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In this episode, Dr. JJ discusses the importance of stress and load on the body. And emphasizes how the importance of stress to grow and thrive applies to business, particularly in transitioning from insurance-based to cash-based practice. Dr. JJ shares her experience in stressing the business system for business growth and highlights that demanding stress in your body will help you achieve meaningful results and a successful business.
Get A Free Copy Of My Book:5 Things You MUST Do to Build a Successful Cash-Based PT Practice. This quick, easy-to-read guide is your no-BS steps to what really works in building a Cash-Based Physical Therapy business.👉 https://bit.ly/CashPTebook
For more on our in person Physical Therapy continuing education classes, check out our Primal University 🎓 https://bit.ly/primaluniversityeducation
In this episode, Dr. JJ discusses the importance of stress and load on the body. And emphasizes how the importance of stress to grow and thrive applies to business, particularly in transitioning from insurance-based to cash-based practice. Dr. JJ shares her experience in stressing the business system for business growth and highlights that demanding stress in your body will help you achieve meaningful results and a successful business.
Get A Free Copy Of My Book:
5 Things You MUST Do to Build a Successful Cash-Based PT Practice. This quick, easy-to-read guide is your no-BS steps to what really works in building a Cash-Based Physical Therapy business.
👉 https://bit.ly/CashPTebook
For more on our in person Physical Therapy continuing education classes, check out our Primal University 🎓 https://bit.ly/primaluniversityeducation
Welcome to The Dr. JJ Thomas Podcast! Here I'll be talking all things physical therapy, raw and unplugged, giving you the unfiltered insights you've been searching for in your cash-based physical therapy business. If you're caught in the grind of the traditional model, swamped with paperwork, or feeling like you're not reaching your full potential as a physical therapist, this podcast was created just for you.
Our businesses are a system, a living system. They need to be fed. They need to be nourished. They need to be cult cultivated. They need to be demanded for change.
Dr. JJ Thomas:Welcome to the doctor JJ Thomas podcast. Hi, everybody. Welcome to the doctor JJ Thomas podcast. I'm JJ Thomas, and I'm thrilled to have you here today. Just wanna say before we start, I'm loving all the feedback you guys are giving.
Dr. JJ Thomas:I'm I'm happy to see you guys are subscribing and liking and and interacting with me because that's that's the whole point here. Like, I'm here to interact with you guys, so just thank you for the engagement. Really excited about today's episode. Today, we're going to talk about stress and load on a system, and specifically how stress and load are important for systems like our business, and your business, hopefully. So what I wanna start with though is a comparison of, something that we as physical therapists all understand really well, and that's the importance of stress and load on a living system like our bodies.
Dr. JJ Thomas:Right? So we know that in a living system, if we don't regenerate by the second that we die like, if cells don't regenerate, if our body doesn't recover, if we're not constantly pushing a stress to a system, then the living system, the body, the muscles, the bones, the joints, the cells are not going to thrive. They're going to die. We see this in the body with with things like red blood cells. Right?
Dr. JJ Thomas:We know that every second, we regenerate 1,000,000 red blood cells. 1,000,000 in every second. And in terms of all cells, we regenerate somewhere between a 100,000,000,000 and 330,000,000,000 cells in a day. That is astronomical, really. I mean, beyond I can't even fathom that.
Dr. JJ Thomas:When I try to type out that number with all the zeros, it's it's ridiculous. And that's per day. And that's just that's evidence with what we do in practice every day that that in a living system like ours, if we don't constantly push stress, because stress is what's gonna force change. Right? Change won't happen unless we put force upon it.
Dr. JJ Thomas:We know that from lots of concepts we use in PT, and we'll talk about them in a second. But if we don't push change, then we die, essentially. Not to be morbid here, but it's the truth. And today, I wanna talk about the comparison of, essentially, our businesses are living systems. Like, if we want our business to thrive, if we want our business to grow, we have to push change.
Dr. JJ Thomas:We have to stress our system a little bit. Let's go back to the language that we all really understand, which is the body. Right? Let's think about examples of how we have to push and stress the systems. Think about let's talk about muscle tissue.
Dr. JJ Thomas:We know that with muscle tissue, if we don't load a joint, let's say the knee, to, like, 65 to 85%, that we're not gonna be able to get activation of those type 2 muscle fibers, those anaerobic muscle fibers. We're not gonna be able to get hypertrophy. Right? We know that through lots of studies done, especially in relationship to, like, blood flow restriction training. It's a different way of loading or stressing the system, But the point is that our body has a built in mechanism.
Dr. JJ Thomas:It it literally demands that we put stress to it in order to invoke change. That's just one example. Right? That's just muscle tissue. Let's talk about tendons.
Dr. JJ Thomas:We know that athletes or, you know, whether they're recreational athletes or whether they're high level professional athletes, people with things such as Achilles tendinopathies, we know that those tendons the research largely supports that tendons respond better to eccentric load. Like, if we're gonna get them out of it, we now understand after years years of rest, ice, and compression, and elevation of just resting tendons, we now know that was wrong. What we know now, and we've known for quite some time and we've actually been able to test it through our clinical practices, is that when we load those tendons appropriately, when we stress the simp the the, when we stress the system, it responds. It gives it the blood flow it needs. It stimulates the neural firing of the muscles that are attached to whatever tendon we're dealing with.
Dr. JJ Thomas:It demands change, just like every living every living part of our system, every living system. Let's take it a step further. Let's talk about bones. I mean, the body is, like, the perfect example of this because again and again and again, we see that we have to stress the system in order to demand change. Right?
Dr. JJ Thomas:With the body, with bones, We know that for instance, look at the astronauts. Right? They have to purposefully load their system so that their bone density changes are not astronomical when they leave space because they're not getting that weight bearing through the through the bones, through the skeletal system that they need. We know that Wolff's law tells us that if we put load on a bone, the bone is going to create and demand cellular repair in a way that promotes bone growth. We see that when we're promoting Osteoporhytic patients to do weight bearing strengthening exercises.
Dr. JJ Thomas:Right? We practice this every day in our practice. And we know that through not just what the research has shown us, but we see it in everyday practice. I can tell you from my own example, I had an ACL tear a little over a year ago now, and so I had surgery September a year ago, so just, to remember, you know, 14 months ago or so. And I I have to say, you know, I've been in practice 23 years now, and experiencing that firsthand was actually really incredible.
Dr. JJ Thomas:I wouldn't change it for the world, and partly because I learned firsthand all the things I've been preaching about demanding load for our patients. So for instance, you know, day day 1, really. Day day 1, I was I came out of surgery. It was largely swollen, edematic. Obviously luckily, I didn't have a lot of pain.
Dr. JJ Thomas:That's a whole interesting another concept. I didn't even get a nerve block, but I didn't have a lot of pain. But I knew that I needed input to my system. My system had been stressed in a way that was traumatic, and I needed to give some stress back to it. So I gave mechanical stress to it.
Dr. JJ Thomas:Right? I just self massaged. But by day 2, I was already doing hitting the BFR for cellular spelling protocols, and that's because my brain, you know, what I'd been preaching to my patients was that when we need to demand repair in a system, we have to basically demand a change in that system. And so right off the bat, I my team brought me my BFR cuff. It was, like, hap one of the happiest days of my life.
Dr. JJ Thomas:Eric showed up with my BFR kit, and, and I and I got to work. And immediately, I saw my quads starting to respond better. And so that was early phase example of how I demanded I demanded a response in my body, and I got it. But other things were true too. Like, beyond just demanding you know, trying to prevent quad atrophy through invoking stress through stim and BFR and exercises and massage input, I found that I was weight bearing through my knee in terms of actual load through my knee, like kneeling, way earlier than I had been doing with my patients prior because I realized it was safe.
Dr. JJ Thomas:And I also realized that if I'm gonna follow, like, Wolff's Law and I'm gonna demand the bone to respond and I had a patellar tendon graft, so I wanted to demand change in that patellar tendon where they took out the middle third. I wanted to give it input. I wanted to create change in a living system that I needed to put input there. I need to put stress there. So I started kneeling very early on.
Dr. JJ Thomas:And it's interesting. That's something that I wasn't asking asking my patients prior. Like, I wasn't really I was so focused on range of motion, and I was so focused on, quad sets, and so focused on what their activation was like, and then gait retraining. And prior to my own injury, I wasn't really asking them about, Hey, let's get kneeling. Let's, like, let's see how you're doing kneeling.
Dr. JJ Thomas:And then as soon as I went through my own rehab, I realized how important that was. So then I started ask I started demanding it out of my patients more. And it's funny. I had a, an ACL, reconstruction patient come to me. She was actually, like when she came to me, she was, like, 6 months out.
Dr. JJ Thomas:This was after my own ACL recovery. She was, like, 6 months out. She had gone through rehab with one of my colleagues down the road, and, they did a great job. She just was looking for a little bit more one on one stuff. So so but when she came, she's already been 6 months out, and I'm like, hey.
Dr. JJ Thomas:Okay. Let's get into kneeling. And she looked at me like, oh. Like, I said something dirty. Like, she was like, oh, what what do you mean?
Dr. JJ Thomas:You want me to kneel? And she had a patellar tendon, graft as well. And I'm like, yeah. I want you to kneel. And she's like, oh, I I don't think I can do that.
Dr. JJ Thomas:And I'm like, yeah. We're gonna do it. And so, luckily, I'd already earned her trust, and so we started on a foam pad. But it's funny. I mean, she had just come to terms with the fact that she didn't think she was gonna kneel ever, and that's not acceptable.
Dr. JJ Thomas:We have to demand load in our patients and, in every single way we can think of. Right? I wanna give one more body example with load just to really hit this point home, and that's like, if you think about how we treat post op patients. Right? We we practice this literally every day in the way we rehab our patients.
Dr. JJ Thomas:Right? We follow the protocols, and the protocols are all based on how the tissue can accept load. Right? How can we safely introduce the load in a way that's gonna create the change that we want in the system? And so just like our protocols, if you look at how our protocols are written, it's like early phases are prevent atrophy and reduce swelling and encourage healthy input to the to the joint and the muscles.
Dr. JJ Thomas:And then as we progress out of that high inflammatory phase and start in getting into the tissue remodeling phase, now we're gonna start increasing our range of motion a little bit, maybe introducing isometric load. Right? And then once their tissue heals a little bit more, now we're gonna start introducing isotonic load, maybe semi centric load, depending on the on the area that was was affected. Right? But then from there, get further down for our athletes.
Dr. JJ Thomas:Now we're demanding more and more load. We have to now challenge them in a way that's gonna prepare them to get on the field. So stressing the system all the way from when they're, you know, just out of surgery, highly swollen, highly irritable, working on the on just tissue remodeling, and then still working on tissue remodeling way out, like, I'm talking 3 to 6 months, even 9 months out, still encouraging what we need out of our athletes so that they can perform because it's our job to prepare them for their tasks. This is a little bit of a I'm gonna I might hang up on this point, because lately, I've had some athletes come, from other places, and they're not getting what they need in that end phase of rehab. They're coming, and what I see is that whoever they were working with maybe was a little afraid to load the system in that dynamic way that this athlete needs to get back to sport.
Dr. JJ Thomas:Right? If we don't load them appropriately, they're at greater risk for injury. So I'm belaboring all this, but it's definitely the language that we understand. Right? Our tissues, our cells, our system, all of it needs load, and when it gets load, even so even more than needing load, when it gets load, that system is gonna thrive, and that system is gonna perform.
Dr. JJ Thomas:And we see it in our athletes, and we see it in our own bodies. So now what I wanna challenge you to do is take this analogy and apply it to your business or your your concept of your business. If you haven't started your cash based practice yet, and you're listening to this podcast because you're looking for ideas, start right from the gate with this concept of our businesses are a system, a living system. They need to be fed. They need to be nourished.
Dr. JJ Thomas:They need to be cult cultivated. They need to be demanded for change. And the way to do that is to stress the system, just like we do in the body. Now how do we stress the system in a business? Right?
Dr. JJ Thomas:Let's start part of it starts with personal, professional growth. When I think about my own path of how I got to where I am now, I know that part of that was that I did not fear stress. Right? Like, I've never not that I don't fear stress. I didn't let fear of stress limit me from performing.
Dr. JJ Thomas:And I just want to take a moment to bring that back to that athlete that I'm talking about, that sport that return to sport athlete where, you know, if you're a therapist and you're not challenging that athlete in a way that's gonna prepare them for the field, that's going to be to their demise. And that's on you. It's the same thing with the system. When you have an opportunity with the business system, when you have an opportunity to be stressed in a in a system, in a way that's intentional, productive, and gonna help you get the change you want in the in the business, you've got to take that opportunity. Regardless of the fear, regardless of the stress, you've got to do it.
Dr. JJ Thomas:I was talking to a friend recently. Actually, I was talking to my team. That's, we had a team meeting and we were talking about social media. And, Lord knows I've come a long way with my social media and I still have a lot to learn. But, we were talking about like one of my employees in particular was kind of like, he's like, you know what?
Dr. JJ Thomas:He's like, I just it doesn't feel like me. Like I feel like when I'm trying to post on social media, it just, you know, I'm having a hard time with it because it it's out of out of my comfort zone. Those are the words he used. And I remembered this moment when I was a newer therapist, and, I was working with my then mentor, who was incredible. And, you know, I I never really asked him these things, but I'm pretty sure he put me in situations that were stressful on purpose.
Dr. JJ Thomas:He was literally an amazing clinician and, and an amazing businessman. And and looking back now at my younger self, I realize there were things he did that at the time I thought were spur of the moment. But in retrospect, I think he was demanding growth out of me. He was demanding that I push myself to change. And so the story I I thought of when my employee was telling me about stepping out of his comfort zone was there was a time where when I was working with my mentor, I really did.
Dr. JJ Thomas:Like, I stressed my own system in a way because I just craved learning, and I just wanted every bit of I mean, he's so knowledgeable. I just wanted to soak all of that up. So so I would treat patients all day long, and then I would spend time with him either at lunch or at the end of the day, helping him on whatever projects he was working on at the time, which is always something. And, a lot of times, he spoke. He he was he taught.
Dr. JJ Thomas:So I would he was not very good with, you know, technology. Not that I was, but I figured out how to do it. And so I would write his his presentations for him. Like, he would say to me, this is what the content I want. These are the points I wanna make, and I would put it into a presentation for him.
Dr. JJ Thomas:So this one presentation I'd done it hundreds of times. This one presentation that we did together, it was it was a orthopedic symposium. Lots and lot like, I wanna say 250 people in the audience, and and not just not just clinicians, but doctors. It was an orthopedic symposium, so any orthopedist could be in the audience. And I he he said to me the day before, listen.
Dr. JJ Thomas:I you gotta dress nice because you're gonna be up on stage with me. And I'm like, okay. Sure. No problem. So I, you know, I wore a suit, and I looked I looked pretty nice.
Dr. JJ Thomas:But I get there, and I'm on stage, and I'm getting the PowerPoint up on on the stage. And then all of a sudden, I get a call from him. He's like, yeah, Jay. I'm not gonna make it. And I'm like, what?
Dr. JJ Thomas:He's like, yeah. You're gonna have to give a presentation. And I'm like, woah. Wait. I'm a new PT.
Dr. JJ Thomas:Like, these these people in the audience are so they know so much more than I do. They've they've been doing this. Like, what if I don't know what I'm doing. I was so stressed. And but I remember thinking, like, well, shit.
Dr. JJ Thomas:You gotta just do this. Like, he's giving you an opportunity. There you don't back out of this. Like, he wouldn't give it to you if he didn't trust you, if he didn't think you were ready. Just like we're not gonna load our patients in a way that they're not ready for, but we sure as hell better be doing our job and pushing them and demanding more of them.
Dr. JJ Thomas:So he did that to me. So he he said, I'm not gonna you're gonna have to do it. And I think he reached out literally, like, 15 minutes before I had to go on stage. And so all of a sudden, I I'm like, okay. Buckle up.
Dr. JJ Thomas:Like, let's just do this. And I go to give the presentation, and I'll never forget I'm sure you guys have had this that, like, like, very legitimate heartbeat in your throat, like, gook gook, looked so loud that I'm like, oh my god. I'm sure the front row can hear my heartbeat in my throat right now. But I just had to stay with it and talk myself through it. And once I got through the intro, it was it was all fun.
Dr. JJ Thomas:And from then on, I don't remember honestly, I don't remember having a heartbeat like that in my throat after that moment. It was stressful, but he put me in that situation because he knew that I needed to grow. He knew that it was something I could handle, and it helped me professionally. It gave me more confidence that next time, if he was like, Jay, I'm not gonna make it, I'm like, alright. I can do this.
Dr. JJ Thomas:I did this before. I knew the content. So that was one aspect of you know, I didn't own my own business then, but that was for sure part of my professional growth that allowed me to be who I am today. Another example of, stressing the system, stressing your business system, outside of professional growth actually, let's go back to professional growth, because I do think I think having the confidence to open your own practice is huge. And I I also think that for our practice, I've said this before.
Dr. JJ Thomas:I I think there's different models of cash based practices. Right? I think our cash based practice, what makes it amazing, is that we demand results. And by that, I mean we demand the best of ourselves for our patients. And so with that has come clinical growth.
Dr. JJ Thomas:Clinical, I've demanded clinical growth in myself. I've demanded stress to my to my clinical growth. So with that, it's come from learning and training and learning and training and learning to teach, and that is another way that I stressed my system, is that after I learned dry needling in 2009 first of all, when I learned dry needling in 2009, I went double certification right off the bat because I was like, Jesus, no one around me is doing it, so I better know my I better know my shit. So I double certified. I really learned it in and out, and then by 2012, I was like, okay, I'm gonna demand I gotta stress my system even more.
Dr. JJ Thomas:I'm gonna I'm gonna start teaching it. And, and again, that was another stress. Like, moving from being really proficient in dry needling to now helping others become proficient in dry needling was a stress to the system. I studied literally, I studied all the time. I studied in between patients.
Dr. JJ Thomas:I studied while when I went home, and I was constantly reviewing the anatomy, and I I studied leading up to courses as I was auditing to teach. I mean, I put myself through stress to become an expert. And if you try to skip that step, it's just like the athlete. If you have an athlete and you get them to do you know, you get their long arc, their knee extension strength to 90%, but you haven't asked them to take that strength and utilize it now in a in a plyometric setting or in a dynamic setting, creating rotational forces, cutting forces, bringing them then to a field, progressing them towards now having opponents. Right?
Dr. JJ Thomas:If you haven't stressed the system in a stepwise fashion, then you're not gonna cut it. It's the same thing in your business. It's the same thing in your personal growth. You have to ask yourself, where do I wanna be? So for our athletes analogy, we want our athletes to kick ass on the field.
Dr. JJ Thomas:We want them to get back on the field and have confidence and fortitude and strength and move the way they moved prior to injury. And we have to work backwards from that and meet little mini goals, and the only way to meet those mini goals is to to demand that we challenge the system in each of those little mini steps. So teaching was another professional milestone, professional challenge that I had to stress my system, my my living system of my business. So now, right around the time that I was teaching is also right after that. 2012, I started teaching.
Dr. JJ Thomas:2013 is when I it literally gave me the guts to be like, you know what? Heck, yeah. I know what the heck I'm talking about. I'm I'm pretty darn good at this. I'm gonna open my own practice and see if people also feel that way, and they did.
Dr. JJ Thomas:So now though, we're talking about the stress of opening your own cash based practice. And that's that's what most of these episodes are about. Right? That's what most of this podcast is intended for is, yes, to help you all be better clinicians, but also to give you the tools to help you have the confidence to take that step and open your own cash based practice. And so I'm here to tell you that the only way you're gonna do it is by stressing your system.
Dr. JJ Thomas:Right? Taking that jump from insurance based world to cash based world. And when I reflect back on my my own, stress of moving out of the insurance based world, I think for most people, and this was true for me, I think for most people, you hit a point where you know it's almost like you're at a you're it's almost like you're at a, literally, the end of a cliff, and you're like, you know what? I'm I can either stand here and wait till the sun goes down and the wolves come and get me, or I can just jump with this parachute and hope it works. And that's kinda where I was when I decided to take that stress on and open my own cash based practice.
Dr. JJ Thomas:But to be honest, I never thought of myself as a business person prior to that moment. I mean, you know, my husband's in finance, and he was always the business mind. But I decided it was the next step for me if I was going to be able to feed, nourish, cultivate that living system in myself and in my in my professional growth. And so I figured it out. Like, the way I figured it out was I resigned from my insurance based practice job.
Dr. JJ Thomas:I found, I tie teamed up with a local group that I was friendly with that wanted to learn dry needling, and so I did part time work with them where I where I not only allowed them to consult me with my patients so they could see dry needling up front and really, like, learn live, but I could consult patients with them also and talk about the systematic approach that we use, to get people better. So so I had that 3 days a week, and then 2 days a week, I built my practice and built my reputation, built my brand, started getting the word out there. And while I was building my brand, I also had the time at back then to do the research on I mean, I remember I remember being so overwhelmed with, like, the question of, do I open a when I wanna open my business license, do I open a sole proprietorship? Do I open an LLC? Like, I don't even know.
Dr. JJ Thomas:I had to I had to research what the differences were, and it was it was that. It was that stress of taking the time to learn and educate myself in that way that was the demand that needed to be met in order to move forward, in order to thrive, like we're saying. So so that was a big win for me. Another example that comes to mind when I think about stressing the systems in terms of your business is one aspect of my business that I think has been a huge player in my ability to keep the momentum with my patients is this 15 minute screen method that we use oftentimes here at at my clinic. And what I did was I developed a system that I could approach people, patients, and I I basically stressed my own system on purpose where I limited myself to 15 minutes to be able to listen to the patient, observe them, choose very specific tests to give them, some some inclination of where we would go with the treatment from there, and show them that it would be worth their time.
Dr. JJ Thomas:And so 15 minutes is not a lot of time, but I practiced and I developed and I honed and I tweaked and I I did these things in a way that stressed it was stressful. Like a patient would come in and I'm like, it's go time every single time, I have 15 minutes. And I worked it out with practice where now, I literally on the spot, very comfortably will do a 15 minute screen and 98% of the time I can show them how I can help them if it's a musculoskeletal issue that I can help. Sometimes, unfortunately, I look at them and I'm like, you know what? This is not a musculoskeletal issue.
Dr. JJ Thomas:I'm gonna send you to this person. But I've still helped them because I've shown them, you know what? I was able to clear this of a musculoskeletal condition, and I'm helping them get to the right place. So I now I still have earned their confidence that, you know what, JJ put me in the right direction even if I'm not the one saying I'm gonna help them. So that 15 minute screen was a clinical tool that I developed within our own practice that was stressful at the time.
Dr. JJ Thomas:It's not stressful anymore because I've gotten so good at it. But if you the point is, if you want your business to grow, just like you want your patients to grow and thrive, what you need to do is demand stress to your system, to your business in a way that's going to produce results. And so you have to ask yourself, how what results do you want? Just like we use the patient example of the athlete getting back to sport. Look at your end game, work backwards, figure out what steps, what mini steps you need to make in order to stress the system kind of stepwise so it's not so overwhelming, and then the outcome's gonna be amazing.
Dr. JJ Thomas:You're gonna find that you're reproducing, regenerating cells within your business, and, and it's gonna thrive. Remember that living systems, living things, they must grow or they will die. And by growing, what we mean is they must be challenged or stressed in a way that demands growth. So treat your business like a living system. Feed it, nurture it, nourish it.
Dr. JJ Thomas:Demand that it grows. Allow yourself to take advantage of stressful situations so that you're demanding change and growth within your business. Show up for it when you're tired. Show up for it when it feels like the business is stagnant. Nourish it and encourage it when it feels vulnerable.
Dr. JJ Thomas:Like, spend the time treating your business like a living thing, and it will come back and repay you a 1000 fold. So if you find yourself wanting to do these things. Right? If you're like, yes, JJ. I'm on board.
Dr. JJ Thomas:I wanna do this. Let's go. I'm gonna demand myself system. And if part of that happens to be professional growth for you, then I would suggest, click the link in the description of the podcast, and that'll direct you to click the link in the description of the podcast, and that'll direct you to our Primal HQ website, which you can sign up for our courses, check our courses out, and I think you'll find that we will be happy to stress your system and professional growth to make you, and your business be awesome and thrive. Thanks so much for coming on today.
Dr. JJ Thomas:Looking forward to next time.