WEBVTT 00:00:00.249 --> 00:00:01.231 And let's do this thing. 00:00:01.372 --> 00:00:03.976 David, Amanda, welcome to the podcast. 00:00:04.658 --> 00:00:05.759 Thank you for having us. 00:00:06.400 --> 00:00:06.782 Thank you. 00:00:06.822 --> 00:00:07.201 Excited. 00:00:08.394 --> 00:00:09.994 So you will be presenting in 00:00:10.054 --> 00:00:11.916 Orlando at the AOMT conference. 00:00:11.936 --> 00:00:13.215 So this is the prequel. 00:00:13.275 --> 00:00:14.355 This is the teaser. 00:00:14.435 --> 00:00:16.736 This is the movie trailer of 00:00:16.836 --> 00:00:18.016 what will be coming up when 00:00:18.056 --> 00:00:19.917 we get together in Florida. 00:00:20.478 --> 00:00:22.437 So my first hard-hitting question is, 00:00:22.498 --> 00:00:25.419 will you be presenting in 00:00:25.498 --> 00:00:26.439 Mickey Mouse ears? 00:00:26.478 --> 00:00:27.759 Are you going to be hitting Disney? 00:00:27.778 --> 00:00:28.719 That's the question everybody asks. 00:00:28.759 --> 00:00:29.420 Are you going to be hitting 00:00:29.460 --> 00:00:30.140 Disney beforehand? 00:00:30.179 --> 00:00:31.239 Amanda's already nodding. 00:00:33.396 --> 00:00:33.856 Of course. 00:00:34.076 --> 00:00:34.317 Yes. 00:00:34.356 --> 00:00:35.758 Or at least a Disney costume, 00:00:35.817 --> 00:00:36.859 maybe of some sort. 00:00:36.899 --> 00:00:38.920 Maybe not Mickey ears, but Disney costume. 00:00:38.941 --> 00:00:39.881 A little flavor. 00:00:40.002 --> 00:00:40.222 Yeah. 00:00:40.402 --> 00:00:41.143 I'm expecting that. 00:00:41.723 --> 00:00:42.804 I do not have the ears, 00:00:42.844 --> 00:00:44.405 but I will be wearing the slippers. 00:00:45.106 --> 00:00:45.987 That's all I'm looking for. 00:00:46.188 --> 00:00:48.409 All right. 00:00:48.630 --> 00:00:49.670 Let's get down to business. 00:00:50.451 --> 00:00:51.472 What are you presenting on? 00:00:51.512 --> 00:00:52.613 What do people get to learn 00:00:52.694 --> 00:00:54.174 from you when you'll be 00:00:54.494 --> 00:00:56.656 together on stage at the AM 00:00:56.698 --> 00:00:58.158 conference this October? 00:00:59.604 --> 00:00:59.844 Yeah, 00:00:59.905 --> 00:01:02.246 so we're actually continuing off of a 00:01:02.326 --> 00:01:03.847 series of presentations 00:01:03.868 --> 00:01:05.989 that we've given at prior AM conferences. 00:01:07.150 --> 00:01:08.950 You know, we've done the shank, 00:01:09.131 --> 00:01:09.590 if you will, 00:01:09.611 --> 00:01:10.871 and the tibialis posteriors 00:01:10.951 --> 00:01:14.233 roll on the hind foot, mid foot last year, 00:01:14.293 --> 00:01:15.334 talking a little bit more 00:01:15.394 --> 00:01:17.275 specific of hind foot and 00:01:17.376 --> 00:01:18.537 transverse tarsal joint. 00:01:18.576 --> 00:01:19.677 And then based on feedback, 00:01:20.037 --> 00:01:21.197 we're continuing down the 00:01:21.237 --> 00:01:22.578 mid foot to the medial and 00:01:22.618 --> 00:01:23.400 lateral columns. 00:01:24.608 --> 00:01:25.968 So it's a sequel is what you're saying, 00:01:25.989 --> 00:01:26.989 which just fits with the 00:01:27.069 --> 00:01:28.391 Universal Studios and the 00:01:28.430 --> 00:01:29.191 whole Florida mindset. 00:01:29.210 --> 00:01:29.871 That's great. 00:01:29.891 --> 00:01:30.272 All right. 00:01:30.632 --> 00:01:31.412 So let's dig into some 00:01:31.453 --> 00:01:32.453 specifics now that we 00:01:32.472 --> 00:01:33.373 understand where in the 00:01:33.414 --> 00:01:34.295 body we're located. 00:01:35.454 --> 00:01:36.115 Can you explain the 00:01:36.156 --> 00:01:37.596 importance of the 00:01:37.757 --> 00:01:38.938 interdependent relationship 00:01:38.977 --> 00:01:40.578 of motion among all the 00:01:40.618 --> 00:01:42.120 segments of the foot and ankle? 00:01:43.260 --> 00:01:44.040 We'll say in functional 00:01:44.061 --> 00:01:44.661 weight bearing because 00:01:44.682 --> 00:01:45.822 that's where we hope people 00:01:46.102 --> 00:01:46.742 are a lot of the time. 00:01:47.512 --> 00:01:49.176 yeah um that's a loaded 00:01:49.236 --> 00:01:52.081 question yeah right to 00:01:52.141 --> 00:01:55.067 start off with but uh yeah so 00:01:56.816 --> 00:01:58.617 The interdependent relationship, I think, 00:01:58.677 --> 00:02:01.478 is best summarized in, you know, 00:02:01.498 --> 00:02:02.819 the concept that we as 00:02:02.859 --> 00:02:03.460 physical therapists 00:02:03.480 --> 00:02:04.240 probably all know is the 00:02:04.281 --> 00:02:05.322 windlass mechanism. 00:02:05.341 --> 00:02:08.243 You know, great toe MTP extension, 00:02:08.563 --> 00:02:09.525 raising up the arch. 00:02:09.585 --> 00:02:11.165 Yes, it's by way of plantar fascia, 00:02:11.246 --> 00:02:12.366 hindfoot supination. 00:02:12.866 --> 00:02:14.348 But I think the outcome of 00:02:14.407 --> 00:02:16.270 that is perhaps even more important. 00:02:16.289 --> 00:02:17.790 And that puts the actual 00:02:17.830 --> 00:02:20.252 gastrocnemius and soleus on 00:02:20.312 --> 00:02:21.432 its best length tension 00:02:21.473 --> 00:02:22.834 relationship to produce 00:02:22.954 --> 00:02:24.656 force to actually propel us forward. 00:02:25.617 --> 00:02:26.280 Adding to that, 00:02:26.340 --> 00:02:27.403 I think knowing that the 00:02:27.443 --> 00:02:28.989 foot is a load-sharing system, 00:02:29.658 --> 00:02:30.379 So it's considered the 00:02:30.419 --> 00:02:32.540 longitudinal arch load sharing system. 00:02:32.681 --> 00:02:32.920 You know, 00:02:32.980 --> 00:02:34.862 obviously just everything is related. 00:02:35.522 --> 00:02:37.685 And you have to have that 00:02:37.745 --> 00:02:38.965 internal rotation of the 00:02:39.026 --> 00:02:40.687 shank to have that proper 00:02:41.127 --> 00:02:42.747 supination pronation of the 00:02:42.807 --> 00:02:44.028 hind foot and the 00:02:44.109 --> 00:02:45.830 subsequent elevation and 00:02:45.870 --> 00:02:47.411 depression of the midfoot 00:02:47.531 --> 00:02:49.051 for our function and weight bearing. 00:02:49.573 --> 00:02:50.693 The biggest factor to that 00:02:50.734 --> 00:02:51.614 is really just what is the 00:02:51.653 --> 00:02:52.675 ground reaction forces 00:02:52.694 --> 00:02:53.275 doing and what can the 00:02:53.314 --> 00:02:54.415 muscles actually produce 00:02:54.436 --> 00:02:55.537 for force against that. 00:02:56.721 --> 00:02:56.981 I mean, 00:02:57.402 --> 00:02:58.186 it seemed like he handled the 00:02:58.225 --> 00:02:59.049 knuckleball pretty well 00:02:59.088 --> 00:02:59.691 right off the bat. 00:02:59.751 --> 00:03:00.032 Okay. 00:03:01.455 --> 00:03:03.195 Moving on then, next pitch would be, 00:03:03.235 --> 00:03:05.537 there's a lot of segments in the foot. 00:03:05.657 --> 00:03:06.437 It might seem simple, 00:03:06.457 --> 00:03:07.998 but there's a lot of different parts, 00:03:08.118 --> 00:03:08.318 right? 00:03:09.199 --> 00:03:09.780 How do the different 00:03:09.819 --> 00:03:10.920 segments contribute to the 00:03:11.040 --> 00:03:12.361 overall function of the foot? 00:03:12.382 --> 00:03:13.443 If someone were to ask you that, 00:03:13.582 --> 00:03:15.063 let's say a new graduate PT, 00:03:15.123 --> 00:03:16.284 now they understand the basics, 00:03:16.384 --> 00:03:17.086 now they're moving on to a 00:03:17.126 --> 00:03:18.186 little more advanced concepts. 00:03:18.627 --> 00:03:19.646 How do those segments or how 00:03:19.667 --> 00:03:20.288 would you explain those 00:03:20.307 --> 00:03:21.147 segments contributing to 00:03:21.168 --> 00:03:23.289 the overall function of that foot? 00:03:23.870 --> 00:03:25.151 Yeah, great question. 00:03:25.251 --> 00:03:26.752 First question is how many? 00:03:26.771 --> 00:03:26.991 There's 10. 00:03:28.128 --> 00:03:29.368 If you really dive into the 00:03:29.628 --> 00:03:30.949 biomechanical descriptions, 00:03:30.990 --> 00:03:32.810 there's 10 segments of the 00:03:32.889 --> 00:03:34.871 actual hind foot, mid foot, forefoot, 00:03:35.390 --> 00:03:36.871 even then the toes included to it. 00:03:36.890 --> 00:03:37.131 And yeah, 00:03:37.151 --> 00:03:38.951 they all are working interdependently. 00:03:38.972 --> 00:03:41.132 I think what's perhaps even 00:03:41.572 --> 00:03:42.652 more important than just 00:03:42.793 --> 00:03:44.532 that is understanding all 00:03:44.552 --> 00:03:45.353 of the muscles that 00:03:45.413 --> 00:03:46.454 actually contribute to it. 00:03:46.473 --> 00:03:48.514 I mean, we're talking 19 intrinsic, 00:03:48.514 --> 00:03:49.875 12 extrinsic muscles. 00:03:50.435 --> 00:03:50.534 Um, 00:03:50.754 --> 00:03:51.895 and we're trying to have a good 00:03:51.914 --> 00:03:53.074 understanding of how are 00:03:53.115 --> 00:03:53.876 each of those muscles 00:03:53.915 --> 00:03:54.936 controlling those segments. 00:03:56.094 --> 00:03:57.697 All in a very small space as well. 00:03:58.116 --> 00:03:58.616 Very much. 00:03:59.318 --> 00:04:00.179 That's a lot to it. 00:04:01.240 --> 00:04:02.020 How about this one? 00:04:02.140 --> 00:04:03.020 Who wants to answer this? 00:04:03.542 --> 00:04:06.084 What role does the extrinsic musculature, 00:04:06.104 --> 00:04:07.164 you mentioned that a second, 00:04:07.205 --> 00:04:08.086 play in controlling the 00:04:08.126 --> 00:04:09.127 combined motion of the foot? 00:04:09.146 --> 00:04:11.368 That feels like a good continuation. 00:04:11.389 --> 00:04:12.349 We'll say foot and ankle 00:04:12.449 --> 00:04:13.811 because that also comes into play. 00:04:14.451 --> 00:04:14.711 Mm-hmm. 00:04:16.564 --> 00:04:19.005 So as far as that, yeah, I'll keep going. 00:04:19.466 --> 00:04:20.425 The extrinsics, you know, 00:04:20.446 --> 00:04:22.247 that's part of my area of 00:04:22.447 --> 00:04:23.747 particular interest and 00:04:23.867 --> 00:04:24.547 what I'm trying to do a 00:04:24.586 --> 00:04:26.187 little bit of investigation 00:04:26.247 --> 00:04:27.228 on more specifically. 00:04:27.387 --> 00:04:28.749 But there is recent 00:04:28.788 --> 00:04:29.348 literature that's 00:04:29.369 --> 00:04:30.069 indicating that the 00:04:30.209 --> 00:04:31.468 extrinsic musculature 00:04:31.569 --> 00:04:33.649 actually supports the quote 00:04:33.670 --> 00:04:35.050 unquote heart arch height. 00:04:35.891 --> 00:04:36.951 I argue that it's actually 00:04:37.031 --> 00:04:38.511 arch mobility more so than 00:04:38.531 --> 00:04:40.151 the actual intrinsic musculature. 00:04:40.752 --> 00:04:44.033 So having very good, you know, activation, 00:04:44.134 --> 00:04:44.634 strength, 00:04:44.694 --> 00:04:47.115 endurance of those muscles is just vital. 00:04:47.136 --> 00:04:49.656 All right. 00:04:49.677 --> 00:04:51.038 So we mentioned key kinetic 00:04:51.117 --> 00:04:52.459 principles a second ago, 00:04:52.478 --> 00:04:54.160 and I want to continue to play off this. 00:04:55.040 --> 00:04:55.980 Help us understand some of 00:04:56.021 --> 00:04:56.740 those key kinetic 00:04:56.761 --> 00:04:58.141 principles relevant to that 00:04:58.242 --> 00:05:00.382 foot and ankle segments 00:05:00.642 --> 00:05:01.444 that we just mentioned. 00:05:02.901 --> 00:05:04.702 Yeah, kinetic as far as the motion goes, 00:05:04.742 --> 00:05:05.002 you know, 00:05:05.083 --> 00:05:06.904 you can't have the proper 00:05:06.944 --> 00:05:08.565 pronation supination of 00:05:08.846 --> 00:05:09.826 anywhere within the foot 00:05:09.867 --> 00:05:10.947 without having the 00:05:10.987 --> 00:05:13.310 appropriate motion at the shank, right, 00:05:13.350 --> 00:05:14.110 internal, external. 00:05:14.692 --> 00:05:17.053 I think a good summary of the kinetics, 00:05:17.074 --> 00:05:18.694 the motion is, you know, 00:05:18.735 --> 00:05:20.357 for the students that are listening in. 00:05:20.916 --> 00:05:22.377 When we do our basic 00:05:22.458 --> 00:05:23.978 odiometry of plantar flexion, 00:05:24.098 --> 00:05:25.559 dorsiflexion of the ankle, 00:05:25.579 --> 00:05:26.259 we know that there's a 00:05:26.619 --> 00:05:28.920 total range of approximately 70 degrees. 00:05:29.461 --> 00:05:30.341 However, in fact, 00:05:30.380 --> 00:05:31.420 there's really only about 00:05:31.420 --> 00:05:35.242 45 to 47 degrees of that 70 00:05:35.242 --> 00:05:36.523 that is really happening at 00:05:36.562 --> 00:05:37.303 the talocrule. 00:05:38.064 --> 00:05:39.204 The rest of it is actually 00:05:39.223 --> 00:05:42.105 occurring minimally at subtalar joint, 00:05:42.946 --> 00:05:44.045 but the majority is 00:05:44.125 --> 00:05:45.446 actually talonavicular and 00:05:45.485 --> 00:05:48.047 some also at calcaneocuboid as well. 00:05:48.867 --> 00:05:49.788 You could include the 00:05:49.867 --> 00:05:50.927 forefoot transverse 00:05:51.088 --> 00:05:52.668 metatarsal joint in there as well. 00:05:52.747 --> 00:05:53.329 Point being, 00:05:54.168 --> 00:05:56.009 there's approximately 35% to 00:05:56.009 --> 00:05:59.170 37% of our plantar flexion, dorsiflexion, 00:05:59.209 --> 00:06:02.031 that is not at the talocruel that we, 00:06:02.290 --> 00:06:03.091 as entry level, 00:06:03.512 --> 00:06:04.672 are taking our measurements at. 00:06:05.617 --> 00:06:06.017 Understood. 00:06:06.158 --> 00:06:07.119 And I'm glad that was not on 00:06:07.139 --> 00:06:08.720 the MPTE because that would be right. 00:06:09.240 --> 00:06:10.360 All right, 00:06:10.380 --> 00:06:12.783 let's get down to what I like 00:06:12.843 --> 00:06:13.862 about conferences when they 00:06:13.903 --> 00:06:15.244 go into in terms of labs 00:06:15.303 --> 00:06:16.464 and techniques and hands on 00:06:16.485 --> 00:06:17.285 and observations. 00:06:18.086 --> 00:06:18.665 Talk about some of those 00:06:18.685 --> 00:06:19.586 specific techniques or 00:06:19.627 --> 00:06:20.427 approaches that will be 00:06:20.487 --> 00:06:21.247 covered in the lab 00:06:21.288 --> 00:06:22.848 presentations to help 00:06:22.889 --> 00:06:24.410 enhance that clinical practice. 00:06:27.021 --> 00:06:28.942 But I think just as what David described, 00:06:28.963 --> 00:06:30.584 we really go into taking 00:06:30.603 --> 00:06:31.764 that detail we talk about 00:06:31.785 --> 00:06:34.706 in how joints move and why 00:06:34.747 --> 00:06:35.507 it's important to look at 00:06:35.588 --> 00:06:37.408 multiple areas and break 00:06:37.428 --> 00:06:38.228 that down into the lab 00:06:38.249 --> 00:06:39.589 technique and look at very 00:06:39.649 --> 00:06:41.831 specific techniques that 00:06:42.271 --> 00:06:43.833 feel both quantity and 00:06:43.973 --> 00:06:45.153 quality of movement. 00:06:45.574 --> 00:06:46.475 And the way we've organized 00:06:46.495 --> 00:06:47.636 the lab sessions is there's 00:06:47.696 --> 00:06:50.958 time for active feedback from myself, 00:06:51.798 --> 00:06:53.338 David, Catherine Patla, 00:06:53.379 --> 00:06:54.319 who's our other colleague 00:06:54.339 --> 00:06:55.341 who's presenting with us, 00:06:56.081 --> 00:06:57.680 Because I think a lot of 00:06:57.740 --> 00:06:59.101 individuals move too fast 00:06:59.141 --> 00:07:00.161 and too quick through end 00:07:00.201 --> 00:07:02.043 range and actually feel 00:07:02.343 --> 00:07:03.622 things are stiff when in 00:07:03.702 --> 00:07:04.903 actuality they're not 00:07:05.384 --> 00:07:06.103 because they've blown 00:07:06.144 --> 00:07:06.944 through the end range and 00:07:06.983 --> 00:07:08.303 don't get to appreciate how 00:07:08.363 --> 00:07:09.425 the motion actually is. 00:07:09.904 --> 00:07:10.964 So we take that time to go 00:07:11.024 --> 00:07:12.084 back and forth and actually 00:07:12.305 --> 00:07:13.906 feel the motion together 00:07:13.925 --> 00:07:15.065 and provide feedback. 00:07:15.125 --> 00:07:16.166 And last time we were 00:07:16.206 --> 00:07:17.127 fortunate to have someone 00:07:17.146 --> 00:07:18.307 who had a problem in our 00:07:18.346 --> 00:07:20.187 session and we could do an assessment, 00:07:20.228 --> 00:07:20.447 treat, 00:07:20.487 --> 00:07:22.788 reassess and see tremendous 00:07:22.827 --> 00:07:23.329 improvements 00:07:23.468 --> 00:07:24.889 instantaneously with what we were doing. 00:07:25.249 --> 00:07:26.269 So we're hoping we can be 00:07:26.290 --> 00:07:27.391 lucky again this time too. 00:07:27.870 --> 00:07:28.391 How was that? 00:07:28.670 --> 00:07:30.752 Treating in front of your colleagues, 00:07:30.812 --> 00:07:31.913 like no pressure there, right? 00:07:32.194 --> 00:07:32.353 Yeah. 00:07:32.853 --> 00:07:33.415 Easy peasy. 00:07:33.735 --> 00:07:34.014 Yeah. 00:07:34.555 --> 00:07:36.016 So that's actually what 00:07:36.055 --> 00:07:37.377 inspired this year's 00:07:37.557 --> 00:07:38.718 discussion is that there 00:07:38.737 --> 00:07:40.379 was so much feedback 00:07:40.418 --> 00:07:41.199 requests that we could 00:07:41.240 --> 00:07:42.521 actually dive in further 00:07:42.581 --> 00:07:43.341 into our treatment 00:07:43.360 --> 00:07:44.362 approaches due to the 00:07:44.422 --> 00:07:47.223 success that we had seen in our session. 00:07:47.663 --> 00:07:48.144 That's great. 00:07:48.225 --> 00:07:48.884 And how, I mean, 00:07:49.305 --> 00:07:50.865 how is it presenting with Dr. Patla? 00:07:50.886 --> 00:07:51.947 I mean, no pressure there as well. 00:07:51.966 --> 00:07:53.048 We're talking about pressure situations. 00:07:53.067 --> 00:07:53.827 That can be kind of fun if 00:07:53.908 --> 00:07:54.749 you're on your team, right? 00:07:55.168 --> 00:07:55.970 Yeah, no, it's awesome. 00:07:56.009 --> 00:07:57.132 I think because we've both 00:07:57.192 --> 00:07:58.014 gone through the fellowship 00:07:58.074 --> 00:07:59.338 with Catherine for so many 00:07:59.379 --> 00:08:00.862 years and our colleagues, 00:08:01.704 --> 00:08:04.189 it's awesome to be on the stage with her. 00:08:04.684 --> 00:08:05.345 It's got to be great. 00:08:05.925 --> 00:08:06.404 All right. 00:08:06.444 --> 00:08:07.526 So let's talk about biases. 00:08:07.565 --> 00:08:09.168 I feel like that's a word 00:08:09.288 --> 00:08:10.369 that I don't know that I 00:08:10.449 --> 00:08:12.329 used it a ton before the last three, 00:08:12.430 --> 00:08:13.031 five years. 00:08:14.091 --> 00:08:15.593 What are some of the common 00:08:15.612 --> 00:08:16.853 biases clinicians might 00:08:16.973 --> 00:08:18.536 have in assessing foot and 00:08:18.576 --> 00:08:19.096 ankle function? 00:08:19.115 --> 00:08:21.658 We sort of alluded to one a second ago. 00:08:21.697 --> 00:08:23.360 And how can self-appraisal 00:08:23.399 --> 00:08:24.600 help identify these? 00:08:24.620 --> 00:08:26.502 Because we got to identify 00:08:26.523 --> 00:08:28.163 it before we can fix it or solve it. 00:08:28.663 --> 00:08:29.305 You got to know it's there. 00:08:29.942 --> 00:08:30.202 Yeah. 00:08:30.543 --> 00:08:31.343 And you first have to admit 00:08:31.403 --> 00:08:33.205 that there even is a potential bias. 00:08:33.325 --> 00:08:33.544 Right. 00:08:33.605 --> 00:08:34.384 And then you kind of walk 00:08:34.404 --> 00:08:35.186 through those steps. 00:08:35.666 --> 00:08:36.605 And so I think part of it is 00:08:36.645 --> 00:08:37.326 going back to one of our 00:08:37.366 --> 00:08:39.086 principles in that you must 00:08:39.126 --> 00:08:40.327 have normal joint function 00:08:40.687 --> 00:08:42.688 to have effective muscle 00:08:43.009 --> 00:08:43.730 function as well. 00:08:44.190 --> 00:08:45.230 And so we really take. 00:08:45.730 --> 00:08:46.331 Say that again. 00:08:46.350 --> 00:08:46.811 One more time. 00:08:47.390 --> 00:08:50.173 You must have effective joint mobility, 00:08:50.552 --> 00:08:51.013 quantity, 00:08:51.092 --> 00:08:53.333 quality in order to have proper 00:08:53.433 --> 00:08:54.455 muscle function. 00:08:54.982 --> 00:08:55.482 Okay, good. 00:08:55.623 --> 00:08:55.964 Okay. 00:08:56.063 --> 00:08:57.945 And so going, starting at that principle, 00:08:57.985 --> 00:08:59.585 we recognize the importance 00:08:59.904 --> 00:09:01.706 of looking at individual 00:09:01.927 --> 00:09:03.967 joint motion at the foot 00:09:04.168 --> 00:09:06.629 and ankle versus just gross 00:09:07.509 --> 00:09:09.429 osteokinematic assessment. 00:09:09.830 --> 00:09:10.711 I think that's the first 00:09:10.791 --> 00:09:13.792 bias that when people look at a foot, 00:09:14.173 --> 00:09:14.552 they, 00:09:15.133 --> 00:09:16.874 it's this nebulous and it's too 00:09:16.933 --> 00:09:17.514 complicated. 00:09:17.553 --> 00:09:18.575 There are too many joints 00:09:19.034 --> 00:09:20.535 and it becomes sloppy in 00:09:20.576 --> 00:09:22.116 the assessment and the treatment. 00:09:22.216 --> 00:09:23.336 And then they get frustrated 00:09:23.376 --> 00:09:24.577 that no one's getting better. 00:09:26.014 --> 00:09:28.499 And so you have to break it down and go, 00:09:28.519 --> 00:09:28.658 okay, 00:09:28.739 --> 00:09:30.522 what do I know and what don't I know 00:09:30.721 --> 00:09:32.205 and how can I get better at that? 00:09:32.686 --> 00:09:33.527 And the foot is one of those 00:09:33.606 --> 00:09:35.409 areas that I think can be 00:09:35.470 --> 00:09:36.712 particularly tricky if you 00:09:36.793 --> 00:09:38.075 don't understand the 00:09:38.095 --> 00:09:39.277 biomechanics well enough. 00:09:40.970 --> 00:09:41.169 All right, 00:09:41.190 --> 00:09:43.971 so you'll be providing an opportunity, 00:09:44.011 --> 00:09:45.594 and that's sort of what an 00:09:45.693 --> 00:09:46.575 AOPT conference has, 00:09:46.595 --> 00:09:47.774 which is there's a lot of hands-on. 00:09:47.816 --> 00:09:48.275 If there wasn't, 00:09:48.296 --> 00:09:49.177 it would feel a little weird. 00:09:49.736 --> 00:09:51.639 But what's the best way you 00:09:51.678 --> 00:09:52.298 might suggest for 00:09:52.339 --> 00:09:53.559 clinicians to apply the 00:09:53.620 --> 00:09:56.522 hands-on practice from your presentation, 00:09:56.643 --> 00:09:59.304 from a conference, when they get home, 00:10:00.044 --> 00:10:00.566 the neck, you know, 00:10:00.586 --> 00:10:02.006 we call it Monday morning applicable. 00:10:02.106 --> 00:10:03.187 Is there a suggestion like, hey, 00:10:03.207 --> 00:10:04.269 we want some carryover. 00:10:04.609 --> 00:10:06.029 We want to have the magic in the room, 00:10:06.049 --> 00:10:06.730 but then we want to be able 00:10:06.770 --> 00:10:07.851 to apply these things. 00:10:07.871 --> 00:10:08.731 We want to make them applicable. 00:10:08.751 --> 00:10:09.472 What would you suggest? 00:10:11.597 --> 00:10:14.139 Yeah, I think ideally in the session, 00:10:14.340 --> 00:10:15.642 being able to go back and 00:10:15.701 --> 00:10:17.283 forth with one of us, like I feel, 00:10:17.363 --> 00:10:18.884 you feel, I feel, you feel. 00:10:19.605 --> 00:10:20.785 And we compare right then 00:10:20.806 --> 00:10:22.607 and there and then doing it 00:10:22.648 --> 00:10:23.488 a couple of times. 00:10:23.587 --> 00:10:23.769 Right. 00:10:23.808 --> 00:10:25.250 This is a skill that you 00:10:25.289 --> 00:10:26.671 need to be using right away. 00:10:27.231 --> 00:10:28.413 But also what I like to do 00:10:28.472 --> 00:10:29.673 clinically is I do a 00:10:29.714 --> 00:10:30.514 functional assessment. 00:10:31.335 --> 00:10:32.995 Then I look at my osteokinematic, 00:10:33.196 --> 00:10:35.136 look at my joint mobility, treat, 00:10:35.317 --> 00:10:36.057 and go back and look at my 00:10:36.097 --> 00:10:36.898 function right away. 00:10:36.977 --> 00:10:38.678 So you know right then and 00:10:38.698 --> 00:10:40.120 there if something is working or not. 00:10:40.179 --> 00:10:41.000 And so I think that's a 00:10:41.139 --> 00:10:42.480 piece that people could take away. 00:10:42.821 --> 00:10:44.922 Day one is using that 00:10:44.961 --> 00:10:45.761 functional assessment, 00:10:46.202 --> 00:10:47.462 going and looking at the joint mobility, 00:10:48.104 --> 00:10:49.163 treat if there's a restriction, 00:10:49.364 --> 00:10:50.384 and go back and reassess. 00:10:50.445 --> 00:10:52.725 And if not, go back again and look again. 00:10:52.846 --> 00:10:55.287 So doing that continual assess, treat, 00:10:55.346 --> 00:10:57.107 reassess is a piece that I 00:10:57.128 --> 00:10:58.328 think is so critical. 00:10:59.294 --> 00:11:00.076 Do you want to add something, David? 00:11:00.515 --> 00:11:00.716 Yeah. 00:11:00.735 --> 00:11:02.437 And speaking clinically, I would say, 00:11:02.457 --> 00:11:02.977 you know, 00:11:02.998 --> 00:11:04.778 they have to just jump in to 00:11:04.818 --> 00:11:05.659 learn how to swim. 00:11:05.759 --> 00:11:05.919 Right. 00:11:05.940 --> 00:11:06.961 If you don't get into the water, 00:11:06.980 --> 00:11:08.663 you're never going to learn. 00:11:08.883 --> 00:11:11.063 So when it comes to the clinical approach, 00:11:11.144 --> 00:11:13.066 they have to just start investigating. 00:11:13.105 --> 00:11:13.846 They have to start putting 00:11:13.866 --> 00:11:14.967 their hands on and they 00:11:15.008 --> 00:11:16.708 have to feel many different emotions. 00:11:16.948 --> 00:11:18.229 feet types. 00:11:18.389 --> 00:11:19.610 Going back to the bias, 00:11:19.769 --> 00:11:20.690 I think one bias is 00:11:20.889 --> 00:11:22.149 presuming that arch height 00:11:22.390 --> 00:11:23.951 is related to risk of injury, 00:11:24.010 --> 00:11:26.251 but that's inconclusive in 00:11:26.272 --> 00:11:26.951 the literature. 00:11:28.192 --> 00:11:29.812 Mobility is arguably more 00:11:29.873 --> 00:11:31.072 important and they have to 00:11:31.113 --> 00:11:32.052 get their hands on 00:11:32.113 --> 00:11:32.993 different feets because 00:11:33.014 --> 00:11:33.894 there's different types of 00:11:33.953 --> 00:11:35.053 mobility for different 00:11:35.153 --> 00:11:36.754 sizes of feet related to 00:11:37.014 --> 00:11:38.215 different amounts of ground 00:11:38.254 --> 00:11:39.914 reaction force for specific 00:11:40.014 --> 00:11:41.975 demands of functional activity in sport. 00:11:43.135 --> 00:11:44.157 So you just got to start touching, 00:11:44.177 --> 00:11:45.417 touching, touching in my opinion. 00:11:46.208 --> 00:11:47.149 I now know what the promo 00:11:47.169 --> 00:11:48.191 will be for the episode. 00:11:48.211 --> 00:11:49.471 It'll be touch as many feet 00:11:49.491 --> 00:11:50.672 as possible from day one. 00:11:50.732 --> 00:11:51.832 Yes, yes, yes. 00:11:52.153 --> 00:11:53.335 And shoes off immediately 00:11:53.394 --> 00:11:54.434 when you first come in the room. 00:11:54.455 --> 00:11:57.158 That'll air the puppies out a little bit. 00:11:57.658 --> 00:11:59.820 But also, too, when we think about, 00:11:59.840 --> 00:12:03.461 I think especially at an AOMT level, 00:12:04.263 --> 00:12:05.903 we feel confident in our 00:12:05.943 --> 00:12:07.004 manual therapy skills, 00:12:07.846 --> 00:12:08.625 in our hands-on skills, 00:12:08.645 --> 00:12:09.667 our manipulation skills. 00:12:10.047 --> 00:12:10.508 But taking... 00:12:14.557 --> 00:12:15.697 time in the clinic to work 00:12:15.778 --> 00:12:18.320 with your to get feedback 00:12:18.659 --> 00:12:20.322 on your techniques and 00:12:20.361 --> 00:12:21.722 maybe spending a lunchtime 00:12:21.783 --> 00:12:22.903 on a friday hey let's run 00:12:22.923 --> 00:12:23.764 through some techniques and 00:12:23.783 --> 00:12:24.565 let's see if it feel the 00:12:24.605 --> 00:12:25.586 same as that I did at the 00:12:25.625 --> 00:12:26.726 conference that we had or 00:12:26.746 --> 00:12:27.687 let me show you some cool 00:12:27.726 --> 00:12:28.548 techniques let's talk 00:12:28.567 --> 00:12:29.208 through what we're doing 00:12:29.528 --> 00:12:30.590 but taking time to hone 00:12:30.610 --> 00:12:32.291 your craft outside of the 00:12:32.331 --> 00:12:33.111 time with the patient 00:12:34.072 --> 00:12:35.113 that's smart all right so 00:12:35.133 --> 00:12:35.953 I'm gonna I'm gonna make 00:12:35.994 --> 00:12:37.034 you pick only one 00:12:37.918 --> 00:12:40.418 What is each of your one key 00:12:40.458 --> 00:12:41.739 takeaway for clinicians 00:12:42.198 --> 00:12:42.999 that they'll be able to 00:12:43.099 --> 00:12:45.320 walk away from after your presentation? 00:12:45.340 --> 00:12:46.179 So this is, again, 00:12:46.200 --> 00:12:47.100 the teaser before the 00:12:47.139 --> 00:12:49.520 teaser regarding your topic. 00:12:49.561 --> 00:12:50.520 What do you got, Amanda? 00:12:50.620 --> 00:12:51.501 What do you think people 00:12:51.522 --> 00:12:52.381 will be able to walk away 00:12:52.422 --> 00:12:53.642 with and be armed with? 00:12:55.081 --> 00:12:56.123 Is that pun intended? 00:12:56.263 --> 00:12:57.123 I'm literally trying to 00:12:57.163 --> 00:12:58.102 think of a foot pun and I 00:12:58.163 --> 00:12:59.964 couldn't before it came out of my mouth. 00:13:00.224 --> 00:13:00.923 Yeah, you got it. 00:13:02.169 --> 00:13:04.230 I think being more confident 00:13:04.971 --> 00:13:07.451 in their ability to assess 00:13:07.552 --> 00:13:08.852 specific joint motion. 00:13:09.352 --> 00:13:10.232 I think that's one thing we 00:13:10.273 --> 00:13:11.212 started last time, 00:13:11.673 --> 00:13:12.274 and we're going to be able 00:13:12.313 --> 00:13:13.714 to capitalize more on that this time. 00:13:14.254 --> 00:13:15.174 All right, David, same question. 00:13:15.839 --> 00:13:16.860 Yeah, I would say two things. 00:13:16.899 --> 00:13:18.561 I would say try to remain as 00:13:18.640 --> 00:13:19.902 objective as possible. 00:13:20.241 --> 00:13:23.125 And then number two is to ask for help, 00:13:23.684 --> 00:13:23.965 right? 00:13:24.645 --> 00:13:25.566 Seek, you know, 00:13:25.625 --> 00:13:26.927 reaffirmation from your 00:13:26.988 --> 00:13:29.009 colleagues like Amanda had highlighted. 00:13:29.028 --> 00:13:30.529 And I think that also speaks 00:13:30.549 --> 00:13:32.030 to the self-appraisal component too. 00:13:33.206 --> 00:13:33.566 Perfect. 00:13:34.888 --> 00:13:36.129 Looking forward to, 00:13:36.589 --> 00:13:37.730 I think October is a good 00:13:37.769 --> 00:13:38.890 time to head south. 00:13:38.951 --> 00:13:40.773 It's not too shabby to go to Orlando. 00:13:40.812 --> 00:13:42.695 So this is the prelude to 00:13:43.176 --> 00:13:44.437 one of many presentations 00:13:44.476 --> 00:13:45.337 going on at the AOMT 00:13:45.378 --> 00:13:46.359 conference this October. 00:13:46.778 --> 00:13:48.640 For more information about the event, 00:13:48.681 --> 00:13:50.402 check out aomt.org. 00:13:50.523 --> 00:13:51.783 David, Amanda, looking forward to it. 00:13:51.823 --> 00:13:52.764 Thanks for the time sharing 00:13:53.164 --> 00:13:54.586 what you'll be presenting on this year. 00:13:55.307 --> 00:13:55.988 Thank you, Jimmy.