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!

 

 

 

 

 

 

 

The 3 Keys to Building an Epic Online Training Program

Online training has grown in popularity in recent years, and for good reason. It dramatically increases your ability to help others reach their goals from only those within a 5-mile radius of your gym to people anywhere in the world.

We built out the start of our Champion online training platform over a year ago and recently updated it.  We spent the year learning, tweaking, and evolving.  Along the way, we learned a bunch.  If you want to build an epic online training service that maximizes its effectiveness, retention, and scalability then there are 3 major keys that we feel you have to master.

One of the people we learned a ton from is Jon Goodman.  Jon runs the PTDC and the Online Trainer Academy.  We sat down with Jon during a recent visit to Boston to discuss these 3 keys, and a bunch more.  Check out our interview and read more about our 3 keys below.

 

Become an Educational Resource

As a coach, if we are to label ourselves experts in the field and expect others to trust us enough to choose us to help them get the results they’re looking for from a training program then we have to do more than send them a list of exercises to perform.

This is one of our core values in everything we do from our social media posts and online training programs to our in-person coaching. It’s not enough to simply tell people ‘what’ to do. Educating your clients on the ‘why’ behind everything in your programming and coaching will empower your clients and make them more likely to succeed and to rave about it to others.

Remember you are not a technician, you are a coach.

A lot of coaches are afraid to show their whole hand and give away too much information. They’re afraid that if they do, then their clients won’t need them anymore and they’ll leave to do it on their own, when in fact it’s often the exact opposite. Helping clients become a better version of themselves by understanding why they’re doing what they are will lead to greater buy-in, results, and longer retention.

 

Provide Accountability

People need more than a program.  In fact, the program is often the easiest part of the process.

Often times, the people coming to you for online programs and coaching have tried numerous other programs in the past. Maybe it wasn’t the right program or didn’t provide enough education, but more often than not, it simply didn’t provide enough of a community of people that supported them, encouraged them, and held them accountable for sticking with it any longer.

Building a community lead by accountability and coaching that provides support for everyone involved will without question foster longer relationships with your clients. Knowing that you have others supporting you, and more importantly, relying on you for their support gives every individual a sense of purpose and ownership over their part of the community.

 

Assure Scalability

You have to remember, people are coming to you with so many different backgrounds, goals, needs, and experience level.  You have to create an option for everyone.

Everyone has a unique starting point and it’s your job to find a way for them to belong.

People fail other programs because they don’t continue to evolve or have options for them once they’ve graduated from a particular plan. If you want to combat this, you have to figure out a way to scale your online training business to the point that it can continue to serve your clients no matter where they’re at in their fitness success path.

There are pros and cons to every style of online training. Individualized coaching can be hyper-specific to a client’s goals and needs, but is limited by the price point and the number of people you have feasibly serve. Training templates have the ability to help an infinite number of people at a low price point but are limited by their generality and lack of customization.

By having a variety of coaching levels to meet people’s goals, needs, and budgets and thinking ahead enough to provide the coaching to answer the potential questions you can maximize your reach and client retention to scale your business.

 

Want to Learn How to Start Your Own Online Training Program?

Online Trainer AcademyMy friend Jon Goodman of the PTDC has a really amazing online training certification program.  Kiefer and I both went through the material several times, it really helped us when developing our programs.  The program is absolutely amazing, not only in how comprehensive it is but also in the quality of all the materials.  I have no doubt that this investment will save you a ton of time and help you get started on the right path.

The program opens a couple of times a year, so if it’s not open now, be sure to sign up for the waitlist to be notified next time it’s available:

 

Want to Join Our Online Training Programs?

champion online personal trainingIf you want to see these principles in action, I encourage you to check out our online programs and “learn by doing.”  I think that really helps with your own authenticity when you can say you’ve been through this type of programming yourself.

We really do pride ourselves in the 3 principles above, so I know that you’ll not only get a great training experience for yourself but also a great educational experience as well.

We have a variety of programs depending on your goals, check them out below:

 

 

My Best Articles and Podcasts of 2018

With the end of 2018 drawing close, I always love to end the year with a quick review of some of my best content of the year!  I personally love reflecting back as I start planning for the new year, and it’s something I really recommend everyone do as well.

Check out the video below to learn how I reflect back on the year and how I plan ahead to make sure the upcoming year is awesome.

As part of my reflection back on 2018, I also review my content for the past year.  I do it so I can think about what I want to do different in the upcoming year, but also to see what some of the most popular content was over the course of the year.

I also know this yearly post is always popular with my readers.

As many of you may of noticed, I had less articles on the blog this year as we started experimenting with more and more “other” types of content, like the podcast, and also more educational content on Youtube and Instagram.  If you haven’t, please take a moment to subscribe to podcast, my Youtube Channel and my Instagram Account to make sure you don’t miss any of this content!

I must say that I missed writing articles, and will be doing more in 2019.  I will always try to develop content in the best platform possible, and just because Instagram was so popular this year, doesn’t mean it was the “best” platform to educate.

Before I get to my best content of the year, I REALLY wanted to hear from you as well.  Please comment below and let me know what you thought?  What did you like best this year?  Do you want more articles?  More Instagram or other social media content?  Different types of podcasts?

I really appreciate everyone of my followers!  Thanks for everything in 2018, and don’t miss some sneak peeks of what’s coming in 2019 below!

 

My Best Articles of 2018


The Difference Between an Expert and a Beginner

The difference between an expert and a beginner

This was by far my favorite article of the year.  It started as an Instagram post, but turned into an article as I felt it was so important.  Instagram is filled with so many people proclaiming expertise right now.  Trust me, we see so many posts that make us shake our head.  Simply put, with more experience we expect many people to regret some of the things that are so adamantly proclaiming right now.  I openly encourage everyone to be active online educating, just be humble and careful, don’t try to come across as an expert.  Share your journey with us so we can all grow as you grow.

 

13 Lessons I Learned from Dr. James Andrews

Many of you know Dr. James Andrews as one of the most famous sports medicine surgeons around.  He’s always on ESPN because so many high level athletes go to see him.  I’m proud to say that he’s a friend and mentor of mine.  He’s not just one of the best surgeons, he’s always an amazing mentor.  Here are just some of the many things I have learned from Dr. Andrews over the years.

 

How to Best Integrate Evidence Based Practiceevidence based medicine light system mike reinold

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.

 

Is Icing an Injury Really Bad for You? What the Science Says

is icing really bad for you? What the science says on icing

Man, ice has really taken a hit lately haha!  So many people on social media are saying that ice is bad for you to perform.  But is any of this based on science???  Not really, more like pseudoscience at best.  Here’s a great guest post from my friend Phil Page.  He does an awesome job discussing what we do, and still don’t, know about icing.

 

Special Tests for Rotator Cuff Tears

Rotator cuff tears are one of the most common injuries we see in orthopedic physical therapy.  During the clinical examination of the shoulder, we want to perform special tests designed to detect a rotator cuff tear.  Here are videos of my 4 favorite special tests for rotator cuff tears that I perform during my clinical examination of the shoulder.  These 4 tests do a good job detecting larger tears that are causing dysfunction.

 

Return to Play Testing After ACL Reconstruction

This was a great guest post from Lenny Macrina.  I spend a lot of time with Len, and I know return to play testing has been a big topic on his mind this year.  Here’s a great review of what we know right now.

 

4 Mistakes People Make When Rehabilitating Hamstring Strains

Don’t make these 4 common mistakes when treating a hamstring strain

Hamstring strains are so common, but also one of the injuries that tend to be the most recurring and nagging over time.  Here are my pearls on diagnosing and treating hamstring strains to try to assure that athletes minimize their chances of have recurring issues.

 

Sorry, Sitting Isn’t Really Bad for You

sitting isnt bad for you sitting isnt the new smoking

This article received a lot of positive press, though many still misunderstood my main point.  There is nothing wrong with sitting all day, it’s never moving that is really causing so many issues!  People that are trying to point the finger at sitting, and posture itself, are really missing the point.  And if you miss the point, you probably aren’t educating your clients as best as you can.

 

5 Exercises You Should Perform If You Sit All Day

5 Exercises to Combat Sitting All Day

See what I did right there?  My follow up to my sitting article shows you a bunch of things to perform if you do sit all day, all centered around my concept of reverse posturing.

 

 

My Best Baseball Content of 2018


3 Things Baseball Players Need to Develop Elite Pitching Performance

For my baseball fans out there, I wanted to write this article for some time.  It’s funny to me to see all these performance enhancement programs and “velocity programs” out there on the internet that really miss the boat on developing baseball pitchers.  Here are the 3 scientifically proven things you should focus on.

 

Baseball Episode: Working with Pitching Coaches and Olympic Lifts with Baseball Pitchers

ask mike reinold show

This was a great podcast episode for baseball fans.  We get asked all the time about olympic lifts for baseball players.  In this episode, we clearly define why we don’t use olympic lifts in this population.  If you work with baseball players, you need to give this episode a listen.

 

My Best Podcast Episodes of 2018


How to Find a Mentor in the Rehabilitation and Fitness Professions

ask mike reinold show

There was a ton of great advice for young rehab and fitness professionals in this episode.  Finding a mentor is extremely valuable, but not always the easiest thing to do.

 

How Do You Treat Chronic Pain Patients in the Sports Medicine or Orthopedic Outpatient Setting?

ask mike reinold show

We’re seeing a lot of people apply the concepts of pain science poorly, especially in the high level orthopedic and sports medicine setting.  In this episode we tackle the concept of chronic pain in this population.

 

Our Biggest Pieces of Advice to Celebrate Our 100th Podcast Episodeask mike reinold show

 

We all gathered around to celebrate our 2 year anniversary and 100th episode to talk about some our best pieces of advice.

 

Special Episode on Strength and Conditioning Program Design

ask mike reinold show

We are really very fortunate to have such an amazing group of physical therapists and strength coaches at Champion.  We all go together to discuss program design.  This is a great effort by the group, all coming together to share their expertise.

 

The Mobility Episode – Is Too Much Mobility Good or Bad?

ask mike reinold show

I really liked this episode.  We deal with a lot of hypermobile people.  One of the first things we do with new clients at Champion is often take a step back on people focusing on too much mobility.  It seems like social media thinks every issue can be solved by mobility, when often times this only makes things worse.

 

My Best Inner Circle Presentations of 2018


How to Perform a Thorough and Systematic Clinical Examination

I started to share some slightly different presentations for my Inner Circle this year.  I realized on social media, that I can share my experience as a clinician to help younger people get better faster.  Not everything in real life is how you learn it in school or from a textbook.  So I wanted to share more clinical pearls that you can only get with experience.  Here is the first of a series of videos on the Clinical Exam process.  These are some of the most popular posts I’ve made for my Inner Circle.

 

How To Best Collaborate Between Physical Therapy And Fitness

We recorded a staff inservice with all our our therapist, coaches, students, and interns to discuss how to best collaborate between professions.  We share a ton of great advice.

 

What’s Coming in 2019?

So, what’s coming in 2019?!   Well, 2019 is going to be huge.  I have a ton of great content planned for the website, but also some MAJOR projects in the works!

  • The Champion Performance Specialist Certification.  I’ve been alluding to this new program that I will be releasing all year, because I’ve been working on it all year long!  This is my biggest program to date, and essentially will teach you everything I do to assess movement and build my performance therapy and training programs.  This.  Is.  Going.  To.  Be.  Huge.   Shooting for February still at this point, be sure you are subscribed to my newsletter.
  • A new Inner Circle.  I have some great ideas for the Inner Circle.  I want to make it a place for younger clinicians to get started on  the right path, and for more experienced clinicians to stay cutting edge and on top of the latest research.  In the past, there has always been great content, but I am really going to organize it much better and start to make it more comprehensive now that I have years of content on there!
  • A free mentorship program for new grads.  This is a big part of what I want to do going forward.  I am at a different point in my career and want to really give back to the next generation and help them get started.  There’s a lot of noise out there right now, I get how overwhelming it can be to get started.

 

Thanks again, I hope you had a great 2018!  See you next year!

 

How to Perform a Thorough and Systematic Clinical Examination – Part 1

The latest Inner Circle webinar recording on How to Perform a Thorough and Systematic Clinical Examination – Part 1 is now available.


How to Perform a Thorough and Systematic Clinical Examination – Part 1

This month’s Inner Circle webinar is on How to Perform a Thorough and Systematic Clinical Examination – Part 1.  In this presentation, I discuss some of the concepts behind how to structure an excellent clinical examination process.  This will assure that you are always following a systematic process to detect any structural and functional issues, and that you can easily create a plan of treatment to help the person reach their goals.  This is part 1 of 2 and will focus on the general concepts and subjective component of the exam.

This webinar series will cover:

  • The 4 main buckets of any clinical examination process
  • How to assure you follow a systematic approach each and every time
  • How to look for structural pathology, as well as find any suboptimal areas of function that may be related
  • How to take your exam and make an effective assessment and treatment plan

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

13 Lessons I Learned from Dr. James Andrews

One of the most influential people in my career has no doubt been Dr. James Andrews.

Many know Dr. Andrews as one of the most prolific and acclaimed orthopedic surgeons of our generation. Heck, he’s been named the Most Influential Man in Sports, which is pretty impressive for someone on the medical side of sports.

But I’m pretty fortunate to know Dr. Andrews as a friend and mentor, someone that has shaped my clinical skills, my work ethic, and my entire career.

I spent nearly 10 years working directly with Dr. Andrews, from a research assistant at ASMI to a PT clinical student to a Sports Physical Therapy Fellow, and finally to a member of his sports medicine team in Birmingham. I’m also fortunate to continue to conduct research, speak at conferences, and collaborate on patient care with Dr. Andrews.

While I’ve learned countless lessons from Dr. Andrews, I spent the day with him recently at the APTA Combined Sections Meeting where we both spoke together in an education session, and later that evening Dr. Andrews was honored with the Sports Section’s most prestigious award.

4 Great Quotes from Dr. James Andrews

During his presentation in our educational session, he showed one slide towards the end with four amazing quotes that I just had to share.

I sat back, listened to Dr. Andrews discuss each of these and thought to myself, wow, the majority of people on social media right now are breaking each of these rules daily.

If you are still talking about what you did yesterday, you are not really doing much today

Many of you know that one of the key principles of my career is never to stop learning. When I look at this first quote, I think of all the people on social media that are busy defending their opinions rather than keeping an open mind and growing. This creates a really poor learning environment when you do this, as you are constantly trying to defend your position, rather than growing and evolving your position as new evidence and experience emerge.

I don’t ever want to be the maker of the big statement, it may come back to haunt you

It’s so easy now to get online, grow a following, and become an influencer. It’s super common now to see people with limited experience making BIG statements because they get caught up in a recent trend, worse, internet marketing.

You don’t want to say something you are going to regret in 5 years. Trust me, my opinions continue to evolve as I learn and grow. I know that everything I teach now will likely be at least a little different in the future.

That’s called growth. Remember when we thought the earth was flat?

Don’t make the big statement. You’re either going to change your mind in the future or worse, spend your efforts defending your big statement instead of evolving.

In medicine, there’s no such thing as always and never

Just another great example of big statements. I’ve worked with many people in my career that speak with “always” and “never.” Nothing is definitive, especially in medicine.

More importantly, if you think this way, you are again sabotaging your ability to grow.

I’m still listening and learning

Probably the most impactful statement of the presentation in my mind, spurring me to post this on Instagram:

Dr. James Andrews, the most renowned orthopedic surgeon in sports medicine, a man that has been practicing sports medicine for almost 50 years, is still listening and learning at this point in his career and life.

Yet how many people do you see on social media that aren’t listening or learning?

If there’s one thing you can take from this article, keep listening and learning.

Dr. James Andrews’ 9 Keys to Patient Care

Later that evening, Kevin Wilk had the honor of introducing Dr. Andrews during the awards ceremony. As part of Kevin’s presentation, he shared Dr. Andrews’ Patient Philosophy.

These 9 keys to patient care are something Dr. Andrews has followed his entire career. To this day, he continues to carry these with him on a little card in his wallet.

1. Listen to the Patient
2. One Must Always be Able to “Read the Patient”
3. The Patient is Always Right

The first keys are all related to your interactions with the patient. Communication and interpersonal skills are just as important as clinical skills in medicine. People want to be heard and are coming to us to help them.

One common mistake I see in young clinicians make is the desire to impress the patient with their knowledge. To truly help people, you need to connect with them first. As the phrase goes, “people don’t care how much you know until they know how much you care.”

It’s really important that you focus on these people skills just as much as your clinical skills.

4. Make the Patient Feel They Were Treated Properly by Their Previous Physician
5. Do Not Say Anything About Another Person

The next two keys focus on your interpersonal skills with other professionals. I can’t tell you how common it is to hear that a patient saw a new clinician and all that clinician talked about was how poorly the previous person was.

Everything is easier to see in hindsight. Don’t make judgments on what others have done in the past because you were not there.

Another point to remember is that the patient likely has a connection to the people in their past. Speaking negatively about them is only going to hurt your new relationship with this specific patient.

Unfortunately, I’ve been in these situations before and have observed people try to get ahead in life by bringing others down. Don’t be that person.

6. Do Not Be the First Person to Make the BIG Statement
7. Always Be Open-Minded

These next two keys are very similar to the lessons learned above, but again another great reminder. Keep listening and learning.

8. Attitude, Responsibility, Knowledge, Desire, and Availability are Always Necessary to be Successful
9. The Physician Must be Confident with Their Diagnosis and Skills. Their Confidence is Reflected Back and Perceived by the Patient

The last two keys are finally about you and your interactions with the patient.

Much of this comes with experience. But even with limited experience, you can show compassion and sincerely want to help people.

You also must be confident in your own self. It is very transparent and easily noticed by the patient if you have any doubt. If there is a specific area that you are not confident in, you owe it to yourself and your patients to become more knowledgeable in that area, so you can become more confident as well.

What to Do Next?

I’m super proud to be able to share the things that I have learned from Dr. Andrews over the years and hope they help you too.

If I were you, I would share and save this article and reflect back on it routinely. I have done this throughout my career and will continue to do so.