Ep 298 – Functional Therapy for the Geriatric Population with Dr. Joi Edwards

An image of an elderly woman laying supine getting bodywork performed by a massage therapist.

Bodywork for the geriatric population helps regain strength, balance, coordination, and a level of functioning—but it also creates a more independent lifestyle. In this episode of The ABMP Podcast, Kristin and Darren are joined by Dr. Joi Edwards to discuss cupping for the geriatric community, how she was drawn to working with the elderly, and her approach when setting goals for these types of patients.

 

Author Images: 
Darren Buford, editor-in-chief of Massage & Bodywork magazine.
Kristin Coverly, director of professional education at ABMP.
Dr. Joi Edwards, owner of Owlchemy Education.
Author Bio: 

Dr. Joi is a licensed massage therapist and a licensed physical therapist. She has a bachelor’s degree in parks and recreation, a doctorate in physical therapy, and specializes in orthopedic manual therapy. She has extensive experience in the orthopedic field with both injuries and surgical conditions. She works full time as a physical therapist, owns a continuing education company, Owlchemy Education, and successfully fuses the science of orthopedics with the art and intuition of massage, bridging the worlds together with the magic of silicone cups. Learn more at www.owlchemyeducation.com.

View Dr. Joi's CE course with Allison Denney, "A Combined Approach: Hands-On and Cupping Techniques for Neck Fascia" in the ABMP Education Center!

Hosts:

Darren Buford is senior director of communications and editor-in-chief for ABMP. He is editor of Massage & Bodywork magazine and has worked for ABMP for 22 years, and been involved in journalism at the association, trade, and consumer levels for 24 years. He has served as board member and president of the Western Publishing Association, as well as board member for Association Media & Publishing. Contact him at editor@abmp.com.

Kristin Coverly, LMT is a massage therapist, educator, and the director of professional education at ABMP. She loves creating continuing education courses, events, and resources to support massage therapists and bodyworkers as they enhance their lives and practices. Contact her at ce@abmp.com.

Sponsors: 

 

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Anatomy Trains is a global leader in online anatomy education and also provides in-classroom certification programs for structural integration in the US, Canada, Australia, Europe, Japan, and China, as well as fresh-tissue cadaver dissection labs and weekend courses. The work of Anatomy Trains originated with founder Tom Myers, who mapped the human body into 13 myofascial meridians in his original book, currently in its fourth edition and translated into 12 languages. The principles of Anatomy Trains are used by osteopaths, physical therapists, bodyworkers, massage therapists, personal trainers, yoga, Pilates, Gyrotonics, and other body-minded manual therapists and movement professionals. Anatomy Trains inspires these practitioners to work with holistic anatomy in treating system-wide patterns to provide improved client outcomes in terms of structure and function.    

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Therapists who are drawn to Precision Neuromuscular Therapy are problem-solvers who want to learn new approaches, but also understand the “why” behind the “what”.  This desire resonates with our emphasis on the problem-solving process, rather than the teaching of a singular technique or approach. Led by founder Douglas Nelson, each PNMT instructor is a busy clinician with decades of practical experience.

We have taught hundreds of hands-on live seminars for more than twenty years, emphasizing precise palpation and assessment skills. PNMT online courses are another rich source of discovery and deeper understanding. Also available is a video resource library (PNMT Portal) with hundreds of videos of treatment, assessment, pathology, and practice pearls.

Learn more at www.pnmt.org

Full Transcript: 

0:00:00.1 Kristin Coverly: Are you a massage therapist? Who loves to problem-solve? Do you see clients with challenging musculoskeletal issues, if so, then studying precision neuromuscular therapy will help to sharpen your decision-making skills and achieve better client outcomes. Our emphasis is on the problem solving process rather than the teaching of a singular technique or approach, led by founder Douglas Nelson. Each PNMT instructor is a busy clinician with decades of practical experience, visit pnmt.org to explore our offerings of live seminars, online courses, or the video resource library, at the PNMT portal. That's pnmt.org.

[music]

0:01:00.4 Darren Buford: I'm Darren Buford.

0:01:00.5 KC: And I'm Kristin Coverly.

0:01:00.6 DB: And welcome to The ABMP podcast, a podcast where we speak with a massage and bodywork profession. Our guest today is Dr. Joi Edwards, Dr. Joi is a Licensed Massage Therapist and licensed physical therapist. She holds a Bachelor's Degree in Parks and Recreation, a doctor degree in Physical Therapy, and holds her specialization in orthopedic manual therapy. She has an extensive experience in the orthopedic field with both injuries and surgical conditions, she works full-time as a physical therapist, owns her own continuing education company, Alchemy education that successfully fuses the science of orthopedics with the art and intuition of massage. Bridging both worlds together with the magic of silicone cups. Learn more at alchemyeducation.com. Hello, Dr. Joi and Hello, Kristen.

0:01:44.9 Dr. Joi Edwards: Hello thank you for having me.

0:01:46.3 KC: Hello. We are thrilled to be talking to you again.

0:01:49.0 DB: And this is amazing, Dr. Joi is in Studio.

[vocalization]

0:01:55.5 DB: And this is Dr. Joi's second time on the podcast. Listeners, during our first conversation, we discussed Dr. Joi's balancing of being a PT and MT, and then we dove really deep into cupping. Listen to that first podcast at ABMP.com/podcast or wherever you listen to our podcast. It's Episode 156, Cupping with Dr. Joi Edwards.

0:02:17.3 KC: And listeners, the reason Dr. Joi is here with us in the ABMP podcast room in person is because she's been here the last few days filming three incredible CE courses on cupping, cupping 101, cupping for orthopedic injuries of the upper extremity and orthopedic conditions of the lower extremity. They are fantastic. They're coming soon to the ABMP Education Center. I can't wait for you to see them. One of the things I've been talking with Dr. Joi about while she's here, is her job working at a Continued Care Retirement Community with the geriatric population, and I know so many of you are curious about working with that population and how different is it than working with someone in their 40s or 30s or 20s, how many accommodations do you make... Is assessment different? All of those questions bubble up, so I'd love to start with you, Dr. Joi, just talking in general. What's it like to work with that population? Tell us about it.

0:03:12.7 DE: So it is amazing actually to work with that population. I started my career off in orthopedics working with 20 year olds, 30 year olds, something like that, but athletic individuals. And I worked, oh man, with that population for maybe 10 or 15 years. And then I was just blessed to be almost thrown into this position with geriatrics and Alzheimer's. I actually did not think that I would like it. Turned out that I absolutely love it. You know, age is so subjective and function with age is so subjective. So nothing is really, really different other than, I mean, I have literally 94 year olds that are planking. I had a lady come to me and say, you know, my shoulder hurts Joi and I wanna know about it, it's when I'm planking. And I'm like, what do you mean it's when you're planking?

0:04:00.5 KC: Does that mean something different to you like, than me?

0:04:03.1 DE: I'm like, like when you used to plank and you know, she's a little bit frustrated because I'm not receiving it the way I should. And she says, you know what? I'll just show you. And so she proceeds to get on the floor and plank on elbows and then tell me like, and literally point to it like it hurts here. And so some accommodations with positioning, maybe somebody can't lay supine, but not really much different between the generations and cupping, I will say is a very new thing to a lot of the population that I see. But they let the results are so immediate and I usually say, Hey, I have this thing right, I wanna... I'm gonna use this thing on you. And I show it to them and it's very unassuming. It's a small cup, you know, there's no bells and whistles and they, yeah, sure, okay, go ahead and use it.

0:04:44.1 DE: And then as I'm doing it, I always see the eyes, the eyes always look like, what is this thing? And I say, alright is everything okay? And it's like, that's amazing. What is it called? And so now they wanna know, what is it called? You know, it's very dismissive at the first introduction. And I have most of the people come back and say, Hey, I need that cup thing. So it's amazing. I mean, the tissue, there's a little bit laxity in the tissues, but I treat everybody the same. I check the tissue. If someone came in and they were, you know, purple and then they were bruised up because maybe they were on blood thinners, then that would be a conversation. You know, maybe I would not choose to use the cups on them. But other than that, I am cupping everybody.

0:05:21.6 DE: I'm cupping for balance, I'm cupping for pain. The balance thing is a bit new for everyone. Some people come in and they say, you know, a lot of people unfortunately write people off because of age. You're 60, you're 70, you're 80, so your balance is gonna be bad. That's just what happens. But it's not really just what happens. So a lot of times it's that, you know, people aren't moving as they were in their 20s and their 30s. So they don't have the range of motion at their ankles. In order to balance, in order to stop from falling over your ankles have to move, your knees have to move, your hips have to move. And if all of those don't work, then there's a thing called a stepping strategy. So I had one guy that came to see me, he was career military. He had been in the military for 30 something years, but his job was to fuel jets.

0:06:03.4 DE: And so he wore these almost knee-high boots because they needed to be his ankle stability as he's almost stepping like three feet into the jet. And so the boots served a purpose, but after he was out of the military, well his ankles weren't moving for 30 years, so the limitations of range of motion in his ankles were poor. And so I worked with him manual therapy 'cause every physical therapy patient that I say, I'm doing my manual therapy, I'm probably gonna pull the cups out. And so what I did with him was I just worked, I looked at his ankles, there was absolutely no dorsiflexion. And so I got him, I mean, not even a lot, it may have been like eight degrees more of dorsiflexion by using the cups and using my hands. So then when I went and stood him in front of me and gave him a little shove, his ankles now could move, the muscles could contract the way they were supposed to. And so his balance was "miraculously fixed". But it was never really a balance issue. It was more of the muscles couldn't do what they were supposed to do. So yeah, I love cups on that population for so many different reasons, but that's a big one that people have never really thought about before.

0:07:11.6 DB: Dr. Joi, you mentioned that you didn't think you would be driven to work with that population. How did that come to happen?

0:07:17.0 DE: So I was working with a company and a lot of the things that were going on with that particular physical therapy company didn't really align with my morals. I was being asked to be creative with billing and I would get in trouble a lot. So there were several sit down meetings and the last one was, did you hear what I said last time? And I just smiled and I said, I did. But, so there were a lot of things like that that went on with that company and it just, it really, it spoke to my soul that I just, I couldn't continue there. I wasn't gonna do what they were asking me to do, number one. And there was no way around it. And so at one point I remember the conversation got a little bit heated and I said, you know what? I think I requested off or something. I said, "Nevermind. I take that request back, I quit," and I quit. And I did not have a net. I didn't have a safety net. I didn't have a job to fall back on. I've always taught my kids, you don't ever quit without having something. And I quit. And as soon as the words left my mouth, I thought, oh my gosh, what did I just do? And then the second thought was, Hey, look what I did. [laughter] And so I quit. And it's funny, I went to my mother's house. I live in North Carolina, my mom is in Seattle. I remember flying to Seattle and I usually, I buy a round trip. I bought a one-way ticket and I usually stay about a week. And I was there for two weeks and my mom was like, is everything okay?

0:08:48.2 DE: Like, are you planning on leaving? But during that time it allowed me to just kind of... I think the stress that had been packed on working with that company was so heavy it allowed me to just kind of decompress. And I was looking for jobs while I was there and it was like the only job that was available was Alzheimer's and Dementia geriatric care. And it was part-time and I needed a full time because, now I'm two weeks of not working. I needed a full time, it was part-time and I thought, this is what's there. I'll work until I can find something better. You know, something that suits me. And I worked maybe the first week and I thought, I am never going anywhere else. It is just, it is really my happy place. And taking that a step further, some years later my father was diagnosed with dementia. And so I really believe that that was a blessing in disguise that I would've never pursued on my own. But I think it has allowed me just honestly the joy of meeting this new person and not saying, man, dad's not the same anymore, but it allows me to meet this new person and fall in love with him so much more. So, I... And for that reason, I just, I really love my job. They are super honest, they are fun. It's an amazing place to be.

0:09:58.1 KC: And isn't it amazing how you take that leap of faith? You take the step, it was right there. You took it and it led to something that you absolutely love. Like you said, you wouldn't have done it otherwise.

0:10:08.7 DE: I wouldn't have done it otherwise. And I, you know, again, looking at it and I'm like every day I'm looking, I'm like, this is the only job available. You know, if that's the only job available, it's like a restaurant. If there's only one car outside of that restaurant, the food's probably not that good. So I'm like, this probably is a job I'm not gonna love. You know, you hear horror stories about dementia and Alzheimer's and all the things. And it was totally not that. And I have never looked back. This is definitely my happy place. And really it's not what you think about as a retirement community, as a nursing home, as an old folks home, you know, at my particular facility, again, there's, you know, 95 year olds planking and we have mini golf and they're doing 5Ks.

0:10:46.8 DE: And I actually have been able to do cupping therapy with aquatic therapy at the same time. So that's... I mean, we have a jacuzzi, so we have that thermal therapy too that all of this is going into treating this client. And I can see people and they may not be on caseload, but I say, oh man, Kristen's walking a little funny. Let me ask her is everything okay. So really getting in there and being like an advocate for them and saying, Why don't you come see me and we'll figure some things out or even let me talk... 'cause we have a doctor on site, we have nurses on site and let me talk to them and put something in their ear so that they can check you out. So I really do like... You know, life is very short and then life when you're in pain or something is going on, it's hard. So being able to be the eyes and maybe even advocates and make life a little bit better for people is an amazing, amazing opportunity.

0:11:36.6 DB: Can you give me just an insight a little bit about the day to day? What would your day to day life be like? Are you walking in and a doctor's prescribing you working with someone or you're just noticing it? Can you just take me through that? Working with the clients.

0:11:49.3 DE: Actually, all of that. So if I were to go to work tomorrow, I already have people that are on caseload. On my caseload. I probably have, I wanna say maybe 25 people that are on my caseload. So that's including outpatient therapy. People that have gone on their own to see the doctor because you know, my ankle hurts, my shoulder hurts, my knee hurts. And then their doctor gives them a prescription to physical therapy. With that, I still have people that are on, my skilled nursing caseload. So people that may have had a stroke yesterday, a stroke last week. I have actually... One of my newest patients is a recent paraplegic. He is very young to be at our facility. He is, I wanna say in his 60s. And he was... He was a construction worker and so he was leaning over a railing to screw something in and his screwdriver caught, but it was enough and his body was already shifted forward.

0:12:47.6 DE: It was enough to throw him over over the railing and he fell 25 feet and on top of the falling, if that wasn't enough, he fell onto rocks, boulders so he didn't fall flat. And so he immediately did not feel anything from the waist down. So he is on caseload. So I would see him, I would see somebody that had had a stroke, maybe somebody that had went to the hospital and they are just debilitated. So I still use cups on those people because go to the hospital, even a day or two in bed without moving, things get stiff. So I'm whipping out my cups and we're working on the stiffness. And even the paraplegic, they're... You know, for him, he now only has half of his body that is functioning. So his arms are doing everything, everything. So his arms are getting tired.

0:13:33.4 DE: So they're tired and they're painful. I'm throwing the cups on him and I told you I have my balance people, I have people that have hip replacements and I will treat them first. We call it on land. So I will treat them with the cups and with my hands. And then in the next maybe 15 minutes, we'll go and we'll jump in that pool 'cause they can walk and they can do exercises in the water that they can't do on land. So best of both worlds. And then I'll have people still... I mean I have... I see I do 10 hour days. And so in that 10 hours I probably see 10 to 12 people. And I will still have evaluations where people come in and bring me a prescription from the doctor that says, you know, treat this person's knee pain, treat the back pain, treat plantar fasciitis.

0:14:11.1 DE: And then they are my new patients and we just go through the cycle every day. For me, I don't make my schedule. So every day is almost like Christmas. I walk in and I don't know exactly who I'm gonna see, but I love seeing the variety. So I love that I can treat on land. I love that I can treat with my hands. We can go on the parallel bars, we can walk outside. Some people need to be able to, holidays are coming up and they live where I work. So everything is flat, but they really want to be able to go to their daughter's house and she has five stairs. Those stairs are really hard, you know, it hurts. It's hard. I don't have enough strength. And so that's our goal. Everything is functional, so we work on that. I might put the cups on them because there's typically pain associated with that strength deficit. And then we work that. So I can work anywhere at any given time.

0:14:51.1 KC: Let's take a short break to hear a word from our sponsors. Hey, lifelong learners. Did you know that Elements Massage Studios are hiring? And at the top of their list is curious massage therapists, like you. Elements Massage Studios are all about improving the lives of everyone they touch for them that includes giving you training in new skills, a supportive team, and chances to grow a client list. If this sounds like it could be your new home, let them know we sent you by going to elementsmassage.com/ABMP. That's elementsmassage.com/ABMP. Let's get back to our conversation.

0:15:31.9 KC: You say sometimes clients are coming to you with a prescription from a doctor and other times they're coming to you just on their own. And I'm curious, oftentimes, I'm sure they're coming because their activities of daily living have been compromised in some way. Can you talk to us about your assessment process with each of these clients and how do you talk to them about the process? How do you assess and then how do you set goals?

0:15:53.9 DE: So everybody is different. In my personal nature, I love to treat functionally. I feel like for the most part, people don't come in because they have pain, right? I have pain, the next door neighbor has pain. We only when the pain starts to affect what we can do. I can't, you know, I love to eat. I say that all the time. I love to eat. So even if I have TMJ pain, I'm not necessarily gonna seek any therapy. But the minute I can't bite into that churro donut, there's a whole issue. I need to see somebody, somebody has to fix this. And so that's typically what I do. Even though they come in with a prescription, I look at the prescription and I respect it, but I'm gonna have a conversation with that patient and say, why are you here?

0:16:33.7 DE: And that's it. It doesn't have to be super medical. What's up, what's going on? And people will say, it hurts here. When I do this, this happens. And so in my head, for a physical therapist, we have to... We have to set goals and then we have to reassess and maybe like four weeks, I think we reassess. And so for me, in my head, as I'm having the conversation, I am writing these goals down. I'm saying, oh my gosh, okay. Kristen cannot reach into the cabinet or when she... She bites down, it's a nine outta 10 pain, you know. And so I'm gonna do what treatments? I think like TMJ, I'm gonna cup for TMJ, I'm going to, you know, cup for anything. And then at some point I'm going to reassess, but all of my goals are functional.

0:17:09.7 DE: And then all of my treatments are functional too. So I'm rarely... I'm rarely one of the physical therapists that are saying stand in the corner and do 30 of these exercises. I'm a manual specialist and so I feel like if you're actually gonna have a copay to come see me or walk whatever distance or drive over to see me, I want you to see me. I want to... I want to do treatment and not watch you in a corner with the stretchy band or with the weight. So I'm putting my hands on almost everybody. I can't think of anybody I wouldn't put my hands on. But at the same time, I give just a few exercises, that again are going with our functional goals for them to do at home so that they can supplement the time that I'm not with them. And then they come back and we're still making really, really good strides towards where they want to be.

0:17:57.9 DB: Now is... Are the goals here with regards to the relationship that you have with the client or also are they extending possibly with the doctor as well?

0:18:07.7 DE: Typically, not, honestly for me, not with the doctor. The doctor doesn't have a lot to do with their goals unfortunately it is just a, go see the doctor and they say, okay, this is my prescription for you to get better. And then, and so it's on me, especially in North Carolina, we are what's called the direct access state. At my particular facility, those people do have to have a referral to come see me. But generally in North Carolina, you can come in off the street and see me and you don't have to have a referral. And then I do my own assessment. I think Kristen asked me that. I don't think I addressed that. But I do my own assessment. So I'm gonna ask a lot of questions. When did it start hurting? What were you doing when it was hurting?

0:18:44.9 DE: How much pain do you have? Or whatever discomfort, what is something... And I usually ask the patient, what do you want to do? What do you want to be able to do that you either can't do now or you can't do well like you used to. What's our goal? And that way they are empowered and it doesn't feel like somebody else is running their wellness. Like they have to be a part of that. And even the paraplegic, you know, he has... Life is new for him. He has a wife, he actually has to do what's called bowel and bladder management. So he can't feel anything. It's not even the waist, it's a little bit higher than the waist. He can't feel when he has to use the bathroom. So he, now that's been the biggest issue for him is that once he leaves the nursing facility, his wife is going to have to do some of that.

0:19:29.0 DE: Some of it, without being too graphic, is called digital stim. So he has to stimulate that area in order to evacuate his bowels. He doesn't want his wife to do that. He wants to be able to get on the toilet by himself and not have his wife do that. He wants to maintain some of his dignity. So my job is to give him everything in me to maintain his dignity. And one of his biggest things is he's so worked up about doing things right, he wants me to grade him after he's done. And he says, "What can I do better?" And everybody is different, and it's... I'm not... People come in, I'm not treating a knee, and I'm not treating a shoulder, there's a whole entire person attached. And then with that, there's family that's affected because of this one person. So it's life that we're treating, right? And so with him, I did... I said, "You know what? We need to work on your mind." And he was like, "What are you talking about? Like physical therapy, what can I lift? I'm ready to... 300 pounds." "No, no, no." I said, "You were a different person, and you... We have to address that."

0:20:31.3 DE: In his mind, he already... He gave himself, I think three months, and he would be doing X, Y, Z. I'm like, "That's super lofty." And so just kinda meeting him where he's at and having these deeper conversations with him. It's always been my philosophy too that if you treat the mind, and you can get the mind in a better state, the body will follow. Life will be better if you can get that mind to a good state. And so with him, my focus is on getting his mind in a happy, healthy state. 'Cause he's gonna have a road ahead of him. We're shopping for recliners, and he... It's really hard for him to get from one place to the other. And he adds that stress on with the wife and with the kids, and I don't want nurses to do this. But we're here, and this is our job, so let us do it. But just having deeper conversations. And everybody is different, some people... The focus is on something else. Again, like I have people that... I had a patient that wanted to be able to walk without a cane, because their great-granddaughter was getting married, and she was in the wedding. So my goal, her goal, was to walk without that cane for some maybe 100 feet.

0:21:34.5 DE: And that made her happy. It wasn't a big thing to me, I'm like, "Well, just walk with the cane, you're still walking." But no, it was a big thing for her, so it was a big thing for me.

0:21:45.9 KC: Well, and the way that you approach the work, the conversations you have, the questions you ask the client, the very personal goals that you set with them has to get them engaged in their own treatment in a much different way. Client... Darren, as the client, wouldn't that be more engaging for you to have a goal that's set to something you aspire to do or want to be able to do again?

0:22:10.6 DB: I totally... From the client perspective, I totally understand the client that you've been working with who has a set list. And like, "I need to accomplish this set list, that's how my brain works. I need to get from a three to five." But also the disarming that you're doing through your intake is... It's really powerful, 'cause I feel like instead of you just looking at, "We're gonna make my knee functional," so your goal is we don't meet any more, so now I'm gonna go ride a bike or do whatever I'm gonna do. You actually have talked to me like a human being. Like you care, like we're actually doing it together, and that just kind of... You already kinda get a very positive stimulation in your mind and your body just hearing that, that somebody is meeting you halfway or more... Anything, honestly. Versus looking at you and going, "Wrist, wrist, assessment, da da, must do this, must... " 'Cause you can see when somebody's ticking off those boxes. And as a client, you don't... I mean, yeah, I wanna get better, and I'll go through the list with you, but now I'm a little bit more motivated, 'cause you're asking questions like what I might do functionally outside in the world.

0:23:21.6 KC: And you're probably more motivated due to self-care, I know I would be, 'cause I'm working towards that goal now with you. Versus like, "I'm gonna let this practitioner do this thing to help me improve." No, I'm in it too, and we're doing it together.

0:23:33.4 DE: And a lot of times too, the goals are different. So I might have a strength goal like you do need to be strong. But a lot of times, I set a goal... So I set a goal for improved strength from three to four out of five. So when I go, and I reassess, and I check it off, "Okay, they are stronger," in my eyes as a therapist, they've met that goal. So I can have all these goals that have nothing to do with function, but in my head, it was a successful episode of care, because all of my goals were met. "Range of motion has increased 10 degrees. Strength has increased." But then when you ask that patient, "How was therapy?" "It didn't help at all." So two completely different ideals, and I'm like, "Are we both in the same room?" Yes, but because their idea of getting better didn't look like mine. And it's not mine, it's not mine as a therapist to say, it's their life. I want to fix or make their life better, I don't wanna... Like you said, Darren, check off these boxes. So what that we're 20 more degrees of dorsiflexion? They still can't get up the stairs, so we're spinning our wheels, and for nothing." So then I feel like the 60-minute treatment, and then even fast forward three weeks, four weeks of therapy has been wasted, and we're nowhere.

0:24:44.1 DE: And you can't get that time back. Life... I can't say that enough, life is short, and I think that it should be as fun and happy as possible. I had two people, actually a husband and wife, that didn't really need therapy. But they were... Gosh, they were going on like a series of four cruises. Like one left from Germany, and then they did that for a couple weeks, and then they left from wherever they were at, Italy. It was crazy. But they knew some of the architectural... Like some of the cities, the steps would be steeper, and they would be skewed a little bit. And so they wanted to make sure that they're balanced. And they did have a little bit of discomfort, I shouldn't say they didn't need therapy, but it was very small. But they wanted to make sure that time while they were away, they could do these things. And so we did some crazy stuff. Like I mentioned the baji, we did the baji. We went, and we climbed these rocks that are nearby. There's a... Used to be a... It was adjacent to a grave yard, but it's very, very kinda steep and hilly. And in my head, I'm stepping up on boxes. And they are, they're very dialed-in.

0:25:48.0 DE: Because it wasn't my goal of increasing knee range of motion to 90 degrees, it was, "Can I step on this weird probably cement step and be okay with that?" And so I developed some exercises. And even I went a step further with these particular people, 'cause they would be away from me for so long, and I wrote, "If this happens, if this hurts, and you get a little bit of swelling, then this is what you're to do." And so I wrote an entire list. And being dialed-in, my gosh, they emailed me three separate times while they were on vacation, "Look at these steps, we have done these steps every day, and no pain, thank you so much." And like when I go home, "How was your day?" "Oh, it was amazing." I really do take that stuff in and internalize it. And I feel so much better when they send me these pictures or catch me in the hallway and say, "Oh, I could play tennis," or... Yeah, it's an amazing feeling. But we are, we're both working toward a common goal. And it does, it feels really, really good.

0:26:45.4 DB: Dr. Joi, what kind of adjustments or contraindications are there, if any, with regards to cupping in the geriatric population?

0:26:55.2 DE: So the biggest thing, I think it's... For the most part, it's the same, we're not cupping the anterior neck. I am a little bit more aware when there's a pacemaker present, I don't want to be the cause of disturbing any rhythm. I really... There's no actual contraindication that you can't cup anybody with a pacemaker, but always err on the side of caution, more safe than sorry. And the biggest thing, I think, is the skin. Sometimes people have pre-existing conditions too, diabetics. And if they can't, if they don't have sensation, then I would not put a cup on that area, because the cup is there, and they can't feel it. What if the suction is too strong? What if I... Oops! I forget that I even put the cup on, so now we have strong suction for too long, and they develop a blister?" People that have diabetes are very, very slow to heal and are prone to infection. So even if they come in, and I do assess... As soon as they walk in the door, I'm assessing. I'm not saying I am, but I'm looking at them from head to toe. My father is one that bruises super easily, but he is on blood thinners. So you can sneeze on him, and his skin is gonna tear. So that type of skin, I would not cup.

0:28:01.9 DE: So I'm just kinda looking at those things. But no huge... There's no big list of, "Oh my gosh, these are things that you can't do with geriatrics." And I don't shy away from it, I go right into it. I do check the skin a lot more often if I do cup them, I do a smaller cup, I do short times, and I'm saying 30 seconds looking at the skin, a minute looking at the skin. And if they kinda go through that first treatment, and everything feels good, then I can build off of it. I can't take it away though, I'm very, very cautious, and my progression is slower, I think, just because I wanna make sure I'm not doing anything to harm them. I had one physical therapy patient... It wasn't with cupping, but physical therapy patient. He was a diabetic, and he didn't have any sensation, I wanna say, from the knee and below. He told me a story, he fell asleep, it was at winter time, with his feet crossed the next to a heater, felt wonderful. He didn't have any sensation, he was too close to the heat, so literally ended up having to amputate three of his toes. Because in a sense, it's almost like the skin melted off. It was that burned that we...

0:29:05.6 DE: They just couldn't save the foot. And so I do think of that and just being very, very careful as I am cupping people that may come in, again, with pre-existing conditions. And we're going through those conditions. Do you bruise easily... If you bump into this. 'Cause, again, people have been with their bodies for a lot longer than I've even been treating, the 15, 20 years I've been in therapy. They've still been with their bodies longer, they know how their bodies react, so we're gonna have a conversation. I think more conversations need to be had just across the world anyway, not just in massage, but a lot more conversation. And I don't have to do everything in that first treatment too, I think some people get so wound up about, "Oh my God!" Especially physical therapists. We have time. So my time is usually 53 minutes that I have with a patient, that includes... Evaluations are a little bit longer, I get 60 minutes, maybe 75, but that's the whole conversation, the subjective. And I'm not rushing, so I'm not checking off any box. We're sitting almost like we're sipping coffee. I want them to tell me everything that they have so that I can be in a better position to treat them.

0:30:06.4 DE: So we're doing that. I'm gonna try to do a little bit of treatment. And I love to give at least one exercise or stretch or a... I call it a no-no list, "Don't do that. Don't go and do that, that's gonna be worse for," whatever. But I try to give them something like that on the first day, and then I still have to document. So I'm trying not to rush through and check off things. But again, that kinda humanality, having conversation, and then going from there.

0:30:29.5 KC: Dr. Joi, I'm curious, what advice do you have for a massage therapist or body worker who's listening who's getting really intrigued about working with the geriatric population, but they don't have experience yet? What advice do you have for them?

0:30:40.3 DE: Do it. Do it, do it, do it. I think... Again, for me, it was something that I never thought I would like. I think try everything. I think if you have... And a lot of these places are very, very open to anybody coming in and volunteering. We have what's called the... They call themselves the Pushers. [chuckle] But they're are the people that live in independent living that come down to skilled nursing, and they push people in their wheelchairs. But even people from the outside can do that. But I would say get in, volunteer, it really does your heart some good. It makes my heart smile every day. A lot of people that live where I work, they don't have family that's nearby. And so any conversation, bringing magazines, volunteering to do anything, it's just a wonderful thing for them. So yeah, get involved. I think it's a beautiful population. I feel like to a degree in America, it's a little bit different. Sometimes we look at our aging population, and we kinda throw them away. They can't do this, they can't hear, they can't... But they're still people. And I know in other countries, as you age, you're almost golden. And people really gravitate toward that, and they try to do more for this population. And, I mean, it's just... It's so appreciated too, it's needed.

0:32:00.5 DB: I'm not sure if there's any facility in the world as lucky enough.

0:32:04.5 KC: Agreed.

0:32:04.7 DB: Unbelievable that you have connected with this place, that this found you as you found it. But just how special that is for them to have you working with them, just incredible.

0:32:14.9 DE: I absolutely love it. Best job ever.

0:32:15.6 KC: That was meant to be.

[overlapping conversation]

0:32:19.0 DB: I wanna thank our guest today, Dr. Joi Edwards. For more information, visit alchemyeducation.com. ABMP podcast listeners, ABMP members have access to more than 50 discounts through their membership. Services include discounts like continuing education, home utilities and cell phone service, legal fees, office equipment, and more. Go to ABMP.com/discounts to learn. Thanks, Dr. Joi, and thanks, Kristen.

0:32:42.9 DE: Thank you so much for having me. It was awesome. Thank you guys.

0:32:46.0 KC: Dr. Joi. It was a blast to have you with us in person.

0:32:49.2 DE: Yay!

0:32:50.3 KC: And thank you for another incredible conversation. You're the best.

0:32:53.7 DE: Yeah. Thank you, thank you so much. I'm so humbled to be here, and oh my gosh, you guys were amazing. So thank you. Thank you for having me. And everybody, thank you for listening.

[music]

0:33:07.7 KC: Members are loving ABMP Five-minute Muscles and ABMP Pocket Pathology, two quick reference web apps included with ABMP membership. ABMP Five-minute Muscles delivers muscle-specific palpation and technique videos, plus origins, insertions and actions for the 83 muscles most commonly addressed by body workers. ABMP Pocket Pathology, created in conjunction with Ruth Werner, puts key information for nearly 200 common pathologies at your fingertips and provides the knowledge you need to help you make informed treatment decisions. Start learning today. ABMP members, log in at abmp.com and look for the links in the featured benefits section of your member home page. Not a member? Learn about these exciting member benefits at abmp.com/more.

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