Aerospace Engineer Turned Physical Therapist on Why Most Posture Problems Are Furniture Problems

Ann Crowe [00:00:00] Which in swimming your hip flexors are strong, but with your hip extended, not with your hip flex. So he did one test. Hip flexion strength on me told me I was too weak. I shouldn't be trying to train for an Ironman.

Vance Crowe [00:00:11] This is Brian Scott combining in Northern Indiana. You are listening to the Vance Crow podcast. Welcome back to the podcast. I'm glad you're here. On Wednesdays, I sit down with an expert to figure out how do you know what you know about the field that you've chosen to spend your life and career focused on? What sort of habits and discipline did it take to develop this knowledge? Now, this week I'm doing something a little bit different because I'm interviewing somebody that I know quite well. In fact, maybe I know her better than I know anybody else on the face of the earth besides myself. That is my wife Ann Crowe. Anne is extraordinary. She started off as an aerospace engineer and while she was studying aerospace, she was actually on the Notre Dame swim team and eventually tried out for the Olympics in backstroke. Later, when she was in a full-time corporate career in the defense industry, she decided that she wanted to take on the task of doing an Ironman. And while she was doing it, she found herself having injuries and not being able to complete some of the parts of the triathlon. And so she ended up going to a physical therapist. And that physical therapist showed her what is truly possible with somebody that cares so much about the details. How can you change the way that you move so that it impacts whether or not you are in pain? This is what Annie loves. It's what she cares about. It's what she thinks about. It's what she talks about all of the time. We end up talking quite a bit about my attempt at running 500 miles over the last year, and what were some of the injuries i I had and what did it take to overcome those injuries, both in learning what exercises I needed to do, but then how to have the mental fortitude to be able to, to change the way that you do something as fundamental as running.

Vance Crowe [00:01:58] And Anne also talks about her swimming career and the challenges with getting faster and how she thought about movement. It's a very interesting interview. It's also very different than other ones that I've done in the past. You will notice very early on that Anne loves and cares about the details. And that's what's so great about this conversation because she cannot help but expand out and try and say, this is what we know about this. This is how you can prevent injury. This is why we know that people are in pain. I just absolutely love it. So I hope you buckle in and enjoy this interview with Ann Crowe of Precision Physical Therapy here in St. Louis, Missouri. Ann Crowe, welcome to the podcast. Thank

Ann Crowe [00:02:41] You. I'm happy to be here.

Vance Crowe [00:02:42] So as we were getting set up, we, I was sitting, you in the chair that I have set 27 other guests and you were not having it. So what, what was up with the chair? Why was that you needed to have a different chair?

Ann Crowe [00:02:56] Well, the chair is very aesthetically pleasing for your set here, and this one is less so. However, it's a little bit too high off the ground for me. So the height of the seat relative to the ground, it's about an inch higher than is comfortable for me and it's too deep. And so I needed to find a chair where I could have good posture. And that's one of my critiques and deed of your podcast is that sometimes your, your guests aren't positioned well. And, and it doesn't always help them in how they appear on the screen. If the chair's not properly sized, just like it wouldn't benefit somebody at, at the conference room table or at their desk chair, you know, if it's not properly sized, then their, their posture won't appear as good as it could be.

Vance Crowe [00:03:42] And so how is it that you know so much about the way people sit in chairs? Why is this the thing that you know so much about? It sounds like you're the princess in the pee.

Ann Crowe [00:03:53] Very particular.

Vance Crowe [00:03:55] You're,

Ann Crowe [00:03:57] I spend a reasonable amount of time helping my clients and patients, my patients, to sit more comfortably in their chairs and understand, you know, I, I primarily work with people who have pain, although I'd of course be interested in helping anyone who had questions about their seating posture in their chair. But when somebody has pain in their chair, oftentimes they're trying to force themselves to sit in a different way or hold themself in a way that they think is good posture. That somebody scolded them when they were young and told them to sit up straight and sit in these ways. And so they're trying really hard to have posture and they think that their posture is contributing to their pain, but they don't realize that it's actually the chair is not a good shape for them, or the chair doesn't support them in the ways their body specifically needs. And, and so I spend a lot of time helping people to understand why the chair that they're in isn't necessarily the right chair for them, or how they need to learn to a adapt or accommodate any chair to meet their specific body requirements.

Vance Crowe [00:04:57] You know, it strikes me as in high school, I did not want to be the kid that was slouching in his chair, but we would have those chairs where the desk is kind of molded over top of it. And so it was for somebody more average in height, not the six foot four. I think I probably weighed 160 pounds if I was sopping wet. What's going on there? Like, is are, are most kids doomed to be slouching and and sitting poorly in those chairs?

Ann Crowe [00:05:24] No, it's just a standardized chair. You know, everybody has the same one. Actually, I hadn't thought of this until now, but my, I think it was fourth grade, it was either fourth or fifth grade. Mr. Slovis, he let me sit on top of the desk 'cause I was so uncomfortable in my chair. And so he said, as long as I could pay attention, I could sit on top of the desk.

Vance Crowe [00:05:43] Oh my gosh, that would've been heaven. I mean, I remember getting to be able to sit away from my chair when I was a kid and every single grade level was uncomfortable for me. Every single one. Yeah. Well,

Ann Crowe [00:05:54] I mean, all chairs, even if the, I honestly don't know a lot about because I work so much with adults, I'm not sure what the sizing is, like how sizing changes over the years for grade school children's chairs. Like I'm not, I would have to look into that further, but I would think that there's a standard and you probably being so tall never fit the standards. So likely the chair was never comfortable for you. But we gotta understand it was probably only comfortable for one or two people in that class

Vance Crowe [00:06:21] Outta 22 kids or 20 people.

Ann Crowe [00:06:23] I mean, probably, probably most of them are uncomfortable just because there's so many different body shapes and sizes. If you're not sitting in the chair for as long, then you wouldn't realize that you're uncomfortable. You wouldn't fall into those slouching positions or having to sit up on the edge of the chair, sit up straight, you wouldn't be sitting on your feet or crossing your legs. So I, I imagine if you have the children all sit there for a certain period of time, 15, 20, 30 minutes, and you'll see postures decline just because the, the chair is an average size and, and most people aren't AV average, like somebody in there might be.

Vance Crowe [00:07:00] And that strikes me that when I'm sitting, I always want to cross my legs. And I've done that since I was, I don't know, maybe fifth or sixth grade. And I used to think that it was a function of trying to mimic my father. You know, my dad sat with his legs crossed, but what's going on there? Why is it more comfortable for men or tall men to cross their legs?

Ann Crowe [00:07:21] Well, Shirley talked to you about this. So there's kind of two directions we can go. Like whether or not you were trying to sit like your father and or why you might be uncomfortable and crossing your legs, which might be a different way

Vance Crowe [00:07:32] For him. Let's stay away from, for him, let stay from the deeply psychological ones of, of I wanted to be like my dad. But, but just the, the function of, is

Ann Crowe [00:07:39] It the chairs? Yeah. So I think for you, the chair is too, is too low relative. So the height, if you have long legs and you have relatively proportional femur to tibia length. So if your tibia is proportionally long 'cause you have long legs, then your knees are a little higher than your hips, which puts you in more hip flexion and it distributes more weight under your seat as opposed to under your legs. And so over time you become more, more uncomfortable because all of your weight then is sitting down and you have weight from your legs that's putting pressure on your sit bones as well as your trunk. So in order to distribute the pressure, you start to sit your hips underneath and start to sit back and shift around in your chair. Once you've kind of tucked your hips under with a posterior pelvic tilt, you know, then you start to, you know, become more and more uncomfortable. 'cause that's not a good sitting posture for your back. And so you try to shift your weight around, you're crossing your legs, you're changing your position. So I think ideally, you know, people would have their feet flat on the ground, which is even hard for me to do in this chair. 'cause now I changed my shoes to match the height of the other chair. Now to the wrong height of this chair,

Vance Crowe [00:08:50] Is this a curse that you have as a, as a pt, that you will always be uncomfortable because you can identify what's actually going on with

Ann Crowe [00:08:56] The body? It's so wonderful because now every time I'm uncomfortable I can identify why. And it's not something that's wrong with my body, it's, it's the chair. So I can identify what's wrong with the chair, what might need to be corrected in order to allow me to sit more comfortably. And so I, you know, I've, I don't like to talk about what makes me uncomfortable, but it's really important for me not to cross my legs for a variety of reasons. And so if I'm leading towards that point where I'm trying to sit on my foot across my legs, that's a clear signal that something needs to be changed.

Vance Crowe [00:09:31] But like when you say something needs to be changed, there are millions of people that would love to sit up straight in a chair, right? And let's say they decide I'm going to do that, they get about five minutes into sitting straight up and down and it is now taking up all of their thinking space. The only, if they wanna maintain that posture, they have to be like, think about sitting up straight, think about sitting up straight. Oh, you're slouching a little bit. Why can't I just say, okay, right. Sit up tall and so

Ann Crowe [00:09:56] It, so yeah, if your body has adopted to certain postures over time, then you have to condition your muscles. You know, even in some cases, you know, the, you might have more tension in some ligaments than others, but you have to condition, just think of muscles. You have to condition them to be, you know, pleased with that posture. The postural muscle is gonna have a ideal point at where the muscle fibers are overlapping. It's gonna be more energy efficient for it to hold. And so you have to, over time, if, if you have adapted to a posture that isn't ideal for your pain condition or just aesthetically pleasing, then you have to work on the muscles in order to accomplish a muscle length and strength with the, you know, that suits the alignment that you're trying to maintain. So, so there are some, just tell, even if the chair is perfectly supported for you, your body's still gonna go, wanna go to the posture that's probably you're in the most frequently that it's most adapted to. So the supports that we would provide or recommend are to prevent you from sliding into, for you, you know, this, this posture.

Vance Crowe [00:11:09] But you

Ann Crowe [00:11:09] Know, it can be the opposite.

Vance Crowe [00:11:10] Anybody that's she's listening is just a slumped over. She did a, oh she did a mocking slump of over. So go ahead.

Ann Crowe [00:11:17] I not mocking, just descriptive. So right. So all of the supports, we can help you to be comfortable there, but the amount of support you might need to fit that posture that you're trying to have might be cumbersome to your task or what you're doing in sitting or driving right, might be getting in the way. So it, you know, then we'd like to give you some corrective exercises to address any muscle imbalances you might

Vance Crowe [00:11:45] Have. What do you think of those little buzzers that people are putting on the back of their neck or up between their shoulder blades to say, Hey, you're slouching again.

Ann Crowe [00:11:53] I think it's a great idea. Assuming you know, why you're slouching.

Vance Crowe [00:11:58] Okay,

Ann Crowe [00:11:59] So I, I think a lot of things are in a, in, there's like, you know, an asterisk and you go down to the bottom of the page and you read like in these cases we believe this. So I think I, most of the time those, those attached to the close in some specific spot or somewhere on,

Vance Crowe [00:12:21] I think they're usually on the back of your neck or at least the one that is advertised to me on Facebook all the time is, is that, depends

Ann Crowe [00:12:26] On which one, but, but so it's gonna calibrate to you know, what you think good posture is and then when you're moving out of that it's gonna remind you. But I think, so for most people that's gonna be, if they're kind of making their spine into more of a C shape, so they're more into flex across their whole spine is gonna create that neck posture where your head starts to move forward again. I think that it's great to have a quick reminder that you're out of that posture because you'll learn more quickly. Just like people who when they then slouch have pain are able to learn to fix it very quickly because that's a signal to them that something has gone wrong in their posture so they fix it. Oh, interesting. The pain decreases.

Vance Crowe [00:13:08] Yeah.

Ann Crowe [00:13:09] So for those that don't have pain, something like a little vibration or a quick reminder, even just a post-it note next to your computer screen, you know, when it's no longer eye level and you're having to look up, you see that post-it note to remind yourself to correct. But you need to have, here I'm just correcting my posture without the appropriate support. So if anybody's watching from that camera, you know, I'm not necessarily doing this right. So, but I think we just need to make sure that that person's just not kind of negatively reinforcing posture correction in their mind such that they hate the buzzing and they hate the posture correction. 'cause if they're having to be reminded constantly of it, you know, every 15 minutes, then they don't have the right chair, they don't have the right support. Their screen's not at the right height. Maybe their keyboard's too far away, like something is wrong in their desk setup or their station or what they're doing that's forcing that posture because if they have the right setup over time, they're gonna migrate and, and exactly what number of minutes, I don't wanna, you know, it's probably different for everyone, but over time they're gonna migrate to the old posture. But if they're in a poor setup for them, they're gonna get buzzed, you know, all the time and it's gonna be really annoying. And then they're just gonna discontinue trying to fix their posture when really they were just trying to fix themselves and they didn't fix the setup. So they have to change their environment to be able to facilitate changing their posture.

Vance Crowe [00:14:28] How do you as a physical therapist, if you're treating people in your office but you're do, do they bring in photographs of their workspace or how does that work?

Ann Crowe [00:14:37] Yep, so we do try and set things up in the office. So we kind of have, you know, keyboards or mouse or a chair and a desk. And there's pros and cons if you have more things to work with versus less. But usually the patient will demonstrate how they're sitting and we give them feedback and we talk about, you know, shoulder height and how their back should be positioned and knee to knee to hip and how the for them should the thigh be parallel a little up a little down, depends on the patient. And we have them set that up in the clinic. So we'll, we'll step through what is wrong that we're fixing with the setup. And then we would go through, I would position them and help them to get set up in a desk type environment if desk is the problem. And then we would have them set it up themselves and then they try to go home and set it up and really being able to adapt edu even if I'm not right there in their office, being able to adapt that education to their office setup makes it so that they could then adapt it to their setup at home. That's might be slightly different than the office. So they need to understand the basic principles. We all do, we all need to understand the basic principles that would support our good posture so that then we can modify any situation that we're in. So as we change those variables, now this, the cushion is different on the seat. Now the depth of the seat is different, you know, so as you change those variables want patients to understand the principles so they can adapt and they don't need us for, for understanding every station. But then they come back and if we've talked a couple times about it and they're still having problems with their workstation, then we'll talk about specific angles of the camera that we want them to take with their workstation.

Ann Crowe [00:16:17] Maybe a video.

Vance Crowe [00:16:19] And they really do this. So you have people coming in and you're like exploring their office to figure out how can we help you sit, I guess you, you're spending eight hours a day on

Ann Crowe [00:16:28] For office workers generally it's, you know, their work is thinking work. So if they're in pain at their desk, their efficiency on their, you know, you know, cognitive, intellectual work is significantly impacted. So it's very important that they're not painful when they're sitting for people that need, need to be able to focus.

Vance Crowe [00:16:54] So when, when you told me about standing desks, I found myself when I was working in corporate America wandering around being like, hmm, that person using that standing desk. Not good. Why? Why is it that standing desks are not obviously going to solve people's

Ann Crowe [00:17:09] Pain dollars? Yeah, standing desks are great. So it's wonderful to be able to change positions during the day. So if you're sitting all day, you know, your hip flexors are getting length, you know, tightened, shortened, your glutes are getting lengthened, you're having to challenge your po. So it's wonderful to sit and stand and sit and stand. I think that's just great in standing desks. When people stand for longer than their posture or their for longer than their body wants to or is adapted to, then they, then all of us will go to a position that is more energy efficient, which might be standing leaning on one hip. It might be hyperextending your legs, it could be starting to lean on the desk. And so there's a lot of positions with the standing desk that if you go to the most energy efficient posture, which your body's always going to gravitate to, then depends on your pain problem. So if it's hip pain or back pain or knee pain depending on what the pain,

Vance Crowe [00:18:09] What you're compensating with,

Ann Crowe [00:18:10] Depending on, yeah, so it, yeah, so it could be not ideal for any of those if you stand with poor po just like if you sit with poor posture, if you stand with poor posture. But definitely I advocate sitting in standing workstations, not for every single patient, but I do think that in general it is a nice idea when executed with good positioning.

Vance Crowe [00:18:29] And what do you think of the, the trend towards those little treadmills, those walking, walking treadmills as you,

Ann Crowe [00:18:35] I cannot, I would really have, I would, I mean I think that's just wonderful, but I don't know how you think on those.

Vance Crowe [00:18:42] Well yeah, you're the princess and the pea, right? You're like always thinking about am I sitting up straight enough or

Ann Crowe [00:18:47] Standing

Vance Crowe [00:18:47] Or whatever.

Ann Crowe [00:18:48] Yeah. I don't know how you think and I, I can imagine if you had monotonous tasks to do, like rote tasks that you didn't have to concentrate on, then those would be really good tasks to do on the walking workstation. And it's a low speed that people are generally walking on those, so things aren't like shaking or anything. I imagine just like anything else you could train yourself to do it over time to be able to focus and to walk. I think it's a wonderful idea and if you can do it, that's great. I struggle with concentrating, for example. I don't think I could write my notes and really be focused on the note that I'm writing while walking. But if I've worked hard enough on trying to be able to do that, I'm sure I could adapt. So I think it's, I think it's great. It, I think it could be great. I mean, what a wonderful way to keep your body moving while you're having to do what would usually be a sedentary task.

Vance Crowe [00:19:45] So I ran 500 miles this year and one of the things that came out of it that I did not realize is because I had so many problems that I had to fix, right? I had hip drop and I had knee pain and I had all, all these issues that I had no idea what they were.

Ann Crowe [00:20:01] Hmm.

Vance Crowe [00:20:02] I, now that I've started to fix them, I can look at other people and, and see their personality in a way coming out in the way that they run. Would you, would you agree with that?

Ann Crowe [00:20:13] I don't know that I, I mean I, I agree that you've gotten really good at identifying movement impairments that don't need slow motion video analysis. So you've gotten really good at that. And it's actually become really fun 'cause we can run together and it's, and we're not

Vance Crowe [00:20:27] Well to describe for other people. What we do is we are jogging together and we see somebody and we say, hmm, their hips are dropping. Oh,

Ann Crowe [00:20:35] And I don't know that we have that tone. You might have that tone. I think it's just, it's nice to be able to identify those, those patterns and be able to see them. It's hard sometimes if you haven't thought of small parts of biomechanics in your own running or in someone else's to then learn to see it. And that's part of, you know, why what I went to school for. And so I spent a lot of time being trained for that. So I love that you can now kind of see it, but we're not doing it in a judging way. We're just, you know, identifying,

Vance Crowe [00:21:03] Oh, I am because what I am the, and the reason I'm doing it is because in order for me to have fixed any of the problems that I had to do, so for example, I had a problem where I had to change my cadence. I had shin splints. Was that what was going on? Something like that. I had shin pain,

Ann Crowe [00:21:19] Right? And

Vance Crowe [00:21:20] You told me, well one of your big problems is that your feet are not moving fast enough. You're not taking enough steps per minute. Is that right?

Ann Crowe [00:21:28] Yes. You're at a low cadence

Vance Crowe [00:21:29] And so what was, what's going on when somebody has a low cadence?

Ann Crowe [00:21:34] So if you just look at when the foot strikes the ground, they're spending more time with their foot in contact with the ground. And so you're imparting the force over a longer, you know, the split second that time is longer each step. And so there's more time for the tissues to deform each step.

Vance Crowe [00:21:56] So when I would see, when I, when I had to go through this, you're going from like 60 steps a minute to 75 or maybe even 80 in my case. Over time I was trying to shift to that level. And the reason that it's so difficult, or at least for me, was that I was like, all right, if I wanna get rid of this pain, I have to move my legs faster. I'm not running any faster, but I have to, to do like, hum that that's a little sped up. But, and the only way that I could do that is if that is the only thing that I thought of. And for me that was like a huge sacrifice. I could no longer listen to music, I couldn't listen to podcasts. Now I'm trying to go for my run, which I don't enjoy and I'm having to keep this in my mind. And so the reason that I think that I'm so judgemental of other people is that I'm looking at them and I'm actually like hating on myself being like, you've gotta hate that cadence that you have. That's wrong. Because in order to overcome this, you have to be willing to give up your music and your podcast.

Ann Crowe [00:22:57] Yes. I think that's specific and unique to you at the time. So Vance has kindly agreed to let me talk about any of his injuries on this podcast. I you

Vance Crowe [00:23:07] Put permission to talk about it

Ann Crowe [00:23:08] And

Vance Crowe [00:23:08] I will edit out anything that you say that isn't, that Vance is an awesome runner. And

Ann Crowe [00:23:14] So you were having what you were calling shin splints, you had, what was the beg, what was the beginning of a stress fracture? So if you would've kept running on it, I believe it would have become a stress fracture. I'm not an x-ray, you know, but, but based on your presentation of symptoms, it seemed like you had ramped up your mileage too quickly and maybe not in the right shoes and there was some strength that was missing and you were developing like point tenderness on your bone on the inside of your shin, you know?

Vance Crowe [00:23:48] Yeah, I mean my experience of this was right.

Ann Crowe [00:23:50] So, okay,

Vance Crowe [00:23:51] Here I am out running, it's cold, it's January and I am, I'm realizing if I just run three miles at a time, it's gonna take me forever. I'm gonna have to do,

Ann Crowe [00:23:59] So

Vance Crowe [00:24:00] I'm gonna go to five miles. And to me it didn't like at first the cardio level of going from three to five, it was tough, but it was just a mental hurdle. But now I'm doing the five miles and all of a sudden my shin hurts and I can run through it. But you start saying like, it's gonna get worse, right?

Ann Crowe [00:24:18] So you, the body can handle 10 to 20% increase in stress a week and adapt to that. And I think you had increased it at a faster rate because of that. You were potentially on the way to developing the stress fracture. And so if you wanted to continue running in the way that you were, I told you you had to change your running completely, which is not what I would tell all patients, but because I'm, I see you and I'm home with you and I know that you are gonna run, you were gonna just run,

Vance Crowe [00:24:52] I was gonna do it no matter what.

Ann Crowe [00:24:53] So in, in most cases what I would recommend, recommend when somebody's trying to train change their cadence, if their cadence needs to change to address their their problem. So, you know, if they're coming in with an, with an issue that they want solved, then cadence may not be the thing that we're recommending. So not everybody needs to change your cadence. Not everybody needs to have the same cadence and you are very tall and so you don't, there's argument as to whether or not you need to be right at the ideal number and what's ideal for what body type. So there's a lot more information and research and that goes into this. But at the time we knew very clearly that strength changes are gonna take six to eight weeks. And if you were gonna be able, if you were gonna keep running, we had to minimize stress on the bone. And the best way to do that was to change your cadence. And so the reason for you changing the cadence was all consuming is because in order to change it, you need, in order to continue running in the, which I, you know, I'm not necessarily advocating the people run through what might become a stress fracture. 'cause you could end up in a boot for a really long time, totally ruins your 500 miles and your season for a good, you know, four months you'll get outta shape. And so I don't run through your stress fractures, but Vance was gonna run. And so then in order for you to maintain this cadence where you did not have pain, then it became all consuming. So I would much rather patients enjoy the process of modifying their gait and learn about their body in a way that doesn't seem so daunting and overwhelming.

Ann Crowe [00:26:25] But for you, the goal of achieving the running mileage was more important than the goal of enjoying your run. And so that's the direction we went for you. If I think exercise should be fun and you should celebrate what your body can do. And so in most cases I would rather somebody, you know, run with their metronome. Maybe they run with a metronome if, if they're a time person or a distance person. So they might choose a certain amount of time they're gonna run with a metronome. Maybe they do 60

Vance Crowe [00:26:54] Seconds. So just so people that aren't, aren't aware. So there are, when you go to try and increase your cadence, it's really hard to know am I doing 60 steps a minute or am I doing 70 or 80? So you can go buy these little things that clip onto your belt and they go beep, beep, beep, beep. And you can set them for the, the cadence that you want. And if there was one thing on earth that would be the most annoying thing in the world, to me it would be a beeping sound telling me at all times, you know what my footstep should be like to, to be clear, Anne and I have no sounds in our house that, that are like

Ann Crowe [00:27:30] Bounce turns off all the alarms,

Vance Crowe [00:27:32] Everything. Like I I do not want random distraction noises. So if I'm already suffering,

Ann Crowe [00:27:37] We had a microwave even turned off like the microwave sound that told you it was done. So you'd microwave something and then you forget about it and you would never know what's in there.

Vance Crowe [00:27:45] If I can turn the beep off, like we don't buy an appliance if I can't turn the beeping off. And so the, the, the interesting thing about doing it with this metronome is you took an activity that I did not enjoy running and you made it a little worse by making me so there's no distractions. But the fascinating thing is you're going through this process and you think for the next 450 miles that I'm gonna run, I'm gonna always have to think about this cadence. But you don't, it's almost like magic. Like one day you forget your metronome and you get back and you check your watch and you're like, oh my god, I ran that whole time and didn't even think about it.

Ann Crowe [00:28:23] What's

Vance Crowe [00:28:24] Going on there? Why is it that that changes like that?

Ann Crowe [00:28:27] You, you have motor learning principles of motor learning. But yeah, I mean even when you, did you vocalize the beeping noise? It sounded pretty close to 1 71.

Vance Crowe [00:28:40] That's right. One 70, that's right.

Ann Crowe [00:28:41] Yeah. I would have to check. I would have to check it. But as so it just sticks in your brain. You know, I, I think I can pretty accurately tell people, you know what, what is just, 'cause I hear so much beeping as I'm working with the metro. I think the fun part of it is that if I run with a metronome, if I've noticed that my cadence is decreasing and I, I want, I know where ideal is for my body and I wanna get back to that ideal and I run with a metron the whole run, it doesn't frustrate me at all to have the Metron on. I can even have it playing behind music that's at a different beat and it doesn't bother me. And I understand that would bother a lot of people, which is why, you know, rock my run or Spotify will, if that were

Vance Crowe [00:29:19] Happening to me and I'm driving a car, I would immediately like spin out of control and smash into a wall. It doesn't, it

Ann Crowe [00:29:25] Doesn't bother me. But I think what's interesting is that once I get home or I start a cool down of walking, the beeping becomes so irritating that I have to turn it off immediately. Even if I've got gloves on, I have to like get, you know, get rid of the beeping once I no longer is serving the purpose of benefiting my body and helping me to train all of a sudden it becomes very frustrating.

Vance Crowe [00:29:48] So you were, you were a swimmer and, and went all the way swim in college, tried out for the Olympics. Did you have to do things like metronomes for strokes? Like as you're swimming through the water, is there an ideal or an optimal or or is it just swing your arms as

Ann Crowe [00:30:03] Fast? Did a little bit. I only had one coach, so I had one not, well, I had a couple great coaches, but I had one that was particularly focused on technique and we had this little, it was, it was a metronome and it was just this little circular rubber, I don't even remember the name of it, but I haven't thought about a metronome for swimming in a long time. But you had it in your, you could put it in your cap and then it was very easy to tell as as your rate of turnover of your stroke cycles decreased. And, and that happened as you were getting tired, you know, so especially over 50 meters. So if you're in a long course as opposed to short course, it was much more obvious in long course as to when your stroke cycle rate would decrease. And you can imagine then you're producing less force, so your body's gonna kind of sink a little lower in the water, you're gonna have more drag, you slow down. So I, I did do that some, but it wasn't nearly the focus. That doesn't mean, you know, it's been a long time since I was competitive swimming, speed swimming. So I, I don't know if that's a large focus in training at this time. It's not something I focus on as much with swimmers who have shoulder or back pain. We're more focused in what positions their shoulder in as they're generating force than we are on the cadence. I, but I think that w would definitely affect performance

Vance Crowe [00:31:30] When I think about swimming in the same way I think about running, my impression with running was the way to get faster is to take more steps, right? So I, and then, which is why when we started doing cadence, it became so awkward for me because I thought, well if you increase your cadence, you're gonna increase your speed. But that's not really what happens. And when you told me, well actually the way you increase your speed is that you kick up your, your heels, you know, a little bit higher, a little bit faster. Is that right? Like

Ann Crowe [00:32:01] I, it you, you could do that.

Vance Crowe [00:32:03] I mean it definitely sped me up when I started focusing on bring your, anytime

Ann Crowe [00:32:07] You change one thing about your running, oftentimes people start running faster and it's not necessarily a bad thing unless the injury is going to suffer because your speed is increased. But yes, so for cadence, your cadence should be the same regardless of speed unless you're sprinting. So with, with endurance running, even if you're going for, it's your easy run versus, you know, you're more difficult if you're, i you, you should have relatively the same cadence. And so a lot of people would increase their cadence to increase their speed, but really what we wanna keep the cadence the same and the amount of ground that you're covering changes to change your speed. So, so how you get that additional force to cover more ground as you're in your floating over the ground phase just depends on what you need. You tend with the increase in cadence that we did to deal address the bone issue, you started shuffling a little bit more, which isn't ideal. And so we talked about making that more circular pattern, lifting your heels up, bringing your knees forward, making sure that you're still getting all of the major muscle groups working through a good range of motion as you're running. And if that increases your speed, I'm fine with that. Increasing your speed, you're develop, you're getting more power from larger muscle groups that are helping you to cover more ground.

Vance Crowe [00:33:31] Well, and so that makes me wonder with swimming, because my imagination was always, the way that you swim faster is you just move, you paddle your arms faster. Is that correct?

Ann Crowe [00:33:43] I mean, you will swim faster if you move your arms fast. So I mean, swimming is, these are not good comparisons.

Vance Crowe [00:33:49] Okay. If you

Ann Crowe [00:33:49] Wanna compare cycling and running, that would be a much better comparison than comparing swimming. Swimming, you're generating a certain amount of force and the pressure that you're putting on the water. So yes, people who are so in both running and sprinting, people who are in both running and swimming, people who are sprinting, going as fast as possible, have a higher turnover relative to their endurance stroke pattern. I feel like we're trying to simplify or compare things that aren't

Vance Crowe [00:34:24] Well that's fine. Comparing apple oranges, we can switch. I mean, it, it, the, the thing that strikes me is that things that seemed obvious to me about like this is the way that you run and the way that you run faster is you take more steps. The way that you swim faster is you take more strokes, but along the way of, of running

Ann Crowe [00:34:41] This, okay, yeah, so swimming fa what goes into swimming faster? Well you need to be more aerodynamic. You need to plane in the water in order to maintain that kind of plain. So when you think of a boat, right, you feel it eventually kind of level out. So the higher you sit in the water, the faster you're gonna go. And so you have to figure out, you know, all your trunk posture and the optimum amount of body roll in order to make it so that you're not sinking down or sliding down into the water. So that comes from a certain amount of force that's generated from your kick. So the force from your kick and the body posture that you're able to maintain, which is not easy to maintain those body postures requires a lot of trunk control, is what's gonna help you to kind of raise up in the water to minimize your drag. And then so that is gonna get you some constant rate of motion through the water. And then the pole additionally, depending on how you use your arms, helps you to kind of raise up in the water as well. And, and is is a huge driver of moving you forward. So different people have different rates of stroke, you know, you people have different surface area of their hands and their forearms, length of their arms relative to their body. There's a lot that goes into why one person might have a higher turnover than another. And I have not read any studies about ideal swim cadence when we were training, and this is not based on my physical therapy knowledge, this is just based on being a swimmer.

Ann Crowe [00:36:14] We knew what, what ideal for us was our coach helped us to identify that one, one coach of very many that I had helped us to identify that and be able to determine if we were falling off of that ideal. So he wasn't necessarily recommending this is the most efficient that's been identified in the research. Maybe that study's there, but I haven't read it if it is, he was saying this is what's seem, this is the most efficient for you. I've counted out, I've timed it, I've watched the video, I've figured out for you and let's see if you can maintain this, what happens over the course of your length of the pool For me, you know, in the Olympic Olympic distance pool, I was doing four of those. So, and what happens, you know, by the fourth one where you're trying to still maintain your, your body moving efficiently through the water, but it's really difficult. So you're in this kind of constant battle to keeping your body posture in order to put your muscles at the right alignment to continue generating force to move you forward most efficiently.

Vance Crowe [00:37:18] Do you find that, so you were an athlete all the way from little childhood all the way through college and then continued on to do things like an Iron man and, but do you find that now that you have studied physical therapy and, and or have your doctorate in it, that you look back on your swimming and think, oh no, what was I so often I thinking

Ann Crowe [00:37:42] So often, but I just have to remind myself that I was so young, you know, you're so young and you don't know what you don't know and

Vance Crowe [00:37:48] What's the thing that, what's the thing that strikes back where you're like, oh my god, I can't believe, I just didn't know that.

Ann Crowe [00:37:55] I think in high school there were athletes that were a lot faster than me that were also a lot taller, bigger and stronger than I was. And I just was a smaller swimmer and I kept trying to figure out what about their technique or their stroke I could mimic, what could I do? And I was looking at the wrong, you

Vance Crowe [00:38:16] Were trying to play their game instead of

Ann Crowe [00:38:17] Playing your game. I wasn't playing the right game. Yeah. And so I think that that was a bit of an issue. I had very little, I had some understanding of nutrition but not a great understanding of nutrition and I did not. Now we know so much about sleep and you know, I didn't really sleep.

Vance Crowe [00:38:38] Yeah, that's the striking thing to me that's still true today, that if you've got something you're, you're, you're like a bulldog, right? Once you've grabbed onto it, you're not going to sleep until the thing is shredded and eaten.

Ann Crowe [00:38:46] I know eaten and I, and, and you know, I did so I engineering in in undergrad and I did that in four years and it took a significant toll on my sleeping and, and I'm sure my performance also, I think there, this is changing a lot in, in swimming, in the way swimming is coached, but we did so much training at like moderate to high intensity but not at race pace. And it was a, sometimes in some coaches we would, it would be the end of the season before we'd be training a lot of race pace.

Vance Crowe [00:39:23] What's the difference between high intensity and race pace?

Ann Crowe [00:39:27] So if you could do a set for, if you could do 20 minutes and keep your heart rate, I have a really high heart rate, but if you could keep your heart rate, you know, in your like red zone or on your, you know, so we would, we, you think of the type of exercise that makes you feel like, you know you're gonna be sick, you know, that type of exercise. So, but you might have repeat sets over and over of some length of the pool where you're keeping your heart rate really high but not at its max. You're not producing your maximum amount of force on the water because you have to then rest 10 seconds and do it again 20 times. But when you're in that race, you're only doing it once and you might have to do it later that day again if you make it to finals,

Vance Crowe [00:40:14] But you can burn everything you've got everything you can get

Ann Crowe [00:40:16] Everything you've got. And so I had one coach that trained us that way, one, but now I suspect there are many and, and I was much faster swimming for that person. So I think by the time I got to college I realized this is silly, why are we doing this? When

Vance Crowe [00:40:37] Really what should you have been doing instead?

Ann Crowe [00:40:39] Well, you know, I'm not a, I'm not a coach and you know, I've, I've studied exercise physiology but not to the extent that great coaches have. So this is again outside of my scope of physical therapy practice and this is coming more from my opinion. You have to have a certain level of fitness and so in early part of the season you have to have a certain level of conditioning and there's theories on how you build that. And so that needs to be built. But I think you need to spend a reasonable amount of the season practicing the pace that you're going to have in your event and knowing how that feels and figuring out how to make yourself most efficient on that turn. Not when you're doing, you know, 85 to 90% effort, but when you're giving it all you've got, it changes how you feel in the water and, and if you don't practice it then you're not going to be as efficient at it as you could be. Just like if you're, you're training so

Vance Crowe [00:41:33] You're energy coming up to the in your body different, you're coming up to the wall at a different speed and a different

Ann Crowe [00:41:39] Slightly right and and

Vance Crowe [00:41:40] It difference and it's enough make a

Ann Crowe [00:41:41] Difference a little bit faster. Yeah, I mean just like anything, you wanna practice what you're gonna go do. And so I think there are ways to break your events down and to practice them at a, at at the speed that your goal is to swim them at. Right? So, and, and this is a long time ago now, so I think the sport is coming along and there are a lot more people and there's a lot more strategies for training that. But that was like a very clear in addition to the nutrition and the sleep and it had become very obvious to me by college what good strength training and bad strength training was for swimming. And it's apparently becoming a lot more obvious now to a lot more strength and conditioning specialists, which is wonderful. But strength and conditioning where you're strengthening the large muscles that move you through the water as opposed to strengthening the postural muscles. You, if you can't maintain your posture in the water, it doesn't matter if you can generate more force 'cause you're gonna be more inefficient, you're gonna sink further, you're gonna be lower in the water, you have more drag. So the most important thing to strengthen is posture

Vance Crowe [00:42:46] Really for

Ann Crowe [00:42:47] Swimming. I mean if you're swimming

Vance Crowe [00:42:48] And what do you mean much muscles are those, if you're

Ann Crowe [00:42:50] Swim a day, your lats are strong. Like do you need to strengthen them more? I mean yes, there's if if there's a point where you know, you can maintain your posture, your abdominal control, your paraspinals, you have the coordination to manage your, you know, your, your glutes and your hamstrings in a certain position where they're still generating force but they're also working to maintain posture. Same thing with your hip flexor. So there's a, there's a ability to kind of hold yourself horizontal with very little support. And that I think is the foundation for strengthening and swimming. And then you have to be able to hold, be able to manage holding yourself horizontal and creating all of these additional forces from different areas of your body. And some of those muscles that are gonna help you maintain horizontal are also going to help propel you forward. But if you only strengthen the ones that propel you forward, then I mean you think of

Vance Crowe [00:43:52] You have a lot of drag that

Ann Crowe [00:43:53] You want. Yeah. So if this muscle isn't strong and you're creating a bunch of force this way, it's gonna pull you into this position and now you're gonna

Vance Crowe [00:43:59] Sinks gonna sink, bring you over crouched. And so it, that's interesting. So do you, how do you know which posture muscles you should be strengthening? Is it where you're weakest then

Ann Crowe [00:44:11] You can identify where somebody is weak based on where their body is? Kinda I don't even, this is, so I, I mostly talk about, I talk a lot about running in the clinic and I talk a lot about swimming posture, but I don't describe a lot of coaching words. So I feel like my language isn't gonna be perfect for this. But you can identify based on where somebody's kind of sinking. So if their lower abdominals aren't supporting their lumbar spine, you'll see that their back will arch a little bit. That'll be the part they're a little bit lower in the water. They may look like they're relaxing their abdominals even though they're not, they have to be using them in order to swim. You know, if you see somebody, if somebody's thoracic paraspinals are weak, they're gonna fall more into like a kyphosis posture, right? A rounded upper spine position. And that posture, you know, their paraspinals aren't strong enough to maintain that position against the pull of their lat. So I, I think it just depends on what the person looks like in terms of what posture needs to be trained. I mean some athletes are rotating a ton from their low back and so they might have great abdominal strength but they're not controlling well in the water. And so even though your shoulders might rotate more than your hips do, it's, it should feel subtle. It shouldn't feel like a lot of rotation in one area, not a lot in the other. And then if you think of like how you would plane in the water, the more even and stable your trunk surface is, the more efficient you're gonna be in general. And, and and you know, you can even move some, you know, move yourself and move some water with your trunk. Whereas if you're your rotating just your shoulders now you're creating some aerodynamic and efficiency.

Vance Crowe [00:45:49] And it strikes me as you're talking about the, all these like postural muscles and and things to focus on with swimming, one of the hardest things for me to learn to do running was to hold my abs. And I don't remember why I needed to do that, but I remember that that was a, that was a big part of me moving forward probably in March or April I started having no

Ann Crowe [00:46:14] Problems. It was a part of you moving forward in martial arts as well, not just letting go of your abdominals and that contributed to some back pain you were having. So in both, it's important in both.

Vance Crowe [00:46:23] So explain that

Ann Crowe [00:46:25] Not everybody needs to hold their abs. Some people hold their abs way too tight and we have to work on relaxing them. We spend a lot of time breathing and trying to let them go. So are

Vance Crowe [00:46:34] Those people that just like way overdid crunches or, or

Ann Crowe [00:46:37] Some crunches but some like way overdone many years of Pilates or people that were always trying to hold their abdomen in, you know, maybe you know your grandma or somebody you know taps your belly and says hold your belly in. You know, something like that. And so people draw their abdominals in and then they do upper chest breathing and they don't let their abdomen expand. That's much more common in women and men. It's more often overtrained abdominals women. There's some postural or aesthetic to drawing your abdominals in, which isn't ideal because it changes your mechanics of breathing and also puts a a certain level of pressure on your pelvic floor and nobody wants extra pressure on their pelvic floor that they don't need. But yeah, so some, so for you, you needed to use your abdominals a little bit more, but I just wanted to be clear that that's not for everyone. And so you needed to use, you were letting your back extend kind of go into an arched position and because you didn't have good glute strength, your hips were dropping, which means your back was an extension, rotation posture each step. And then there's the force of running, which is three to five times your body weight. So now you're loading your spine in an arched rotated position. It's not, you were having some radicular symptoms that I think started in, you were having them when you were running, but I think they started in martial arts and you were just like, when we talked about the swimmer that lets their shoulders move and keeps their hips really still the swimmers still using their abs 'cause they have to plane in the water, but you weren't using them very much and so you would let your shoulders rotate significantly more than your hips.

Ann Crowe [00:48:10] And, and so that puts a lot of torsion on your lumbar spine and if you are kind of creating imprecise motion there, you can aggravate the nerves. And so you had aggravated the nerves so you needed to, to control your spine posture when you're running and doing martial arts. And also I imagine it helps you to generate more power in martial arts if you have better trunk control.

Vance Crowe [00:48:34] Yeah, that's definitely true. I think the, the difficult part for me for martial arts is, well there are many things that are difficult, but one of them is I, I don't have the same ability to just cue my abs or cue like move my hips or my knees. Like I feel like there are other people that have a lot more body control. They can just imagine these things and I can't do it at all.

Ann Crowe [00:48:59] Oh, you can, you can.

Vance Crowe [00:49:01] Well, okay, I mean I, I obviously can over time, but I

Ann Crowe [00:49:05] Practice, some people take longer than others and I, and that can be difficult. That can, that's one of the, everybody wants to call their physical therapist and ask how many visits does this injury take? And some, you know, there's some answer where we can say, well in general this is what I see. Someone might need two visits and they can figure it all out on their own and the next person might be really challenged with learning to move differently. And it's just not, it's just not something that comes easy to them. And so then they need more feedback and more feedback. Hopefully we can help them to have that feedback at home, learn how to give themself that feedback with a mirror, with their hand positioning, with, with having that understanding sensation of where muscles are working. Their human EMG

Vance Crowe [00:49:52] Video must, may must be revolutionary for physical therapists. 'cause you could take somebody's camera and

Ann Crowe [00:49:57] Show it to them. Yeah, yeah. It is very helpful. So I think, so it's just, so to come back to your question or your statement that it was difficult to you, I understand that it's difficult and for some people it's easy to make changes and for some people, you know, we would start with one change for two weeks and then add another change for two weeks. Whereas you might have someone that can come in and even though best evidence wouldn't say to do this, but you could give them two or three things to work on and they come back in a week and they fixed all of it.

Vance Crowe [00:50:28] Yeah. The the other thing that has struck me over this is even more than lifting because I was doing it so regularly with running, if you did integrate something into your run and you were able to do it two or three times, eventually you don't have to think about it every second and then you go two or three more times and you can let go of it and eventually you just have that pattern.

Ann Crowe [00:50:51] But

Vance Crowe [00:50:51] It's hard to imagine it when you're first starting. It seems like completely overwhelming that it's gonna tax every amount of concentration that I have to make these things happen.

Ann Crowe [00:51:02] Right? So for some people it's completely overwhelming but I, I just don't want every listener to think that if they try to change small things about their running, that it's gonna be overwhelming. 'cause it doesn't have to be. And you can change those things in increments. So like we, we were talking about time or distance, you could say the first half mile. So people, like, some people only run for time and some people only run for distance. And so just go by who you are. But if, if spend the first two to five minutes focused on this thing, or maybe you hate doing it, so you focus on one minute of doing that thing and then you run, you know, for the rest of the interval that we've discussed without it. And then you think of it again, and then you don't think of it and think of it again. It just, it doesn't have to be all consuming. It can be a pleasant experience and you can slowly build to where you enjoy making that change and it's not so frustrating.

Vance Crowe [00:51:52] Yeah, I mean part of this is that the way that I came to running was that I read David Goggin's book who, like that guy just decided I'm gonna run through this brick wall and I don't care how bad it hurts me. That's what I'm gonna do. And I found it to be very inspiring. One of the components of the book that I thought was so inspiring was he basically says, you want to embrace the suffering. You, you want to fully take it on. And that way it is a sacrifice that you're making for something else in the future. And I think one of the things that I'm figuring out as we're talking is it is really helpful to me to think about how terrible it is because then I'm doing something to face how terrible it is and then I'm accomplishing something. Whereas for you, you want running an exercise to be fun. It's like much lighter, it's much more, I mean now in your career.

Ann Crowe [00:52:42] That's e that's exactly, and and I of course, unfortunately, I am always biased to think other people want what I want and they don't. So for you, you wanted to overcome suffering and so that's what you got to do. And you changed your running really quickly and you were able to not allow that stress fracture to continue progressing over time. We managed it. And you had feedback at home. So we could every day briefly not, you know, Vance doesn't let me talk to it for very long about these things, but we could briefly discuss what was going on. I could give you some advice. You know, you didn't have to wait a week between appointments, so you were able to overcome that and continue running. And to you it was, it was enjoyable or justified suffering. Whereas, for example, we go on a run together and you can tell me exactly how many hills are left. I don't know where the hills are.

Vance Crowe [00:53:32] Yeah, that's right.

Ann Crowe [00:53:33] I don't care where the, I'm just, I'm happy when I'm going uphill 'cause I always feel better going uphill and, and so it, it doesn't bother me. I, I, you know, it and

Vance Crowe [00:53:40] Me, if I'm not increasing the number of hills, I feel like I'm becoming weaker and it's not gonna work and I'm gonna give up and I'll be a failure. So for me, like the, the act of the sacrifice of running is the satisfying thing. In fact, like the most satisfying thing about the run period was when I would sit down and write in my phone. I had this spreadsheet and I'd get to put in 3.5 or 5.1. That was the best part of the whole thing. 'cause it was like, yeah, I just got that done. And like, now looking back on it, I don't hate running. I sometimes describe that I do, but I think that's a lot of like, I need to hate it in order for it to feel like I earned something when I'm done.

Ann Crowe [00:54:23] I think the, I I, I agree with that statement and, and, and what I have, how I've seen you interact with running, it seems like you love hating it, so that's great.

Vance Crowe [00:54:38] But

Ann Crowe [00:54:39] I have, I know for myself that if I just go out to enjoy it, I don't get any faster. Like I can go for longer because I'll, I'll set a mileage for myself that I'm gonna do, but I don't get any fa I don't go, I don't get faster unless I run with someone else because I'm just out there having a good time. But I mean, my biggest joy during running is, you know, if I didn't have any pain then I was really happy. But I love running with my dog and you, I love running with you and we have a great time and you make me faster. And that makes me feel really good that I'm getting better. But I, I talk to the, if it's just me and the dog, then I talk to her on the run and I can tell that I'm telling her things that like, I think someone should say to me,

Vance Crowe [00:55:21] What do you, what what do you say to her?

Ann Crowe [00:55:23] I don't know. Like if she's running right next to me and she's keeping a constant speed and she's not veering off and she hits the turns, right? So she turns with me. If I say right or left, she'll turn at the, you know, will turn together. She's a

Vance Crowe [00:55:34] Good dog. Yeah,

Ann Crowe [00:55:35] She's such a good dog. So anyway, but if, if she's doing a good job on the run and, and she's not getting distracted and she's not slowing down, she's keeping constant pace and I'll like tell her what a good dog she is.

Vance Crowe [00:55:46] I didn't know that that's what you want. You, so you want some, you want me to turn to you and be like, you're,

Ann Crowe [00:55:50] No, I

Vance Crowe [00:55:50] Don't want you to do

Ann Crowe [00:55:51] That.

Vance Crowe [00:55:51] Take a right turn.

Ann Crowe [00:55:52] No, but I don't know, I think that the, like I don't, it's just, it's so fun to run with the dog and then I, you know, she, I can tell her she's doing a great job and it makes me happy. And so then it's just a happy run

Vance Crowe [00:56:03] You run with the dog with something that would drive me nuts, which is you wear a belt and then you strap the leash to the belt and the leash has some spring to it. So there's like a,

Ann Crowe [00:56:12] I love this belt, it's so wonderful.

Vance Crowe [00:56:13] So it, it strikes me though as a physical therapist that, that you would like that because it seems like if the dog does any kind of pulling, it's, it's right at a, at a vulnerable point, it's on your hips and it could knock you, you over. Oh

Ann Crowe [00:56:25] It's much easier on your body. So just like we talked about the caveat, like the little asterisk, but I don't remember what we talking

Vance Crowe [00:56:33] About before. Everything you say is a caveat, so it's fine. You're never gonna gimme a direct answer. Simple answer. Okay, if

Ann Crowe [00:56:37] You don't have good balance or your dog is significantly stronger than you, then this might not be a great option because we definitely, you don't wanna fall down. Like if you, you know, fracture your wrist, even if it's just your wrist, you still aren't gonna be able to run 'cause they don't want the ca you to bounce with the cast on. So, you know, use your good judgment on whether or not this type of leash is appropriate for you and your dog. But I love these running leashes that have a good spring. It's got a, it's got an elastic in it. So our dog is relatively well-trained for running, but if there's a deer or a squirrel that's just a little too close that she just can't help herself and, and I'm sure we could train her out of that, but something about it is the curiosity of the dog. And she's having so much fun. I don't want her to trip me, but at the same time, like I don't wanna have to yell at her if she's or not yell at her. But I, I don't wanna be, I don't, I want it to be a pleasant run and she's good enough now that we can just have a good time. So having this leash makes it so if she pulls even a little bit, it doesn't pull up my shoulder, which rotates my back and then I have to draw my shoulder back and that will change where my feet land and how much rotation is in my trunk. If I'm having to hold my arm still, then I'll, you have to rotate more in your trunk to counterbalance the movement of your legs. So I just, I really like that it sits at the hip, not not at the belly, but not at the waist. So I don't want it pulling, you know, onto my spine, but it sits around my hips. The weight of the connection to the leash is heavy enough that as long as it's attached to the dog and not free floating, then it doesn't bounce.

Ann Crowe [00:58:15] So it's really nice 'cause it, it doesn't bounce and annoy you, it just sits on your hip. And then if she pulls a little bit, it it gives before it stops her. So instead of, you know, all of a sudden jerking like where the pull is quick to your body, it's a slow and then it stops her. So I, I think it's very nice. I've recommended it to a number of patients that have been really happy. I think they felt silly wearing, you know, a belted leash and then got over it 'cause they realized how wonderful it is. So if, if you have back pain or shoulder pain or neck pain as you're walking your dog and you're constantly having to do this p even if you try it

Vance Crowe [00:58:51] Has never crossed my mind. Even the fact that I've run with the dog. I've never really thought about the fact that just even holding the leash

Ann Crowe [00:58:57] Changes your mechanics especially. And then you're holding it on one you, we've trained her to be on the right most of the time if there's not traffic. And so now you're changing how you're right. Which is why the last time we were doing a trail run with the dog, I asked you to take the dog even though it's not the leash that I like because I think it was changing how you draw your leg forward. 'cause the leash that we have that's not the extendable leash is shorter. And so she's closer to your feet and then she can't get out of the way 'cause you're on the trail. And so as you bring your leg forward, you're, we call it immediately rotating at your hip, you're using more of your TFL that attaches into your IT band to draw the leg forward is creating rotation at your knee as it contacts the ground. So you're setting yourself up for, to be in a rotated position. So I think there's, there's so many things and if somebody comes in the clinic and doesn't, I try to ask all of these things like, are you running with your phone or a water bottle? You are running with someone else. Are they always on the same side? You turn your head as you talk to them, do you have a leash? Where do you hold it? What's the dog do? How much do they pull? All of those things will change. You know, what your mechanics are when you're running and if you have a chronicle for use injury, then these things matter a lot and we can screen out the ones that don't matter. So it's not like we're gonna change all of 'em. We're gonna identify the one that could be has the potential. If you think of the physics of the situation, what has the potential to be contributing to the pain based on the way the stress and the joint, the biomechanics of the joint, you know, which forces are affecting the tissue that's injured.

Vance Crowe [01:00:22] You know, I'd never thought before about, you've described two different scenarios, one with the office where, hey, we wanna see what you're sitting at, what you're doing there. And then the next one with your running, hey we wanna know are you holding a water bottle or a leash or those things. So much of your work has to be about getting into the mind of another person and their experience of the world. How are they interfacing with the real world? It it's not just like, oh I got sick. Right? Like

Ann Crowe [01:00:52] I think the part where you might would would say getting into the mind of another person is understanding their goals and objectives and what problem were they wanting to solve? Not what problem do you want to solve. So, and that brings us back to your example of the stress fracture or potential budding stress fracture because you had an objective that wouldn't have been my objective for you. So that's the part where you're, you're saying are you trying to understand the goals and objectives, the mind of the person that you're working with? Because in my ideal world, running would be fun and you would change things slowly over time and you would accomplish your goal by, you know, doing this metered approach. But that wasn't you. That wasn't you and your objective and intent. And so we have to meet you where you are. If it's not something that's going to harm you other than I would have to educate you, make sure you understand why it could be harmful to you and your, your long-term goals and health. So what I would say in I'm doing is looking at, yes, how does that person interface with the world, but what are all the, I approach everything like an engineer. So we have a problem to solve, we have a set of theories, you know, there's certain context within I'm going to solve it. We have a number of givens, you know, there's all these variables that are influence the equation. So I just wanna understand what are all the variables and what am I solving for and what I'm solving for is what you want. And that's the, that's the psychologic component is is how do we constrain what we're solving for in that physical therapy equation based on the objective of what you want.

Ann Crowe [01:02:34] Because it's, it's not that, you know, the, you personally wanna have be able to continue with this running goal without taking too much of a break. And that's more valuable to you than enjoying the process. And the rate of accomplishing those two goals are different. And so it's just, we're just trying to add, so you have the, the physics, the biomechanics, the things that we know, making sure that you know all of those things. So if you always ran with a leash and I never asked you if you ran with a leash and you never told me, you know, until your last day and you're like, I'm so glad that I can now run this full distance with my dog again. 'cause I just, I've really missed running with my dog and I, and I say, oh my gosh, I didn't know you were running with your dog. What kind of leash are you using? I mean that would be, I would go home and be really upset about that. I mean that would affect like the rest of my week if I had worked with you and you had some variable that was affecting your care and and delaying your progress and I didn't ask the right question to get that information from you and you could have gotten better faster. I mean that would, that would,

Vance Crowe [01:03:40] Yeah. I mean I know

Ann Crowe [01:03:41] It would ruin my day.

Vance Crowe [01:03:42] I know that you come home and when puzzle pieces are not fitting together, it's, it it's pretty taxing for you. It

Ann Crowe [01:03:49] Is. But even if they di even if things got fit together, but they just took longer than I thought and I find out there was something I didn't know that I didn't ask and maybe I should have or maybe, maybe it was silly to think that I should have asked it and known about it, but I don't. You just, so I care a lot about the details and that's what makes physical therapy fun. So

Vance Crowe [01:04:09] That, did you know when you were making the switch, so you were an aerospace engineer and then you make this leap, you were a systems engineer for in, in the defense industry and then you make the leap over to physical therapy. Did you know that physical therapy was going to all be in the details?

Ann Crowe [01:04:28] I think it's really did you know you could turn physical therapy into all of the details, you know? Oh, okay. I don't know if ever, I mean I think that's right. All physical therapists care about the details but or I, I suspect that they, that they do. I don't think that I, I don't think that I realized that the details would matter so much. I just really liked the physics of human movement. And once I understood and more about the physics of how the bones could move and how it could change soft tissue injury and how I could choose to change that movement to change that pain, that is what was so fascinating to me. So I was, I started being interested in physical therapy. Well because I really didn't like to have pain and it, but also because it's just this unique puzzle to solve. It's, but I was more interested in the biomechanics of it. And so then I guess you could extrapolate and say, well if I was interested in, in a engineering type physics problem, there's a lot of details and systems engineering isn't a lot of physics. I mean it can be, but I was on the more like contract side of things, system requirements, testing, making sure all the processes are done properly. And so that's a lot of details but not a lot of physics. And I just love the physics. So physical therapy gave me the chance to work with lots of people, which I love in one-on-one and not big groups, which I also like.

Ann Crowe [01:06:04] And, and, and to apply biomechanics physics in a way that's really fun and has a direct result on somebody's life immediately. As opposed to like many engineering big huge engineering projects have an effect on, on a lot of people's lives, but it's more steps removed. So this is more fun.

Vance Crowe [01:06:30] More fun.

Ann Crowe [01:06:30] It's more, yeah. Oh yeah, it's fun.

Vance Crowe [01:06:32] The, the thing that you said there that I've never heard you say before, Shirley sarin and and I were on here, so you of course know Shirley 'cause you introduced her to me. She is the, the godmother of your field of the specific time. I'm fortunate to know Shirley of physical therapy and we had a part of a conversation about changing the name of physical therapy because it's almost like, you know, therapy doesn't really name it right? Physical therapy, like people have associations with that and what you are doing, what Shirley sermons system is, the, the MSI movement there, there are people that use this movement systems integration. Is that what the asking

Ann Crowe [01:07:08] I suspect she would argue that it's not just her system that she's

Vance Crowe [01:07:12] Sure. Yeah, she actually told me that she corrected me as well. That it's the system that she helped create that is now considered widely used in physical therapy. But stay with me here. The, the physics part of the physical therapy. I've never heard you emphasize that part of it really that a part of physical therapy is physics. I mean I know that that's what you care.

Ann Crowe [01:07:30] It's all, that's why it's so fun is 'cause it's all physics. But I think there are a lot of, so we would call that a biomechanic approach in physical therapy, like focusing a lot on the physics. And there's a lot of therapists who also focus a lot on the psychology aspect and there's a lot more research into chronic pain and what's going on in neuroscience. So physical therapy isn't only biomechanics, but my approach is heavily weighted in biomechanics because that's my strength. And if there's a patient that I can identify that isn't going to benefit as much from biomechanic approach, then that's when we need to pair with other providers who have more of a neuroscience or psychology background and, and could provide more benefit for certain individuals. And so there are groups of people who will best and hopefully in research over time we're able to clearly identify those groups so the patients can identify themselves as to where they will receive the most benefit. But if changing their posture or pattern changes their pain, then probably they will have significant benefit from coming into a biomechanics based physical therapy approach. We're very focused in the patient being able to solve their own problems. So giving them an understanding and a structure, a framework within they can view this issue that they have and be able to solve it themselves. So I'm there guiding them to learn about themself, to learn about their specific unique alignment, their geometry of their body and their strengths and weaknesses and how the tasks that they do every day or that they do for fun, you know, their hobbies and sports and caregiving tasks, how their body and those tasks, you know, can create this ideal, we can create an ideal pattern within those constraints for them to minimize stress on affected tissues.

Ann Crowe [01:09:22] So that's kind of my approach. And I think in some ways that gives people control over their symptoms. And so there is a psychology aspect to all of it. When you can control your pain, you know, you have a different relationship with it. So, but that's, but that's not the, but that's not my area, my area of studies, the biomechanics piece, I mean I, I have been trained in understand some of the other things that influence orthopedic biomechanic physical therapy care in my education. It's, it's just as I've continued to study, I've continued to study on movement and endurance athletics and overuse injuries as opposed to continuing into other directions. So just like any degree, you get your basic degree and then you can continue along whatever path interests you the most. And oftentimes that's also what you're the best at. And so it's just the way that my mind thinks,

Vance Crowe [01:10:20] The thing that you come home with and you have the most enthusiasm and excitement is, at least in my, from my perspective, is when somebody solves their pain problem that they didn't imagine that they could solve. So when was the first time you started to see I can do this. Like I, I I, I know enough about the human body that somebody can come to me with a pain problem like that? You know, I've never done that to somebody that's amazing.

Ann Crowe [01:10:54] Well, ever. Well, I don't know about everybody. I experiment on myself. So I think before going to school and before going to physical therapy, I would experiment on myself and you can see that you can change small things to make a difference. It's just without, as an engineer, without clear guidance from a physical therapist, I couldn't sustainably change things. When did I know I could affect another person? I mean, even as an engineer you would be, you know, some, a family member says, Hey, I have this problem and I know you learned a lot about shoe orthotics or I know you learned a lot about this or that, and we'd talk about it and try and figure out if there was a solution. So I knew that you could have an effect, but those were not effective solutions that I was coming up with before I had any training. But then, you know, on your clinicals you realize, you know, you can make a significant difference for somebody's life and that's early in your education that, that you can make small changes. And I think as you spend more time and you treat more patients, you get more efficient. And I hope to continue getting more and more efficient. But yeah, so in school I get, I I

Vance Crowe [01:12:06] I mean pain is just such a focusing thing and, and I mean I had been injured before in my life, but maybe in June or so I was lifting in addition to running and doing juujitsu. And I remember I, I went to do deadlift and I hadn't done it in a while and my back had something happen to it. Like I could just feel a stretcher. And the only thing I cared about was solving that pain. Like, it, it took over everything else in my life. The way that I sat, the way that I talked to the way that I drove whe whether or not I drove. And that was, that was like a crystallizing moment for me about your career was that I would have paid literally anything to make that pain stop. Do you see people in the level of pain that I was in, very often

Ann Crowe [01:13:01] I would say I see people often who have a lot higher level of pain than you had at the time.

Vance Crowe [01:13:08] Oh God.

Ann Crowe [01:13:08] Because you were in this acute phase of this pain. But if I wasn't at home giving you advice,

Vance Crowe [01:13:22] It would've taken me weeks to get into it. Well

Ann Crowe [01:13:24] You'd have to go see your physician to get a referral and then you

Vance Crowe [01:13:27] Would have to wait. The Missouri, you have point, you have to have a doctor's referral in order to go get it to see a physical therapist. Right. And then, so I would've had to have done that and then I would've gotten in line to see a physical therapist.

Ann Crowe [01:13:37] Right. So for some people they, I mean I think you were in the point of that pain was new and so it was so concerning to you because it was, it was new and intense and sometimes people have been living with that for a while by the time they come into pt. Oh. And so they might be more anxious about it and upset or they might, you know, be wondering if this is just their new state of life and they're not calm about it, but they're not sure what can change and you know, wondering if they should have a surgery or if there's something dramatic they should be doing so. Right. I think you, for all of the audience, Vance does not complain about almost anything. But because I ask him constantly about what's bothering him or if he's having any problems, then he tells me about them. And so we can help to resolve any issue you have really quickly, which is help to keep you active, keep you weightlifting, continue to do running and martial arts and you've been able to adapt to new sports and things a lot more quickly that you would be harder, you know, nearing your 40th year.

Vance Crowe [01:14:53] Oh, I mean there's no doubt like the, the craziest thing certainly over the last two years, but definitely the, the last year where I came to the realization that if you just have a little bit more knowledge about what's going on with you, you can head off problems that you were gonna have, but you don't know to head off problems until you've faced a problem. And it's a lot harder to fix a problem once you've started having pain than it is

Ann Crowe [01:15:18] To Yeah. If you've had that pain for two months. And so I think that's, I when you, you were originally asking about what people come in, like what

Vance Crowe [01:15:29] Level of pain? Yeah.

Ann Crowe [01:15:30] Right. And so in order to choose to address the pain, you have to have the activation energy to get into a doctor, which if you don't have a primary care, right? So something that's preventing you from exercising or you were exercising and got injured or you know, something happened in your day, it was a laundry basket or you have some pain, it's preventing you from participating in your physical activity to get into the doctor and then get into the therapist and then wait for the appointments. You have to have, it has to be bad enough in your life that you're gonna take all those steps. And so over the time that it takes for it to get bad enough to affect so much of your life that you've realized that your rest and the ice and the CBD oil you were using or whatever isn't solving the issue and that you actually do wanna come in to see a physical therapist, it becomes longer to address those issues the longer you've had them. So if you come home and you tell me, you know, I lifted something just wrong at the gym and this just is bothering me in my neck and I could give you something you could do for a day or two, it goes away. It's gone. It doesn't come back for a long time. And I mean, we'd like to fix the way you lifted something, but, but, but it's not that quick and simple if you've had it for a long time. And that's where it really starts affecting people's physical activity and their ability to par participate in the activities that they love and enjoy the things that keep them fit and healthy. And

Vance Crowe [01:16:58] Then, I mean, one of the reasons that I didn't want to take time off is because when I got in shape enough to be able to run five miles where I didn't want to die when I was done, then you think, oh, I have an injury, but if I take off to rest that injury then I'm going to have to get back into shape. And it is like, for me it was a deep motivator to address problems early on because I would actually, you're right, I would rather not tell you because I don't want you poking and prodding and watching the way that I'm walking or moving. But then I came to the realization like a a an ounce of prevention is worth pounds and pounds of cure

Ann Crowe [01:17:33] And partially, 'cause I told you if you kept running, you're gonna end up in a boot.

Vance Crowe [01:17:37] I didn't like that you wouldn't people to run at all. Didn't like that. I didn't like that.

Ann Crowe [01:17:38] And so there's not that many eng I mean there's some, like, I don't don't, I don't want everybody out there being like, I can just keep running even though I'm in injured because I think most of the time you can, but there's some situations in which it's really not a good idea and if you have a stress fracture, it's a terrible idea. And so you can end up in a boot for a really long time. And so I let you know that this, that the pain that you were having when that was the issue that you were having had the potential to force you to sit out from a lot of things for a long time, then I think maybe you took it more seriously. But if you hadn't had somebody to talk to, then you might've just kept running, you know, like the author of your book, just continue and and destroy yourself. And then you'd have gotten to a point where you would've had to take time off. And, and I think there's a lot of people that get to the point that they have to take time off. 'cause you don't know what, what's serious, what's not. You know, you have a lot of aches and pains in running, should I just keep running through it? What if I just ice it? What if I take a couple days off? What if I do this, I'm gonna change my shoes. You know? So there's, there's a lot of temporary solutions that can compound over time to inhibit your ability to accomplish your goals. So if you don't get the, if you don't get good advice at the right time, so, but not everybody has access to good advice at the right time.

Vance Crowe [01:18:56] Well, so speaking of access, you are jumping out of your job with Washington University that you've loved and had as a clinician for a while, but you're starting your own clinic. What has prompted this move? What do you hope to do in this clinic?

Ann Crowe [01:19:14] I, ever since I decided I wanted to change careers, the model that I saw that I was so excited about that I thought that inspired me to understand that physical therapy was something that I might want for my, you know, my life work and my life's work was a one-on-one physical therapy model in a private practice. And even as I selected my clinicals, I tried to, to go see a number of different private practice. How do they run? What is, what are the pros and cons? What are the challenges they have? How are they overcoming them? How is it changing different parts of the country? So I've always, I've been interested in private practice, but a big part of that is wanting to work one-on-one with a patient for the amount of time that they need. And there's pros and cons to that because there's,

Vance Crowe [01:20:16] What does that mean? You're so, so just so people are clear in many physical therapy places, I've actually never been, I haven't been to physical therapy since I was like seven or something like that, but in many places you either have a 30 minute visit, which, which five of those minutes are gonna be taken up with the PT doing notes and things like that. So 25 minutes of visit or you go to a clinic where you see the physical therapist for a few minutes, five minutes, 10 minutes, and then you go into group training with, with a phy physical therapy assistant. And they're saying they told you to do these exercises, I'm going to give you those. And what you wanted to do was to create an experience where somebody could come to see you for all the way up to almost an hour. And it's just you and them working through what was your environment that you're in, what's causing this, what are your goals? And now let's do the exercises. And then when they come in the next time you get to spend a full 55 minutes with them doing that. Is that right?

Ann Crowe [01:21:13] That's exactly right. And that's, so that was the model I, that had such a big impact on me when I was changing from being a swimmer to training for triathlons. And that's what I saw. I had seen physical therapy before, but that's where I saw it be something I would want for my life. And, and in my clinicals, that's where I felt

Vance Crowe [01:21:41] You're driving me nuts. This is a great story. So Ann is in, is competing for Iron Man and trying to get through to be able to do this. It's a how many mile swim,

Ann Crowe [01:21:53] I dunno. Two and a halfish, two

Vance Crowe [01:21:54] And a half miles and a hundred mile bike ride and then a marathon and you're trying to do this,

Ann Crowe [01:21:59] It's 112 and then a marathon

Vance Crowe [01:22:00] And you saw the details. So then you get injured or you're trying, you're having pain while you're running and you go see a woman named Carrie Kramer. And this really changes things about the way that you saw. So

Ann Crowe [01:22:14] I was not adapted at all for running. So a swimmer doesn't have, I didn't have any lateral stability in swimming other than weightlifting. I didn't have very good movement patterns. I didn't have any hip strength. You don't have, most swimmers don't have good ankle. We call it dorsiflexion, like how much your ankle bends because they're having their foot pointed in the whole time. I i in swimming, you adapt your muscles to be strong in certain muscle lengths that are not the lengths that you need for running or cycling. There's all kinds of ways that you create, you adapt your body to an aquatic sport that help you not at all except for your cardiovascular endurance, which is really high. So if you have just swam and you're a single sport swimmer, you then go to running and cycling and you do not have the geometry. You know, it's just not right. It's not a, it's not a great transition, but you have such great cardiovascular capacity that you can run or bike with that terrible form forever.

Vance Crowe [01:23:24] Ah.

Ann Crowe [01:23:25] So I think that's a, that's a big challenge. You know, you take a swimmer and you put them into land-based and then we see this challenge with triathletes all the time. And so I had a physical therapist who taught me how to overcome these issues and how to move differently. And she never once said, you shouldn't be doing this. And I, and the orthopedist told me I shouldn't be doing that. You know, that I,

Vance Crowe [01:23:54] That you shouldn't be running or you shouldn't be doing the Ironman. Right.

Ann Crowe [01:23:57] So he did one strength test on me, which was hip flexion strength, which in swimming your hip flexors are strong, but with your hip extended, not with your hip flex. So he did one test, hip flexion strength on me told me I was too weak, I shouldn't be trying to train for an Ironman. And I found that to be very insulting. And the only reason I'd gone to the orthopedist was 'cause I didn't have a primary care and I wonder referral to physical therapy. 'cause I knew physical therapy would help. And he wasn't totally wrong. He didn't have very much time and he just said, you don't have the strength you're required for running and biking. Right. That's what he was, what he, you know, I'm sure it could have been said different or more delicate where it didn't seem like a confrontation and a challenge to me. It seemed caring instead it seemed very not caring and very offensive, particularly since I, it wasn't that long since I was competing in the Olympic trials and I didn't consider myself to be weak. So the physical therapist was able to help me through the injuries that I had as I accomplished this goal that I'd had since I was a child of, of doing it, completing an Ironman. And she never told me that I shouldn't be doing it. As I've learned more about, I mean she would of course educate me in the risks if there were any risks, but the injuries that I had were not severe. They weren't things that were gonna follow me through the rest of my life.

Ann Crowe [01:25:29] So

Vance Crowe [01:25:30] Basically you find this physical therapist that says, it's not that you can't do this, you just need to know how these systems work. You need to know how your body works. And that kind of clicked into place

Ann Crowe [01:25:39] Yes. And, and what you need for running and cycling and, and how we can modify things because of your background is swimming and because of your timeline and deadlines. And so I think that's just wonderful 'cause just like we're talking about before with what you wanted in your goals,

Vance Crowe [01:25:52] I wanted to run 500 miles. Yeah. And how are we gonna, it's not, it's not whether or not I should, it's tell me what I need to do in order to make this happen. Right.

Ann Crowe [01:25:59] And that's what she taught me is what did I need to do in order to make it, to, to achieve the goals as opposed to saying that they were the wrong goals. And I think if I would've had, if I had some, there are injuries that will follow, could follow you. And if you don't address them properly, then it's a big mistake to continue with that Iron Man training. And if I had had one of those, I'm sure she would've told me that. So she wasn't like just doing whatever I wanted as the client,

Vance Crowe [01:26:27] But she was able to assess your actual strength and what what did you need to strengthen and

Ann Crowe [01:26:31] Right. And she had the time to communicate that to me. And I understand now that the orthopedist didn't have, he, you know, might c 50 40 to 50 patients that day and he doesn't have the time to delicately, you know, understand my goals and communicate with me about what it's that I need and understand my background and athletic history. And that's where the physical therapist fills the gap.

Vance Crowe [01:26:49] And so you are now starting a PT clinic with business partner Jesse Slo,

Ann Crowe [01:26:56] Who

Vance Crowe [01:26:56] Is the wife of Camden Velo, who is also on the podcast. He was the trucking executive. That is a very interesting podcast. So what is the name of your clinic? Where are you opening and what are you doing?

Ann Crowe [01:27:07] Precision physical therapy. We will be in Clayton, Missouri. And so

Vance Crowe [01:27:13] That's like a suburb of St. Louis for, for anybody listening, it's, it's like St. Louis City, the downtown is, is all the way down by the river, but Clayton is away by the interstate and it's kind of the financial district of the St. Louis County area.

Ann Crowe [01:27:27] Yeah. And we hope that location will be convenient to many patients as I've described already. I think access to care is important. And I guess the access that we're providing is convenience and location. So we, we hope that that location will make it easy for patients who are getting off of their work schedule, who are taking time out of their day. Yeah.

Vance Crowe [01:27:50] What you're saying is it's, it's a little bit rare to have a physical therapy clinic where you're having it in Clayton, but you guys made the assessment we wanna make it wanna make, there are a couple it easy for people to, to be able to come to the clinic a after work or during their day, be able to see a clinician for an hour, get their exercises and get out so that way they can make easy

Ann Crowe [01:28:11] Back to, to do as easy as possible to address, to address a problem as close as possible to when it arises. And so we wanna make it convenient for someone to say, Hey, you know, I did this deadlift at the gym and now I'm having this problem, I need to get in right away. And I, and in order to fit it into my work schedule and my family schedule, it needs to be in a location I ca that's accessible to me.

Vance Crowe [01:28:34] Th this is so you and I are like the type of people that we're, we're taking chances and we're, we're trying to do big things. And when I fully came to the real, I was always gonna be supportive of you. You decide you wanna leave aerospace and go to become a physical therapist. I'm a hundred percent behind it. You, you know that. But, but when I went through pain and then realized like, this will literally dominate my life, it will take over everything. That was when I was like, maybe one of the best things I've ever done was to support you to become a person that could solve other people's pain. And I am really, really excited for, for you guys because you are taking a business model that you've seen kind of done in other places. But it's a, it's a stretch. It's, hey, we're gonna have have patients that come visit us for an hour and we are not going to be dictated to by the insurance. So we're gonna be out of network, which means, you know, there's a different cost structure and it's a

Ann Crowe [01:29:36] Big risk.

Vance Crowe [01:29:36] It's a big risk. We're gonna go and be in Clayton, Missouri, which there may be a few other clinics, but it's high rent. But the reason that you do it is so people can do it. So, so people can get to it. So I love like that this is a moment right as your PT clinic is opening and that you were able to stop by and talk about, you know, what, what you're passionate about and what you know about. And I am, I am really glad to see you and Jesse starting your, your clinic.

Ann Crowe [01:30:03] Thank you. You know, our, our aim is to work with patients who have complicated conditions, who haven't had success in physical therapy in a traditional model. And those with complicated lives that need physical therapy to fit within the structure that they can provide.

Vance Crowe [01:30:16] And I think from knowing both you and Jesse, the thing that I have come to really respect is we're sitting here talking about dorsal flexion and, and valgus knee, but that, that anybody can come in and we'll be taught at the level that works for them because I actually can't handle all the details. All I want to know is gimme the exercise, I will fix it and then I'll get back in there. And I think it's neat that you guys both have this capacity to, to understand something really complicated, but make it simple to understand. Thank you. So if people wanna find you on the internet and, and reach out and try and schedule something, how would they do that?

Ann Crowe [01:30:54] Our website is precision, ST l.com, P-R-E-C-I-S-I-O and s tl.com. And you can schedule from the website, you can schedule initial evaluation, you can go ahead and take a look at all the services that we provide.

Vance Crowe [01:31:11] And for people that don't have pain, one of the cool things that you guys are offering is, is the ability to do a checkup, Hey, I want to, yeah.

Ann Crowe [01:31:18] So, and that's the model that we would really like to see is whether somebody has pain or not. Let's say a patient comes through physical therapy in our clinic that they follow up in six months for a checkup, just like you would do with your dentist to make sure everything's going well in with the expectation that there's some potential preventative benefit there from making sure that the muscle length and strength and balances the way that you are moving throughout your day, that, that you're reminded on how to continue addressing those to improve the mechanics of your joints.

Vance Crowe [01:31:54] Well I think it's an exciting time and I'm really, I I I believe that there are a lot of people not just that have pain, but they wanna say, Hey, I want to be ready to do juujitsu or I wanna run my 500 miles and I'm excited that you're gonna be out there helping make it possible. So thank you so much for stopping by the podcast and we can go eat lunch now. Alright,

Ann Crowe [01:32:14] Thank you.

Vance Crowe [01:32:15] Well that's gonna do it for this week's interview. Thank you so much to Ann Crowe for stopping by. If you'd like to learn more about her physical therapy clinic, it is precision tl.com. Good luck to Anne and her business partner, Jesse Velo. I'm very excited to see where this business venture takes you. If you are the per type of person that puts together events or runs conferences, or you're on the board of a group that wants to bring in great speakers, that is a big part of what I do. In addition to doing consulting for agriculture and the banking industry, I also come give keynotes and put on workshops to help people become tangibly better communicators. I offer classes on how to bridge generational divides inside of the workplace, how to tell stories that are much more impactful than your competitors and really how to think through challenging communications issues that maybe don't seem like they're communications issues, but when you dig into them that they are. If you'd like to learn more, check out my website, Vance Crowe dot com. And I hope you do. And if you'd like to reach out and talk, always know that I love, love, love Twitter. I am at Vance Crowe, so I'm gonna sign off, but make sure you tune in on Friday when we'll do an as the Crow Flies episode, where I talk about ways that you can become a tangibly better communicator. Looking forward to it. And we'll see you on Friday.