The Beyond Pain Podcast

Episode 11: The Sole of Foot Care with Courtney Conley

• Par Four Performance • Episode 11

Share episode

Send us a text

DM Us! We love chatting with our audience, please feel free to do so on Instagram and say what's up!

Want to work with us? Apply here!

Watch on YouTube here.

Use our code for 10% off services/education/products
CUPOFJOESPOD_10
https://gaithappens.com/cupofjoespod/

Summary
Dr. Courtney Conley, a chiropractor and founder of Gait Happens, discusses her journey into foot health and the importance of respecting the body. She emphasizes the need for appropriate footwear and taking more walks as simple ways to improve foot and ankle health. Dr. Conley also highlights the importance of creating a safe and supportive environment for patients, where they feel heard and understood. She encourages clinicians to blend their knowledge and listen to their patients' experiences to provide effective care.

Bio
Dr. Courtney Conley is the founder and creator of Gait Happens where she has the opportunity to truly realize her dream of helping as many people as possible reclaim their foot function.

She’s an internationally renowned foot and gait specialist who teaches both nationally and internationally. Dr. Conley is a chiropractic physician who specializes in foot and gait mechanics. She holds a BA in Kinesiology, a BA in Human Biology and a doctorate in Chiropractic Medicine.

She is the owner and operator of Total Health Solutions clinic and Total Health Performance gym in Lakewood, CO, where she heads patient care with a focus on restoring gait mechanics and helping people resolve foot problems to move more easily and with less pain.

Dr. Conley is a founding member of the Healthy Foot Alliance, an international team of practitioners whose collective goal is to bring light to the benefits of natural footwear and prevent unnecessary surgical procedures by improving foot foundation and creating a stable platform from the ground up.

Takeaways
Pay attention to your foot and ankle health by wearing appropriate footwear and taking more walks.

Create a safe and supportive environment for patients, where they feel heard and understood.

Blend your knowledge and listen to your patients' experiences to provide effective care.

Respect your body and give it the time and attention it needs for recovery and healing.

Joe Gambino (00:00.334)
Welcome back into the Beyond Pain podcast. I am one of your hosts, Joe Gambino, and I'm here with your other host, Joe Lavaca. You can find us both on Instagram at Joe Lavaca, actually at, my God, I don't even know Joe's mixing up our handles today. At strength and motion underscore PT and I am at Joe Gambino DPT on Instagram. See, that's what happens. I don't have this stuff right in front of me to read it anymore.

Courtney (00:00.378)
I'm sorry.

Joe LaVacca (00:18.05)
We're already going to have to edit this in post already, like one minute into the podcast today.

Joe Gambino (00:29.454)
We are always happy to have a conversation, so feel free to reach out to us. And if you are interested in working with one of us, we do have an application form in the show notes that you can fill out as well. And one of us will get back to you. And we are here with Courtney. Welcome. She is the founder of Gait Happens, and she's also Joe's wonderful fiance.

and welcome to the show.

Courtney (01:00.922)
Thank you so much. I've been looking forward to this.

Joe Gambino (01:02.454)
I think we put you in a category of a very special guest. Yes, yes. So welcome to the show. Why don't you take the floor? Nothing to do with Joe. Yeah, exactly.

Courtney (01:08.602)
thank you.

Joe LaVacca (01:08.93)
We did.

Joe LaVacca (01:12.482)
And that has nothing to do with our relationship. Nothing, just because you are special.

Courtney (01:20.474)
Thanks.

Joe Gambino (01:23.086)
Take the floor court, let our listeners know a little bit more about you. Share whatever you want to share.

Courtney (01:29.562)
Yeah, so I'm a chiropractor in Lakewood, Colorado. I have a practice out here with a bunch of other wonderful physicians. I started Gait Happens in 2017. So we vary our foot and gait based. And it's been really wonderful to see the interest in.

kind of my passion grows so much over the years. I really think this industry of foot health is really starting to blossom and people are starting to pay more attention. So it's been very fun to see.

Joe Gambino (02:03.086)
That's awesome. What, I don't know if I know the story or not, but how did you get into just like focusing or where'd your love from working on the foot come from?

Courtney (02:14.874)
You know, I think with anything, when you become so passionate about a topic, it's somehow, you know, a personal experience or journey that you've gone through.

I was a dancer as a kid, so I spent a lot of time in pointe shoes and then I became a triathlete and I was running and cycling all the time and poor footwear and I never really paid attention to my feet. You know, I have bunions, I have neuromas, I had kind of all the things. So through my own personal journey of trying to improve that, you know, I...

kind of learned along the way. I worked in a couple of orthotic labs. And at the time, that's what we knew to do. It was just, you know, make orthotics, brace the foot. And so I was always constantly like tweaking something and trying to make sure that, you know, I could offload what was happening in my foot. And it just never really came to fruition. And that's when I kind of went down the self exploration of, you know, looking at the foot.

very similarly to how we look at the rest of the body, which is, you know, strength and endurance and resilience. And that's when things started to change for me and I brought it into the clinic and it's all she wrote.

Joe LaVacca (03:28.642)
Well, I think that you're I like the word that you use there yourself exploration and your journey that kind of continues to go on and on and on and on and I know you are so dedicated to your crafts that you're always learning fun facts and new information So would you want to share your most recent favorite fun fact? You've learned about the foot or ankle or walking or anything related to your specialty?

Courtney (03:56.09)
I thought you were going to ask me about the wasps.

Joe LaVacca (03:59.458)
Well, this could be a fun fact too. We're gonna build to that. We're gonna build to that. You're foreshadowing for the listeners. So let's start with a fun fact about the foot that you recently learned and then a fun fact about life you've recently learned.

Courtney (04:13.082)
I obsess over things as Joe knows, so I will read and reread and restudy over and over again. But I was teaching a course this week on plantar plate injuries and I learned that there is something called a Churchill sign, which is, do you want to know what the Churchill sign is?

Joe LaVacca (04:39.394)
Well, yeah, I mean, don't leave us hanging.

Courtney (04:40.962)
So when you're foot, when you start to see a space in between your digits, so like in between two and three, for example, the majority of the time that's called the daylight sign. And that's when a neuroma is there, because the toes have to make room for where the neuroma is. But it can also be the Churchill sign because you have a late stage hammer toe and that can also cause a split in the toes.

Joe LaVacca (05:07.234)
Wow.

Courtney (05:08.09)
Are you blown away? Who's blown away by that fun fact?

Joe LaVacca (05:10.946)
That's a fun one. Joe, what do you think? Did you know about the Churchill sign?

Joe Gambino (05:13.55)
I actually I think I've heard of it before like way back in pre -tea school, but I would not have been able to Remotely tell you what it is today. That's for sure

Courtney (05:22.874)
Thank you.

Joe LaVacca (05:24.834)
I wonder if it was named after Winston Churchill. Where's the origination of this court? Was it like Dr. Churchill or anything like that? Okay, cool. We'll have to dig a little bit deeper into that one.

Courtney (05:29.818)
I don't know.

Well, when you Google the Churchill sign, there's many pictures of Winston Churchill going like this or this, whatever it is. So.

Joe LaVacca (05:40.802)
wow, that's fun. there we go. I like the connection there. Yeah, perfect. Excellent. All right, what about a fun fact about life, Court? What's your fun fact about life that you've recently learned?

Joe Gambino (05:43.054)
And there it is. That's the real fun fact.

Courtney (05:53.21)
So I am allergic to wasps. So I have an obsession. There's a nest above my, one of my windows. And so I was Googling like facts about wasps and I did not know that they will like find roadkill and then take the meat from the animal. They won't eat it, but they'll bring it back to their nest and feed it to the larva.

Joe LaVacca (06:20.61)
cannibals.

Courtney (06:22.298)
Yeah, I mean, I would never have thought that.

Joe LaVacca (06:25.666)
Joe, did you know this fun fact about wasps?

Joe Gambino (06:26.67)
No, I know what you're not. I'm learning a lot today.

Courtney (06:30.21)
you

Joe LaVacca (06:31.842)
I think it makes them more horrifying to be honest, because I just thought that they were like bees, like they just cared about plants and honey, and they were just bringing that back to their nest. But now that I know that they're actually bringing flesh, it makes them even more scary, because now I'm thinking, are they trying to take a piece of my flesh when they're hovering around me? So, wasps are bad, wasps are bad. I think that's another good takeaway for today.

Courtney (06:46.234)
Yeah.

Joe Gambino (06:59.15)
Yeah, that I had zero idea. This is a sort of a potential horror film I see coming.

Courtney (07:05.138)
I'm going to go ahead and close the video.

Joe LaVacca (07:10.05)
100%. Joe, should we ask her about coffee? Should we do a coffee fact before we get into everything?

Joe Gambino (07:14.35)
yes, yeah, let's do that because I do want to backtrack for one second because I have a question on something she said, but yes, let's go with coffee. Why don't you ask the question, Joey Boy, and then we'll go from there.

Joe LaVacca (07:26.338)
All right, well, of course, as you know, Joe and I started this a long time ago. We were dabbling in it. We called it Cup of Joe's. There was some coffee theme for some reason. So now we always ask guests, how do you take your coffee? What's your favorite style, brand? Do you add anything to it? What's your special sauce in the morning?

Courtney (07:48.154)
black, but collagen, that's my collagen, but it has to be the advanced collagen with the vitamin C, not just the regular kind.

Joe LaVacca (07:50.562)
That's it.

we put college in it.

Joe LaVacca (08:01.666)
the super, super ingredient.

Joe Gambino (08:03.246)
Gotcha. And is it hot, iced? You don't do iced? Wow. That's a rarity.

Courtney (08:06.778)
I don't, I do not drink iced coffee. I think it's... No.

Courtney (08:13.498)
Because you drink it too fast and you get sick.

Joe LaVacca (08:13.506)
I feel like somebody else...

Didn't somebody else talk to us about not wanting iced coffee? They don't do iced coffee? I feel like that was a thing recently. But we've only had a few guests on and I don't think it was Stella or Tyler. So.

Joe Gambino (08:27.566)
Yeah, this is the third guest and we can't remember anyone else's coffee hours.

Joe LaVacca (08:31.586)
Yeah, yeah, yeah, yeah. We're gonna start a board. We're gonna start a board.

Joe Gambino (08:37.166)
Yeah, I guess so, right? All right, anyway, going back, because I actually find it interesting because I feel like there's only two areas of the body that in general, in generalities, when we're speaking that way, they are treated differently than the rest of the body. It's the spine. And I feel like the other one is the foot. Was there, I don't know, there's maybe two ways you can answer or two questions I can give you. You can just pick whichever direction. Was there a turning point for you when you decided to...

Joe LaVacca (08:39.234)
Mm -hmm.

Joe Gambino (09:05.646)
Or did you actually think that at one point where like the foot you treated differently than the rest of the body and at some point there was a turning point for you? Or the other way you can kind of go about it is why do you think there is a difference from a general perspective, why people treat the foot differently than a shoulder, a knee, something like that.

Courtney (09:24.282)
You know, I think it's a complex part of the body. You know, there's a lot happening there. So I think from an educational perspective, I know we didn't get a lot of it going through school. So it was just, you know, this is you have foot pain, here's an orthotic and or surgery. And when I first got out of school and we were treating patients with orthotics all the time, they were always coming back.

It was their foot would feel better for a little bit, but then they'd come back and there would be knee pain and then there would be hip pain. And then there, so I just felt like we were masking, what was going on instead of really figuring out why this was happening in the first place. And that's where I think I really started to switch gears again with my own experience. Cause I was like, I don't feel good when I run something always is bothering me. And.

The solution wasn't to keep tweaking my orthotic. It finally started to work when I started removing it. So that was a very kind of long process of the removal of the, you know, orthotic, if you will, and then really focusing on getting stronger. And I think that's a perspective really that we've mastered everywhere else. I mean, I think we know that, you know, to be a resilient human, we need strength and we need endurance and that we definitely need to do that at the foot.

Joe LaVacca (10:48.354)
Right, right. I think that kind of leads in nicely to maybe this other question about your own journey with pain. And have you had any experiences, injuries that really stick out to you that you've a, struggled with, or maybe have shaped your opinions personally and maybe even professionally to a deeper extent?

Courtney (11:16.986)
Yeah, I mean, I think it's such a great question. I think all of those experiences, and pain in particular, helps kind of create us. And it helps form really...

part of, I don't want to say identity, but really forms how we deal with things. When I was young, my parents got divorced when I was 13. And it was a very pivotal time in my life. And you harbor a lot of emotional pain with that. And the only way I really knew how to combat that pain at that age was to just go deep into everything and really take things to a maximum level.

which I did with everything, so the good and the bad. So I studied very hard and I partied very hard and I exercised very hard. And then as I started to get older, I realized that the bad addictions weren't gonna get me anywhere. So I simply exercised, became my new addiction and I went after it very hard. Which...

I think, you know, has its good and bad points, but when you use exercise as the only thing to quiet your mind, when you start to experience pain, the thought of not exercising, you're like, there's no way because I'll go crazy. Which, you know, I would have. So when I was younger and I'm like,

feeling pain, whether that's emotional and or physical, my go -to is I'm just going to go exercise. And I could, I mean, I had, you know, I think minor injuries, luckily nothing ever really sidelined me, but I had minor injuries and I would just push through it. And it was, you know, I was training for an Ironman at the time for many years. So you just push through and you're running and you're biking and you're just pushing through these, you know, smaller injuries and

Courtney (13:22.906)
I never really took the time to, I think, respect my body, to calm down, to recover. And then I hit 40, which was almost 10 years ago, and it catches up to you. And then these injuries that you were able to push through before, you can no longer do. And so that was a very big crossroads for me because,

That was really the only way I was dealing with a lot of pain and I use that term very broad. So I had to start changing the way I looked at it and finding other ways to...

really combat all of it. And so now I like to think of myself as like the queen of modification because I still use exercise, but I'm smarter about it. You know, if something doesn't feel good, I'll go for a walk. I won't like try to run 10 miles. So I think that's, you know, important to be able to recognize. And luckily I have the background to know when I can do that, you know, but that's been a very big, very big factor for me, I think.

Joe LaVacca (14:40.098)
Do you think that... Go ahead Joe.

Joe Gambino (14:40.718)
Good year.

Nah, go ahead, finish that.

Joe LaVacca (14:46.018)
So do you think that you mentioned like how you deep dive into a lot of maybe obstacles or have always been that way from like a young age? Do you find that the deep dive and your knowledge and your background was helpful during the acute like these like little nagging injuries? Did you feel like there was like a double -edged sword there? Where it was almost like paralysis, bi -analysis, like you knew too much?

Did you ever feel? And then, you know, so describe that experience if you could. And, you know, like you just said, like knowing my, you know, knowing a little bit about my background, your education, knowing like what to do. But it seems like sometimes with people I talk to, not even past guests, but just clinicians. And Joe, I think you could probably vouch for this too is. Sometimes we know too much and where do you?

Courtney (15:20.602)
Yes.

Joe LaVacca (15:44.834)
kind of draw that line of like, hey, I just need to give this time because we also probably know about prognosis and healing times and regression to the means and things like that. So what's that experience like for you when you're trying to deep dive your own problem or maybe deep dive a client's problem?

Courtney (16:01.978)
It's really funny because I have this joke that I will like literally tell people that when I have foot pain, I'll like literally Google it because I'm like, what's wrong with my foot? Because I think your knowledge, you know, especially when you're trying to treat yourself completely goes out the window and you either become so obsessed with it that you're like, I mean, should I do this? How many calf raises should I do? Should I, you know, or then you just completely like,

completely get paralyzed. And I think one of the biggest things that has been beneficial for me is to surround yourself with smart colleagues. So I know that being able to call on my friends and be able to have them kind of talk me out of some of the thoughts, because it's really wild. I sit here and will talk to my patients about this stuff all day long.

And I'll be like, you probably don't want to run 10 miles today. And then I'll go and do the exact same thing that I would never tell my patients to do. And then I'm sitting there going, well, I don't understand why this is happening, but you know, it's what you do.

Joe Gambino (17:12.238)
That's pretty funny. I was gonna on this point, I think it's hard even as a, you know, a physical therapist, a chiropractor, someone who knows about pain when it's for yourself, because I just believe pain is such like internal experience, right? It's very hard to like see past it sometimes. So you're always like, should I tweak this or tweak that? And you're not being very objective anymore, because you're just taking your experiences and kind of playing around with different things and having, I think, an objective eye or somebody else looking at it or.

you know, telling you what to do to kind of curb that is I think just helps a ton. And I think that's even the hard part with people who become our clients, right? Or not even in the space, right? You're just kind of like so sucked into your pain that even if you know what to do or not know what to do, it becomes hard because you're always just reacting to how you feel as opposed to like what you actually need to do to get out of pain or how do you modify something. And you always use your past experiences as like, that used to be my problem all the time is I would always take my past experience with dead lifting and that was the thing that caused pain.

I'm like, well, 225 is really life for me. So I always had like 245 to 275 as like, this is my entry point back into dead lifting. And it always caused a flare up. And I never decided like, maybe I should build up some volume at lower weights that don't cause pain, right? Like, but there's always that almost ego or like your own past experience that say like, this is where I really need to be. And I see that happen a ton of times with people.

Courtney (18:33.818)
Yeah, for sure. And I always think, I'll tell my patients to do certain things. And I think maybe because I talk about it all day long that I do them myself. And then I'm like, shit. I haven't done the work that I'm telling my patients to do. And it's always a good check for me to kind of go back and make sure I'm doing the thing.

Joe LaVacca (18:57.89)
Right. So let's go deeper into there too, Cor, because you mentioned you have neuroma, you have a bunion. You mentioned all these other injuries to maybe the lower body in particular, maybe even from your time being a dancer and athlete in Chicago and earlier on. But now that you are so respected in the field and looked up to by so many clients and professionals alike, was there ever a feeling when you're

struggling with these things that you couldn't have this pain, you couldn't have this injury because of your background and because of what you specialize in.

Courtney (19:37.85)
Well, first, thank you. I feel like I'm a work in progress. I think I always will be. But yes, of course. I always used to tell myself, don't ask someone who's bankrupt for financial advice. And now I think about it and I'm like, maybe you want to find the person who was bankrupt.

who now is successful and that's the person that you want to ask for advice because they've lived it, they've experienced it, they've overcome. And I think when I first started this, I was on the, people look up to me to like, have these perfect foot mechanics and I have to be strong and I can never get injured and...

You know, I think when I became more honest with myself, as well as with my audience, and it was, Hey, this is the reality here. Like, this is what I've struggled through. it really became, I think I became more relatable to the audience and then, you know, everything that I do continuously to try to help my feet and to help my movement are educational opportunities. That's the way I look at them now, to be able to not only improve myself, but then

and carry that into the clinic. And that's what I think really was, it was a very big kind of switch in my thinking about that. And it also calmed me down, right? I knew that I didn't have to be, you know, shit happens, gait happens. Right?

Joe Gambino (21:13.294)
I like that little twist in there.

But I mean, I feel like a lot of people who get into PT, a lot of times it's their story that even brings them in there. And I'll never, I think I probably mentioned this on the podcast already, but I'll never forget this one time I was working with the patient of Perfect Stride. And I might've been around the time, Jo, and I had like really bad back flare up. And one of my patients looked at me and she was like, you get hurt? It was like almost like just because I'm a physical therapist, right? Like I'm like immune to pain, right? Like it can't happen to me. And I was like, it made me take a step back. And I was like,

Joe LaVacca (21:40.93)
Yep.

Joe Gambino (21:48.526)
Like is that really the perception of what it like sure I mean I know it's what what to do and I and I'm active and I can maybe do some things to and like better, you know, you know solve my own pain problems but like no, it's just those interesting that someone would say that that you know, they wouldn't expect me to ever have pain or anything like that. So it's I think there's a odd lens that people kind of look at you and expect something higher right or almost like put you on a pedestal in a sense. So I kind of get that.

I do want to go back to something you said there. You said that in the beginning, it took you some time to start to like respect your body. And I kind of want to go back there because I think it's kind of always good for people to hear and to learn. So what kind of lessons did you learn? And as far as like respecting your body and what do you do now?

Courtney (22:17.082)
Yeah.

Joe Gambino (22:41.038)
to either avoid overtraining or navigate your own pain issues and kind of like give yourself that respect, but still allow you to push yourself from like a fitness perspective.

Courtney (22:51.994)
Yeah, I mean, I think ever since I was little, people have been telling me to slow down. And I used to constantly try to battle that. Like I have to, how do I slow down? How do I slow down? And I finally, now I just embrace it. And I'm like, well, I don't think I'm going to slow down in every kind of area of my life, but especially with movement and the kind of respecting my body with all of that, I've learned to listen a little bit better.

you know, on days where, you know, I'm either overworked or under slept, I still have to get something in. I know that from a, especially from my mental capacity and my mental health. So, you know, I will modify and those are the days where I'm becoming more of a, more of a walker, you know?

I think it's a very underrated form of activity. I really do. So we can always take a walk. So that's been a really good way for me to kind of slow things down. You know.

I'll still try to amp it up a little bit. Like I was in a, a rucking stage there for awhile. And I'm like, you know what, Courtney, you really, you really don't need to do this. You can just go outside and take a walk. so those are the things I've started to do instead of just trying to push, push, push all the time. And the listening to my body, the recovery and paying attention to that has really been, has really been very beneficial to me, especially as I age, because I'm in this thing for the long game.

You know, if I get injured now because I'm not listening, then I know that's gonna put me out and that's not gonna be good for anybody. Probably especially Joe.

Joe LaVacca (24:45.314)
I was just going to say, yeah, I think that, you know, I'm always thinking about my life and my wellbeing as, you know, Courtney goes through any struggles or obstacles. So I appreciate you saying that, Courtney. Was there a specific, you know, moment, mentor, book, blog that really helped you shift that perception? Or was it just a lot of like trial and error and just experience and realizing maybe we need to change something?

Courtney (24:55.706)
Yes.

Courtney (25:14.17)
I think it was a lot of trial and error. And to be honest, I will give you some credit here. It's a lot of the conversations that you and I have had. It's hard for me to still kind of take what I've learned and apply it. To...

to listen to those things. And I think that by talking with you and really listening and all of this, this isn't working for me. I should probably switch it up. I mean, it's all of those experiences I think that have helped.

Joe LaVacca (25:56.034)
Joe's the same way, right? Joe, I just help you constantly also, right? That's it. I'm just here to help.

Joe Gambino (26:00.878)
That's right. I was going to say, I mean, Joe, Joe just impacting everyone's life, especially on this call, you know, Joe was surprised. I forget what episode the whatever episode number was when we were talking about my pain history. Yes. I mean, who was one of my mentors and he was surprised that I mentioned that like Joe, we worked together for like eight years and it was my first place out of work. And I don't know how we, you know,

Courtney (26:04.378)
Ha ha!

Joe LaVacca (26:07.458)
Mm -hmm.

Joe LaVacca (26:20.29)
I was.

Joe Gambino (26:26.638)
talk shop every single day. So it was a huge influence on what I did as a physical therapist.

Courtney (26:32.474)
I think that's so important. I think you have to, I'm so grateful for all of the mentors that I've had and still do. I mean, I have in my pocket, probably five people that I still will call and...

you know, talk to probably on a weekly basis about, you know, things or things that I want to learn or things that I'm confused about. And I think that's important. No matter how deep we get into our profession, you have to have that.

you know, community of people that you can call on and rely upon and learn from. And I think, you know, even from a pain perspective, when we experience things like that, you have to have people in a community that you can embrace.

Joe LaVacca (27:20.002)
And I think it's easier and harder than ever to probably do that because I definitely have my biases and my lens and the way I view problems with clients. But, you know, learning from Joe from more of a performance standpoint and coaching standpoint, even through his posts and our conversations and then learning from you through a more biomechanical lens and kind of knowing when to zone in, you know, I'm able to take my bias, but then blend them with

the two of you and others' viewpoints. So I think it really is important for not only clinicians listening, but for clients listening. And I say this to clients a lot, go find your doppelganger in your life. You know, like who is going to be similar to you, experiencing the same things? You know, what makes them more able to cope with their stresses in life? What do they do different? And then you can always kind of pull from them. But I think that's...

you know, maybe even an important conversation for us, like who's our doppelgangers and then who are sort of like the opposing viewpoints or the opposite side of the coin. And, you know, blending, I think all those opinions is probably an art form. And again, things that are probably the easier and hardest to do now with social media and everything else. So if we think about that, you know, blending perspective and your viewpoint with biomechanics and, you know,

your detailed approach to assessments, how are you taking those worlds, explaining pain to your clients? Where do you make space for that in these assessments with people?

Courtney (29:04.09)
Yeah, I mean, I think that's something that has been learned over the years. I'd like to think I'm becoming a bit better at it over the years, because I think those are difficult conversations to have, explaining pain to patients. I think the first and foremost thing is to create an environment.

for the patient where they feel safe. I know in my office, for example, I have a standing desk. And over the years, I think when you have a patient that comes in who is in pain, you can really start to learn what they need. And so for example,

When I see someone come in and I know, you know, I can sense their energy. You can kind of see how they're reacting. You can see how they're moving. I don't stand at that desk. I grab my stool. I get right up next to them and I'm like, you know, sitting like right across from them. You know, if my, if I can feel that they're okay, my hands on their knee or there's some, you know, there's more of an intimate setting that's happening there. and I think that's an important.

place to start even before I start talking about my explanation of pain. And I think that dials down their kind of intensity of the situation. You know, I'm Italian as we all are. So there's usually some tears involved when we start getting into the deep. But, you know, and then my kind of, even with all the patients, my kind of, you know, statement, and I'll riff off of this, is that, you know,

pain isn't necessarily a predictor or correlated with tissue damage. So that's kind of where we'll start. And being in the foot and ankle world, I always go with the example of an ankle sprain, for example. So if someone's outside and they sprain their ankle and you have this ankle that's swollen and it's, you see these acute symptoms, their pain is on the same level as their tissue damage, right? So they're on,

Courtney (31:15.962)
you know, the same kind of platform. And then when you have patients that are more in chronic pain, that pain doesn't align with their tissue damage. So I'll go through and explain that to them about the sensitivity of their system. And, you know, when they're fire alarms going off in their body, it's like their house is exploding when in reality, there's a lot of other factors that are contributing to that.

So, you know, I like to work with each patient individually. You know, I'll know when I need to take things a little bit slower. I'll know when I need to kind of amp things up a little bit, but I'll dance along that line. But I think most importantly is creating that environment where, you know, they feel safe and that they can talk to you. And I think that goes a very, very long way.

Joe Gambino (32:06.862)
I 100 % agree with that. I think having that connection and trust is probably the only way, right, that you're going to really be able to connect with somebody and help them, especially with their, it's a very, very chronic situation. I want to switch here. Go ahead, Gordon, sorry.

Courtney (32:22.394)
Yeah, I'm 

Joe Gambino (32:28.334)
Mm -hmm.

Courtney (32:32.09)
world, the healthcare world, you know, a lot of clinicians don't have time. They don't have time to listen. They don't have time to sit there with them and talk to them. And I think that was one of the, you know, when we changed our practice from an insurance based model to cash based model, that was one of the things I, you know, I stress with everybody is take the time with your people. You know, they want to be heard. They need to be heard. And, you know, that in itself,

When you have someone in pain, they don't want to be rushed. They don't want to be skirted out the door. You have to listen to what they're saying.

Joe Gambino (33:09.23)
I resonate with that a lot. Actually, Perfect Stride was the only reason why I think I stayed in physical therapy because that one environment was huge because when I was going through my clinical rotations and I was seeing 20 people in a shift where you're just bouncing from person to person, especially coming as I was a personal trainer before all of this, and I always spent an hour with somebody and was able to build a relationship with them and work with them and really build that like...

that trust factor with them. I think that was huge. And I almost was like, this really isn't for me. And I had perfect tribe, you know, out of network, but you know, we had our hour sessions with people and I was like, okay, this is really what I envisioned the field to be, not what the other stuff was. So that was a big saving grace for me to even continue down this pathway.

Joe LaVacca (34:00.386)
Yeah, and it's still in common, right? I think that for all three of us being able to devote that time to people, there's still way more clinicians and practices that exist that are more of that model where you were saying, Joe, 20 people a day, you know, maybe north of that. And I think that that's where, you know, maybe this debate is still so pushing back and forth on the importance of communication and alliance and, you know, viewing the

person in front of you as that, a person, not a body part and not a diagnosis. So for me going through sports PT and being in that model, yeah, it was like really a challenge for me to shift and give the time and attention that each person either deserved or wanted. And I think that's the biggest feedback I get now too, is that this is so much different, just being able to sit and talk and ask questions and now with apps and...

you know, all these other programs, people are able to stay in touch between sessions so much better. So they never really feel alone. And, you know, so thank you guys for pointing that out. I think that's really great.

Courtney (35:08.058)
I think the question really becomes is, you know, people listening to this are...

Joe Gambino (35:11.118)
Courtney, last question for you. I always like to have something very, very actionable for listeners to kind of go home with in this sense. So if you were to, I don't know, I'll say three, but you can as many tips as you want here. What would you think that the one thing you would recommend for anybody who's listening in order to just, if they just wanted better foot health, better ankle health, what kind of things would you tell them to start doing?

Courtney (35:36.41)
I mean, just pay attention. I mean, I think, you know, when we think about all of these things that we need to do for our longevity, right? The quality of life, it can start to get very overwhelming. And so the way I like to teach this and educate it is it doesn't have to be another big thing, right? Like low hanging fruit, for example, is just where appropriate footwear.

You know, that is a very big thing that I talk to people about all the time. And research is starting to follow it now that if you simply wear shoes that allow your feet to splay, for example, or can feel the ground, you're gonna start to gain strength in the foot simply from wearing a better shoe. So that's a low -hanging fruit for people. Taking more walks. You know, I'm doing a lot of research on walking now and...

The average steps a day for Americans is 4 ,500, which means that 50 % of us are taking less than 4 ,500 steps a day. And we know that that 4 ,500 marker decreases all cause mortality and dementia. So if you want to talk about easy and low hanging fruit, get yourself a good pair of footwear and just go outside and take more walks. And I think that's a very, very good place to start.

Joe LaVacca (36:56.866)
Is there any like, like just as a last thing, just with the walking programming, is there just a way that you typically would advise clients on that, whether it's increasing time per day, steps per day? Do you have them journal anything? Like how do you get them to build up if they're below 4500 or maybe just flirting around that?

Courtney (37:19.802)
Yeah, I mean, small doses, you know, and it depends on if we're transitioning them with footwear too. but I do like the, I don't know. Did I steal this from you or did you steal it from me? The colors at the end of the day.

Joe LaVacca (37:33.666)
No, that was you. I think that was you.

Courtney (37:36.346)
So what I'll have them do is, you know, it's really interesting when people start looking at their step count and then I'll have them, you know, I don't like to use numbers. So we'll just use red, yellow or green. And at the end of the day, just color in the day, how did you feel? And it's really interesting to me because people are afraid, you know, especially when there's foot pain or there's any type of pain, they're like, I don't want to go for a longer walk because I'm afraid. And so we'll say, okay.

Take another five minutes and at the end of that day, just see how you feel. And then we'll have them look at the month. And it's always really wild because more often than not, they're green days. They can see that they were moving more. So, hey, you took X amount of steps on this day and you felt better. And I think when we're in it, we don't necessarily pay attention to the green days. We really only focus on the red days.

So at the end of the month, it's like, wow, I really didn't feel good. And I'm like, well, did you? Cause look here, you actually have a lot of green days here and we know what's making it better is walking more. So I think it's a good kind of objective measure because we know that pain is not being able to, you know, using pain as an objective measure. So I really like that.

Joe LaVacca (38:58.754)
Joe Gambino (38:58.798)
I like that a lot. That's a great way to look at it.

Joe LaVacca (39:02.818)
You had that client that I remember, and this is why I know it was yours, that was coloring in her sheet. And I think the red days popped up when her husband was out of town, right? Or traveling with work or something. There was something within her relationship there where you guys figured out like, hey, you know what? Yeah, we might have some sensitivity in these tissues, but look at this pattern here. It's every Tuesday.

you know, what's so special about Tuesdays? And it's like, well, that's the night, you know, my husband works late or he's out of town or things like that. And I think that's kind of really what makes, you know, your philosophy and maybe all the girls philosophy at Gait Happens and here at THS so unique is that I think people follow you sometimes and they expect that, you know, your whole assessment treatment plan orientation is just biomechanics, just joint angles.

just wedging a foot or moving it differently. And just hearing you talk today, there's just so much more to that that you focus on, maybe even first and foremost with people. So whether that we call that passion, connection, I don't know if you give it a label of like what your secret ingredient is there, but I think that's really important for people to realize that to me, you do such a great job blending all those worlds. And I think that that...

is a nice takeaway for people in pain listening that, you know, there's ever, even when we see the experts in the field, the people who are doing it really, really well are blending all their knowledge. And even for clinicians who, like we said, may be stuck in these, you know, tough situations, you know, start focusing on one thing at a time and then move from there rather than trying to build up too many things all at once.

Courtney (40:46.49)
Yep. Don't make me cry.

Joe LaVacca (40:49.922)
I was gonna say, we did really good today.

Courtney (40:52.89)
I'm sorry.

Joe Gambino (40:53.422)
Yeah, you made it court you made it Well court I appreciate you coming on the show and I think this was a great conversation general I think there's a lot of great take homes for people to have with this episode I'll get everything in the show notes as far as how people can reach out to if there's anything in specific that you want me to put in there Let me know and For those who are listening

All of our listeners, the 11, the 10 of you guys that are on YouTube as well, we love you. If you're listening this far into the episode, extra love for you guys and cordial, love you guys.

Courtney (41:28.666)
Love you too.

Joe LaVacca (41:28.674)
Love you too.