Episode 63: From Figure Skating to Physical Therapy: Myth-Busting Pain & Performance

Have you ever received conflicting advice from your surgeon and your physical therapist? Who do you listen to when one says you are ready to run, and the other says you aren't?

In this episode of The GFY Podcast, we are joined by Kathleen Criss, a physical therapist and fellow University of Delaware Athletic Training alum. Kathleen shares her unique journey from being a competitive figure skater for 18 years to treating complex outpatient cases in a hospital system.   

The group dives deep into the systemic communication gaps in healthcare. Kathleen breaks down her "Two-Parent" analogy for post-op recovery, explains why your pain might not actually be coming from that disc bulge on your MRI, and discusses how the international world of figure skating prepared her to connect with patients from all walks of life.   

In This Episode, We Cover:

• Figure Skating & Backflips: A dive into the recent controversies of acrobatic moves in figure skating, including Ilia Malinin's legal backflip and the trailblazing history of Surya Bonaly.   
• The "Two-Parent" Analogy: Why your surgeon and your PT have different perspectives. The surgeon looks at tissue healing, while the PT evaluates your functional performance—and why both "parents" need to agree before you return to sport.   
• Systemic Healthcare Gaps: Why it's not the physician's fault that they only have 15 minutes to spend with you, and how rehab professionals fill that vital educational gap.   
• Myth-Busting MRI Results: Why having a disc bulge doesn't automatically mean it's the source of your pain, and how to de-escalate the stress of scary imaging results.   
• The Placebo of Surgery: Michael shares a mind-blowing study on "sham surgeries" for back fractures that yielded the exact same results as actual surgical interventions.   

Resources Mentioned:

• Guest: Kathleen Chris, PT, DPT, ATC.
• Concepts: Tissue Healing vs. Performance Readiness; Multifactorial Pain.   

Connect with Us:If you enjoyed this episode, please leave us a review on your listening platform or subscribe to our YouTube channel!   

Disclaimer: Although we are healthcare providers, we are not YOUR healthcare provider. Content is for educational purposes only. Please consult your physician before making lifestyle changes.   

Transcript

Speaker: 0:00

Welcome to the GFP podcast podcast by healthcare professionals providing healthcare. Healthcare professionals Man, I can't even do it right Huh? Oh, you blew it. I know, I know, I screwed it up Um. Go Fix Yourself podcast hosted by me, Michael Stan and Michael Bruno. Although we are healthcare providers, we're not healthcare provider. Your healthcare provider. We will discuss general health interventions in this podcast, but you should not take that as health advice that works in every situation. Before doing anything on your changes, please consult with This podcast and views from this podcast are separate from our full time jobs and our own opinions. If you're enjoying the podcast, please leave us a review on your listening platform and or subscribe to our podcast at YouTube. Links to our show can be found in the show notes on any platform that you're listening to. Today we have Kathleen Chris on uh, Blue Hen you that twenty sixteen University of Delaware twenty sixteen. Um, Kathleen, if you want to give us a quick, quick rundown on where you've been, where you're at now, what your interests are. Yeah. Roll heads do that twenty ten year, ten year reunion. Stay tuned. I don't say that it makes me I don't like that at all. Ten years since college. Geez. Yeah. That's crazy. Um, yeah. So I did my undergraduate and of Delaware, and then I actually And then, um, I knew from the beginning I wanted to go into physical therapy. So after my gap year, returned school, and then moved down to for outpatient for a hospital Pretty much my my course. Yeah. And I know, I know because the I'm seeing all that stuff. Tell us, tell us about the, uh, were in college. Yeah, I was a figure skater for, Um, I started when I was four. I would say I was, like, competitive light and that I trained to compete, but I was never, like, a top level national international type skater. Um, and then University of Delaware was the only college that I applied to that continuing skating would be even an option. Um, and I knew I wanted to go Um, and I took freshman year, I University of Delaware has a figure skating team. Um, they have two. They have a synchro team, which of skaters all skating together And then they have, um, like a figure skating team, which I say is almost like gymnastics or swimming. So it's still like individual Everyone's doing their And when you compete, the score you get in that event contributes points to your school's team. Um, and so I took freshman year to kind of test out the waters in terms of being an athletic training interest, which obviously a very high demand major. Um, and continuing to train or kind of still do skating in this new format and um, between like myself figuring it out and also talking with like at program fan and good old Dan and Doctor K, um, figured that it would be doable that people have done it before. And so, um, sophomore, junior Delaware's figure skating team, shout out Courtney. Hey. And, um, then kind of I pretty much like, once I graduated, I stopped skating. I kind of transitioned into Um, I taught, like, all the learn to skate program. And then, um, Covid shut down, I kind of let my coaching done it yet. But I will say all of this, like giving me the itch again. I don't know, I might I might get my coaching certification again. We'll see. Oh that kid I they call him like Right. The. Yeah. He's the same kid who did the Yeah. In his programs he has backflip. So you can you know, I literally through like Instagram Reels and So you can tell me if this is But someone said that that because it was so dangerous. And he was just like, I don't Is that true? So it's legal now. So he's not doing it illegally. Um, yeah. The backflip has been creating a because a lot of people I mean, Like everyone has to say Everybody has to kind of nitpick And so headlines about him being backflip in competition are and somewhat rightly so. He's not the first person to do He's the first person to do it Um, there, I actually believe I would have thought there was a French skater by the name of Surya Bonaly, who was a high level skater international competitor when I was little, sometime in the like, maybe mid to late nineties, early two thousand, I don't one hundred percent remember. And she could do a backflip and and landed on one leg and then It was incredible. Um, and I actually, I didn't had already been deemed illegal years ago had had done one. And I think after he did it is I'm not one hundred percent sure have learned recently. Um, and so she had really tested the waters and, um, there was one competition. I also can't remember if it was actually the Olympics at this point, but there was one like really big competition, and she was pretty much already out of medal contention. And so she had been told, you know, like you can't do this backflip. And she decided to do it anyway and she wanted to showcase what And she already knew that she And so, um, she did it anyway. And so her story is a really cool one, just to kind of give people some of like the background of the backflip and figure skating, a little bit of like a shoe walk so Ilya could run. Um, but yes, he is the first one Now that so in general, over the acrobatic type movements have point earners or, you know, So you'll see a lot more people handed cartwheels on the ice or within like footwork sequences. They're doing these more acrobatic even, almost like, um, like martial arts type kick jump type movements. Um, in skating, which it's it's Everything has to keep evolving and kind of evolving with the times. And so that is where things are And, and people are rising to I does the backflip actually My understanding is like he just I don't I don't know the I got like, I have been so removed from like, the rules of figure skating that I don't know the specifics. On if his backflip counts for has a point value, but if he's or something like that, it may contributes to a higher level. So like figure skating has jumps that are worth a certain Whereas like the spins and footwork sequences, they're graded on levels of difficulty, and those levels are still worth points. But you can have like a level one or level two, level three, level four. And so like I said, I'm not one hundred percent sure, but a backflip or an acrobatic movement might be one of the, like, things that you could do to increase your level of difficulty, of an element of like a footwork sequence or something. So obviously you're down into Um, is what I got. So. So kind of based on all your experience and all that, you're an outpatient, uh, physical therapy setting. Now, kind of talk about how those experiences you have, that knowledge you have and how you kind of apply some of that stuff to your patients that you deal with. Now. Gosh, I think my background in everything I do in life, period. Um, I think with physical therapy, the, the big edge that figure skating gets me number one. Like so technically in my in sports and performing arts, also like a hospital type a So I still see a lot of like especially based off of kind of I get a lot of international, a lot of like medically complex patients. Um, so My life of figure skating So I am from new Jersey. I grew up in new Jersey. I trained in new Jersey for the was a subset of time for a few actually moved out to California were training at an Um, and so there were skaters. There were I mean, there were not like us really elite skaters who were training at this center. Um, but we also would get a team from Japan every summer. A team from Italy would come We have skaters from all across at this rank. Um, in the summertime, the coaches and even skaters who have just moved out to California because this rink was kind of like a hot spot for skating. So we had skaters who represented Armenia and, um, Russia and, um, just a bunch of other countries. So I was surrounded by people of all ages, people of all from different countries, a bunch of different language. I can speak like a tiny little bit of a lot of different languages. Um, and so really just being able, like, I feel like I connect in some way to everyone Um, also, right now it's fun to talk about because a lot of people don't I don't exactly advertise that as a figure skater. So like when I talk about it now, it's just a fun talking point. But yeah, just in general, I That's one of my like, I can doesn't matter who you you've done in life. If you're older than me, if typically can find something Um, and I really credit that to I have worked with a lot of countries that are in turmoil. Um, and so like same thing. Now we get a lot of people who In turmoil or they're they're better medical care. And so being able to kind of seen it in my life, this is not Um, and like, you know, using like, language barriers, like have experience with in life. And so putting that into like my like was an easier transition I like it, I like it. I mean, I always say So like you have sounds like you complexity to that. So being able to connect with first language, might be coming and still make them feel they can, you know, like what they're coming in for. I think that's a huge part of I chiropractic school, like my small class, it's like I would Some people just had no, like bedside manner, personal skills and stuff. And I was like, yeah, how are Like, I'm not saying like you Like, not. I'm not saying like you have you to how are you going to be going to be able to communicate? You can't communicate with me. And I'm like, I'm trying to That's crazy. Well, then you go and talk to frustrated with the medical their appointment and it's like, going in to help. There's a lot of people and I this is this is a systemic issue, right? This is not at the fault of the It's not the fault of the This is very much a systemic I will die on that hill that a lot of our healthcare problems are systemic and like patient and provider really like to go at it. And it's like we're we have a We're not enemies. Right. But the communication bit is so You know they the again I work with like sports and I work with a lot of post op and I am very lucky I get access to a lot of patients preoperatively which is should be gold standard, but it's not fully the standard of care everywhere. Um, and you know, I, I have with my patients. The surgeons are seeing patients There's no way they have the information to the patient in a digest it and understand it and just it's not possible. And again, it's not their fault. The physicians are given this like quota of patients to see they don't have the time to fully communicate. And so I think I know there's but I think that education and if not more important for post-operative journey than just Um, oh yeah. Being able to like, set expectations because they don't again, they just they can't get them. And being able to I do a lot of myth busting in my office, especially in the social media era. There are a lot of mouths Yeah. Um, and so doing a lot of myth media things or even from even providers who are still giving or they're talking, I wouldn't outside of their lane. Um, you know, I a lot of I don't I've got great relationships with, but I think this is a patients who come in saying, back to this in three months, And I'd be like, okay, I the way it's kind of like two parents. You have your surgeon parent and And like we look at things from They're looking at tissue And when it's safe to do things I'm looking at your performance. And are you showing a level of performance that can support the activity that you're trying to do? Both parents have to say, yes, no. Maybe dad will say yes. Both parents have to agree that And oftentimes, I mean, I've had it I've had like people, you know, surgeons may not fully or other providers again, not necessarily surgeons. Other providers may not fully understand like the scope of activity that certain people are doing. Um, I'm going to be having my like talking about everything and like, how long am You know, I don't do a typical No, I'm not the athletes that lifting the weights. I'm still doing the testing like And so my return to work timeline should look different than someone who does a desk job. Um, and I don't know that that I feel like I went way off on a No. You're good. Um, even, um, like you kind of A surgeon and this wise surgeon, of just said it. They talk to you for fifteen There's no chance they actually fully grasp what everything is that they're doing at that time point. And that's where you're able to grasp it and it goes both ways. Is it letting them do more sooner, or is it letting or stopping them from doing anything? Because I, like you see it both ways, just depending on who they see. Yeah. And some of it is on us, like I think I don't, you know, I can't talk to all rehab providers, but like if we're seeing something, I think we could do maybe a better job of keeping the doctors in the know so that they have in their brain of, oh, you know what? I'm getting a lot of emails ready to run until four months Um, or like that. So then they're it's in the front of their brain a little bit more. Maybe I should be changing how I I've done it. I when I word things to when I red flags to patients. I'm talking about like signs and symptoms like DVT and pulmonary embolism. I had learned that there were quite a few people that I learned that are like symptoms of a PE was like back pain that either like went through or like wrapped around. And I didn't remember that being kind of a telltale sign of symptoms. Like I changed my wording to I was like, hey, I've also heard people experience this symptom because that's what I was experiencing clinically, which is also part of the evidence based practice, right, is clinical experience. And so I don't know that everybody is taking that clinical experience into their like education component of treating patients. Um, I also think, you know, stay in your lane, which is that that I'm super passionate about. Um, of like I don't tell other So like they couldn't. And again, this is not this is not a so don't tell me how to do mine. But this is also like a but you So you couldn't possibly know what the full rehab process of the surgery that you do looks like. You know how many, how many doctors and surgeons have I shadowed? How many have shadowed me? Um, something that, like my, um. I think my department is actually doing a really good job. Our one of our residency programs, they do make their residents shadow physical therapy. Mhm. I like that and I love that outside of them, I have had one happened to like he was co And he happened to come in and But I still appreciated it because like I did certain things and he asked questions about why I did things a certain way or like why there's a certain like a certain exercise that he really likes that I don't like. And he asked me why I don't like And we actually got to have a conversation about it while treating a patient, when again, like we all have limited time that that back and forth outside of work hours can't always happen. Um, so there's my hot take. Is that more? I love that doctors and training work in conjunction with rehab your rehab providers. I love it and like it sounds relationship when you guys are the same system. There's a lot better understanding me in the private sector. I get some wacky comments like It's like my surgeon or My, uh, my ortho told me to like, never bend down ever again and like, I yeah, right between them seeing that person and seeing me like there were two years of misinformation and fear avoidance and all of these crazy things. I was like, let's nip that in Touch your toes. Like, you know what I mean? Like, it's it's crazy that want to trust your provider. That's giving you like the the best possible information for you. And a lot of the times it's the than anything else. So it's like, hey, if bending forward hurts just like don't do that. And you're like, not the But like I can be, you know, sympathetic from where you're coming from. To your point, if you only have Um, so from there, like on in my world, there's a lot more like I like the term myth busting, but I'm like, it always feels like I'm contradicting. It's like, yeah, I know your told you this, but I'm telling So how do you go about having everyone's on the same team and I feel like I still struggle with what is the right way to approach that. Like, at what point do I feel like it's my responsibility to have a conversation with the provider of like, hey, I'm seeing a I, I haven't done this yet. This is just like brain thoughts your patients where they're telling them another thing. And it seems like this is a little bit of like a pressure point. Can we work this out so that I think I think if you're if you you have easier access to you're like getting referrals that that probably should It's really hard, but I kind of would recommend the same thing if you are if you're pretty regularly getting referrals from the same provider and you're like hearing from the same hearing, the same thing from patients who see that provider, that's what I would recommend is like maybe at that point, just like try to get on a phone call with them. If it's not, if it's something That I haven't seen worked with Um, and also just like in that moment, my job is to try to, like, just de-escalate stress, right? Because the patient is now You're telling me one thing and Um, I have this situation. I have it not infrequently. I had it recently with, um, a kid who had had like an orthopedic orif, um, and surgeon was telling them that they could run. I was telling them that based on ready to run. Um, could not do a single leg And so and, like then this is an because it's a minor. And so parents are, um, And if anyone is going to get giving different pieces of parents of a patient, um, which Now, as a parent myself, I get it because I find myself questioning things. Um, and to me, the, the, the Like approach it is number one, try to get over any imposter syndrome and say like, okay, they're an expert in their field. I'm an expert in my field. And so like my opinion, like I need to believe that my opinion matters just as much as the other providers, or else the patient certainly isn't going to believe it. Right. Um, if my primary care told me told me, another thing, I'm cardiologist a little bit more the specific thing. Um, so if it's like a rehab related clearing for activity thing, we should be kind of the final. Again, both parents have to But like we should be the final say because I'm worried about body performance. And like if you do this thing, are you going to be at risk for re-injuring or injuring something else? And so me, for me, again, in this specific situation, it's about educating like, yes from like your repeat imaging that you've had your healing is going really great. They think that at this phase of I'm looking at something a I'm looking at is his is their And so I straight up like show the parent like this is a criteria that I have for returns like starting running around and like running around your backyard. Sure a little bit different. But in terms of like getting progression to do a return to And I will show them like, hey, the, you know, non-surgical leg, Do you see how different that Can you imagine if you're difference, especially running, long time like that's not going So we have to focus on this part Everyone's goal is to get this returning to sport. That's my goal too. I want to do it safely. And from what I'm looking at, X-rays to see if they can I'm doing this test to see if I can also recommend that it's safe. I think that's the best way Like throw myself under the bus know what I don't know. I can't give you the clearance can't give you the restriction But I can tell you what I'm education tells me. And then patient can make a an Music to my ears. Yeah, and I totally agree with There's the. From a physician. It's a lot more black and white. Which is why it seems like physician said whatever. It's like, hey, bone was not Now bone is attached to muscle, And it's like they did the They fixed the. Yeah, exactly. And then you take them and Like if you want to be ready to run, you have to single leg squat, hop test whatever your criteria is. And it's like I'm telling you, know, pass that. And it's like, if you can't pass It's very simple. So like that gives them the I know, like I should be here So it's like, okay. Like it's, it's like a, it's put in more work or take more versus being like, like dad said an opinion based thing. It's more like concrete. They're able to grasp it a lot Yeah. So I think giving like if we're that also helps the concern hearing I'm not ready. It's like, yeah, you're not But like this is a really easy We just have to spend a little This is our plan to get you to And I do that so frequently of I don't think you're ready to This is why. And this is what I need to see You need to be able to do your And also, you know, your muscle testing at X percentage, you need to be able to do your hop testing. We need to then go through all cutting, change of direction, components of your sport to then then they're like, oh shoot, Like, I get it, I get it now. Yeah. I also like to put this in the patients, because that's the I see a lot. And same thing of doing again, But this is where I feel like Um, is the way that I word it is like we used to think. We know a lot more than we did Um, and people get it, I think. I know you guys have kind of touched on this before, but like relating imaging to your pain is your thing. The thing that's causing your Yes or no? Is it going to heal? A lot of people get really stuck on like, okay, well I have a disc bulge. Like is that going to heal? It needs to heal in order for me And so doing a lot of talking about like, okay, well, I know, I know you've talked about this, Bruno. Like talking about like people who have a disc will have pain, have disabled. Don't have pain. Have clear findings. Have pain. Have clear findings. Don't have pain. I use that analogy all the time like this is not to dismiss your You also have findings. It doesn't mean that it's not I just like to use it to kind of It's all like de-escalating the Um, and also like, okay, sometimes this heal, sometimes they don't. But like, you could have been walking around with this for a long time and not known it, um, versus again in other providers being like, well, you have this thing and that's what's causing your symptoms. And like we need to do x, y, z Um, one hundred percent. That's, there's it's a definitely a slippery slope when people get like attached to one thing. I feel like it's something that is like, it's like pain is factorial. Yeah, it's a factor. Maybe. Maybe not. Like. And if I was being very blunt with clients, it's like it doesn't. It's like I have a disc bulge and like, what's your point? Like, does it matter? Can you still do the things that Like there's so many other almost being like dismissive of diagnosis is something that see a lot more like chronic pain have a disc bulge and like It's like, that's where I go And I'm like, okay, like we have to do it a little gently because they've held on to this belief for however twenty years or something. Yeah. So it's like, okay, like, let me wrong, but let's do stuff and Yes. You know, and it's a it's a hard there is some there is a my provider's not freaking about Maybe I shouldn't, but you also that and like staying calm and dismissing my pain because, again, it comes from not you, The system of like patience all medically gaslit dismissed. Things are not found until later And so I personally, I also just feel like as an empath, like I have a hard time being like I've. Or I almost feel like I overexplain like your pain is real. Like you are not crazy. This is not in your head. Your pain is so real. It's just like I try to throw Like we just don't know as much Like we we in some ways we know kind of means that we know less pinpoint your pain on anymore. It's just it's so And that's kind of hard to hear It's not like it was doctors or it was they're doing anything like ill will by telling people, oh, it's your disc bulge and that's what hurts or anything like that. Like we want to tell people there's a thing that we can identify and like fix and do something about. And unfortunately, sometimes we work that way, or there's not instantly gratifying thing or know, doctors who refer people specifically put like McKenzie referral and the patient comes I'm like, well, we might use But again, doing that like education work of but actually like the more recent research is showing that, you know, there is no one specific method that like is the best for treating back pain. And really like I might use some We might, if that. If that works for you, we might But I'm not going to just do it back pain need. I love it, I love it and like to something to blame and someone route, it's like, oh, let's Great. Maybe that like, maybe that is percent of people, but then you people, you blame the disc or the injection or whatever, other side without. And they they don't have any They're like, okay, now I'm Yeah. That's I'm going to give you the research to I'm like, it's I've quoted before where it was in shoulders. They've done they actually did back from falls. Um, you know, what they're But like, they did the regular inject to, like, help solidify help, to help stabilize it. But then they also did a sham like, Tap the Bone seven times had the same results. So that's a straight up. That's a real I can't believe it got how the hell that got approved. Approved? Like who the hell. How old is that stuff? It's back. It was in Europe. There's crazy Europe. But like, that's like, that's Where, uh, on the surgery side, on, like, how surgery can affect anything for you. Right. And that goes back to pain is so complex that like, even the imaging can put spin you through a loop. Um it depends. Yes. Oh, boy, oh boy. I think that's a good place to Kathleen, we appreciate you Um, and I don't know if you've episodes, but we have the guest Go fix yourself. So take us out. Give it your best shot. Oh, gosh. Go fix yourself. There you go.