Treating Back, Hip and Neck Pain Through Virtual Sessions

You know, so there's a lot of aspects to this that makes me feel like that our new society is going to have a lot more people working from home and there's going to be a lot more people who might be afraid of being around other people for a period of time. I'm not saying that's right or wrong in regards to the fear aspect of it, but I think the reality is that, I mean, we're not supposed to be six feet close now, you know, unless it's immediate household members, people that you're living with, or people that I guess in theory we contaminated already. 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 everyone, it's Dr. Sebastian Gonzales, your host for the Restoring Human Movement podcast. Thanks for joining the Movement Movement. This is the podcast where movement providers come together to improve patient outcome and to be improving on our communication style. The fact of the matter is, a lot of patients don't know what we're talking about, and we try to get them to give the necessary information that we need to help them. So, think of it like we're all sitting around a bar having a beer. Actually, this month I can't have alcohol, so I decided to take a spritzer water.

And you decided to get a Bud Light, I'm not sure why, and someone else got a, isn't there a Bud Executive now? There's a BudWise or Executive? Gross. So, what we're going to do is have a nice three-way conversation around here, and me and you are a healthcare provider, and then our friend is a podcaster, so we're not quite sure if they understand what we're talking about, so we're going to keep things simple. So, what you can expect in this podcast today is we're actually going to go over some concepts of maybe how to evolve with the COVID-19 virus, and this is more from a healthcare perspective or at least some brainstorming ideas that I've had that I think that might be helpful to everybody.

Now, all the stuff that I'm going to talk about today is not necessarily set in stone, nor things that I suggest that you guys do based upon your state guidelines, but I think it's things that we as a healthcare profession, especially chiropractors, PTs, should maybe consider. And so, just as every podcast, I want you to go back into the archives and see what podcasts are interesting to you. Pick the titles and listen to those because there's some really good stuff back there. Also, too, I'd like to share a little bit about myself via short story, so you guys can hopefully like your host and follow along this learning journey with me.

So, we'll get right in that short story, then we'll get right into the content material. So, just as probably a lot of you guys did some emergency buying with this COVID-19 scare, I decided to do a little bit on my own, and I decided to get one important item, which was popcorn. And I realized that when I was walking through the bulk, I was walking through the bulk buy areas of sprouts, and I was buying beans and rice and so on, some dry goods, because number one, I know that people are like, I don't know why you're panic buying. And I just realized we don't have an earthquake kit, and we live in California, so I think that's probably an important thing we should have anyways.

So, I decided I'm an Eagle Scout, I should have my stuff, and I got some. So, then as I was passing through things, and everyone's freaking out and just kind of panicking and kind of dodging and weaving throughout each other, like I didn't feel comfortable in there for some reason, and I just left. And then I, but I was standing right by the popcorn bin, and like nobody wanted the popcorn. So, I told Allie later, I said, hey, can you, are you going back to the store? Can you, can you get me some popcorn, like five pounds of popcorn? I'm going to hoard that stuff. Maybe some coconut oil, so I can actually, you know, pop it up real nice.

Actually, I'm going to get more coconut oil now that I think about it. Anyways, what was your bulk buy? Now into the show. Now, as we as chiropractors and PTs and trainers have, strength coaches have gone through now what we consider a big life-changing thing that, I mean, I consider on, on larger than the grounds of, you know, Y2K and, you know, like the, all the other scares that we've had throughout our life. This is almost like our war, you know? And so, things change, like things change after these events. We are in adapting society, and as I see, a lot of people are working from home, and they're working from home, which is having some positive effects on the environment, it looks like.

It looks like China's population, or sorry, their pollution has gone down quite a bit, and I saw a post today that the canals in Venice are now clear, and there's fish back, and there's swans. So, maybe this is not a bad thing. I know that I'm not going to get all political with you guys, but I'm just considering the possibility that this might be something that sticks around for a while, and it might become one of our new realities. The freeways are clear. People are, when they're working from home, they don't have to waste as much time commuting, and if you think about it, like, if now this system's in play, and it's been in play for a little bit of time.

By the way, I'm recording this at the beginning of California's, what do they call it, sit and stay? Basically, you're not supposed to really go outside unless for emergency services, or foods, or goods, and something like that. So, it's still evolving, but at the same time, what if this happened for two months, three months, you know? And they're thinking there's a possibility of a second spike, so maybe this is now what the norm is. And if you consider large groups, let's just say, like, let's just say Wells Fargo. Say they get a big building, Wells Fargo, and there's, like, 500 people working in there, and there's half of them that could work virtually, and they proved over these last couple months they could work virtually.

Why would they not consider to do that? And then downsize the building, possibly. You know, so there's a lot of aspects to this that makes me feel like that our new society is going to have a lot more people working from home, and there's going to be a lot more people who might be afraid of being around other people for a period of time. I'm not saying that's right or wrong in regards to the fear aspect of it, but I think the reality is that, I mean, we're not supposed to be six feet close now, you know, unless it's immediate household members, people that you're living with, or people that, I guess, in theory, we contaminated already, and that we're going to share the sickness together rather than share it with other groups.

And so, if you think about it here, if there's that fearfulness for six months, a year, even like not even aggressive fearfulness, but partial fearfulness of actually going into a clinic that's, say, seeing 100 people a day, you know, that's a lot of bodies in a building to share a possibility of, you know, some ongoing type of second spike thing that we have here. So, and what about busy PT clinics? Like, there's a lot of people in there at one time, and I know that a lot of older people, especially geriatrics, are the ones that are using these things, using PT and some of the modalities that they use.

Like, we think ultrasound and massage and manual therapy and mobilization, which are all very helpful, but how are we supposed to do this if these people are not able to come in? How can we help these people? So, I think when we go through this, there's going to be a new lay of the land, and I think telemedicine is going to be part of it. Now, from my knowledge right now, I don't think there's a lot of great telemedicine codes for insurance. I know that Sam Collins, who has been on the show before, he put out a post recently on some telemedicine codes that would pay, but they're not necessarily, they're not going to keep the doors open.

Like, they're not going to be ones that are going to be as useful. And also, too, I think a lot of people probably have not tested them. So, how do you even know that that insurance carrier will be willing to pay that? So, what happens here? What happens to our patients willing to pay? Are they able to pay? A lot of people have been laid off. A lot of people have other priorities they're spending their money on. And so, are they willing to pay? Are we able to help those people? Either way, let's just say we are willing to help them. Now, the problem comes up of, do you have the skill sets to help them improve without physically touching them?

So, I believe there's a lot of different ways to learn how to move or how to coach somebody. And I think trainers and strength coaches have been very good at it over the years because they're great at cueing. There's verbal, there's kinesthetic, and there's visual are the major three from my understanding. So, let's just say if we're in a gym or if we're in an office and we're manually or tactile cueing somebody that's touching them. So, that one's kind of out at this point. Can we do the other two? Are we good at doing the other two? And if you are good at doing the other two, now it comes down to, do you feel comfortable comfortable and effective with your selection of exercises as medication?

Do you feel comfortable suggesting that doing this one exercise or the second exercise will have a favorable outcome and it's the route to take with this person? If you're not, then I think that's something we can improve on. And I guess the last part here is that do you feel comfortable in your outcome? Do you feel comfortable somebody with back pain can get better with these couple exercises? And here is the timeline they should be feeling it in before they progress to the next step. So, with our skills as manual therapists, it's like, again, if you've been a listener to the podcast, you know that I'm a proponent of movement as medicine.

I'm a proponent of getting people to feel like they're in control. And I believe there's backs and hip cases and neck ones that I literally do not need to touch to get them to feel better. Now, examination and orthopedics and neurologicals, it's a different story. But also, too, we can't argue the value of just general physical preparedness as a medication. Like, when people have knee problems, when they just start moving a little bit and strengthening a little bit, they feel better. I mean, how can we refute that, you know? People physically active generally have less, like, degenerative, quote-unquote, aches and pains.

So, I personally feel confident with necks, like rhomboid strains, let's just say, or that would be probably like a C5 radiculopathy. Most of them I do not need to touch to actually get them to feel better. Now, granted, the neck and the shoulder area, it deserves a little bit more need for TLC and a little bit of manual therapy. But if you're not able to do that and we've taken your major tools away, what can you do now? With low backs, I don't need to touch them. With hips, sciatica, I don't need to touch them. Except if we're talking about, like, the chronic ongoing cases. But the new acute ones, the subacute, like the ones that are fresher, I don't, I'm very confident in my suggestions that I do not need to put my hands on them to make them feel better.

Now, when, I guess my question to you is, do you feel comfortable with it? And I don't mean this in a, you know, like, I'm, look how great I am type of way. I mean this in, honestly, do you feel like you're good at those skills? Because if you're not, and this becomes the new lay of the land, what are you going to do? Because we might not be able to see all these people in volume. Or look at Trader Joe's. Trader Joe's does not allow more than X amount of people in the store at one time before the other ones come in. I mean, what if you were, what if you were bogged down now, time-wise, of how many people you can see in your clinic because of the amount of sanitation you now have to do between patients?

Not saying that you weren't doing sanitation before, but what if you needed to do a lot more? So there's a lot of aspects I think we need to consider with this, and I think virtual is a really good way to go, or just general physical preparedness and considering movement as medicine. Now, before I go on to a little bit more, I'm going to give you a rough parameters again of the box system that I came up with. There's a podcast that we did late last year. I want to say it's, you know, in October or November where it was the four bucket system. I've now evolved that a little bit into, I call it the five steps of true recovery, and I created a little pyramid here where patients and clients can understand where they are and what they need to do and why certain suggestions were made.

Now, this thing is very, it's fairly general, but it sets a nice expectation in my opinion. Step one is the bottom of the pyramid, and hopefully at this point, I'm pretty sure we have posted it on Instagram somewhere in the stories. Look in the stories. That's performancehb on Instagram. Please follow us. There's a lot of free information there. There's a lot of good stuff in there in regards to exercise, but it's all about the selection, right? So, step one is history examination and working diagnosis. History is obviously, it takes a little bit of time to look through the person's paperwork, examine them appropriately, do the orthopedics and neurological tests, rule some stuff out, rule red flags out, and then figure out our differential diagnosis and working diagnosis.

The reason why I put working diagnosis in step one is because we're working with testing what works, and it's not that we know. No one really knows what your diagnosis is 100% because there's always differentials in there. If your diagnosis was your diagnosis, and it responded well to the treatment that was for that diagnosis, then we confirm the working diagnosis. If we are treating a type of infection, and we know it will respond to this type of antibiotics, and it works, then we've confirmed that diagnosis, but now the person's better. If we're looking at a pinched nerve in the neck, creating rhomboid tightness, our differentials could be a rhomboid strain, it could be a rib out, it could be C5 radiculopathy, C6 radiculopathy, C7 radiculopathy, and so on.

Or it could be like a disc protrusion, disc herniation, so on. Now, if we're working on the premise that it is a C5 radiculopathy, and we treat it as such, in my experience, reasonably, within a less than two-week period of time, I like to under-promise, over-deliver. So I usually say, within the first week, you should feel a 50% improvement if you do what I tell you to do. Now, on the back end, I think, God, tomorrow they might feel 50% better. That'd be amazing, but I don't really want to tell them that too much, because I don't want them to be upset that when they don't have that, they think it's not working.

But with that being said, we have now confirmed the working diagnosis if it works. Step two is first aid and safety net. Basically, the stuff that I told them to do is the first aid or safety net. If you get in trouble, things tend to feel a little bit iffy, go to your safety net, go to the thing that works, do first aid, it's all good. So that is the second part up of the triangle or pyramid. The third step is corrective exercise, buttressing, or breaks. And I'll explain that here is a corrective exercise as an example, or correcting a pattern, rather. Correcting a pattern, say you have someone with piriformis pain, and then it hurts when they sit down to stand up, like the stand-up-to-sit-down movement.

But you put a stick on their back, and you have them link three spots on their spine up to that, and they stand up via a hip hinge, a hip movement, and then their pain goes away. That is correcting the movement of squatting. Buttressing would be maybe if this person really was not testing well in a side plank endurance test, and it looked like they could only hold it for like two seconds. It wasn't painful. If it was just effortful, then the other side was like 30 seconds, then maybe we do a little buttressing up there. We realize that maybe the frontal plane is a little bit more iffy. And so what we would maybe do is have them side plank to death on one side.

As long as it's not painful, it's just effortful. Have them sit to stand however they do, and they say, wow, that feels better. That is a buttress effect. We're buttressing up the spine or the hip. In this case, we're talking about local hip in that case. Maybe the concept of the DNS co-contraction around the hip joint by working the adductors, the hip flexors, the small external rotators, and so on, might be the route to go to make the hip centrate. We can use that in multiple different spots. Even areas of the neck where we have unstable necks, they say, or people who are clinically unstable, it's still a game of building some co-contraction around the neck itself, which you can do that with a bird dog and a side plank and a, let's just say, a dead bug.

Because now we're using gravity in different planes of movement to then butt your set thing up. Or you can go to the standard where you kind of have them put their head against the wall. Not hitting it, but different movements and using the wall as resistance. That's okay, too. There's different ways to do this. There's no one single corrective or buttress or brakes. Now, a brake, in this case, might be if we figure out what's bothering this person is the back tends to round, and that's what creates this problem. Then maybe we build a braking system to stop the rounding of the back momentarily.

And that might be a bunch of supermans, a bunch of dead bugs, or sorry, bird dogs. It might be something that builds the tone momentarily of the spinal erector group. In that case, we don't have to put the stick on their back anymore. You just let them sit to stand and they feel better. Now, the reason these first three parts of the pyramid are the most important to me because, number one, is that you just select where a good starting point is. Not everybody needs a first aid or safety net. Not everyone needs step two. A lot of people end up going right into step three, and that's kind of our general physical preparedness.

Or even into step four, which is like they're kind of good at some of the stuff on the ground. They just are generally weak, you know, and that would be like you just get someone to do squats, and they're like, holy shit, my knees feel better, you know. Or they do deadlifting, like, holy shit, my back feels better, you know. And you don't have to go bring, strip it all down to make them do the stuff that they're already competent at, and it doesn't really make them feel better. So, all this can be figured out by figuring out what type of case they are. And that comes down to a very diligent step one in having experience that your suggestions for that working diagnosis will work.

Now, I want to share with you guys a break. We're going to do a break, and I want to share with you guys a webinar series that I put together. I'm extremely proud of it, and I'm going to continue to promote this thing to death because I think it'd be a huge mistake to have made it, such as I did, and did put 15 hours into it of recorded content, and then nobody finds it. So, if I was talking to my five, not five-year-old self, I guess myself that was in practice for five years, or even a couple years ago, I would say, if you do not get this, it's a complete waste of your money to go to any other CEU, unless it's on my CEU list that I listed in the workshop.

So, I believe in it that strongly. It will help guide you into what CEUs are going to be useful, and ways to organize the content that you guys get at some of the CEUs. How do things like FRC plug into here? How do things like DNS plug into here? How do things like Dan Johns plug into here? I cover all this stuff. I don't go through all of the parts, the nuances of those, but I'll tell you where they plug in for sure, and I'll show you the steps that I take to make people feel better with hips, and shoulders, and low backs, and cervical spines, and referred symptoms. IT bands, hip FAIs, things of that nature.

And so, I'm going to share with you one of the testimonials, or at least part of an email that I got from one of my students that was in there. And so, I won't spare you, I won't go through the entire thing, but basically, they were working with someone with hip, and they didn't feel comfortable with hip people until we did the hip course. And so, this was just the next week after we did the hip course. And so, they said they missed a few steps in the exam and treatment, but they felt way better and more comfortable than ever dealing with a hip complaint. I can't wait to master this and mess around with more.

And so, they had a really good experience in it. I guess that's not the best testimonial, but I don't want to reveal all too many of the details that they said because it might get too much into personal stuff. Either way, they felt comfortable mastering or dealing with hips. And so, if you're having trouble dealing with hips, I encourage you to go through the first course I have, which is one of six, which is on the p2sportscare.com slash products page. It's one of six hip complaints. Go through there. It's the best money you'll ever spend. Again, I don't make money on the podcast, but if you want to know what I really think about how to treat people, it's in there.

See you on the other side. Now, back into the show. Now, how does this play into a virtual arena? That is kind of, it's unknown right now since really what it comes down to is that when you're in a virtual setting, we don't have all the information to diagnose. Although, there might be a situation here where, I mean, if you think about with nurses, like some people call in, like people call in their telemedicine nursing centers to triage at hospitals. They're like, hey, I'm having chest pain and there's, it's like, it hurts now when I lay down, but not when I stand up. And, you know, I'm, all that kind of stuff.

They're like, well, is your arm numb a little bit, tingly? Is your face okay? Yeah. Yeah, those are okay. Are you sweating? No, no, no. Do you ever have heartburn? Yeah, I do. You know, then maybe this is heartburn, you know. So, there's things like that and that's probably a very bastardized version of a triage on a phone because I don't typically call them, but there's other clinics that do this. There's other places that do this. And I'll be straight with you. I've heard marijuana clinics back in the day before California was able to do, before it legalized marijuana. People go into these rooms with a computer.

There'd be no doctor in there. Like, I've heard that places do that. How are these places doing that? And we as musculoskeletal experts can't recommend a specific exercise for somebody's problem. I think what's going to happen here is that when it all comes down to it, if we have months and months of people just not able to come in to see someone, a musculoskeletal expert for their problem, we're going to realize that we need to be very good at just screening the people that are not able to, that are not going to respond. Meaning, like, your red flags and things like that or, you know, the cases of that nature.

But also, too, figuring out how to demonstrate an orthopedic exam to somebody. Meaning, let's just say we're talking about with the neck. Well, let's just say Kemp's. Kemp's is an easy one. Go ahead and try to touch your opposite pocket. Look over your shoulder when you do so. How about Stork's test? Can everybody think about how to do a Stork's test if you had a visual and verbal communication style? I think everybody can do that. How about bend over and touch your toes? Can everyone do that? I think so. How about doing heel walk, toe walk, tandem gait, repeated movements, pronator drift? Those are all things that could be done virtually, but we can't do everything, okay?

The hard part is that we can't do everything. And I think that if we're going to go down this route, I think we should be willing to be honest with patients and not accept every case. I think we just talk to them about, hey, look, you got a couple iffy things here. I know going to, you know, the neurologist in the hospital that has COVID-19 is not optimal, but I really think that you should go see them, you know, because we're being honest with the patient and we're doing what's best for them. We're not just trying to get them into a bunch of care. Now, if there's somebody who looks like a very easy case, let's just say, let's just say sprained ankle.

People with sprained ankles, they don't know what to do. Say there's no bruising involved, like they can bear weight upon it. We're following the Ottawa rules. Like you can verbally, or sorry, you can visually see that. How is this not something that we could just say, you know what, I think we should wrap that up for a little bit. Let me show you how to wrap that thing, all right, and I want you to ice it a little bit, and when you can start bearing more weight on it, I want you to go for a little bit of a walk and just go for a little breaks there. And here's, do you have a band? Amazon is now, it has bands, so why don't you order this band here, and here are some exercises I want you to do.

If you don't have capacity to do that, sit by a wall, and I want you to push the side of your foot into the wall and hold it for 10 seconds. You should feel a burn on the outer side of your shin. Good, and then after that, I want you to do a bunch of toe heel raises, like you're going to do a calf pump. How is this something we cannot do? I think we all can. Now, with our profession, how it is, like I've called a lot of states actually over the past years about virtual telemedicine for chiropractors, and I think I called about 30 states. None of them that I talked to had a ruling in any way, shape, or fashion.

I said, they said, that's an interesting question. Can we get back to you later? And no one gets back to me anyways. So, it's an interesting thing. So, what do we do now? I kind of think our legislation should do a good job of allowing us to do our job. Let every chiropractor and PT and strength coach should be able to do, in my opinion, should be able to do some form of virtual coaching for the cases that look like they fall within that category. And I'd love to hear you guys' feedback on this because it's kind of like, it's just a no man's line is the thing. And it's something that, you know, people don't really talk about.

There's people doing this stuff online already. And they're helping people. Like, isn't the whole point to help people? Right? I mean, that's why we got into this profession. But if you can't touch people, how are you supposed to help people? Now, getting on to, I've gotten this question quite a few times from people about what should we do about, where do we learn how to do what you're talking about? How do we learn to do more corrective exercise? Or how do we learn to coach more loading? Well, my first thought with people is that if you want some good instruction on how to just coach general fitness.

By the way, we're not, as healthcare professionals, we're not trying to take the job of a strength coach. We're trying to help someone get from their zero point of where they're really struggling or having a lot of pain to the point where they can do stuff on their own or go to someone who will program more, with more variety. All right? I've told people that I will do a very good job of getting you through the push, pull, carry, squat, and hinge with, it'll be super boring. But at the same time, it'll produce results into the point to where you're going to feel comfortable feeling like you can go out and explore the world with your body.

By the way, I guess I didn't go fully up there on the pyramid, which I will in a second. Getting into strength training and resistance training, it builds some more support systems to help your body work as one unit so then you can go out and do the things that you want to do. I don't want to hang out in a gym and I don't want to get massive glutes. I don't want to do that. Like, I'll do it. Like, I don't mind doing it, but that's not my goal in life. My goal in life is to go run or play baseball or, you know, feel like I can backpack for 20 miles on a trip without feeling like I'm going to, like, hurt myself.

Because as you start to get to a certain age, you start wondering, am I too old? Is this what it is? So I think when we get into step four, which is strength training and resistance training, we have a lot of skills because we know the person's case well. We know what's happening in their body. But also, too, at this point, we can communicate it very well to a strength coach who is willing to co-manage and now we're off to the races. And they will get them into movement variation or what I call step five is playfulness or variety of movement variability. I like playfulness in this aspect because playfulness is non-choreographed movement variety.

You don't have to think about it. You just chase a squirrel and that just happens. I don't think about how many different spots the baseball could be pitched while I hit it at different speeds. It just happens. And so the playfulness will unlock what, in my opinion, the strength coaching or the strength training does is makes us move like damn robots. All right? We're not supposed to do that. We're supposed to be a little bit more fluid in movement. So how do you learn this stuff? I would say if you're looking for step twos, there is a lot of – I think MDT is great. I think McKenzie's protocols are good or end range loading, whatever you want to call it, is a good starting point.

I also think neurodynamics by Michael Shacklock is a good starting point. Or we just take the general like go-to stuff, which is first aid. Is there anything really wrong with someone with a – like they have a shoulder problem or neck problem if you put them in a shoulder sling? Is there anything wrong with that? Is there anything wrong with using a boot or a cast for a couple days? Is there anything wrong with crutches? It is a first aid. It's a means to an end. It's a chilly area out so we can build it up. All right? There's nothing wrong with those. And so you could just go with your go-tos.

And so if these – in this case, manual therapy is your first aid, that's okay. If adjusting's your first aid, that's okay. If those ones work and you can, in this case, virtually dictate how that's supposed to happen, by all means, go ahead. Step three, the correctives. Where do you learn these things? I personally use a lot of McGill's work as well as DNS, as well as animal flow type of stuff, as well as floor-based exercises. Work from Guido Van Reisigen as well with his attractor shape principles. I've gotten some from Scott Morrison, the PT, who did a workshop as well for slop to mole loading.

There's a lot of different places I got this. I got this from Shadowing, Cody D-Mac, and Ben Ramos, and a bunch of people. I mean, shoot, you can learn a lot of these on YouTube, but now learning when and where to apply them is a different story. For strength training, I love to follow Mike Boyle and Dan John's type of stuff. So I think they're very simple in the way they coach, and I think it works as long as we know what we're suggesting for. If I was to suggest a five-circuit strength training program to somebody with a hip problem and it included a deep squat, they might not work well in that situation.

So I might start with a hinge or a sumo deadlift. So know why you're suggesting and why you're suggesting it. Know what you're suggesting and why you're suggesting it. All right? There has to be a strategy. And this is going back into what I mentioned earlier is do you feel confident in your skills of recommending what you're recommending? And do you feel confident in the timelines? I always feel very cocky when I suggest to people, I'm like, do this, and you'll more than likely feel better in a week. And they're like, well, what? You know, like, should I do this? I'm going to say, just do what I, please do what I told you to do.

And I'm not, it's not that I feel like it will always work. I feel like it is a high probability. Okay? Somebody asked me before, they said, well, what if this, we're going to treat, I said, we're going to treat this like a disc. And he said, well, what if it's a muscle spasm? And I'm like, well, you know what, according to what I know, that with what you showed me today, 10% of your problem, or your problem could be a muscle spasm, but it's only 10%. Like it's a percent, the probability is 10%. It's not a lot. All right? Could it be trigger points? Maybe. Could it be a facet? Maybe. But based upon what you showed me, I'm like 75% sure this is a disc.

So if you want to go against the odds, you can. But if you want to play it based upon the information we have at hand, please do what I'm telling you to do. I might be wrong. I totally might be wrong. But we should go with the highest probability of success, lowest risk first. All right? Now, where can you learn this stuff? I know that over the course of the last, gosh, over the last year, there was, I've been promoting a couple workshops I'm going to do. We had to cancel some, and actually, as of the time we're recording this, there's one at the end of May for students, May 30th, that, I mean, for all we know, that one gets canceled, you know, too.

And so I think the whole thing, the lay of the land is going to change for CEUs. It's going to change for, you know, workshops. It's going to change for patient care. I think even if you work at a bank, it's going to change. All this, I think, is going to change. And it's not necessarily for the worse. It's just we're evolving. We're adapting. People adapt. Humanity will adapt. And that's a good thing. Too bad it comes with, you know, costs. But I think we're all going to come out better on the other side of this. So I don't want you to think this whole thing is a negative thing because there's definitely negatives, but there's going to be positives, too.

So in regards to learning it, I have put one of my interns as his task right now is to get some workshops going. If he can get those workshops going, they're going to be virtual ones. The virtual ones are going to be, it's going to be like a webinar. I'm going to do a case-by-case one because, honestly, I don't know how I can spend 12 hours on a webinar. I would just kill myself. And so I think in little bits and chunks, I think this will work a lot better. Also, too, in the near future, I don't intend on offering CEUs that are sanctioned by the state. It's a little bit more challenging than expected.

It's doable, but at the same time, it puts a little bit more regulation over what we can do. And I totally recognize we need to get the CEUs done. But at the same time, I think for my personal abilities, I think having a little bit more gunslinger mentality and just going for the fences on things is going to be better. That way, we can do a webinar if it's starting in a week. And we don't have to worry about if there's going to be five people or 50 people because CEs cost money. All right? The whole thing costs money. So what we're going to do is Mike Valesco is my intern at this point or one of my interns at this point.

Part of his internship is to learn about business. And so he is going to – his job is to promote these workshops. All right? I'm going to help him out a little bit here. And so let's just see what – I know Mike had a – he had a direction to give people. So there was an email. Sorry, Mike. Everyone's going to get your email, man. So here is his email. Mike, by the way. This is great. So I looked at your email. You know how we keep calling you Mikey? And your email is Mikey. God. So it's M-I-K-I-E. That's Mikey. Valesco is V-E-L-A-S-C-O at gmail.com. No spaces. So that's Mikey Valesco, V-E-L-A-S-C-O, wait, V-E-L-A-S-C-O at gmail.com.

Or you can reach out to him on Instagram. That's future underscore DC underscore Mike V. Future underscore DC underscore Mike V. Just reach out to him. He's in a little white coat there. So cute. On Instagram. And so we're going to make these affordable to everybody. And it's a first go. And I don't know how things will go. But I think what we're going to end up doing is we're going to end up doing basically how to fully go through a process, a five-step process of something like HIP-FAI. Like what are history and examination standard things that we would see as well as possible working diagnosis.

How are you going to get this person to 50% within a week? What strategies to take? We're also going to go over corrective exercise. But you're seeing breaks, strength training, and then questioning the person to figure out what the playfulness they might want to do is. So using these things, what my expectations are is that we just level up. And again, just like every workshop that I've taught, I want to learn what you learn too. And this is a nice sharing of what everybody's knowledge is because I don't pretend to know everything. I don't know everything. But I just know things that will work with some cases.

So we're going to cover certain types of cases for about an hour, hour and a half via a Zoom webinar. And the pricing is going to be very affordable. So just talk to him about what it is. And I don't know if we're going to be recording them actually, but we'll see. We're going to make it live for those who want to show up and you can do Q&A and we're going to demonstrate a bunch of really cool stuff. And so you guys can walk away feeling like, God, I feel really good at hips right now. I have a step-by-step process of what to do. Because I know with students, the lagging thing is they're like, we learn a lot of things.

Now, how do we put it together? This is going to be how you put it together. Okay? And just on a special note too, I know that I've said this before and I feel like an ass when I say this is that I don't plan on having a lot of shadowers anymore. I used to. I used to have a lot more shadowers. There's a lot of work in having someone shadow. And I love helping out everybody. But if you've shadowed me and you've thought, man, I want to learn some more, this is the easiest way for me to share. And it also helps me, you know, make some money too. So I'm not going to be apologetic about charging people with it because I've given out a lot of goodwill over the years and I'm not saying, you know, it's my turn or anything.

But this is the easiest way for me to help people learn more. All right? Because I've had a lot of people ask via Instagram, like, where do I learn some of these things? Just learn them from me. All right? I'll tell you where I've learned my things too. But if you want to learn it in the way that I use it, just learn it from me. I would love to teach some people, but it won't be CEU based. So on to the next part with this is if you're going to do virtuals, what are some tools that you might need? Number one is you might need a liability waiver. So that's something that you might want to talk to an attorney about just to make sure that everybody understands what is expected.

And, you know, in regards to diagnostics and assessments and history taking and outcome and payments and things like that. Also, too, on that note, you do need to figure out what your payments would be. But I think the hardest part for everyone is tech. So with tech, how would you actually do a video session? Well, you know, I've done it on Zoom for a lot of years, and video sessions, even with podcasting, is free. If you have one other person on the other end, podcasting is, or sorry, Zoom is completely free, and you can do it for hours on end, and it is perfectly fine. You can do it from your phone.

You can do it from a computer. You can do it from an iPad. All right? So the person on the other end, all they need is a link, especially on their computer. I'm not sure about a phone. I think they might need to download the app on the phone, which is not very hard. But it might be harder for some, if you're working with older people who are a little bit un-tech savvy, or I guess even young people that are un-tech savvy. So that might be something you might want to address in the beginning. Skype, in my opinion, I don't love Skype, but I've done it in the past, too. Skype, in my opinion, is more unstable.

Like, I've had it fall apart multiple times on me with people, and I don't like that part. And also, too, for whatever reason, I just cannot remember my Skype thing, like my Skype username and stuff. And I look for people on Skype to invite them to the thing, and I can't find them, even though they gave me the right name. I just, I'm not a big fan of Skype in that sense. Now, interesting thing, too, is we just got an email the other day from Jane App. And so, if you guys are using, if you're not using Jane App, then I think you should. Jane App is an EHR, by the way. They're not sponsoring this podcast.

It's just, I've had a really good experience with them over the years, or over the year that I've been using them. And they just sent a nice feature, which I need to find it here. There it is. So, I'm looking at an email. They sent it on March 19th. So, they said, they're offering free of charge for the next couple months is telemedicine. And this is really cool. So, you just log into your account. You have the appointment time with the person already there, and it's booked specifically for telemedicine services. You have them pay through the processor right there, and the video can be started with just a single click, and everything's encrypted and secure and so on.

And so, I think this is something that I'm going to look more into as well. Jane has been amazing with customer service, and I know that I've used a couple EHRs over the years, and Jane is by far the best. You call up. They're super nice when you call, and then you just ask them, hey, I don't know how to charge this person. Great. Cool. Do you mind if I log into your thing? Yeah, sure you can. And so, they see, oh, patient number 75. Is that the one you're talking about? Yeah. What are you trying to do? Collect that $75? Yeah. Okay. Here's how you do it. So, they're really cool. Even with the simplest questions, they're, I know, I feel like needy sometimes when I call them, like, gosh, that was probably in a tutorial somewhere.

By the way, they have a lot of tutorials. So, video tutorials as well as picture screenshots of the entire system. So, I think if you are on the fence, you know, if you're a new doc and you're looking for some EHR systems, Jane has, Jane is so easy. It's so easy. And there's not a lot of them up front for you, basically, just pay per month so you can ditch it whenever you want to. So, that is something there. I think maybe the other parts of tech that you might want is, you might want an area that looks fairly clean behind you. You might want it quiet. I've done some video calls with people and, you know, they, surprisingly, a lot of people have dogs that love to, they love to jump on when they get on the ground.

And so, there's about five to ten minutes where people are going to corral their dog. And so, making sure that you have the emails and messages in place to make sure that you're not wasting time because it's a one-to-one type of thing or you might go straight to another appointment. It's, you want to make sure the patient gets, it's everything they need in that session. So, those are considerations and just framing things well that, for people to have the success that they need. Let them know that it's going to be whatever time frame that it is because they might be used to, I know in our office, they're used to kind of, there's interns there, there's more, they can always, it's not a definitive amount of time.

But if I'm one-on-one with them, I need to make sure to let them know, hey, I got 30, we got 30 minutes, we're going to stop this at this time. If you're doing a circuit and we've done two rounds of the circuit, I want you to do four. So, just afterwards, just continue through. All right, I'm going to send you an email with all of the exercises that we did and some rough rep ranges as well as like how often to do them. And so, the cool thing too with doing videos, video sessions is I don't feel like a jerk having a computer in front of me when I'm with somebody. So, I can just easily type some stuff out, double task a little bit while they're going through like a farmer's carry and I say, come back, you know, after you feel tired and I can start working on things to center it to them.

So, it's not like I have to spend a lot of time later doing things. Now, I think that's all I really have for this topic at this point. But again, corralling back to the central topic, I think our MSK, PT, DC legislating bodies should address this topic. I know it's a daunting topic. I think they should address it and make sure that everybody is understand what the formalities are because it's the wild, wild west. All right? And I think that we can help more people if we can unleash the chains a little bit more. So, if people are looking for it, people are going to be scared to go in. Like, personally, I don't want to go to the store right now.

All right? And I think that this is going to help more people than we think. And I think if we're good people at just generally, genuinely suggesting what they should be doing, we're going to become a good triage. All right? People with back pain or neck pain, you know, minus the other red flags, should not be going to urgent care or the ER. All right? Like, I have a couple physicians that are patients of mine. And again, this is going to be independent of each physician or MD. But they're like, yeah, I don't know any of this stuff. You know? And like, the same thread, I don't know anything about nutrition and blood work.

I don't know anything about, you know, I don't know anything about COVID-19. You know, I don't know anything about cellular biology really anymore. I don't know anything about pharmacology. All right? So, everybody has their special skill sets. And it is commonplace for everybody to run to their general practitioner's office with these problems. But the CRISP protocols, Don Murphy was on the podcast before. You should go back and listen to his. He had a really good call to action is the primary spine practitioner should be the one that if they're well skilled at evaluation and management of these problems, we can save a lot of healthcare dollars for people by going through the unneeded, more advanced types of interventions that might not have a better outcome.

We can certainly do this. I think we can do this as a team. I think we should get our boards on board with this. And I think we should make a good stand. All right? How's that for a good exit with this? So, I hope you guys are continuing to be part of the movement. Again, everything in this podcast I mentioned in regards to legality of doing these things, I think you should talk to someone in your state, talk to an attorney, talk to your malpractice insurance, and just make sure that you know what your abilities are. So, please share this with another practitioner who would value this information and would learn from it.

So, the only way this podcast continues to grow is with you sharing it. I do not promote the podcast. I'm literally doing this from my bedroom right now. I don't know if you can hear the difference of audio. I do this because it's a passion project, okay? Please share this. The biggest compliment you can give me is to share this with a couple people who have not heard this information yet. So, thanks for being part of the movement. I'll talk to you guys soon.