Chronic pain patients and athletic injuries can be troublesome so we dive deep into GRIP Approach with Dr. Benjamin Fergus DC. It’s a blend of the popular rehab ideas but with a pre-post exam to show global functional movement restored and pain relief.
His passion to learn more and to help the specific type of patients that just weren’t getting better by other doctors and the struggle with always having to do so much trial and error with different approaches to see what works for a patient plus trying to discharge them were the catalyst to start formulating this new GRIP approach to movement and pain relief.
Chronic and complex pain/disease cases and surprisingly athletes can have similar functional deficits in global movements that can create pain, less than optimal performance and hinder being released from care.
GRIP takes lots rehab ideas, breaks them apart, then streamlines them to be easier and more effective.
What are the benefits to a global motion ie: squat to pick up something or a lunge, compared to isolating a muscle group on a machine?
Dr. Fergus has a huge following in Japan (courtesy of Kaiso) and the approach resonates with their thoughts on rehab, he goes into why and what that means.
What marketing is he doing to grow the GRIP Approach system?
Dr. Benjamin explains how this is a diagnostic system to evaluate a person for rehab and may end up replacing the McKenzie, SFMA or DNS evals in your office.
What’s your beef with patient’s perception of persistent pain aka Subjective Variability? For example: it hurt two days ago but today at the doctor’s office it doesn’t really hurt as much.
What are your approaches to moving away from subjective pain scores to objective evaluation regardless of pain?
Questions to ask to shift conversation from Pain to Function?
- What things are you having trouble doing?
- How long have you had trouble doing them?
- What have you tried to overcome this but failed to work?
This approach can come off as a mechanical analysis but he explains how it’s actually a nervous system challenge.
Superficial treatment like IASTM or Pin and Stretch don’t lead to long term deep structural changes (they do inhibit the discomfort from movement and increase range of motion though).
What can change deep structures?
- Chiropractic adjustments of a restricted joint to normalize mechanotransduction
- Deep compression with cross friction the size of a nickel for 2-10 minutes. (can change extracellular matrix, elastic changes and normalize cells in the area.
- Needling techniques (Dr Moz) which can irritate the cells, but in a good way.
Should you use a thumb, elbow, Steel Instrument or maybe technology called Shockwave? Shockwave is acoustic percussive waves that can penetrate deep and shown to make changes.
Let’s define reciprocal inhibition, concentric and eccentric motions.
Logistically, how much time does a GRIP exam take and what would a typical office visit look like and take time wise?
Why do you prefer global movement and less concentric type exercises.
What does a typical patient encounter look like? We adjust, do soft tissue and we evaluate with global positions but then we teach at home exercises that they might do 3-4 times a day.
How do you handle the athletic trainers, massage therapists that learn everything that you teach them or paid for them to learn and then they leave in 6 months?
Hint: contracts and educational reimbursements
Clinical Rehabilitation – Pavel Kolar, Foot Orthoses and Other Forms of Conservative Foot Care – Thomas C. Michaud, D.C., Human Locomotion The Conservative Management of Gait Related Disorders – Thomas C. Michaud, D.C., Clinical Neurodynamics A New System of Neuromusculoskeletal Treatment – Michael Shacklock
facebook.com/gripapproach and ig www.gripapproach.com
Benjamin Fergus, developed the GRIP Global Rehabilitation and Injury Prevention Approach and lectures internationally 20-30 courses a year and its translated into 7 languages. GRIP Approach largely focuses on chronic pain, limitations in activity, and patients who are running out of options. Major influences come from Dynamic Neuromuscular Stabilization, Fascia Research, Leon Chaitow, David Butler, Thomas Michaud, and Michael Shacklock work.
Show notes can be found at http://www.adoctorsperspective.net/115 here you can also find links to things mentioned and the full transcript.
Episode 115 eradicate chronic pain with group approach. I'm host Dr. Justin trust Claire today
Justin Trosclair 0:12
with Dr. Benjamin Farkas perspective. During 2017 and 2018 podcast Awards Nominated host as we get behind the curtain look at all types of doctors and guests specialties. Let's hear a doctor's perspective.
By the time this episode comes out, it should be a Happy St. Patrick's Day. It was recorded on Valentine's Day. Dr. Benjamin just had a kid. So he had his paternity leave. And he said, hey, let's do this interview method. All right, let's do it. Grip approach is something that I took note of back at forward, Casey, that was Episode 79. I believe they really got me thinking this for like complex pain cases, also athletes, and we're going to discuss like, how do you get rid of like this subjective pain that chronic pain patients have and going into something more like global exercises and movement patterns, you know, being that it's chiropractic based, you know, it's not just manipulate the joint, manipulate the spine, there's all this, you know, some soft tissue work involved, very specific style, and very specific exam protocol that you could do for each area of the body very involved. And so we're going to break it down so that we can understand what is it Why would we do it? How long is the treatment last for a patient, you know, logistics matter, too. But Dr. Benjamin Fergus is the creator of grip approach. He's a big following in Japan, as well. It has its roots in some McKinsey, SF ma are in DNS type systems, I just want to take a second and say thank you to those who have given reviews and podcast, I'm always looking forward to reading those. We don't have that many. So that's a goal. Now I need to try to get more reviews. If you didn't know, it's based on the country you live in. thought that was interesting. Also, thanks to those people that listen to me out in Romania, Taiwan, China, Saudi Arabia, Poland, listening still Hello, and thank you. Alright, let's jump into this one. All the sermons can be found at a doctor's perspective, slash 115. Let's go hashtag behind the curtain.
Live from China and North Chicago. Today on the show, we have got a guy that has actually created a whole technique of thinking and rehab, which to me is out of control, because that's just not my forte at all. But this is how I was able to do it. And not only is he doing it, he teaches like 30 times a year internationally has been translated into seven languages. It's called the Global rehabilitation and injury prevention approach, aka grip approach. Dr. Benjamin Fergus, thank you so much for being on the show.
Thanks for having me. great introduction.
Justin Trosclair 2:54
Oh, man. Well, you know, I met you in for Casey, I heard a little bit we were trying to couple things actually became one of the dummies up there. That's right. Interest scapula.
Yeah. and ended up being Come on. Okay. And I was like, Oh, that's fantastic. I guess my self prescribed rehab is doing something because I definitely had hurt my shoulder. And my wife's like, sure hurts again, it's like, yes, I'm going to just stop talking about it.
I don't want to get mad at me, like, stop hurting yourself. But I'm sure anyway, one of the things I read about is what you're focusing on is like chronic persistent pain, stuff that just hasn't gotten better for like either athletes or just, you know, normal people. And the last resort type of patients were like, man, I don't want surgery, but there's really not much else I can do. also put down that you have some influences, like the dynamic neuromuscular stabilization. She's gotten really a lot of press to me on on the forum, Facebook page. And then yeah, fascia, Chateau Butler, Michelle, and Shaq lock, all that stuff based on a cut, you cut your legs out. Now, when you're explaining the grip of produce a little bit, maybe, but if you know that, you should be like, okay, audience and that was kind of what it's going to be about. Yeah,
that's if you're juggling all those different viewpoints. When they all settle in one spot, you got grip approach.
Justin Trosclair 4:14
So give us a little rundown? What does that kind of look like? How did you get so involved with the create something like this?
Yeah. So I essentially I jumped into the process. With problem, I wanted to solve two problems. Actually, one the cases that really interested me were the ones where you know, you're going into the trenches, and you're picking up somebody who's failed and failed and failed at getting better and saying, Let's find a way to get you out and get you better. So that was the first thing is I wanted to tackle the nasty cases that nobody wants to touch. And there wasn't a essentially a great system available to tackle those cases, at least in my perspective, there's a lot of different things in terms of what you need to do nutritionally with chronic and complex cases. You know, being able to add lean muscle mass and get people moving. Again, these were concepts that were sort of known in chronic and complex pain cases. But really what it came down to, at least at the time that I started, was, here's a handful of things that you can try one after another with these cases. And that's still a lot of trial and error. It wasn't seen this, this is a unique presentation. And here's how you structure, your evaluation, your rehab process. And here's what you can expect for our prognosis and discharge. nobody's talking about discharging chronic and complex failed cases at this point. But we try to we try to look at these cases and say, here's a structure that lets us understand it. So that we, we know what the prognosis is, and then we can actually discharge these patients and get them living their lives again. So that was the first problem what how do we do it? How do we find a structure that works with that population? The second problem as I as I was seeking something that worked with chronic and complex cases, I amassed a lot of education, both from books and seminars, and late night conversations at the bar after Of course, I had a lot of ideas that I wanted to apply, I wanted to see if they worked. And but nothing was sticking to a central system of rehabilitation. And so grip approach is, is trying to attack those two problems. It's taking all of the amazing resources that we have right now for rehab and saying, What's the central idea that can unite all of these and help you decide when to use one, one technique versus another? And how do we apply it specifically for the population of chronic and complex pain or chronic and complex disease. But we stumbled upon something kind of cool along the way, in that the evaluation system that we use in chronic and complex cases, had a lot of crossover with the athletic population. And it turns out that athletic humans, and non athletic humans and chronic pain, have some movements that they both have to do, they both need some of the same base parts. And so that open, that's really cool, exciting opportunity for me to take our system and demonstrate its use in the athletic population, we're now utilize with collegiate professional and Olympic teams across the world. And it's just been a really exciting addition to our main mission, which is or medicating chronic pain in Chicago, and then globally.
Justin Trosclair 7:38
Wow. So I got to follow up on this one. Global is that like saying you should be able to squat, you should be able to bring your arms overhead and a normal person, like, what does that look like?
I will those those are good examples. Those global means a full body perspective. So a squat and overhead movement, those are definitely be full body movements. But really, it's coming back at the tunnel vision approaches of saying you got a knee problem. Here, let's load this direction 10 times for a set six times a day right here at this one joint that you say is an algae that's a really focused on all of you approach. In grip, we we look at the same the problem and we assess it when classify and say, What natural human movement involved in the whole body can we use for your exercise to rehab it. And in that way, it's a more natural rehab process, because it uses the movements were all you know, developed with. But the integration in the step back into normal activity is so much faster, because you're not doing a weird rehab exercise for a nice lead a joint you're, you're teaching the body how to use all of its parts in each range of motion and each plane of motion. Together Again,
Justin Trosclair 8:53
okay, that's the mobile part. So the lens would incorporate the whole spine and the button muscles and the leg muscles, versus just the Thera band and doing some leg extensions. inflection that's
Yeah, that's, that's right. We want we want to get some periphery in our approach. Okay.
Justin Trosclair 9:09
It for my own curiosity, you had this the thing you It started developing? Did you have to like market it to these colleges, or the it just sort of naturally approached? And then when you when you said, you said something, I mean, you just started like one seminar, you're like, well, I've had some people make comments about, they'd like to learn this, I guess I'll put on a seminar and then boom, boom, boom, like, a lot for like, activator, impulse adjusting, you know, I can see that. But then like a rehab system you like this is new. And now I'm all over?
Sure it you know, it is a lot. But I would come come back with you and say we're still a very new organization. And that's, that's 30 courses a year spread out throughout the entire globe, that's not 30 Chicago courses are 30 us courses, that's a couple classes here and there for a few handfuls of people. So I see, we're still really young. And our following is small. And we don't have a giant body of research that looks at our technique in isolation, we just have the research that we have based the approach and the technique on. So we're, we're we're a finger lean seminar company. Right now, we're assuming we're small. But in terms of marketing, I'm not a Marketing Pro, what we do is try to get the idea out there. And I really like what Elon Musk has done with his Tesla company, he said, I've got a way that an electric motor will work, I'm going to perfect it make a sales model that works. And then my goal is to release my plans to all the other automakers so they can also move us forward on this mission. With group approach with my clinic, we have a clear mission, we want to eradicate chronic pain in Chicago and then globally. And what I'm saying is, once we perfected that system in our office, I now have to get it out there. If it was realistic to just get it out there for free, we would do that. But ultimately, when we got to fly into a country and and put on a course there's some fees involved with it. But my big thing is, is not necessarily to to market and be the next, you know what of rehab, our goal is to get more and more people wanting to conquer chronic pain, rather than just maintaining patient that has chronic pain. And we want to give them the tools to do that. So in terms of marketing, we were fortunate enough to have a lot of attendees of our first few courses here in Chicago, I think a lot of my local colleagues had some curiosity with what I was doing because it was different. And they they just want to peek under the hood and see what was going on. And for a few of them, it really caught on and they share that with their friends and colleagues. And we've just sort of organically grown from that point. And but we really kind of blew up the first time we presented it Tokyo, Japan, my associate instructor and host in Japan, Kazue, he is a pretty big name in sports medicine in Japan. And he hosted our first course after you know, meeting meet here in the US and invited a lot of his friends, which were kind of the the who's who of Japan. And we had a really great weekend seminar, we chatted a lot, we hung out a lot after the course. And I think what we were doing with rehab resonated really well with the population there, at least in my own perspective of create Japanese companies, they're really good at taking a complicated idea, breaking apart, simplifying it and making it better and making it streamlined. And that resonates with me, I feel like that's what we did with grip, we took a lot of really great rehab approaches, and we took it apart, we put it back together in a cleaner way made it simple, made it streamlined and made it effective. So I think that resonated and we took off there in Japan.
Justin Trosclair 13:02
So I want to definitely ask you questions about like more about what the group is this if people listening to like, get to what it is,
I don't want to know. But I'm
Justin Trosclair 13:10
sure, before we jump more into that, you know, I just put a post out there today. And that's some good responses on Facebook about invite that take one class, you know, if I'm a doctor who's like, I can only afford one class a year, or I'm just not that guy who wants to spend five weekends a year becoming certified in the next whatever? Or would this approach be an appropriate similar to me, like I didn't have to take the McKinsey and the DNS and all these other seminars all at the same, you know, in progression, I can just take this and have a good foundation.
Sure. Well, you know, this is going to be a biased opinion, because I you know, I'm the one that put the course together, right? I'll I'll tell you more of how we use it and our office.
This is the first real diagnostic window that we examine all of our patients with so somebody in our office might occasionally get a McKinsey examination once or twice a year, somebody in our office will likely get a neuro dynamic solutions or Michael shot clockwork, they're probably going to get evaluated anytime they have limb pain with that technique. Somebody in our office might run an athlete through an SF ma test, prior to starting a fitness program with us. And then again three months later to mark progress. But the only thing that really happens every single time outside of our standard examine history is a grip approach exam, because it gives us the most clear actionable data. Every test tells you what kind of rehab to do and what kind of tissue therapy might be effective. And if you really pay attention to the classification system, it's going to tell you exactly what your prognosis is, and and how to structure your whole visit. So in in my office, and in my perspective, yes, this is a framework that you can use as your central rehab approach.
Justin Trosclair 15:00
Because you're talking Is it a tissue issue? Is it a joint issue? Is that a neurologic issues? Those are your three classifications right? Those are the big ones. Yeah. Alright. So let's go and talk about this for a second. I was kind of going through some of your notes that I've seen. And I was like, this is pretty cool. Patients have chronic pain. Two days ago, man, it was like a nine today I finally got into your office. It's only like a four. So you doing all these tests? And it's frustrating. Like, this doesn't hurt. No, but they've heard yesterday, kinda like oh my gosh, can we just pretend it heard a lot today? Like, what? What's going on with that? And does this technique help get rid of that? variability?
Oh, man, you're singing my song. That's huge. So we we term all of that subject of variability. As scientists, you want to reduce variables, right? So when you have a chronic pain case, somebody that failed treatment time and time again, the first thing you gotta do is get rid of all the variables and test one or two things at a time. So that makes sense. Yeah. So So if subjective data of it's a nine yesterday, it's a for today, it's going to be a six tomorrow, if that's all just a random variable, then it's not going to help us solve the case, in my perspective. And so we absolutely need a way to evaluate patients every single time that doesn't require me to ask the pain question doesn't require me to ask how much pain you have? Where is it? What's it look like? What color? Is it? And is it better on a day that you drive a nice sports car, versus a day that you walk in the mud? That's so variable, it just will not lead to long term success. So yes, our system comes in and says, okay, you came to me with low back pain, I'm going to acknowledge that and give you a low back pain, form an objective assessment for low back pain that you're going to fill out, you're going to tell me all about that pain, I'm going to scan it into my file, and I'm not going to look at it to your real exam. And when you come in, I'm just going to ask you three simple questions. One, I'm going to ask you, what things are you having trouble doing? To? How long have you been having trouble doing that? And three, what have you tried to do so far to overcome that? That didn't work? Those are my big three questions. What can't you do? How long have you struggled with it? And what has failed to get you back? And at that point, our first three questions immediately changed the conversation away from the Whoa, is me of subjective pain to specifically, what do you want your life to look like? When we're done with care? What do you want to be able to do again, and if we can successfully change that conversation in the first five minutes of the visit, then we're going to have pretty successful outcomes.
Justin Trosclair 17:43
So we were joking beginning about my shoulder. Quick question is, what were you heard? Okay, the shoulder Alright, cool. And then we'll catch you doing like, all right, and these are these certain motions that you'll put the person through. And you just looking like, okay, you should be able to your elbows to be able to stay straight and cross across your chest without like, in the inner like your your shoulder powering up. And obviously, it doesn't matter about pain or not like maybe it's pain that stopping you from being able to do it. But regardless, I'm looking at that it's not working. And so I think you have you evaluated, and then there's certain rehab that you would do, and then later on when you check it again, you like yeah, see, now it's better. That's what we're looking for is actually moving? Yeah.
Yeah, absolutely. And I, I think I wouldn't want people to fall into the trap of this in purely a mechanical approach. So the big thing that you said, it's important is that I asked you to move your arm and a certain way, I wasn't moving it forward for you to see if you had a competent shoulder. I was saying what does your nervous system think that your body can do? And if there was a joint issue, that joint would communicate with your nervous system that no, you can't do that today. But maybe there was no joint issue. And you have just inhibited that movement based on disuse, or former injury itself, a brain or neurology focused approach that looks at the body as a way to communicate how well the nervous system is working.
Justin Trosclair 19:09
So like someone who's standing on one leg, or close your eyes, March in place, and they're in a turning 70 degrees, that one direction you like, what was going on there, buddy? Yeah, herbs are not talking to your muscles. Very good,
right? Well, it's a people think of, you know, a brain living in a body, but it's not really like that our skin and our joints and our joint capsules, and fascia. They're an extension of our nervous system, our nervous system, especially our peripheral nervous system, that stuff's embedded in the physical body. So if there's some mechanically something that's not working in a connective tissue, the joints, it's going to screw up the sensory information that the brain gets. So it's one big system, its body and brain together. But our focus is not just on the anatomy, its first, what is your brain, think about the body? And then if it's not thinking well about the body, then we go in and say, is there actually something wrong with the joint tissue? Whereas it's just motor inhibition?
Justin Trosclair 20:07
Now we're avoidance? Are we looking at? Is there going to be some is team going on? Or some pink was opinion release type style? Are we looking at maybe some flaws where you know, different approaches that way, when we're addressing the tissues are? What's your thoughts on that?
Well, I think you have to look at the literature on what we currently currently know about connective tissue, including muscle on fascia. And in at least in my current interpretation of that literature, superficial tissue techniques don't lead to long lasting or permanent deep structural changes, meaning pen and stretch has not been shown to be more effective in later sliding, then compression has. So if I have a tissue or a structure that I want to change, I can either pin and stretch or apply compression, and have a similar response and the connective tissue. So if I know these superficial scraping techniques and pennant stretching techniques, might not have the full physiological effect in the tissue that I'm desiring, then I have to think of them as a brain focused approach as well. I think pen and stretch or whatever three letter brand name you want to give it. I think what it does really well is inhibit the discomfort that a patient feels with movement. The literature wouldn't support the actual tissue changes that are proposed with that mechanism. But I think it does a phenomenal job at increasing range of motion via reducing pain or sensitivity inhibition by the patient. So when I say we're going to use a targeted structural intervention, it really comes down to who techniques let's let me take that back three techniques for us that the majority of the current research supports.
One would be the chiropractic adjustment of a restricted joint segment to normalize McKenna transduction at that joint and remove some barrier to would be a deep compression with cross friction in a small surface area the size of a nickel for two to 10 minutes. This is in line with the facial manipulation technique proposed by the psychos and also studied by Lee made and sleep. That intense deep friction over a small surface area has been shown to change the extracellular matrix on his theological side has been shown to influence elastic changes and propagate normalization of cells in the area. And finally, if that is too sensitive for a patient, we will use needling techniques in that same area. She points or I'm a big fan of Dr. Maas work out of Colorado will apply some needle stimulation to the major nerves that lead into the area, as well as locally we're trying to irritate the cells and create a proliferative effect locally in those tissues.
Justin Trosclair 23:23
We're talking dry needling, or like acupuncture, or
my my background is in both traditional acupuncture and biomedical acupuncture. The way I use it is my personal blend of the two, where I will hit a couple big meridian points, if I'm working in a lower extremity, I'm going to hit you know, stomach 36 and liver three, but then I'm going to go specifically to the structures I want to change. And I'm going to try to get a micro injury to drive proliferative changes in the tissues.
Justin Trosclair 23:55
Have you ever saw I think it isn't like, Well, I'm not technically acupuncture certified? And I'm not going to spend a year year to get it done? You know, we got to have that to the staff. Sure. Can you use electric acupuncture or cold laser or something like that to stimulate those areas? Or have you looked into that?
I bet? That's a great question. I think the Eastham acupuncture would primarily drive motor control changes, not necessarily proliferative changes in the tissues. So if if your diagnosis is over tissue injury, then I don't feel I can overcome the tissue structural changes with electro acupuncture, but I think I could influence improve motor control in that area.
Justin Trosclair 24:37
And when you were referring to the second mode, the deep cross friction, are we talking? Yes? Can we use some sort of steel instrument to save that?
Yeah, you can, you can use whatever you want, as long as you're being as precise as possible. And going over a small surface area, it's like if you want to get too deep, and most of our motor effects around the deep connective tissue, you know, you're going to get deeper using your pinky than your thumb just based on surface area, right. So I will use my elbow four points, I will use a knuckle four points, my thumbs or fingers or you could use a blade as well. But the point is to get to the depth of the tissue that you're trying to create proliferative changes in and then keep your friction there long enough to actually drive that micro trauma and proliferation. Okay,
Justin Trosclair 25:30
yeah, I can just think of this. If you haven't bought an instrument, take the seminar grip, then you'll be like, oh, wow, okay, I'm glad I didn't buy 10 instruments. I only needed this little bitty one you might
want to Yeah, I would say the what I do in my office is really from the tissue perspective. It's a mixture of thumb, finger, elbow, and Shockwave.
Justin Trosclair 25:55
So Shockwave is a tool is a thing you can purchase.
Yeah, so a shockwave device. It creates a percussive wave, or an acoustic percussive wave through an applicator tip that has been shown to drive proliferative changes and tissues. It's been heavily studied and is approaching what we would call a gold standard for true plantar fasciitis. And we've also used it really, really well with frozen shoulder and he said capsule itis cases, and medial and lateral upon the lightest cases, it's great for the density tissues. But it actually works really well applied in the areas that we're assessing with a grip approach. Okay, so it would be my one tool outside of my hands that I use. I personally don't use soft instrument, soft tissue instruments just because I like to feel I get from my hands. But I will go to Shockwave as as needed. So you can tell
Justin Trosclair 26:51
I'm someone who's, I'm a big instrument adjuster as well from way back and not do a ton manual stuff, too. But the longevity? You see these old guys have these stones that are permanently been, you know, 80 degrees, the opposite direction. Like what are you doing? Yeah, I've been doing trigger point where it for the last 15 years son, what do you think
it's it's funny the the first 10 or 20, or maybe even 100 course reviews, I got grip approach where comments like thank you for saving my thumbs, thank you for preventing me from getting the AR t thumb that's going to send me into retirement because it's not stressful for your thumbs or fingers, the way we teach it, we show it in a way that's all about applying perpendicular force the tissue to get to depth first, and then the movement small and you can use a lot of support in the area. So it's actually really easy on the provider compared to a lot of soft tissue techniques. See, this is what I wanted to know, because these are those little things like, if I'm evaluating the course, I want to know going in this is good.
Justin Trosclair 27:55
Yeah, let's see, global movement versus East centric, concentric. Sometimes I get them confused. I'm sure somebody else who's listening to this or like, I don't know, etc. That sound very similar. What's Yeah, all right, we're at the gym. Let's say we're at the gym, we're just we're not worried about grip. For now, we're just want to know, we know that globally centric is better than concentrate. But I'm one of those definitions real quick for us.
Okay, well, let's keep it simple. You're you're carrying some groceries in your house, you lift your groceries up out of the car and pull them close to your shoulder, that's concentric or shortly and activity of your biceps. On the opposite side of your arm, it's lengthening or E centric contraction of your triceps, and you walk up your steps and you lower those grocery bags back down, you have East centric or lengthening activity of the biceps and concentric or shortening activity of the triceps. Here's where people get things mixed up a little bit, they always think about the muscle on the front of the limb, essentially. So if I'm lowering my groceries down, I'm doing an East centric bicep exercise. But in all reality, you're also doing a concentric tricep exercise. But because the tricep is not being resisted in that activity, people don't think much about it. But what we know from some decent studies of reciprocal inhibition is that two sides of a limb have to work in coordination with one another. And if you don't have that happening, we have poor coordination, poor motor control, and potentially some pinching and pain. We take it one step further and say the muscles that surrounded on all sides have to be able to work in concert, that's fine tuning of movement. You may have heard me harp on concentric activity. At forward, Casey. And I want to clarify that concentric activities phenomenal, I love to lift up weights with concentric activity, I love to sprint and get good concentric activity of my glutes. But what I'm concerned with, is when somebody needs stabilization of their torso, through movements of let's say, walking, or dancing, and all they know how to do is concentric clenching, then you've got a robot, you've got somebody that hasn't figured out how to move yet, you got somebody is going to overload their body, and it's going to lock down the periphery. So the goal is not to eliminate concentric activity. The goal is to balance that concentric activity with really could control of East centric lengthening, we want full motor output, not just focused, partial monitor output,
Justin Trosclair 30:42
sheer fan of, quote, working the negatives at the gym. We,
you could say that, yeah, but we're all about movements, we'd go to the gym and say we're going to we're going to work a push and pull in a squat. And in those movements, if they're coached well and done well, you you're going to get all of the fine details. And then
Justin Trosclair 31:02
I got another one or two questions on, if I didn't know much about rehab, as like, you know, I pass the class, but I didn't really care. But man, all of a sudden, I do care, I'm more into like evidence base now.
Do they need to take any classes or read a book before they come to your so that they just or at least prepared for the things that you're going to refer to? I know they don't. However, there are books that I would recommend if somebody is interested, we, especially our performance classes, we bring people in as beginners and we try to let them go as intermediate. And then as you keep on going, you've started as an intermediate and leave as as an expert. For all of our classes, we have a minimum of four hours of pre study that's sent to you their videos that I've recorded, that gives you the prerequisite knowledge to begin in class.
Oh, so that's
Yeah, it's pre recorded, you can watch it you get a two weeks or four weeks ahead of time, watch it at your own leisure, go over it a couple times. So that you're you're hitting the ground running when it comes to Core state, because we're going to give you a lot of info. And we want you to just have a basic idea of why and what we're trying to accomplish with it. But I challenge a doc, I'd say anybody in manual medicine is a rehab Doc, you may just be using a specific or isolated slice of rehab. So if you are an adjustment only Doc, you are doing joint rehab with mechanical stimulus, right, you're an expert in improving mechanic transduction of the joints, that's a slice of rehab, we just want to fill out the rest of that pie for you.
Justin Trosclair 32:42
Yeah, before we move on, when we're looking at time wise, in the office of some some techniques, people think I've got an hour to spend with each patient. And reality, especially if you take insurance, while places I was at in Colorado, you get $40 you can adjust them and make 40. Or you could do three units of rehab, you still getting 40. So there's not a lot of encouragement to make me want to do more rehab.
So what I was gathering is you got to do a little do now then you got to teach him something, and then you probably got a teacher some home exercises. So what kind of time frame are we looking at per patient? Is it a lot of it in house? Do they do a lot of stuff at their home instead? What's that look like?
Well, there's some variable to it. And ultimately, I'd say, you know, it's hard to be both the Walmart and the whole foods, you can't, you can't be both and pull it off. Okay, you're going to get your clientele mixed up. And in, if somebody has a chronic or complex presentation, there, they're probably not looking for the quick, let me try this one thing out type of fix there. They're trying to say, hey, can anybody solve this, I want my life back. And so it to position our cells to do that? Well, we do need more time, I spend a lot of time in my exam, a short exam for me is 45 minutes for a new patient. Okay, a long exam is 60 to 75 minutes, rarely the 75. But when we're talking about something that a patient suffer with, for longer than I've been in practice, they deserve an extra 15 minutes of exam for me to figure that out. So or, personally, my first sessions are 45 to 60 minutes, I have some colleagues that are do it first exam and 20 to 40 minutes just based on their more acute presentation, I'd say when I get thrown a softball, like acute low back pain or acute knee pain, I could probably complete that exam and in a couple minutes as well. It's just based on my population, I'm a 45 to 60 minute guy, my treatment plans, I if the person has a competent body that's capable of healing, and that we're not going to overload. I like to spend 30 minutes with them and their treatment, that 30 minutes would be mobilization of what needs to be mobilized. It would be education of the exercises that they need to do at home, including the dosing. And it would be fatiguing their system in office to drive a bigger change in office. And we always make sure we have at least five minutes to discuss fears, anxieties and motivations going forward as it's a big part of recovery. So that's a big one. Yeah, absolutely. So I'd say we're position for the 20 to 30 minute visit and the 40 to 60 minute exam. Let's say you don't have that. And you mentioned the $40 visit. If we extrapolate that out, let's say a 40 $40
visits worth, what 15 minutes. What do you think? Yeah, so that make your our hundred and $60. Okay. Okay, so if $160 an hour is a reasonable fee, then you've got 15 minutes of pay. If that's not a reasonable fee, then you need to get an assistant and help you to see more patients where you're doing part of it, maybe the diagnosis and the clinical level manipulation, and they are following up with the remainder of your treatment.
But in 15 minutes, what would I do with a patient 15 minutes, I would bring them in ready to go with my diagnosis known, instead of tackling four big movement deficit, I would tackle to movement deficits, I would mobilize the spine, I would do to two points times two minutes of maybe facial manipulation. So now we're at six minutes total. And that would leave me the following six to eight minutes to educate them on the rehab to do at home. And we would, we would just focus on picking one or two deficits. And then at re exam, we choose the next one or two instead of my current model, where I'll tackle three or four episodes at a single time.
Justin Trosclair 37:00
Okay, that's important, though, right? I mean, everything's business as well. And if they don't, you know, we already said it. So you could hire like a personal trainer,
depends on your practice, what I use in my practice is an athletic trainer who is very good. And he has a license to do tissue treatment, he has a license to triage patient.
And he has a license and experience to rehab. And I think he's phenomenal, our practice wouldn't run nearly as well without him. But I spend a lot of time just educating him to be really good at everything that requires his look and his touch on. And so he can, he can run the majority of the case for me after examination. Now, not everybody's going to have the luxury of having a really good athletic trainer and being able to pay them in their area. And so a personal trainer could run some of the rehab, some of the basic exercises under your supervision. And massage therapist could run some of the tissue treatments under your provision, but you'd have to be committed to training them. Our performance classes and grip are really good for that to bring somebody who you want to be your assistant, take the class together, learn the system, and kind of divvy up who's going to do what?
Justin Trosclair 38:13
Okay, that makes good sense. And I've seen people have to sign like a contract. Like if I'm going to invest this much time and money into someone like this. I can't just have them leave in three months. Obviously, they're no good at one thing that's tough. Yeah, I mean,
we had more than a few times, yeah. But we, we found a nice fix for it.
Justin Trosclair 38:33
Okay. My example was from a mechanic, it was a diesel truck mechanic, he'd pay to get them trained. And then like, within three or four months, they would leave and he's like, no,
wasted. So he's like, nope, you're signing a contract, you work for me for a year. So
I I'll put this idea out there and attribute it to Josh Saturday, who runs the clinic gym hybrid. Yeah, he's a big proponent of education as well. And I told I have the same problem of all these people that want to come to my clinic and work with me. And once they learn my system, they leave and they start somewhere else. And that was both exciting and frustrating. It was exciting for one reason. Remember what I said our mission was, we want to eradicate chronic pain in Chicago, but then globally. So every time somebody learned our system, and split before they gave me the value that I was hoping to get from them, I kind of had this nice thought, oh, they're going to take this, they're going to help a lot of people wherever they're at. So I was happy about that, but ultimately have a business to run as well.
That could be a little disappointing. So Josh had this great idea of decide how long you want to work together. In my current arrangement, we were both sides committed to three years. And my end of that commitment as providing X number of dollars of education to that individual. And their commitment is to stay the three years and use the Education and our business. And if they depart before that, they have to reimburse me for the education expenses that I put into them. So that's kind of the sticking point on it.
Ah, see that we thought that it's
I find, I feel that it's fair. And I think our staff finds it is fair to they get a lot more education paid for then any position I've had before. And all they have to do is stick around and bring some value back into the office, which they're doing a good job of.
Justin Trosclair 40:27
That's perfect, great, great. Hey, what are you finding that the authors who take your seminars? And they're really gung ho, of course, that first month, and then reality hits in? And they're like, Ah, that's what about this? What about that? What's something that we can expect to be like, struggle with or need to refocus on,
you know, there, there's beauty and simplicity here. The complex part of our system is that it's comprehensive, that covers the whole body had to tell that's the complex part. But outside of that, it is a very simple three step process of assess global reset exercise, and TSI, targeted structural intervention, and then retest. So no matter how complex we get by being comprehensive, it always falls back to the same simple three step. So I occasionally get a question, you know, docs call in and they say, I've got this case, this is what's happening. It had pretty simply go back and said, Okay, tell me which functional range of motion from test you looked at? And say, Yeah, I was kind of light at examine this area. Let me get that data. And I'll get back to you must say, okay, we're going to look at this person does power lifter, that's having l five disc issue. And, and we've just identified as you did your thorough testing, that they're lacking hip and to motion, pelvic retro motion, and right lumbar lateral motion? Well, let's get those components back on track first, and see everything improves. So I think usually, when I talk with attendees, a few months or a year after they take a class, we just go back to the same simple points of the course. And when you double down on the key details that make every human work, the answer kind of reveals itself to you by using the system. So we typically don't have these big frustrating moments. In my experience. So far, there are exceptions, there are cases that don't behave the way science says they should behave. I love those cases, though. Those are the cases that keep you up at night excited to find an option for me, yeah, not for everybody. And so when those cases come up, I you we have an option on my webpage, www grip approach. com, there's a tab on the top that says consultations. And you have an option to book a 30 or 60 minute consultation with me, that can be a video conference from Dr. Doctor. Or you can mention this to your patient and pass the fee on to them and say, there's this doctor in Chicago that specializes in chronic and complex cases, he's agreed to do a one hour session with the two of us, you have an iPad, you record them doing the movements, I may, on my end, have my assistant demonstrate the movements and then you repeat it on your side, we solve those cases and we give you some clean rehab to do so we do have that follow up consultation. So we're not going to leave you high and dry. We want you to find in this system, the answers that that you had been seeking for a long time and we don't want to make it hard for you to get those answers.
Justin Trosclair 43:40
Let's say you've been a practice for a while and you've niche down into say, low back pain and headaches, you know, chiropractic bread and butter. Um, you know, I don't really care about elbow pain, I don't care about knee pain. Can we take this course and do more with what we already specialize in? Or do you are you end up having to learn a little bit more about all this other stuff that you really don't want to implement any practice? Like a neat, I'm out the door?
Yeah, we're going to give you the whole system. Okay. So, you know, it's what's a good way to think about this, if you've got if you really like the Lord of the Rings trilogy, but you especially like book number two, I'm still going to sell you the three part books, I think the story is best if you know the beginning and the end, right. But the second book is going to be in there, you can go to that second book as many times as you want and read that second book. So when we go through the classes, I'm going to give you the whole system so you can look had to tell. But I'm also going to say if you're if you're the headset guy, double star, this one, this one comes up all the time in my headache cases. And you'll leave and say okay, these are the 20 movements. He said double star for my my particular population, I'm going to start testing these on every one of these cases and get some consistent data. So you'll get you'll get more than you need. But eventually, you'll want to say, hey, maybe I do asked to look at the thoracic spine for this low back pain patient. Or maybe I do I have to look at the ankle for this patient and you'll have a quick encyclopedic reference for that.
Justin Trosclair 45:10
Perfect trying to answer all the questions that people would have like a
Justin Trosclair 45:14
I was excited about it because I want to go to your one in Taiwan. Yes, that's right. Yeah. In China. I'm a fighter Taiwan. It's a lot cheaper. Good damn something going back to America. So it'll be fun. Want to switch gears just a little bit? A little personal. You just had a kid. Congratulations. Thank you. You too. Yeah, man. Hey, mind just rolled over. No way. How old is she? About five? Five?
Okay, that's good. Yeah, five, we typically see babies rolling from their belly to their side of their back to their side. That's That's great. Yeah.
Justin Trosclair 45:44
We woke up this morning. And the kid was completely 90 degrees. opposite of what we put her this morning. I was like,
Oh, no. Like, what are you doing, kid? That's getting exciting, huh? Yeah, it's fun.
Justin Trosclair 45:57
Anyway, I'm happy Valentine's Day. That's when we recorded it. So when it comes out, people be like, Oh, that's a while back.
In for everybody else's listening. Happy St. Patty's Day.
Justin Trosclair 46:10
Exactly. Yeah, that will cover
you got a family? How are you able to do all this stuff? and still have a good marriage?
very patient life. Okay. No, you know, here's, here's the thing, I, I love this stuff. I don't I don't view it as work. For the most part. I view it as fun. I view it as hobby, and I interest that's really deep for me. I feel very blessed and fortunate to be in a career that I love and that I'm motivated to keep in. And I like it more than TV. So I don't watch a lot of TV. I think I've tried to minimize things in my life that take a lot of time but don't add value. And that has maximize the amount of time I can spend on things that do add value. like spending time with family studying a complex case or cooking a nice dinner.
Justin Trosclair 47:04
Hey, you made a comment about some kind of books earlier you have any that are not required reading for grip but sure if I read as a human mind, Doctor,
yeah, so there's some good ones I if you're just getting into rehab, a really good rehab overview book is from one of my mentors, Professor collage from Prague. It's called clinical rehabilitation by collage K. Oh la our collage at all I believe.
Clinical rehabilitation should be a dark blue book. That one is a great overview of a lot of different techniques. It's got a few good chapters on DNS, which is a big part of my background.
Outside of that, one of the best biomechanical books, see if I have it with me here. I do think this is one of the best biomechanical books written by a chiropractor. It's called foot or foe seas and other forms of conservative foot care by Thomas Mashad. He had a follow up to this book, which is human locomotion, the conservative management of bait related disorders, both books by Thomas Mashad. He's a chiropractor out of Connecticut, I believe. The reason I like these books is it goes from the foot up and from the hip down, have very clean and extremely detailed discussion of what has to happen biomechanically from joint the joint. And that can easily be extrapolated up the chain into the lumbar spine, thoracic spine, shoulder, neck and upper limbs. So I think it gives a really good framework for how to think about the body and in its mechanical properties.
Finally, I would recommend Michael shack locks test text, which I can't recall the time title off off him, they don't have it on my desk right now. But Michael shack lock has a great book, through neuro dynamic solutions, it might just be mobilization of the nervous system, although that could be the butler text. But Michael shot clocks book is another great resource for understanding how sensitization of the peripheral nervous system can affect motor control and movement capacity.
Justin Trosclair 49:26
Okay, and last but not least, a fund Indian to everything. Any favorite phone apps are blogs or things that you just finding yourself gravitating towards? Could be anything. Yeah, not Candy Crush,
I have one one app that I like a lot. That's medical related that I think just does a great job. It's called essential anatomy five. And it's a good like 3d peel back or peel through of the body. You can add structures and remove structures. And so great fun out to just dive into and say, hey, I want to learn about this new art rate today. And I want I want to look at the way this artery courses from the heart down to the right arm. You can do that in this app. So I like that one a lot.
In terms of fun apps, I'm just swiping through my phone right now. I don't have a whole lot of fun stuff on here, unfortunately.
Justin Trosclair 50:21
Come on, Doc.
But I've got this new baby app called glow baby and it will record nursing and type of times and that's helpful.
Justin Trosclair 50:29
yeah. That's a good one. glow. glow baby.
Justin Trosclair 50:35
Because the I'm typing that one.
Yeah, no. Other than that, I think I'm not technology based outside of what I need it for.
Justin Trosclair 50:47
No problem. And of course, websites, what's what, how do we get in touch with you, and whatever the plug that you may have?
Yeah, sure. websites on Facebook look up grip approach. There are also branches of that, and Taiwan, Korea and Japan that you can find grip approach on Facebook, also approach on Instagram. And our website is www dot grip approach. com, you can contact me on Facebook. My personal Facebook is Benjamin Fergus, you'll see me there in a blue suit coat and probably a red tie, looking to the left of your screen. And
I am pretty responsive there. Otherwise, there's a contact page on the website. And we respond to those emails, usually within five or so days. If you are interested in setting up a consultation for yourself or for a patient, they're a pretty valuable resource. Even if you don't know the system, I can walk you or your patient through an examination and give you some really good feedback that's in the console portion of our website. In terms of upcoming classes, look, we're currently trying to keep our schedule more compact to 10 to 15 classes a year. So a little less spread out, hopefully more meaningful local classes. So our 2019 schedule is up. And we're currently planning our 2020 schedule.
Justin Trosclair 52:20
All right. That's the first I really appreciate you being on the show answering all these fun questions and definitely will have a show notes page dedicated to you. And then whenever it comes out, you can spread it however you want. So I'm really appreciate you just diving into the system and answering all the questions that I might have, which I would assume other people would have as well.
Thanks for asking great questions spent fun.
that wraps up another
Justin Trosclair 52:48
episode. If you can send me review that's dot net slash subscribe, Apple, Google stitcher Android devices, you just click that button, it will take exactly the page you need to you can write a review hopefully a five star you like said it does help for other people to discover what we're doing here. And one thing I haven't really talked about too much is the doctor's perspective, net slash support page through about a host a cup of coffee, go for it. If you want to pledge a little higher fee, there's buttons for that there's even monthly recurring for those who feel like wow, this is like the cheapest mentor coach program I've ever seen. Because you interview so many different kinds of doctors and and have been able to implement things that I've heard and it works. So monthly recurring payments, which also you can get you my books for free t shirts for free. The first book, you know that deals with health and exercise, getting on a diet, getting your financial health and order as well. things to learn in China, you know that books is available as well. And one thing that I don't have I don't have like a full blown page about coaching and things. But there's a little button there. I've had people request, hey, doctors and non doctors asking me can I do more than just answer a couple of questions? Or could you be my coach for a little while and I say yeah, we can do that. So something I haven't really advertised but it's something that I can do and do whether it's marketing, some strategies for new patients growth, those types of topics, you're interested just email me Justin at a doctor's perspective. net. If you have any ideas for guests, please send an email Justin at a doctor's perspective. NET I'd love to hear who you think would be good or a profession that you may not have heard yet, and we've got over 100 episodes is gonna be like our third year super excited we're going a little mini series like we've been doing, which has been fun. I hope you've enjoyed them as well that's that's the feedback I've gotten on remind everybody that we have some great affiliate links available if you're into instrument assisted soft tissue manipulation, we've got the edge tool and we got the hot grips saves you about 10% also with the edge you've got the like blood pressure cuff restrictions system you've got the G sweet inexpensive Mr. In case you'd like to in cash practice and of course I got my own electric acupuncture pin to go with the needle acupuncture book on time you know have a bundle set ring get them all together for a great price. also have the free downloads at doctor's perspective, net slash blueprints. And what lately I've been doing is substituting a fifth one like I've done a neat and depend on the guests, I might do a different type. So check back there. You've got the primal paleo grass fed protein bone broth style, save 10% on that no sugar, allergy free, gluten free, dairy free all those types of things mentor box get taught by the author, we got set preset for those floss bands. And you may have heard about one of the episodes really like those. If you want to know what hosting us for podcasting, blueberry, pure VPN, it's one of those ones I use to help keep my payments secure as well as access the internet more safely in the Amazon products that you might want. Click the link in the show notes pages. So all those resources can be found a doctor's perspective, net slash resources. There's also t shirts at.net slash t shirts, put up some new designs from time to time like making lemons out of lemonade, shrimp po boy plus all the Chiropractic and podcast swag that you could want. As always, listen, critically think and implement. Have a great week.
We just went hashtag behind the curtain. Hope you will listen and integrate what some of these guests have said. By all means please share it on social media rather review and you go to the show notes page. You can find all the references for today's guest. You've been listening to Dr. Justin Charles Claire giving you a doctor's perspective.
Transcribed by https://otter.ai