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5 Ways We Eat Our Own Young As Healthcare Professionals & WHY IT MUST STOP! - themanualtherapist.comq


It’s been mentioned, discussed, and sadly… often joked about at professional conferences. Our business leaders openly admit it occurs, and, for the most part — it’s simply accepted as part of being a healthcare professional.



Join guest Shawn Riester and Erson as they recount a very early story from the beginning of their careers. Sometimes people just don't get certain hints. Before active listening was even a thing, almost 20 years ago, steps were taken by Shawn to save Erson.

Untold Physio Stories is sponsored by


EDGE Health and Tech Solutions - we level up your website with full SEO optimization, turn it into a referral generating machine and do full G Suite and Telehealth integrations - find out more at https://edgehealthandtech.com


Modern Manual Therapy Insiders - over 650 Exclusive videos, Research Reviews, Webinars, Online Discussion - learn easy to apply Clinical Practice Patterns, integrate Pain Science with Manual Therapy and Patient Education - Join now at https://insiders.modernmanualtherapy.com


Also, be sure to check out EDGE Mobility System's Best Sellers - Something for every PT, OT, DC, MT, ATC or Fitness Minded Individual - https://edgemobsys.com/bestsellers


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The Magic Pill That Treats All Ailments - themanualtherapist.com

What if I told you that there is a pill that could treat almost every chronic condition.

Would you be willing to take it? 🤔
5 Metaphors for Reframing Pain and Damage - themanualtherapist.com

🔥TOP 5 FRIDAYS🔥

5 Metaphors for Reframing Pain and Damage


Pain does NOT always equal damage, especially when symptoms persist beyond normal healing times.

When dealing with symptoms that someone cannot see, it is oftentimes interpreted that the more painful a movement/activity is the more damaging it can be.

This simply is not true as pain is much more complex than any dichotomous relationship involving tissue damage.

Some people can have lots of damage with no pain and others can have lots of pain with no damage.
Pain Metaphors by Cameron Faller


Metaphors are often used to help validate that an individual’s pain is real while helping them reframe the belief that it may not be dangerous.

👉Sunburn Analogy - This is a great analogy when someone is performing a particular movement or exercise that is painful, but it reduces or becomes abolished within minutes after the exercise has been performed.

👉Bruises vs Paper Cuts - This concept works well when an individual might come in with an MRI or X-ray that shows normal degeneration but is worried that it's the sole cause of their pain. We know through research that the amount of degeneration does not predict someone’s pain experience.

👉Motion Sensitivity Analogy - This works well for someone with central sensitivity or a heightened nervous system. The concept would be to work on dimming the sensitivity down to a point where the light alerts us when a car comes up, but not when every leaf blows by.

👉Cup Analogy - This was first described by Greg Lehman who described our pain tolerance like a cup. The more factors or stresses in the cup is likely to lead to more intolerance. In order to improve that tolerance, you can either work on reducing the stresses in the cup, or building the cup bigger. 

👉Broken Heart Analogy - This works well when someone might be undergoing a very emotional pain experience. If pain is limiting someone from accomplishing their job, hobby, sport, etc., it may become emotional which only heightens the pain response.

Utilizing analogies and metaphors may help reframe an individual's perception and reduce the threat level in regards to a movement or activity they need to perform

"Aspire to Inspire" - via Cam Faller, DPT 

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Untold Physio Stories - A Very Valuable Lesson with Shawn Riester - themanualtherapist.com

Sometimes patients deserve the benefit of the doubt. And.... sometimes they absolutely do not. Listen in as Erson recounts a valuable lesson he taught one of his very first mentees, and good friend Shawn Riester.


Untold Physio Stories is sponsored by


EDGE Health and Tech Solutions - we level up your website with full SEO optimization, turn it into a referral generating machine and do full G Suite and Telehealth integrations - find out more at https://edgehealthandtech.com


Modern Manual Therapy Insiders - over 650 Exclusive videos, Research Reviews, Webinars, Online Discussion - learn easy to apply Clinical Practice Patterns, integrate Pain Science with Manual Therapy and Patient Education - Join now at https://insiders.modernmanualtherapy.com


Also, be sure to check out EDGE Mobility System's Best Sellers - Something for every PT, OT, DC, MT, ATC or Fitness Minded Individual - https://edgemobsys.com/bestsellers

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Enhancing Your Physical Therapy Business with Nutrition - themanualtherapist.com

Physical Therapists (PTs) can easily add nutrition to their practice. Doing so can improve patient outcomes, provide a “stand-out” service versus other local providers, and offer an increase in revenue. Incorporating nutrition into physical therapy practice is recognized in the “scope” of PTs by the American Physical Therapy Association (APTA) and makes good business sense. Several of our other blog posts highlight the why and how PTs should offer nutrition and what the APTA and practice acts say about PTs offering nutrition, but this article is going to focus solely on the business side of PTs providing nutrition.

Adding nutrition services to PTs running cash-based practices is a must. The biggest standout item within cash-based PT practices is that the client pays, not insurance. As such, you as the provider only have to justify your time and services to the client, not a third party payer. Provided the State you are practicing in allows nutritional counseling and you’ve had the training, you can spend as little or as much time assessing, prescribing, and modifying a patient’s diet to fit a specific nutritional paradigm. The best thing to do is be sure to define the scope of work with the patient before you sink a good chunk of time in assessing a diet: come to an agreed price and know how much time you are going to spend before you begin pouring over dietary assessments and food logs. Some clients are willing to fork out serious bucks for nutrition, especially to a provider they trust, like the PT who helped them recover from an injury or surgery! Chiropractors, naturopaths, podiatrists, and other providers have been and still are offering cash-based nutrition counseling on-top of their existing practice patterns -- why should PTs be excluded? One tip I offer given my cash-based PT practice: avoid selling supplements. Supplements seem like a lucrative way to gain huge revenue potential...and that’s all they are there for. The evidence truly does not support most supplementation, perhaps with the exception of B12, Vitamin D, and/or probiotics in some cases. As a PT provider adding in supplements it opens you to a whole new risk area for liability, both financially and in practice. What happens when your supplements harms a patient? What happens when a client does not like your supplements? Do you offer a refund or pay for harm done? These are major questions, but wait there’s even more...You will need to buy and stock supplements, usually in whole-sale fashion. Inventory, track expiration dates, and develop a flow model and point of sale for your supplements. You will have to consider if you offer commission for staff to sell supplements, track commissions, and likely also have to worry about State and local taxes. In the end, supplements can make you big bucks but also big headaches: the evidence does not support them and neither should your practice.

For PTs working in an insurance model, whether in private practice or as a staff employee, nutrition can still offer a business perk. While the cash-based PT practice stands out already because he or she does not accept insurance, your practice can stand out further by advertising you offer nutritional services at your practice. You can place this on your Google search questions, your website, your business Facebook page, and by telling your active patients -- just be sure to check your State laws on how it ought to be phrased and if advertising nutritional counseling is even allowed in your specific State with your credentials. Offering nutritional services as an insurance-based physical therapy practice will certainly make you stand-out versus the other clinics in the area. Patients will see your practice as, perhaps, more holistic, complementary, or even wellness focused. Attaching such perceptions helps build brand identity, credibility, and can increase repeat utilization of your business for multiple lines of services (not just PT).

If you own a private practice standing out is important but so is the revenue stream that keeps operations afloat. Nutritional services can be yet another billable service that can be offered through insurance in various ways. First, some patients have insurance that pays for nutritional counseling specifically; as always, check your State laws as to what credentials you need to offer such counseling and check the insurance stipulations for payment too. Deriving revenue from solely billing nutritional counseling alone may be difficult for PTs given that many states and insurance plans require licensed dietitians or nutritionists to offer these services using those specific codes.

Second, PTs can provide billable time for nutritional counseling through the patient education current procedure terminology (CPT) code 98960 for individual patient education. The education must be rooted in an evidenced-based approach and sponsored by an appropriate medical professional associations. We recommend the APTA, American College of Lifestyle Medicine, Physicians Committee for Responsible Medicine, and/or American Nutrition and Dietetics as appropriate and evidence-based sources of nutritional information. Other codes can be used but it must be clearly rationalized in the notes to be justified for insurance. Here is a fabulous WebPT blog post that outlines how PTs can offer patient education in general. Appreciate that this may be the best avenue for insurance PTs to incorporate nutrition services. As a practice owner you can expect a PT to offer an additional unit or two per day depending on the staff PT’s engagement and patient caseload/type. Instead of pushing your staff to dig deep for extra therapeutic exercises or to kill their hands by adding in an extra unit of manual PT to increase units, consider asking your staff (if trained and it is State appropriate) to explore patients’ diets. Even a 15 minute conversation can open up other social determinants of health (SDOH) like smoking, stress management, and dietary patterns. Such things can not only impact physical therapy outcomes but also health and life! An extra unit or two per day could equate to an extra $27-54 per day or roughly $1,215 per month -- that could cover a salary for a technician for half the month! As a staff PT you may not care what the practice pulls in; but you ought to know that the practice assumes the risk, pays your paycheck, and fights the insurance fight everyday -- keeping a small private practice afloat by adding “extra services” will be the future need for small PT practices nationwide.

Third, PTs can transition patients to maintenance PT after traditional insurance therapy. Maintenance PT can include normal physical therapy services with the addition of nutrition counseling (again, depending on training and State laws). In such a case patients usually are cash pay and will be willing to pay for nutritional services, particularly if it will help their physical condition and health. Here is perhaps the best avenue for PT practices to capitalize on nutritional services, assuming your clinic or facility offers maintenance PT. Plus, with the recent changes in the eligibility of payment for preventive services from a health savings account (HSA), such preventative nutritional services may qualify to be paid from an HSA soon. The benefits of this method is the practice gets paid immediately after the service; there is no waiting for reimbursement or devaluation from a third party payer. Moreover, the practice will earn more per unit time if the practice bills for maintenance PT and the patient agrees to payment of services based on time. In other words, instead of earning $27 per unit like in an insurance situation, a practice could charge a flat $150 fee for a 1 hour nutritional assessment because it takes one hour of the PT’s time to complete (just like a 1 hour PT evaluation). That works out to more like $37.50 per 15 minute unit of time. Another avenue could be just to charge a flat rate fee for all nutritional services (assessment, prescriptions, follow-ups) and market and sell them in packages. Health coaches do a fabulous job of such marketing and business structuring. For example, one health coach in South Florida charges her clients a flat $4,000 fee with a minimum buy in for 3 months! In this fee the patient gets a nutritional evaluation, dietary recommendations, and follow ups of encouragement for meal and fitness compliance. When PTs complain about dwindling reimbursement and the lack of revenue opportunities, I look at such a health coach as an inspiration to change what and how we as PTs are providing care. Break out of the “model” and do something new by adding nutritional care to your practice today! To learn more about nutrition, dietary counseling, and how it all relates to physical therapy practice, check out our board-approved, online continuing education courses for nutrition and PTs.

Want to Learn More?PT and Nutrition: A Recipe for Better Outcomes - themanualtherapist.com




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5 Types of Bias Involved with Research - themanualtherapist.com

5 Types of Bias Involved with Research 

Bias can be defined as "a difference in a particular direction between the results of a study and what happens in real life."

Research cannot fully control all types of bias, but a well-designed study will always examine the effects certain biases had on their results.
Types of Bias by Cameron Faller


👉Selection Bias - This type of bias involves the selection of participants, or groups, based off from who will likely respond well in which proper randomization will never be achieved (i.e. measuring the effect exercise has on blood pressure for a group of individuals who love to exercise and will also eat healthier options)

👉Performance Bias - Participants are more likely to perform better when they know that the task being observed is expected to have an outcome. This ultimately undermines the capacity to make valid inferences about the effectiveness of an intervention.

👉Detection Bias - Detection bias occurs when a therapist or assessors has knowledge of the treatment a participant receives and may subconsciously interpret outcomes that favor the intervention group. Studies are able to control for this by blinding the assessor or therapist when measuring outcomes

👉Attrition Bias - No matter how well a study is run, there will always be participants who drop out. This skews the data especially when a greater number of participants dropped out of one group compared to another. Having a follow-up percentage of at least 85%, or obtaining an intention-to-treat analysis are ways studies can help decrease this bias.

👉Confirmation Bias - Confirmation bias occurs by interpreting the evidence or running analyses until the findings support current beliefs. This can occur both when conducting research, or reading the results of specific research.

Being able to assess the risk of bias helps give more or less weight to the value of the evidence.

Taking evidence from a study without assessing any risk of bias leads to the potential of providing inaccurate advice or expectations.

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“The Devil is in the Details”


Learn more online - new online discussion group included!


Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school. 
  • NEW - Online Discussion Group
  • Live cases
  • webinars
  • lecture
  • Live Q&A
  • over 600 videos - hundreds of techniques and more! 
  • Check out MMT Insiders
Keeping it Eclectic...

Untold Physio Stories - Post Op Complications with Alex Kirbach - themanualtherapist.com

Alex Kirbach joins Untold Physio Stories again with a story about recognizing post op complications and communications difficulties with a clinical instructor. Alex can be found at Kirbach Physical Therapy


Untold Physio Stories is sponsored by


EDGE Health and Tech Solutions - we level up your website with full SEO optimization, turn it into a referral generating machine and do full G Suite and Telehealth integrations - find out more at https://edgehealthandtech.com


Modern Manual Therapy Insiders - over 650 Exclusive videos, Research Reviews, Webinars, Online Discussion - learn easy to apply Clinical Practice Patterns, integrate Pain Science with Manual Therapy and Patient Education - Join now at https://insiders.modernmanualtherapy.com


Also, be sure to check out EDGE Mobility System's Best Sellers - Something for every PT, OT, DC, MT, ATC or Fitness Minded Individual - https://edgemobsys.com/bestsellers


Keeping it Eclectic...