Pediatric manual therapy has been built on adult techniques — and that’s a problem.
Educator, clinician, and researcher Ginny Henderson joins us to expose the missing guidelines, the hidden dangers, and the new evidence-based techniques designed specifically for growing bodies.
We cover:
• Why kids’ bones are more vulnerable — and how to mobilize safely
• The biggest misconceptions clinicians bring from adult PT
• Combining joint mechanics with motor learning for better outcomes
• How chronic pain presents differently in children
• The powerful (and often overlooked) influence of parent beliefs
• When pain is nociceptive… and when it’s actually nociplastic
• How PTs can start making better decisions tomorrow with pediatric patients
This is one of those “I didn’t even know I needed this” conversations — and it might change how you treat kids forever.
00:00:03 --> 00:00:03 All right,
00:00:03 --> 00:00:04 today's guest is tackling one of the
00:00:04 --> 00:00:07 biggest blind spots in physical therapy,
00:00:07 --> 00:00:09 pediatric manual therapy.
00:00:09 --> 00:00:10 Now, for decades,
00:00:10 --> 00:00:13 we've borrowed adult techniques and, well,
00:00:13 --> 00:00:16 just crossed our fingers because clear
00:00:16 --> 00:00:17 evidence-based guidelines for treating
00:00:17 --> 00:00:18 kids
00:00:18 --> 00:00:20 simply don't exist.
00:00:21 --> 00:00:22 Our guest is changing that.
00:00:22 --> 00:00:23 She's an educator, researcher,
00:00:24 --> 00:00:26 and pediatric specialist whose work
00:00:26 --> 00:00:28 focuses on chronic pain in children and
00:00:28 --> 00:00:29 the safe,
00:00:29 --> 00:00:32 effective use of manual therapy for a
00:00:32 --> 00:00:34 growing musculoskeletal system.
00:00:35 --> 00:00:36 She's developing new techniques
00:00:36 --> 00:00:37 specifically built for kids,
00:00:38 --> 00:00:41 not scaled down adult care.
00:00:41 --> 00:00:42 And she's helping train the next
00:00:42 --> 00:00:44 generation of clinicians to approach
00:00:44 --> 00:00:47 pediatric patients with confidence,
00:00:47 --> 00:00:47 compassion,
00:00:48 --> 00:00:49 and hashtag science.
00:00:49 --> 00:00:51 If you've ever wondered how to actually
00:00:52 --> 00:00:54 mobilize a child's joint safely,
00:00:55 --> 00:00:57 how parent beliefs and trauma influence
00:00:57 --> 00:00:58 chronic pain in kids,
00:00:59 --> 00:01:00 or why participation,
00:01:00 --> 00:01:01 not just range of motion,
00:01:02 --> 00:01:03 should be your primary outcome,
00:01:04 --> 00:01:06 this is the conversation.
00:01:06 --> 00:01:07 You didn't even know you needed,
00:01:07 --> 00:01:08 but you do.
00:01:09 --> 00:01:11 Ginny Henderson is here to fill one of
00:01:11 --> 00:01:13 the biggest gaps in our profession,
00:01:13 --> 00:01:14 and I can't wait to dive in.
00:01:14 --> 00:01:15 We bring her in.
00:01:15 --> 00:01:17 Ginny, welcome to the show.
00:01:18 --> 00:01:19 Thank you.
00:01:19 --> 00:01:20 How was the intro?
00:01:20 --> 00:01:21 Did I hype you up well?
00:01:21 --> 00:01:24 You did really, really well, yes.
00:01:24 --> 00:01:24 Perfect.
00:01:25 --> 00:01:26 All right, let's dig into this.
00:01:27 --> 00:01:28 There's a special place in my heart for
00:01:28 --> 00:01:30 pediatric physical therapists.
00:01:31 --> 00:01:33 I posed as a pediatric physical therapist
00:01:33 --> 00:01:33 for a year,
00:01:34 --> 00:01:35 about a year out of PT school.
00:01:36 --> 00:01:36 Loved it.
00:01:36 --> 00:01:37 The impact,
00:01:37 --> 00:01:41 it was very difficult to have a bad
00:01:41 --> 00:01:41 mood.
00:01:41 --> 00:01:42 I'm not saying a hard day.
00:01:42 --> 00:01:44 It was very easy to have a difficult
00:01:44 --> 00:01:45 day, a lot of work.
00:01:45 --> 00:01:46 But at the end of the day,
00:01:46 --> 00:01:47 in the middle of the day,
00:01:47 --> 00:01:48 and even when you crawl out of bed,
00:01:48 --> 00:01:50 it did feel rewarding.
00:01:50 --> 00:01:52 It was a very clear path to rewarding.
00:01:53 --> 00:01:54 So thanks for doing what you do and
00:01:54 --> 00:01:57 focusing on pediatric patients,
00:01:57 --> 00:01:58 not tiny adults.
00:01:58 --> 00:01:59 That's what my mentor taught me.
00:02:00 --> 00:02:01 Amy said, they're not small,
00:02:01 --> 00:02:02 they're not tiny adults.
00:02:03 --> 00:02:03 They're not.
00:02:04 --> 00:02:06 So what made you first realize that
00:02:06 --> 00:02:09 pediatric manual therapy has a major gap
00:02:10 --> 00:02:11 in clear evidence based guidelines?
00:02:11 --> 00:02:13 What was the what was that moment?
00:02:13 --> 00:02:15 And then you just took it upon yourself.
00:02:15 --> 00:02:16 You're like, all right,
00:02:16 --> 00:02:17 this is my this is my fight.
00:02:17 --> 00:02:19 I'm going to dive in.
00:02:19 --> 00:02:19 Sure.
00:02:19 --> 00:02:21 So I started in adult therapy for my
00:02:22 --> 00:02:23 first seventeen years of practice.
00:02:24 --> 00:02:28 And then my daughter had a heart condition
00:02:28 --> 00:02:30 and we spent six months at Texas
00:02:30 --> 00:02:30 Children's.
00:02:31 --> 00:02:33 And I had that moment of.
00:02:33 --> 00:02:35 I want to do what these people do.
00:02:35 --> 00:02:37 I want to step into the lives and
00:02:37 --> 00:02:38 the stories of families.
00:02:39 --> 00:02:41 And so I switched over into peds.
00:02:41 --> 00:02:42 Well, at the same time,
00:02:43 --> 00:02:44 I was going through my manual therapy
00:02:44 --> 00:02:45 fellowship with them.
00:02:46 --> 00:02:48 And so I was doing both of these
00:02:48 --> 00:02:50 together where I was kind of changing my
00:02:50 --> 00:02:53 way of thinking and trying to understand
00:02:53 --> 00:02:56 how the pediatric paradigm worked while
00:02:56 --> 00:02:58 learning all of these techniques and how
00:02:58 --> 00:02:59 they come together.
00:02:59 --> 00:03:00 And I realized that
00:03:01 --> 00:03:03 we speak two different languages in adult
00:03:03 --> 00:03:04 treatment versus pediatrics.
00:03:05 --> 00:03:07 And I would have coworkers come up to
00:03:07 --> 00:03:08 me and say, Hey,
00:03:08 --> 00:03:10 I know you're in this manual therapy
00:03:10 --> 00:03:10 course.
00:03:10 --> 00:03:12 I've got this kid who had Botox to
00:03:12 --> 00:03:13 his adductors.
00:03:13 --> 00:03:14 And now when he abducts,
00:03:14 --> 00:03:16 he's getting a pinching pain.
00:03:16 --> 00:03:17 Is there anything you can help me do?
00:03:17 --> 00:03:18 And I'm like, yeah,
00:03:18 --> 00:03:20 let's inferior gliding, you know?
00:03:20 --> 00:03:21 And so we started doing that.
00:03:21 --> 00:03:21 And,
00:03:22 --> 00:03:24 but I realized that the way it was
00:03:24 --> 00:03:25 being taught to me and the way I
00:03:26 --> 00:03:28 needed to teach it to them,
00:03:29 --> 00:03:29 was different.
00:03:29 --> 00:03:31 And when you look at the ICF model,
00:03:32 --> 00:03:34 pediatrics is much more participation and
00:03:34 --> 00:03:35 activity based.
00:03:35 --> 00:03:37 And they're not looking to say,
00:03:37 --> 00:03:39 how can I increase shoulder flexion?
00:03:40 --> 00:03:40 They're looking to say,
00:03:40 --> 00:03:42 how can I help this kid lift his
00:03:42 --> 00:03:44 arm to put his shirt on by himself?
00:03:45 --> 00:03:48 And I knew the starting place was really
00:03:48 --> 00:03:51 looking at what are the goals of pediatric
00:03:51 --> 00:03:52 therapists?
00:03:52 --> 00:03:54 And so I started drawing the pump tool
00:03:55 --> 00:03:55 and
00:03:55 --> 00:03:56 And going, OK,
00:03:56 --> 00:03:57 what else do they need to know?
00:03:57 --> 00:03:57 Well,
00:03:57 --> 00:03:58 they obviously need to know red flags.
00:03:59 --> 00:04:01 And so really started to research those
00:04:01 --> 00:04:02 and put that together.
00:04:02 --> 00:04:03 And then at that same time,
00:04:03 --> 00:04:04 I was getting into pain.
00:04:05 --> 00:04:08 And the article came out on how to
00:04:08 --> 00:04:10 manually manual therapy for different pain
00:04:10 --> 00:04:10 types.
00:04:10 --> 00:04:11 And I was like,
00:04:11 --> 00:04:13 I could have written this like I literally
00:04:13 --> 00:04:14 was already thinking about this.
00:04:14 --> 00:04:15 I wish I had been there.
00:04:17 --> 00:04:18 known enough to be included in that
00:04:18 --> 00:04:19 because I would have loved to have been
00:04:19 --> 00:04:20 in that room.
00:04:20 --> 00:04:22 And so it just really started putting all
00:04:22 --> 00:04:23 of that together.
00:04:23 --> 00:04:25 And then that's when I applied to the
00:04:25 --> 00:04:29 SCD at Texas Tech and told them,
00:04:30 --> 00:04:30 they said, you know,
00:04:30 --> 00:04:32 you'll do a dissertation.
00:04:32 --> 00:04:33 And I said, well, actually,
00:04:33 --> 00:04:34 I already have something I want to look
00:04:34 --> 00:04:37 into and sent that to them.
00:04:37 --> 00:04:40 And they just helped me really flesh it
00:04:40 --> 00:04:42 out and kind of take it to the
00:04:42 --> 00:04:42 next level.
00:04:43 --> 00:04:45 Just so we don't leave the audience
00:04:45 --> 00:04:47 behind, what is the SCD?
00:04:47 --> 00:04:48 Walk them through that.
00:04:48 --> 00:04:50 The Doctorate of Science in Rehabilitation
00:04:50 --> 00:04:51 Sciences.
00:04:51 --> 00:04:53 So Texas Tech has that program.
00:04:54 --> 00:04:56 And I chose that one because I knew
00:04:56 --> 00:04:57 other people who were in it and I
00:04:57 --> 00:04:58 had heard great things about it.
00:04:59 --> 00:05:00 And so I kind of came in with
00:05:00 --> 00:05:03 this piece that I knew I wanted to
00:05:04 --> 00:05:06 get other brains to think with me about.
00:05:08 --> 00:05:09 And they had the people to do it.
00:05:09 --> 00:05:09 Yeah.
00:05:10 --> 00:05:10 All right,
00:05:10 --> 00:05:12 so let's get into your not only research
00:05:12 --> 00:05:13 but clinical work.
00:05:14 --> 00:05:14 In your mind,
00:05:14 --> 00:05:16 what are the biggest misconceptions or
00:05:16 --> 00:05:19 mistakes clinicians might make when
00:05:19 --> 00:05:21 applying adult manual therapy techniques
00:05:22 --> 00:05:22 to kids?
00:05:23 --> 00:05:24 What are the things you wish you could
00:05:24 --> 00:05:26 erase?
00:05:26 --> 00:05:27 I think
00:05:28 --> 00:05:30 The danger that we see in the clinic
00:05:31 --> 00:05:33 is putting too much pressure through the
00:05:33 --> 00:05:34 shaft of long bones,
00:05:35 --> 00:05:38 because not only do you have kids with
00:05:38 --> 00:05:41 underlying diagnoses like cerebral palsy
00:05:42 --> 00:05:43 or muscular dystrophy,
00:05:43 --> 00:05:47 or even cystic fibrosis who have changes
00:05:47 --> 00:05:48 in their bone mineral density,
00:05:49 --> 00:05:50 but you also have a period of growth
00:05:50 --> 00:05:53 and development when bone mineral density
00:05:53 --> 00:05:54 is actually at its lowest,
00:05:54 --> 00:05:55 when the bones grow
00:05:56 --> 00:05:57 but they haven't thickened yet.
00:05:58 --> 00:06:00 And so one of the dangers I I've
00:06:00 --> 00:06:03 seen is people who come in and try
00:06:03 --> 00:06:05 to use their adult techniques and they end
00:06:05 --> 00:06:07 up fracturing a femur really is what it
00:06:07 --> 00:06:08 comes down to.
00:06:08 --> 00:06:10 And so the thing you have to do
00:06:10 --> 00:06:12 is really work through the joint.
00:06:12 --> 00:06:15 There is in terms of another misconception
00:06:15 --> 00:06:17 is people are really fearful that they're
00:06:17 --> 00:06:18 going to damage the joint.
00:06:19 --> 00:06:21 But what we know from manipulation under
00:06:21 --> 00:06:24 anesthesia with kids is that they are far
00:06:24 --> 00:06:25 more aggressive.
00:06:25 --> 00:06:28 and they don't create joint damage and so
00:06:28 --> 00:06:30 we have these other pieces out there that
00:06:30 --> 00:06:33 can kind of they can inform us and
00:06:33 --> 00:06:35 i even had someone tell me once that
00:06:35 --> 00:06:38 they would never mobilize a kid because
00:06:38 --> 00:06:40 they wouldn't want to produce a skippy
00:06:40 --> 00:06:42 which is a slip capital femoral epiphysis
00:06:42 --> 00:06:43 and i'm like well if you look at
00:06:43 --> 00:06:44 what causes a slip capital femoral
00:06:44 --> 00:06:47 epiphysis it's not joint mobilization like
00:06:47 --> 00:06:49 this child is destined to have a skippy
00:06:49 --> 00:06:52 right and so i think people just don't
00:06:53 --> 00:06:54 know, um,
00:06:54 --> 00:06:58 what techniques are safe and who they can
00:06:58 --> 00:07:00 do them on and who,
00:07:00 --> 00:07:01 when they need to modify it.
00:07:01 --> 00:07:03 And so kind of our next step right
00:07:03 --> 00:07:04 now is we're looking and saying,
00:07:04 --> 00:07:05 who can you manipulate?
00:07:06 --> 00:07:07 Who can you mobilize?
00:07:08 --> 00:07:09 And then who can you facilitate?
00:07:10 --> 00:07:11 And really at the end of the day,
00:07:11 --> 00:07:12 we're just trying to impact
00:07:12 --> 00:07:16 mechanoreceptors and with kids, your, um,
00:07:17 --> 00:07:20 Joint mobility is not usually as big of
00:07:20 --> 00:07:25 an issue as motor control or issues with
00:07:25 --> 00:07:26 sustained postures and fear.
00:07:27 --> 00:07:29 And so your goals are different.
00:07:29 --> 00:07:31 What your challenges are different.
00:07:31 --> 00:07:34 And we just need to know how we
00:07:34 --> 00:07:36 need to modify that for children.
00:07:37 --> 00:07:39 They're not small adults.
00:07:39 --> 00:07:40 It feels like there's a theme there.
00:07:41 --> 00:07:42 They're not just adults.
00:07:44 --> 00:07:46 I even remember in my fellowship,
00:07:47 --> 00:07:48 people who don't treat kids,
00:07:48 --> 00:07:49 when they think of pediatrics,
00:07:50 --> 00:07:51 all they think of is that developmental
00:07:51 --> 00:07:52 neuro crew.
00:07:53 --> 00:07:53 And they're like, well,
00:07:53 --> 00:07:54 joint mobilization is not for them.
00:07:54 --> 00:07:55 You do kids.
00:07:55 --> 00:07:56 You do neuro.
00:07:56 --> 00:07:57 And it's like, no,
00:07:57 --> 00:07:59 there's a whole lot of orthopedics in a
00:07:59 --> 00:07:59 child.
00:08:00 --> 00:08:01 the same amount of orthopedics that the
00:08:01 --> 00:08:02 adults have.
00:08:02 --> 00:08:05 And so not every pediatric patient has a
00:08:06 --> 00:08:08 neurological underlying diagnosis.
00:08:09 --> 00:08:11 Same with not joint,
00:08:11 --> 00:08:13 every neurological patient with a
00:08:13 --> 00:08:15 neurological diagnosis still has joints
00:08:16 --> 00:08:16 and they still,
00:08:16 --> 00:08:18 and their joints move the same ways,
00:08:19 --> 00:08:21 but issues like spasticity,
00:08:22 --> 00:08:23 prolonged positioning,
00:08:23 --> 00:08:26 they affect the joints differently.
00:08:26 --> 00:08:27 And so you have to,
00:08:28 --> 00:08:30 You can't disregard an entire group
00:08:30 --> 00:08:32 because you don't know about it.
00:08:32 --> 00:08:34 And so my hope is to raise awareness,
00:08:34 --> 00:08:37 but really raise it from the standpoint of
00:08:37 --> 00:08:41 good foundational underlying knowledge of
00:08:41 --> 00:08:43 what the red flags are and then give
00:08:43 --> 00:08:46 people an alternative to achieve the same
00:08:46 --> 00:08:46 thing.
00:08:47 --> 00:08:47 Love that.
00:08:48 --> 00:08:49 Well, let's talk some about some of that.
00:08:49 --> 00:08:50 You're developing alternative techniques
00:08:50 --> 00:08:53 designed around the biomechanics of the
00:08:53 --> 00:08:55 growing musculoskeletal system.
00:08:56 --> 00:08:58 Walk us through what makes these
00:08:58 --> 00:08:59 techniques different.
00:08:59 --> 00:09:00 I feel like a second ago,
00:09:00 --> 00:09:02 we talked about anatomy and physiology
00:09:02 --> 00:09:03 being a little bit different,
00:09:03 --> 00:09:05 but some similarities, some difference.
00:09:05 --> 00:09:06 What about the techniques makes those
00:09:06 --> 00:09:07 things different?
00:09:07 --> 00:09:08 You mentioned one, hey,
00:09:08 --> 00:09:09 maybe not putting the force through the
00:09:09 --> 00:09:09 bone.
00:09:09 --> 00:09:10 Are there others?
00:09:11 --> 00:09:11 Yeah,
00:09:11 --> 00:09:13 so we really try to work through the
00:09:14 --> 00:09:14 joint,
00:09:14 --> 00:09:17 but also looking at combined motions.
00:09:17 --> 00:09:19 So a lot of times when we think
00:09:19 --> 00:09:20 about joint mobilization,
00:09:20 --> 00:09:22 we think of a posterior glide.
00:09:22 --> 00:09:24 We think of a inferior glide.
00:09:24 --> 00:09:25 You know, we think about,
00:09:25 --> 00:09:28 but really when you look at the joint,
00:09:28 --> 00:09:29 it's generally,
00:09:29 --> 00:09:31 it has motion all the way around it,
00:09:31 --> 00:09:31 right?
00:09:31 --> 00:09:34 And so looking at something like hip
00:09:34 --> 00:09:37 dysplasia, where you need to work,
00:09:38 --> 00:09:41 congruently into inferior and external
00:09:41 --> 00:09:43 rotation or in order to bring to
00:09:43 --> 00:09:46 facilitate that joint being in the right
00:09:46 --> 00:09:48 position and then activating the muscles.
00:09:48 --> 00:09:52 So really trying to understand that joint
00:09:52 --> 00:09:54 limitation generally doesn't happen in
00:09:54 --> 00:09:55 just one plane.
00:09:56 --> 00:09:57 And so we're looking to say,
00:09:57 --> 00:09:59 how can we work through the joint?
00:09:59 --> 00:10:02 And really a lot of it is bringing
00:10:02 --> 00:10:04 in ideas that, um,
00:10:05 --> 00:10:07 adult predecessors have i mean all manual
00:10:07 --> 00:10:08 therapy is done when you look at it
00:10:09 --> 00:10:10 over time is everybody has kind of
00:10:10 --> 00:10:13 improved on or changed what the guy who
00:10:13 --> 00:10:15 did before them did right so it's it's
00:10:15 --> 00:10:17 not new rocket science so we look at
00:10:18 --> 00:10:19 movement with mobilization i would say
00:10:19 --> 00:10:22 that's probably the closest piece to it
00:10:22 --> 00:10:26 and there's a pnf mobilization technique
00:10:26 --> 00:10:27 that it's in the literature where you use
00:10:27 --> 00:10:30 pnf patterns with mobilization and
00:10:30 --> 00:10:33 facilitation so but a lot of those are
00:10:33 --> 00:10:37 adult manual therapy ideas and trying to
00:10:37 --> 00:10:40 bring that language into pediatrics and
00:10:40 --> 00:10:41 say okay now what are we seeing in
00:10:41 --> 00:10:45 these kiddos that we can apply these
00:10:45 --> 00:10:48 techniques to and add the word pediatric
00:10:48 --> 00:10:50 to it pediatric joint facilitation but
00:10:50 --> 00:10:52 it's not like we're the first person who
00:10:52 --> 00:10:54 came up with combined emotions and working
00:10:54 --> 00:10:56 at the joint instead of the shaft right
00:10:56 --> 00:11:00 so um and then really taking that into
00:11:00 --> 00:11:01 a motor learning piece because
00:11:02 --> 00:11:04 At this point, until kids reach puberty,
00:11:04 --> 00:11:07 their greatest gains are coming in motor
00:11:07 --> 00:11:08 control and motor learning.
00:11:09 --> 00:11:10 Their brains are growing and they're
00:11:11 --> 00:11:11 learning.
00:11:11 --> 00:11:13 And so that's where the biggest bang for
00:11:13 --> 00:11:14 your buck is.
00:11:14 --> 00:11:15 So with kids,
00:11:15 --> 00:11:19 it's not about getting the joint in the
00:11:19 --> 00:11:21 right position and then doing a whole lot
00:11:21 --> 00:11:22 of straight leg raises and trying to
00:11:22 --> 00:11:24 increase the strength of the hip flexor
00:11:25 --> 00:11:26 and focusing on it from that standpoint.
00:11:27 --> 00:11:29 It's about training their brain to use
00:11:29 --> 00:11:31 their hip flexor to climb stairs.
00:11:32 --> 00:11:34 Now that they have figured out how to
00:11:34 --> 00:11:36 inferiorly and posteriorly glide.
00:11:36 --> 00:11:38 And so everything comes back into that
00:11:39 --> 00:11:41 movement pattern and the motor control
00:11:41 --> 00:11:42 that we want them to have,
00:11:42 --> 00:11:44 which brings us all the way back to
00:11:44 --> 00:11:47 the participation and activity component
00:11:47 --> 00:11:48 of the ICF.
00:11:48 --> 00:11:48 Right.
00:11:48 --> 00:11:49 Because at the end of the day,
00:11:49 --> 00:11:50 with kids,
00:11:50 --> 00:11:52 we want to say he can't climb stairs.
00:11:53 --> 00:11:54 We're not looking and saying this older
00:11:54 --> 00:11:56 woman has pain with hip flexion.
00:11:56 --> 00:11:56 Right.
00:11:57 --> 00:12:00 So we've got to think about it throughout
00:12:00 --> 00:12:03 the model and throughout the end goal of
00:12:03 --> 00:12:06 getting kids to be able to do what
00:12:06 --> 00:12:07 they do for a living,
00:12:07 --> 00:12:09 which is play and participate in their
00:12:09 --> 00:12:09 world.
00:12:10 --> 00:12:13 And so how can joint mobilization play a
00:12:13 --> 00:12:16 piece of that puzzle to achieve that end
00:12:16 --> 00:12:16 goal?
00:12:16 --> 00:12:18 And how can we give that tool to
00:12:18 --> 00:12:20 pediatric therapists in a safe manner?
00:12:21 --> 00:12:21 Well,
00:12:21 --> 00:12:23 you already answered or took my next
00:12:23 --> 00:12:23 question.
00:12:23 --> 00:12:24 It was on the list.
00:12:24 --> 00:12:25 It was going to be a great radio
00:12:25 --> 00:12:27 segue, but you mentioned before,
00:12:27 --> 00:12:29 there was always this question when I was
00:12:30 --> 00:12:31 a pediatric PT,
00:12:32 --> 00:12:33 at what age do we stop making it
00:12:33 --> 00:12:36 fun and about participation in sport
00:12:36 --> 00:12:39 instead of just gaining a few extra
00:12:39 --> 00:12:40 degrees of range of motion in this
00:12:40 --> 00:12:41 particular joint?
00:12:41 --> 00:12:42 And I think
00:12:43 --> 00:12:43 You know,
00:12:43 --> 00:12:45 that was the first rule for my mentor
00:12:45 --> 00:12:46 in Peds was if you can't make it
00:12:46 --> 00:12:48 fun, don't bother asking them to do it.
00:12:49 --> 00:12:50 And I think it's sad.
00:12:50 --> 00:12:52 Is it eighteen?
00:12:52 --> 00:12:52 Is it twenty one?
00:12:52 --> 00:12:53 Is it twenty five?
00:12:53 --> 00:12:55 All of a sudden we make it adult.
00:12:56 --> 00:12:58 And outside the physiology,
00:12:59 --> 00:13:01 people want to do stuff that has meaning
00:13:01 --> 00:13:03 and has and has fun or brings fun
00:13:03 --> 00:13:04 back to their life.
00:13:05 --> 00:13:06 I feel like ninety percent of what I
00:13:06 --> 00:13:07 did as a pediatric PT,
00:13:07 --> 00:13:09 maybe ninety five percent was obstacle
00:13:09 --> 00:13:10 courses.
00:13:10 --> 00:13:11 I knew what I wanted you to do.
00:13:12 --> 00:13:13 Let me figure out a fun way to
00:13:13 --> 00:13:13 make you do it.
00:13:14 --> 00:13:15 And then I'll reward you with a zip
00:13:15 --> 00:13:15 line at the end.
00:13:15 --> 00:13:19 But when you look at outcomes like that,
00:13:20 --> 00:13:20 does it change?
00:13:20 --> 00:13:22 I'm guessing it changes everything about
00:13:23 --> 00:13:24 what success looks like in pediatric
00:13:25 --> 00:13:25 manual therapy.
00:13:26 --> 00:13:27 It sounds like that's the middle of the
00:13:27 --> 00:13:30 ICF model for you, which is not.
00:13:30 --> 00:13:31 It's the child and the fun and the
00:13:31 --> 00:13:32 participation.
00:13:33 --> 00:13:34 Right.
00:13:34 --> 00:13:35 It is all about when parents come in,
00:13:35 --> 00:13:38 they don't come in and say, hey,
00:13:38 --> 00:13:39 my kid, you know,
00:13:39 --> 00:13:41 isn't clearing his foot well when he in
00:13:41 --> 00:13:42 the swing phase.
00:13:43 --> 00:13:43 Right.
00:13:43 --> 00:13:43 Right.
00:13:44 --> 00:13:45 You know, come in and they say,
00:13:45 --> 00:13:46 my kid can't keep up with his friends
00:13:46 --> 00:13:47 on the playground and he keeps falling in
00:13:47 --> 00:13:48 the mulch.
00:13:48 --> 00:13:48 Right.
00:13:49 --> 00:13:50 And so you have to look and say,
00:13:51 --> 00:13:52 why is this happening?
00:13:53 --> 00:13:54 And how can I make it where this
00:13:54 --> 00:13:56 kid can keep up with his friends or
00:13:57 --> 00:13:58 come closer to keeping up with his friends
00:13:58 --> 00:13:59 in the playground?
00:13:59 --> 00:14:01 So we bring it back, you know,
00:14:01 --> 00:14:03 from the big picture down to the,
00:14:03 --> 00:14:04 but at the end,
00:14:04 --> 00:14:06 the test of whether or not we succeed
00:14:07 --> 00:14:08 is going to be looking at something like
00:14:08 --> 00:14:09 a six minute walk test.
00:14:09 --> 00:14:11 It's going to be these functional outcome
00:14:11 --> 00:14:12 measures that we say,
00:14:13 --> 00:14:16 did what we do make a change in,
00:14:16 --> 00:14:16 in,
00:14:17 --> 00:14:19 an objective change in how he performed,
00:14:20 --> 00:14:21 which has been going to carry over into
00:14:21 --> 00:14:22 his world.
00:14:23 --> 00:14:26 And so that's why I think pediatrics is
00:14:27 --> 00:14:31 so good at screenings that are functional
00:14:32 --> 00:14:34 and that are developmentally specific.
00:14:34 --> 00:14:36 Now, as we start getting into teenagers,
00:14:36 --> 00:14:37 we start to get away from that a
00:14:37 --> 00:14:38 little bit.
00:14:38 --> 00:14:39 But even then,
00:14:39 --> 00:14:41 just to give you an example,
00:14:41 --> 00:14:42 I'll get a gymnast who has low back
00:14:42 --> 00:14:43 pain.
00:14:43 --> 00:14:46 And they can't do gymnastics because their
00:14:46 --> 00:14:47 back hurts and they're in danger of a
00:14:47 --> 00:14:48 spondy.
00:14:48 --> 00:14:49 So I come in here and I go,
00:14:49 --> 00:14:51 well, you've got terrible hip extension.
00:14:52 --> 00:14:54 And so by treating their hip extension,
00:14:54 --> 00:14:56 then I can make it where they're not
00:14:56 --> 00:14:58 as dependent upon their lumbar extension.
00:14:59 --> 00:15:02 And now they can do gymnastics and not
00:15:02 --> 00:15:04 hurt whether or not it's hip extension.
00:15:04 --> 00:15:05 They don't care.
00:15:05 --> 00:15:06 What they want to know is when I
00:15:06 --> 00:15:08 do back handsprings, does my back hurt?
00:15:09 --> 00:15:09 And
00:15:10 --> 00:15:11 And so you just have to,
00:15:12 --> 00:15:13 we can bring it down to that piece,
00:15:13 --> 00:15:15 but if we can't bring it back into
00:15:16 --> 00:15:18 play and activity and sports and
00:15:18 --> 00:15:20 interacting with our families,
00:15:20 --> 00:15:23 then all we have is a bunch of
00:15:23 --> 00:15:24 measurements on a piece of paper.
00:15:24 --> 00:15:26 We don't have any life change out of
00:15:26 --> 00:15:27 it.
00:15:27 --> 00:15:27 There it is.
00:15:28 --> 00:15:30 Let's shift gears a little bit to chronic
00:15:30 --> 00:15:31 pain in kids.
00:15:32 --> 00:15:35 What do clinicians consistently miss about
00:15:35 --> 00:15:38 the role of parent beliefs, trauma,
00:15:38 --> 00:15:39 and adolescent development?
00:15:41 --> 00:15:43 So chronic pain is such a fascinating
00:15:43 --> 00:15:44 topic right now, right?
00:15:44 --> 00:15:47 And it's another one of those places where
00:15:48 --> 00:15:50 people love to talk about it in adults
00:15:50 --> 00:15:52 and they're terrified to talk about it in
00:15:52 --> 00:15:52 kids.
00:15:53 --> 00:15:55 And pediatric therapists are generally
00:15:55 --> 00:15:56 terrified to treat it.
00:15:57 --> 00:15:59 And the problem that we have is that
00:15:59 --> 00:16:01 we have this biomedical model that we've
00:16:01 --> 00:16:04 been trained to in PT school that we
00:16:04 --> 00:16:07 try to apply to our patients with chronic
00:16:07 --> 00:16:08 pain
00:16:09 --> 00:16:12 And we can't exercise chronic pain away.
00:16:13 --> 00:16:16 And so while movement is important for
00:16:16 --> 00:16:16 treating chronic pain,
00:16:17 --> 00:16:19 it is one piece of a probably five
00:16:19 --> 00:16:20 piece puzzle.
00:16:20 --> 00:16:22 And the other pieces that we need to
00:16:22 --> 00:16:25 train pediatric therapists in is to
00:16:25 --> 00:16:26 understand the
00:16:27 --> 00:16:29 how the patient got there how their brain
00:16:29 --> 00:16:31 is working what the the central
00:16:32 --> 00:16:34 involvement is but also one time i heard
00:16:34 --> 00:16:36 this word the nocebo effect and i was
00:16:36 --> 00:16:38 like and i was like this is it
00:16:38 --> 00:16:41 because i can sit down with a kid
00:16:41 --> 00:16:43 and i can do pain education and i
00:16:43 --> 00:16:46 can do desensitization and i can help them
00:16:46 --> 00:16:49 understand pacing but if they go home with
00:16:49 --> 00:16:50 a parent
00:16:50 --> 00:16:52 who had chronic pain all of their life,
00:16:52 --> 00:16:54 who then babies them and says, oh, baby,
00:16:54 --> 00:16:55 you don't need to go to school today.
00:16:55 --> 00:16:56 I can see it on your face.
00:16:56 --> 00:16:57 You're really hurting.
00:16:57 --> 00:16:59 You should probably just stay home and
00:16:59 --> 00:17:00 work from home.
00:17:00 --> 00:17:01 Or why don't you go lay down?
00:17:01 --> 00:17:03 You had a you had a you know,
00:17:04 --> 00:17:05 you had to walk home from school.
00:17:05 --> 00:17:07 I know you're hurting that that nocebo
00:17:07 --> 00:17:09 effect that they get the other six days
00:17:09 --> 00:17:10 of the week.
00:17:10 --> 00:17:11 I can't compete with that.
00:17:12 --> 00:17:12 Yeah.
00:17:12 --> 00:17:15 So we have to have a place where
00:17:15 --> 00:17:19 we can safely help parents understand
00:17:21 --> 00:17:24 the psychosocial side of chronic pain that
00:17:24 --> 00:17:28 is not threatening to them or disregarding
00:17:28 --> 00:17:29 their own experience.
00:17:30 --> 00:17:33 And you have to validate what the parent
00:17:33 --> 00:17:34 has gone through,
00:17:34 --> 00:17:36 but say the way that you've addressed your
00:17:36 --> 00:17:40 pain is not necessarily the way that
00:17:40 --> 00:17:42 science supports addressing it now in what
00:17:42 --> 00:17:44 we know to be true.
00:17:44 --> 00:17:47 And if you can't capture the parent
00:17:48 --> 00:17:49 then the child is going to hear a
00:17:49 --> 00:17:51 different story the other six days of the
00:17:51 --> 00:17:51 week.
00:17:51 --> 00:17:54 And then the other piece is you have
00:17:54 --> 00:17:57 to get a hold of that underlying stressor.
00:17:57 --> 00:18:00 I have a patient who has been with
00:18:00 --> 00:18:01 me for a while,
00:18:01 --> 00:18:03 and he has a legitimate diagnosis.
00:18:03 --> 00:18:07 I mean, he has a PARS defect,
00:18:07 --> 00:18:08 legitimate diagnosis,
00:18:09 --> 00:18:10 but he only feels pain in math class.
00:18:12 --> 00:18:15 And so he goes to the school nurse
00:18:15 --> 00:18:17 every day in tears.
00:18:18 --> 00:18:20 But he's scared to death of failing math.
00:18:21 --> 00:18:23 He has a processing issue with it.
00:18:23 --> 00:18:26 And so when he has the emotional response
00:18:26 --> 00:18:27 to the stress of math,
00:18:28 --> 00:18:31 the place where his body processes that is
00:18:31 --> 00:18:32 the place of least resistance,
00:18:32 --> 00:18:33 which is his low back.
00:18:33 --> 00:18:33 Sure.
00:18:34 --> 00:18:35 And so you look at that and you
00:18:35 --> 00:18:37 go, that's no see plastic paint.
00:18:38 --> 00:18:40 As opposed to nociceptive pain,
00:18:40 --> 00:18:42 which he would say he plays baseball.
00:18:43 --> 00:18:43 You know,
00:18:43 --> 00:18:45 that when I throw the ball and I
00:18:45 --> 00:18:47 rotate to the right and extend for my
00:18:47 --> 00:18:49 windup, I feel it.
00:18:49 --> 00:18:50 That's nociceptive.
00:18:50 --> 00:18:53 But I've got this underlying condition
00:18:53 --> 00:18:54 that I've been dealing with and I look
00:18:54 --> 00:18:56 really, really good in the clinic.
00:18:56 --> 00:18:57 But when I'm in math,
00:18:57 --> 00:18:58 my pain's an eight out of ten.
00:18:59 --> 00:19:00 That's nociplastic.
00:19:00 --> 00:19:02 So what do you do with parents there?
00:19:04 --> 00:19:06 Or, or, you know, both of your patients,
00:19:06 --> 00:19:07 because I was taught that like your
00:19:07 --> 00:19:08 patients aren't just the kids there,
00:19:08 --> 00:19:09 you're inheriting parents as well.
00:19:10 --> 00:19:11 And that's a good thing to make it
00:19:11 --> 00:19:12 hard.
00:19:13 --> 00:19:14 But how do you do that?
00:19:14 --> 00:19:16 Because I'm sure there's clinicians who
00:19:16 --> 00:19:18 are parents listening going, oh yeah,
00:19:18 --> 00:19:20 magically when it's time to go to math
00:19:20 --> 00:19:22 class, things hurt, right?
00:19:23 --> 00:19:24 Where do you start that education?
00:19:25 --> 00:19:26 I mean, I guess, where do you start?
00:19:26 --> 00:19:27 I have no idea.
00:19:27 --> 00:19:28 Unwrap me that.
00:19:29 --> 00:19:29 Sure.
00:19:29 --> 00:19:30 I think you,
00:19:30 --> 00:19:32 you validate what the child's
00:19:32 --> 00:19:33 experiencing, right?
00:19:33 --> 00:19:34 Right.
00:19:34 --> 00:19:35 Because the parents will say,
00:19:35 --> 00:19:36 is my kid crazy?
00:19:36 --> 00:19:37 Is he trying to get out of something?
00:19:37 --> 00:19:41 You know, you you you get past that.
00:19:41 --> 00:19:43 I always recommend psychology.
00:19:43 --> 00:19:45 We are not psychologists.
00:19:45 --> 00:19:47 But but we can.
00:19:48 --> 00:19:50 Psychology is hard to access for a lot
00:19:50 --> 00:19:50 of people.
00:19:51 --> 00:19:51 Sure.
00:19:51 --> 00:19:57 And we can still validate, educate people.
00:19:58 --> 00:20:02 and I think redirect to a new way
00:20:02 --> 00:20:04 of looking at and thinking about these
00:20:04 --> 00:20:04 things.
00:20:04 --> 00:20:06 So I say we have to lower his
00:20:06 --> 00:20:10 stress level about math, right?
00:20:10 --> 00:20:13 And so you're either getting math help or
00:20:13 --> 00:20:14 you're letting know at the end of the
00:20:14 --> 00:20:16 day you're really not that upset if he
00:20:16 --> 00:20:17 doesn't do well enough.
00:20:17 --> 00:20:21 Like if we can lower those stressors in
00:20:22 --> 00:20:24 pain education world and P&E world,
00:20:24 --> 00:20:26 neuroscience education where they talk
00:20:26 --> 00:20:28 about this lion walking around with you.
00:20:28 --> 00:20:31 And the lion has all of these different
00:20:31 --> 00:20:33 words on it that are like my bills,
00:20:33 --> 00:20:35 my marriage, math class,
00:20:35 --> 00:20:37 my performance on the volleyball team,
00:20:37 --> 00:20:38 whatever it is.
00:20:38 --> 00:20:38 Right.
00:20:39 --> 00:20:41 And that whatever your thing is,
00:20:41 --> 00:20:44 that lion is this constant threat to you
00:20:44 --> 00:20:46 that increases your pain.
00:20:46 --> 00:20:48 And basically you have to make the lion
00:20:49 --> 00:20:49 into a little cub.
00:20:50 --> 00:20:51 You have to make the lion safe and
00:20:51 --> 00:20:52 no longer threatening.
00:20:53 --> 00:20:55 And so if that means for this kiddo
00:20:56 --> 00:20:58 to say, it's okay,
00:20:58 --> 00:20:59 if you don't get math,
00:20:59 --> 00:21:00 we're going to get you help.
00:21:00 --> 00:21:01 And even then,
00:21:01 --> 00:21:02 if you make a D in math,
00:21:03 --> 00:21:04 you're going to be a great person.
00:21:04 --> 00:21:06 And this is not a reflection of who
00:21:06 --> 00:21:06 you are,
00:21:06 --> 00:21:09 like to bring down the threat such that
00:21:10 --> 00:21:12 if the people around me are okay with
00:21:12 --> 00:21:13 it, then I can be okay with it.
00:21:14 --> 00:21:16 And when it comes to things like
00:21:17 --> 00:21:18 family abuse.
00:21:18 --> 00:21:19 I mean, in pediatrics,
00:21:19 --> 00:21:21 we have to be really aware of that
00:21:21 --> 00:21:23 and really sensitive to that and ask those
00:21:23 --> 00:21:24 questions.
00:21:24 --> 00:21:28 But those are all things that I say
00:21:28 --> 00:21:31 that I'm in seven and I never had
00:21:32 --> 00:21:34 a kid or had a patient who was
00:21:34 --> 00:21:37 a suicide risk until I started treating
00:21:37 --> 00:21:38 pediatric chronic pain.
00:21:39 --> 00:21:39 Now,
00:21:40 --> 00:21:41 I would say we have one every couple
00:21:41 --> 00:21:42 of months.
00:21:43 --> 00:21:46 And so it is heavy and
00:21:46 --> 00:21:50 And there is a deep psychological piece to
00:21:50 --> 00:21:50 it,
00:21:50 --> 00:21:52 which is why our pain clinics tend to,
00:21:52 --> 00:21:52 you know,
00:21:52 --> 00:21:54 they include a psychologist because it is
00:21:55 --> 00:21:57 it's not this biomedical model only.
00:21:57 --> 00:21:59 While movement's important is it's a
00:21:59 --> 00:22:01 biopsychosocial approach as well.
00:22:01 --> 00:22:04 And and it's a team approach.
00:22:05 --> 00:22:07 So it's hard.
00:22:07 --> 00:22:08 But then, you know,
00:22:08 --> 00:22:10 there's some really there are things we
00:22:10 --> 00:22:11 can do as therapists and somebody.
00:22:11 --> 00:22:12 But then why even send them to therapy?
00:22:12 --> 00:22:13 Right.
00:22:13 --> 00:22:13 Like,
00:22:13 --> 00:22:14 why not just send them all to psychology?
00:22:14 --> 00:22:14 Right.
00:22:15 --> 00:22:18 And there are things that we can do
00:22:18 --> 00:22:20 like they movement does help.
00:22:20 --> 00:22:23 We are trying to change how we sensitize,
00:22:23 --> 00:22:25 how sensitize the nerves are.
00:22:25 --> 00:22:28 Then we also like I noticed that my
00:22:28 --> 00:22:30 kids with chronic pain all have a
00:22:30 --> 00:22:31 difference in their two point
00:22:31 --> 00:22:31 discrimination.
00:22:32 --> 00:22:34 And so I can address their two point
00:22:34 --> 00:22:35 discrimination.
00:22:35 --> 00:22:37 And I basically just rock back and forth.
00:22:37 --> 00:22:38 I'm like two points or one point.
00:22:38 --> 00:22:40 And if I know what their normal is
00:22:40 --> 00:22:41 and I can address that.
00:22:42 --> 00:22:43 they'll come back the next time and say,
00:22:43 --> 00:22:44 I had less pain this week.
00:22:45 --> 00:22:45 It's crazy,
00:22:45 --> 00:22:47 but it's about connecting their brain to
00:22:47 --> 00:22:50 that part of the body in a way
00:22:50 --> 00:22:52 that's not, that's not smudge.
00:22:52 --> 00:22:53 It's not haywire.
00:22:54 --> 00:22:55 And so there are things that we can
00:22:55 --> 00:22:56 do like that.
00:22:56 --> 00:22:57 Our kids with Ehlers-Danlos,
00:22:58 --> 00:23:01 they really lack proprioceptive control
00:23:01 --> 00:23:03 and feedback because their ligaments are
00:23:03 --> 00:23:04 so lax.
00:23:04 --> 00:23:07 And so if we can help their joints
00:23:07 --> 00:23:09 talk to their brain and their brain talk
00:23:09 --> 00:23:10 to their joints,
00:23:11 --> 00:23:13 then um we can make a difference but
00:23:13 --> 00:23:14 it doesn't happen in six to eight weeks
00:23:16 --> 00:23:18 it takes a lot longer and it's um
00:23:18 --> 00:23:21 but there's not many people who are doing
00:23:21 --> 00:23:23 it like i have patients who drive two
00:23:23 --> 00:23:26 hours and my co-workers easily have
00:23:26 --> 00:23:28 patients who drive just as far to see
00:23:28 --> 00:23:30 them because there's just there's not
00:23:30 --> 00:23:31 pediatric therapists who feel confident
00:23:31 --> 00:23:32 treating it
00:23:32 --> 00:23:34 Sure.
00:23:34 --> 00:23:36 Let's go to the clinician who's listening
00:23:36 --> 00:23:36 right now.
00:23:37 --> 00:23:39 For the clinician who's listening who has,
00:23:39 --> 00:23:40 you know,
00:23:40 --> 00:23:41 tomorrow who has a child with pain or
00:23:41 --> 00:23:43 mobility limitations on their schedule,
00:23:43 --> 00:23:46 what's just one thing you want them doing
00:23:46 --> 00:23:49 differently right away with that kiddo on
00:23:49 --> 00:23:50 their schedule tomorrow?
00:23:52 --> 00:23:53 so i think one of the things that
00:23:53 --> 00:23:55 we've learned with kids that are different
00:23:55 --> 00:23:58 from adults is with adults we say correct
00:23:58 --> 00:24:01 the dysfunction and once you correct the
00:24:01 --> 00:24:03 dysfunction then they will move better and
00:24:03 --> 00:24:05 they'll feel better with kids they want
00:24:05 --> 00:24:07 their pain that the kid in the mom
00:24:07 --> 00:24:09 wants their pain addressed first so i
00:24:09 --> 00:24:11 always start with those grade one and
00:24:11 --> 00:24:13 grade two mobilizations actually away from
00:24:13 --> 00:24:16 the site and i really want to bring
00:24:17 --> 00:24:19 down their pain and build their trust
00:24:19 --> 00:24:20 if I go in with a kid and
00:24:20 --> 00:24:22 immediately go straight to the joint and
00:24:22 --> 00:24:23 start getting aggressive with it,
00:24:24 --> 00:24:26 if it's a no C plastic issue,
00:24:26 --> 00:24:27 if it's a pain issue,
00:24:27 --> 00:24:29 I'm going to send that through the roof,
00:24:29 --> 00:24:30 right?
00:24:30 --> 00:24:33 If it is just a positional issue,
00:24:34 --> 00:24:35 then I may correct it,
00:24:35 --> 00:24:37 but they may come in with more pain.
00:24:38 --> 00:24:39 They may, a lot of times they'll say,
00:24:39 --> 00:24:41 I felt great for and then it hurt
00:24:41 --> 00:24:42 worse.
00:24:43 --> 00:24:44 And that is that, um,
00:24:45 --> 00:24:47 just immediate pain relief because of the
00:24:47 --> 00:24:48 chemical change.
00:24:49 --> 00:24:51 But I have to build the trust of
00:24:51 --> 00:24:51 the patient.
00:24:51 --> 00:24:54 So there is a psychological piece to it.
00:24:54 --> 00:24:56 So I usually start away from the joint.
00:24:56 --> 00:24:58 And then if I feel the need to
00:24:58 --> 00:24:59 correct something,
00:24:59 --> 00:25:00 like I'll do a lot of SI joint
00:25:00 --> 00:25:01 manipulations.
00:25:02 --> 00:25:03 And I probably won't do that on the
00:25:03 --> 00:25:04 first visit,
00:25:04 --> 00:25:06 I will start by just springing the SI
00:25:06 --> 00:25:06 joint,
00:25:07 --> 00:25:08 because they've got an adult putting her
00:25:08 --> 00:25:09 hands on her butt,
00:25:09 --> 00:25:10 you know what I mean?
00:25:10 --> 00:25:13 And so for a kid, that's,
00:25:13 --> 00:25:14 That's strange.
00:25:14 --> 00:25:18 I've got to really just think about how
00:25:18 --> 00:25:20 am I approaching this person,
00:25:20 --> 00:25:23 this little person and their ability to
00:25:23 --> 00:25:25 process what's going on in their world as
00:25:25 --> 00:25:27 much as fixing this joint.
00:25:29 --> 00:25:30 And in adult,
00:25:30 --> 00:25:32 I think we fix the joint and in
00:25:33 --> 00:25:33 pediatrics,
00:25:33 --> 00:25:35 I think we treat the person a little
00:25:35 --> 00:25:36 bit better.
00:25:36 --> 00:25:37 Not that we shouldn't,
00:25:37 --> 00:25:40 but they're not small adults.
00:25:40 --> 00:25:41 They're not small adults.
00:25:42 --> 00:25:43 You ready for lightning round?
00:25:43 --> 00:25:44 I did not prepare, Jenny,
00:25:44 --> 00:25:45 for lightning round.
00:25:45 --> 00:25:47 Are you ready for lightning round?
00:25:48 --> 00:25:49 I'm ready for what?
00:25:49 --> 00:25:49 I mean,
00:25:49 --> 00:25:50 I'm as ready as I'm going to be.
00:25:51 --> 00:25:51 You're a PT.
00:25:52 --> 00:25:52 We'll figure it out.
00:25:52 --> 00:25:53 All right, lightning round.
00:25:54 --> 00:25:57 We'll do myth or fact, pediatric edition.
00:25:57 --> 00:25:58 I'm going to throw something out.
00:25:58 --> 00:25:59 You tell me myth, fact,
00:25:59 --> 00:26:01 and maybe a sentence or two why.
00:26:01 --> 00:26:02 What if I get it wrong?
00:26:02 --> 00:26:04 Do you already know the answer?
00:26:04 --> 00:26:04 Wrong?
00:26:04 --> 00:26:04 Okay.
00:26:05 --> 00:26:06 Give the authority here.
00:26:06 --> 00:26:07 All right, myth or fact?
00:26:07 --> 00:26:07 Lightning round.
00:26:07 --> 00:26:08 Jenny,
00:26:09 --> 00:26:11 kids are too fragile for joint
00:26:11 --> 00:26:12 mobilization.
00:26:12 --> 00:26:13 Myth or fact?
00:26:14 --> 00:26:15 Myth.
00:26:15 --> 00:26:16 Why?
00:26:17 --> 00:26:19 Because it's more about how you do it
00:26:19 --> 00:26:20 than what you do.
00:26:20 --> 00:26:23 And you can treat the joint and treat
00:26:23 --> 00:26:23 it differently,
00:26:24 --> 00:26:26 and the kid would be completely fine.
00:26:27 --> 00:26:28 Myth or fact?
00:26:29 --> 00:26:32 Pain in kids usually means tissue damage.
00:26:32 --> 00:26:34 Ooh.
00:26:36 --> 00:26:36 Usually.
00:26:37 --> 00:26:41 Um, I would say that, Oh, you're getting,
00:26:41 --> 00:26:41 you're messing with me.
00:26:42 --> 00:26:42 Okay.
00:26:42 --> 00:26:43 So there's a whole thing.
00:26:44 --> 00:26:46 Pain does not mean tissue damage.
00:26:46 --> 00:26:46 Okay.
00:26:46 --> 00:26:48 Okay.
00:26:48 --> 00:26:49 Cause it's at the brain,
00:26:49 --> 00:26:53 but no deceptive pain or usually
00:26:53 --> 00:26:54 originates with some kind of damage,
00:26:54 --> 00:26:56 but pain as a whole.
00:26:56 --> 00:26:56 No.
00:26:57 --> 00:26:57 Right.
00:26:57 --> 00:26:57 Okay.
00:26:58 --> 00:26:58 Last one.
00:26:59 --> 00:26:59 Last one.
00:26:59 --> 00:27:01 Teens exaggerate chronic pain for
00:27:01 --> 00:27:02 attention.
00:27:03 --> 00:27:05 I don't think that's true.
00:27:05 --> 00:27:05 That's a myth.
00:27:05 --> 00:27:07 That's a myth.
00:27:07 --> 00:27:08 They want to be with their friends.
00:27:08 --> 00:27:09 They want to participate in their world.
00:27:09 --> 00:27:11 All right.
00:27:11 --> 00:27:13 Last thing we do on the show here
00:27:13 --> 00:27:14 with AOMT is called Words of Wisdom.
00:27:14 --> 00:27:16 What's the last idea, concept?
00:27:16 --> 00:27:18 What's your mic drop moment, Jenny?
00:27:18 --> 00:27:19 What do you got for us?
00:27:19 --> 00:27:20 What do you want to leave the audience
00:27:20 --> 00:27:20 with?
00:27:20 --> 00:27:24 Do I get a second?
00:27:24 --> 00:27:25 Sure, you get a second.
00:27:25 --> 00:27:28 I'll play the Jeopardy music right now.
00:27:29 --> 00:27:30 Mic drop moment.
00:27:35 --> 00:27:40 Gosh, I. Oh, you're killing me.
00:27:40 --> 00:27:42 I got one for you.
00:27:42 --> 00:27:43 I know what it is.
00:27:43 --> 00:27:45 Kids aren't little adults.
00:27:45 --> 00:27:46 Kids aren't little adults.
00:27:46 --> 00:27:47 I mean, they're really not.
00:27:47 --> 00:27:48 And also, I mean,
00:27:50 --> 00:27:52 if there's something that you don't know
00:27:52 --> 00:27:54 about, don't just throw it out.
00:27:54 --> 00:27:55 Investigate it.
00:27:55 --> 00:27:56 Ask questions.
00:27:56 --> 00:27:57 Learn about it.
00:27:57 --> 00:27:59 I think they I mean,
00:27:59 --> 00:28:00 that would be the biggest thing is people
00:28:00 --> 00:28:01 who are just an absolute no.
00:28:01 --> 00:28:02 And you're like,
00:28:02 --> 00:28:03 have you ever been trained in this?
00:28:03 --> 00:28:04 Have you ever read an article?
00:28:05 --> 00:28:08 And I think give yourself a chance to
00:28:08 --> 00:28:10 learn about it because then you might
00:28:10 --> 00:28:12 really be able to help somebody and make
00:28:12 --> 00:28:13 a difference.
00:28:13 --> 00:28:14 Ginny, thanks for doing what you do.
00:28:15 --> 00:28:17 And thanks for talking to us here on
00:28:17 --> 00:28:18 Hands On, Hands Off through AOMT.
00:28:19 --> 00:28:20 Thank you for having me.