How to Get Buy-In for Active Care and Home Exercises

I think for me personally, the things that have worked well for me is taking more time in the beginning in building the trust. And I don't think people really know how much you know or care how much you know until they know how much you care. And really they're in there for them. It's not for you to showcase how much you know. You're listening to the Restoring Human Movement podcast where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. And now, your host, Dr. Sebastian Gonzales. Hey guys, it's Dr. Sebastian, it's also on the mic today for the Restoring Human Movement podcast.

Thanks for being part of the movement movement. Now, if you have been on the Facebook group already, which is called Patient Education for the Modern Sports Doc, again, Patient Education for the Modern Sports Doc, that's the one that I created. Obviously, it doesn't have the same name as the podcast. Maybe it should one day. We'll see. But it is actually where I put a lot of the drawings, the articles, the content that I create specifically to communicate better with my patients. And a lot of stuff I'll put on there are patient-centric. They are not necessarily always things that you will learn from. You might learn how to communicate in a different way about the concepts that we know, but you might not learn any new information from them. I do put links to the podcast in there as well, but also, too, what I'm looking for. And part of the reason why I'm doing this podcast today as a solo is because I'm going to answer a lot of the questions that I've gotten individually from some of you. And if you're part of the group, you're going to realize that when you first get into the group, unless for some reason I missed this on some of you, I usually ask in the beginning, and it's not an automated robot. That is actually me. I'm looking to see what you want to see from this group. And I've taken your guys' questions and concerns and feedback, and I want to address it today on this podcast. Now, one thing that I want to address, too, is that this Facebook group, I'm a little envious of some of the other ones, like Forward Thinking Chiropractic Alliance is one where people are very active. The Progressive, what is it? The Progressive, dang it, Progressive Chiropractic Physicians Association is a closed group. That one's pretty active as well. I would love this one to be active. And I'm not thinking in the way of arguing back and forth about whose style is better and whatnot. I'm thinking about interactive in the way that if you have something to share with another clinician that will make their life easier, think about all the stuff that you wish you would have had access to, or the stuff that, like the paperwork you took from school before you left school, and you're like, I'm going to need this because I need all these forms. These are going to be useful, and I don't know if this would be better as a Slack channel or not. If you guys use Slack, it's a little bit easier to search than on a Facebook group. But I want this to be a spot where people can make their life easier. Docs can make their life easier. And obviously, like I said, the content that I put on is stuff that I created because I know what's in it. I will gladly share other people's stuff if it looks like it's not extremely self-promoting. It's just trying to help out a cause. And so if you have stuff, post it on there. And if it benefits everybody, great. That's what we need. So going into this podcast today, again, I'm going to take a couple of the feedback that you guys gave me and try to address them one by one. And I'm going to answer it as if I'm speaking to that person. So some of these people are students. Some of the people have been in practice for a while. So just take that into account when I'm answering these things. And also, too, I want to make sure that everyone realizes that I'm not saying my way is the only way. It's just my bias, my experiences. So I'll give you my take on these things because this is what you asked for. So I can only speak as myself. I cannot be somebody else. So if you have not already, by the way, subscribe to this podcast. Please review it on iTunes or Google Play. The reason why I want you to review it again is because it helps me share the information that you're liking. Okay. So ranking is extremely important for people who make podcasts.

So please do so. It will mean a ton. I all I can give back is just better content. And I don't see foresee a end to this podcast coming anytime soon. But I do really do like getting feedback. It helps me create more content and the stuff that you guys want. Now, before we get into that stuff, obviously, I'm going to reveal a little bit about myself. And let's go into a short story. And then we'll get straight into the questions. So there was this one time where I was on an airplane next to this lady who she it was about a two hour flight. And she definitely occupied the full hour, 45 minutes telling me a lot about her health related issues because she knew I was in sports injuries. She didn't know what type she didn't know DC, PT, ATC, you know, that stuff. But she was telling me all about her history of things, which is is an interesting story. So I was it was it was kind of interesting to see. But at the same time, I was not really giving any advice. So I was just listening. So throughout the entire thing, actually, it's funny, she was just bashing on things that didn't work for her. She's like, chiropractic just sucks. And, you know, I would never recommend anybody do it. I'm like, Oh, okay, cool. Great. Like in the story she was telling, I like it sounded like was wasn't right for care anyway. So I understand where she's coming from. I wasn't correcting her or gonna argue with her plus I was gonna be for two hours on the plane. So I just kept listening. Cool, great, cool. And throughout the flight, which I'll come back to that part of the story again. So she knew I was in in healthcare. And she knew I was a doctor of some type. So throughout that plane ride about like three, four rows back, there's a bathroom back there because we're towards the back of the plane.

And there's a girl in there just heaving her brains out. And she was back there for probably about 30 minutes or so just like vomiting. And finally, she had to get her back to land. So they cleared out two rows to quarantine. And they put in the very back of the plane, by the way, if you sit in the back of the plane, it sounds like that's where they quarantine people because they they remove the other rows to other areas. So she's back there just heaving her brains out too. And they're like, is there a doctor on board? And the lady shakes me and she's like, you're a doctor, you should go back there. And I was like, no, no, I don't do I don't do systemic necessarily. And plus, I can hear her heaving, breathing and yelling. She what I'm what I'm going to do for I don't administer some administer medicine. Plus, I can tell she has an airway and a heart in a heartbeat. So she's, she's, she's as good as I'm gonna make her. So I'm like, I don't think so.

That's not my expertise. Let's not do that. So don't don't don't throw me out there. I would have volunteered if I if I thought I could help the person. But so when we finally land, then she's like, well, I really like talking to you. Maybe if I'm in your area, I can come in and see you. I'm like, great, cool. She's like, do you have a card? I'm thinking, oh, dear God. Okay, so here here's my card. I give her the card. And it says DC amongst other credentials on it. And she's like, DC, what's that? And I was like, oh, it's chiropractic. And she's like, oh, I'm sorry, I shouldn't have been. So she started backpedaling a little bit. I'm like, no, no, don't worry. I mean, it sounded like it wasn't right for you. But it was the whole time we were on the flight. I was thinking, don't don't ask me what I do. Don't don't ask my credentials, because it's going to make the whole thing really awkward after all the things you already said. So but that was a time that I almost got pulled to do the medical emergency on an airplane. I also learned that that's where they quarantine people in the very back of the airplane. So I choose not to sit back there unless they really scrub those seats down. And lastly, I guess, yeah, give your business card and right when you're about to leave the plane. So you don't have to talk much more after that. Here we go to the show. Okay, so the first question was, I actually I don't know if I should be releasing names or not. So I'm just going to I'll email you. Actually, I will direct message you if you've been on this podcast. So hopefully you'll enjoy the answers. But the first one is someone who says I'll just read verbatim. I'm hoping to learn. So I always ask, what are you looking for this group? So I'm hoping to learn more about what it's like being a sports doc as well as a sports doc as well as different ways to explain various subjects to my future patients. So this was a student, obviously. Now, the first thing that I kind of think about when people ask me or when people say sports doc, and especially when it comes from students, is I think that the sports doc insinuates sideline work and insinuates working with athletic professionals like professional athletes. And I don't think it does. And actually, the reason I bring this up is because that some of the seminars I've been going to lately, like they give great information. It's great advanced information. There's stuff on concussions. There's stuff on biofeedback. There's stuff on various different types of things that you can do with these professional athletes. And they always say, hey, here's what we're doing with our professional athletes. And here's how you can use it with yours. And every time I'm sitting back there, I'm thinking, I've worked with professional athletes before. And I didn't I didn't really like it. And I don't anymore. And I know maybe it sounds that I'm bashing the whole I'm not bashing people who work with professional athletes, by all means, do your thing. If it's your thing, it just ain't my thing. And it's not because they don't necessarily come in. It's but it's that the simplification of working with other people who are athletic professionals. And I've actually considered rebranding my whole, my whole practice around we treat athletic professionals, not professional athletes, professional athletes, they in my experience of working with them. And not necessarily with the actual athletes themselves, but surrounding the athletes, since they're usually worth a lot of money, they're an asset, there's also a lot of cooks in the kitchen. And it's a little bit hard to get what you believe is the proper treatment plan or proper progress, and then delegate effectively, as you usually do, maybe in your own clinic, when you have a lot of cooks in the kitchen. And perhaps I was not conditioned to do that. And I'm very used to being able to be the director of things and realizing what the person needs to implement and being like more of the quarterback. So I think students really need to be aware of what they're asking for when they're looking to work with sports in exactly what your target market is. Because I know that when I was working with one of the local colleges, I love working with a coach with great communication.

The student athletes were amazing. And they appreciated all the stuff that we did and the progress we were making. But working with the training room, we had different things we were talking about to the athletes. And then that provided a lot of animosity. And it provided a discontinuity of care. And eventually, we broke the whole thing off as a kind of a semi-formal thing. And it was very unfortunate because the students really are the ones that suffered. And because I was still good friends with the coach, and we heard about some of the injuries or injuries or lack of time training that these people had. And I'm like, I really want to help them. But it's too tough to bump heads. So I think when students are working into athletics or athletic populations, I think it's important to narrow down exactly what your target is. And I personally love to work with the weekend warriors and the people who were past athletes, but now are professionals within life. They have kids, they don't have as much time to do the stuff that you're asking them to do. If you were a professional athlete, they're usually very responsive. They're very moldable. They're very coachable because they've had that training in the past. They've been on a team or been in a sport where they have been expected to hit certain expectations to excel. So you can't always say that with general population or people who have not been through athletics. And I can only speak from the people that I've worked with in the past. Some of the people who are not athletes or those ones that I saw or have been athletes in the past were very, it was hard to get them to do the things that I required them to do to get to the next level of care. My example would be if they had a radiculopathy and I asked them to provide first aid to the nerve, do X, Y, and Z every couple hours in the day, come back in a week, and we're going to advance this into more of a musculoskeletal approach. Now that the nerve is going to be cooled down a little bit, they'd come back and then they have the same exact state they were. And they had a lot of excuses.

And I've, I, I'm, I'm not one that really takes excuses. Well, like I understand, I understand life is busy. I understand stuff happens, but at the same time, something didn't happen for the last five days. I mean, one day was busy, parts of another day was busy, but do the stuff. Like I'm, I'm a very big proponent of if you, you need to build a bank account with your, with your rehab or your corrective strategies or your homework. If you don't have five minutes a day, don't spend five, five minutes, spend, spend 30 seconds, spend one minute. If you find a break that's two minutes, spend one minute doing it. So there's, there's a lot of things that I, excuses that I feel like non-athletic populations or past athletes will have. So that's why I really enjoy working with past athletes that are no longer athletes because now there's less bumping heads. Now coming into that whole realm of like who I actually enjoy working with from the sports perspective is I think my, my, my main population that I like working with are people who mainly run and they, it's funny. I think when people tend to get a little bit more advanced in age, say you're 30s, whether you're a past athlete or not, a lot of them tend to default to running. Like if you have a past high school basketball player and they're starting to gain a little bit of weight, like I have a friend like this and he doesn't go and play pickup basketball. He doesn't ask how to play basketball better. He just starts to run. And so a lot of those populations are people who are very dedicated and how are very goal minded and they tend to be very responsive, but also too, they also have a lot of things that they lack in their training because they are working for a living. So I love working with those types of people. And I guess to, to cap, cap this one off, uh, I, I think that we, as a profession, we need to realize that there, there is, there is definitely a lot of honor of working with, uh, Olympians and professional athletes. And it's like, you've been chosen to work with them and it's, it's very, it's very cool to say, but at the same time, they actually, those people have more attention than any of these weekend warrior people. And those are really the major part of the population that suffers. They have aches and pains that think are age related. They drop out of their care very quickly. There is a, or sometimes, but I think those people actually have a bigger need and we can, and we can do more with them. So I would like to just remind everybody that when you're going to these seminars and they're talking about how you can use these for performance basis or professional athletes, just remember that you scale that back a little bit, and you can start using with athletic popular or athletic professionals. And to bring that back even further, I just talked to Brennan Gassami about this is that a lot of times you have these kind of these hacks, like these, these very nitty gritty things that we're going to be working with, with these professional athletes. But a lot of times our normal weekend warriors are, they're not there. They don't need that. They need a broader spectrum correction. I mean, for, for the most part, if someone's running, and they have hamstring tightness, single side, and we realize maybe it's disc or radiculopathy related, then maybe we get them to sit less throughout the day. Maybe we can improve their posture in the chair. Like we don't need to go nuts with the latest and greatest stuff out there.

It might be something very simple. And I think we need to realize that when we're learning about all these advanced things we can do, just sometimes it's the basics. So let's see, in the other part, different ways to explain various subjects to my future patients. Well, I think that really comes to practice. And I think you should start with your your family members, ask them what questions they have about their health. And you're going to realize that I think very quickly that when you start to explain things in a way that you would speak them speak to speak to your classmates about with those. And see if you start talking above the patient or the non-medical person, then you're going to start, then you're going to start to realize that they're going to start to glaze over and they will really won't retain everything you're talking about. So I would speak to them in a very simple way, not demeaning way, but simple way and use analogies and similes a lot. I use those a ton in my clinic. And that's where a lot of my cueing system has come from. Cues are different for different people. I tend to change them every day because I think it's exciting for me. And not everyone responds to the same cues. So try that with your family and friends first, and it'll carry over to future patients as well. Okay, on the next question, it says, they want to see a variety of approaches and implementations of active care into treatments. So patients understand importance. What they learn, I, what, what they learned, I would say, but more of the, not to learn what I would say, but more of the patient communication aspect, like listening to your podcast and the different ways that people explain to patients and talk about their approaches with patient care. Thanks for listening to the podcast, by the way. So hopefully you heard this one too. So let's, let's bring that back a little bit there. Approaches and implementations of active care. So they understand importance. I think I can nail that one right there. The, the importance aspect for me is when you actually, if you listen back to the podcast I did, I think it's 105. I did it with Dr. Cody D-Mac. We did a, a dual podcast and we went over a little bit about just our progression of how we kind of, not necessarily debunk the person's belief of what they have. And we were talking about syndromes and is the syndrome or the muscle in question really the issue or is there something else that we can differentiate it with? So let's, let's, let's play two different types of situations here. So a person comes in, they start pointing at their piriformis and you start rubbing on the piriformis. It starts to feel better. You do adjustments, whatever happens.

And so you did everything active or sorry, passive care there. I would consider those passive care because the patient really can't do them on their own. And by the way, just to disclaimer that I've no problem with doing, uh, adjusting it and active or in passive care in muscle work. It just, uh, it for, I frame it for the patient because I think there's a time and place and it empowers them more when we, when we can do active care. So consider that we did that. The person gets up and starts walking around. They say, Oh, that feels better. And then we start to implement whatever active care we decide. And after that they say, Oh yeah, it still feels better. What are they going to think? So they're probably going to think in my experience, they're probably going to think that the manual therapy is what corrected them, which could, yeah, it made them feel better, but they're going to say that manual therapy fixed me. It helped me. Now let's reverse that order a little bit and let's have them come in with their piriformis syndrome and let's have them do say a McKinsey extension. We'll just have them do like 20 reps or so. They walk around, they feel better. We know for a fact that it's, it's nothing seemingly even like a hip stretch or piriformis stretch to them. They walk around, they feel better.

They're like, Hey, that feels better. Then you do some active care or then you do some manual therapy. What are they going to think? So they're, I think they're going to provide their, you're going to provide some doubt in their mind about what is needed, but also too, they're going to be a little bit more receptive of learning more of the thing that they did that was so simple that you didn't even have to touch them for. So I think those aspects of buy-in are very important and they're going to come in different shapes and sizes with people of different types of conditions. If you're, if you're looking to overall though, implement active care, like I talked, I talked to a friend about this recently because he has a place in New York and he doesn't really have a lot of spots for active care. And he's like, I, I do a lot of passive care here. People are happy and, but I really want to implement active care. How do I get them to want to do that? Because they've been coming for manual therapy for so long that how do I introduce that? I'm like, that's, you know, that's a good question. I think it's really going to come along with number one, do they, they, do they trust your judgment or not? Um, and sometimes even the people you trust, you might not trust their judgment on that one thing because you're, you're very strongly thinking something else or you have a different truth in your mind. So I propose to him, then why don't you just give people, tell people you, you need three minutes, two to three minutes, if you can make them feel better via an exercise. And I would strongly encourage not to do anything that would seem like the person's going to say, oh, it just got warmed up because that's a really common thing that I've noticed with people here is we start, we start moving some stuff around and if it's not a quick enough thing, like say we can do it in 30 seconds and make them feel a little bit better after they've, after they've tested the movement, which is bothersome. And it's not enough time to really say something warmed up that much. So it kind of takes off the table. But if you bargain with the person a little bit and say, look, I'll do passive care on you. I'll do manual therapies and stuff, but I'm trying something new today. I think you need this.

Let's try this and see if it makes you feel better. If it does make you feel better, you do that at home. And then over the next week or so, they've been doing it at home. They're like, hey, I got a good response from that. That's good. I was able to control my own problem. That's great. It's probably a scary thing for chiropractic business though, because you're like, well, shoot, you can control your own pain. You don't need to see me anymore. But I think that's actually wrong because I think there's a lot of things which are purgatory active cares that are actually, you need to advance upon them. It's just, there's just daylight. It's like you're hitting like this hurricane and you hit the eye a couple of times. There's like multiple eyes in there, but it doesn't mean it's not going to come back and return. So I think just framing that a little bit and just letting them know that if this does work at home, we need to advance on this. So when they come back next time, they're going to be like, oh, cool. What's the next thing? And I think for patients too, if they've already been through what they would say, quote unquote, unsuccessful physical therapy, they'll usually come in with like a list of exercises and they'll say, I don't know any of these exercises. I don't know how to do them. And plus when I did do them in the past, it took too long. So I think what the problem there is that there's not a specific enough exercise that's going to give the person the outcome desired. So I don't have a problem with doing a lot of things, but a lot of people will not do them if there's too many things there. So I usually have people do three things. Ideally, if I'm on point and I'm not kind of giving extra time, which I'm a fault of for a while, because if I don't have anyone after, I just like experimenting. And three things is pretty, it's a lot of things. And the person wants to really remember them, they're probably going to say, can I take a video of this? Or can you take a video of me doing this? Which we did a couple of them today. So that is something that you can use to start introducing active care to people, but they have to be, you have to frame it to where they understand that they will be able to modify and decrease their own pain or their own symptoms by doing these exercises. And then there is more after. And my ideal thing is for at least weekend warriors or for people who are sub weekend warrior is I'm looking to get them to some type of load tolerance because they're going to be picking up bags of groceries, lifting their kids through waves, you know, moving dogs and put them into cars. They're going to be doing this stuff anyway. So you might as well just teach them how to do it really well and be really robust with it. So I think that's probably one of the easiest ways. And the, I guess the ways to get that buy-in, probably the things that I use the most for buy-in, and you're going to have to tweak these with people if you don't use them already, is abdominal stiffness. That was from the McGill work. And from DNS, you, you have your, your base of support. So a lot of people get very sloppy with what they use their hand or when they're using their hand or foot to push off of something. Example would be a squat. They get sloppy with their foot contact. They're doing push-ups, they get sloppy with their hand contact, and they start having hip, back, or shoulder issues. When you clean up that base of support and have them push the earth away and use an external cue like that, a lot of times that'll, that'll clean things up. With pain with walking, usually arm swing works. That's a McGill thing. Just make them swing and swing their arms like they own the world and they're late for an airplane. So those things all seem to really work. I'm thinking about trying to think about something with a hip. I know, I know with all those syndromes, you should probably listen to episode 105 with all the syndromes that me and Cody DMAC kind of go over and we go over some of the things that we usually use on there to create a good change within about 30 seconds to a minute with these people with most cases. So let's see.

The next part of that question was more patient communication aspect. Okay, we kind of covered that. All right, next one. Hope you guys are ready and hope you're getting something from this. Take a deep breath. I'm going to be talking for a little bit more. Okay, so the next one we have someone asking, the biggest inquiry is about learning how to give proper patient education and understanding the verbiage for them to comply with the treatment or at-home exercises. I'm a student, I'm in a student clinic, not seeing athletes, just general population, and they just wanted the passive modalities and didn't want to stick, didn't want to work for their care, even though it will greatly benefit them. This is a tough thing here.

I would say that you, people need to be, the solution will present to them when they're ready for it. And I know this is going to be probably a big cop out because I don't have a strict answer for this one because all of these people have different come from's and different reasons and barriers for them not wanting to do whatever they're not wanting to do. I think we all kind of know, at least as I say with nutrition, we all kind of know, generally speaking, eat stuff green, don't eat too many red meats and drink lots of water, but people don't do it. So there's different reasons why people are doing what they're doing or not doing what they're supposed to be doing. So I don't have a good experience anymore. There's been years that have gone by where I've had like a really what I kind of called true general population person. And but for the most part, I think kind of like what I went back to in that other one, where you need to make a bargain with them and kind of meet them where they're at and just recognize that they asked for something specific. They want passive modalities. That's great. You'll give that to them, but they need to give something back in return. And I think in student clinic, I don't think they're paying that much.

So I feel like it'd be a little bit easier to do in there rather than someone who is paying high bucks for the thing they specifically want, and they want it now. So I would I would make that negotiation with them. And the great thing about being I think in student clinic is that you have the opportunity to work with these people that honestly, they're probably never going to see you again after you're out of clinic. I don't think I had I think I had one person that never saw me outside a student clinic. You're not going to build a practice at a student clinic. And just you might be saying, well, these people really like me. True. But I think they're going to the student clinic for a reason. It's probably a discounted service. Or they're local right there, and you're not going to be there anymore. So I I tend to think almost like with the Groupon type of people with this.

If you run a Groupon, you're going to get Groupon people, people who are looking for discounts and so on. If you're if you're looking if you're charging a high dollar price, you have people who are very, very dedicated to change. So these people are probably not paying that much. And I think that's a problem with that. But I would strongly suggest that you guys start working on your sales tactics and sale selling to me in the past, even as of a couple years ago was like a dirty word. It's like you're selling it's people are always selling crap. And we're not selling crap. We're selling something that we believe in here. And I know that when people come in and see me, and I have a friend who does who he does this, he will call up and they say, Hey, I want to how much for a quick adjustment? Can I come in for a quick adjustment? He says, Yeah, sure. Come on in. Let's do a quick adjustment. And he practices very much like me, very much active care, very much tissue work when needed. And very much with wanting the person to become self reliant and not dependent upon his passive care. So he's like, Yeah, sure. Come on in. So he brings him in, he does a full exam. He does an adjustment. He's like, Hey, how'd that feel? Great. Cool. By the way, there's more that I can give you. And you can probably do a lot of this on your own and feel better. Even like when you get to the point where it's very bad like this, then you could, you can, you can probably get rid of it yourself. Like how it has a sound to you. Can I teach you some of that? And I mean, who in their, who in their right mind would say no. So he might teach some of that kind of stuff. But then next time they might call in again for, Hey, I need that adjustment again real quick. And he's like, Hey, what'd you do to make it better? Oh, nothing. It just, once it gets like this and I sleep real bad and like, I just need an adjustment. So he says he'll do this a couple of times.

And my question was why, you know, like it sounds terrible. Like someone coming in, telling you what they need and not listening to what you say. It sounds terrible. It sounds like you're basically, you're not a clinician, a diagnostician. You're a tool. And he's like, yeah, but they are going to go down the street to somebody else who will not recommend maybe better than I will. And they're paying me for the first few times to, to be in their ear chirping at them, basically telling them the things that they need to hear. And at some point that light bulb might go off and they say, Oh yeah, I'm starting to trust you more. And I think this all really comes down to trust, you know? So he's, he's willing to take those two times and check his ego and just start to build that trust from the person. And I know in the past, and even now I'm, I'm not that good at that. Like all, I have had a couple people and I, my, my intern, which is now Jeremy, now you're gone, man. Why the heck he gone? So my intern was there and we, I took a phone call of someone who wanted, uh, they wanted something that I didn't think they needed. And so I said, look, just, just come in and, uh, you know, take a look over. And I spent about 10 minutes talking with them on the phone. And there was actually two people within the same month that I took the time on the phone. I got them in. And by the time they left, they were just so hyped on active care. And we didn't even do any passive care the first time. And he's like, how, he's like, holy shit, how'd you convert them? You know, like, well, so we did the, we did the buy-in method. We figured out something that would, that changed or modified their symptoms significantly enough where they're like, holy shit, what is that? I want it. You know? So I think you have to get them to that. And if you're not getting them to that, then I would really question if you, in this, I mean, this in the nicest way, I question if you really know the mechanics of what you're trying to do.

So tweak and test on these people. I don't think there's anything wrong with that. They're, they're coming in there for their healthcare, but also too, it's a student clinic to teach students. Go in there with the anticipation that you're going to actually not have to do any active care in this person. If you can prove within the first minute of, of working with them, that you can make them feel better. And again, examples is McKinsey stuff. An example is, uh, when people have a radiculopathy or a hip condition, like a femoral acetabular impingement, I just hug, I hug their hips. It looks like I'm getting creepy, but I just hug them in the hips really hard. And they're like, oh, that's so good. Can you stay there? You know? So all I'm doing is giving them the support that they needed or their body was wanting to get that area, whatever it was to not get pissed off. And when I explained that very clearly, they're like, okay, how do we do that? They're probably not thinking, well, you, you made me looser right there. Let's get looser. You know, they're not going to ask for necessarily a stretch. I mean, they could, but I would clearly explain to them is that in simple terms is something's going to respond if it needs, it's going to respond if, if, if it's, if we're given it the thing that it wants. The body has supportive systems, which can help out with decreasing, uh, tension or pressure on certain things. But also there's other situations where the supportive systems are all working and this air just needs to be, it needs to be, uh, elongated, lengthened, loosened. You know, we can use the general speaking WD-40 or duct tape. So if your body wanted WD-40 in that case where I hugged them, it would not have responded to duct tape and vice versa, the same thing. And we're not always going to find that the person responds well to duct tape, but if I'm supplying the support to the area and it is responding, we need to get the body to figure out how to get that to stay. And then their, their symptoms will decrease. Now finding that actual exercise or that magic exercise is it's, it's a little bit more challenging and the cueing is actually a little bit more challenging too. So people won't always respond to the same stuff. So those are things that, uh, that's a little bit more hands-on experience.

And I'm hoping that actually SCU, I think, uh, I'm going to do a YouTube conversation with them pretty soon here, I think in October. So I think this one's going to be releasing, but I would love to do one where we're almost, we can do a, like a workshop, find some people with some problems and then attempt everybody in the workshop, like hopefully there'd be like 50 kids there. Everyone attempt to get this person to feel better without actually touching them or performing a manual, a manual correction or sorry, a manual therapy technique. Cause I guess grabbing them and cueing them and tactile cueing is a thing. So it's a little bit, uh, I don't be too restrictive of that, but I think that would be a great thing. And not to say we aren't going to start you or not, not to say we should stop using all of our passive cares. I just think there's a time and place.

And I think in our profession, we've overly utilized them. And I, I think that we're only going to have patients happier with us when they finally realize that they need to build a supportive system and they have a checklist of things they need to start working on on their own. Uh, let me go back to that question and see what I missed here. The passive modalities and, but yeah, so I think that's, I think that's the buy-in thing and the practice and honing in your skills of being confident that you know what that area will probably respond to. And let me just clarify this one more time because I don't, I don't want you to think I'm shooting in the dark with half these things is that we, we can have a differential diagnosis list, but also to the diagnosis, I don't think necessarily tells us what the body will respond to. So example, piriformis syndrome, let's just say is the piriformis syndrome from a radiculopathy? Is it from a flexion or extension intolerant lumbar spine condition? Is it actually that the piriformis has actually been fried up and it would have a positive imaging? So there's multiple reasons why this area could be hypertonic.

So now we have the checklist of things, of theories of why maybe this area would respond favorably to some of the challenges we'll put it in, give an example. So if it's a flexion intolerant type of type of situation, which that's referring to the piriformis and increasing tone, then perhaps they would respond well to some bird dog exercises. Maybe, maybe not. Another thing you can try is then abdominal bracing. Does that work? Maybe, maybe not. Maybe McKinsey would work and you make sure they don't flex when you go back to test them again. Perhaps it's an IVF closure issue or closing dysfunction as Michael Shacklock would call it. In that case, lateral tilt away might improve it or possibly frontal plane challenges like suitcase carries might help them walk better.

So those are all possibilities or, and we get into the, say, piriformis area. Now you can probably try single leg activities, try to activate the supporting areas of the hip, the glute max, the glute med, all the rotators and so on. So the hip, so the piriformis doesn't have to quote unquote work so hard. So these are all theories that we could be having there that if usually, if cued well and, if cued well and done well with the right intention, they will respond favorably down one of these paths. If they respond favorably down the path, I tend to follow it. That's just me. And, and usually we're off to the races with that. So formulate your differential diagnosis, but also your theories of what that diagnosis that you believe it to be will respond to. And your responsibility as a clinician is to disprove other conditions or other, or theories that it might respond to. So, you know, the favorable path your, your job is to be able to guide this person, not to make them dependent. Now the next one, let's see what this is. My main goal as a student, yeah, a lot of students in here. My main goal as a student is to see what's working for those DCs who are practicing and create my own system of patient education for which I am seeing patients. And then it's my turn to share. I like that. So yeah, everyone needs to share. So I'd really challenge you DCs out there that are in this group, this patient education from the modern sports stock. Can you share what's working for you? And just put a blanketed post in there and say, hey, these are the things that really work for me in my practice in how I communicate with patients and get them to do what is suggested to be done. Now, I think for me personally, the things that have worked well for me is taking more time in the beginning in building the trust. And I don't think people really know how much you know or care how much you know until they know how much you care. And really, they're in there for them.

It's not for you to showcase how much you know. Take what they're dropping down there and make sure you do all your due diligence, obviously. And it's kind of funny when you go through the history taking process, or at least when I do, is there's things I need to get to, but sometimes their interjections in the conversation really don't make any sense. It's like someone's coming in for headaches and that you start talking to them about bowel and bladder function. So that might not make any sense to them, but maybe if I frame that better, it'd make sense to them. And I think in the beginning, just getting them to realize that you're taking the time to listen to their concerns and answer their questions, I think you'll get more from them. And I think when I had spoken to, maybe it was Bobby, maybe that I had spoke to him about this, but I think patient care is really just, it's pretty much like dating, but don't date your patients. It's, you kind of have to listen. It's a story back and forth, but for the most part, people like being listened to. So you need to make sure that they feel understood and heard before they actually take the next step in the relationship, which is doing something that you ask them to do. Okay. So that is a big thing. And I've really gone, gone more and more to the point where I spend way too much time probably in my history taken. And they're for things that are not necessarily on the exam form, but they're important in regards to late relationship building with patients. And they need to share the mechanics of the injury, what they like, what their goals are, what they expect from you, what their hangups are, you know, what are their barriers that are going to stop them from succeeding in this with you? You know, why are they there? What are they looking for? What drove them to be in, to be in your office today? Or why'd they make that call?

So I think those are things that you need to definitely address. And then lastly, when you finally get to the point where you fully understand what they're going through, and this is where I start to fall apart a little bit, because I feel like it's a little direct is that, you know, do you feel that these, the, the corrections that I'm suggesting, or the treatment care, treatment plan I'm suggesting will, will work for you? Yes or no? If they say yes, then it's like, are, then are you the right person? So I say, I should be saying, do you think I'm the right person to help you with this? And I think these yeses that you get, it's, it's, it's a verbal confirmation that, that they're in. And I've spoken with a few teachers about this is that, I mean, I'm a little jealous of their opportunity to work with someone for two to three months at a time. And they're like, oh, we can make such a transformation in these kids. And they're going to be so like, they're usually so happy at the end.

And we take them through this, this, and that. And I say, it's so enjoy, it's so enjoyful to work with them. And I say, that's, that's cool. Like, I really like, like the cases that I have for, I'm not, not, not necessarily not saying that you should keep people for a long, a long, long time, but they might do check-ins. They might do once every couple of weeks, once every month. These are ones where you actually get them to take, you get to take them further than you ever thought possible. And some of the people in the beginning, again, getting to that relationship status, because everybody, like when you date people, you sometimes you go on one date, sometimes two, sometimes six months, sometimes forever, you know, and you never know which ones those will be.

But in the beginning, I think that's your best opportunity to figure out what this person needs from you to make this a relationship. So I think that communication is really important to get the results that you're looking for as a clinician, and being able to have the freedom that you want to be able to help them through their problem. Okay, next question. I'm open to hearing anything. Always working to recognize self-selection biases when addressing individual patient needs. In short, evidence-based, or they, so they wanted in short, evidence-informed strategies. Let's not do that one yet. So basically, they're trying to recognize their self-selecting bias.

And I think this is actually something I didn't realize until years and years after practice. And it's kind of funny, I see the progression of my treatments and my recommendations. I've gone from a lot of passive care to a lot of active care, and it seems like just a turn on its head. And I'm pretty sure that my selection for these people was based upon my past experiences. I, when I went through school, or before I went through school, when I was in high school, I had a lot of, I had a lot of active release with me. But at the same time, we were doing a ton of strength training. A lot of machine-based stuff, but we were doing a lot of strength training. And if you've heard me tell a story about this before, I used to leave the guy's office, drive my stick shift car, and I could barely, like, you had that, like, twitch when you're pushing down on the clutch.

So they worked to me a lot. But my belief was that the active release was the only thing that really helped. Everything else was just kind of like parts. But as I start to look back, I think it was the encompassing of everything. So, and that's kind of how we practice, how I practice here today. And after going through my second back issue that was last year, I saw that how much the mechanics and posture and how much desensitizing and how much mental turmoil the people get in is important to address. And that's why I started implementing that a little bit more. So I think those are all my self-selection biases as well. And I think we all would benefit from seeing why we recommend certain things to certain people. And just recognizing, too, that our way might not be the only way.

And I totally recognize that. These are just things that have worked for me in the past. So I'm sharing them. His next part was, in short, evidence, they want to find evidence. In short, evidence-informed strategies, verbal or manual palliatives to facilitate improved patient outcome. That was really techie. Let's see if we can break that down. Evidence-informed strategies. I think evidence-informed is a really good point, actually. Evidence-informed, and I went back and forth a little bit on this on a picture that I drew. And I don't think the person that asked the question to just to say, hey, is there any evidence to this was prodding me at all. I think they were probably joking. But either way, they're right. There was really not a lot of evidence to base my drawing on or the philosophy or the theory that I was going on. That's why I called it the theory. And it was based upon the Yandler Cross model and some of the focal research on certain things like patellofemoral pain syndrome and finding out that hip impingement, really, we can increase the amount of pinch-free or symptom-free hip flexion if we posteriorly tilt the ileum. So these are all like the focal points and putting those together. And within my clinical practice, I found that a lot of these things seem to blend. And there's a common intersection point. So he said evidence-informed strategies, I think, is a big, big, big thing because evidence-informed versus evidence-based are different. And evidence-based is that we have actually proof of it. And after speaking with Andy Galpin, the researcher in session number 106, I kind of, it was around the timeframe where I was having that thought of, should I be creating this poster or not if it's not based upon hard evidence?

And because someone sent me one of Greg Lehman's articles that he wrote about lower cross syndrome as well. And basically, there was not a lot of support. So after talking to Andy, he informed me that actually, it's actually advised. Researchers are, they don't research everything, nor can they possibly research everything. And they usually control one variable. Ideally, when there's multiple variables, it's a little harder. So pieceworking these things together is probably the best thing that I could do. And so he said something to the effect of, and you guys can listen to the podcast, so if I say it wrong, obviously correct me. One third of the stuff that we use in practice now is evidence-backed. The rest of it is just stuff that is not, it's not mal-informed. It's not that the evidence suggests that it's wrong. It's just not supported because now we haven't gotten there yet, or there's too many variables to really test it. So I think those are, I think it's an important takeaway, at least it was to me, because I realized that there's a lot of things that people really do accept or clinicians accept that are not really evidence-based, or at least they weren't in the beginning. And some things that kind of popped to the top of my head, and I'm not saying these aren't evidence-backed by any means. I'm just saying that when I think about when the FMS was derived on a napkin, was there any basis to that? Probably not. And I think of all the stuff that Dan John does for strength conditioning, I think a lot of it is observational, and it works. And Mike Boyle, the same thing, it just seemed to work. So why not use it? So some of these things that are evidence-informed, I think are, it's probably better, and I know the podcast is called Evidence-Based, Evidence-Based. And that was actually before I realized the nomenclature, or these are the differences of terms. So I think just knowing that we are doing the right thing clinically is important, or at least we're taking the person in the right direction. Now, if something has been proven to not work, let's just say going back to static stretching before actually going on to the field of play, we know that typically makes people slower than, why are we doing it? Why are we going against the grain on it when we shouldn't be? We should be doing the things that are at least not proven yet or proven. So I think we're going to have a really hard time finding exactly evidence-based things. But evidence-informed, I think there's quite a few of them. And I think a lot of you know in the back of your head the things you're like, hmm, I never looked up research on that, but I think that it seems to work. So I use it. And the next one is, which is a statement, I love talking cues. I'll definitely have to listen to that podcast soon. Thank you so much. So that was in reference that I had a podcast with, it was Brian Carroll, and we were talking about cueing. I think cueing, I think about, I think about actually the, the art of cueing, because I think it's a big thing, because part of what people I think will respond best to is not necessarily the, the lame cues or the ones that are boring. They seem to respond to ones that are just ridiculous, or at least for me.

And I know that back in, I think it was session 101, I was telling stories that people were sending me videos, patients were sending me videos of them doing their cues and saying them like, I'm going to crush the oranges. I need to smash the Oreo, double stuffed filling, gone, you know, things like that. So I think the art of cueing is, it's, it's, it's interesting. It's fun to me. And I think we have to take the person's come from and get them to, and to kind of meet them there. And if the person doesn't know, I'll give you an example is, so sometimes we're getting, I'm trying to get people into a hip hinge to get them into a deadlift to then unload their back or unload their hip or whatever the heck it might be. So I want to get them to hip hinge. So I can, I can say all the internal cueing, by the way, if you guys don't know the difference between internal and external cueing, I think you need to really address that. Internal cueing is extremely subpar when compared to external. External is how you affect the external environment, such as if I was to, I like the, I like the, you can squeeze, say, squeeze your cheeks together, butt cheeks together, or you can say smash the Oreo cookie, double stuffed, get the filling all out with your cheeks. So that is how you're affecting an external thing, how you're affecting something else, or you can use something that's familiar to the person. And just to retract back to that hip hinge, what seems to work for me is just say, have you ever played a sport? Yeah. Basketball. Cool. How were you, how were you resting as someone was about to inbound the ball? And they would go right into the hip hinge. Or you play baseball? Yeah, I played baseball. Cool. How would you do? What would you do if you're, if the person was still going to the, not even in the windup yet, you're just kind of waiting and they'd show it to you. So you have to find things that they're, that they're used to. And that would be, if, if someone hasn't had any athletic, any athletics in the past, you might describe that in a very different way. And that's not my expertise of working with that population. So I wouldn't know what typically works. So you have to find something in your own way there. So I think a couple cues that I tend to use are with, if I'm looking for them to stabilize or stiffen their lap pec strategy, which is going to be a torso stiffening technique. Then I tell them to squeeze a, or try to break a walnut in their hand. If they don't seem to respond to that, I put my finger right in their fist and I say, squeeze my finger. Don't pull it though. Because if they pull it, they'll break my finger off, but try to smash my finger. If they're still not doing it, I put my hands in their armpits and I say, can you smash my hands? Or I'll say, you know how, like, I want you to make your pits as sweaty as possible. Can you make those pits really sweaty? And they're like, what do you mean? It's like, well, you gotta, you gotta smash them together, right? So that's one. Another one that works is making oranges into orange juice. That has worked. That was a Dan John one that I picked up to get them to activate their cheeks or straighten out. Like say they're doing a side plank. They just won't straighten out. I tend to use, I want you to break a quarter between your cheeks into five nickels for me. I want you to be the human slot machine. Push your belt buckle towards me. I'll be in front of them or I'll put my finger right on their belt buckle area or their ASIS. And I'll say, can you push this part towards me? Can you push my finger towards me? Or if they're seemingly doing too much of something and they're overextending, say, I'll put my hand right there. They say, don't, don't let, don't touch my hand, stay away from my hand. So those are all things that seem to work. And obviously, there's a very, there's a large variety of different things that we can, uh, be cueing, but those are ones that tend to work. I know that with the neck ones are for packing the chin or just getting them to, to bring their chin jut away. I usually tell them, Hey, I got a hand that I just, I just, I was just playing with fish. I got a stinky hand. I'm going to put my hand toward your face.

You're not allowed to move your body, but I want you, what would you do if I was putting my hand toward your face? Some people turn, turn, which that wouldn't work for them, but other ones will just start, they'll start to slip backwards. Um, Cody uses, if, if I was trying to kiss you and you didn't want to be rude, but you didn't want to kiss me, what would you do? And they usually sink back a little bit. And then, then they start to smile and he says, and he says, I don't be creepy inviting though. So then they will back it up a little bit. So those are all cues, which tend to work. Let's go on to the next question. I'm looking to find a better way to inform and explain things to my future clients. I think we addressed that one. I have a love for fitness and started, just started chiro school with plans to be a plans primarily to be a sports chiro. There you go with the sports chiro thing again. So if you're going to be a sports chiro, by the way, I strongly suggest you start to engage with the population that you want to treat. And don't just say, I want to treat athletes because that's bullshit. You need to be able to, you need to be able to narrow down the exact type of person that you want to work with. If you want to work with runners, go hang out with runners. If you want to go work in a CrossFit population, go, go with them. If you want to work with Olympic barbell clubs or Olympic lifters, go hang out with them. Power lifters, same thing. You need to figure out the terminology and all the type of things that they do, the habits they do. And I mean, there's a lot of different nuances of each sport and each athlete that need to be addressed. And when you speak to them in that very certain way, they're going to know that you know your shit. And again, that trust is going to be the thing that which is probably the most important. Let's go on to the next one. That was a real quick one. And I think it's gonna be the last one. So this person said, I'd like to see, I'd like to see clinical case studies and, and how they were or could be approached. Also some business info can never go wrong. Ooh, okay. I do have other podcasts on business info, by the way, in case you have not heard them already. I think I did one recently. It was on 103, five secrets to content creation. And I will do more in the future, but you guys are gonna have to let me know exactly what you want to know about that. In relationship to the clinical case studies, this is something actually I've been considering. And I've recorded about four of them, complete minus red flag hunting, as well as review of systems. I basically recorded the entire exam that I've done on a few people that I didn't actually know what was going to happen. And one of them, I remember it was long, like the video almost ran out. And towards the end, I was trying so many things, I was not getting that buy in. I found a couple instances where there was a hint of it, because I still want to go down that active care route. And so I don't know what's going to happen with these cases. So they were completely blind on my part. So I did dig, dig, dig on them.

But those ones are ones that I have them in my vault still. And part of me wants to put them out on a curriculum, which is going to be a place where we would have ideally other clinicians also start to dump videos. And not there to be judged or saying that they're doing it wrong. It would be nice to maybe have a constructive criticism part of maybe how things can improve. But more so that we can learn from different treatment ways or different exam findings and just see what each person kind of does differently. So I haven't released those yet, partly because I'm a little afraid that you guys will criticize my exam skills pretty critically, because I tend to jump around and I follow trails very quickly, which, which honestly does tend to leave some of the examination, the orthopedic, neurological, sometimes off the table, which I don't know if it's necessarily bad or good thing.

But I tend to find that it seems to have pretty good results, but also the two at the same time for documentation purposes. I feel like I should be doing all those things. But at the same, at the same time, you find someone didn't have a labral tear, how many labral tests do you have to do to prove that it's not a labral tear. So I've, I tend to follow the cases like that. Now, if you guys want to have ones like that, I let me know in direct message me on this on the Facebook group against Sebastian Gonzales, and just tell me, tell me what exactly you're looking for. Because I think this is something that is we're going to all want a little bit more of honestly. And after going through a couple seminars, we had case studies at the end, everybody thought, damn, those case studies were good. Like that was the most enlightening part. Like presentations are great, but case studies, it's like, this is the shit in action. So if you, if you're looking for stuff like that, tell me, because it's a bigger production. And honestly, there's, I have a couple videographers that I've considered having followed me around with these things and do an actual production with it, but it's going to cost a lot. And I, from a business perspective, I would have to get a bunch of waivers signed. I would have to make sure that they sign kind of their HIPAA way just for educational purposes. And I would have to make sure that I'm not dumping money into something that no one wants. So if I did decide to do that, and if you guys look like you wanted it, then I would probably, I'd probably ask kind of like the posters in the beginning. Uh, if you guys believe in the process, just give me some money to fund it.

And then I'll just give you a lifetime access to that type of thing. So, but that's, that's just a thought. I, I would love to see how other clinicians examine, cause I think I would learn a ton. And I think through that, I think I would want to actually send these videographers to other clinicians to see what they're doing. So consider that you have your favorite DC or PT or person that you follow that you're like, I really wish I could see them examine an ankle. I don't know shit about ankles. I need to examine an ankle. I don't want to see what the hell they would do. This would make that possible, hopefully. So if you guys are interested in that direct message me or, uh, email me seb at p2sportscare.com. Again, that's seb at p2sportscare.com.

Now I think that'll be it for this podcast today. And if you're looking for the show notes on this, you know where to find them, p2sportscare.com. So, uh, no slash, just search session or actually just search the number. We are going to be 108 on this. So 108, no pound, no hashtag, none of that stuff. And just go through and check out all the notes. If there's going to be links that are correlated to this, you're going to find them in there as well. Lastly, if you have not gone and given a review again, this is reviews are really important for me to see feedback, feedback, feedback, feedback, just like with working with patients. If patients gave you the honest, uh, honest opinion of what they thought of your interaction, when they did not come back again, you would improve your skills.

And that's what I'm looking for on this. I'm improved. I'm trying to improve. So tell me what you like and don't like review it. And if you review it, I will hopefully jump this podcast to bigger popularity. Currently, we're getting about, I think about a thousand downloads per episode. I'd love to jump that to 10 within the year. I would love it. So if you want to help me with that, please share with a couple of your clinician friends. If you have any students that if you're a clinician, you're listening to this and you have interns or students, please share with them. Uh, I think I haven't had negative feedback yet. So I'm hoping that everyone does like it there. Now, lastly, I'll see you guys later.

Don't forget, leave each other a bit on how you found them. And if you're a girl or if you have a girl, have them date an Eagle Scout. That's all I'm saying. Later.