The Disruption is happening-- Jeff Moore

This past weekend, I had the opportunity to attend a course with Jeff Moore (@jeffmooredpt) and Jerry Durham (@Jerry_DurhamPT) at Entropy Physiotherapy (@EntropyPhysio) in Chicago. This was the third course I've attended there in the past year, and the second featuring Jerry. As I've written about before, Entropy, co-owned by Sandy Hilton (@SandyHiltonPT) and Sarah Haag (@SarahHaagPT) is hands down, the BEST place I've ever been for a course. It's not just because of the quality of presenters they bring in, the hostesses themselves, the outstanding coffee, snacks, lunch, after hours dinners, drinks and burlesque shows (wait, what?), it's the entire experience. 

I encourage everyone to check out the selection of upcoming amazing presenters here: http://entropy-physio.com/professional-courses. 

Thunder and Lightning- it's a moniker that has been frequently used to label such things as a running back tandem in the NFL, or perhaps a boxer's fists. In this case, the characterization applies equally to both. Both Jeff and Jerry like to disrupt the status quo, and both energize and inspire the people around them. 

Jeff Moore: For those of you who haven't been able to catch Jeff live with his #PTonICE periscope, the beard game and passion are strong with this one. I'm placing his current beard status at "sea captain." To describe Jeff as passionate is like describing Warren Buffett as "wealthy"-- just a slight understatement. As I tweeted in response to a request to record a portion of Jeff's talk, "it would have broken Periscope." I've wanted to meet Jeff n person for a while now and see how he runs a course. And let me tell you, the live show is a whole different ball game.

Jerry Durham: I'm pretty sure he doesn't need an introduction. And I'm also pretty sure he hasn't been clean-shaven since puberty. This weekend he had it dialed in at "Tom Brady three-day growth." Jerry is co-owner of San Francisco Sport and Spine, an out-of-network operation of three clinics in the Bay area. He may be best known for the "Customer Life Cycle," yelling at people on the internet for using the words "reimbursement" or "discharge," fancy socks, bourbon, and live-tweeting every single blow-by-blow of every SF Giants game.

I'm not saying I'm Batman, but have you ever seen us together in the same room?-- Jerry Durham

A huge bonus of the weekend came at the end of the day on Saturday when we had the opportunity to hear a story from a former patient of Sandy Hilton's, Erin Jackson. Through Jerry Durham this past year, Erin was one of two featured guests on the first ever patient panel at CSM. She was also recently a guest on the Healthy, Wealthy, Smart Podcast with Karen Litzy (@karenlitzyNYC). Erin held a captive audience as she discussed her ordeal with chronic pain as well as the lengths she had to go through navigating the U,S. healthcare system.  It was a powerful reminder of not only how much our words and actions matter, but also of what the detrimental affects can be when misused, as well as the extremely positive outcome when applied appropriately.

One other thing of note is that in most courses I've been to or at courses that I teach, around 4pm is when you start to see people begin to look at their watches and start to think about the other things they'll be doing when they leave for the day. Especially when Erin was talking,  no one was looking at their watch. I think she went at least to 5:45 but no one was even considering leaving. No one wanted to leave Monday evening at 8pm until it was suggested we keep the conversation going at the bar. That exemplifies the quality of the courses that Entropy provides and that exemplifies the dedication and focus of the people that attend the courses. 

As was pointed out on several occasions throughout the weekend, it was great to be in a room with like-minded, goal-oriented people interested in having the conversation and finding solutions to problems. It was also a real treat for me to be able to meet and engage with the following people: Jeff, Jerry, Sarah, and Sandy of course, but also Jason Robinson (@JRPT7), Sarah Greenhagen (@SarahGreenhagen), Ann Wendel (@PranaPT), Aaron Burkett (@ptfromou), Jimmy Picard (@JimmyP_DPT), Adam Fritsch (@AdamFritschDPT), Kevin Moffat, Tim Seppelt, Jim Hoyme (@therapypartners), and Erin Jackson (@healthy_lawyer). Thanks to all for an awesome weekend!

Be the change you wish to see in the world-- Gandhi

Now, on to the highlights:

It took just 37 seconds and two sentences into his opening section for Jerry to drop his first f-bomb.

In contrast, it took Jeff eight hours and four old fashioneds (at the bar down the street) before he broke it out.

Jeff Moore might challenge for the most spoken words per minute by a PT

"It's not about interventions--it's about patient engagement"

Disruption-- things don't need to be done the way they've been done

"Be comfortable with what you don't know"-- Jerry Durham

"If you listen to the pt and ask the right questions, they will tell you what's wrong with them and how to treat them-- I sincerely believe that"-- Jerry Durham

99% of ppl who call a PT office, they expect the same outcome b/c they don't know what it is that we do. what separates us from another PT?

It is the emotional recollection of HOW we felt at a particular occasion that drives future behavior-- Dr. Joseph LeDoux

"Putting patients first drives both a company's favorability and perception of value when it comes to healthcare"-- Mike Bowen, Insights director, Siegel and Gale

In healthcare, the overarching goal for providers as well as stakeholders must be improving value for patients, where value is defined as the health outcomes achieved that matter to patients relative to the cost of achieving them

Jeff Moore's "Round the Corner" moment-- a description won't do it justice. You need to see it live. But if it doesn't get you excited about doing what we do and the impact you have on people, I don't know what will. 

The most important first question: "How can I help you today?"
The most important follow-up question: "Is there anything else?"-- Aaron Burkett

You do not have a standard exam for every patient!-- Jeff Moore

"Do as little as possible but as much as you need"-- Jeff Moore

You need baselines so you can test and re-test. You don't know what changed if you don't know where they started from.-- Jeff Moore

We are in the customer service industry. If you don't like that, then go into research!-- Jeff Moore

Don't expect the APTA to market for you. You market your community!- Jeff Moore

People don't want someone to fix them, they want someone to work hard at it-- Jeff Moore

"Trust builds equity to be wrong"-- Jason Robinson

You want to take your customers through an emotional experience-- Jerry Durham

What is most important to the patient? 

It's about the person in front of you!

"I don't care what the insurance company things, I care what my patient thinks"-- Sandy Hilton

We do not "discharge" patients-- we complete a course of care-- Jerry Durham

Patients for life: "I want to be alongside you and your family for the long term"-- Jeff Moore

"We have to remember, we are all patients. I'm a PT, but I'm also a patient"-- Ann Wendel

" I needed the input of confidence that I would recover to help me recover"-- Erin Jackson

"0/10 pain is not a life goal! I didn't want to exist like a potted plant. I want to do things!"-- Erin Jackson

I had to continuously recover from encounters with health care providers because people didn't listen-- Erin Jackson

"Engagement is how you recharge"- Jeff Moore

"You don't need X amount of rest. You need X amount of inspiration!"-- Jeff Moore



Thanks for reading,

-Andrew


header image credit: http://darkroom.baltimoresun.com/2013/06/lightning-strikes-sears-tower-storm/#1

Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

Keeping it Eclectic...

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Don't look for flaws. Look for ability-- Greg Lehman

This past weekend I had the opportunity to attend a course with Greg Lehman (@GregLehman) at Entropy Physiotherapy in Chicago, IL. I think I first became familiar with Greg after hearing him on the Chews Health podcast last year discussing the intersection of biomechanics, pain, and movement. Since then I have followed his blog and resources on his website, http://www.greglehman.ca/. For anyone who may be unfamiliar with Greg, he did his Masters in biomechanics under renowned spine biomechanics researcher Stu McGill, and then went on to chiropractic college followed by physio school. 

Even with his prestigious background, Greg delivers content without ego, almost in a self-deprecating manner, yet still full of conviction and veritas. Although most of the course attendees likely already were of a certain mindset prior to attending the course, Greg challenged the "gestalt" of our current way of thinking--regardless what we may have learned in school, the way many of us have been practicing for years, or what very charismatic and convincing thought leaders in our field may have us believe.

Greg's website provides two excellent and free resources for clinicians that I highly recommend. The first is his pain fundamentals workbook, which he indicated is currently being updated, and the second, is his guideline to treatment fundamentals. I often email the "pain fundamentals" manual directly to patients to complement some of the education provided during treatment sessions, especially for some of those concepts that are more challenging for people to embrace. There are some other good resources out there as well, including Mosley and Butler's Explain Pain, and Adriaan Louw's Why Do I Hurt. But when we are attempting to do something as difficult as changing people's thoughts, opinions and behavior, especially when it is something that many people may be resistant to, I find it harder to convince people to pay for something. That's another reason why this free resource is so beneficial. And as Greg stated several times during the weekend, "sometimes it's better for your patient to get this information from someone else other than you."

Before we get too much further, here's just a few words about Entropy Physiotherapy:

Co-owned by Sarah Haag and Sandy Hilton, this is the second time I've attended a course there, and it won't be the last. The first was last summer for a one-day workshop on the "customer life-cycle" with none other than Jerry Durham (@Jerry_DurhamPT), who by the way, will be back again along with Jeff Moore (@jeffmooredpt) May 20-22 for "The business of managing low back pain". I highly encourage everyone to attend. 

A photo of the class at Entropy Physiotherapy. (Check out the good-looking guy in the middle in the green shirt. No, not that guy in front. No, no--that's Ryan Smith (@RyanSmith_ATC) standing in the back. I'm talking about the guy sitting in the mid.....nevermind).

Entropy is a very inviting and comfortable space for attending a course. Class size tends to be smaller so it makes for a more intimate interaction with not only the instructor but also the other attendees. Sarah and Sandy are fantastic hosts and not just because they make great coffee. When you consider the quality of instructors that are brought in, from Greg Lehman, and Jerry Durham, to Mike Stewart and and Diane Jacobs, compared to a weekend SFMA course that costs around $1000 for a weekend, less than $400 for the quality and value you receive is quite the bargain. For upcoming courses, check out the link here: 2016 Entropy Physiotherapy course line-up


And now, here's Greg:

I know what you're thinking. Greg Lehman must really have to go to the bathroom. Either that or he's demonstrating the latest dance craze sweeping across Canada, (which I can't be sure of since he didn't expressly say that he wasn't). Well, you'd be wrong on both counts. He is in fact demonstrating a reasonable exercise for someone with anterior hip pain to train into. (Cue record screech). 

But isn't that just an unbelievably horrible and "faulty" movement pattern? It depends. It might be a good way to load the joint and tissues in a novel way to stimulate an adaptation response. Depending on the activity or demands of the individual, many people may find themselves at some point in a similar position. Wouldn't it be good to prepare the body for this movement so instead of being perceived as "threatening," it has already become accustomed and desensitized to the the position? 

It was somewhat unsettling, yet at the same time welcoming, to be confronted with a challenge to concepts that have become so commonplace not only in physical therapy, but in general movement practice and the strength training community. I admittedly had fallen into the trap of "diagnosing," "correcting," and "treating" "abnormal" movement patterns. Yet, some of those lingering doubts and questions I had are what drew me to Greg's approach and way of thinking. 

When the student is ready, the teacher will appear-- Chinese proverb

The concept of what is the right way to move or what constitutes a good movement may be like the Matrix--the wool that's been pulled over our eyes to keep us from seeing the truth. The truth, in fact, might be that there is no spoon. What or who truly defines a good or bad movement? Could it be that there is no faulty movement unless there is pain? Could there just be movement?

Woah!

There is no easy answer. And many things that will help contribute to our understanding are still unknown. As usual, what we think we know is always changing. The key is that we keep welcoming and adjusting to that change. 

Here are some highlights of my takeaways from the weekend. 

On Movement:

• Knee valgus and spinal flexion aren't inherently "bad"
• the lumbar spine goes through significant flexion in exercises such as the squat and kettlebell swing even when trying to maintain "neutral spine,"
• Degeneration and damage are poorly related to pain, so how can we define a faulty movement pattern?
• We can't extrapolate biomechanics for heavy lifting to regular activities like sitting and texting
• Movement preparedness trumps movement quality
• The best movement screen is one that tests what the person does or needs to do and determines if they can do it
• Movement screen needs to be specific to the sport, e.g. golf swing, gymnastics
• Are you human? Then you're not dead. You can load and you can adapt
• When someone has a painful movement:
• Change it and the movement is desensitized
• Increase tolerance to that movement
• It's more about movement OPTIONS and less about ideals
• creates variety
• shows patient they can move without fear
• demonstrates that they have the ability to move
• builds confidence and self-efficacy
• modifies symptoms
• desensitizes painful movement while body adapts
• Muscle activation is analgesic (short-term)
• Movement is good. Moving differently increases confidence
• Rehab must match the demands of the patient's goals
• No movement is off limits forever!
• Meaningful movement trumps remedial movement
• Alternatives to "correcting" patterns--break the pain habit with NEW movement options
• Example--how many ways can you perform a single-leg squat?
• The best exercise just may be the one you're NOT doing

 Confront people with their strength!-- Greg Lehman

On Pain:

• Pain is normal! Maybe acceptance is the key. If we shift what it means to have pain, maybe that in and of itself is de-threatening
• Pain is more about sensitivity than injury
• Pain tells us little about the state of the tissues
• Pain is an alarm. What does a fire alarm going off tell you?
• fire?
• smoke?
• where located?
• how intense?
• or just a test of the system?
• When something hurts, there are two options: 
• change/avoid it. 
• adapt to it
• Movement and pain get wired together--Pain can become a habit
• We can use "conscious uncoupling" with concept of neuroplasticity
• modify the movement and repeat to form new habit
• load sensitized area in "novel" positions and patterns
• load/move in ways that are similar to painful movement but shy of pain
• retrain previously painful movement 
• Context and expectation fuel sensitivity
• Pain science helps people think differently about their situation
• If pain is an opinion of the brain, we need to help change their opinion

At it's simplest, treatment is merely manipulating load/stress and then asking the person to adapt-- Greg Lehman

On Treatment: 

• Our treatments and interactions can be simple to yield complex result
• Mindset shift--at its core, most everything we do is the same. (ART, Mulligan, McKenzie, insert your treatment paradigm of choice). 
• We facilitate an adaptation and find the right trigger for that for that individual
• Is it all just graded exposure?
• You cannot mobilize/manipulate in a specific direction. The skin-fascia-bone interface is friction-less, so the only force that can be applied is perpendicular to the direction of motion. (Bereznick, Ross, and McGill 2002)
• Manual therapy is like jump-starting a car. What do you do after that? Do you just let the car sit there? No! You drive it. So get moving!
• We are not machines, however. We adapt to appropriate stress and increase our resilience
• How do we know an impairment is an impairment? Must relate to activity
• Static stretching might not be as bad as we think!
• Based on recent research
• Greg challenged his own bias on this topic
• It may not matter how you correct a movement. The right way to do it is the one that is pain-free!
• The body adapts--not immediately and not infinitely so we must respect this

As always, thanks for reading.

-Andrew

Interested in live cases where I apply this approach and integrate it with pain science, manual therapy, repeated motions, IASTM, with emphasis on patient education? Check out Modern Manual Therapy!

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