#PTonICE Daily Show The Institute of Clinical Excellence

Alan Fredendall // #FitnessAthleteFriday // www.ptonice.com 


In today's episode of the PT on ICE Daily Show, Fitness Athlete division leader Alan Fredendall discusses what creatine is, how we get it, and the concept that not everyone may need to supplement creatine
Take a listen to the episode or check out the full show notes on our blog at www.ptonice.com/blog
If you're looking to learn from our Fitness Athlete division, check out our live physical therapy courses or our online physical therapy courses. Check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab.
EPISODE TRANSCRIPTION
ALAN FREDENDALL
Do we really need creatine? If not, who does? Let's start today by talking about what is creatine? How do we get it? Where does it come from? What does it do from a performance perspective? And then let's finish about talking about potentially who may and who may not need to take creatine.

WHAT IS CREATINE?
So starting from the top, what is creatine? You've probably heard about it. You've probably taken it at this point and how do we get it? We're going to reference a lot the International Society of Sports Nutrition position papers which come from the International Society of Sports Nutrition. They publish their own journal and more importantly they publish these position papers on a frequent basis that cover a wide variety of of supplement diet and nutrition topics. They are incredibly comprehensive. They cover the thousands and thousands and thousands of supplements that are up there as well as all of the articles, the other thousands and thousands of articles that have research about those supplements that come out on an annual basis. And so these position papers are great because they do such a great job of summarizing all of the research in this area. And so asking the question, what is creatine? Where does it come from? 95% of the chemical known as creatine is found in our skeletal muscles, so our working muscle. And then about 5% is in our brain. We do have a little bit in our liver, but primarily, creatine is stored in our muscle. We have to get it somehow externally. We do not make it on our own. We usually get it between one to five grams a day. is what we're looking for. And that primarily comes from eating red meat such as beef or coming from fish, approximately 16 ounces about a pound per day. And so if you think that you are not eating that much red meat or fish or eating that at all, and you know that for sure, maybe you follow a vegan or vegetarian based diet, then the recommendation for many, many years has been supplementation, typically as five grams of creatine monohydrate per day. If you've ever taken this or you've known somebody who's taken this, it kind of just comes in a big tub like protein powder. It is a tasteless, odorless white powder that you can certainly do what we would call a dry scoop with some water. You can mix it with water or juice. It does not have a taste at all and so it does not really need to be mixed. It can be taken at any time of the day. And over the years, there have been different research papers on the concept of preloading creatine, taking a large dose to kind of bump up levels in our system and then tapering off to the maintenance dose. And what really decades of research at this time point have shown is that just taking five grams a day has the same effect as any sort of preloading, deloading effect. Just taking that five grams every day gets you to the levels where it's found to be optimal.

WHAT DOES CREATINE DO?
So that's what it is and how we get it. What does it do in our body? Why is it so talked about? Creatine has a number of great effects that have been shown in the research and have been shown and reinforced an

Dr. Lindsey Hughey // #TechniqueThursday // www.ptonice.com 


In today's episode of the PT on ICE Daily Show, Extremity Management division leader Lindsey Hughey explains the rationale behind myofascial decompression or "cupping" for patellar tendinopathy and provides a technique demonstration.
Take a listen to the podcast episode or check out the full show notes on our blog at www.ptonice.com/blog.
Check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab.
EPISODE TRANSCRIPTION
LINDSEY HUGHEY
PT on ICE Daily Show, waiting for YouTube and Instagram to catch up. So we are live on both. How's it going? I am joining you again this week on the PT on ICE Daily Show. Welcome. I'm Dr. Lindsey Hughey. I currently serve as one of the division leads at extremity management. And today I want to share with you a myofascial decompression technique for patellar tendinopathy. So today is either Technique Tuesday or Leadership Thursday. So we're bringing Technique Thursday to you all live. My model today is Daniel, my son. So what I want to unpack is a little bit about how do we know someone has patellar tendinopathy and who this might be appropriate for. with patellar tendinopathy, show you the technique, literally just demo it for you live, what you do, and then we'll chat also like how do you know the treatment worked. So we'll talk a little bit about our test retest options for patellar tendinopathy. And then we'll call it a morning technique Thursday, not Tuesday. Great to be with you all again. So first things first, someone with patellar tendinopathy is going to complain of a recent spike in load. Usually it's energy storage and release activities like jumping, sprinting. The other complaint, vice versa, they might have is that a dramatic de-load where they haven't, maybe it's their off season and then they stopped loading completely. this might flare up that patellar tendon. They will complain of pain with energy storage movements, and they'll specifically complain of pain right at the patellar tendon, where that inferior border of the patella sits to the tibial tubercle. When you palpate that as the clinician, that will be tender to palpation. Often when they extend their knees, so you're doing manual muscle testing of quadriceps, that will also cause their symptoms to blip. Having them do a one-legged squat on a slant board is another load test that will often bring on symptoms. The person with moderate to high irritability, patellar tendinopathy, often has coinciding hypertonicity throughout their quadriceps. So when you palpate, it's not just that patellar tendon that is bothering them. Like their quad also is kind of guarded around that knee joint. So myofascial decompression can be a great adjunct to treatment. If you've heard any podcasts that I've done on tendinopathy, you know, that load is our love language, or if you've been at our course, you know that. So ultimately, the teller tendinopathy is going to be healed by high tensile loading that involves loading the local tendon, the local muscle, quadriceps, the chain, and then off eventually gets into energy surge and release. So know this treatment technique that I'm about to show you is just an adjunct to care that creates a modulating window of opportunity to load that person better. So consider it's moderate to high irritability human. And so that's someone that like not just is their activity or sport starting to get interrupted. It's usually our basketball or volleyball players, but also like daily life is starting to get aggravated. They're not sleeping as well. Their performance has dropped. These folks need that treatment that kind of takes that edge off. So without further ado, you kind of understand who the person wit

Dr. Jeff Musgrave // #GeriOnICE // www.ptonice.com 


In today's episode of the PT on ICE Daily Show, join Modern Management of the Older Adult lead faculty Jeff Musgrave shares shares how by being too quick to limit risk for our patients we can expedite deconditioning, worsen social isolation and mortality of our patients.
Take a listen to learn how to better serve this population of patients & athletes, or check out the full show notes on our blog at www.ptonice.com/blog.
If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab.
EPISODE TRANSCRIPTION
JEFF MUSGRAVE
Welcome to the PT on ICE Daily Show brought to you by the Institute of Clinical Excellence. My name is Dr. Jeff Musgrave, doctor of physical therapy. Super excited to be talking to you about everyone dies, not everyone lives. So I am fresh off an epic motorcycle adventure with the CEO Jeff Moore and Matt in the bike fit division of our company. And it was an epic trip. And a great way to summarize this trip is a quote from a motorcycle brand that I've started following recently. We don't promote this brand in any way, I just thought the quote was great, which is, everyone dies, not everyone lives. So just to kind of set the stage a little bit, I'm new to motorcycling, brand new thing, it's something just recently I decided was Important to me a risk that I wanted to take Lots of people in my life very well-meaning that care about me deeply Wanted to just share all the worst case scenarios. They wanted to instill enough fear in me To maybe prevent me from going or to make sure that I'm super safe and and I get that right there is some inherent risk Taking a motorcycle up a cliff face lots of things can happen Some injuries occurred, there were some wrecks, but most importantly, there was the opportunity to really live life. in a very deep, meaningful way to accept some risk, to have a lot of fun, to have some fun stories, to make some fun memories that are gonna last me, I hope, the rest of my life. And I think this is very relevant whether we're talking about older adults or even younger adults. But I think we come in contact with this type of problem with older adults most common. So commonly with older adults, In that same vein, we're trying to help our patients be safe. We want them to make decisions that are going to prevent injuries, prevent falls, and for a lot of our older adults, a fall can be a very serious thing. I'm not making light of that in any way. We know that lots of our older adults are living with low reserve. and low physical resiliency and reserve, so they have very little margin. So if they fall and they have decades of deconditioning, their bones are weak, their body systems are not prepared to help them recover quickly, and this can have a huge impact on their life. So I want to say I recognize that, and we preach this fitness forward approach to try to help build that reserve and build that resiliency, but still what I tend to see when I interact with clinicians, working with older adults, is we treat older adults with kid gloves and we don't want them to be put at any level of risk. But I think the thing that we forget is what they're missing out on. What are the things that they want to do that are risky and how meaningful may they be to their life? So I'd like to give you a few tips just from my clinical experience to help patients live until they die. We want them to live their life as fully as possible, and I think sometimes we don't think about, when we limit our patients, what the downstream effect is for their life. So I've got a few tips her

Dr. Lindsey Hughey // #ClinicalTuesday // www.ptonice.com 


In today's episode of the PT on ICE Daily Show, Extremity Division leader Lindsey Hughey discusses the role & function of tendons in the body, traditional rehabilitation approaches to treating tendinopathy, as well as a new procedure called TENEX for tendinopathy management.
Take a listen to the episode or check out the full show notes on our blog at www.ptonice.com/blog.
If you're looking to learn more about our Extremity Management course or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab.
EPISODE TRANSCRIPTION
LINDSEY HUGHEY
Morning PT on ICE Daily Show. How's it going? Welcome to Clinical Tuesday. I am Dr. Lindsey Hugey and I will be your host today and we're going to chat all things TENEX and TENEX care specifically for our tendons. So I'll chat with you a little bit about what it is, what the procedure proposes to do and kind of what we're seeing in regards to its effects So the title officially today is, does TENEX get a 10 for tendinopathy care? So let's dive right in. And I do want to say, spoiler alert, it does not get a 10 for tendinopathy treatment. So first, before we dive into what is TENEX, Let's just chat about in general what tendons need to heal as a little reminder to kind of set the stage. And if you've been to our extremity management course, this will just really be a review.

TENDON FUNCTION
But our tendons in their most basic function, they connect muscle to bone. They are to act like a spring and they are to be mechanoresponsive, right? To take on load, transmit force up and down and across. they are responsible for speed and acceleration, they need to take on compression and friction. As soon as we spike loads quickly or dramatically deload activity, we will see changes in capacity of not only that tendon, for better or for worse, but also in the structures they're attached to. So consider the muscle, local muscle, and then that bone. So not just the tendon will either gain and be challenged by spikes in load and or will reduce, right, if you dramatically deload. So come to our course if you want to, extremity management, want to learn even more about that, but that's kind of tendon basics. For those that have treated tendinopathy and are in the outpatient space, folks that do a lot of repetitive action or athletes often get tendinopathy at some point in their life. And this results in pain. It can result in sickening and swelling at that tendon, but really it's decreased performance, whether it's in their job that they need to do and or their sport participation. And a lot of folks think this is just going to go away on its own. And they'll try conservative measures, whether it's they've looked it up on Dr. Google or they've consulted their doc. And I want to set the stage of what's really being told for conservative management of our attendants. It's rest, it is NSAIDs, injections, surgery, PRP, stem cell, shockwave therapy, and then physical therapy is on there as well, but we know there's a lot of treatment variation in our profession in regards to building the capacity of that tendon.

WHAT IS TENEX?
Now on this list for conservative management is TENEX. So I kind of want to set the stage. We now know what kind of tendon function, what will challenge a tendon, and now we know what is really recommended for tendinopathy care. We tend to see, because of this treatment variation as well, right, from rests to anti-inflammatories to surgery and physical therapy, somewhere in between, we see people, and then some folks just not getting care at all, going on to chronicity. telling their docs that, you know, this is hanging on for more than three to s

Dr. Heather Salzer // #ICEPelvic // www.ptonice.com 


In today's episode of the PT on ICE Daily Show, ICE Pelvic faculty member Heather Salzer discusses a case study involving helping a patient increase her calorie & protein intake during postpartum to improve her recovery & performance.
Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog.
If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab.
Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter!
EPISODE TRANSCRIPTION
HEATHER SALZER
Good morning, PT on ICE Daily Show. Happy Monday. I'm Dr. Heather Salzer and I'm here with the Pelvic Division at ICE. And this morning we are going to talk about hacks to hit protein and calorie needs to help us stay out of low energy states and avoid RETs. So at the ICE Pelvic Division here, We talk a lot about REDS, also known as relative energy deficiency in sport. It's something that can have widespread effects. It can affect our immunity, sleep, energy across the day, muscle building function, and then a lot of pelvic kind of class specific things like fertility, increase our risk of urinary incontinence. If you want to deep dive into REDS, please join us in one of our pelvic we go into it in great detail, but when we talk about it, we always get the question of, okay, well, if I need to be eating that much, or if my clients need to be eating that much, that feels like a lot. How can we actually get there? So for the podcast today, we're gonna go through a case example, and as we talk about that, discuss overall calorie needs from Red's perspective, and protein needs, because that's something that a lot of people struggle with as well. And as we go through that example, we'll go through hacks of little changes that someone could make in their diet to make these things a little easier. So meet Kristen. She is our client today, and she is 32 years old and around 160 pounds. She's got a three-year-old at home and a 10-month-old that she is breastfeeding. Kristen runs two to three days a week at a pretty moderate, sometimes higher intensity, and she also crossfits around three days a week. She's also pretty busy chasing around her three-year-old and while carrying her 10-month-old with her as well. So how much does Kristen need to be eating a day when you ask her and are getting some feedback from her? So someone with her general demographics would need relatively about 1,500 calories just at absolute baseline doing nothing else. When we add in her activity across the day, we're looking at closer to 2,500 calories. Then we add in breastfeeding on top of that and she's sitting at close to 3,000 calories a day in terms of her caloric need. if we're thinking about how much protein we want her to be getting, likely we're trying to be somewhere in that close to one gram of protein per pound of body weight, just because of her high activity and breastfeeding. So we're looking at like 150, 160 grams of protein. That can be a lot. When we ask this question to our clients, a lot of times, her it's like, whoa, I am not getting anywhere close to 3,000 calories and you want me to eat how much protein? Don't you know that I have kids that I'm chasing after? When am I supposed to meal prep enough to make all of that happen? So let's go through her day, talk about what she might be eating to start with, and then little tweaks we can make to change it along the way. So we ask her, Kristen, what do you eat fo

Dr. Zach Long // #FitnessAthleteFriday // www.ptonice.com 


In today's episode of the PT on ICE Daily Show, Fitness Athlete lead faculty Zach Long discusses the importance of the need for simultaneously strong & flexible lats to optimize performance & reduce injury risk in CrossFit and other functional fitness athletes.
Take a listen to the episode or check out the full show notes on our blog at www.ptonice.com/blog
If you're looking to learn from our Fitness Athlete division, check out our live physical therapy courses or our online physical therapy courses. Check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab.
EPISODE TRANSCRIPTION
ZACH LONG
It is August 2nd, 2024. I am your host today, Dr. Zach Long, lead faculty inside of our fitness athlete division, teaching our live course and our level two course that we just, uh, just changed the name of that. So excited to talk to you today about the lats specifically in the CrossFit athlete, why this is such an important muscle group for us to appreciate and why I call it the glutes of the upper body because it's just that important of a muscle. We focus so much in the lower body on glute development for athletes, for health, for performance. The lats are the key when it comes to the CrossFit athlete. Why is it key? Two big reasons. Number one, lat inflexibility will drastically impact many skills the CrossFit athlete is trying to develop. But what I want to focus on a little bit more today is lat strength. So let's get rid of the flexibility issue first. So if your lats are tight, what we're going to so commonly see is all overhead lifts affected. But we're really going to see athletes struggle with things like the overhead squat, whereas they're going down into that squat and their hips being flexed, that lat inflexibility is going to really wreck havoc on somebody's overhead squat. And then when we look at so many gymnastic skills as well, If you can't fully open that shoulder up into in-range flexion, you'll struggle with your kipping mechanics. Things like handstand walking will also be drastically impacted if you don't have great lat flexibility. But again, our focus today is going to be a little bit more on the strength of the lats and why that's so important. So obviously we all know that the lats create shoulder extension. So they're going to take our arm from being overhead down towards our side and behind our body. That is a movement pattern that shows up so much in CrossFit, probably more than any other recreational fitness activity. So if the lats aren't strong, movements like your kipping pull-ups, your muscle-ups, your toes-to-bars, are going to be impacted. Even your deadlifts, your cleans, your snatches, the lats are so important in those movements to keep that barbell close to your body and become more mechanically efficient in those movement patterns. So we've got to have really strong lats. I think one great example that I love to do when we're teaching a live course to help people really feel and understand how important the lats are in just barbell-based movements is to have somebody do a hip hinge holding an empty barbell. You slide that barbell down your thigh as you hinge over, and then you stop with that barbell sitting right at the patella. And then you take a second and you let that barbell drift three or four inches out in front of your knees, and then you pull it back to where it's touching your knees. You can do that a few times. And what you'll notice really quickly when you do that is as soon as that bar starts to drift away from your body, you'll feel your back tension really increase as your lumbar paraspinals have to work a lot harder when that barbell gets away from the body. I often explain t