Deep dive into MSK sports podiatry with Nick Knight. What is plantar plate injury, how do you treat MSK as a podiatrist, clinical research, 3d gait analysis, zero gravity treadmills, and his love of field hockey. A fresh look at what you can specialize in.
Podiatry was not his first idea for a profession but from being excluded from the military and physical therapy Nick picked it. Luckily, there is a whole aspect/ specialty of sports based – MSK based podiatry and he just fell in love with that aspect of the profession and now wouldn’t change his career.
He spent a lot of time shadowing MSK doctors during university and purposing choose jobs that were musculoskeletal focused. Knight and his wife are huge field hockey players so he would much rather treat sport injuries than tackle diabetic ulcers all day.
When are custom orthotics appropriate compared to a High Quality over the counter version?
How long does he typically have people wear orthotics?
Nick Knight’s most common condition is forefoot pain, particularly the plantar plate. I ask him to walk us through a typical treatment protocol. Most podiatrists focus on the plantar fascia and heel area so tune in to the forefoot answer. Knight, DPM will also discuss how he is publishing his findings for conservative treatment for plantar plate injuries because for now the research is heavy on surgical interventions.
His research is finding that the techniques used can get people back to running and not re-injuring the area.
Problem is about 40% can have a plantar plate injury and not have symptoms. However 10 years later do they have issues like a hammer toe?
Nick, sports podiatrist, gives us 3 powerful stories of how his treatment allowed patients to walk in their wedding after an Achilles’ rupture, walk pain free on vacations and stroke recovery.
Reasons to talk more functional improvements instead of pain focused with your patients. Realize that people expect to lose functional mobility as they age and that doesn’t have to be the case. Also don’t underestimate the need to handle realistic expectations.
What are his thoughts on weightless AlterG zero gravity Treadmills? Who benefits from zero gravity treadmills?
A Few signs to look out for when getting a 3D foot and running gait analysis to know if you are getting a good or bad assessment. Watching the foot vs the foot and knee, do they talk about over pronation, or do they immediately try to sell you an insert to straighten you up.
Podiatry in the UK is working hard to produce more evidence based research, why is that? How do we get more research outside of the NHS because you miss a lot of types of patients if you don’t?
Once again we hear that hiring the right staff should focus on personal skills and how they line up with your brand because the clinical or office skills can all be taught.
His marketing is highly geared to talking to other doctors in his area and facebook ads. In fact, he doesn’t even track the return on investment of his facebook ads, find out why?
He and his wife love playing field hockey and he shares some stories about how the passion for the sport has strengthened their marriage.
Facebook: NK Sports PodiatryGary Vaynerchuk, Lisa Sanders , Shoe Dog, Kiddiecare and Neville Wright
Show notes can be found at http://www.adoctorsperspective.net/124 here you can also find links to things mentioned and the full transcript.
This episode is a part of the Six Weeks of Feet Podiatry Series 2019. Put your email for a quick Reference Guide.
Justin Trosclair 0:06
Episode 124 ms. k sports podiatrist. I'm your host, Dr Justin trosclair. And today, we are Nick nights perspective 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.
Thanks for tuning in again, hope your week is going amazing, the quarter is going fantastic meeting your goal. I want to start out and just say thank you to my 130 guests so far. Without you I couldn't have a show. And I know sometimes there's a coaches that some people don't really care for that because it feels like there's an ulterior motive, it's like sure, but as long as they provide value on the show, I'm okay with them potentially getting client, right, if they provide value. And then there's other guests, they just want to share what they've experienced with they've learned and other guests, they look at it as an opportunity to showcase what they can do to their local community. And it's a good opportunity for them. So it's a win win on both sides. So I really appreciate them and everything that they bring to the table each week. I know I've learned a lot and was such a variety of guests. It's everything that I wanted it to be. So thank you again. Now, this is the last week of our official podiatry series, we had a couple people that were unable to make the deadline. So don't be shocked if in the next two months or three months, we have a few extra podiatry guests.
Unknown Speaker 1:33
Justin Trosclair 1:34
we are coming from Hampshire United Kingdom, which is south of London. I'm not sure how far away but it's definitely not London. He's got a fun story. podiatry was not his first choice. But as luck would have it, it was the best choice for him to do the things that he loved because he's super into sports. And so we actually find out what what kind of musculoskeletal focused podiatrist do, what kind of conditions are they treating, the one that he explains is one that I hadn't really heard much about. So that's cool. It's not like ankle sprains or nothing against ankle sprains. We had another guest that talked about that. But just it's a new topic for the series, which is fantastic. We're going to talk about the zero gravity treadmill, as well as doing those 3d gait analysis at shoe stores, what to look out for the good and the bad. And also doctor night is into research, not PhD style, but like the clinical aspect. And so he has some research that he is finalizing, we're not sure when that's going to actually, you know, come out, but the results of promising for what he researched. So we'll talk about that a little bit as well. We'll touch on hiring staff, and ways to keep his wife happy since they've been known each other since 14. Yes, that long. All in all, a fantastic episode, I do want to give you a heads up the first 10 minutes or so there's a little bit more popping than usual, his microphone was too close, but we fixed it. And so just bear with it a little bit. And you'll be able to get a ton of information. Remember all the show notes and transcripts, which will have grammatical errors. So if you like to do that, you want to contribute to the show, send me an email with a polished transcript, and I will copy and paste it now even put your name below it, letting people know that you are the one that edited to perfection. If you do that, well we will give you a shout out as well on the show the page, a doctor's perspective, net slash 124. Let's go hashtag behind the curtain.
Live from China and Hampshire, United Kingdom. We want to walk to the show a fantastic sports podiatrist. His name is Nick night.
Unknown Speaker 3:32
Welcome to the show. Many thanks for having me on. Absolutely. I'm excited.
Justin Trosclair 3:37
We've had I've been trying to get I should say in this podiatry series, a sports person who that's all they do. And we've had some kind of dabble in it. But from your website, it looks like you're on hardcore. I mean, you got weights in there probably throw some kettle bells around. I don't know. Yeah. So I'm excited to hear about that. And before we get into it, what of all things what made you think podiatry
Unknown Speaker 4:00
mistake? I was originally always wanted to actually tell I want to go in the military and school I was going through the process, going to some weeks trips away the rural engineers. But I didn't tell them I will exercise induced asthma. So I told him at the very end and they sort of just looked at me then Believe me, but that was it. That's why military career over freedom started.
Unknown Speaker 4:25
So then I've got a physiotherapist. So I signed up to be a physio new places. And then some some things happened, which meant that basically just didn't go through. So I thought, well, I was 1718 at the time. And someone said what podiatry and I thought what this now I never had that in my life. So I literally, back in the day before we had Google and everything. But I lived in something called Yellow Pages, which back in England is sort of a directory of just people's businesses, telephone numbers. So I find people wrote a few people have any one person replied. And that was a big school paradigm and eSports podiatrist, I went shadowing him for a couple of days, and sort of said, What did he say awful went to uni. And the rest is history, say say?
Justin Trosclair 5:12
it like that. It's funny to see how the things play out. And we'll ask you later on, but like, you know, where do you see the future casting of podiatry and advice for students later on? So you're a podiatrist. And that's what you chose to do. But there's so many options. I mean, you could just do nails all day, you could do surgeries and repair all these ruptures. But you went more into sports Ms. k field. So how that occur and what's that look like in podiatry the world?
Unknown Speaker 5:40
So I was quite fortunate as the universe chose to go to Northampton, we had a chap called one of my electricity, Steve able, and he was a big sport semicircle Space Police will put on interest. And every Friday we either had a sports or pediatrics musty sleazeball clinic, and I've played sport my whole life I much rather be outdoors and indoors. And let's imagine that's what attracts me doesn't live up to, to begin with, then. Right five, I've almost got this sort of a year's worth of experience before I graduate. Let's just build on that. So that's where we were I knew exactly, that's where I wanted to go. I wasn't interested in being a surgeon, I wasn't interested in the routine, I wasn't interested in working in diabetes or rheumatology, I knew exactly that sports aspect where I wanted to go. So I just made sure that any jobs I got after university of April need to get more and more experienced, where I then left the NHS and started up away.
Justin Trosclair 6:39
And originally the you did have to learn all that stuff.
Unknown Speaker 6:42
Yeah, so yeah, Free University. We don't some placements. And when I first graduated, I had to work in diabetic clinics, I had to work rheumatology clinics, I had to work to nail camp by always made sure that I had one day a week, at least in a musculoskeletal setting just to continue learning. But yeah, so it's, I'll do the same again, because it's a nice space. And it definitely just confirms to me what I wanted to do. And then I was just fortunate along my journey to help to meet people on the way you could just help me steer me in the right direction.
Justin Trosclair 7:14
Are you a small amount of Ms. k providers? I mean, y'all like of all the podiatrist, y'all are kind of a little small sliver, right.
Unknown Speaker 7:21
Yeah, I would say say I don't know the exact numbers, but the dollar tree in the UK this profession anyway. But I would say the pure people who like myself, he just he only must case Cleveland sports injuries. That's an even much, much smaller, busier, there are a lot of people who do a mix of Moscow squeeze or mix of routine. But there aren't many of us that purely I don't own any scalpels. I don't own any known issues, or any about there's nothing in my clinic, like that.
Justin Trosclair 7:51
say there's not doing orthotics all day
Unknown Speaker 7:54
night, I don't think so I reckon robust 30% of my, my clinical stuff. But mostly we're doing a rehab because we've got the gyms we got the weights, we got the travel, we got 3ds analysis. So the way I look at it is that we're able stronger, and then if they still got problems, once they're stronger, then we can fix. Whereas if you asked me five years ago, before I had that knowledge around about the rehabilitation, on just issue people orthotics all the time, and now it is massively reduced, the more I learn the less I issue or theses. So it's a good thing.
Justin Trosclair 8:28
Yeah. If you don't need it, don't get them. Yeah, exactly. Do you recommend just curious, you know, I use some of the ones that are there, like the doctor brand of over the it's kind of over the counter, if you want to think about it, they're not custom. Do you still recommend people use those type? Yeah, I mean, I don't I don't think Nike has a very good insert to be, you know, those types of shows.
Unknown Speaker 8:46
And is Yeah, I, I will give people and recommend people to go buy some off the counter. For me, it's not there's no evidence to show that the custom devices always going to be better than off the shelf device. It's all about getting the right product. So the right person. And if I am the patient who I want them to use them with those seeds for six, eight weeks, I've always tried to put them in an off the shelf pair because it's a lot cheaper for them with the dash in six weeks, just in case you don't need me anymore. So but I I won't. If someone comes in as I've been told on he both feet, but I don't have any pain. They won't get orthotics. I don't believe he is not broke, don't fix it. So some people are hunting for problems. And that's a bad way to go down is you don't know.
Justin Trosclair 9:31
Yeah. Now also, you got to retrain the entire calf and all the little foot muscles for a reason. Now it hurts doc. Dang. Yeah. Well, what are some of the most common issues that you're seeing on a day to day basis? I maybe want to like read your favorite. And then like, walk us through, like, what are you doing for these people? You know, because I know what I do.
Unknown Speaker 9:48
And I know what a PT might do. Me in our clinics, we were different in that actually forefoot pain is the most common problem we see. Whereas most podiatrist, their common problem is heel pain, Pacific, specifically plantar fasciitis. But that's for foot pain. So, and the most one of the most common conditions we'll see is a plan to replace injury. We were just about to publish, we're looking at starting to publish our own clinical data, because if you look at managing it is this a load of evidence and research wrote about the surgical approaches. There's nothing out there around the conservative management of plans, plate injuries. So we just ordered our own data as we speak. And the initial sort of me having sort of a quick glance of it is showing encouraging results. So what we tend to be doing is, we use a lot of taping in getting to offload to toe will put a stiff, rigid carbon insole inside the shoe for six to eight weeks, give the transit strengthening exercises, possibly then he give him an author basis, as well as possible, don't just offload the formats, and then graded returned to running and then the exercise program specific to this folder like HTC. For example, if they're around, they need to jump up and down the hallways, they can't do that can't run. So we're finding that when we do that together, we're actually getting people back to running in their staying room. They're not getting reinjured as of as of yet so it's all very new because no one's actually looking at data and publishing anything like this at the moment. So we could be sort of the first to offer Okay, look, this is what we're doing. This is the regime we come up with. In our hands it works we want other people to see is it just is it just me and my staff that it worked before? Actually Can anyone say this will work for anyone and it will be fun to find out what would be a journey we're going to go along I think with this and because I'm getting into their reputation. I had someone kind of patient comes all the plans to play King and I'm leading it is just an interest in people. I've had people travel from abroad to come see me just to help treat their punter, please and this I seem to be getting a reputation for this.
Justin Trosclair 11:58
For us who don't know what a plant are pleat is, what is that like the first and second toe? Or should I just shut up and let you tell me what it is?
Unknown Speaker 12:06
So if you think that is it, essentially is an extension of the plantar fasciitis, the plantar fascia comes down to the lesson today is the structure that help detach from metatarsal to your failings effectively. And if you see someone with a hammer to deformity, the chances are they've had opponents play injury which has then resulted in a hematoma deformity issue is that around about 40% of people can have a positive place injury and have no symptoms. Big Question from that is we don't know how to these people have no symptoms in 10 years time, do they have symptoms? And that's the question I want to but I haven't gotten that answer my my guess is that if you've had a plant like rupture, he also you developing and hammertoe later on in life that will be higher. And then that may cause symptoms. So people think the hammer is a problem. But actually that problem starts with me 10 years ago when the club the plate told ruptured. But they didn't. They didn't. They didn't think about it.
Justin Trosclair 13:04
And while they could just not hurt.
Unknown Speaker 13:07
Yeah, yeah, he can't. I don't know why. But that's what the evidence shows us. And they've done some studies looking at that. And yeah, that's what they they found is most of the papers are quote the most we're talking about plans to play in Greece, because Wow, that's, that's not a small number. That's not like five times that's a big chunk of people say, yeah, the human body, at least to me every day.
Unknown Speaker 13:30
It really does. Same here. I mean,
Justin Trosclair 13:34
all right. One of the powerful things that we can do is, is stories. And it sounds like from what you already said, You got people will come and all over the place. Because you're the plantar plate King. So
Unknown Speaker 13:48
that's not my words. That's my patient. I've never called myself the king of anything. So
Justin Trosclair 13:52
you don't want to put that on your email, Nick power.
Unknown Speaker 13:56
quotation, my motto is never be a smartest person in the room. That'd be nice. If that's the case, I'm in the wrong room, I need to leave room. So is it always level?
Justin Trosclair 14:08
That's fantastic. So give us like a story or two of like the success stories that you have that just makes you say, this is why I keep doing podiatry. This is what gets me up in the morning.
Unknown Speaker 14:18
So one of them was she wasn't a sporting patient. She had a stroke many years ago, it was least five to 10 years before she saw me. And she was having issues with confidence and walking and felt like she's gonna Keep on tripping and falling and she was starting to put on weight and she's starting a little depressed about everything. And we worked with her for a few months, about the skinny her moving best getting stronger. And then you got to the point where she'd go 10 mile walk and not worry about it. She just come back of their enough crying because she felt she got her life back. And to me that in a way. Yeah, GM. me This is the sort of misconception people think us basically. So they think sports, they think high end athletes. But for us, it's as long as you've got a goal and you want to get active, it doesn't matter if your goal is to go out for a few miles walk with the family in the weekend, wherever it is to be an Olympic champion. At the end of the day, you want to be active, you have a goal, so it will help you. So another story would be a lady with stage three to be all at posterior attendant apathy. And unfortunately, she had rheumatoid arthritis as well, which was really aggravating and she has a longitudinal splits will get big to work in medical history. She wasn't a candidate for surgery to high risk for her and her son was sort of a sub elite tennis player. So he started to break free speech. She was traveling all over the world with him playing tennis and she was finding that she just couldn't do the walking anywhere.
Unknown Speaker 16:01
We worked with for about a year and we use the muscle stimulator we use Ritchie braces, we're going to really nice, strong. And it it takes me about a year that if we want to just because I think rheumatoid arthritis is playing such a factor. Because we're also seeing her her steroids constantly be changed her methotrexate, and then she read on the biologics. And she sent out one day sent I think we're getting better. So the boys actually just been away with my mom lives in New York. And I just been over there. And I just realize I just went for a walk and walk around Central Park and I went away. Yeah, the hallway. And they didn't know it was falling. So yeah, that was because she come in hobbling. If you got the point where she gets in trouble with us, I'm doing everything she won't take. And
Justin Trosclair 16:49
patients forget how quick where they like where they were in pain? Yes. And when they start getting better, they're like, I'm still hurting you like, Yeah, but you can actually go five kilometers now before you couldn't even go one, then I
Unknown Speaker 17:00
go Yeah, we don't speak about pain clinic I we talk about function more IE, how much can you do before you have to stop. And we often will take patients back to where they were just to remind people quickly forget where they were, then people also quickly think that being in pain and not walking as far as I want to is normal. So there's the other side of it as well.
Justin Trosclair 17:24
I don't know about you, sometimes I feel like those type of clients when you're doing Ms. k work is great. Because sometimes these athletes they want so much. And you might be really excited about that. I'm one of the demands that they need. Or maybe they're above my skill set. Or it's just, they really need this to work as much as possible. And I'm just kinda like, Well, you know, maybe just have enough experience with it those high athletes where you can just say, hey, you actually need to take a break, or Hey, you know what, your Olympic dreams, they're crushed. You know, I don't want to be that guy that says Sorry, buddy.
Unknown Speaker 17:56
Next year, it could be especially when is the professional athletes is their career is is hard to have those conversations with them. But when you're involved in those kind of cases, it's not just myself, it's myself. There'll be a physiotherapist, I'll be strictly initially engaged. There'll be a sports doctor. There'll be a whole team of us involved in those cases, normally the sports doctor has of the ultimate control of the case. And they they sort of then farm out the work to us podiatrists videos of strength conditioning coaches. So I don't normally ask the athletes directly, because that normally comes from the doctor. So season is all conversations. Yeah, so but it's we've had a couple where we turn around and said, Look, your dream of doing getting a time good time at the London Marathon This year, we're going to have to postpone that because you just missed too much training. And you're not going to get it back. Because the issue is, is when you're competing at super high level, having an injury or taking good people forget how long it will take you to get back to that. They get me wrong, he's an athlete, he get back to doing sort of a two hour
Unknown Speaker 19:09
20 marathon quite quickly. But then if they want to try and break down to sort doing it to tend to a marathon, then actually it takes a work just to get shamed those extra sort of 510 minutes off. Yeah. So yeah, it has its challenges. It has its perks as well. There's different types of challenges from treating the normal eat, but you still get you're still under pressure with the normal least because we had a he was a decent runner, a decent club runner, ruptured Achilles tendon. And then a few months after surgery, he he had his wedding and he wanted to walk down the aisle on a date for his wedding, which is, which is a big thing. So that was touching guy, but he got there. So yeah, that was the stress thing. Okay. We hope we can get him in a bit. He knew that. It was a long shot, and it paid off. But he knew he understood. And his expectations are managed. This may happen. I think overall, that's a big thing, you know, manage people's expectations and what they realistically going to get out of treatment.
Justin Trosclair 20:12
Yeah, very good. Would you do any of the weightless treadmill stuff? You don't have
Unknown Speaker 20:18
any anti gravity? The OC g? Yeah. So do you do that? What do you think about that? We've got one in the CJ, one of the physiotherapy clinics, I work house, we've got one in there. Absolutely love it. Absolutely love. It is fantastic. For people have gone in three days to hear from running on the weightless trip on the anti gravity travel. It's also good for people who, if you need them to lose some weight, put them on the treadmill and say, Look, this would be like if you lost 20% of your body weight. This is how it would feel. Whoo. But it's also good for people who have had a stroke or something to help them to walk again. He can do it a safe environment, you can take the weight off and he crashes get them to learn. So it has multiple users. I don't think there's enough of them personally in the country. I think they're there. They're a very, very good tool. I think they're on the east. But I think they're really handy because they're not cheap.
Justin Trosclair 21:11
Yeah. So when you're looking at 3d analysis, I know in America, sometimes you go to like the shoe store. And they'll have like a little setup or, you know, maybe sometimes they'll have like a doctor desk is trying to like get their name out there is like a little clinic. Let me analyze your your walk, is there any like one or two pointers that we should look at to know if this person knows what they're doing? Or, you know, common things that we see, like a lot of your runners have the same issue. So that's kind of where to start with.
Unknown Speaker 21:36
So I think for me, big red flags are if you go and say get shoes fitted, or even if you're in a medical clinic, if they're doing a gaze analysis, and they're just looking, say they're trying to fit shoes on, and they're just looking just at the foot, and nothing else, and they're just talking about overpopulation, and you've got a flat foot. So you do this? Well, actually, the first question is the language to connect, this is a thought. So let's have the hip so you need to look at it all. And because there is actually little evidence out there linking excessive procreation to injuries, and I personally hate the term overpopulation because it doesn't tell us anything. But people get pounded and pounded around all the time. And it just, it just frustrates me. And then if they turn around and say, right, we're going to take you in a set of issues or sticky understandable theses to straighten you up. But that's when you you say no, I'm out of here you go. Just run away as quick as you can. Because they're just, they're the things I would look out for they're the big things to say, alarm bells should be ringing like it,
Justin Trosclair 22:41
you know, I was reading something or listening to a podcast the other day, and one of the things they were people were talking about, how do I get people's email, you know, and, and they were telling me like a banker or like real estate or something. And one of their suggestion was look at the top five bad things about something. And I was just, that's what just popped in my head is like, Oh, there you go. You got a top five to watch out for what again, analysis, boom, give me your email. And now you got some you got them on a on a on a back end marketing campaign. But that's just where my brain goes.
Okay, this is kind of a dual question. So you can take it how you want any advice for the either the person that's kind of in high school or like undergrad looking to go into maybe podiatry, they're thinking about it and then bridging that into where do you see in in this in the UK over the next five years,
Unknown Speaker 23:26
so I think I'm going to be biased because I am a podiatrist and I love my job so maybe take me off for a game just because I love my job and I love being an artist and I would recommend it to anyone I mean I inside I'm glad I'm a big fish problem the physio because I feel that people will assume that I can specialize more but actually titles don't matter but that's that's that's a whole nother conversation. I think if someone if they're in prison let's say let's do it don't put on a tree the UK has has a quite a reputation of its own la podiatrists just cut nails, take off colors and remove poles and that's all people don't often see the big ID and you can still go and do that with my degree in podiatry is great because he got so many that you can train to become a surgeon you can need a sports things on a deacon worker, rheumatology, pediatrics, diabetes do the routine there are so many avenues in which you can go down there we access a certain medication that we can administer and issue to patients as well. So it's Don't be put off by the cover as it were so don't be the attempt he is is something I would if you were interested in it. Go in shadow a couple of pedometers and if you can go and channel what I would call a generalist, someone who just does nails called Canis. But then if you interested in the surgery, you think you're you may be interested in the sports going shallow, just a sports podiatrist almost must this little bit I'll go shadow assertion because I have people who might have someone in my clinic yesterday, and I have people all the time. And most people are actually really receptive for people coming into the clinic, I think and then the second part of that question is podiatry in the UK is actually what we call an at risk professional, we were actually declining workforce not increasing. Hmm. So we definitely a terrible time ahead. And that's part of the reason why is that as a profession we are being crapper collects on our own data. So excuse me, so we can actually show how effective we are. Hence why I'm doing all the thing base to show how effective we are. So when do you then come to the commissioning bodies? They say, Hey, welcome podiatry Do we know we're good? We know we can help people, but we just haven't got the numbers to back it up. And I think there's going to be a tough time for podiatry in the next five years. We're all end up. I don't know. But the way I view it always going to be people who need my help. So my total knee pain every time I but to be honest, my patients they care about my size, will they just come in saying I've got this problem? Can you help me? They really don't mind if I'm a feature I get called physiotherapist, Doctor, podiatrist, pediatrician, all those things on a daily basis. And I correct them that patient, they don't care. As long as I can get them better. That's all they're worried about.
Justin Trosclair 26:18
Okay, so research takes money. And I don't know how much PhDs are out there doing hardcore research, but podiatry versus just what the PTS or the physios they're doing research. So we just have to hang our hat on what they're doing. But it's two different things like for the MS. k stuff, great, but when you're talking diabetic ulcers and all that, I mean, I don't know who else would be doing those things in the NHS system, if you're doing them,
Unknown Speaker 26:43
research is, is getting done, I think the turkeys to take a step back and look at things because a lot of the research is done within each NHS setting. Because the issue in private practice, you trying to obtain ethics,
Unknown Speaker 27:00
financing and research music is expensive. However, we know that most predominantly contacts in the UK, outside of the NHS. So if you're doing research on your patients in the NHS, you're actually missing a much bigger cohorts outside the NHS. So we need to cover aware of how can we get research into sort of private practice. And with Molly became a thing, I want to build a brand and the company that we do have a research budget privately, then we start contributing towards the literature. But I also think from my view, the other thing is that I've just come back and do my research project. So I've seen both sides of the coin of the research and the clinical aspect. And I think there is a bit of a gap. So what happens in research has always happened in clinic, and it can take up to 17 years to research to filter down the whole practice. And we need to, we need to bridge that gap. So there are a couple of clinicians who what they call the clinical academics. So there are people who research but they're also people that work clinics. And I think researchers need to try and start team and other clinicians or unconsciously to start to research because then you can then see both sides of the coin and work together. And once we get that, I think we'll start seeing changes. But it all comes down to housing, finance. Yeah, it will cost money and it will down fortunately,
Justin Trosclair 28:19
y'all have a strong body of podiatrists that actually contribute to the national organization,
Unknown Speaker 28:26
is that mandatory? is not mandatory know? The answer should be publishing. There are a small handful of technologists who do publish on a regular basis within the UK setting. We just need to find out how can we increase that? And how can we try and bring clinics on board. So actually, when you're doing his research, you get the researchers to do the bulk of the stats and the research. But he confusing their data towards the recession in here then stop building bigger better studies. But he is to be due to police. And the issue is is it's just time and money. They can hit sir. Yeah. And it takes a realize it takes a special kind of person. So I always thought I'd be good at research, I will do my research project. I realized I'm not a researcher. I'm severely dyslexic. And I found it was the hardest thing I ever done writing in an academic way. And so it made me realize I am a collision who's interested in research. And I'm prepared to help out and research. But I am the only way a receptor so maybe it's who we need to find out just in our lanes. And yeah, about not just my view, I may be completely wrong. But I agree
Justin Trosclair 29:45
to know where you're good at it. I'm working on this, and I will do what I can. But if you guys could take the reins and write this thing up and tell me what you want. I can do it. Just what do you need? Yeah,
Unknown Speaker 29:54
Justin Trosclair 29:56
So you sound like you have your own clinic based on your logo and everything in a key would be yours. So hiring staff, how do you find good ones? What makes them good? What kind of advice do you have for us.
Unknown Speaker 30:09
So I recently had to one of our staff members have to get a new one. And I think the big thing of hiring staff is hold your personal clinical brand. First of all, I put one advert on a school face on a Facebook group. And I had about 15 to 60 applicants just from there wasn't even a paid ad with it. It's just literally a post I put up. So much interest because apparently I'm starting to this brand that we that's what we do, we just bought some less case police or so people knew what they wanted. And I think you should trying to create a culture of people in your clinic who it has to be about work ethic and the right person, I can teach clinical skills to people but apart teach personal skills. So it's about people trying to be efficient with that time is people who are willing to go the extra mile when they need it. Because you know, for wellbeing a condition yourself is you have days where you're rounding three, you just got to say slightly later. And then you have days where the quality can maybe get off home a little earlier, just it's just swings around us all comes around again. And I think it's about for me making sure that they've got the company's interests at heart as well. So we're all singing off the same same hymn sheet, say, for me, it comes back to more personal extreme clinical ones, because, yes, you got to have some skills, but you can eat that. But I can't change people's personalities, by hope by building the brand I attracts people that I want anyway,
Justin Trosclair 31:45
are you able to have your own, which I'll call them, we call them chiropractic assistance, you know, they can do the front desk, they can do insurance, but at the same time, if you teach them how to do rehab, or some kind of, you know, put muscle pads on somebody, you can do all those types of things. Y'all have the same system? Or do you have to have like a person that's extremely specialized with a certification?
Unknown Speaker 32:07
Yes. So there's no reason why we can do that. And that's something I am looking into. So you can get podiatry assistance, you can get physiotherapy assistance. Currently, our date, however, will I may look at is actually see it's a bit of a dodgy shoot or something is employed them for a few hours. So they're doing their training, and then we can help supplement what they're learning as well. And then they can do some of the say some of the, if we tell them this is the exercises, I want you to teach this patient go away and teach it because you saw there's always a set standard operating procedures or a set structure, almost like a flowchart. A software, it's got to follow instructions. And that's a good thing. And it'll be again, I didn't know actually that there's talks will bring in a sort of poetry apprenticeship scheme. So people will stay going through their education, assess on police officers set, we've set learning objectives to do so there's no reason why you can't incorporate it. The biggest thing I've learned actually, in the last couple of months is I realized that Coalition's make rubbish admin stuff, and expensive admin staff. So if you got a condition, don't get into admin, hire an admin.
Justin Trosclair 33:21
So it can fill in. You don't want them full time doing that.
as they should be.
Unknown Speaker 33:29
Yeah, I am absolutely rubbish at doing administrative tasks. If you ask me, how do we build insurance companies? I've got no idea. asked my secretary, she'll tell you, but he personally No idea.
Justin Trosclair 33:41
Yeah, I, before I saw my clinic, I talked to my assistant. And she was kind of telling me to she's like, Hey, you think we can record the flow on the computer or like, don't need to write down how to do all this bill. And she's like, I'd hate to, you know, get in a car accident. And you're out of luck? Because I'm the only person that does it. Like, you know what? That's a great idea. I appreciate that. Once you get on that.
Unknown Speaker 34:04
Yeah, everything you know, is there's a standard authorization procedure for everything. So if the unfortunate happened, and I lost my admin personally, yeah, someone else would come in, and they'd be good to go pick up
Justin Trosclair 34:17
perfect. Hey, we all like to market I've noticed you have a really good color scheme, you got a pretty good logo going on your website is you must have a really good professional, I would think setting up everything because everything was really good. I'm like, wow, I'm jealous. I wish I would do something like that.
Plus other marketing, give us some of your tips on that.
Unknown Speaker 34:38
So for me, the biggest and best marketing tool I've had so far has been going out and just speaking to other health care professionals. And just building that up, saying that, Hi, I'm Nick, this is what I can do. Let's have a chat. Let's. So that's how I built up my relationships with my foot and ankle with the PD surgeons that were fair a little work to me. And then that filters down to word of mouth from patients that you already as good as the last patient you treated. So if they have a good experience, they're more likely to go away and shout about it. And then the other thing for me is social media is Facebook, fantastic. For marketing, I think people have to view face because a mass marathon, not a sprint. And Gary Vega trucks speaks a lot about that. And his if people wanted books to read, have a read of some of his books there. I audio listen to everything. So they they do some they get to listen to, for example, I don't measure return on investment or Facebook, because I got a stage where it's relevant yet. And I'll be decent Facebook for help build my business for over a year. And I still think I'm not in a place where I need to start measuring. Because it's and I think if you some people, they'll do a Facebook ads. And then they'll say, oh, it didn't work. So Facebook doesn't work? Well, they just have be consistent enough, in my opinion, is
Unknown Speaker 36:02
someone's brand recognition for you.
Unknown Speaker 36:04
Yeah, you got to build that brand. First. You can't just sort that know, like trust relationship. You got to already can't just go over sale. Here I am. I think you.
Justin Trosclair 36:14
You mean that doesn't work?
Unknown Speaker 36:16
Yeah. So. So yeah, they would be my tips on trying to go out and help bring more work into your into the company,
Justin Trosclair 36:26
when you're going to talk to orthopedic surgeons, and who knows what else? Do you have like a game plan that you can share? Like, what are you talking about? How are you approaching them yet to bring food? Or tea?
Unknown Speaker 36:38
Yeah, no, I won't go unless they've got tea.
Unknown Speaker 36:42
So I just go in, I just sit there and I'll chat. And I will just offer my opinion when a patient comes in. And I'll say, Well, actually, this is how I would do this, or this is what I would do. And then a lot of the time they sit down Actually no, that's the central idea. Let's try this before operating. And so don't go in with a set game plan, just go in there, be myself offer my opinion. and nine times out of 10 then tends to build a relationship from there. So I think just go in there and be yourself. Don't try and be someone you know, because you get caught it actually, especially if it's not
Justin Trosclair 37:15
flowing good with your conversation. You're like, Ah, yeah, what was that supposed to say? Or at that point?
Unknown Speaker 37:21
Yeah. And I disagree them as well. If they say something, and I go, I don't quite believe that. I'll say, Well, actually, my views are the same on that. Because if you see if you talk about surgeons, they are tremendously skilled operating, but they won't know all the latest evidence behind the conservative management. So they may be giving some advice to someone that's actually slightly dated, and they'll happily say it to work. Here's the latest evidence, and I'll email you the paper if you want. You can have a read. And then yeah, so I've actually changed some of the orthopedic surgeons I work with on conservative management advice they give to someone patients,
Justin Trosclair 38:00
that's true, because they might say this is a surgical candidate, you're like, no, and for the last four years, you can actually done this and you don't have to do that surgery.
Unknown Speaker 38:09
And the flip side of me is I I try and keep up to date as best I can with the surgical techniques and everything but I'm not a surgery. So I'll give my patient some basic advice from surgery Bible say look, if you want to speak to someone about surgery, speak to the surgeon. Yeah, they do. They are I don't operate to say, I'm not the best person to give. And again, that's about staying in your lane and just move it along when it goes past my relax.
Justin Trosclair 38:34
Was it's been fantastic. I gotta respect your time. So we're gonna, we're gonna put it into fourth gear. We're going to go to the personal side. Let's get at it. You ready? Yeah. Okay, now you have your own business. Now Vacation all of a sudden isn't just given to you. So what can you do to take time off and recharge.
Unknown Speaker 38:51
So me take it off is so important. My wife gets a generous annual leave allows. So basically when she's off, just put time off. When I first started my business, I was petrified about taking time off, but now I'm like, I just do it. And you know what? The business is still there when I come back as and disappear.
Unknown Speaker 39:12
And it is so important that you do that. Otherwise you just burn out. So that's what I personally don't work weekends. I play too much sports hockey is my main sports. So I will never work on a Saturday because hockey. Yeah, not a field hockey. Ice hockey.
Unknown Speaker 39:28
Okay, field hockey. I was wondering like really ice hockey.
Unknown Speaker 39:32
Okay, field hockey. Yeah, I don't even know barely know what that is. But yeah, okay. Yeah, go with it
Unknown Speaker 39:36
is getting bigger in the US, the US women teams are getting better and better. So yeah, that's what I do. I make sure that I have my analysts tell my patients cc Can I see on a Saturday? And I sort of say, No, I'm playing sports as well. So I will say some no look, but if you want seem assassinate, we can work around hockey. But for me to think of yourself around that, you're going to have to pay at least double my normal fees. If you won't see me. No one ever does. shuts it down. He says I'm not interested see people on the weekend. I've got no issue with my staff or to work weekend, or whatever for sending my staff. So where can we can't because I I don't, I will only ask my staff to do what I'm comfortable doing myself. If they want to work a Saturday and have a week day off? Fine if they don't want to work Saturday or whatever, and say you must work Saturday, because I will never work on Saturday. So
Justin Trosclair 40:29
yeah, I hear that. How are you keeping a home work life balance
Unknown Speaker 40:33
that as the business grows, that's difficult, really difficult. So I found I've had to reduce my clinical hours to make sure that I was finding that I was working so many hours in clinic, then trying to do the business stuff, then trying to finish my MSC, then having a newborn, I was just like, whoa, this is too much. Something's gotta give. So I had a chat with my business coach about Okay, where do we go with things. So I reduce my clinical hours, got some stuff in and just handed in my master's dissertation. So that's all now work, life is much better, so that I will work during the week, quite Harper, then make sure I don't do anything on the weekends at all. I'm kind of lucky in a way that my wife's got a stressor. She's a general practitioner. So she's a doctor. And she works long hours as well. So it's it's not uncommon for us to have a 12 hour day. But we make sure by the time Friday evening comes, we don't do anything until Monday morning. And that for me that just says enough just to recharge and he goes but how many businesses he gives us if I need to drop this one off at nursery forgot the flexibility in my diary just to do that, because I'm my own boss. So if I don't want to work, but just work. It's as simple as that. Really.
Justin Trosclair 41:46
Yeah. And you've been able to hire people to fill in those gaps.
Unknown Speaker 41:49
Justin Trosclair 41:50
I was about to say, what do you do with your kids? Because if you're going 10 hours, and she's working 12 hours, a
Unknown Speaker 41:56
lot of my family live really close by great mom, moms, they buy my father in law, mother in law, then she goes to nursery, so really good family support, which is awesome. We couldn't do without so we really great full family around.
Unknown Speaker 42:11
That's perfect. And I know not everybody has that. So there's one more person living near family of some sort? Is Yeah, yeah, he's
Unknown Speaker 42:17
my co buck.
Justin Trosclair 42:18
They love it. They love seeing her. You've been married for a while. So what are you doing to keep that marriage part alive? Keep that love alive? And all that?
Unknown Speaker 42:28
Yeah, we we actually met my wife at school playing hockey. And so part of the reason was really, we both got a love for sport, and we play golf for the same sport. So as a family, we're down a Hockey Club in winter, most weekends. And yeah, for us, it's just we just we don't we don't put we don't sound silly. We don't put we don't try to force anything. We just let things happen. We chat every day. Always make sure we have at least one Drake or one smile, at least for the whole day. And yeah, it's a that just seems to where people ask me all the time. Well, how have you gone from like, since the age of 14, and I'm 31 was 31. How's it worse? I don't know, sort of one of the things we never really planned it just, it just materialized and but I think playing the same sport and having the same interest for us really helps because we've missed family birthdays, I've missed anniversary, she's missed anniversary to play hockey, because hockey means that much. Our family know, if you organize something on a Saturday in the winter, me and my wife will not be there. Unless we're not playing hockey. This is how important it is to us. And I think that's part of the reason that's what keeps us going as a couple. And we both work in the medical industry. So we have some interesting discussions around what's happened to work today. And so No kidding.
Justin Trosclair 43:48
A lot of injuries and hockey.
Unknown Speaker 43:49
Yeah. And he's you see the normal musculoskeletal injuries that you get in most sort of field sports. You don't see as much ACL injuries and look as you start context. The big ones you tend to see, actually when you see one is dislocated shoulders. It's fractured cheekbones, because if you've been hit to have a hockey stick or hit of a hockey ball, or these are solid lumps of plastic that can easily travel over 100 miles an hour. And if it hits you it's hurts.
Justin Trosclair 44:17
Younger know how much they need helmets.
Up drop broken randomly. I'm like, I wouldn't mind a
Unknown Speaker 44:28
little rest. You go back to London 2012 games. One of there's a Kate Richardson wolf one of the female GB hockey buzz I was there watching the game at the Olympics. And it was she she got hit by the pool and she broke her jaw. Then three days later, she was about playing and she went surgery hadn't pin she had to wear a mask but she was back playing again. I just think like if you're a player or as equal as soccer, that's it. They'd be afraid they wouldn't get back up again.
Justin Trosclair 44:58
Yeah, it's sort of I did a Australian Football one summer and that's a brutal brutal brutal Denver hurry. So I was playing like coed It was a sort of like touch you know, because it's girls and guys. And that's just not fair. And also practice and whatnot. And I anyway, I go to practice one day and they went they came back from a game and they Oh, whatever Tony. He fell his elbow dislocated. I say dislocated like how bad like, Oh, it was bad. It was bad. I was like, Oh, I can't be not and I'm good. I'm good. I can't do this. This is how out of control. And then you see the the YouTube clips you like that's an eight foot drop.
Unknown Speaker 45:33
to the ground is like now I'm done.
Justin Trosclair 45:37
Hockey. Okay, cool. Now we know more about that. wrapping it up. It's a fun question. There's no wrong answers, favorite books, blogs, podcasts, some that you secretly love and some that just, you know, definitely everybody should check out.
Unknown Speaker 45:51
I'm quite sad. And at least the books I read are medical journals and whatnot. So I won't go down in it. Today's my favorite book of all time. Well, the gossip itself is such my favorite. I forgot the name of it. But it was by the Lisa Saunders. He was the medic to come out of all the cases for the Dr. House TV series. Oh, yeah. And I read her book about it. And that was a really good read. Most recently, one of the best books I've read is a shoe dog, the story of how Nike develops, really, really good reads. And then business wise, there was a book by the devil, right. And he devoted to the company in the UK called kitty care. And he just talked about his journey. Now the reason I, I liked that book, because it's little things like he's a bit he's dyslexic, the way he speaks the way his brain works, he uses software called dragon I used to do my nose and he use it for writing a book in it. I just had a lot of connections with him. And he realized that you could listen to all these books from different business people, whether it's health care, working in the baby sector, by the end of the day is still businesses, lots of could take away from actually going outside of your own sector learning wherever sectors and bringing it back. So yeah, that would be but that's my sort of reading lists really level that it's just medical journal. So so pretty sad. Really.
Justin Trosclair 47:12
Where you know, you gotta stay up to it somehow.
Unknown Speaker 47:15
Yeah, it keeps me up to date. Otherwise, I'll never keep up the day. So what's popular music around in the UK right now? Or what I think should popular versus what you actually like? I don't know, it could be the same. So I'm still listening to the same stuff that I listened to when I was 14. Yeah, so I still listen to a lot of offspring or loss of Foo Fighters. Were not chili peppers. I love that song rock. Yeah,
Justin Trosclair 47:39
Unknown Speaker 47:40
kids. Yeah, exactly. I love that. So I think it's this thing called carriage possibly. I got no idea what it is really, that seems to be popular at the moment. Like, I couldn't tell you what it is. Jesus makes you sound old. Doesn't it? Just show my age? Wow, that sounds bad, doesn't it? Say 30 years they share my age? It's
Unknown Speaker 47:59
36 was a so much older than you. I list the top 40 sometimes and I'm just like, Wow. Okay, so this is what's popular right now. It's like, this is interesting.
Unknown Speaker 48:07
Yeah, it's a load of rubbish. So
Justin Trosclair 48:11
speaking of being old, I remember being like in junior high or high school, and my buddy's mom was listening to the station that I was listening to. And she was all into it. And Stephens like, what's this old lady doing? And I look back like, she wasn't old. She was probably like, 30 it was like, I still love this music. I just haven't glad you guys like it, too. I was like, oh, man, perspective, when you get older.
Unknown Speaker 48:33
Now I listen to a radio station called radio one over here a lot. And it is targeted for a younger audience and myself were often the operator Where is that? Sometimes I think people would say I listened to radio one. And I get that look from people like Oh, you're too old to listen to that station.
Justin Trosclair 48:49
Just don't play it in your clinic.
Unknown Speaker 48:50
Yeah, exactly. So
Justin Trosclair 48:52
that's awesome. Well, how can people get more information about you? What's your website, all that jazz.
Unknown Speaker 48:57
So website is in K sports, podiatry, cable UK, and on Facebook and K sports. But if you're on Facebook, and K sports pot on Twitter, and then podiatry and K sports on Instagram, say it depends what flavor of social media you like, but we're on the ball and our YouTube is we make a sports but if your YouTube channel which we're loading more and more stuff up to it, and that's great, because I get comments all around the world. On the YouTube stuff is amazing how I can you can reach people anywhere, just
Unknown Speaker 49:31
search correctly and you'll find it.
Unknown Speaker 49:33
Justin Trosclair 49:34
And by the way, it's in K as in his name, Nick night. If you are Yes, if you couldn't understand them.
Unknown Speaker 49:40
British accent sorry.
Justin Trosclair 49:42
Yeah, I'm just you know, one day if I go home for like a while, I need to do a podcast episode because my thick Cajun accent I'll come out. And if I could do a foreign episode again, we'd both be like
Unknown Speaker 49:51
Justin Trosclair 49:53
Say it again, please?
Well, Nick, I really appreciate your time sharing all this information, and really appreciate you being a part of the big series.
Unknown Speaker 50:01
Thank you for having me.
Justin Trosclair 50:08
Another great interview has ended. As I always say, I hope you listened critically think and implement something so that your practice life family life can improve this week, one hit you up with a few links today, if you like to know the top episodes of 2018 and 2017, where you just go to.net slash top 1718. And you can get a PDF of all those episodes, it's like 22 of them. If you're interested on any of the programs that I've actually been interviewed on, just go to net slash as heard on the play on as, as seen on you know, so as heard on, if you didn't know, the needless acupuncture book sales page has been revamped. So it looks a lot better. You know, sometimes when you look at a web page, it doesn't look like it's put together will be like, Man, I'm not sure about this thing. But it's been redone looks better. And also, if you have an Android device and you're curious about it, you can actually download the same five protocols blueprints, if you will, right, they're on your phone at the needless acupuncture app. And for less than $4, you can get the whole book on your phone from the Android Google Play Store. So just to check that out. The electric acupuncture pin is still available at a great rate, you can get it on its own or as a package, seeing it the book, The E pin, as well as the regular points. Now, some of the things that I'm recommending blueberry hosting, that's who I use, I really like them a lot. I'm not gonna lie to you. Fiverr is where I get a lot of my music done my logos, I don't know if you noticed on Facebook, I believe my picture is now a face with a bunch of words and just saw that real quick, was cheap. Wanna try that for a little while it's fun. Turtle pillow is a travel pillow it actually like an HP minute. So you can rest your neck and your chin on that. So you don't get like the chicken Bob, where you you know, you sleep and you wake up really fast. And you know, those those U shaped ones, I just don't think they work very well. So for me, it's worked really well. I've traveled about 10 different countries with it across the pond, as they say really highly recommend that if you're into instrument assisted soft tissue manipulation, two options, you got hot grip. So that's that's hot grips, and also net slash edge, you can get tools there as well. But they also have way more than just tools they've got how to get to use Google Apps as your EMR blood flow restriction cuffs, there's a lot of research on that device and you can check that episode from the past, you can get an automatic 10% discount on all the products from the edge mobility equipment. One of the devices I use to to send out snippets of the podcast via picture and quotes from the text that I write on the show notes is missing letter, they just took all the last E and letter.com. Pretty much you know you can do a blast and two months and like five weeks or two months, I like to do nine emails over 12 months. So that person who was interviewed last month doesn't just get lost, right? You know, so every day I have a new episode at a highlight and it's all automated, really cool. Definitely check it out. If you need to record your screen like screen cast o Matic also j lab audio speakers have said it before. I love them, it's a great company. Now I get to actually be an affiliate for them. So if you end up buying into their products, it's like anything I get a little piece probably have like three or four different products. I mean, they just the battery life so longer sounds quality is amazing. And for the price that came live it have been. And of course the show notes. Anytime you see a book link, buy it, it comes to me and net slash t shirts will help us out. And lastly, again, something I don't talk about too much. But if you need coaching, whether it's via the today's choices, tomorrow's health need some help with taking those small steps and accountability so that you can actually lose the weight or start exercising more or get your budget in order. Just let me know I can help with that. Also, if you just need some minor marketing coaching or things like that, I can help you out with that as well go to.net slash support. And of course on there you can also buy the close the cup of coffee are even more than that. There's different options available. So thanks for tuning in. And we'll see you next week on the Minnesota.
We just went hashtag behind the curtain. I hope you will be listen and integrate what some of these guests have said. By all means please share across your 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 trosclair giving you a doctor's perspective.
Transcribed by https://otter.ai