Part 2: “I’ll never grow up, never grow up, never grow up! Not me!” ― J.M. Barrie, Peter Pan

I entered physical therapy school at Emory, inspired to learn and give back to patients just as my previous therapists and mentors had done for me. Following graduation from physical therapy school, I began working in a hospital-based outpatient pediatric and adolescent sports medicine clinic. What could be better? I treated young athletes who were healthy, vibrant and motivated to get back to their sports. I saw athletes from every sport you can dream of: from Irish dance to fencing; competitive kayaking to synchronized swimming.  I often marveled at the fortune of knowing every patient in the room was under age 21. As specialists, we always made sure therapy was kid-friendly, fun and sport-specific. The kids were motivated, we were motivated, and we knew we were doing a good thing.

Pilates at CHOA

Working at Children’s Healthcare of Atlanta in the Sports Medicine Program, I blended my Pilates teacher training with sports-specific rehabilitation. And sometimes, I got yelled at by parents.

Now, some people would not consider elements of this setting to be fun.  For me, I love the “teenage attitude.”  It is entertaining.  Add that to the paradox of the parent who is struggling to contain the attitude, and we have a real winner in my book.  Most kids are pretty good, but I’ve encountered some real gems in my time:

(1) My favorite response to receiving the all-star eye roll from a 13-year-old girl: “So, when you roll your eyes like that, is it because you’re really dizzy or something? I’m just wondering because you’re doing it a lot and I’m concerned for your health.” She never rolled her eyes again.

(2) Show up late to therapy because you were giving your mom a hard time? You owe me a pushup for each minute you’re late.Try it! They’ll show up early and ask you to do pushups for each minute they were early!

(3) Don’t do your home exercises because the dog ate your theraband? Wall sits for 10 minutes. The next time they come they’ll tell you about how they magically found the theraband under their bed.

It’s interesting to hear about the struggles each teen and family member face: from middle school dance to studying pre-algebra; prom dress shopping and recruiting for college sports. It’s a small glimpse into a life that many could classify as far from reality.  But to them, it’s their reality. We have to recognize and respect that.

I’ve probably learned more about how to Tweet, use Apple products, Snapchat, braid my hair, paint my nails, wear leggings and Uggs, and dream of the Elf on the Shelf from my young patients than I could ever imagine learning through my own life experiences.  Prom dresses are now preferably short and Instagram likes are the new marker of 7th grade popularity. Let’s be honest, I specialize in this field simply so I can keep up with current events.

As an undergraduate psychology major with a special focus in developmental psychology, the pediatric and adolescent age group has always fascinated me.  It’s interesting how quickly changes occur in this cohort, and how we can capitalize on developmental processes to create positive outcomes. We can literally help pave the way toward a successful adulthood, including positive physical and mental health. I want my young patients to avoid becoming the adult with chronic sports-related injuries, like me.

Despite my love for this setting, I eventually moved out of the pediatric hospital setting and into private practice. This allowed me raise the bar on exercising my passions and work alongside some of my most valued mentors. Given that I no longer worked for an exclusively pediatric clinic, I inherited some adult patients too. “Grown-ups,” if you will. Prior to starting my current job, I recall having nightmares about this unchartered territory. How on earth was I to work with grown-ups? I was barely one myself!

Eventually, I noticed that I could really treat grown-ups the same way I treat kids and teenagers. In my book, most grown-ups are just big kids. Grown-ups will tell you they don’t generally recall magically becoming adult-like at age 18 or age 21. People in pain are stressed, regardless of age. They have stressed family members, too. And yes, sometimes those family members just may back you into a corner and yell at you.

Grown-ups are motivated and many are athletic, just like kids. Sometimes, they tell me the dog ate their theraband. They show up late too, and sometimes it’s still because they were giving their moms a hard time. Interestingly, an anecdotal trial over several months showed me that most grown-ups still love receiving stickers and prizes for good behavior or good work. My colleague Kate has also figured out that some grown-ups also like hugging a teddy bear when receiving uncomfortable manual therapy treatments.

It was comforting to see my new practice this way and my nightmares decreased, but I felt like I was out on an island. I encountered professional conversations with adult specialists about how treating kids can’t be very different than treating adults.

I believe that while adults can often be classified as big kids and often respond to similar treatment strategies I use on younger patients, the adage doesn’t necessarily work in reverse. Say it with me folks: Kids and teens are not just small adults. Now repeat that 100 or 1000—or however many times it takes until it sinks in. Kids’ and teens’ brains and bodies are literally wired and built differently. They have different physiologies and priorities. Still not convinced? This excellent editorial sums it up quite nicely.

That’s not to say kids’ priorities are any less important. It takes a savvy mind to recognize that kids’ issues aren’t any less important to the kid than issues that an adult may consider more realistic. Yes, kids live in a different world and on a different planet. They aren’t supposed to see the world the way we do. I’ve been told “Oh, it’s a kid, they are so easy to treat because they are so healthy and don’t have chronic problems. Their issues just aren’t as big.”  Every statement in that phrase is generally true, minus the word easy. Both groups bring their own unique challenges. They are very different animals–apples and oranges, if you will.

Sometimes I just want to say “Try spending an hour with someone who only speaks in a language of tweets, facebook walls, OMG, selfies, besties, next weekend’s school dance, the trip to summer camp, and the PSAT.” You think that’s easy? Think again.  With treating kids comes the responsibility of maintaining an influence as a positive role model, but also doing your homework (every day) to stay on their level. And let me tell you—my young patients think I am sooooo cool as a grown-up because I have a Twitter account. Score!

After working on my pediatric-adolescent-adult island for a while, I stumbled across this article. “AHA!” I thought, “someone from the New York Times is with me on this whole grown-ups and kids thing!”


Celebrating Halloween dressed as Superwoman. I have been known to let several of my young—and older— patients “fly.”

In addition to treating kids for who they are, I also often face the question of which specialist a kid or teen should see. Parents and colleagues may ask “What does it matter if the child sees a pediatric specialist?” or “Should I take them to an adult specialist instead of a pediatric one? That specialist works with professional athletes, therefore he/she must be better.” That’s the same logic as going to see a veterinarian for your bronchitis. Per the astute philosopher Cosmo Kramer, veterinarians must be better because they have to be able to cure a lizard, a chicken, a pig and a frog all in the same day!

Because it is an adult specialist, does that make him or her a better clinician for your child?  Unlikely. Medical specialists come in all shapes and sizes and have all different types of training. Pediatric-trained specialists understand the unique needs of the child & adolescent body and mind. What’s most important is matching a child with the clinician who can best suit his or her needs given training and experience. And most importantly, pediatric specialists can tolerate the continuous all-star eye roll and keep up with the latest and greatest about One Direction and Instagram. But it’s not all fun and games. They can usually come up with every kid-friendly term and metaphor in the book to explain scary and complicated medical concepts to their patients. And guess what—those kid-friendly terms and metaphors work great for grown-ups, too.

Part 1: From stuffed animals to screaming parents

During the first year of my career, I stood in a corner while being yelled at by an angry father who wanted to know when his injured child was going to play baseball again.

Despite the steam rising from my reddening cheeks, I calmly reassured this parent. Beneath the anger, he was undoubtedly stressed about his kid’s health and sport. I told him that his child was in good hands and we were working to get him back in the game as quickly as possible. It wasn’t until later that my colleague Jill gave me a high five for my Oscar-winning performance. Only she could tell that beneath my calm demeanor, I was panicked that this father was going to fire little old me, the new graduate who couldn’t possibly know anything about baseball.

It’s during these moments–and believe me, I’ve had more than my fair share–that I reflect on my own injury history as a competitive swimmer. It began early in my teenage years and continued into college swimming and adulthood with even more problems. Each injury or problem has brought stress, doubt, anger, grief and frustration. It’s hard enough to be a patient going through it and miss out on what you love. Add on a parent or loved one, and that multiplies the challenge.


Every athlete faces disappointment at some point. Being injured can be more disappointing than not winning. That’s me on the left at age 12 getting 7th place in a race.

This is the stuff that drives me. Yell at me? No problem! I’ll take it with grace and a smile on my face. In the end, I may “win” this battle, but the good news is, we all are winners at that point.

Parents aren’t the only ones who challenge the method to my madness on a daily basis. I often hear phrases from colleagues like “I could never work with kids. They’re so hard to understand,” or “It’s not the kids, it’s the parents who are the tough part-you get two patients for the price of one!” or “How do you even know how to talk to kids?” Ok, I’ll admit it. It’s no cakewalk. To me, the thrill of the challenge behind the success in working with kids far outweighs the frustration of juggling each child, teen or family member’s individualized needs.

The story of how I ended up in this field may be compelling to nobody but me, although my colleague Dan Dale decided to publish this article about it in APTA Perspectives magazine, May 2013 issue. I like to believe that in retrospect, it makes sense that I’m as inspired as I am.  But I’m not on TV and I don’t have a pet monkey with cymbals to get your attention so I’ll resort to the next best thing: a blog!

My parents will tell you that I was the kid who craved the toy doctor kit. I told everyone I was going to be a doctor. I had the healthiest stuffed animals in the world because they had their blood pressure taken regularly.  Usually I don’t back down from my goals, and even at age 5, I like to think I foresaw the future.

I am now a Doctor of Physical Therapy (DPT). Dr. Julie for short. I am a sports physical therapist with a special interest in pediatric and adolescent orthopaedics and sports medicine. Looking back on my PT “upbringing,” it’s a little ironic to see where I am given my first exposure to the practice was a juxtaposition with how I work these days.

I first experienced PT at age 15 when I injured my back during swim drylands while landing the perfect 3-foot vertical box jump. Sticking a landing on a feat like this is admirable if you’re aiming for Olympic gymnastics.  However, I’m not sure it’s the most functional exercise for swimmers whose only jumping involves a headfirst leap off a platform into water.  My perfect-10 performance did not get me to the Olympics, but it did earn me a ticket to the neighborhood PT clinic. It was there that I recall always being put into a quiet room where some teenager rubbed gel on my back with a warm metal probe. Then I laid on the table and did a bunch of exercises while nobody watched. Then the same teenager came in and strapped electrodes to my back and made me lay with them on an ice pack for 20 minutes. I’m pretty sure that teenager was my classmate in Spanish class. At the time, that was PT to me. I didn’t know any different.

It didn’t take me long to realize that it was not, in fact, PT.  Eight years later in a classroom at Emory University, I would learn that the warm metal probe (therapeutic ultrasound) should not be used over the spine and generally not in adolescents under age 16 without medical clearance. I also learned that teenagers could not lawfully perform these treatments in Georgia. Hmmmm…

Looking back, I kind of wish my own angry parent would have backed my nonexistent PT into a corner and yelled at him. Or perhaps it was a her. Honestly, I can’t remember. That’s how great of an impression he or she left on me.

To add insult to injury, that back pain never really went away.  Then there was the shoulder surgery, months of PT, and decision to end my swimming career at Duke University.  During and after graduate school, I had more PT for continued shoulder pain, back pain, and all the other “pains” that came along with being a busy professional student-turned-professional clinician.  And yes, you guessed it, I’m still in PT. One would think that at some point I’d get sick of it.  But I just figured I’m already there, I might as well get paid to do it.


This is Blair: my therapist, mentor, friend, colleague and boss. She continues to inspire me to be a better therapist, and most importantly, a better nerd. She even inspired me to dress up like this, get up at 3 AM and cheer her on as she ran a half marathon. Now that’s influence, folks.

Somewhere along the way, through all of my own PT and PT education, I realized what real PT is. I learned that being a rock star physical therapist involves taking the same drive that I put into my own life and applying it to patient care.  It’s striving to be at the top of the profession, exercising an insatiable curiosity for the “why” behind the things we do.  I only wish I’d known at 15 what I know now. Where is my flux capacitor when I need it?

Real PT includes teaching, learning, coaching, mentoring, cheerleading, researching, parenting, teamworking, being totally hands-on, and making a few friends along the way. What it’s not is putting a kid into a room to be isolated away from other kids and patients, to perform nonspecific exercises, have contraindicated modalities performed by an unlicensed professional, and be totally unsupervised by a licensed physical therapist.  That, in my book, is not noteworthy.

Since age 15, I have fortunately had a few notable therapists and mentors along the way who set the record straight for me on what this whole PT thing is about. I have been fortunate to transition from student, mentee and patient to now working alongside them as a colleague.  Along the way each of them instilled in me a small sense of “I want to be just like them when I grow up!” And despite the frustrations of injury after injury, their influence has inspired me to give back to athletes just like myself.


At the 2013 APTA Combined Sections Meeting, I ran into my friend Rosie and former physical therapist from Duke, Kerry. Turns out we all passed our board certification in sports physical therapy at the same time. Full circle.