it’s not all text-book based. So you got to get some experience with those things. You have to keep a growth mindset. It’d be pretty important. All right, how about one more? What do you got? Who’s going to be the finale? Better be a good one. We’re going to end on a good strong one. What do you guys think? I think we should randomly pick somebody that has their video off and just unmute them and see what noises we hear. That could be good. What do you think? Dianna, I’ll let you pick someone.

Dianna Moulden: Okay, gosh.

Mike Reinold: Oh boy, everyone’s flipping their videos off.

Dianna Moulden: I know. Everybody is going to drop in numbers.

Mike Reinold: Everybody’s like, “Got to go.” Leave meeting, leave meeting.

Dianna Moulden: Does anyone else have a question? Brianna, do you have a question that you didn’t ask?

Student: I think Daniel raised his hand there.

Mike Reinold: Did you see one? I didn’t see it.

Dianna Moulden: You know what’s funny? So Julian unmuted himself. Julian, do you have a question? Because you would’ve been the person I would’ve picked to unmute.

Student: Man, I have my camera on.

Dianna Moulden: I can’t see you, but I was just going to scroll through list and find you and unmute you.

Student: I’m in a new house today, by the way.

Mike Reinold: I like it. I like the background.

Dianna Moulden: He has a new house every week that he’s in.

Mike Reinold: That’s funny.

Student: I think Daniel did have a question though. I saw him raise his thumbs, so he’s saying his question.

Mike Reinold: I don’t see Daniel. Let me see. Oh, there we go.

Student: Right, unmute.

Mike Reinold: Oh, okay. I got you. What’s up, Daniel?

Student: Can you hear me?

Mike Reinold: Yeah, I can see you now. What’s going on?

Student: What I was wondering, so you have obviously strength and conditioning experience. You’re coming in or working as a PT with the CSCS, which not necessarily everybody will have. So what I’m wondering is if you can speak to working in a team environment with, let’s say, the strength coach for the Red Sox or whoever it is, is prescribing programs to athletes and there seems to be a discrepancy. Or based on your experience, your knowledge, you feel there might be a conflict with what they’re being given to do day in, day out in the training versus what their rehab might entail and how you might go about dealing with those conflicts if they even arise, or if at that level strength coaches just kind of know what they’re talking about and you take it as is.

Mike Reinold: Well, you would hope they do. I think that’s the key. Because when you build a team, you have to build a team of like-minded people that all bring a different skillset to the table. Hopefully, you’ve built the right team and you’re close, but collaboration’s the key. And that’s part of some of our core fundamentals at Champion that we built here is that we wanted to have a bunch of multidisciplinary skillsets working together. That’s why we have a gym. That’s why we have PT and we kind of integrate the two together.

Mike Reinold: Could I write somebody’s training program? Yeah, absolutely. I mean I’ve done it plenty of times, but I’d rather hire a coach that’s really good at programming to be that person. But the key comes down to this, it’s collaboration. This is sometimes where young physical therapists, physios, get into trouble a little bit, especially with sport coaches versus strength coaches, start to step on toes and all of a sudden you think you’re a golf mechanical expert and you’re trying to tweak somebody’s grip or swing or something like that. Oftentimes it’s about stepping on toes a little bit.

Mike Reinold: The way we do it is pretty simple. At Champion, it’s pretty simple. If I have somebody that’s working with me exclusively and they want to start getting into the gym, I don’t go out there and say, “Hey, do A, B and C,” because then I’m telling them how to do their job. What I go out there and I say is, “Hey, I want you to focus on this and I want you to avoid this.” I don’t tell them how to get their job done. I just say, “I want you to focus on… Let’s get some good glute development and we need some posterior chains cranked,” or something like that and then let them run with it. If the team’s set up well and you have the right people in place, then that is going to work itself out.

Mike Reinold: What you’re going to get in trouble as a young clinician is you come in there and you start overstepping a little bit and you start telling them exactly what to do. That’s going to really be stuffy to them and it’s not going to really go well, especially in a collaborative team environment like collegiate or pro sports or something like that. Just surround yourself with good people and I think that helps. Awesome.

Student: Thank you.

Mike Reinold: Yeah. Good question. I like it. Tell you what, I want to leave you guys with this one thing because this is what I’ve been telling my students a lot here. And I’ve done this a little bit online, but I probably need to get a little bit more formal. I’m trying to put together a free course for students and new grads that go over even some of these questions we’re talking about, because everybody has the same questions. But I want to leave you guys with this. This is the development process that I see and where you guys see in this phase.

Mike Reinold: As you progress through your careers, you go from… Everyone wants to be an expert right away. You have to develop in this order. It starts with knowledge, then skill, then experience, and then judgment. That’s the big, big, big key right there. You’re never going to be an expert at your craft, even if it’s just a niche type thing or a diverse thing, you’re never going to be specific to that.

Mike Reinold: Let me explain. So knowledge, you’ve learned that in school. You got your book smarts. You have that. You have knowledge. You could always get smarter. Don’t get me wrong, but you have knowledge. But you don’t have a ton of skills yet, assuming you guys don’t. Maybe you guys are starting. You’re starting to get a little bit of skills in school and your clinicals, but it takes you a couple years to get some skills out in the clinical setting too.

Mike Reinold: So knowledge comes first, then skills, but you still have no experience. Then in your head you’re going to be like, “Oh, okay. All right. Geez, last time I saw something like this, it went like that.” And you can start making some opinions a little bit stronger based on that. So you need some experience and then finally you have judgment. Everybody wants to proclaim expertise on Instagram nowadays and seem like an expert, but you have to go through those four phases, knowledge, skill, experience and judgment. That’s how you become finely tuned with your craft and you start feeling good about yourself.

Mike Reinold: Just remember what phase you’re in right now. I would say the biggest phase you guys need right now is skills and reps. We say that all the time is just keep trying to find what skillset do you think you’re most deficient in? Do that little mini-audit and get better at that skill while you’re getting reps. Then in three to five years you’re going to look back and you’re going to be so confident in yourself because now you developed those things. You’ve got a little bit of judgment, and then you can start becoming a little bit more of an expert in a small portion of our field. Then that keeps just layering itself on.

Mike Reinold: So just keep that in mind with that development because I think then you can really focus on what you probably need most right now, and for now it’s probably reps. So just get out there. Remember, when everybody graduates, they all feel unsure of themselves, right? They’re not truly confident in their skillsets, but you guys know way more than you think. You just need experience. You need to like, okay, let me get this person out of shoulder pain, and then you’re like, “Yeah, I did it.” And then you’ll know what to do next time and then that’ll get better and better every time. Make sense? Awesome.

Mike Reinold: Well, thank you so much for having me. And obviously, for Dianna and Brianna for being a part of the organization of this and all the great questions, all the great videos. I’m not bitter about half of you that never turned their cameras on, but thanks so much for doing this. Heck, I’m easy to find online. So if you guys have questions down the road, just reach out and good luck with your upcoming careers once this pandemic ends, right?

Dianna Moulden: Yes. Thank you so much, Mike. This was invaluable to the group.

Mike Reinold: Awesome. Cool. Thanks, guys. Take care. Have a good day. Social distance bump. Let’s do it.

The Power of 1%

Today’s post is a guest post from a good friend of mine Pat Rigsby.  Pat is a fitness business genius and has helped us enormously at Champion PT and Performance.  This article really resonated with me, as I am a big believer of constantly tweaking my systems.  This goes for all my “systems” – my manual therapy system, my corrective exercise system, my program design system, and even all my personal and business systems.  This concept was a big part of building out the Champion Performance Specialist systems.  I’m constantly trying to improve myself everyday, and this article really put it in perspective for me. It’s like a snowball effect, slowly getting bigger and better over time.  This applies to so much, not just a fitness business, like Pat uses as an exmaple.  If you aren’t trying to get 1% better today, you are falling behind.

The Power of 1%

One of the biggest differentiators between the great business and the average ones is that the great ones keep improving.  They kept evolving their training system and making it 1% better, over and over.

Someone who looks at their sales system or their assessment system may say “that doesn’t look that different from what I do.”  But again – the great ones keep improving things, 1% at a time.

And if you look at their businesses, all the things that they do from their Initial Consultation to their Referral Systems to their Training System don’t necessarily look like something you’ve never seen before…they just do them all a little bit better than most everyone else.

That’s why the best businesses succeed…they take what works, they plug it into their businesses and they ‘plus it’ over and over…improving each component by 1% time and time again.  And when it’s all said and done you have a business that has maybe 20 different components which are each 10-20% better (at minimum) than the competition.  But because of the compound effect, this doesn’t make their business 10-20% better.  Because every piece works synergistically with the others their improvement actually multiplies the improvement of the other areas.

It’s the difference between 100 clients and 400.  The difference between $150,000 a year and $750,000.

If that seems hard to believe, here’s how a 20% increase compounded changes things, illustrated another way:

  • 10 X 10 x 10 x 10 x 10 x 10 x 10 x 10 x 10 x 10 = 10,000,000,000
  • 12 x 12 x 12 x 12 x 12 x 12 x 12 x 12 x 12 x 12 = 61,917,364,224

12 is only 20% bigger than 10, but compounded the difference is HUGE.

So how can you put this into action?

Model Success

That’s what you’re doing by reading this, so you’re already off to a good start.  The best business owners I know may have invented a few things from scratch, but most of the components of their businesses were things that they learned from other successful fitness pros and businesses that they adapted, improved and made their own.

So study what’s working.  Borrow from successful businesses.  Model their success.

Implement

We all see dozens of good ideas…in products, at events, in Mastermind Meetings. But I’d guess most people actually implement about 2% of what they learn. The best businesses are living, breathing pictures of implementation.  All the things people say they’re going to implement – the best ones actually do.

Remember – It’s not what you know.  It’s what you do.  You can say you’re a relationship business, but if you drop the ball over and over – you’re not.  You can say you’re all about referrals, but if you don’t have referral systems in place that are working – you’re not.

The best implement. So should you.

Plussing

‘Plussing’ is a Walt Disney term for continually improving and it should be a regular part of your vocabulary.  You may learn a referral system from someone and implement it, but you shouldn’t settle for it ‘as is.’  You should always be looking ways to make it a little more effective.  We often talk about getting 1% better.  This is getting 1% better in action.  Improving your referral reward or the way you ask.  Improving your internal language.  Improving your training system.  1% at a time.  This ‘plussing’ will eventually give you that 10-20% edge in every area that the best business owners have.

So that’s it.  Your ‘all too simple’ way to build a powerhouse business.  So put it into action and reap the same rewards that the industry’s best business have reaped.

Get Started Today, 1% At A Time

[Note from Mike] Here is your first step towards 1%. Start learning something new today.  When I was just starting Champion PT and Performance, I sought out as much information as possible to assure I started in the right direction.  I’m not a fan of making rookie mistakes when I can learn from the mistakes of others.  One of the best resources I discovered was Pat Rigsby.  Pat is a business guru, with a specialty in the health and fitness industry.

I asked Pat if he could offer anything special to my readers so they could start getting 1% better and he responded!  Pat has a special offer to my readers to get his latest book, The Fitness Entrepreneur’s Handbook, for free. 

The Fitness Entrepreneur's Handbook Pat Rigsby

I actually bought the book myself a couple of years ago for $20, haha, so you’re already doing better than me.  In fact, this article of the Power of 1% is actually from that book!  

But let me be clear, even if you aren’t starting a “fitness” business, this is a great resource for both personal development or if you want to start a physical therapy business.  Especially if you want to try to creat a hybrid fitness / physical therapy model like Champion.  

A 3-Step Plan to Deal with Burnout as a Physical Therapist

Today’s post is a guest post from Jenna Gourlay and Phil Plisky from Professional Rebellion.  We recently featured a podcast episode where we discussed how to avoid burnout as a physical therapist.  We talked about some of our strategies for avoiding, overcoming, and propelling yourself forward.  After releasing that, Jenna and Phil reached out to let me know they started a website to help physical therapists deal with burnout.  Here’s some great tips below, but also check out their website.

 

I could feel myself getting madder and madder. Not like an annoyed mad where you just need to step away for a minute, mad like I had to bite down to stop myself from saying anything I’d regret.

He just didn’t get it.

And even though he didn’t get it, he was still trying to give me advice.

I’m sitting there telling him how burnt out I am and how much I hate Physical Therapy and he’s telling me I need to change my caseload and change my attitude.

Really? Change my attitude, like I just chose this one? You think I want to be burnt out?

This is exactly what I wanted (eye roll)… to spend a ridiculous amount of time and money on a career I can’t stand.

No, I legitimately feel like I need to leave my career in PT. I cannot listen to one more patient tell me that he has an eleven out of ten pain and a high pain tolerance after arriving ten minutes late. I can’t do it.

I can’t muster the energy to try and inspire unmotivated patients. I can’t be satisfied with the average PT salary, the average PT schedule, or the average PT caseload.

He doesn’t understand… He isn’t the average and he doesn’t get what it is like to be stuck and have no idea how to move forward. He doesn’t understand the feeling of not having control over your day. Of not being able to figure out a time to go to the dentist, let alone get a haircut. He doesn’t have the loans that, regardless of how many payments are made, seem to gain interest as quickly as its paid.

He experiences none of this… but he’s telling me to own my day. Well, my day sucks and I don’t want to own it…

 

How to Deal with Burnout as a Physical Therapist

This was years ago now, but the memory of the feeling hasn’t left. I remember how frustrated, mad, and hopeless I felt. I remember thinking that everyone giving advice was doing so from their ivory tower and therefore just didn’t understand.

But, here’s my mistake: The people I was talking to were in a much different position than I was. They had a much better day than I did and they loved PT in a way I couldn’t fathom. BUT, they COULD relate and their advice was actually genuine, not accusatory.

They were speaking from already having experienced what I was experiencing.

Burnout isn’t your fault, but getting past it has to become your mission.

I hate to say it, but eventually you have to accept the problem of burnout as your own. I know, I know, I’m doing the exact thing that made me so angry. But, the reason everyone tells you what to do or how to beat it is because they recognize that no one is going to rescue you.

 

3 Step Plan to Overcome Physical Therapy Burnout

I’ve seen all the videos of what is wrong in healthcare and why its causing burnout. I agree, but I think we are far from an entire overhaul of the healthcare system to fix the problem of burnout.

The only way to fix our situation is to change it ourselves with the support of others.

Want to know what I did? Here’s my 3 step plan that I used that may also help you.

 

Step One: Find Your Ideal

It has been said that people are happiest when they are learning and growing. Have you been working toward a new set of skills or knowledge? And if you have, have you been intentional about it?

If not, this can be a big source of burnout.

Take a look a the person who has your ideal career. What do you need to study to set yourself up for the opportunities you are looking for?

Make a list of what you need to get you where you want to go. Do you need better manual skills, a higher level evaluation approach, public speaking ability, or teaching experience? Once you know what you need, start finding the courses, books, or opportunities you need to get yourself there. This is your personalized growth plan and it will act as your road map.

  • Look at where you are and where you ultimately want to be
  • List the skills you’ll need, the people you may need to be involved with, and/or the information you need to learn

 

Step Two: Don’t Just Plan, Go Do It

The thing about burnout is that you get stuck in this never ending cycle. You’re burnt out so you feel exhausted, and then you feel exhausted so you don’t have the energy to change anything about being burnt out.

When this goes on long enough, it is human nature to feel like we need some grandiose plan. We start planning and planning and planning then we get tired or lose momentum by the time it comes to acting.

Treat beating burnout like row of dominos. Do one thing and let a chain reaction occur where you continue to progress.

  • Choose ONE action and do it NOW
  • Choose a SECOND action and SCHEDULE when you will do it

 

Step Three: Find Your Team

Burnout is not something to address alone. The power of having good people around you is unparalleled when it comes to changing your environment. People to challenge you, support you and hold you accountable can be the difference between being stuck and propelling forward.

Be intentional about the team that you create around you.

Some may already have this available at work while others may need to be more creative in joining a tribe, like Mike’s Inner Circle.

A group to support and guide you should never be underestimated.

  • Look for others in positions or areas you wish to grow into and start to “seek what they sought.” Take courses, read articles, join discussions.
  • Find a group to hold you accountable. This is best when it is made up of individuals also aiming to level up and progress.
  • Establish a mentor to help guide you through the process. No one said it was easy and no one has all the answers. The best thing we can do is find someone to help and provide perspective along the way.

 

Ready to End Your Physical Therapy Burnout?

Burnout is not the end, burnout is the beginning.

What comes after it is what will ultimately define you. It can be the first step in going from average to amazing. Do you have negative and frustrating feelings? Burnout is not your greatest setback, it’s the secret weapon to your next success; go get something amazing.

Ready to end your physical therapy burnout?

Great. The first step is getting started!

Looking for more resources to jumpstart your career, check out some of the free resources at the Professional Rebellion:

 

About the Authors

Jenna Gourlay, PT, DPT, SCS, is the co-founder of the Professional Rebellion, a platform where people believe their ideal career is possible come together.  She is currently working toward her ideal career and wants as many people as possible to join her on the journey.  She is an adjunct professor at the University of Evansville, works with the women’s volleyball and basketball teams, and mentors within the sports residency program of ProRehab and University of Evansville. She believes that the top is not the loneliest and that we climb best together.

Phil Plisky, PT, DSc, OCS, ATC, CSCS, is the co-founder of the Professional Rebellion, where he guides and mentors professionals on the path to their ideal careers.  His mission is to advance the profession by inspiring those with the power to change it.  He does this as a researcher, Associate Professor at the University of Evansville, Director of the Sports Residency program, co-developer in Functional Movement Systems, and professional sports consultant.

 

Do You Want to Learn More About Optimizing Movement and Enhancing Performance? 

I’m really excited to be launching my brand new course for rehabilitation and fitness professionals looking to help people restore, optimize, and enhance performance.   It’s my Introduction to Performance Therapy Training course.

And you know what the best part is???

It’s absolutely FREE!

Check out the information and video below, and click the link below to enroll today!

Introduction to Performance Therapy and Training

If you’re anything like me, I’m sure you’d love to work with more highly motivated people, and even athletes, that want to focus on improving their performance.

But I remember not really feeling prepared for this or knowing how to get started, I really felt overwhelmed. We all learned the basics, but no one really teaches you how to optimize movement and enhance performance.

Over these years, I’ve learned a ton. Good and bad! But everything I have learned has shaped what I do, and it took some time and experience to realize this.

There so much info out there, but people tell me all the time they’re still confused and that they feel like they just start treatments and training programs and aren’t even confident that they choosing the right ones!

Check out this video for more of what I mean:

Enroll in My Course for FREE

I want to help.  When we started our facility at Champion PT and Performance, one of our biggest goals was to develop a simple system for our physical therapists and strength coaches to help people move and perform better.

My Introduction to Performance Therapy and Training program will teach you our 4-step system at Champion to assure you have everything you need to start helping people move and perform better.

Introduction to Performance Therapy and Training

Best of all, it’s absolutely free to anyone that signs up for my Newsletter. You’ll get all my best articles straight to your email, and immediate free access to the course.

Thank so much, hope you enjoy!

sign up now for free

How To Best Collaborate Between Physical Therapy And Fitness

The latest Inner Circle webinar recording on How To Best Collaborate Between Physical Therapy And Fitness is now available.

How To Best Collaborate Between Physical Therapy And Fitness

This month’s Inner Circle webinar is on How To Best Collaborate Between Physical Therapy And Fitness.  In this presentation, the strength coach and physical therapy staff at Champion PT and Performance team up to discuss better ways to communicate and collaborate between professions

This presentation will cover:

  • Why it’s so important to develop relationships between professions
  • How to find people to collaborate with that share your core values
  • How and why you should stay within “your box” and create a team of people to collaborate with
  • How to best communicate between professions

To access this webinar:

The Difference Between an Expert and a Beginner

A couple of weeks ago, I made an Instagram post of a graph that I found showing the difference between a expert and a beginner.  BTW, if you aren’t, you should be following me on Instagram, I have a ton of content up there.  That post has created a lot of buzz and a ridiculous amount of likes, comments, and shares in social media.  I absolutely loved the message and want to share this with everyone.

the difference between an expert and beginners

I recently came across this graph and was really floored with how accurately it depicted our evolution of knowledge and expertise. This has become more and more relevant with social media allowing everyone to have an opinion and to self proclaim expertise. ⠀

When we first start out, we have a period where we rapidly progress from feeling like we know nothing to feel like we know everything.  Maybe it’s false self confidence or maybe it is just ego, but it’s pretty common.  You then often proclaim expertise.  Some people get stuck here.  Others soon realize that what they thought was true, may not be true!  The humble people amongst us will progress and start to realize there is so much to learn!  Congrats, you made it.

At Champion, we always discuss this concept with our physical therapy students and strength and conditioning interns. They all want to start a website and social media branding, and often try to do it by pretending they are experts.  Essentially, they are using the “fake it ’til you make it” mentality.  They’ll learn something and then the next day talk about it on social media as if they were now experts on the topic.

I always advise our students that anyone with experience will see this lack of authenticity and it will ultimately end up hurting their brand in the long run.

Trust me, when I see some posts on Instagram I shake my head.

Often times it’s proclaiming something that with a little more experience, they would realize maybe isn’t the best idea. And if you are too vocal about your stance, you’ll end up defending your position in the future instead of keeping an open mind and adapting as you learn and experience more. ⠀

What can you do about it?

Rather that self proclaim expertise, embrace the fact that you are learning and share your journey. That will help you grow more personally, and all of us on social media will grow with you.⠀The key to becoming an expert has less to do with how much you know and more to do with realizing how much more there is to learn.

 

How to Best Integrate Evidence Based Practice

Over the last couple of decades, our professions have made great strides towards moving towards evidence-based practice.  As our understanding of the body and principles behind our professions expand, it is imperative we seek out evidence behind our exercises and manual therapy techniques so that we provide the best services as fast and safe as possible.

However, I am seeing a trend too far along the curve towards evidence-based practice that I am not sure is good or bad.  I feel like I have heard so many people arguing against a technique just because it has lack of evidence suggesting efficacy.

We have created this “paralysis-by-evidence” situation where some people think you can’t do anything unless it has strong evidence suggesting it is effective.  This approach is challenging and ultimately unrealistic.

 

What is Evidence-Based Practice?

I have felt many times on social media that some people have forgotten the three components to evidence-based practice:

  1. Best available evidence
  2. Clinicians experience, knowledge, and skills
  3. The patient’s wants and needs

As you can see, “best available evidence” is only one component of evidence-based practice.

Far too many times, especially in the physical therapy world, we are forcing “evidence-based physical therapy” on our patients based solely on best available evidence, instead of providing them with the service they originally came to see you for, which is to simple to “feel better.”   I am not talking about a situation with a pharmaceutical effect and potential serious adverse reactions, I am talking more about some of our exercises and manual therapy techniques that will at best make people feel better and at worse do nothing.

Now before you begin your criticisms, please continue to read the rest of this article.  You should at all times base your practice on evidence.

However, what do you do when there is lack of evidence?

 

The Evidence-Based Practice Light System

When I teach students and young clinicians how to begin integrating evidence based practice, I always begin discussing what I call the evidence-based practice light system.  Using this system, it becomes clear very quickly what techniques you should absolutely perform and not perform.

evidence based practice light system mike reinold

  • Red Light = Stop.  If there is strong evidence by quality randomized controlled trials suggesting a safety concern or lack of efficacy, then you should find an alternative approach that may be more advantageous.
  • Yellow Light = Proceed, but with caution.  When there is conflicting information, or there aren’t enough quality studies examining the effect you are assessing, then you must proceed with caution.  In this scenario, perhaps there are some low quality studies (like a case study or publication without strong methodology) that show efficacy, or maybe even some conflicting results in the literature without an overwhelming trend towards efficacy or lack of efficacy.
  • Green Light = Go.  If there is strong evidence by quality randomized controlled trials suggesting efficacy, then you can comfortable use this approach with evidence-based justification.

There are many great resources to search the available evidence on a technique in question, including published clinical practice guidelines, the APTA’s evidence based practice website, and performing your own literature review on PubMed.

 

How to Integrate Evidence Based Practice

Unfortunately, where do you think the majority of our techniques, assessments, exercises and other approaches fall into the evidence-based light system?

Yellow.

It is very hard to create a well controlled study assessing everything we do.  I often see issues with groupings of people based on things like “shoulder pain” or “patellofemoral pain.”  How do you define those?  They are so broad there is no doubt that trying to assess efficacy of an intervention is going to be challenging.  Or how about the flip side of that?  The study that looks at “massage” for a certain pathology.  How do you define “massage?”  Would I do it different than you?

So a large amount of time we are going to have a lack of evidence, or conflicting evidence, suggesting an effect or lack of effect. In this scenario, you have to make the judgment yourself based on sound theoretical principles and experience.

That’s key.  Sound theoretical principles and your experience.

If you do not have enough experience yourself, I am OK with you relying on the experience of an expert clinician.  Just realize that the number of social media followers does not make you an expert, experience does.  However, you should never be comfortable doing anything just because someone else told you that it was effective in THEIR experience.  You should continue to carefully scrutinize the technique in your hands based on YOUR experience.

As new research is conducted and evidence becomes available, you will need to continually refine your techniques based on our current understanding of the evidence.

Base the foundation of what you do on green light principles.  But in the meantime, don’t feel that everything needs to fall within the green light designation.   Consider including techniques that fall within the yellow light designation if based on sound theoretical principles and your experience has shown positive outcomes.

 

 

 

Evidence Based Practice Light System – Photo by Kathera