WEBVTT 00:00:03.029 --> 00:00:03.250 All right, 00:00:03.270 --> 00:00:04.551 today's guest is tackling one of the 00:00:04.751 --> 00:00:07.152 biggest blind spots in physical therapy, 00:00:07.232 --> 00:00:09.092 pediatric manual therapy. 00:00:09.532 --> 00:00:10.413 Now, for decades, 00:00:10.432 --> 00:00:13.695 we've borrowed adult techniques and, well, 00:00:13.734 --> 00:00:16.015 just crossed our fingers because clear 00:00:16.155 --> 00:00:17.817 evidence-based guidelines for treating 00:00:17.856 --> 00:00:18.176 kids 00:00:18.917 --> 00:00:20.538 simply don't exist. 00:00:21.277 --> 00:00:22.338 Our guest is changing that. 00:00:22.678 --> 00:00:23.978 She's an educator, researcher, 00:00:24.079 --> 00:00:26.181 and pediatric specialist whose work 00:00:26.240 --> 00:00:28.882 focuses on chronic pain in children and 00:00:28.902 --> 00:00:29.382 the safe, 00:00:29.442 --> 00:00:32.683 effective use of manual therapy for a 00:00:32.764 --> 00:00:34.945 growing musculoskeletal system. 00:00:35.244 --> 00:00:36.484 She's developing new techniques 00:00:36.645 --> 00:00:37.945 specifically built for kids, 00:00:38.106 --> 00:00:41.167 not scaled down adult care. 00:00:41.628 --> 00:00:42.747 And she's helping train the next 00:00:42.787 --> 00:00:44.908 generation of clinicians to approach 00:00:44.948 --> 00:00:47.090 pediatric patients with confidence, 00:00:47.109 --> 00:00:47.591 compassion, 00:00:48.496 --> 00:00:49.457 and hashtag science. 00:00:49.817 --> 00:00:51.917 If you've ever wondered how to actually 00:00:52.057 --> 00:00:54.460 mobilize a child's joint safely, 00:00:55.000 --> 00:00:57.642 how parent beliefs and trauma influence 00:00:57.701 --> 00:00:58.621 chronic pain in kids, 00:00:59.082 --> 00:01:00.624 or why participation, 00:01:00.743 --> 00:01:01.963 not just range of motion, 00:01:02.445 --> 00:01:03.905 should be your primary outcome, 00:01:04.085 --> 00:01:06.266 this is the conversation. 00:01:06.387 --> 00:01:07.548 You didn't even know you needed, 00:01:07.707 --> 00:01:08.909 but you do. 00:01:09.028 --> 00:01:11.390 Ginny Henderson is here to fill one of 00:01:11.409 --> 00:01:13.090 the biggest gaps in our profession, 00:01:13.210 --> 00:01:14.831 and I can't wait to dive in. 00:01:14.891 --> 00:01:15.612 We bring her in. 00:01:15.873 --> 00:01:17.373 Ginny, welcome to the show. 00:01:18.575 --> 00:01:19.596 Thank you. 00:01:19.635 --> 00:01:20.356 How was the intro? 00:01:20.376 --> 00:01:21.798 Did I hype you up well? 00:01:21.817 --> 00:01:24.480 You did really, really well, yes. 00:01:24.560 --> 00:01:24.980 Perfect. 00:01:25.561 --> 00:01:26.902 All right, let's dig into this. 00:01:27.362 --> 00:01:28.784 There's a special place in my heart for 00:01:28.823 --> 00:01:30.444 pediatric physical therapists. 00:01:31.426 --> 00:01:33.388 I posed as a pediatric physical therapist 00:01:33.427 --> 00:01:33.987 for a year, 00:01:34.808 --> 00:01:35.930 about a year out of PT school. 00:01:36.329 --> 00:01:36.790 Loved it. 00:01:36.891 --> 00:01:37.691 The impact, 00:01:37.831 --> 00:01:41.495 it was very difficult to have a bad 00:01:41.555 --> 00:01:41.795 mood. 00:01:41.855 --> 00:01:42.816 I'm not saying a hard day. 00:01:42.835 --> 00:01:44.037 It was very easy to have a difficult 00:01:44.076 --> 00:01:45.037 day, a lot of work. 00:01:45.578 --> 00:01:46.618 But at the end of the day, 00:01:46.679 --> 00:01:47.620 in the middle of the day, 00:01:47.719 --> 00:01:48.820 and even when you crawl out of bed, 00:01:48.900 --> 00:01:50.322 it did feel rewarding. 00:01:50.441 --> 00:01:52.843 It was a very clear path to rewarding. 00:01:53.245 --> 00:01:54.525 So thanks for doing what you do and 00:01:54.566 --> 00:01:57.367 focusing on pediatric patients, 00:01:57.588 --> 00:01:58.569 not tiny adults. 00:01:58.629 --> 00:01:59.850 That's what my mentor taught me. 00:02:00.010 --> 00:02:01.311 Amy said, they're not small, 00:02:01.331 --> 00:02:02.332 they're not tiny adults. 00:02:03.233 --> 00:02:03.713 They're not. 00:02:04.519 --> 00:02:06.561 So what made you first realize that 00:02:06.620 --> 00:02:09.882 pediatric manual therapy has a major gap 00:02:10.002 --> 00:02:11.762 in clear evidence based guidelines? 00:02:11.842 --> 00:02:13.322 What was the what was that moment? 00:02:13.382 --> 00:02:15.663 And then you just took it upon yourself. 00:02:15.682 --> 00:02:16.282 You're like, all right, 00:02:16.323 --> 00:02:17.584 this is my this is my fight. 00:02:17.604 --> 00:02:19.104 I'm going to dive in. 00:02:19.144 --> 00:02:19.503 Sure. 00:02:19.584 --> 00:02:21.965 So I started in adult therapy for my 00:02:22.004 --> 00:02:23.465 first seventeen years of practice. 00:02:24.164 --> 00:02:28.507 And then my daughter had a heart condition 00:02:28.706 --> 00:02:30.167 and we spent six months at Texas 00:02:30.206 --> 00:02:30.627 Children's. 00:02:31.326 --> 00:02:33.168 And I had that moment of. 00:02:33.912 --> 00:02:35.173 I want to do what these people do. 00:02:35.593 --> 00:02:37.314 I want to step into the lives and 00:02:37.335 --> 00:02:38.695 the stories of families. 00:02:39.137 --> 00:02:41.538 And so I switched over into peds. 00:02:41.598 --> 00:02:42.759 Well, at the same time, 00:02:43.000 --> 00:02:44.260 I was going through my manual therapy 00:02:44.281 --> 00:02:45.581 fellowship with them. 00:02:46.943 --> 00:02:48.324 And so I was doing both of these 00:02:48.344 --> 00:02:50.806 together where I was kind of changing my 00:02:50.826 --> 00:02:53.769 way of thinking and trying to understand 00:02:53.889 --> 00:02:56.611 how the pediatric paradigm worked while 00:02:56.651 --> 00:02:58.272 learning all of these techniques and how 00:02:58.312 --> 00:02:59.074 they come together. 00:02:59.114 --> 00:03:00.314 And I realized that 00:03:01.026 --> 00:03:03.248 we speak two different languages in adult 00:03:03.269 --> 00:03:04.909 treatment versus pediatrics. 00:03:05.290 --> 00:03:07.772 And I would have coworkers come up to 00:03:07.793 --> 00:03:08.913 me and say, Hey, 00:03:08.973 --> 00:03:10.134 I know you're in this manual therapy 00:03:10.175 --> 00:03:10.574 course. 00:03:10.974 --> 00:03:12.676 I've got this kid who had Botox to 00:03:12.697 --> 00:03:13.417 his adductors. 00:03:13.456 --> 00:03:14.518 And now when he abducts, 00:03:14.538 --> 00:03:16.000 he's getting a pinching pain. 00:03:16.020 --> 00:03:17.420 Is there anything you can help me do? 00:03:17.461 --> 00:03:18.521 And I'm like, yeah, 00:03:18.562 --> 00:03:20.182 let's inferior gliding, you know? 00:03:20.223 --> 00:03:21.584 And so we started doing that. 00:03:21.743 --> 00:03:21.865 And, 00:03:22.284 --> 00:03:24.045 but I realized that the way it was 00:03:24.086 --> 00:03:25.987 being taught to me and the way I 00:03:26.027 --> 00:03:28.189 needed to teach it to them, 00:03:29.064 --> 00:03:29.705 was different. 00:03:29.885 --> 00:03:31.706 And when you look at the ICF model, 00:03:32.328 --> 00:03:34.210 pediatrics is much more participation and 00:03:34.250 --> 00:03:35.009 activity based. 00:03:35.550 --> 00:03:37.532 And they're not looking to say, 00:03:37.592 --> 00:03:39.675 how can I increase shoulder flexion? 00:03:40.074 --> 00:03:40.756 They're looking to say, 00:03:40.836 --> 00:03:42.477 how can I help this kid lift his 00:03:42.537 --> 00:03:44.158 arm to put his shirt on by himself? 00:03:45.039 --> 00:03:48.342 And I knew the starting place was really 00:03:48.462 --> 00:03:51.825 looking at what are the goals of pediatric 00:03:51.846 --> 00:03:52.406 therapists? 00:03:52.566 --> 00:03:54.407 And so I started drawing the pump tool 00:03:55.248 --> 00:03:55.389 and 00:03:55.795 --> 00:03:56.235 And going, OK, 00:03:56.276 --> 00:03:57.257 what else do they need to know? 00:03:57.276 --> 00:03:57.356 Well, 00:03:57.377 --> 00:03:58.896 they obviously need to know red flags. 00:03:59.437 --> 00:04:01.679 And so really started to research those 00:04:01.699 --> 00:04:02.679 and put that together. 00:04:02.758 --> 00:04:03.739 And then at that same time, 00:04:03.759 --> 00:04:04.840 I was getting into pain. 00:04:05.500 --> 00:04:08.581 And the article came out on how to 00:04:08.622 --> 00:04:10.562 manually manual therapy for different pain 00:04:10.603 --> 00:04:10.943 types. 00:04:10.962 --> 00:04:11.383 And I was like, 00:04:11.522 --> 00:04:13.084 I could have written this like I literally 00:04:13.123 --> 00:04:14.324 was already thinking about this. 00:04:14.403 --> 00:04:15.284 I wish I had been there. 00:04:17.276 --> 00:04:18.757 known enough to be included in that 00:04:18.776 --> 00:04:19.658 because I would have loved to have been 00:04:19.677 --> 00:04:20.238 in that room. 00:04:20.959 --> 00:04:22.600 And so it just really started putting all 00:04:22.661 --> 00:04:23.622 of that together. 00:04:23.961 --> 00:04:25.663 And then that's when I applied to the 00:04:25.843 --> 00:04:29.687 SCD at Texas Tech and told them, 00:04:30.048 --> 00:04:30.648 they said, you know, 00:04:30.829 --> 00:04:32.129 you'll do a dissertation. 00:04:32.170 --> 00:04:33.011 And I said, well, actually, 00:04:33.050 --> 00:04:34.432 I already have something I want to look 00:04:34.492 --> 00:04:37.134 into and sent that to them. 00:04:37.355 --> 00:04:40.216 And they just helped me really flesh it 00:04:40.377 --> 00:04:42.338 out and kind of take it to the 00:04:42.358 --> 00:04:42.759 next level. 00:04:43.665 --> 00:04:45.067 Just so we don't leave the audience 00:04:45.666 --> 00:04:47.228 behind, what is the SCD? 00:04:47.648 --> 00:04:48.348 Walk them through that. 00:04:48.367 --> 00:04:50.468 The Doctorate of Science in Rehabilitation 00:04:50.488 --> 00:04:51.088 Sciences. 00:04:51.589 --> 00:04:53.591 So Texas Tech has that program. 00:04:54.170 --> 00:04:56.732 And I chose that one because I knew 00:04:56.752 --> 00:04:57.732 other people who were in it and I 00:04:57.771 --> 00:04:58.932 had heard great things about it. 00:04:59.552 --> 00:05:00.934 And so I kind of came in with 00:05:00.973 --> 00:05:03.615 this piece that I knew I wanted to 00:05:04.555 --> 00:05:06.617 get other brains to think with me about. 00:05:08.137 --> 00:05:09.197 And they had the people to do it. 00:05:09.218 --> 00:05:09.437 Yeah. 00:05:10.677 --> 00:05:10.877 All right, 00:05:10.896 --> 00:05:12.819 so let's get into your not only research 00:05:12.858 --> 00:05:13.598 but clinical work. 00:05:14.199 --> 00:05:14.660 In your mind, 00:05:14.720 --> 00:05:16.821 what are the biggest misconceptions or 00:05:16.860 --> 00:05:19.142 mistakes clinicians might make when 00:05:19.163 --> 00:05:21.644 applying adult manual therapy techniques 00:05:22.204 --> 00:05:22.966 to kids? 00:05:23.725 --> 00:05:24.706 What are the things you wish you could 00:05:24.747 --> 00:05:26.067 erase? 00:05:26.769 --> 00:05:27.369 I think 00:05:28.196 --> 00:05:30.637 The danger that we see in the clinic 00:05:31.338 --> 00:05:33.519 is putting too much pressure through the 00:05:33.559 --> 00:05:34.899 shaft of long bones, 00:05:35.579 --> 00:05:38.541 because not only do you have kids with 00:05:38.622 --> 00:05:41.983 underlying diagnoses like cerebral palsy 00:05:42.264 --> 00:05:43.925 or muscular dystrophy, 00:05:43.964 --> 00:05:47.146 or even cystic fibrosis who have changes 00:05:47.305 --> 00:05:48.666 in their bone mineral density, 00:05:49.127 --> 00:05:50.807 but you also have a period of growth 00:05:50.827 --> 00:05:53.370 and development when bone mineral density 00:05:53.410 --> 00:05:54.550 is actually at its lowest, 00:05:54.569 --> 00:05:55.610 when the bones grow 00:05:56.108 --> 00:05:57.670 but they haven't thickened yet. 00:05:58.189 --> 00:06:00.271 And so one of the dangers I I've 00:06:00.350 --> 00:06:03.012 seen is people who come in and try 00:06:03.031 --> 00:06:05.692 to use their adult techniques and they end 00:06:05.793 --> 00:06:07.894 up fracturing a femur really is what it 00:06:07.913 --> 00:06:08.473 comes down to. 00:06:08.694 --> 00:06:10.295 And so the thing you have to do 00:06:10.314 --> 00:06:12.276 is really work through the joint. 00:06:12.935 --> 00:06:15.216 There is in terms of another misconception 00:06:15.257 --> 00:06:17.017 is people are really fearful that they're 00:06:17.038 --> 00:06:18.577 going to damage the joint. 00:06:19.117 --> 00:06:21.899 But what we know from manipulation under 00:06:21.939 --> 00:06:24.620 anesthesia with kids is that they are far 00:06:24.661 --> 00:06:25.360 more aggressive. 00:06:25.995 --> 00:06:28.257 and they don't create joint damage and so 00:06:28.317 --> 00:06:30.620 we have these other pieces out there that 00:06:30.680 --> 00:06:33.262 can kind of they can inform us and 00:06:33.502 --> 00:06:35.184 i even had someone tell me once that 00:06:35.524 --> 00:06:38.127 they would never mobilize a kid because 00:06:38.146 --> 00:06:40.247 they wouldn't want to produce a skippy 00:06:40.267 --> 00:06:42.230 which is a slip capital femoral epiphysis 00:06:42.350 --> 00:06:43.370 and i'm like well if you look at 00:06:43.391 --> 00:06:44.911 what causes a slip capital femoral 00:06:44.932 --> 00:06:47.634 epiphysis it's not joint mobilization like 00:06:47.654 --> 00:06:49.235 this child is destined to have a skippy 00:06:49.255 --> 00:06:52.538 right and so i think people just don't 00:06:53.374 --> 00:06:54.634 know, um, 00:06:54.694 --> 00:06:58.615 what techniques are safe and who they can 00:06:58.675 --> 00:07:00.334 do them on and who, 00:07:00.456 --> 00:07:01.855 when they need to modify it. 00:07:01.975 --> 00:07:03.456 And so kind of our next step right 00:07:03.495 --> 00:07:04.596 now is we're looking and saying, 00:07:04.675 --> 00:07:05.776 who can you manipulate? 00:07:06.656 --> 00:07:07.997 Who can you mobilize? 00:07:08.297 --> 00:07:09.817 And then who can you facilitate? 00:07:10.298 --> 00:07:11.677 And really at the end of the day, 00:07:11.737 --> 00:07:12.798 we're just trying to impact 00:07:12.817 --> 00:07:16.918 mechanoreceptors and with kids, your, um, 00:07:17.841 --> 00:07:20.425 Joint mobility is not usually as big of 00:07:20.444 --> 00:07:25.632 an issue as motor control or issues with 00:07:25.672 --> 00:07:26.973 sustained postures and fear. 00:07:27.954 --> 00:07:29.857 And so your goals are different. 00:07:29.877 --> 00:07:31.658 What your challenges are different. 00:07:31.718 --> 00:07:34.543 And we just need to know how we 00:07:34.603 --> 00:07:36.305 need to modify that for children. 00:07:37.997 --> 00:07:39.218 They're not small adults. 00:07:39.319 --> 00:07:40.278 It feels like there's a theme there. 00:07:41.259 --> 00:07:42.600 They're not just adults. 00:07:44.680 --> 00:07:46.180 I even remember in my fellowship, 00:07:47.081 --> 00:07:48.341 people who don't treat kids, 00:07:48.362 --> 00:07:49.723 when they think of pediatrics, 00:07:50.142 --> 00:07:51.803 all they think of is that developmental 00:07:51.843 --> 00:07:52.483 neuro crew. 00:07:53.084 --> 00:07:53.663 And they're like, well, 00:07:53.704 --> 00:07:54.805 joint mobilization is not for them. 00:07:54.845 --> 00:07:55.865 You do kids. 00:07:55.884 --> 00:07:56.665 You do neuro. 00:07:56.766 --> 00:07:57.346 And it's like, no, 00:07:57.365 --> 00:07:59.346 there's a whole lot of orthopedics in a 00:07:59.387 --> 00:07:59.706 child. 00:08:00.295 --> 00:08:01.576 the same amount of orthopedics that the 00:08:01.617 --> 00:08:02.177 adults have. 00:08:02.677 --> 00:08:05.918 And so not every pediatric patient has a 00:08:06.338 --> 00:08:08.478 neurological underlying diagnosis. 00:08:09.098 --> 00:08:11.279 Same with not joint, 00:08:11.399 --> 00:08:13.040 every neurological patient with a 00:08:13.081 --> 00:08:15.562 neurological diagnosis still has joints 00:08:16.221 --> 00:08:16.742 and they still, 00:08:16.762 --> 00:08:18.783 and their joints move the same ways, 00:08:19.202 --> 00:08:21.504 but issues like spasticity, 00:08:22.343 --> 00:08:23.464 prolonged positioning, 00:08:23.944 --> 00:08:26.084 they affect the joints differently. 00:08:26.125 --> 00:08:27.185 And so you have to, 00:08:28.512 --> 00:08:30.675 You can't disregard an entire group 00:08:30.714 --> 00:08:32.196 because you don't know about it. 00:08:32.235 --> 00:08:34.057 And so my hope is to raise awareness, 00:08:34.097 --> 00:08:37.100 but really raise it from the standpoint of 00:08:37.941 --> 00:08:41.183 good foundational underlying knowledge of 00:08:41.283 --> 00:08:43.865 what the red flags are and then give 00:08:43.905 --> 00:08:46.028 people an alternative to achieve the same 00:08:46.067 --> 00:08:46.268 thing. 00:08:47.044 --> 00:08:47.465 Love that. 00:08:48.164 --> 00:08:49.326 Well, let's talk some about some of that. 00:08:49.346 --> 00:08:50.785 You're developing alternative techniques 00:08:50.826 --> 00:08:53.826 designed around the biomechanics of the 00:08:53.886 --> 00:08:55.767 growing musculoskeletal system. 00:08:56.167 --> 00:08:58.467 Walk us through what makes these 00:08:58.508 --> 00:08:59.508 techniques different. 00:08:59.748 --> 00:09:00.528 I feel like a second ago, 00:09:00.567 --> 00:09:02.208 we talked about anatomy and physiology 00:09:02.249 --> 00:09:03.308 being a little bit different, 00:09:03.349 --> 00:09:05.090 but some similarities, some difference. 00:09:05.450 --> 00:09:06.909 What about the techniques makes those 00:09:06.950 --> 00:09:07.470 things different? 00:09:07.490 --> 00:09:08.350 You mentioned one, hey, 00:09:08.370 --> 00:09:09.530 maybe not putting the force through the 00:09:09.591 --> 00:09:09.811 bone. 00:09:09.831 --> 00:09:10.471 Are there others? 00:09:11.572 --> 00:09:11.692 Yeah, 00:09:11.732 --> 00:09:13.975 so we really try to work through the 00:09:14.014 --> 00:09:14.375 joint, 00:09:14.755 --> 00:09:17.317 but also looking at combined motions. 00:09:17.759 --> 00:09:19.080 So a lot of times when we think 00:09:19.120 --> 00:09:20.221 about joint mobilization, 00:09:20.260 --> 00:09:22.243 we think of a posterior glide. 00:09:22.383 --> 00:09:24.245 We think of a inferior glide. 00:09:24.264 --> 00:09:25.105 You know, we think about, 00:09:25.546 --> 00:09:28.028 but really when you look at the joint, 00:09:28.128 --> 00:09:29.269 it's generally, 00:09:29.408 --> 00:09:31.110 it has motion all the way around it, 00:09:31.270 --> 00:09:31.571 right? 00:09:31.672 --> 00:09:34.793 And so looking at something like hip 00:09:34.813 --> 00:09:37.576 dysplasia, where you need to work, 00:09:38.697 --> 00:09:41.379 congruently into inferior and external 00:09:41.418 --> 00:09:43.321 rotation or in order to bring to 00:09:43.341 --> 00:09:46.243 facilitate that joint being in the right 00:09:46.283 --> 00:09:48.504 position and then activating the muscles. 00:09:48.565 --> 00:09:52.349 So really trying to understand that joint 00:09:52.389 --> 00:09:54.630 limitation generally doesn't happen in 00:09:54.750 --> 00:09:55.892 just one plane. 00:09:56.611 --> 00:09:57.852 And so we're looking to say, 00:09:57.913 --> 00:09:59.514 how can we work through the joint? 00:09:59.975 --> 00:10:02.557 And really a lot of it is bringing 00:10:02.677 --> 00:10:04.438 in ideas that, um, 00:10:05.089 --> 00:10:07.450 adult predecessors have i mean all manual 00:10:07.470 --> 00:10:08.971 therapy is done when you look at it 00:10:09.010 --> 00:10:10.932 over time is everybody has kind of 00:10:10.991 --> 00:10:13.253 improved on or changed what the guy who 00:10:13.293 --> 00:10:15.153 did before them did right so it's it's 00:10:15.234 --> 00:10:17.934 not new rocket science so we look at 00:10:18.395 --> 00:10:19.936 movement with mobilization i would say 00:10:19.975 --> 00:10:22.356 that's probably the closest piece to it 00:10:22.898 --> 00:10:26.339 and there's a pnf mobilization technique 00:10:26.359 --> 00:10:27.759 that it's in the literature where you use 00:10:27.799 --> 00:10:30.421 pnf patterns with mobilization and 00:10:30.461 --> 00:10:33.482 facilitation so but a lot of those are 00:10:33.979 --> 00:10:37.700 adult manual therapy ideas and trying to 00:10:37.799 --> 00:10:40.139 bring that language into pediatrics and 00:10:40.159 --> 00:10:41.559 say okay now what are we seeing in 00:10:41.580 --> 00:10:45.240 these kiddos that we can apply these 00:10:45.280 --> 00:10:48.282 techniques to and add the word pediatric 00:10:48.302 --> 00:10:50.121 to it pediatric joint facilitation but 00:10:50.162 --> 00:10:52.302 it's not like we're the first person who 00:10:52.341 --> 00:10:54.442 came up with combined emotions and working 00:10:54.482 --> 00:10:56.663 at the joint instead of the shaft right 00:10:56.722 --> 00:11:00.163 so um and then really taking that into 00:11:00.203 --> 00:11:01.543 a motor learning piece because 00:11:02.081 --> 00:11:04.182 At this point, until kids reach puberty, 00:11:04.543 --> 00:11:07.623 their greatest gains are coming in motor 00:11:07.643 --> 00:11:08.903 control and motor learning. 00:11:09.504 --> 00:11:10.844 Their brains are growing and they're 00:11:11.004 --> 00:11:11.504 learning. 00:11:11.964 --> 00:11:13.524 And so that's where the biggest bang for 00:11:13.544 --> 00:11:14.325 your buck is. 00:11:14.705 --> 00:11:15.865 So with kids, 00:11:15.945 --> 00:11:19.225 it's not about getting the joint in the 00:11:19.265 --> 00:11:21.407 right position and then doing a whole lot 00:11:21.427 --> 00:11:22.826 of straight leg raises and trying to 00:11:22.947 --> 00:11:24.726 increase the strength of the hip flexor 00:11:25.167 --> 00:11:26.908 and focusing on it from that standpoint. 00:11:27.268 --> 00:11:29.528 It's about training their brain to use 00:11:29.548 --> 00:11:31.589 their hip flexor to climb stairs. 00:11:32.357 --> 00:11:34.139 Now that they have figured out how to 00:11:34.278 --> 00:11:36.120 inferiorly and posteriorly glide. 00:11:36.620 --> 00:11:38.900 And so everything comes back into that 00:11:39.020 --> 00:11:41.381 movement pattern and the motor control 00:11:41.402 --> 00:11:42.582 that we want them to have, 00:11:42.923 --> 00:11:44.644 which brings us all the way back to 00:11:44.663 --> 00:11:47.205 the participation and activity component 00:11:47.245 --> 00:11:48.004 of the ICF. 00:11:48.284 --> 00:11:48.625 Right. 00:11:48.644 --> 00:11:49.605 Because at the end of the day, 00:11:49.645 --> 00:11:50.166 with kids, 00:11:50.206 --> 00:11:52.726 we want to say he can't climb stairs. 00:11:53.187 --> 00:11:54.768 We're not looking and saying this older 00:11:54.807 --> 00:11:56.168 woman has pain with hip flexion. 00:11:56.188 --> 00:11:56.708 Right. 00:11:57.115 --> 00:12:00.438 So we've got to think about it throughout 00:12:00.479 --> 00:12:03.480 the model and throughout the end goal of 00:12:03.961 --> 00:12:06.202 getting kids to be able to do what 00:12:06.283 --> 00:12:07.303 they do for a living, 00:12:07.344 --> 00:12:09.164 which is play and participate in their 00:12:09.184 --> 00:12:09.586 world. 00:12:10.086 --> 00:12:13.288 And so how can joint mobilization play a 00:12:13.447 --> 00:12:16.110 piece of that puzzle to achieve that end 00:12:16.171 --> 00:12:16.471 goal? 00:12:16.510 --> 00:12:18.032 And how can we give that tool to 00:12:18.773 --> 00:12:20.474 pediatric therapists in a safe manner? 00:12:21.263 --> 00:12:21.923 Well, 00:12:21.943 --> 00:12:23.625 you already answered or took my next 00:12:23.664 --> 00:12:23.966 question. 00:12:23.985 --> 00:12:24.525 It was on the list. 00:12:24.546 --> 00:12:25.586 It was going to be a great radio 00:12:25.626 --> 00:12:27.828 segue, but you mentioned before, 00:12:27.909 --> 00:12:29.490 there was always this question when I was 00:12:30.272 --> 00:12:31.552 a pediatric PT, 00:12:32.333 --> 00:12:33.674 at what age do we stop making it 00:12:33.735 --> 00:12:36.017 fun and about participation in sport 00:12:36.177 --> 00:12:39.000 instead of just gaining a few extra 00:12:39.120 --> 00:12:40.361 degrees of range of motion in this 00:12:40.402 --> 00:12:41.783 particular joint? 00:12:41.923 --> 00:12:42.302 And I think 00:12:43.327 --> 00:12:43.849 You know, 00:12:43.869 --> 00:12:45.169 that was the first rule for my mentor 00:12:45.230 --> 00:12:46.932 in Peds was if you can't make it 00:12:46.951 --> 00:12:48.813 fun, don't bother asking them to do it. 00:12:49.354 --> 00:12:50.554 And I think it's sad. 00:12:50.836 --> 00:12:52.017 Is it eighteen? 00:12:52.057 --> 00:12:52.937 Is it twenty one? 00:12:52.957 --> 00:12:53.798 Is it twenty five? 00:12:53.859 --> 00:12:55.921 All of a sudden we make it adult. 00:12:56.380 --> 00:12:58.163 And outside the physiology, 00:12:59.485 --> 00:13:01.407 people want to do stuff that has meaning 00:13:01.447 --> 00:13:03.568 and has and has fun or brings fun 00:13:03.609 --> 00:13:04.470 back to their life. 00:13:05.471 --> 00:13:06.451 I feel like ninety percent of what I 00:13:06.471 --> 00:13:07.652 did as a pediatric PT, 00:13:07.892 --> 00:13:09.933 maybe ninety five percent was obstacle 00:13:09.974 --> 00:13:10.394 courses. 00:13:10.835 --> 00:13:11.955 I knew what I wanted you to do. 00:13:12.155 --> 00:13:13.255 Let me figure out a fun way to 00:13:13.296 --> 00:13:13.937 make you do it. 00:13:14.017 --> 00:13:15.138 And then I'll reward you with a zip 00:13:15.177 --> 00:13:15.857 line at the end. 00:13:15.918 --> 00:13:19.500 But when you look at outcomes like that, 00:13:20.041 --> 00:13:20.562 does it change? 00:13:20.741 --> 00:13:22.783 I'm guessing it changes everything about 00:13:23.244 --> 00:13:24.985 what success looks like in pediatric 00:13:25.024 --> 00:13:25.785 manual therapy. 00:13:26.405 --> 00:13:27.606 It sounds like that's the middle of the 00:13:27.687 --> 00:13:30.750 ICF model for you, which is not. 00:13:30.889 --> 00:13:31.889 It's the child and the fun and the 00:13:31.909 --> 00:13:32.431 participation. 00:13:33.716 --> 00:13:34.017 Right. 00:13:34.136 --> 00:13:35.837 It is all about when parents come in, 00:13:35.878 --> 00:13:38.019 they don't come in and say, hey, 00:13:38.059 --> 00:13:39.240 my kid, you know, 00:13:39.340 --> 00:13:41.861 isn't clearing his foot well when he in 00:13:41.881 --> 00:13:42.682 the swing phase. 00:13:43.003 --> 00:13:43.263 Right. 00:13:43.283 --> 00:13:43.403 Right. 00:13:44.043 --> 00:13:45.004 You know, come in and they say, 00:13:45.063 --> 00:13:46.424 my kid can't keep up with his friends 00:13:46.465 --> 00:13:47.684 on the playground and he keeps falling in 00:13:47.705 --> 00:13:48.306 the mulch. 00:13:48.365 --> 00:13:48.566 Right. 00:13:49.424 --> 00:13:50.905 And so you have to look and say, 00:13:51.366 --> 00:13:52.988 why is this happening? 00:13:53.107 --> 00:13:54.528 And how can I make it where this 00:13:54.589 --> 00:13:56.750 kid can keep up with his friends or 00:13:57.169 --> 00:13:58.730 come closer to keeping up with his friends 00:13:58.750 --> 00:13:59.392 in the playground? 00:13:59.792 --> 00:14:01.452 So we bring it back, you know, 00:14:01.493 --> 00:14:03.173 from the big picture down to the, 00:14:03.214 --> 00:14:04.235 but at the end, 00:14:04.654 --> 00:14:06.655 the test of whether or not we succeed 00:14:07.116 --> 00:14:08.677 is going to be looking at something like 00:14:08.697 --> 00:14:09.677 a six minute walk test. 00:14:09.717 --> 00:14:11.759 It's going to be these functional outcome 00:14:11.799 --> 00:14:12.759 measures that we say, 00:14:13.221 --> 00:14:16.263 did what we do make a change in, 00:14:16.283 --> 00:14:16.403 in, 00:14:17.273 --> 00:14:19.734 an objective change in how he performed, 00:14:20.073 --> 00:14:21.735 which has been going to carry over into 00:14:21.794 --> 00:14:22.434 his world. 00:14:23.254 --> 00:14:26.995 And so that's why I think pediatrics is 00:14:27.035 --> 00:14:31.597 so good at screenings that are functional 00:14:32.398 --> 00:14:34.278 and that are developmentally specific. 00:14:34.759 --> 00:14:36.580 Now, as we start getting into teenagers, 00:14:36.620 --> 00:14:37.899 we start to get away from that a 00:14:37.919 --> 00:14:38.419 little bit. 00:14:38.820 --> 00:14:39.780 But even then, 00:14:39.841 --> 00:14:41.041 just to give you an example, 00:14:41.160 --> 00:14:42.861 I'll get a gymnast who has low back 00:14:42.881 --> 00:14:43.162 pain. 00:14:43.994 --> 00:14:46.215 And they can't do gymnastics because their 00:14:46.254 --> 00:14:47.475 back hurts and they're in danger of a 00:14:47.535 --> 00:14:48.035 spondy. 00:14:48.416 --> 00:14:49.716 So I come in here and I go, 00:14:49.777 --> 00:14:51.437 well, you've got terrible hip extension. 00:14:52.038 --> 00:14:54.698 And so by treating their hip extension, 00:14:54.818 --> 00:14:56.799 then I can make it where they're not 00:14:56.860 --> 00:14:58.679 as dependent upon their lumbar extension. 00:14:59.181 --> 00:15:02.322 And now they can do gymnastics and not 00:15:02.381 --> 00:15:04.243 hurt whether or not it's hip extension. 00:15:04.283 --> 00:15:05.003 They don't care. 00:15:05.023 --> 00:15:06.783 What they want to know is when I 00:15:06.823 --> 00:15:08.764 do back handsprings, does my back hurt? 00:15:09.205 --> 00:15:09.404 And 00:15:10.365 --> 00:15:11.745 And so you just have to, 00:15:12.166 --> 00:15:13.527 we can bring it down to that piece, 00:15:13.547 --> 00:15:15.807 but if we can't bring it back into 00:15:16.388 --> 00:15:18.629 play and activity and sports and 00:15:18.788 --> 00:15:20.190 interacting with our families, 00:15:20.750 --> 00:15:23.110 then all we have is a bunch of 00:15:23.131 --> 00:15:24.412 measurements on a piece of paper. 00:15:24.451 --> 00:15:26.832 We don't have any life change out of 00:15:26.893 --> 00:15:27.013 it. 00:15:27.413 --> 00:15:27.974 There it is. 00:15:28.494 --> 00:15:30.075 Let's shift gears a little bit to chronic 00:15:30.095 --> 00:15:31.416 pain in kids. 00:15:32.015 --> 00:15:35.638 What do clinicians consistently miss about 00:15:35.697 --> 00:15:38.099 the role of parent beliefs, trauma, 00:15:38.519 --> 00:15:39.879 and adolescent development? 00:15:41.229 --> 00:15:43.188 So chronic pain is such a fascinating 00:15:43.229 --> 00:15:44.370 topic right now, right? 00:15:44.429 --> 00:15:47.710 And it's another one of those places where 00:15:48.091 --> 00:15:50.191 people love to talk about it in adults 00:15:50.431 --> 00:15:52.010 and they're terrified to talk about it in 00:15:52.051 --> 00:15:52.471 kids. 00:15:53.052 --> 00:15:55.652 And pediatric therapists are generally 00:15:55.692 --> 00:15:56.792 terrified to treat it. 00:15:57.373 --> 00:15:59.253 And the problem that we have is that 00:15:59.273 --> 00:16:01.153 we have this biomedical model that we've 00:16:01.173 --> 00:16:04.073 been trained to in PT school that we 00:16:04.134 --> 00:16:07.934 try to apply to our patients with chronic 00:16:07.975 --> 00:16:08.315 pain 00:16:09.346 --> 00:16:12.389 And we can't exercise chronic pain away. 00:16:13.090 --> 00:16:16.073 And so while movement is important for 00:16:16.114 --> 00:16:16.955 treating chronic pain, 00:16:17.054 --> 00:16:19.437 it is one piece of a probably five 00:16:19.476 --> 00:16:20.217 piece puzzle. 00:16:20.879 --> 00:16:22.760 And the other pieces that we need to 00:16:22.801 --> 00:16:25.344 train pediatric therapists in is to 00:16:25.464 --> 00:16:26.404 understand the 00:16:27.282 --> 00:16:29.582 how the patient got there how their brain 00:16:29.623 --> 00:16:31.965 is working what the the central 00:16:32.004 --> 00:16:34.306 involvement is but also one time i heard 00:16:34.346 --> 00:16:36.368 this word the nocebo effect and i was 00:16:36.408 --> 00:16:38.109 like and i was like this is it 00:16:38.528 --> 00:16:41.270 because i can sit down with a kid 00:16:41.311 --> 00:16:43.751 and i can do pain education and i 00:16:43.792 --> 00:16:46.234 can do desensitization and i can help them 00:16:46.293 --> 00:16:49.394 understand pacing but if they go home with 00:16:49.434 --> 00:16:50.015 a parent 00:16:50.436 --> 00:16:52.177 who had chronic pain all of their life, 00:16:52.477 --> 00:16:54.538 who then babies them and says, oh, baby, 00:16:54.558 --> 00:16:55.519 you don't need to go to school today. 00:16:55.580 --> 00:16:56.360 I can see it on your face. 00:16:56.379 --> 00:16:57.100 You're really hurting. 00:16:57.140 --> 00:16:59.042 You should probably just stay home and 00:16:59.523 --> 00:17:00.143 work from home. 00:17:00.182 --> 00:17:01.443 Or why don't you go lay down? 00:17:01.844 --> 00:17:03.424 You had a you had a you know, 00:17:04.006 --> 00:17:05.086 you had to walk home from school. 00:17:05.125 --> 00:17:07.428 I know you're hurting that that nocebo 00:17:07.468 --> 00:17:09.710 effect that they get the other six days 00:17:09.750 --> 00:17:10.269 of the week. 00:17:10.750 --> 00:17:11.871 I can't compete with that. 00:17:12.231 --> 00:17:12.951 Yeah. 00:17:12.971 --> 00:17:15.314 So we have to have a place where 00:17:15.913 --> 00:17:19.856 we can safely help parents understand 00:17:21.007 --> 00:17:24.209 the psychosocial side of chronic pain that 00:17:24.269 --> 00:17:28.191 is not threatening to them or disregarding 00:17:28.211 --> 00:17:29.551 their own experience. 00:17:30.573 --> 00:17:33.493 And you have to validate what the parent 00:17:33.534 --> 00:17:34.154 has gone through, 00:17:34.174 --> 00:17:36.816 but say the way that you've addressed your 00:17:36.855 --> 00:17:40.097 pain is not necessarily the way that 00:17:40.198 --> 00:17:42.740 science supports addressing it now in what 00:17:42.759 --> 00:17:44.381 we know to be true. 00:17:44.641 --> 00:17:47.883 And if you can't capture the parent 00:17:48.499 --> 00:17:49.680 then the child is going to hear a 00:17:49.720 --> 00:17:51.160 different story the other six days of the 00:17:51.180 --> 00:17:51.461 week. 00:17:51.800 --> 00:17:54.862 And then the other piece is you have 00:17:54.902 --> 00:17:57.183 to get a hold of that underlying stressor. 00:17:57.884 --> 00:18:00.705 I have a patient who has been with 00:18:00.746 --> 00:18:01.286 me for a while, 00:18:01.346 --> 00:18:03.567 and he has a legitimate diagnosis. 00:18:03.606 --> 00:18:07.229 I mean, he has a PARS defect, 00:18:07.409 --> 00:18:08.569 legitimate diagnosis, 00:18:09.009 --> 00:18:10.951 but he only feels pain in math class. 00:18:12.471 --> 00:18:15.294 And so he goes to the school nurse 00:18:15.574 --> 00:18:17.894 every day in tears. 00:18:18.569 --> 00:18:20.990 But he's scared to death of failing math. 00:18:21.070 --> 00:18:23.032 He has a processing issue with it. 00:18:23.393 --> 00:18:26.213 And so when he has the emotional response 00:18:26.253 --> 00:18:27.634 to the stress of math, 00:18:28.174 --> 00:18:31.217 the place where his body processes that is 00:18:31.257 --> 00:18:32.397 the place of least resistance, 00:18:32.417 --> 00:18:33.198 which is his low back. 00:18:33.218 --> 00:18:33.298 Sure. 00:18:34.699 --> 00:18:35.799 And so you look at that and you 00:18:35.819 --> 00:18:37.881 go, that's no see plastic paint. 00:18:38.432 --> 00:18:40.394 As opposed to nociceptive pain, 00:18:40.433 --> 00:18:42.714 which he would say he plays baseball. 00:18:43.115 --> 00:18:43.355 You know, 00:18:43.375 --> 00:18:45.116 that when I throw the ball and I 00:18:45.237 --> 00:18:47.577 rotate to the right and extend for my 00:18:47.617 --> 00:18:49.199 windup, I feel it. 00:18:49.239 --> 00:18:50.359 That's nociceptive. 00:18:50.799 --> 00:18:53.181 But I've got this underlying condition 00:18:53.201 --> 00:18:54.882 that I've been dealing with and I look 00:18:54.922 --> 00:18:56.262 really, really good in the clinic. 00:18:56.363 --> 00:18:57.324 But when I'm in math, 00:18:57.364 --> 00:18:58.625 my pain's an eight out of ten. 00:18:59.224 --> 00:19:00.586 That's nociplastic. 00:19:00.806 --> 00:19:02.586 So what do you do with parents there? 00:19:04.142 --> 00:19:06.122 Or, or, you know, both of your patients, 00:19:06.142 --> 00:19:07.403 because I was taught that like your 00:19:07.442 --> 00:19:08.702 patients aren't just the kids there, 00:19:08.742 --> 00:19:09.982 you're inheriting parents as well. 00:19:10.343 --> 00:19:11.962 And that's a good thing to make it 00:19:11.982 --> 00:19:12.182 hard. 00:19:13.443 --> 00:19:14.344 But how do you do that? 00:19:14.384 --> 00:19:16.124 Because I'm sure there's clinicians who 00:19:16.163 --> 00:19:18.003 are parents listening going, oh yeah, 00:19:18.084 --> 00:19:20.644 magically when it's time to go to math 00:19:20.664 --> 00:19:22.825 class, things hurt, right? 00:19:23.305 --> 00:19:24.986 Where do you start that education? 00:19:25.105 --> 00:19:26.586 I mean, I guess, where do you start? 00:19:26.665 --> 00:19:27.226 I have no idea. 00:19:27.645 --> 00:19:28.945 Unwrap me that. 00:19:29.046 --> 00:19:29.385 Sure. 00:19:29.526 --> 00:19:30.306 I think you, 00:19:30.445 --> 00:19:32.487 you validate what the child's 00:19:32.507 --> 00:19:33.426 experiencing, right? 00:19:33.874 --> 00:19:34.193 Right. 00:19:34.614 --> 00:19:35.494 Because the parents will say, 00:19:35.515 --> 00:19:36.315 is my kid crazy? 00:19:36.355 --> 00:19:37.536 Is he trying to get out of something? 00:19:37.576 --> 00:19:41.557 You know, you you you get past that. 00:19:41.978 --> 00:19:43.759 I always recommend psychology. 00:19:43.919 --> 00:19:45.259 We are not psychologists. 00:19:45.880 --> 00:19:47.619 But but we can. 00:19:48.560 --> 00:19:50.461 Psychology is hard to access for a lot 00:19:50.501 --> 00:19:50.942 of people. 00:19:51.221 --> 00:19:51.582 Sure. 00:19:51.642 --> 00:19:57.704 And we can still validate, educate people. 00:19:58.125 --> 00:20:02.210 and I think redirect to a new way 00:20:02.289 --> 00:20:04.131 of looking at and thinking about these 00:20:04.171 --> 00:20:04.432 things. 00:20:04.471 --> 00:20:06.614 So I say we have to lower his 00:20:06.673 --> 00:20:10.096 stress level about math, right? 00:20:10.196 --> 00:20:13.298 And so you're either getting math help or 00:20:13.338 --> 00:20:14.599 you're letting know at the end of the 00:20:14.641 --> 00:20:16.642 day you're really not that upset if he 00:20:16.682 --> 00:20:17.423 doesn't do well enough. 00:20:17.462 --> 00:20:21.086 Like if we can lower those stressors in 00:20:22.887 --> 00:20:24.108 pain education world and P&E world, 00:20:24.903 --> 00:20:26.124 neuroscience education where they talk 00:20:26.144 --> 00:20:28.105 about this lion walking around with you. 00:20:28.605 --> 00:20:31.125 And the lion has all of these different 00:20:31.165 --> 00:20:33.826 words on it that are like my bills, 00:20:33.886 --> 00:20:35.768 my marriage, math class, 00:20:35.847 --> 00:20:37.567 my performance on the volleyball team, 00:20:37.587 --> 00:20:38.248 whatever it is. 00:20:38.288 --> 00:20:38.587 Right. 00:20:39.288 --> 00:20:41.548 And that whatever your thing is, 00:20:41.588 --> 00:20:44.269 that lion is this constant threat to you 00:20:44.589 --> 00:20:46.351 that increases your pain. 00:20:46.411 --> 00:20:48.912 And basically you have to make the lion 00:20:49.071 --> 00:20:49.991 into a little cub. 00:20:50.011 --> 00:20:51.873 You have to make the lion safe and 00:20:51.932 --> 00:20:52.772 no longer threatening. 00:20:53.567 --> 00:20:55.688 And so if that means for this kiddo 00:20:56.008 --> 00:20:58.488 to say, it's okay, 00:20:58.608 --> 00:20:59.429 if you don't get math, 00:20:59.469 --> 00:21:00.429 we're going to get you help. 00:21:00.709 --> 00:21:01.229 And even then, 00:21:01.269 --> 00:21:02.369 if you make a D in math, 00:21:03.349 --> 00:21:04.490 you're going to be a great person. 00:21:04.549 --> 00:21:06.411 And this is not a reflection of who 00:21:06.431 --> 00:21:06.730 you are, 00:21:06.750 --> 00:21:09.152 like to bring down the threat such that 00:21:10.632 --> 00:21:12.333 if the people around me are okay with 00:21:12.373 --> 00:21:13.772 it, then I can be okay with it. 00:21:14.532 --> 00:21:16.773 And when it comes to things like 00:21:17.263 --> 00:21:18.263 family abuse. 00:21:18.284 --> 00:21:19.845 I mean, in pediatrics, 00:21:19.884 --> 00:21:21.424 we have to be really aware of that 00:21:21.505 --> 00:21:23.505 and really sensitive to that and ask those 00:21:23.565 --> 00:21:24.164 questions. 00:21:24.525 --> 00:21:28.066 But those are all things that I say 00:21:28.145 --> 00:21:31.946 that I'm in seven and I never had 00:21:32.067 --> 00:21:34.688 a kid or had a patient who was 00:21:34.708 --> 00:21:37.508 a suicide risk until I started treating 00:21:37.548 --> 00:21:38.627 pediatric chronic pain. 00:21:39.729 --> 00:21:39.929 Now, 00:21:40.048 --> 00:21:41.388 I would say we have one every couple 00:21:41.409 --> 00:21:42.249 of months. 00:21:43.368 --> 00:21:46.289 And so it is heavy and 00:21:46.782 --> 00:21:50.204 And there is a deep psychological piece to 00:21:50.224 --> 00:21:50.265 it, 00:21:50.285 --> 00:21:52.106 which is why our pain clinics tend to, 00:21:52.126 --> 00:21:52.467 you know, 00:21:52.487 --> 00:21:54.929 they include a psychologist because it is 00:21:55.068 --> 00:21:57.230 it's not this biomedical model only. 00:21:57.269 --> 00:21:59.491 While movement's important is it's a 00:21:59.551 --> 00:22:01.353 biopsychosocial approach as well. 00:22:01.653 --> 00:22:04.596 And and it's a team approach. 00:22:05.695 --> 00:22:07.498 So it's hard. 00:22:07.877 --> 00:22:08.557 But then, you know, 00:22:08.577 --> 00:22:10.059 there's some really there are things we 00:22:10.099 --> 00:22:11.140 can do as therapists and somebody. 00:22:11.319 --> 00:22:12.681 But then why even send them to therapy? 00:22:12.821 --> 00:22:13.082 Right. 00:22:13.122 --> 00:22:13.221 Like, 00:22:13.261 --> 00:22:14.583 why not just send them all to psychology? 00:22:14.603 --> 00:22:14.823 Right. 00:22:15.598 --> 00:22:18.019 And there are things that we can do 00:22:18.099 --> 00:22:20.260 like they movement does help. 00:22:20.300 --> 00:22:23.663 We are trying to change how we sensitize, 00:22:23.843 --> 00:22:25.262 how sensitize the nerves are. 00:22:25.782 --> 00:22:28.404 Then we also like I noticed that my 00:22:28.424 --> 00:22:30.244 kids with chronic pain all have a 00:22:30.305 --> 00:22:31.145 difference in their two point 00:22:31.165 --> 00:22:31.846 discrimination. 00:22:32.566 --> 00:22:34.906 And so I can address their two point 00:22:34.946 --> 00:22:35.527 discrimination. 00:22:35.567 --> 00:22:37.147 And I basically just rock back and forth. 00:22:37.208 --> 00:22:38.388 I'm like two points or one point. 00:22:38.848 --> 00:22:40.368 And if I know what their normal is 00:22:40.450 --> 00:22:41.529 and I can address that. 00:22:42.204 --> 00:22:43.565 they'll come back the next time and say, 00:22:43.585 --> 00:22:44.726 I had less pain this week. 00:22:45.246 --> 00:22:45.685 It's crazy, 00:22:45.705 --> 00:22:47.846 but it's about connecting their brain to 00:22:47.905 --> 00:22:50.267 that part of the body in a way 00:22:50.307 --> 00:22:52.346 that's not, that's not smudge. 00:22:52.386 --> 00:22:53.267 It's not haywire. 00:22:54.027 --> 00:22:55.548 And so there are things that we can 00:22:55.587 --> 00:22:56.367 do like that. 00:22:56.448 --> 00:22:57.887 Our kids with Ehlers-Danlos, 00:22:58.428 --> 00:23:01.608 they really lack proprioceptive control 00:23:01.648 --> 00:23:03.869 and feedback because their ligaments are 00:23:03.910 --> 00:23:04.529 so lax. 00:23:04.690 --> 00:23:07.569 And so if we can help their joints 00:23:07.630 --> 00:23:09.851 talk to their brain and their brain talk 00:23:09.891 --> 00:23:10.671 to their joints, 00:23:11.214 --> 00:23:13.136 then um we can make a difference but 00:23:13.176 --> 00:23:14.719 it doesn't happen in six to eight weeks 00:23:16.180 --> 00:23:18.522 it takes a lot longer and it's um 00:23:18.542 --> 00:23:21.046 but there's not many people who are doing 00:23:21.105 --> 00:23:23.468 it like i have patients who drive two 00:23:23.508 --> 00:23:26.551 hours and my co-workers easily have 00:23:26.592 --> 00:23:28.894 patients who drive just as far to see 00:23:28.933 --> 00:23:30.415 them because there's just there's not 00:23:30.496 --> 00:23:31.938 pediatric therapists who feel confident 00:23:31.958 --> 00:23:32.298 treating it 00:23:32.721 --> 00:23:34.343 Sure. 00:23:34.423 --> 00:23:36.483 Let's go to the clinician who's listening 00:23:36.503 --> 00:23:36.983 right now. 00:23:37.064 --> 00:23:39.964 For the clinician who's listening who has, 00:23:39.984 --> 00:23:40.365 you know, 00:23:40.404 --> 00:23:41.826 tomorrow who has a child with pain or 00:23:41.865 --> 00:23:43.467 mobility limitations on their schedule, 00:23:43.926 --> 00:23:46.548 what's just one thing you want them doing 00:23:46.627 --> 00:23:49.288 differently right away with that kiddo on 00:23:49.308 --> 00:23:50.789 their schedule tomorrow? 00:23:52.309 --> 00:23:53.770 so i think one of the things that 00:23:53.790 --> 00:23:55.050 we've learned with kids that are different 00:23:55.070 --> 00:23:58.532 from adults is with adults we say correct 00:23:58.553 --> 00:24:01.174 the dysfunction and once you correct the 00:24:01.214 --> 00:24:03.256 dysfunction then they will move better and 00:24:03.276 --> 00:24:05.696 they'll feel better with kids they want 00:24:05.717 --> 00:24:07.258 their pain that the kid in the mom 00:24:07.278 --> 00:24:09.419 wants their pain addressed first so i 00:24:09.598 --> 00:24:11.660 always start with those grade one and 00:24:11.700 --> 00:24:13.800 grade two mobilizations actually away from 00:24:13.820 --> 00:24:16.982 the site and i really want to bring 00:24:17.022 --> 00:24:19.003 down their pain and build their trust 00:24:19.611 --> 00:24:20.872 if I go in with a kid and 00:24:20.912 --> 00:24:22.573 immediately go straight to the joint and 00:24:22.633 --> 00:24:23.973 start getting aggressive with it, 00:24:24.673 --> 00:24:26.795 if it's a no C plastic issue, 00:24:26.835 --> 00:24:27.516 if it's a pain issue, 00:24:27.635 --> 00:24:29.797 I'm going to send that through the roof, 00:24:29.876 --> 00:24:30.217 right? 00:24:30.837 --> 00:24:33.459 If it is just a positional issue, 00:24:34.039 --> 00:24:35.099 then I may correct it, 00:24:35.240 --> 00:24:37.642 but they may come in with more pain. 00:24:38.261 --> 00:24:39.403 They may, a lot of times they'll say, 00:24:39.742 --> 00:24:41.804 I felt great for and then it hurt 00:24:41.844 --> 00:24:42.223 worse. 00:24:43.025 --> 00:24:44.865 And that is that, um, 00:24:45.669 --> 00:24:47.690 just immediate pain relief because of the 00:24:47.730 --> 00:24:48.490 chemical change. 00:24:49.171 --> 00:24:51.271 But I have to build the trust of 00:24:51.311 --> 00:24:51.771 the patient. 00:24:51.791 --> 00:24:54.252 So there is a psychological piece to it. 00:24:54.292 --> 00:24:56.534 So I usually start away from the joint. 00:24:56.973 --> 00:24:58.694 And then if I feel the need to 00:24:58.734 --> 00:24:59.455 correct something, 00:24:59.476 --> 00:25:00.776 like I'll do a lot of SI joint 00:25:00.796 --> 00:25:01.496 manipulations. 00:25:02.196 --> 00:25:03.857 And I probably won't do that on the 00:25:03.917 --> 00:25:04.458 first visit, 00:25:04.698 --> 00:25:06.318 I will start by just springing the SI 00:25:06.338 --> 00:25:06.638 joint, 00:25:07.038 --> 00:25:08.759 because they've got an adult putting her 00:25:08.819 --> 00:25:09.640 hands on her butt, 00:25:09.859 --> 00:25:10.520 you know what I mean? 00:25:10.601 --> 00:25:13.142 And so for a kid, that's, 00:25:13.630 --> 00:25:14.349 That's strange. 00:25:14.609 --> 00:25:18.392 I've got to really just think about how 00:25:18.412 --> 00:25:20.032 am I approaching this person, 00:25:20.272 --> 00:25:23.054 this little person and their ability to 00:25:23.114 --> 00:25:25.394 process what's going on in their world as 00:25:25.494 --> 00:25:27.996 much as fixing this joint. 00:25:29.056 --> 00:25:30.156 And in adult, 00:25:30.196 --> 00:25:32.958 I think we fix the joint and in 00:25:33.137 --> 00:25:33.718 pediatrics, 00:25:33.778 --> 00:25:35.939 I think we treat the person a little 00:25:35.959 --> 00:25:36.419 bit better. 00:25:36.759 --> 00:25:37.419 Not that we shouldn't, 00:25:37.880 --> 00:25:40.339 but they're not small adults. 00:25:40.359 --> 00:25:41.520 They're not small adults. 00:25:42.520 --> 00:25:43.461 You ready for lightning round? 00:25:43.481 --> 00:25:44.542 I did not prepare, Jenny, 00:25:44.563 --> 00:25:45.064 for lightning round. 00:25:45.084 --> 00:25:47.926 Are you ready for lightning round? 00:25:48.027 --> 00:25:49.367 I'm ready for what? 00:25:49.708 --> 00:25:49.867 I mean, 00:25:49.887 --> 00:25:50.909 I'm as ready as I'm going to be. 00:25:51.269 --> 00:25:51.930 You're a PT. 00:25:52.230 --> 00:25:52.871 We'll figure it out. 00:25:52.951 --> 00:25:53.672 All right, lightning round. 00:25:54.692 --> 00:25:57.115 We'll do myth or fact, pediatric edition. 00:25:57.134 --> 00:25:58.237 I'm going to throw something out. 00:25:58.257 --> 00:25:59.958 You tell me myth, fact, 00:25:59.998 --> 00:26:01.420 and maybe a sentence or two why. 00:26:01.440 --> 00:26:02.381 What if I get it wrong? 00:26:02.780 --> 00:26:04.362 Do you already know the answer? 00:26:04.402 --> 00:26:04.742 Wrong? 00:26:04.762 --> 00:26:04.843 Okay. 00:26:05.564 --> 00:26:06.403 Give the authority here. 00:26:06.483 --> 00:26:07.285 All right, myth or fact? 00:26:07.305 --> 00:26:07.785 Lightning round. 00:26:07.825 --> 00:26:08.125 Jenny, 00:26:09.464 --> 00:26:11.625 kids are too fragile for joint 00:26:11.685 --> 00:26:12.445 mobilization. 00:26:12.546 --> 00:26:13.567 Myth or fact? 00:26:14.287 --> 00:26:15.346 Myth. 00:26:15.446 --> 00:26:16.988 Why? 00:26:17.028 --> 00:26:19.388 Because it's more about how you do it 00:26:19.489 --> 00:26:20.368 than what you do. 00:26:20.749 --> 00:26:23.109 And you can treat the joint and treat 00:26:23.150 --> 00:26:23.789 it differently, 00:26:24.170 --> 00:26:26.371 and the kid would be completely fine. 00:26:27.632 --> 00:26:28.872 Myth or fact? 00:26:29.592 --> 00:26:32.113 Pain in kids usually means tissue damage. 00:26:32.153 --> 00:26:34.413 Ooh. 00:26:36.280 --> 00:26:36.800 Usually. 00:26:37.281 --> 00:26:41.282 Um, I would say that, Oh, you're getting, 00:26:41.303 --> 00:26:41.982 you're messing with me. 00:26:42.044 --> 00:26:42.384 Okay. 00:26:42.403 --> 00:26:43.463 So there's a whole thing. 00:26:44.163 --> 00:26:46.244 Pain does not mean tissue damage. 00:26:46.265 --> 00:26:46.424 Okay. 00:26:46.484 --> 00:26:48.326 Okay. 00:26:48.346 --> 00:26:49.185 Cause it's at the brain, 00:26:49.287 --> 00:26:53.147 but no deceptive pain or usually 00:26:53.228 --> 00:26:54.729 originates with some kind of damage, 00:26:54.749 --> 00:26:56.368 but pain as a whole. 00:26:56.490 --> 00:26:56.730 No. 00:26:57.369 --> 00:26:57.589 Right. 00:26:57.750 --> 00:26:57.950 Okay. 00:26:58.549 --> 00:26:58.990 Last one. 00:26:59.070 --> 00:26:59.471 Last one. 00:26:59.570 --> 00:27:01.832 Teens exaggerate chronic pain for 00:27:01.912 --> 00:27:02.332 attention. 00:27:03.422 --> 00:27:05.343 I don't think that's true. 00:27:05.383 --> 00:27:05.883 That's a myth. 00:27:05.923 --> 00:27:07.202 That's a myth. 00:27:07.222 --> 00:27:08.183 They want to be with their friends. 00:27:08.223 --> 00:27:09.523 They want to participate in their world. 00:27:09.923 --> 00:27:11.625 All right. 00:27:11.644 --> 00:27:13.164 Last thing we do on the show here 00:27:13.184 --> 00:27:14.605 with AOMT is called Words of Wisdom. 00:27:14.625 --> 00:27:16.925 What's the last idea, concept? 00:27:16.945 --> 00:27:18.326 What's your mic drop moment, Jenny? 00:27:18.346 --> 00:27:19.146 What do you got for us? 00:27:19.166 --> 00:27:20.186 What do you want to leave the audience 00:27:20.207 --> 00:27:20.406 with? 00:27:20.446 --> 00:27:24.548 Do I get a second? 00:27:24.568 --> 00:27:25.469 Sure, you get a second. 00:27:25.528 --> 00:27:28.890 I'll play the Jeopardy music right now. 00:27:29.450 --> 00:27:30.510 Mic drop moment. 00:27:35.195 --> 00:27:40.640 Gosh, I. Oh, you're killing me. 00:27:40.660 --> 00:27:42.161 I got one for you. 00:27:42.340 --> 00:27:43.041 I know what it is. 00:27:43.501 --> 00:27:45.002 Kids aren't little adults. 00:27:45.482 --> 00:27:46.523 Kids aren't little adults. 00:27:46.544 --> 00:27:47.944 I mean, they're really not. 00:27:47.984 --> 00:27:48.826 And also, I mean, 00:27:50.686 --> 00:27:52.028 if there's something that you don't know 00:27:52.087 --> 00:27:54.730 about, don't just throw it out. 00:27:54.849 --> 00:27:55.690 Investigate it. 00:27:55.810 --> 00:27:56.471 Ask questions. 00:27:56.550 --> 00:27:57.111 Learn about it. 00:27:57.192 --> 00:27:59.232 I think they I mean, 00:27:59.252 --> 00:28:00.334 that would be the biggest thing is people 00:28:00.354 --> 00:28:01.795 who are just an absolute no. 00:28:01.835 --> 00:28:02.194 And you're like, 00:28:02.515 --> 00:28:03.756 have you ever been trained in this? 00:28:03.776 --> 00:28:04.856 Have you ever read an article? 00:28:05.749 --> 00:28:08.250 And I think give yourself a chance to 00:28:08.291 --> 00:28:10.232 learn about it because then you might 00:28:10.252 --> 00:28:12.615 really be able to help somebody and make 00:28:12.635 --> 00:28:13.717 a difference. 00:28:13.737 --> 00:28:14.958 Ginny, thanks for doing what you do. 00:28:15.337 --> 00:28:17.299 And thanks for talking to us here on 00:28:17.339 --> 00:28:18.601 Hands On, Hands Off through AOMT. 00:28:19.521 --> 00:28:20.383 Thank you for having me.