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Mar 22, 2023

Mental Health for You and Your Patients with Emily Perrin

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Dr. Yoni Rosenblatt: Welcome to the True Sports Physical Therapy Podcast. Emily Perrin, been way too long...

Emily Perrin: Yes.

Dr. Yoni Rosenblatt: Putting this thing together, you're catching me at a great time because I get to record this on a Friday, and I call this no-filter Friday...

Emily Perrin: Oh, amazing.

Dr. Yoni Rosenblatt: Because at this point, I'm so tired of biting my tongue, so usually when I'm in office, I'm actually telling my patients what I think about their progress or really telling them about... They didn't make the right choice with their surgeon or whatever. So hopefully, you get the best out of me.

Emily Perrin: Awesome.

Dr. Yoni Rosenblatt: Hopefully, our audience comes back [chuckle] and listens after this, but this is gonna be an awesome topic in terms of covering mental health. It's something that I've really changed my tune on as a practitioner. Before we get rolling, 'cause this ain't about me, this is about you, tell us about Emily Perrin.

Emily Perrin: Oh my goodness. Okay, geez. Where do I start? I am a mental health therapist. I have a master's in clinical social work. There's a couple of different routes you can go to become a therapist, and I went the social work route. I loved it, and I'm a mindfulness and performance coach. What does that mean? We can dive into that. We are going to dive into that...

Dr. Yoni Rosenblatt: Yeah, we will.

Emily Perrin: And really, my background is in sport, I played college soccer at UVA.

Dr. Yoni Rosenblatt: Go Hoos.

Emily Perrin: Yes, Wahoo Wah. And then, I coached collegiately at the University of Pennsylvania, and then transitioned into this work that I do now. I also have a dad that was a college basketball coach for the first 10 years of my life and has a PhD in Sports Psychology.

Dr. Yoni Rosenblatt: Wow.

Emily Perrin: So, I feel like I was very much meant to be in this work in the world of sport, doing what I'm doing.

Dr. Yoni Rosenblatt: Did you think about doing anything else ever?

Emily Perrin: Yeah, it's funny, I actually wanted to go to physical therapy school for a little bit, and I thought about being a teacher and then... No, really, I... Obviously, I got into coaching and when I was at Penn and I was an assistant there, I really did. I was doing my Master's in Sport Management at Drexel, thinking, "Okay, I'm gonna make a career out of this. I'll be a head coach one day." And I just really... In the maybe second year of coaching, I realized, so, little of what I love about coaching is the Xs and Os and the recruiting, and especially at the college level, recruiting is such a beast, and I really didn't enjoy that part.

Emily Perrin: What I really loved, was the connection and talking to players off the field, and our girls were... They were at an Ivy League institution, and they were the most brilliant human beings, but I could just see the struggle to manage and maintain being an elite competitor and the academic work. And that's when I was like, "Huh, how do we help them? How do we help these kids?" And so, really that's when I left coaching and I made the decision to pivot and go a different direction.

Dr. Yoni Rosenblatt: Good for you. There's so much that goes on between the ears of an athlete, let alone, a hyper-intelligent athlete or an over-achieving athlete, even academically. So I'm not surprised by that. Also, what position did you play?

Emily Perrin: I was a striker.

Dr. Yoni Rosenblatt: You're a striker. Okay, so no stranger to pressure. Right?

Emily Perrin: Yeah.

Dr. Yoni Rosenblatt: And so, it seems like an outstanding fit, and I've seen you in practice, it's been unbelievable, I'm really thankful for our dear friend Cookie Carr for putting us together...

Emily Perrin: Hooking us up, yeah.

Dr. Yoni Rosenblatt: Super awesome, and a specimen in and of herself. So shout out to Cookie Carr, but one of the things that you came back to or you mentioned there, was mindfulness, it's such a buzzword, which is unbelievable that it's gotten to that level, so few people I feel like, know what the hell it means.

Emily Perrin: Yeah, yeah, and that's really because this is a 2500 year old concept, it comes from both Buddhist and Hindu philosophy, and as it's come to the United States, Western culture, mainstream culture, it's lost a lot of its real meaning. So to...

Dr. Yoni Rosenblatt: Hold on, what about Marcus Aurelius? What about that guy and his stoicism. That's not mindfulness? 

Emily Perrin: It is, yeah, it definitely... There's those pieces of that. Yeah, that are definitely... Yeah.

Dr. Yoni Rosenblatt: Okay, just checking.

Emily Perrin: For sure. No, you're spot on, Yoni. So, if we were to define mindfulness, I use the definition from Jon Kabat-Zinn, who is the founder of Mindfulness Based Stress Reduction, and he says that it is paying attention on purpose, in the present moment, without judgment. And so, more often than not, when I come in to work with athletes and teams or organizations, and I just throw it out there like, "Hey, what does it mean to be mindful? If I were to ask you to tie your shoe mindfully, what would that mean?" More often than not, they can spit back to me like, "Oh, we've gotta really pay attention, we've got to focus, we've gotta be present." Which is another concept, that's just thrown out there.

Emily Perrin: And we don't really associate this without judgment piece, to being mindful, and that's a really critical part because it's the attitude by which we are present and paying attention. So it's actually a really profound concept, and in any given moment, to be mindful is not necessarily challenging, but the problem is, our brains, our minds are moving 100 miles a minute, and so to be able to step into that type of being, that presence, can actually be really challenging, and so that is the foundation of all the work that I do.

Dr. Yoni Rosenblatt: That is profound. It sounds a little esoteric when you describe it like that. I wanna know a little bit more concretely, and let's live in the world, first of the patient, and then get into the clinician or the practitioner.

Emily Perrin: Yeah.

Dr. Yoni Rosenblatt: How do we do that? If you're saying it's a positive, to be present, give me actionable items for that athlete that's laying on your table and either writhing in pain or struggling with some piece of the rehab process. What am I teaching them? To be mindful.

Emily Perrin: Yeah, that's a great question, and I think it's one that's super important to hit on because so much in this world, the mental space, sport performance, especially, we really have to remember we've gotta move from concept to implementation.

Dr. Yoni Rosenblatt: Yeah.

Emily Perrin: How are we doing it? And so, what I will say is that... And I'll give this disclaimer because the reality is oftentimes, mindfulness and meditation are thought of as the same thing, they're not. Mindfulness is a way of being. It's a skill we can train. Meditation is a very formal practice, that we can train mindfulness through. I'll be very adamant, and I always am very adamant, this work is not for everyone, there are times and places where actually to be mindful and to tap into our experience in the here now, is actually not the right decision if we're experiencing heightened levels of anxiety, we're in a really dark place.

Emily Perrin: So I will say that, but generally, for any athlete, and especially an athlete that is navigating injury, let's think about this and I'll paint a little bit of a scenario 'cause I think that will help, 'cause I've been there, I've torn an ACL, I've had multiple surgeries. When you're on the training table and you're at rehab or you're working with your PT, and you're doing just the most mundane quad squeeze, right? [chuckle]

Dr. Yoni Rosenblatt: There's nothing mundane about a quad squeeze. Let's get that straight. I don't know what could be mundane about that, but okay, yes.

Emily Perrin: Leg lift to whatever. Okay. So, for an athlete that has to just be on that table, doing that thing, the reality is, is that the only thing that's ever in the present moment is the physical body, the mind, our thinking, has the ability to time travel. And so that athlete could, in any given exercise, while they're on that table, be thinking about all of the, "What if? What if I never become the player that I thought I was gonna be? What if I never get back to where I was?" All of the above. So, the mind is... And I'm a very visual person, I think you can imagine it as like the mind is up here, doing its own thing, above the physical body.

Dr. Yoni Rosenblatt: Okay. So, for those of you who are just listening, Emily, just waved her hands wildly over her head, when she said up there.

Emily Perrin: Oh, yeah. Yeah, so hands are over the head, waving around. And then you've got the physical body that's actually on the table in the present moment. And so a really simple practice that I give to my athletes, it's more of a reflection than anything is like, can you just, throughout your day or even within a PT exercise or being at PT for the 45 minutes or 50 minutes that you're there, can you occasionally tap into, "Huh, what am I thinking about?"

Dr. Yoni Rosenblatt: Yeah.

Emily Perrin: "Where's my mind right now?" Is my mind going down the rabbit hole and thinking about all the what ifs? Or is my mind actually connected to my quad right now? Which is where my mind should be.

Dr. Yoni Rosenblatt: Yeah.

Emily Perrin: And they talk about also, that's the heart of the mind-body connection, and so really just... And again, I love to have athletes just doing that very, almost informally, really pausing and very literally asking themselves like, "Where's my brain right now? What am I thinking about it?" And then, have them notice where the brain is, we don't judge that, and this is where that layer of without judgment comes in because a lot of times, we notice, "Oh my gosh, I'm not thinking about what I should be and I'm wrong."

Dr. Yoni Rosenblatt: Yeah.

Emily Perrin: I'm gonna beat myself up. This shouldn't... I shouldn't have this problem. And so the judgment. And so, in that moment, we're teaching the skill of more balance, your mind has wandered off, the mind does that. So just very kindly, gently connect it back to the quad, that's a rep, that's a mental rep of mindfulness right there.

Dr. Yoni Rosenblatt: Okay, that's really interesting. And you're saying that you're gonna get better at that the more you practice.

Emily Perrin: Yeah.

Dr. Yoni Rosenblatt: Okay, I'll tell you what this reminds me of.

Emily Perrin: Let's go.

Dr. Yoni Rosenblatt: One second, this reminds me of being 13 years old and sitting in, what we call a Talmud class. Talmud, for those of you who don't know, is a book, a giant book that reads from right to left, all the writing is an Aramaic, from right to left, there are no vowels, it's nearly impossible to read, let alone translate, and I'm a 13 year old being told, "Hey, pay attention to this." And as I sat there and looked at that book, I would just hear myself say to myself, "Just God damn it, pay attention. What are you doing? Stop thinking about ball or stop thinking about the girls or whatever." And I would get... I'm like, "Why can't I pay attention?" So what you're saying, at that point, I should have said is, "Brain, it's not that big of a deal. Let's see if we can bring it back."

Emily Perrin: Yes.

Dr. Yoni Rosenblatt: And had I done that, I would have achieved, God knows what.

Emily Perrin: Yeah, and that little bit of... And some of this, that we're talking about really then starts to dabble into self compassion work, which is a totally different, oh my gosh, I love it. And I think it's so needed for so many of us because most of us are our worst enemies. But what we're really getting at there, is changing the relationship that we have to our thinking, changing the relationship that we have to our feeling, to our behaving. And so, we're changing that response, which can be a really profound thing, especially for an athlete who tends to sit in a place of constantly critiquing themselves.

Dr. Yoni Rosenblatt: Sure, yeah.

Emily Perrin: And it's a skill. So, yes, you alluded to the fact that the more that you do it, the better at it you get. Yes, the brain is a muscle. We know that. Neuroplasticity, it's fascinating. And so the more that we engage in that little process, I almost see it as like a cat and mouse game, you're just like, "Where's the brain? Oh, there it is. Bring it back."

Dr. Yoni Rosenblatt: Yeah.

Emily Perrin: The better at it you get. And we're really... Yes, we're training a couple things, 'cause that also is training your ability to concentrate and focus and be present, and again, redirect the mind, have more agency about what you're actually thinking about, and then also change, again, how we're relating and responding to our own thinking.

Dr. Yoni Rosenblatt: Okay, so how do I say that to my patient, without sounding like my head's are in the clouds? They come to me for knee pain, let's say, if they come to me for knee pain and I see them, maybe wandering off, how do I work that in so that I don't sound like a lunatic?

Emily Perrin: Yeah, so this is something that I even as a therapist, I do with my clients. What are you thinking about? Ask them.

Dr. Yoni Rosenblatt: In conversation. Well done.

Emily Perrin: Yeah, absolutely, because we have to think of it this way, and this is where I love the translation to sport. Let's take any middle school, high school athlete, they don't just show up to practice with all the tools and the skills, coaches have to teach them stuff. And so, it's the same thing here. And so, by you engaging in just that little bit of like, "Hey, what we're thinking about?" That starts to get them engaging in that process, and then you just have the conversation, and I think you can keep it... Depending on the age of your athlete, you can keep it... I work with eight year olds, that are doing this mindfulness.

Dr. Yoni Rosenblatt: Sounds brutal.

Emily Perrin: And you can keep it really simple like, "Hey, I know that a lot of times, when we have an injury, it's really easy to have the mind wander off and think about all the what-ifs and be really worried about the recovery process and the comeback and so, something that can just be really helpful, is every once in a while, can you just tap into like, "What are you thinking about? What are you worried about?" And just acknowledge that it's okay, and then see if you can just redirect.

Dr. Yoni Rosenblatt: Yeah.

Emily Perrin: It's not something... And again, this is... I have this conversation so often when I come in and work with teams and athletes it's, Okay, great, you've taught us this definition, this skill, you've given us this thing. And I turn around the next day like, "Why isn't it working?" I'm like...

Dr. Yoni Rosenblatt: You gotta work, yeah.

Emily Perrin: You didn't just... I work so much in lacrosse, you know this, I joke all the time, I'm like, "You didn't just pick up a lacrosse stick and be at Duke." Or, "You didn't pick up a lacrosse stick and a day later you're at Michigan." You work at it. And so that is this very quintessential. We have to get those mental reps, those mindfulness reps, exercising what I call that mindfulness muscle.

Dr. Yoni Rosenblatt: Okay, how does the athlete know they're getting better at it. I live in this world, where I'm constantly trying to assess, intervene, measure again. So, how do we measure our success? How does the athlete feel better about it, how does the therapist know they're getting better at teaching it?

Emily Perrin: Yeah. I was just having this conversation with a friend of mine, I was actually on her podcast a few days ago, she's a sports dietician, and we were talking about how our society, our culture, we love to measure things, we love data, we love intelligence, we love it.

Dr. Yoni Rosenblatt: PTs love it.

Emily Perrin: Yeah. And what I will say is this, one, we can't always measure.

Dr. Yoni Rosenblatt: We have to measure.

Emily Perrin: Okay, well...

Dr. Yoni Rosenblatt: Okay, but we can't. [chuckle] Yeah.

Emily Perrin: Okay. We can't always. But I think there is something really profound that allows us to see that we are making progress, and that is to... Well, one, hopefully when you're diving into this type of stuff, I am a huge advocate of like, work with someone. Work with someone like me or find a therapist or a sport psych, someone that can really help you, but two, the way that most people can tell that they are making progress with this stuff, is that they come into some type of situation and they have a response that they wouldn't have had five months ago. They respond and it's a very simple... I'll use traffic as an example because I am... I have been known to have serious road rage, like serious road rage, okay?

Dr. Yoni Rosenblatt: With you.

Emily Perrin: And I just don't have time and patience for people who can't drive. However, very shortly into my own mindfulness meditation journey, I noticed, I would get cut off or I'd be in rush hour traffic, and I wouldn't be having that same visceral, pissed off, angry reaction, that gut... What we call autopilot reaction, to just respond. I would be a little bit more able to handle my surroundings, like what was going on, I would be responding more efficiently.

Dr. Yoni Rosenblatt: Yeah.

Emily Perrin: I wouldn't... It wouldn't really get to me. And so, it's little things like that that we can tap into and say, "Oh, holy crap. This making a difference." Yeah.

Dr. Yoni Rosenblatt: I'm getting better, I love that. If you could just come up with a way to measure that like, "Hey, I freaked out three times in the last month."

Emily Perrin: So, yeah... I mean, yes, and what I will do with a lot of my clients in a clinical setting... I even do this with my coaching clients and athletes, is get a journal and track it. There are certain... And especially... Let's take anxiety 'cause I work with a lot of people that have very chronic anxiety, is like yeah, you can actually measure that. Give yourself a scale, 1 to 10. And so, yes, in that sense, there definitely would be ways that if I was working with an athlete, we could track it and we could look at responses and trains of thought and all that stuff, but... Yeah. I think it's also... This is, again, you're gonna get mad at me, but sometimes it's more of a feeling.

Dr. Yoni Rosenblatt: I'm not gonna get mad, I'm just gonna breathe. I'm gonna calm down, yeah. Go ahead. It's more of a feeling, which is fair, which by the way, there is as much as I love numbers because it shows we're getting somewhere, it increases patient buy in and increases therapists buy in. There is so much of our world that is art that is subjective, that is not measurable, and I think it's naive to just cross that off and say that that doesn't exist. So I can definitely appreciate that. Let me give you a case that I'm currently struggling with, and I'd love to know how the mental health expert would educate both me, clinician and patient.

Emily Perrin: Sure.

Dr. Yoni Rosenblatt: So elite level athlete plays a bunch of football on Sundays, and he's coming back from his knee injury, and he is crushing it. I mean, he's killing it. He's way ahead of schedule. We gotta reign him in. Hard worker, and obviously a super accomplished athlete. I give him an elite level drill, which he has no business doing, and he's not awesome at it, and it is over, the session is over, because he is infuriated with himself and he doesn't realize that he is so far ahead, etcetera, etcetera. What can the therapist do in that instance, 25-year-old athlete, 41-year-old physical therapist, what do I do?

Emily Perrin: Okay, so I love this because there is a lot of parallels to an athlete that's not injured on the field, throwing the ball away a couple of times, and then totally taking themselves out of the game.

Dr. Yoni Rosenblatt: Yup.

Emily Perrin: Also a lot of parallels to us as humans, people that just live our lives and make a mistake in the real world and totally for the rest of the day, we're done. And this is why I love this work 'cause it's applicable to everyone. Essentially, what we need to understand is that in that moment, this athlete went through that drill, you're saying that they maybe completed it maybe didn't. Not great.

Dr. Yoni Rosenblatt: Not to the their liking.

Emily Perrin: Not to their level, okay, so really what we need to understand at a very... Or I think at a very foundational level is that if we come back to this idea of being present and having the brain really connected and in tune with where the body is in time and space, clearly something is going on where his brain, his train of thought has totally derailed, it's gone off to some type of... And I call this a lot of the times, the rabbit hole, it's out of the typical like... Hopefully, everyone that is listening has seen Alison in Wonderland where she kind of like curiously starts to peek down the rabbit hole and then all of a sudden she's at the bottom of the rabbit hole, right?

Emily Perrin: And that's... I think many of us resonate with that with our trains of thought, right? And so this athlete's train of thought has clearly just plummeted. And what I think can be really helpful and one, we need to understand that that's a real experience, that's a real experience for every single person, it's so easy for us as potentially the PT or anyone watching the scenario to be like, "Don't worry about it. No big deal," but it is a big deal to that athlete, we need to acknowledge that. And so what can be really helpful is really, again, coming back to this idea of like, "Okay, how do we help this athlete view their experience or step into their experience from a more mindful lens? And so I kind of think about it almost as like we don't, as humans, live our day-to-day from a mindful lens, we just don't... It's not possible to be there 100% of the time, I just kissed the mic. Sorry.

Dr. Yoni Rosenblatt: I was wondering what that was.

Emily Perrin: I got really excited. And so we very much have to make the conscious and intentional transition to mindfulness, and I'm putting in a fake cap on right now, almost like putting your mindfulness cap on. And so...

Dr. Yoni Rosenblatt: By the way, I see you doing that and I wasn't sure what you were doing, so I'm glad you...

Emily Perrin: Yeah I'm putting a cap on, the mindfulness cap. Right? And so, in this instance, what can be really helpful is to almost allow the athlete to come back into the present moment, so understanding and even coming back to a little bit of the exercise that I was giving earlier, which is just like, where is the brain right now? Right? We're not gonna judge it, we're not gonna beat ourselves up over it because we're already doing that chances are, right? We're just gonna acknowledge that, we're gonna take a deep breath and we're gonna come back to the present moment.

Emily Perrin: Now, that in itself, I can work with athletes on that for six months before. That's a well-oiled, fine-tuned machine. From a physical therapy standpoint, I think what can be really helpful is understanding that again, the only thing that's ever in the present moment is the physical body. So can we get this athlete in some way, shape or form to get out of their head a little bit and back into their body. And so can you have the athlete take actually a little bit of a pause? Can you... I don't know what the exercise was, maybe you could give me a little context like, was there football involved? Put the football down. Step away from the drill. What are you thinking about right now? What's your train of thought, you don't need to tell me, but just like, can you bring again, a little bit of that concept, that skill of mindfulness to just notice where the mind is. Don't make it wrong. It's not wrong. You're pissed off. It's okay. That's a valid experience.

Emily Perrin: And then allowing them to take a little bit of that time to process, right? We need to also understand that coming back from an injury is a process, it's a journey, and so this is part of their journey, and then really just helping them kinda feel their way back into their body, something that I love very simple, is like, can you help an athlete just feel their feet. This, in a very literal sense, that's grounding. What it means to ground is to be and feel very connected, mind and body. And so can you help the athlete just feel their feet.

Dr. Yoni Rosenblatt: How?

Emily Perrin: So is the athlete in shoes or not.

Dr. Yoni Rosenblatt: Never.

Emily Perrin: Never in shoes. I love it. Okay, so that's even better, right? So very simple, have the athlete... Okay, and again, I'm building on this process. Right?

Dr. Yoni Rosenblatt: Yeah, but I'll make it more complicated 'cause we're on the field, we're running a complex W drill. He's in cleats, those shoes ain't coming off, so the dude happens to train barefoot at time, but he's wearing cleats.

Emily Perrin: Let's do it. Let's make it as complex as possible. Right?

Dr. Yoni Rosenblatt: He's wearing cleats. So what do you do?

Emily Perrin: And so this is something that... What I will say it, and I know I'm trying to give information to PTs. Some of this is like, "Well, the reality is, is that being able to... People think that feeling your feet is really simple, but it can actually be very complex for many people, right? 

Dr. Yoni Rosenblatt: Sure.

Emily Perrin: So this might be a continued process for PT and athlete, but in a very literal sense, we can hopefully get to the point where we can connect with our feet in any given moment. And so something that can be really simple for an athlete that's in cleats is like, "Okay, can you wiggle your toes? What sensation can you pick up, can you pick up the pressure, can you pick up the movement at the knuckles, can you feel the big toe?"

Dr. Yoni Rosenblatt: Am I doing this as a PT on the field? 

Emily Perrin: I would say no.

Dr. Yoni Rosenblatt: Okay. Tell me what I'm doing?

Emily Perrin: Because, hopefully, this athlete is working with someone like me. No, I'm just kidding.

Dr. Yoni Rosenblatt: Yeah, your card.

Emily Perrin: But this is something that would hopefully be ingrained in the athlete's routine. I mean... Actually, let me take that back. I mean, you could totally do this as a PT because I think what... And what I love about you guys, True Sports, 'cause I'm a client of yours, and I know you guys as friends and professionals like you do really... You go above and beyond. And so this could absolutely be something that, especially if your athlete is feeling and you're watching your athlete's body language, just totally take themselves out of it, I really believe that the most efficient thing in that moment is not to get them back on the line and do the thing, again, like step away.

Dr. Yoni Rosenblatt: Pause.

Emily Perrin: Pause, put the football down. Pausing is actually a very radical counter-intuitive thing because we're shifting away from go, go, go, go, go, go, go, which is where we live our lives. Pausing is really what allows us to step into presence, in my opinion. And so having that athletes step away and then say, "Hey, okay, you know what? Take a deep breath. Where's your mind right now?" Coming back to that cat and mouse game, where's the mind? Don't make it wrong, just kind of acknowledge where your mind is at right now. It's okay if you're kinda pissed off and you're beating yourself up, it's okay, let me try something with you or are you willing to try something. I'm a huge advocate of ask athletes, not every single athlete is into this, so ask them, would you be willing to try something with me?

Emily Perrin: Okay, let's just see if right now you can collect your attention and you can focus for 10 seconds on the feeling of your feet, wiggle your toes for me. What do you feel. And you can even have a lot of times what I'll do when I'm working with a pro-athlete especially, is I'll have this conversation out loud with them so that they're not going through it alone in their head, like, talk to me, what do you feel? Well, I feel all of my... The little knuckles moving, right? I feel the pressure or the contact of the big toe coming down, I feel actually a little bit of squeezing 'cause my cleats are a little tight, right? Okay, great. So what you just did is you redirected that athletes train of thought, their attention from going down the rabbit hole too, my feet.

Dr. Yoni Rosenblatt: I love it. So what I just heard, and I'll tell you how I would do it, and you can critique it. Number one. Don't minimize. Number two, pause, just take a break. Three would be potentially some type of deep breathing with four being grounding them, however you're able to accomplish that. So what I would do in this instance, I know he's listening to this pod, so I'm not gonna be able to do it, but what I would do is when she gets upset, frustrated, one, don't be like, "Dude, it's not a big deal." Which is usually what I do, but it's not a big deal. So now that I've learned, so I wouldn't say that, but rather what I would do is see if I can just give them space for a heartbeat, then kinda come in and that's my pause and then kinda come in in terms of deep breathing, maybe it's directed deep breathing. So it's like, "Let's just pop on your back, do some diaphragmatic breathing, just part of the exercise, I don't need to get into what's going on between your ears." Maybe it's that.

Emily Perrin: Yeah.

Dr. Yoni Rosenblatt: And then a close second would be, let's just... I wanna superset some balance work here. What do you feel working there? What do you feel when you are on single leg maybe still on your cleat and then... So maybe that, if there is any type of stigma between, wait a minute, am I working for what's below the neck or between the ears, maybe that peels it away, but still able to use some of those tools that you shared. What do you think?

Emily Perrin: Yeah, I love that. And I think it's fun 'cause we're kinda work shopping this and a lot of... So much of this work when you get into it, and I even, I emphasize this with my athletes, there's a lot of different ways to get at the same thing, and really understanding that you have to find what resonates and works for you. And I would say that that's the same message for PTs and how they relay that and work with their clients with this stuff. I loved what you just said. I think that's a really great way to... I mean, geez, we don't even probably have time to get into some of the breath work piece of things, but the breath work in general is so profound, and again, I kinda classify that as mindfulness because it is. That can be... The breath work and the pausing can be something that I think all PTs are implementing, that can be really helpful.

Dr. Yoni Rosenblatt: This is where I would highlight and I opened with this a little bit at the beginning of pod, where I've begun to change my tune, coming out of school as a younger PT, I thought everything you were just saying was freaking garbage, and then... And it's Friday, and then it's crazy now how... Like I said, mindfulness has become a buzz word, but also when you look at some of the research that's being produced on when you say breath work, but just understand the diaphragmatic breathing and how to go through that and physiologically. What's transpiring, right? And that's the world we live in, for better or worse, is anatomically physiologically what's transpiring. The effects are unbelievable. So when you listen to the big dogs of the research world, the Andrew Hubermans of the world, which who by the way, Cookie Carr introducing me to Andrew Hubermans Stanford connection, but...

Emily Perrin: That's right.

Dr. Yoni Rosenblatt: Yeah, but that's all he talks about. It's all he talks about. It's really cool. So when we talk about this breathing stuff, that's totally solid. Do you wanna hear the second thing I really changed my tune on?

Emily Perrin: Yeah.

Dr. Yoni Rosenblatt: Dry needling. When I came out of school and my boss at the time was telling me about needling, I was like dude you are an idiot.


Dr. Yoni Rosenblatt: Here's why, here's why I said that, because I've literally watched acupunctures treat disc herniation and bulges, having the patient stand up, bend forward at the hips. Oh, you feel that shooting down your left leg? Okay, well, we're gonna needle you in this position. I'm like, "What are you doing to that person," but if you look at the literature, if you just have the humility to say, hey I was wrong about that, like SI joint dysfunction, we can't palpate it. I was wrong. So coming around on that is another thing that I totally changed my mind. That's a whole different episode. Maybe we'll get to it, maybe the producer will cut this entire thing out, I don't know, but maybe worth mentioning, but I digress. Okay, so that's how I would use it. I think that's super helpful to know that that's somewhere on your radar. I wanna shift focus a little bit to being a sports PT professionally, to the professional side, talk to me about what the word burnout means in current mental health literature.

Emily Perrin: Yes. Oh gosh. And you guys are...

Dr. Yoni Rosenblatt: Burnt-out.

Emily Perrin: Here's the... Yeah, burnout for everyone, I will say is, it's real. So burnout... Hold on, you're gonna have to cut this.

Dr. Yoni Rosenblatt: You're good

Emily Perrin: And edit it.

Dr. Yoni Rosenblatt: Don't minimize burnout.

Emily Perrin: I don't know where I had it. Oh, there we go. Okay. Ready?

Dr. Yoni Rosenblatt: I'm ready.

Emily Perrin: Okay, so burnout, also kind of a buzz word, burnout, and I like Herbert Freudenberger's definition. It basically has three components, so the first one is that we are emotionally exhausted, which is fatigue for exhausted, and it's really a lot of burnout came from or is centered around professionals that have to care, and so a lot of times it's called compassion fatigue. But we also know that it doesn't necessarily have to come from caring and compassion. Okay, the second piece is depersonalization, and so that is kind of like the depletion of empathy, we just start to not care. The last piece is decreased sense of accomplishment. So nothing I do matters, I'm not really making a difference. Now, that is a definition that has a lot of complexity to it, and I think this is where people feel like they are emotionally exhausted, tapped out, burnt out, but maybe don't meet all three of those requirements.

Emily Perrin: I'm certainly not gonna sit here and say, "You're not burnout burned out," [laughter] you know what I'm saying? And this is where, again, even as a mental health clinician, it's like we love to... We have to diagnose things and things have to fit in boxes, and I just don't... I don't jive with that, it doesn't feel right to me, so I'll just throw that out there, but I think in terms of burnout rates right now across all professions, we're at an all-time high.

Dr. Yoni Rosenblatt: I'm not surprised by that. I do feel like our levels of activity as a society have never been higher, and I'm sure in five years from now it's gonna be worse than it is today, so I'm not surprised by that. What do we do about it?

Emily Perrin: Yeah, so well, let's back up and also talk a little bit about what you might... Because I also probably... And you probably see this, you probably have a lot of PTs that they are in burnout, and they don't even know it.

Dr. Yoni Rosenblatt: Sure.

Emily Perrin: And the crazy thing is, is that it can look like a lot of different things. It can manifest in a lot of different ways, but I'll give you some just general broad brushstroke ways that burnout can manifest. So obviously, the first one is, you're exhausted, and typically the exhaustion is the type of exhaustion where you're sleeping an adequate amount and you wake up and you are still trying to peel your eyes open. So it does not matter how much rest you're getting, you are still feeling so tired. Yet, the funny thing is, is that a lot of people are so, so tired, but they really struggle to sleep, there's sleep disturbances. So that's either they can't fall asleep, they're not sleeping well, so they're not sleeping through the night. They can't nap all the above. The emotional toll, this is a lot of times experienced as lack of motivation, just no desire to do anything even when you absolutely love your job. I am coming off a little bit of burnout like I wake up every single day, I love my job. I love what I do, and I had burnout.

Emily Perrin: And so that's can... And a lot of times we see that in just little things, even things that are not work-related like really struggling to just like get laundry done or unload the dishwasher, stuff like that. Digestive issues, it's a big one. Just mood changes. You can experience heightened levels of anxiety really a low, low mood, irritability. A lot of times people's immune function will be down so they'll get sick, they'll have random soft tissue injuries, headaches, all the above. So those are some things to kind of like be looking at. What do we do about it? Geez, if I could solve that, I'd probably...

Dr. Yoni Rosenblatt: Your... I'll cut you off just for a second because it reminds me of an interesting conversation that I just had. A buddy of mine is a high-level eye surgeon and we were talking about... I had a concussion patient so I was talking to him about some visual disturbances and then we started talking about... I wish I remembered the clinical diagnosis in which the layers of the retina will actually begin to get kind of stuck to one another and we were talking about interventions for that and he said, they do the absolute best with mindfulness, with breathing, with meditation. I'm like, dude, what are you talking, that's insane.

Dr. Yoni Rosenblatt: But I bring that story up because this is a guy who's dying to inject eyeballs and perform surgery on eyes and he's saying like, we can't figure this thing out. They do better with mindfulness breathing. So when you talk about the mind-body connection I'm not surprised to hear you say, hey, burnout goes to eventually soft tissue injuries. So he said he'll have patients walk in with that presentation in their eyeballs and he'll say, hey, anything stressful recently? And every time, they're like, yes, something insane just happened and my eye decided to constrict because of it. It's wild, so the lesson is when you're interviewing that patient you're doing the subjective. Why do they have Achilles tendinopathy or why is there a knee killing them or why did their ACL blow out? Maybe there's some of this.

Emily Perrin: Absolutely, there absolutely is. Because the mind and the body are working on a feedback loop. They're constantly talking to each other. And yeah, I think it's really important for you guys as PT's to understand that, and to ask about that because that is a part of the puzzle in the equation. And what you're alluding to is that, hey, this stuff, mindfulness, meditation, breathwork, yoga, which yoga gets a bad rep but really what I just mean is mindful movement which I think you guys are doing a lot of that to be honest, is really helpful.

Dr. Yoni Rosenblatt: Just get a movement, which is... Mindfully. Which is why we say that movement is medicine. That's really interesting. Okay, so let's bring it back to the PT. The PT, within our field, it's crazy to see this outpatient sports PT model or by the way, even worse is inside an organization like you're working with a pro-level team. The hours are just lunacy. But let's say you're in an outpatient clinic and you're working your 12:00-8:00 shift and then you have the 7:00-3:00 shift the next day. That's easy to get towards burnout. Give me a routine that's gonna either prevent or treat my burnout.

Emily Perrin: Yeah, so I think the... And I love my visuals, metaphors, analogies. What we have to think of is stress, burnout, it's like a bucket. So if you're listening, picture a bucket. Any type of bucket, it doesn't matter. And life, things, stressors, whether they're good or bad, are constantly being put into the bucket. That 12:00-8:00 shift, and then that 7:00-3:00 shift. Things are constantly going in. And if we are not slowly draining the bucket daily, what's gonna happen to the bucket? It's gonna overflow. That's when we hit burnout and stress and all the above. So I really emphasize this has to be especially for those of us that... Because to be fair mental health professionals are very similar, we're just accumulating people's thoughts and feelings all day long. If we're not draining the stress bucket every single day then yeah, it is gonna overflow.

Emily Perrin: So I have always been... And I think this is where this is the self-care movement has done us a little bit of a disservice because self-care, I think, has often been sold as, well, we need time and it's gotta be this lush, luxurious thing. And it really doesn't. I am so much more, I want you to be consistently, in short increments of time, draining your stress bucket. It does not have to be this hour-long, 45-minute-long thing. That stuff is great if you can go to a restorative yoga class or go do whatever. But more often than not, you guys don't have time to do that. Your turnaround from that 12:00-8:00 shift to then be there, because 7 o'clock is not 7 o'clock, it's...

Dr. Yoni Rosenblatt: Up at 5:00.

Emily Perrin: Right, you're up at 5:00. So this is an ongoing cycle that you have to be doing regularly and consistently. So let's kind of go through a couple of my favorite practices that really help with stress reduction, which is what we're kind of getting at, but also just the actual managing of our mind, our body, and emotions, which is mindfulness. So let's start with the exercise that I gave you minutes ago. Which was this cat and mouse game of just checking in periodically with like, hey, where's my mind at? That is something that you can do as you're working with a client. That's something that we can do in the run of day-to-day. And I think for PTs, that's actually... I mean, even like mental health clinicians that's something that's a really good habit to get into. Because we also have to remember that if your brain is constantly go, go, go, go, go, like to-do lists, oh, I've got to do this, I've got to get this, okay, this patient needs this, yada, yada, yada. You have to remember that's impacting your mind-body system. We have to really think of it as the mind-body system. You're just keeping the wheels spinning.

Emily Perrin: You're adding to that stress bucket. And so can you tap into that train of thought periodically throughout your day? And can you play that cat and mouse game of, oh, man, I'm really going off on my to-do list right now. Okay, let me just take a deep breath here. Let me push-pause for a second. Okay, now let me return. If you do that four or five times a day, you're interrupting that go, go, go, that autopilot that's adding to your load. So that's number one. So that's a... I mean, I try to do that at least once an hour. Where's my mind? What am I thinking about? How am I doing?

Emily Perrin: Okay, number two. We really want to emphasize what we call down-regulating practices. So again, we have to think all of this, the stress, the burnout, we're talking about the nervous system. And so with the nervous system essentially we've got up-regulating practices thinking of that sympathetic nervous system. What a lot of people think is fight or flight response.

Emily Perrin: This is what athletes tap into when they're in performance. This is where PTs are when they're on the go, go, go, go, go. It's not bad, we need it. But in order to combat burnout and stress, we need to shift out of it. And again, that doesn't take long, but we have to consistently be doing it. So we're thinking about down-regulating, shifting the nervous system from that sympathetic state to a parasympathetic state. We don't need to go into more detail than that. And the cool thing is that mindfulness, meditation, breathwork, and yoga have all been shown...

Dr. Yoni Rosenblatt: To do that.

Emily Perrin: To do that.

Dr. Yoni Rosenblatt: I love that. I do want to get into the weeds on it. Okay, so it's...

Emily Perrin: Okay, let's do it.

Dr. Yoni Rosenblatt: I just worked my 12:00-8:00. If I'm lucky, I saw a patient every 45 minutes from 12:00-8:00. If I'm not lucky, I saw a patient every 30 minutes or every 20 minutes. So I'm done with my, call it 25 visits that day. I get home, I throw some food, I shower, I go to bed. I wake up at 5:00, I'm back in the office, it's 7 o'clock and I have slated for myself let's say we're at True Sports at 7:00 AM, at 7:45 and then 8:30. Tell me what I do at 7:45, I'm thinking either it's happening while I'm stretching a hip. I'm gonna take a couple of deep breaths. I'm gonna make sure they're diaphragmatic. I'm gonna try to downshift. Or I'm gonna get religious about it being in between 7:44 to 7:45, I'm sneaking behind the leg press and I'm doing some deep breathing, but give me another idea.

Emily Perrin: I love that. So yeah, you're essentially getting out. There's two ways to do it. And I think about this even in my life because therapy is the same way. You're seeing clients on the hour every 50 minutes, you have essentially eight minutes to get notes in and to grab a snack, grab dinner and then you're on to the next one. So route one is, okay, are you consistently carving out little moments of time throughout your day in the run of your crazy schedule? I think that's a yes. And are you also, at the end of the day or at the start of the day, are you implementing something that's helping as well?

Dr. Yoni Rosenblatt: What are they? Yeah. What are they?

Emily Perrin: So at the end of the day, one of my favorites is just getting my legs up the wall. For those of you that follow me on social media it's all over the place. I have my athletes do that. And you don't even have to actually sit and throw your legs fully up on the wall. Put a couple pillows under them. It is that very quintessential, get off your feet, get your legs up, relax. It tends to be for most people a very soothing, grounding practice. There's also the logistical pieces of it which is you're getting blood flow. You guys are probably on your feet all day long. So you're getting blood flow, lymphatic flow back towards the heart, which is where it needs to be.

Emily Perrin: And twofold, a lot of times when we're in that position it can be really easy to focus on the breath and add breathwork or a meditation or a visualization in. So you're killing two birds with one stone, essentially. So five minutes, eight minutes, 10 minutes, the end of the day, you get home. Dedicate, so say, okay, so I'm absolutely starving at the end of a shift. I get that.

Emily Perrin: Okay, go eat your dinner, go shower and then say, okay, I'm gonna set my timer. I'm gonna go five minutes. I'm gonna put my legs up on my couch. And I'm just gonna... And you don't even need to do more than that to start. I'm such an advocate of you don't need to move a mountain today, baby steps. So just get your feet up for a little bit. You can even scroll TikTok, look at Instagram, continue watching your TV show, or finish your notes. Adding a practice like that can be phenomenal. If you are a meditator, that's when, for me at the end of a day because I also really struggle with sleep. I'm putting my meditation practice, my more structured practice, at the end of the day. That's one way to do it. But if we're talking about the in the run of the day, what you mentioned is phenomenal. I love it. I...

Dr. Yoni Rosenblatt: What did I mention? I blacked out. I was meditating.

Emily Perrin: The breathwork. So I've got 30 seconds, one minute here to go behind a leg press and do that.

Dr. Yoni Rosenblatt: And what is it? What am I doing? Box breathing? Pyramid breathing? What am I doing?

Emily Perrin: Okay, to start, breathwork is we need to... Unless you have experience with breathwork or you understand breathwork, I think it's really important that A, you get a little bit of information on it because it can be very sensitive. The nervous system can respond to it. And so there's a lot of people and the reason I say this is because we're literally living in a time where anxiety and stress and panic are at an all time high. And for most people that are experiencing heightened levels of anxiety, breathwork is not okay.

Dr. Yoni Rosenblatt: It might not be for you.

Emily Perrin: It makes people more anxious and more nervous. So that's not really a practice that I would steer you towards. I would steer you towards maybe potentially more body-based practice. So it's... And this is the hard part. It's this... All of this is so nuanced. And so a lot of it is like trial and error. You've got to really figure out what works for you. So if we are gonna go down the breathwork route, which is not bad, a really simple practice is just being able to feel one breath. You don't need to necessarily dive into changing or altering or holding. Because again, those are actually can be more advanced practices that like... I mean, again, if we get back to that anxiety factor, to tell an anxious person to then hold their breath could be like the worst thing on the earth. So can you get them to just... Or can you... As PT is like can you just feel one breath?

Emily Perrin: And yes, if we're talking about that more diaphragmatic breath, yeah, what really is fun, it's a... I think I did this in the session that I had your PT's in, is actually to play around and try breathwork on your side. So when we lay on our sides, the belly hangs out a little bit. And that can be really uncomfortable for people because we also live in a society that's like, suck it in, hold it in. Ab six pack, yeah. So when you lay on your side though and you think about this like in bed. The belly has real room to just totally let go. And so if you lay down on your side and you take a couple of what I say, just more deliberate breaths, you don't even need to make them like super big or again, hold the breath, just more deliberate breaths. Really allowing the... Because in order to take a diaphragmatic breath think about it, the belly has to go somewhere.

Dr. Yoni Rosenblatt: Yeah, sure.

Emily Perrin: The diaphragm pushes down, the lungs expand, the diaphragm pushes down, the belly...

Dr. Yoni Rosenblatt: Push it out.

Emily Perrin: Where's the belly gonna go? It's gonna go out. So even just being able to connect with that process as you're literally sitting with a patient or watching a patient, 'cause you can do that, can be... We get back to that bucket analogy, that can be a little bit of a drain, of your draining some of the stress out. So connecting to that just feeling of the breath, trying to allow the belly to really relax. And again, a cool way to explore that is in that sideline position. That's also something that you can do with your clients if they can get on their side. But yeah, so throughout the day, really tapping into... And this is where I'm like, use technology to your advantage. I'm not kidding, Yoni, for the first when I was... So I studied meditation with a former Buddhist monk for like a year. And in order to get some of this stuff ingrained in my head, sticky notes, set alarms on your phone. Do you have a smartwatch? Can you set an alarm.

Emily Perrin: So if you see a client from 7:00-7:45 know that maybe from... The client walks out the door at 7:45-7:46, you've gotta go do something or clean up or whatever. Like 7:47, you've set your alarm so that, oh, yeah, I gotta breathe. Oh yeah, I need to just sit down for a second. Oh yeah, I need to check in where's my mind at right now? Stuff like that. I mean, this is where you have to get creative with it. And this is so much what I do when I'm working with individuals. Do you guys have a lunch break?

Dr. Yoni Rosenblatt: Totally therapist-dependent.

Emily Perrin: Okay. So that's another one. And I mean, even talk about like how so much of this is connected to gut health. Meals is a really great place, really great reminder. When I sit down to eat a meal before I am picking up a fork or engaging in eating, take a belly breath. Take 10 seconds to just feel my body in my seat, feel my feet. So what we're getting at there is habit stacking. You're stacking things onto things that you're already doing and trying to do as much of that as you can throughout your day.

Dr. Yoni Rosenblatt: Yeah, that's really invaluable. Having done this profession for 15, 16, 17 years. Adding some of these things I can really see increasing and enhancing the longevity of my career or whoever's listening, to their careers. I think it'll also increase your effectiveness in a given session. It's gonna make you a better PT. It's gonna make you a better athlete potentially. It's gonna make you a better employer, employee. There's so much to gain there. Just so we have it like in a tight bundle, the three things you would encourage to fight burnout would be?

Emily Perrin: Sorry, are you talking like the actual like the practices?

Dr. Yoni Rosenblatt: Yes.

Emily Perrin: Okay, so one, I think... We're gonna have to edit this so that there's not a big pause.

Dr. Yoni Rosenblatt: Great.

Emily Perrin: So essentially what you want me to get at is like...

Dr. Yoni Rosenblatt: I want three actions.

Emily Perrin: Diaphragmatic breathing. Okay, okay, got it, okay. Okay, first one is definitely breathwork. Breathwork being a nuance practice finding within breathwork what works for you. Really trying to engage that diaphragm, what we call belly breathing. Two, I would say one of my favorite practices is a mindful pause and it is that very quintessential, stop what you are doing, put your phone down, shift out of auto pilot, close your computer, stop talking to people.

Dr. Yoni Rosenblatt: Pause.

Emily Perrin: Breathe, pause. Notice where is my mind right now? You can schedule that in as well, set a timer, you can do that multiple times in a day, I certainly do. And that's kind of a halfway to a meditation practice. I think three would be adding some type of mindful movement and when I say mindful movement, I consider restorative postures in that. So legs up the wall, going for a nice gentle walk would be a great one.

Dr. Yoni Rosenblatt: Putting those three things together, that should be a piece of what we're taught in graduate school. Just those three things like how do you survive your career as a PT and I have to believe it's the same in the mental health world, where you are just absorbing people's pain and complaints and...

Emily Perrin: All the time.

Dr. Yoni Rosenblatt: And by the way goals or whatever it is that they're dumping on your plate, ways to drain that bucket are essential. I wish that was covered and that might be the most important thing that you've shared thus far. That is gold in and of itself, so I appreciate you sharing that with the audience. One last piece I wanna get to is, what are the red flags for which an athlete may report or show that we need to refer out for?

Emily Perrin: Gosh, that's a great one. So the first is, and some of this is nuanced because it is also gonna depend on how long you've been working with the athlete, some of this is a little bit easier to tell when you've been working with an athlete longer. So the first one is gonna be any drastic change in mood. So is the athlete coming in one day and just a total, out-of-left-field shift in mood, whether that's up or down. The best way to describe it is like...

Dr. Yoni Rosenblatt: That was weird.

Emily Perrin: That was weird. Yeah, that's a shift. And again, it's one of those where that even not necessarily is like, "Oh my God, I've gotta now refer this person." This is where I think even some of this... Gosh, you talk about resources and what should be classes for PTs is like, hey, how do you have some of these conversations of, where are you at? What is the heart of communication which is being able to listen, those are really profound skills that a PT needs to be able to determine some of this stuff.

Dr. Yoni Rosenblatt: I'll tell you what they also need, they also need room in the schedule to spend time...

Emily Perrin: Yeah, to do that.

Dr. Yoni Rosenblatt: With their patient to understand. I can envision a number of instances and set-ups where you have no idea if that mood is out of norm because you don't know the patient. So I think you have to have the time to do that.

Emily Perrin: Gosh, which is... I mean, that's even a case with us, right?

Dr. Yoni Rosenblatt: For sure.

Emily Perrin: So yes, 100%, I'm with you on that. I think also being able to listen, pick up on how they're speaking to themselves is a big one. Athletes tend to be very critical on themselves, but when you start noticing language that could potentially be tied to their self-worth, that's definitely a sign where it's like, "What's going on here? How are you actually doing?" The hardest part is that we live in a culture of society that asks how you're doing and we don't actually really...

Dr. Yoni Rosenblatt: Listen.

Emily Perrin: Wanna know or wanna listen and people don't ever expect to really honestly answer, how are you feeling? So this is where, again, I love you guys and the work you do because...

Dr. Yoni Rosenblatt: We love you, too.

Emily Perrin: You guys go above and beyond. I see... Every time I come in, it's like, you do have really genuine and authentic relationships with your clients. I think that's so, so important. Look at also isolation. So again, this is gonna depend a little bit on how well you know the athlete or how long you've worked with them, but are they withdrawing, are there changes in their social activity, are they... Because we also have to remember that isolation is a massive piece of being injured. You're on the sidelines more often than not. When kids are at practice, you're in the training room. So listening for... Are they also withdrawing even more outside of that, are they getting out, are they continuing to go to class, are they continuing to hang out with their friends or speak with their family members. So watching that isolation piece, that's for sure also gonna be very tied into mood.

Dr. Yoni Rosenblatt: It is. I'll tell you, I look into a lot of those things and try to listen for those cues and so I think that's totally worthwhile. Another thing that I look at is massive shifts in weight and appearance. And so we'll have a lot of college athletes, we'll have a lot of athletes kinda leave, go to college, come back and it's like, uh, you look very different.

Emily Perrin: Yeah. It's a big one.

Dr. Yoni Rosenblatt: And you're just like, you're keeping note in your head to see, is there a referral that needs to be made. I would humbly submit that as a reflect.

Emily Perrin: 100%. Yeah.

Dr. Yoni Rosenblatt: And so when we go to look to refer out, how do we know who to send to? 

Emily Perrin: Yeah, also a fantastic question.

Dr. Yoni Rosenblatt:

Emily Perrin: No, stop it. So I think it's important to remember that, just like PTs, not all mental health clinicians are the same. We all specialize in different things. You are looking for a mental health, a licensed professional, so to be able to treat, diagnose, just like I believe PTs, you have to be licensed by the state?

Dr. Yoni Rosenblatt: Sure.

Emily Perrin: Same thing, right? So you're looking for, whether it's a licensed counselor, whether it's a licensed social worker, a psychologist, or even a psychiatrist, the differentiator is that a psychiatrist is gonna be dealing with medication. I think medication has a purpose, it has a place, I think it does wonderful things, but my feeling has always been we don't need to start there. Psychiatrists absolutely do psychotherapy and assessment and evaluation so you really can't go wrong with any of those. But yeah, you're looking for a licensed mental health professional and it doesn't always need to be someone that deals with athletes. There are so many qualified, amazing clinicians. I'll be perfectly honest, let's talk about the weight issue, eating disorders. I don't specialize in eating disorders. Do I treat people with them? Yeah, but that's not my...

Dr. Yoni Rosenblatt: Sole focus.

Emily Perrin: Bread and butter. And so it's generally, when you're looking at a mental health clinicians bio, more often than not, they provide their trainings, the interventions that they use, the modalities that they use. And so that's really important information for a parent, an athlete, to know, what are the types of interventions they use. Therapy is no longer just talk therapy. We're not moving in a time and a space where we just have people come in and sit on our couch and talk to us. I'm training in what's called somatic therapy, which is a very movement-based, mind-body modality, that's completely different than someone that just does cognitive behavioral therapy. So really understanding some of that, and again, even just basic like Google that in, will be able to tell you but then also, you guys can always ask me as well.

Dr. Yoni Rosenblatt: Yeah. So that's totally valuable. And your point about, it's very similar to PT, we would say the same thing where it's like, you wanna find someone that specializes, but you're also saying something that I think lands in that you gotta build your network. When I got introduced to you, the title, the bite, it could have meant a million different things, but it's all about getting to know the people who you're referring to, then you can make an awesome match and referral and say, "Hey, go see Em, she's awesome at X." And it makes you, the referring provider, look even better, and it's gonna be best for the patient, that's number one. So I think that really lands. So thanks for sharing that.

Emily Perrin: Absolutely.

Dr. Yoni Rosenblatt: Okay. I wanna wrap up with a lightning round.

Emily Perrin: Oh gosh, okay. Here we go.

Dr. Yoni Rosenblatt: But it's gotta be the first thing that comes to your mind.

Emily Perrin: Okay.

Dr. Yoni Rosenblatt: You ready?

Emily Perrin: Yep.

Dr. Yoni Rosenblatt: The sport requiring the highest level of mental fortitude.

Emily Perrin: Baseball.

Dr. Yoni Rosenblatt: Good freaking answer and that's the right answer. Thank you so much for saying that.

Emily Perrin: Only 'cause I've worked so much in it, baseball, 100%.

Dr. Yoni Rosenblatt: Because?

Emily Perrin: You fail so much.

Dr. Yoni Rosenblatt: You fail so much, that's a great point. Also, there's nowhere to hide.

Emily Perrin: There's nowhere to hide.

Dr. Yoni Rosenblatt: So you're on an island always and there's so many reps.

Emily Perrin: So many reps and there's not a lot of flow in this sport. So there's so much time for your brain to be elsewhere, talk about being able to ground and connect the brain to the present moment. When you're out in left field and a ball hasn't come your way in three innings, what are you thinking about?

Dr. Yoni Rosenblatt: I don't know. It's very scary to me.

Emily Perrin: It's 100%, it's baseball.

Dr. Yoni Rosenblatt: Just thinking about that. Okay, good, good answer. Next, athlete you'd most love to work with.

Emily Perrin: Oh my gosh. I was gonna say Serena Williams, but she's not... She's retired.

Dr. Yoni Rosenblatt: Okay, you would have said Serena, but now that you can't say Serena, you would say? 

Emily Perrin: Oh my gosh, this is overwhelming. Can I say a team?

Dr. Yoni Rosenblatt: I encourage you to take deep breaths.

Emily Perrin: Okay.

Dr. Yoni Rosenblatt: And relax and pause.

Emily Perrin: An athlete.

Dr. Yoni Rosenblatt: No, you can't say a team. Is it Austin Colish?

Emily Perrin: Oh, I love Austin.

Dr. Yoni Rosenblatt: What athlete?

Emily Perrin: I don't know. No one's ever asked me that before.

Dr. Yoni Rosenblatt: Well, that's why you're here on the True Sports Physical Therapy Podcast.

Emily Perrin: I would really love to, maybe not work with, but have a conversation with Kevin Love.

Dr. Yoni Rosenblatt: Good answer. Because?

Emily Perrin: He has done a tremendous amount for Mental Health Awareness, his foundation is absolutely incredible, they also do a ton in the workshop in psychoeducation realm, which I'm super fascinated in. I just love connecting with... So much of his mental health journey, everybody has a story and I just think his story and his willingness and vulnerability to share is super cool. So Kevin Love if you're listening, I'll have a conversation with you.

Dr. Yoni Rosenblatt: There you go. Reach out. Yeah, you will? Okay, you'll make time for that? Okay. Now, where is Emily Perrin in five years?

Emily Perrin: That's a great question.

Dr. Yoni Rosenblatt: Lightening round.

Emily Perrin: Very similar to where I am now. Continue to do this work, hopefully on more of a national and international level and that's not because a recognition piece, that's just because I genuinely believe in this work and I believe in changing lives and making sure that we are starting to reverse some of the mental health crisis that we are facing right now.

Dr. Yoni Rosenblatt: Yeah, it is. It's a massive crisis. And I've seen your work and you obviously do outstanding work. You've helped me today get better.

Emily Perrin: Amazing.

Dr. Yoni Rosenblatt: Just in this conversation, I think you've helped this audience get better and just think about that trickle-down effect, how many athletes are gonna benefit from the thousands of sports PTs that are listening from what you just gave them. So I think you'll be at that stated goal in about a year based upon that, so...

Emily Perrin: You're the best.

Dr. Yoni Rosenblatt: Yeah, I appreciate that. So congratulations on that. Thank you for joining us, tell us where to find you.

Emily Perrin: So active on really all platforms, not TikTok 'cause, it's for the life of me, can't figure it out. Instagram, Emilyperrinlmsw, Twitter, Emilylperrin. My website, my company is Perrin Wellness and Performance, you can find me pretty much through any of those.

Dr. Yoni Rosenblatt: That is... That's awesome. And obviously, just so much to learn from you. I'm sure we'll have you back on. Thank you so much.

Emily Perrin: Let's go.

Dr. Yoni Rosenblatt: So much for joining us. Appreciate your time. Thanks Em.

Emily Perrin: Thank you for having me.


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