The Simple 3 Step Method To Get Better Results For Your Patients (Copy This Now)

Show Notes

In this episode, Dr. JJ Thomas shares her proven 3-Step Method that has revolutionized her cash-based physical therapy practice, this method is a simple yet effective technique that has not only skyrocketed her business but also consistently delivered better results for her patients. Discover the strategies that can transform your practice, enhance patient satisfaction, and foster long-term success in the competitive healthcare landscape.

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What is The Dr. JJ Thomas Podcast?

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.

Dr. JJ Thomas: 00:00

Our patients should feel their value should feel our value every single session. And so if you take this model, you take this structure, and you apply this evaluation method to every single visit, I guarantee your patients are going to be so happy, and they're gonna get results. Welcome to the doctor JJ Thomas podcast. Hey, everyone. Welcome to Doctor.

Dr. JJ Thomas: 00:25

JJ Thomas Podcast. Thanks so much for joining us today. Really pumped about today's episode. Something that's really true to my heart because I think it's actually maybe the single most thing that really helped me grow my practice, to the successful cash based practice it is. And so what I'm going to gift you guys with today is I'm going to reveal, our methods that we use here, the way that we structure our evaluations to basically get better results and show your value to your patients right on that first visit.

Dr. JJ Thomas: 00:59

It's, really an incredible tool. And when you refine this this structure of this evaluation, it's, like I said, literally going to change the growth of your CASH based practice, not only through the numbers of the patients that you see and and can retain, but also through the results you're getting with them. So for most of us who that's why we're in this and that's why we wanna get into this, and that's why we wanna get into growing our cash based practices to help more people, this, episode is gonna give you the tools to do that. So, in light of my excitement, I'm standing today. I couldn't even they couldn't even get me to sit down.

Dr. JJ Thomas: 01:35

I was like, screw that. I can't sit down for these things anymore. So hopefully, you'll, you'll get as much out of it as I have through the years. I wanna start by going through with you guys what inspired me to talk about this. The idea for this episode kind of came out really most recently.

Dr. JJ Thomas: 01:52

As I've explained in previous episodes, I started my practice 10 years ago, my cash based practice. And a lot of things you know, there was some stumbling I did along the way, and there were some things that I just organically figured out, luckily. And now that I've hired therapists, now we have a practice of 5 therapists, 3 full time, 2 part time therapists. Now as I hire and train therapists on-site, I realize some of the limitations that they're having that are reminding me, oh, yeah. That's right.

Dr. JJ Thomas: 02:20

I did struggle with that when I first came out. And came out of the insurance based world and and morphed into this cash based world. And one of the things that were highlighted for me recently is the difference that there has to be on that very first day in the evaluation. What I notice when I'm working with my therapist here at my practice is that when they're coming out of the insurance based world or even I have one clinician. She's a great, passionate, new therapist.

Dr. JJ Thomas: 02:47

But even just coming out of school, and working in clinics where that are insurance based, what has happened already in both of those cases is that their evaluation process has already been sort of, forgive me for saying this, but it's the truth, watered down, stripped down to, like, the necessities. Right? Like, what's deemed as the necessities, which, unfortunately, if you're really targeting an evaluation to just meet the kind of minimum criteria, then you're only gonna get minimum results. My, my admin, David, who's wiser than, wiser than I can explain, he has a saying I love to repeat. And it's it's 50% effort is gonna get is gonna yield 50% results.

Dr. JJ Thomas: 03:30

And that's true in our evaluations. But unfortunately, in the insurance based world, we're stuck with this process that is, has to be watered down because we've got we know we have another person waiting and 2 other people still finishing up on exercises. So so in that, what I find is these therapists coming out of this model, and myself included back in the day when I started, have developed these habits of, as I said, stripping some of the meat and potatoes out of the evaluation process that we might have originally learned back in PT school. But we out of out of pure survival, we had to morph it into something that really wasn't, the best for our patients. So what we're gonna do today is we're gonna analyze that a little bit deeper, a lot deeper, actually.

Dr. JJ Thomas: 04:18

And I'm gonna share with you what I've been training my staff on. I'm gonna share with you the structured systematic approach that we use to, again, both get results with our patients, which is really the number one goal for everyone. And also just as importantly, show them our value. Because if we're really expecting them to pay cash for our services and to pay us upfront in lieu of going to an insurance based model where they don't see that that payment right upfront like they do in our world. If we're gonna ask them to do that, then we need to do those two things first.

Dr. JJ Thomas: 04:52

We need to show them that we're different. We need to get them results. And we need to show you show them that we value their time. So that's what we're gonna do today. Before I talk about the way we do that method, like, it's literally a systematic structured approach, and I'm gonna spell it out for you so hopefully you can reproduce it brilliantly.

Dr. JJ Thomas: 05:12

But before we do that, I wanna frame this in the mindset of, let's think about our audience. Right? Let's think about the patients that are coming to us and why they're choosing us over going to an insurance based model. If you think about the patients that are choosing to come to us for our services, they're usually one of 2 people. They either I always tell people that people are like, what type of patients do you see?

Dr. JJ Thomas: 05:38

Because they're all intrigued about the fact that people come here and pay cash. I say, they we usually get people that failed treatment somewhere else or they wanna be better yesterday. Essentially, most people fall into those 2 two categories. And essentially, what we're saying, really, the underlying themes of all of that is that those people value their time. You know, they're the people that are in the insurance based model, and they're looking around at the the craziness of, you know, people set call it I've heard patients all the time, oh, it's in the rat race.

Dr. JJ Thomas: 06:09

It's in the it's the numbers game. It's it's the, you know, the, the assembly line, they'll call it. Where there's therapists managing multiple people, and they know that it's not efficient. And they know that there's absolutely no way any human, no matter how amazing they are, can actually give them their best when they're managing multiple people. So most of the patients we get fall into that category, potentially.

Dr. JJ Thomas: 06:36

Or they went to those places, they trusted the process, they gave it their all, they're like, this is the way it is. I'm gonna give it my all, and I know that therapist is giving me all they can. And they they hit a plateau, and they realized, I'm not where I need to be. I value my body, and I value my goals. And I've given this all I can, but I'm plateaued, and I'm I'm missing something still.

Dr. JJ Thomas: 06:59

So those people will also seek us out because they realize, okay, I'm gonna go there. I'm gonna pay upfront for their services, but they're gonna promise me 1 on one time. And what I've heard, because this is what I'm gonna help you create, is that your brand is gonna become such that people will hear now that not only will they have 1 on 1 time with you, but they're gonna get results and their time's gonna be valued. And you're gonna show them you're different than everyone else. So how can we do that?

Dr. JJ Thomas: 07:31

This is literally what we do with every single patient. And I'm gonna structure it as an evaluation because that's really, I'd say, maybe the most important. You know, that 1 on 1 first visit with them is maybe your most important session. However, you can take the same structure and apply it to every single visit. Because the truth is, our patients should feel their value should feel our value every single session.

Dr. JJ Thomas: 07:57

And so if you take this model, you take this structure, and you apply this evaluation method to every single visit, I guarantee your patients are going to be so happy and they're gonna get results. So here's what it is. The first step in this process is you're going to listen to your patients. Now I know you guys are listening to this. You're like, I listen to my patients.

Dr. JJ Thomas: 08:18

Even if you're in the insurance based world now, I listen to my patients. Sure you do. Most people have the intention of really listening to their patients. But when you have the distractions of everyone around you, I guarantee you're not listening with the same intensity that you can in this cash based world. And so I want you to think about the word listening, and I want you to think about reframing that to listening with intention.

Dr. JJ Thomas: 08:40

Okay? When they're speaking about their history, I want you to listen to the things they're saying about the, the the way their injury progressed. Right? So we're talking about compounding factors. So as they're talking about their injury, I want you to start in your mind.

Dr. JJ Thomas: 08:59

Maybe, you know, you'll find you'll get a in a groove with when to interrupt patients to get information and when not to. That's an art of what we do. Right? But immediately, as they're speaking, I want you to listen with questions in mind. And as they're talking, think what compounding factors have led them to this course that their injury has gotten to where it is.

Dr. JJ Thomas: 09:22

That might be a surgical history. That might be a traumatic incident, either physical or emotional. Remember that we know from pain neuroscience that emotional trauma can also manifest into physical, dysfunction. So these are questions that you may have to find the appropriate time to ask, but you're listening with these questions in mind. Additionally, you're going to think about why did this stuff happen when it happened?

Dr. JJ Thomas: 09:47

What events were going on in that person's life? Maybe if they're coming for headaches, you might be asking yourself, I wonder if they had a dental appointment that was extremely long and their mouth was open for a very long time. And is there a TMJ component? I don't know. But all these questions, this active listening is now going through your head, and you're asking yourself things.

Dr. JJ Thomas: 10:07

And, and as they're talking, you're gonna find an opportunity to see these out from them. Because if they knew the answer, they'd be telling you it. But they don't. They're coming to you, and they need you to listen. If they say to you, Yeah.

Dr. JJ Thomas: 10:28

My neck really bothers me worse at night when I'm sitting on the couch with my wife, but not as bad when I'm standing static at the grocery store, ironically enough. You know, in school, they would say weight bearing is obviously gonna be worse for a cervical disc issue. Right? So standing, weight bearing, gravity, okay. But if it's really just a disc issue, why would it be worse at night when you're sitting on the couch versus standing?

Dr. JJ Thomas: 10:53

We need to think about positional questions. And what that's gonna tell you now is, hey, I need to check his lumbar spine because maybe the lumbar spine is an additional component that the other therapists didn't have the opportunity to check because they couldn't get there because they were too distracted with other things. So that is the opportunity, is to listen with the greater intention so that you can find these areas that are maybe subtle, but relevant and absolutely important. The other piece to the listening, the last piece I want to mention is, obviously, again, we were taught to think about irritability of symptoms. When we learn in school, one of the most important things to understand where the framework of that person is in their in their recovery tissue recovery, and inflammatory process is how inflammatory are they?

Dr. JJ Thomas: 11:43

How irritable are their symptoms? Really getting a really good picture of that through listening is gonna help you direct their treatment appropriately and get a win for them that day. So all of those things, listening with intention. From there, after you've had some theories already brewing based on how you're listening to them, you're gonna move to the next stage or phase of this, evaluation structure, and that's gonna be observation. And again, we were taught to observe in school, but I'm not talking about, like, just looking at them and running through some quick tests.

Dr. JJ Thomas: 12:16

I'm talking about truly, truly observing them. Okay? Down to the skin. Right? When we're looking at someone, ask yourself right now, am I looking at their skin?

Dr. JJ Thomas: 12:27

Because the skin, being one of the biggest organs of the body, is gonna reveal a lot about what's happening underneath in the neurovascular system. So if you take your observation to a whole another level, and now you start looking at their skin as a possible window into mechanisms that are contributing to their dysfunction, you are going to find a whole lot of doors opening for you. I want to tell you a couple clinical examples that really highlight this, importance of observing with a whole another level. One of them, was actually years ago. It was actually probably close to 10 years ago when I first opened my CASH based practice.

Dr. JJ Thomas: 13:05

And, it was someone that I treated that was actually a fellow mom, and we were on the sidelines. Our daughters did cheer together, and, we were on the sidelines one day, and she's telling me about this this rampant, poison ivy that she had. And she's like, I have this ridiculous poison ivy on both my legs, and it's been treated with 2 or 3 bouts of steroids, and it's not changing. And I'm like, well, that's odd. Like, steroids should have kicked it out.

Dr. JJ Thomas: 13:32

At least 1, at least 2 should have kicked it out. That's odd. So my inquisitive mind couldn't help but ask. I'm like, what what's tell me what's going on in your life? Like, anything else different going on?

Dr. JJ Thomas: 13:42

How do you think you got it? And she's like, well, I think I think I got it running in the woods. Like, oh, alright. I knew she was a runner. Have you changed your running recently?

Dr. JJ Thomas: 13:50

Have you done anything different, you know, other than running in the woods now? She's like, well, I've really ramped up my miles. So my my listening is inquisitive. Right? My active listening, my ears are up.

Dr. JJ Thomas: 14:00

I'm like, That's interesting. Like, well, let me see. Let me see what it the skin looks like where the let me see the poison ivy. She pulls up her pants, because she had them covered because she was worried about it being contagious. And she pulls up her pant leg and I look and it's a very clear medial shin L4 distribution of, like, what looks like poison ivy.

Dr. JJ Thomas: 14:21

It's a it's a rash. And I'm like, That's interesting. It's both sides, hasn't responded to steroid treatment. It's really kind of the L4 distribution. I'm gonna ask a little further.

Dr. JJ Thomas: 14:31

So I'm observing her skin. It really looked like both shins, l 4. I start sieving, start investigating, which is gonna be the next step that I'll tell you later. But I'm asking her more and more, well, how about any history of back issues? Well, you had an L4 issue a while ago.

Dr. JJ Thomas: 14:47

Ding, ding, ding. Okay. I'm like, listen. I said, look, I'm not sure if this could be it or not, but let's do a let's do a movement evaluation on you. And let's see if there's a musculoskeletal component to this because the body will try to reveal things through the skin sometimes when it's not getting what it needs.

Dr. JJ Thomas: 15:05

Long story short, on a separate day, my friend came to my, office, and we looked at her movement. And we revealed a dysfunction at L4 5 and specifically in, like, her gluteals, which are also, ironically, fed by L4 5, glute med men. And we treated those and the shins, and her poison ivy went away. So the skin revealed an underlying neuromusculoskeletal deficit that the docs missed because it seemed so clear to be poison ivy. The point is, this girl was getting misdiagnosed because people weren't actively listening and observing really diligently.

Dr. JJ Thomas: 15:44

Now, I had the benefit of knowing that she didn't respond to the steroid treatment. But like I said, the skin will reveal a lot if you'll let it. Along those same lines of observation of the skin, there's another guy that comes to mind. This guy came to me for foot pain after a diagnosed partial plantar fascial tear. And I'm doing my full evaluation.

Dr. JJ Thomas: 16:06

I'll go through that process in a second, but looking at him head to toe, like I always do. Then I get him on the table, and I'm looking at the foot as I'm I'm at that piece of it. And as I'm observing his foot, I notice he has what looks like toenail fungus on his big toe and his little toe. So big toe, little toe, but the middle three toes were totally fine. Like, clean as a whistle.

Dr. JJ Thomas: 16:27

I said, what's going on here? He said, oh, yeah. It's like a fungus, but I treated it with antifungal. It's not responding. I'm like, listen.

Dr. JJ Thomas: 16:36

Let's do some tests. So long story short, this guy had some neurovascular dysfunction at the at the medial and lateral, so l l four and s one, distribution. Could have been per like, distal nerve entrapment as well, but the point is that made him sup sup susceptible to the plantar fascial tear in the first place. So poor neurovascular flow down to the distal low extremity obviously is going to put him make him more susceptible to a plantar fascial tear. So I said to him, listen, I know right off the bat, we're gonna treat you for this plantar fascial tear, but there's a there's a component here that's coming all the way up the back.

Dr. JJ Thomas: 17:17

So we needed to treat that whole body in order to really get him up to the level that he deserved to be. But on that first session, he's like, wow. I can't believe nobody pointed that out before. No wonder it didn't respond to antifungals. No wonder, like, everything I've done for the treatment of these nails isn't changing because the nails are a window into the neurovascular system.

Dr. JJ Thomas: 17:38

Could he have an a fungal thing as well? Yes. But it would have been likely that it would have been all the toast because fungus is pretty contagious. So, again, the point is, don't miss the opportunity to see what's happening by truly observing your patients. And the skin, and the nails, and the the small details, hair growth changes, all of those things are gonna really, open doors for you that you don't even realize are there until you start looking.

Dr. JJ Thomas: 18:05

Another piece of the observation, obviously, that's, like, one of the underlying things that I think people most often miss. When when we teach courses, all the courses we teach, this is something that we emphasize all the minor details that you can catch through just really careful observation. I'm talking like like Sherlock Holmes' observation and investigation. But what we're used to looking at is is posture and movement. Right?

Dr. JJ Thomas: 18:29

And absolutely, we're gonna take this observation to a whole another level with posture. When you're looking at someone's posture so, again, when you're gonna evaluate a patient, we're on that, first, you're gonna really listen to them, then you're gonna really observe them. And part of that observation is gonna be skin and nails and other things that you may not be accustomed to. But additionally, you're gonna look at posture. And that might be the posture that they have on the table when they're sitting there talking to you.

Dr. JJ Thomas: 18:54

Whatever jumps out at you, I want you to put in the back of your mind to evaluate and and really delve into later. So when they're sitting there and they're telling you their story, are they kinda like rotated and hunched one way? Is their head off kilter? Are they really slumped? What is their posture telling you?

Dr. JJ Thomas: 19:13

Are they, like, maneuvering a lot because they're clearly uncomfortable? Their posture is gonna reveal things to you that you should be looking at before they even know you're watching them. So that's the second piece of the observation. And then the 3rd piece of the observation that I really wanna highlight for you is, I may I alluded to it earlier, Some of the habitual patterns that we've developed in the insurance based world during our evaluations is to hone in on the area of pain first and then try to backtrack out of that. That's really backwards.

Dr. JJ Thomas: 19:46

What we need to do is we need to take a a 100 foot view first. We have to back up and take a global perspective of our patients' body, posture, movement, everything we see on them, and then hone in on what the things are that we think are contributing to their dysfunction. When you have that approach, you're not gonna miss things. Because if you come in with that laser focus, you can't even see the other stuff without the bias of what you saw in that laser focus first. So absolutely, you're gonna spend time focused on the area they came to you for.

Dr. JJ Thomas: 20:21

But if you do it in the reverse, like many people in the insurance based world have gotten in the habit of, purely because of time limitations, then you're gonna fall into the same pattern mistakes. So take a 100 foot view, look at global movement perspective, and then focus it in. And you can tie the pieces together much more deliberately. So that brings us to our 3rd phase of this evaluation this structured evaluation, and that's the investigation process. So we have a framework now based on what we've listened to and heard, based on what we've observed and questioned in our own mind, and now we're gonna investigate.

Dr. JJ Thomas: 20:57

And the way we're gonna do that is what we're specialized in. Right? Our specialty as PTs is the neuromusculoskeletal system as it relates to movement and pain. So our investigation is going to be centered around movement. I encourage you to find a method that will help you analyze movement from head to toe and look for patterns that are gonna highlight contributing factors that you might not otherwise catch if you weren't trained to look for them.

Dr. JJ Thomas: 21:26

So I've mentioned many times, I've trained in things such as SFMA, selective functional movement assessment, a brand of the FMS from Gray Cook. I've also studied with, a group called the Raggi Method, which is Daniele Raggi. He's an Italian, native who, I was fortunate enough, one of 7 people. They came here and trained us in their postural evaluation methods. And all of these methods, the thing they have in common is they do just what I said, that last pit of piece of the observation, is they take a global perspective and then they'll manipulate different patterns of that to to find connections.

Dr. JJ Thomas: 22:04

And what that's going to give you as a clinician, it's going to arm you with the ability of finding connections that you may not find otherwise. I'm gonna give you an example. So we've spoken about some of these in previous podcasts. But let's take, let's take someone, for instance, who has limited cervical rotation. Okay?

Dr. JJ Thomas: 22:26

And I might check their cervical rotation in standing, and they're 40 degrees to the right. And then I might say, you know what? Let's have you cross your right shoulder right hand over your left shoulder, and then look to the right, and all of a sudden they go further. What that does for us is it I changed a variable. I'm becoming such a super sleuth of, of movement that I am going to find that contributing factor.

Dr. JJ Thomas: 22:56

By shortening the pecs and the anterior delts and that anterior chain here, if they move further, that tells me that, potentially, the anterior delts and pecs are pulling on that clavicular attachment, which is pulling on upper trapezius and other neck structures and limiting their ability to rotate to our head to the right. It's reproducible. If it's a real thing, it's a great you can prove to them right there how it's connected. You say, put your arm down, rotate right, 40 degrees. Put your arm up, rotate right.

Dr. JJ Thomas: 23:27

Boom. They go 60 degrees. You do it again and again and again until all of a sudden you see their eyes, like, catching on. Like, oh, wait a minute. You're going back to our original motive here, which is show them we're different, show them we're gonna get results, and show them their time is valuable with us.

Dr. JJ Thomas: 23:44

So when you learn how to manipulate movement in that very deliberate way, in a way that highlights movement deficits that might not otherwise be apparent, you're taking that evaluation. And you're not only showing them that you're gonna get results, but you're showing them that you value their time. And you're not gonna waste their time chasing the same thing that all the other therapists they saw before you are chasing. What I find in my practice now is that patients who originally came to me after coming from somewhere else where they didn't do this type of evaluation, they don't even mess around next time. They're like they know their time is valuable, and they don't wanna spend 3 months at another clinic where they're doing that same thing.

Dr. JJ Thomas: 24:25

They wanna come here and get the answers right away. So become a super sleuth with movement. There are many methods that you can, like I said, study in. We have our own courses. I'll talk to about them at the end of the show.

Dr. JJ Thomas: 24:37

We have developed our own methods to help you guys be super slits. So that's another piece to that, to that process of listen to your patients, observe, and investigate. So the other piece of this investigation process is there are 2 major things you're gonna look for in your investigation. One of them is you're going to look for a reproducible sign. Now most of you have learned that in PT school, but I think it's lost its art.

Dr. JJ Thomas: 25:05

I think, again, people get into this insurance based world, and they're so busy chasing the pain and just trying to tread water that they forget to go back to that reproducible sign. That reproducible sign is going to prove to you and your patient that you're on the right track every single time. So in that first evaluation, we are always gonna try to find that reproducible sign. The other thing we need to find, which is relevant but not the same as the reproducible sign, is the major movement deficits. So 2 major things we're looking for in our investigation.

Dr. JJ Thomas: 25:38

We're gonna find a major movement deficit or a few, we're gonna find a reproducible sign. And the importance to that is that when we want to prove to our patients that one factor is related to the other, we need both of those to measure it and show them. I'm gonna use an example. This actually was just a patient. I think I just saw her yesterday.

Dr. JJ Thomas: 26:01

Senior in high school, amazing field hockey player, already committed, she's a goalie, already committed to college, great athlete, high pain tolerance, total workhorse, like, warrior workhorse. I know the family really well. She's amazing. This girl had a tibial plateau fracture in June. And she was immobilized for 6 weeks, to let the fracture heal.

Dr. JJ Thomas: 26:25

And she was also non weight bearing. She went to the local place down the road. Great people, great therapists, insurance based though. And, in this practice, they did a lot of great things for her. They progressed her strength.

Dr. JJ Thomas: 26:38

They progressed her, you know, range of motion as they were able. They followed the protocols. They eventually got her to running. And she's telling me this yesterday as I'm as I'm listening intently and observing. I'm like, okay, so you got to running.

Dr. JJ Thomas: 26:51

How'd that go? She's like, well, it was okay. I I'm doing okay now. And I said, did you have like a little hitch first? Because oftentimes they will, you know.

Dr. JJ Thomas: 26:59

She's like, yeah, I definitely had a hitch. She's like, I feel like that worked itself out, but I definitely had a hitch at first. And she said, but my biggest complaint now is, I get this, like, shooting pain. And she said, it's pretty unpredictable. She's like, I could be walking and get it.

Dr. JJ Thomas: 27:14

I could be playing and get it. She's like, but when I get it, it, like, makes my knee give out. It's kinda scary. And, so I'm listening to her intently, and I'm I'm thinking about what this could mean. And I know that the place that she went did a lot of great things.

Dr. JJ Thomas: 27:27

Like I said, they did blood flow restriction therapy for her knee, for her quad and hamstring, for her glutes. So I already know in my mind some of the things that that she's doing, or that she did. But her mom said to me, you know, the reason we're here now is because she got much better, but she kind of plateaued at like this 80%. And now she still has this problem, and we nobody can seem to change it. So it's my job to find this reproducible sign.

Dr. JJ Thomas: 27:52

So a lot of times for the knee, I'll check like a step down, like a big step down, you know? We did like like a very large step down to watch watch, mechanics and control and and see if it reproduces her pain. It didn't. Both sides were equal. She had decent control.

Dr. JJ Thomas: 28:07

She looked pretty good. Range was pretty good. She had a hip flexor tightness ankle tightness. I said, you know what? I really need a better reproducible sign.

Dr. JJ Thomas: 28:14

So let's go in the gym area. I took her in the gym area. We did single leg hopping. Single leg lateral hopping, bounding was totally fine, equal on both sides. Single leg vertical hop, however, significantly different, like 50% in terms of deficit on the right versus the left.

Dr. JJ Thomas: 28:32

We additionally did, like, the like, the crossover hop test, like, the typical ACL three crossover hop test. Again, right versus left was like 50% less in terms of distance and power. So this was a reproducible sign. She didn't have her pain, but she was like, oh, yeah. That really feels very different.

Dr. JJ Thomas: 28:52

She could immediately identify with the difference. So that made me question further. In my investigation, I'm now asking, okay, why does she not have that same power? I know that she did a lot of work on the quad and hamstring. What's going on there?

Dr. JJ Thomas: 29:04

I looked at the ankle again. We treated, based on what I felt with looking at the ankle and the the deep muscles of the posterior compartment of the leg. She was tight in flexor hallucis longus, posterior tib, flexor, digitorum longus, so all these sort of deep posterior compartment muscles. And, we treated them with needling. In doing them, I should disc I should also say we had to go through gastric soleus for a lot of them.

Dr. JJ Thomas: 29:30

Range of motion of so we had a deficit. Range of motion deficit of the ankle improved after needling. But more importantly, I took her over to the hop test. Reproducible sign normalized. Pretty much as soon as she hopped a vertical single leg and the diagonal through triple hops, she was like, oh my god.

Dr. JJ Thomas: 29:47

That feels so good. She didn't even know that was a deficit. But we had to find those things so that we could show her that we're different, show her that we get results, we're results driven, and show her that we value her time. So that piece of the investigation process, that finding those two things, a reproducible sign but you also need that movement deficit piece because the reproducible sign alone is not gonna get you there. I was able to show that she couldn't hop, but I couldn't tell you why until I went back and found that deficit at the ankle.

Dr. JJ Thomas: 30:19

So you need both of those things. Then when you treat the movement deficit and you correlate it back to the reproducible sign, now your patient understands why you're doing all these things that nobody else has done. The truth is they want you to do something that's different because they've been doing the same thing and it hasn't given them a different result. They want to do something different, but it's scary when somebody all of a sudden starts saying, I'm gonna treat your ankle to make your knee better. So you have to prove it to them.

Dr. JJ Thomas: 30:47

That is part of the investigation, and we owe it to them to follow those patterns and follow this structure so we can do so we can do just that. The last piece of well, there's 2 more pieces to this structure of this evaluation that are gonna help you get results and show your value to your pay to your patients. And one of them, I just I already kind of disclosed. One of them is now that you've investigated, you need to test your theories. In that patient example I just gave you with the the field hockey goalie who had the, the tibial stress fracture the I'm sorry.

Dr. JJ Thomas: 31:24

It was an impaction fracture. She immediately got results after treatment. But she wouldn't have known that if we didn't test retest. So in summary, we're gonna listen to our patients. We're gonna observe them.

Dr. JJ Thomas: 31:40

We're gonna investigate. Then we're gonna test it. When we test it, we owe it to them to retest it because we need to prove to them and to us that we're on the right track or not. And in the last part of this sequence, this structure, what we're gonna do is reinforce it. Because, really, the best gift we can give our patients is independence from us.

Dr. JJ Thomas: 32:05

So once we've done all these things and we know we're on the right track, we're now gonna reinforce whatever it is they need to be able to be free from us, essentially. So if I take that field hockey goalie example again, what I gave her for home, not a lot. I said, you know what I want you to do? You guys can guess it. I want you to single leg hop.

Dr. JJ Thomas: 32:23

I want you to single leg hop for vertical. I want you to single leg hop for distance. Those two deficits that she had and we showed improvement with after treatment, that's what we're gonna target. So that was it. That was her homework.

Dr. JJ Thomas: 32:34

But I had to give her something. I owed it to her to give her something to reinforce the gains we made. It gives her accountability. It gives her some ownership. It gives her, that feeling of, yes, I'm making progress on the right way.

Dr. JJ Thomas: 32:47

And it's actually giving her what she needs in terms of functional re reinforcement of the patterns she needs to to win, to to get the outcome she needs. So that's it. That's the method. It's in if you if you look at these words on paper, it's not that different than what we learned in PT school. But what I'm asking you to do is take this step by step process and really own it in the way that I'm talking about.

Dr. JJ Thomas: 33:13

Really listen with a greater intent. Really observe with a greater, expectation of what you might find and and greater observation of what could be underlying all of this history. Really investigate in a way that reveals things that you wouldn't find if you weren't looking for them. Really test those patterns in a way that shows and reveals things that, again, wouldn't be present if you didn't look for them. Really take that patient and show it to them, retest them.

Dr. JJ Thomas: 33:44

And lastly, reinforce it in a way that proves to them that you're worth their time. When you follow all these processes, you're going to see, not only time and time again are patients gonna be proven your value, But you're proving it to yourself, and you're giving yourself the confidence that you can continue to do this wonderful thing in this cash based world, and that you're worth it. So if you need more help with this, this is obviously a passion of mine. I would love to spend more time teaching you, in any of these concepts, whether it's the investigation process or the evaluation process. We, as I said, have some courses.

Dr. JJ Thomas: 34:23

The first big 2 day course is gonna, it's launching in early February, but the sign ups are live on our website at primalhq.com, which is Primal University. And you can also subscribe to be on our email list for all of our upcoming courses by simply kick clicking the link in the description. You'll get the free ebook that's also very informative on cash based practice. But, ultimately, that will, download you to our email list so we can keep you updated on all of our courses, and and you hopefully, you can learn more to make your cash based business a success. Thank you again for coming on the doctor JJ Thomas podcast.

Dr. JJ Thomas: 34:59

Love spending time with you and looking forward to more of it. Reach out if I can do anything to help.