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You Spin Me Round (Like A Record)

Ann bio photo-1

You Spin Me Round (Like A Record)

On a recent Saturday morning I woke up and turned over to grab my phone to see what time it was. All of a sudden WHOOMP, the whole world flipped upside down. “Uggggghhhh”, I moaned as I lay there motionless, trying to explain to my husband what I was wailing about. Vertigo.

Unfortunately, this wasn’t my first experience with Benign Paroxysmal Positional Vertigo (BPPV). I had my first bout with BPPV over 20 years ago, under the same circumstances (went to bed fine, woke up in the morning and turned over to discover the whole world flipped upside down.) At that time I had no idea what was going on. At least this time I did.


BPPV is the most common disorder of the inner ear’s vestibular system. 2.4% of people will experience it in their lifetime. Let’s first talk about the name of the disorder.

Benign indicates that it is not life threatening and generally doesn’t progress.

Paroxysmal indicates sudden onset of symptoms.

Positional refers to the fact that the symptoms usually occur with changes in head position.

Vertigo is a spinning sensation.

How does it happen?

Our vestibular organs in our inner ear consist of the utricle, saccule and 3 semicircular canals. The semicircular canals detect rotational movement of the head. When the head rotates the fluid exerts pressure against the cupula, the sensory receptor at the base of the canal. The receptor then sends impulses to the brain about the head’s movement.

BPPV occurs when the otoconia (tiny crystals of calcium carbonate that are a normal part of the inner ear’s anatomy) detach from the otolithic membrane in the utricle and collect in one of the semicircular canals. When the head is still, the otoconia settle. When the head moves, the otoconia shift. This stimulates the cupula to send false signals to the brain, producing vertigo and triggering nystagmus (involuntary eye movements). See more here.


Image here

 What causes it?

The most common cause of BPPV in people under 50 years old is trauma. About five years ago, I wiped out skiing and hit my head hard (I was wearing a helmet, thank goodness). I sustained a concussion and took a nice trip down the mountain in the ski patrol sled. Following that incident, I developed BPPV and had treatment that resolved the issue. Any impact to the head can cause BPPV, and anyone who has suffered a concussion should be evaluated for it.

In folks over 50, the cause is generally unknown. It might possibly be caused by age related degeneration of the otolithic membrane.

Sometimes the cause of BPPV is a virus affecting the ear and causing vestibular neuritis. Less commonly, it can be related to Meniere’s disease.

Ugh! What does it feel like?

BPPV most commonly occurs when going from sitting to lying down, when turning over in bed, or when looking up. The sensation of vertigo (spinning) can last from a few seconds to a minute, and can make you feel nauseous. Typically, only one side is affected, and you will feel the vertigo when turning to one side or looking up in a certain direction (hence the “positional” in the name).

How is BPPV diagnosed?

Clinically, BPPV is diagnosed by looking for nystagmus (involuntary eye movements) and vertigo when the head is placed in certain positions. This is called the Dix-Hallpike maneuver. Sometimes lab work may be ordered to rule out other causes of BPPV.

How is it treated?

When BPPV strikes, you will want to get rid of it as soon as possible (it’s that miserable). Medications are not effective in treating BPPV, as they mask the symptoms and can sometimes cause more harm (I was prescribed Meclizine, a motion sickness medication, which I didn’t take).

The most common treatment is a Cannalith Repositioning Procedure (CRP), usually called the Epley Maneuver. This treatment can be performed by a physical therapist or an ENT who specializes in vestibular issues. You will be taken through a series of four movements that move the otoconia back into the utricle, where they no longer stimulate the cuppula.

You should always have this condition evaluated and treated by a physical therapist or ENT, but I will share the steps of the Epley Manuever here:





Wait 24 hours before you perform the full sequence again.

It can be uncomfortable to go through this maneuver because it first puts you in the position that brings on the vertigo, and then you often feel the vertigo again during the repositioning. The procedure is often effective the first time, although it may need to be repeated for complete relief from symptoms. Some patients are given vestibular exercises to do at home as a follow up.

Happily, I can report that my symptoms were almost 100% resolved after doing this maneuver 2 nights in a row. The unfortunate news is that BPPV recurs in 1/3 of patients after 1 year, and in 50% of patients within 5 years. At least I know what to do if it strikes again!

Have you ever experienced vertigo? What do you do for treatment?




Creating Your Cash Based Practice

Over the past few years I’ve received countless emails, Tweets and phone calls from therapists with questions about starting and running a cash based practice. I’ve had the privilege to work one on one with some excellent therapists who are now venturing out on their own with this practice model; but, I can only help so many people at a time that way.

I’m excited to launch my first Webinar designed to help you create the practice of your dreams. Thinking Outside the Box: Creating Your Cash Based Practice was designed to answer your questions. Whether you’re starting a new 100% cash based practice, transitioning from an insurance based to cash based practice, or looking to add cash based services to your existing practice, you’ll find what you need here.



To your success!

What Do You Love?


What Do You Love?


As a private practice owner and health and fitness writer, I’m no stranger to the ups and downs of being an entrepreneur. I somewhat reluctantly took on this role back in 2003, when I first opened my private practice. I had been frustrated for months at my job in a busy rehab hospital, and thought that I could do better on my own. Without any formal business training, I sat down with a yellow legal pad and outlined what I wanted my business to look like.

Now more than 10 years later (with four years in the middle working for someone else), I find myself thinking a lot about the good, the bad, and the ugly of self-employment. A few recent articles have caught my attention, and given me food for thought. The articles cover topics we don’t often discuss as business owners: the risk, the sleepless nights, the stress of an empty schedule or a phone that doesn’t ring. After talking with many business owners over the years, I know that we all share the same joys and frustrations, and I think that we need to talk more openly about our struggles in order to support each other.

It goes against the grain for most business owners to talk about their struggles. After all, we take pride in our image. We want to appear in control and successful at all times. But this often comes at a great cost. This article discusses the psychological price of entrepreneurship in a candid fashion. It discusses the toll taken by lack of a steady paycheck, working long hours, risking security, and loss of time with friends and family. Several prominent business owners openly discuss their struggles with start-ups and failed ventures.

The same article points out that our strengths can also be our weaknesses:

 “People who are on the energetic, motivated, and creative side are both more likely to be entrepreneurial and more likely to have strong emotional states,” says Freeman. Those states may include depression, despair, hopelessness, worthlessness, loss of motivation, and suicidal thinking. The same passionate dispositions that drive founders heedlessly toward success can sometimes consume them.”

In the all-consuming frenzy of daily activities related to owning a business, it is often our own health that suffers the most. Many business owners neglect sleep, exercise, and healthy eating habits, adding fuel to the fire that stress causes to our health. When we refuse to talk openly about our struggles, we are left feeling isolated and alone.

For some entrepreneurs, these feelings come as a total surprise. Several years into owning a business, we may look around and ask ourselves, “How did I get here? I can’t believe that this is what I wanted, and now I’m so unhappy/stressed/apathetic/exhausted.” While I believe it is normal to go through periods where we question our decision to run a business, some people remain disillusioned and have trouble moving forward.

When we identify with our company to the point where it defines us as a person, that’s when we run into trouble. We have all heard sayings like, “When you do what you love, you’ll never work another day in your life.” While this is a lovely, romantic idea, I believe it couldn’t be further from the truth. Owning a business is hard work. Period. It is no wonder we experience disillusionment when we open a business expecting every day to involve unicorns and rainbows. There is no way around it: you will work more hours for less pay (initially) and be fully responsible for not only yourself, but also any employees you hire.

This article from Slate Magazine titled “In the Name of Love” discusses the problems with the “Do What You Love” philosophy:

There’s little doubt that “do what you love” (DWYL) is now the unofficial work mantra for our time. The problem with DWYL, however, is that it leads not to salvation but to the devaluation of actual work—and more importantly, the dehumanization of the vast majority of laborers.

The article points out that we should not forget that labor is something we do for compensation, and that most people in the world do not have any choice but to “work” to survive.

The article also makes the point that when we believe that we are “doing what we love” we have difficulty putting appropriate boundaries in place around our work. This is something that most entrepreneurs deal with at some time in their career. If we aren’t careful, our “work” hours extend to 7 or 8pm, and weekends, and holidays, and vacations…you get the idea.

Because we have convinced ourselves that we love our work, we forget to build a LIFE that we love in the process.

In the end, a life which lacks balance is no life at all. When we recognize our work as work, it helps us to re-engage in the business of living.

The closing paragraph of this article says:

If we acknowledged all of our work as work, we could set appropriate limits for it, demanding fair compensation and humane schedules that allow for family and leisure time.

And if we did that, more of us could get around to doing what it is we really love.

So, as usual, I have more questions than answers; but, I would love to hear from other entrepreneurs. How do you deal with the stress of running a business? Who do you confide in? What do you truly love, and are you dedicating enough time to it?









PPS13 In My Shoes

Red shoes

Red shoes

PPS13 In My Shoes

I just got back from PPS13 in New Orleans, and all I can say is WOW. What a spectacular time. Everything was top notch, from the programming to the closing party. I did a recap for WebPT here.

While I made the point in my post for WebPT that PPS13 was all about connecting, I want to share more of the personal side of my trip here on my blog. I got to see old friends and made new friends, and I got to sit and talk with the leaders of our profession about business and life. What a rush to get together with other private practice owners who could listen, display empathy, get excited for my successes, and offer advice for the future. Here are some of the highlights from my trip:

We got to meet up with a friend of mine before the conference started. He does a lot of work in NOLA in the fitness industry, and was able to give us a tour of the New Orleans Athletic Club. This place was absolutely amazing. It opened in 1872 and is one of the oldest athletic clubs in the states. Where else can you work out on an elliptical machine in a room filled with chandeliers?!


Their indoor pool is open to the 2nd level, where they have a boxing ring!

NOAC pool

After our tour, we went to have lunch with some friends from Kentucky (shout out to Patrick @PatrickMyersPT), Brad (@MyPTapexbrad) and Nick (@NickAustinPT)). And then we made our way to the famous Pat O’ Brien’s for Hurricanes. In the rain. We had a few…

Pat O briens

Over Hurricanes, I met Quinn Worden (@PTsAreHeros). Quinn is an impressive 24 year old with a vision to change the supply chain for physical therapy products. Check out his company PT United to see how you can forget about keeping a stock room full of products for your clinic and order directly through Quinn. The best part is that my patients can order equipment directly through my website from PT United and have it delivered to their home. Here’s me and Quinn in the Superdome (more on that later)!

me and Quinn

The next day, I attended Larry Benz’s (@PhysicalTherapy) talk on “What Patients Want.” Key points: a knowledgable therapist who runs on time and displays empathy. I got to spend some time getting to know Larry at PPS and he impresses me a great deal.

Larry talk

I finally got to meet owner of WebPT,  Heidi Jannenga (@HeidiJannenga)and talk with some of the WebPT (@WebPT) employees.

Me Heidi

I met and spend a good amount of time talking to Jeff Hathaway (@ProActivePT). If you are looking for someone who understands where physical therapy is and where we should be going, talk to Jeff. He found me by my pink pants, which I had posted on Twitter prior to leaving for PPS.

Jeff H

One of the highlights of my trip was a dinner at Clancy’s, hosted by Jason Richardson (@TNBackPain). Jason is a passionate therapist who has a vision for the future. He gathered together an amazing group of people for an unforgettable evening of food and conversation. Mike Eisenhart (@mikeeisenhart) posted a great account of that dinner, so I’ll let you read it in his words here.

Here are some of the great photos from dinner:

Jason's dinner

these guys@Jerry_DurhamPT @TNBackPain and @Sturdy

me and Jerry dinnerMe and Jerry Durham

On Friday I heard Jarod Carter (@DrJarodCarter) speak on one of my favorite topics: Cash Based Physical Therapy. And, after 2 years of talking with Jarod via phone, email and social media, I finally got to meet him and hang out for a while. Jarod is a great guy and a hard worker:

me and jarod

Just when I thought things couldn’t get any better, they did. We attended the closing party for PPS which started at the hotel, turned into a parade marching through the streets of new Orleans with a marching band and police escorts, and ended at the Superdome! The organizers of PPS really did an outstanding job – we had food, drinks and a field goal kicking contest on the field in the Superdome. It was unreal!

Superdome outside

I also got to talk with Jamey Schrier (@JameySchrier). Jamey and I went to undergrad together at U of Delaware. We toiled through our PT school pre-requisites together, and then attended U of Maryland for PT School a few years apart. Jamey owns a clinic in Maryland and also provides business coaching. I am taking part in his virtual workshop, The 21 Day Jump Start.

Me and Jamey

As you can see, my week in New Orleans was filled with fun, learning, inspiration, and connecting with friends new and old. I highly recommend attending PPS next year. Who knows, you could get lucky and get to hang out with Richard Simmons…

Richard simmons

Congrats, Meghan!

Congrats to Prana Physical Therapy patient, Meghan, who recently completed  an Ironman Triathlon! Meghan is the ideal patient: she works hard both in physical therapy and in her training. She trains smart and rarely is injured. I had the pleasure of working with her as she trained for this race, and it is very gratifying to see her cross the finish line! Here’s her testimonial:

Ann!!  Thank you for all of your help.  I finished my Ironman on Saturday.  I couldn’t have done it without your help.  Thank you so much for getting me there.  It was the most unbelievable day.  I have attached a finish line pic.


Whether you’re a weekend warrior, Ironman or somewhere in between, we would love to help you reach your goals! Please let us know how we can assist you!


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