E 133 Mobility or Stability Issue Daniel Bockmann DC

e133 a doctors perspective mobility stability dan bockmann dc sm
Dr. Daniel Bockmann, DC talks to Dr. Justin Trosclair DC on A Doctor’s Perspective Podcast.

We breakdown MSK injuries to the fundamentals of a mobility or stability issue. Daniel Bockmann DC walks us through his eval and rehab flow with an Achilles tendon as a demo. As well as his work with volleyball, musicians and starting his own seminar.

How did he figure out he liked the functional rehab aspect of chiropractic care?  Sports Medicine and Rehabilitation for Spine and Extremities is his passion. Getting out of pain is one thing but getting someone to return to play is a different ballgame.

Dr. Bockmann even works on post-operative injuries which is somewhat unique for a chiropractor.

His 5 methods of treatment for mobility or stability are: stretches, exercise, massage, spinal manipulation, and lifestyle modification. His core thoughts on injury are: a stability problem (tight or loose) or a mobility problem (too much or little).

Craig Liebenson – Functional Rehabilitation of the Spine- FPM courses, Stuart McGill, PhD, and Gray Cook-SFMA Selective Functional Movement Assessment are some of Dr. Daniel’s major influencers.

Dr. Bockmann will break down his stability or mobility ideas for us and discuss treatment options including what low tech equipment he utilizes.

Achilles tendon injury happened during the NBA Finals so we have a chat about the mechanism of injury and ways to prevent and rehab it. One common comment from the injured player is “who hit my ankle or it felt like a gun shot.”

What is his mark to know if you love what you do everyday?

When looking for an associate job, see if you can work on off hours and just pay rent based on a percentage of collections. It’s like building your own clinic and the owner understands that you will be opening up in town at some point in the future.

His number one marketing tip: Reviews on google and yelp. What is his advice on when to ask for reviews?

How did he start adjusting Bands that our Touring through his area… along with being a volleyball AVP go to chiropractor for Austin?

Dr. Bockmann is rolling out his own hands-on 1 day seminars to teach you about his mobility or stability rehab approach. He walks you through everything from the exam, explaining the problem to the patient, all the soft tissue work and exercises and releasing the patient.

 Dr. Daniel even discusses his fees and treatment length. We tie that into high deductibles and meeting patient expectations and clinic goals. Patients want to get out of pain and get back to their activities.

PSFS, patient specific function scale, is his go to Outcome Assessment. Ask the 3 activities that you are most limited from because of pain. Have the patient score them 0 – 10 (0 is can’t do). Get the average and when you revisit those activities in 6 visits or the reexam and the final release, you should see an improvement of in that average.

On the vacation question, he gives a creative and sometimes forgotten way to take cheaper vacations: credit card points.

Books: Cathryn Jakobson Ramin – Crooked, Mark Twain- Huckleberry Finn,  Patrick Rothfuss – The Name of the Wind Kingkiller Chronicles (trilogoy)

Austin Spine and Sport his website

The 10x knee rehab machine was mentioned from PJ Ewing episode 103.

Show notes can be found at https://adoctorsperspective.net/133 here you can also find links to things mentioned and the full transcript.

a doctors perspective e133 mobility stability dan bockmann dc 1
Full Transcript of the Interview (probably has some grammatical errors). Just Click to expand

Justin Trosclair 0:05
Episode 133, mobility, our stability issues. I’m

your host, Dr. Justin Trosclair. And today, Dr. Daniel Bachmann’s perspective, joined 2017 is 2018 podcast Awards Nominated host as we get behind the curtain looked at all types of doctors and guests specialties. Let’s hear a doctor’s perspective.

Thanks again for joining me this week, I think you’re gonna like the guests, as the title suggests mobility or stability, or actually, is it both? And yes, bomb it is. So we’re going to go through all of what’s he looking for when we’re talking about mobility or stability. He’s creating a one day seminar to kind of help go through, you know, all the joints that he treats. But that’s only a small part of the actual interview, most of it is talking about Nick his definition, his theory, how’s he look at things because the way he does rehab is very simple and effective. In fact, you he’s able to be one of the training doctor for the abp volleyball, which is a professional organization, I go to for some musicians that come into town, and a lot of that stems from online reviews as well. So as part of his marketing, at the time of the recording, there was a prominent Achilles injury there in the NBA Finals. So we use that as an example for him walking us through his technique protocols, and also his favorite patient outcome assessment, which is different than probably what you think. Like it’s not Oswald dream. We got to review the other day. I’m not 100% sure if I put it in the past episode, but here it is, again, Igor K, DC, wrote, Doc, great job on creating such an array of good and useful information, I see that lots of work was put into the podcast. Good job. Well, Igor, I appreciate your feedback. Appreciate the encouragement. And I do put a lot of effort and time into these, which I hope everyone notices. Well, you know, these numbers come out later than when I do them. But next week, going on a little riverboat cruise Schengen city, three days down, the no one like that before. So looking forward to it, spend time with the family get away from work for a little while, the adventure of teaching and Shanghai has been going well, it’s little bit of teaching, a little consulting little bit of setup, it’s 70. And having great Chinese hospitality. Speaking of real quick, I don’t have a dedicated page for the pro loan, fast moving diet, but I just started it this week, I’m on day four or five is not really a weight loss diet. But I think that’s how they want you to like promoted a little bit, but I look at it as more of I can do it for one week, per month for three consecutive months. Yeah, I’ll lose the abdominal fat. That’s an important part. For me, that’s where I keep it. Blood pressure goes down. triglycerides, LDL, glucose tolerance is better like hemoglobin a one C, C reactive protein, oh should go down. So I’ve already taken my blood work, and I’m waiting, you know, I gotta retake it, but I’m excited for it. And the big thing is the UPS up regulation of stem cells after you’re done fasting, and then repeating when they’re big things is ever a fast, but you actually get to eat some food and the food is specially made. That’s why they you know, it’s these boxes and the food’s given to you. So I’m like 800 calories a day. that interest you just shoot me an email or response. You can also go to a doctor’s perspective, net slash resources. To find out more about that. I think that’s enough. For now. All the show notes and transcript can be found at a doctor’s perspective, net slash 133. Let’s go hashtag behind the curtain.

Live from China in Austin, Texas. Today we got a Doctor of Chiropractic who says his treatment approaches outcome driven, which means he has specific functional and pain goals for every patient that comes in. He’s got proven methods that work in a big thing is how to educate patients on how to prevent future occurrences which is I think, very good thing. Now he works with Semi Pro Football musicians and not only for himself but for volleyball players in the abp. So that’s a nice little niche he’s got going on. Please welcome to the show, Dr. Daniel Bachmann.

Unknown Speaker 3:57
Hey, everyone, Doc, thanks a lot for having me on. I love your podcasts and you do great work. I’m glad to be here.

Justin Trosclair 4:03
music to my ears right there.

We always got to start the interview with you know why chiropractic? We’re actually the same alumni.

Unknown Speaker 4:12
Oh, really. So you went to PCC as well,

Justin Trosclair 4:14
GCC would not have crossed paths. Some of the things I definitely gonna want to know about later. For the listeners to volleyball, I’ve only treated one like a really good volleyball player. And that was really fun. And then musicians like Well, that was kind of cool. You know, like it looking at your page and everything like, How in the world did you get into that? Just what is functional rehab? What is functional? Yes. And all that stuff look like? So that’s what you’re going to get today. So let’s just jump in why chiropractic? And you’re obviously a fit guy. So what’s the backstory?

Unknown Speaker 4:47
Okay, so it’s an interesting story, how I got into chiropractic. So it’s kind of crazy. So I when I was a senior in high school, they gave us an aptitude test and a skills test to like, see what we’re good that and what we’re interested in, right and kind of point us in the direction of a career. Well, I took the test, and both of the two tests, and both of them said I should become a chiropractor, which I was like, What is that? And my counselor was like, I’m not sure I think it’s some kind of bone doctor. Not even like, right, exactly. So neither of us knew what it was. But it sound like, oh, Doctor sounds pretty good. So maybe I should go for that. I said, Well, what do I need to do? And she said, Well, it’s pre med. So I said, Well, I’ll go pre med. So now there was a big gap in there. So I went pre med for a while. And then I did then I kind of discovered the college life. And long story short, I had a lot of fun, and didn’t really take much school for 10 years. I Bart’s ended for 10 years. And then I got married, and I realized, Hey, I don’t want to retire and raise a family on a bartender salary. So I started reconsidering what career path I might take. And I went back to my wife said, Hey, what about chiropractic?

Justin Trosclair 6:01
And I said, Okay,

Unknown Speaker 6:02
so I jumped in. I went, I took 40. Basically, I was short for my undergrad, I was short, 40 hours of science. So I’d taken every other class. It’s a lot of hours, and I took the 40 hours in one year, I will I took summer classes. And I mean, I just went great guns. And I also had to raise my GPA at the same time to get accepted. So it was kind of crunch time. But I did it. Then I went to Texas chiropractic college in Pasadena, Texas, and where you which you know, well stink, Edina, Texas? Oh, yeah. Yes. And, and that, and honestly, I think it’s amazing that an 18 year old, which we are at high school, as a high school senior, we’re being asked to make this monumental decision about what we’re going to do for the rest of our life. We have no idea whether we’re going to enjoy it, whether we’re going to be good at it. But we have to make this massive investment in time money towards this thing. And we just kind of cross our fingers and hope is the right thing. So I feel completely fortunate to come to just unreservedly love what I do. It’s it’s I feel lucky to have landed here. It’s very rewarding job. I look forward to every day. That’s my measure for how much do you like your your job? It’s how you feel when you’re driving to work. Do you feel like oh my god, another I gotta psych myself up for this? Or do you feel like what’s today going to bring me? What kind of new exciting different case Am I going to get? How am I going to be challenged? What kind of big therapeutic wins Could I get today? How many? How many people can I see light up and happiness or be able to get out of a chair again, or something? You know, whatever, whatever the thing is, it’s exciting. And I and I feel super, super lucky to have landed here.

Justin Trosclair 7:51
Sometimes I wonder if we should be taking a year or not a year off but doing something for like a year. And if it’s expected, then that’s great. Cuz Yeah, I’m with you, man, like bartending for 10 years. That’s a long time. 3040 hours at one time of all your sciences, that would be brutal. I mean, it’s kind of like college private college. At that point. You just like, Oh my gosh, how are we supposed to get through all these hours and study and so you prepared yourself but love it, man. Love it so far. And then there’s so many avenues of like, I guess chiropractic niches down old people pediatrics just being around of them? Yes. Yeah. How did you kind of get into the functional part?

Unknown Speaker 8:30
So first of all, I would kind of Yeah, you’re right, there are a bunch of different kind of paths you can take once you become a chiropractor, similar to an MD right. So you can MD you can become a pediatrician or radiologists or an oncologist or a family practice, right? We don’t have those same options. But we do have different certifications and deployment programs, or call them sub specialties. If you like areas of focus that you can go in. And mine I defined mine as sportsman medicine, and rehabilitation for spine and extremities. Sports Medicine, meaning injuries, they don’t have to be athletes, but I mean, people, I mean, generally athletes hurt themselves, if they’re pursuing that. It’s common, and they want to get back to sports. So I think sports medicine kind of encompasses both the kind of injury which are often extremity injuries, and the fact that you’re trying to restore an athlete back to their sport, getting someone out of pain is one thing return to play, or they call it rtmp is, is kind of itself a separate thing. It’s a separate process. Because getting you to where you can feed yourself, dress yourself and go back to work is a worthy goal. But it’s a much lower bar than being able to perform at a high level like, you know, collegiate level or professional or whatever. So that I would say is the sports medicine bit. And I do pre and post surgical rehab. So So ACL, yeah, ACL reconstruction are labeled tear repair shoulder ACL or Achilles rupture reconstruction, bicep tendon ruptures. I mean, I’ve kind of done it all fractures, I do. post op fracture rehab, what did you take for that?

Justin Trosclair 10:10
Because that’s a pretty unique thing for a chiropractor to do. I’m normally like, you know, that’s for physical therapy, you got that? I don’t even want to see it.

Unknown Speaker 10:17
Right. So it’s a weird answer to your question. I have zero extra certifications. Okay, I kind of just figured out, I’ve written all my own rehab protocols myself, and I’ve kind of cobbled them together from other things I’ve seen and heard, and combine that with stuff that I observed with my patients in practice. And I just, I just had patients come in and asked me if I could fix something. And I said, hey, let’s try. This was decades ago, but Right, right. But now, I mean, I have neurosurgeons sending me their post op, you know, spinal fusions, or discount dummies, or pediatric surgeons sending me their been post op Benny and activities, which is crazy, because I mean, I always say yes, and I’m over and then I’m like, panicking. me back, when I first got this hat, you know, you’ve never had one and then you get one, you kind of panicking, but it makes you try harder. And then once you learn that thing, then you’ve done it, and you can do it again. And it makes you less afraid of the things in the future. So I would think to it’s kind of like a mixed bag, there’s probably certain protocols that you get taught at like a program like you’re going to do this and you know this and step one,

Justin Trosclair 11:25
step two, yes. And it we talked to a guy a PJ, he was doing some special knee rehab after like, surgery, you know, you get to the Replace, and sex machine and it pretty much CPF story. Yeah, it restores, you know, not that one that’s actually been in it. It’ll restore your motion in about two weeks. And then when you go to the PT, they’re the one now you’re working on, like strength and everything. So it’s a really cool concept where we’re not just worried about your range of motion, we got to get you like back on the field. Yes, the idea being you’ll probably put them through different rehab program, like different exercises, different load bearing that would be different than just let’s make sure you have full range of motion in.

Unknown Speaker 12:06
But yes, so so I’ll do a follow up, please this question. You said, where do I get this stuff? Well, and you’re right, most chiropractors. I mean, as someone with a chiropractor does their backpack, we’re back crackers. Right, right. But, and that’s true. That is a tool in our tool bag. That’s just one tool in our tool bag. So for example, all I have five treatment tools that I use for patients just five, and they are stretches, exercise, massage, spinal manipulation, lifestyle modification. That’s it. No ultrasound, no traction, no. electro therapy. No braces, no heat, no ice, no anti implant. No. That’s it. And that’s those are the tools I use to fix everyone. And I have actually, I’m happy to talk with you about it. But I have my protocol is pretty simple. And it applies to all areas neck, back, knee, shoulder, foot ankle wherever the same rules apply. But of course, you remember at PCC we had physical medicine rehab rehabilitation classes, right? I mean, we can vaguely remember that orthopedics, we had some orthopedics classes, and all that. But the problem is, they never gave us any actual plans or programs. There’s like you said, there’s no checklist, like Okay, first do this, then when they can do that you do this, we never got that. We learned how to apply electric stem and how to do ultrasound and what kinds of things they might be good for. But when you get an actual live patient sitting down in front of you, who’s got tons of pain and swelling, what do you do you know

Justin Trosclair 13:44
if your test is positive?

Unknown Speaker 13:46
Yes, exactly. They’ve got everything, right. Yeah, all your tests are positive. So basically, I just kind of muddle through. And honestly, I like a lot of Craig Levinson’s work. I don’t know if you’re familiar with him. He wrote functional, real the rehabilitation of the spine and Professor Stuart MacGill monster in his field, and Greg cook. So to me, those are the great cook of functional movement systems. Those three guys are top of there. If you follow them, you’re going good places.

Justin Trosclair 14:21
So you studied the classic three people that most people are creating these long certification programs and everything. Those are the main guys that they pull research from anyway.

Unknown Speaker 14:33
Yes, and I say research loosely because I’ve watched, I’ve listened to podcasts. And I’ve watched some YouTube videos of them. And I kind of got their concepts. I never took a course or anything with any of them. I did read correctly been since fun rehab book 20 years ago, but the ideas are what from them, or what I used to kind of create my stuff and test it out and see what works and what doesn’t, if it works, I use it. If it doesn’t, I try something else. And I just kept doing that until all that was left was a real small list of easy rules to follow that you could plug in any patient. Anybody part.

Justin Trosclair 15:06
So what is like one of the core concepts that you adhere to whenever you’re looking at your package?

Unknown Speaker 15:12
Hmm, that is the question to ask. So basically, if you think about it, all injury and pain head to toe has really only two, two main reasons for that pain. And it’s either mobility problems, or stability problems, move. And I mean, I’m talking about problems with moving parts, joints, muscles, bones, ligaments, nerves, all that stuff that goes with it. So mobility problems, you can either have too much mobility, like if you tore your ACL, your knee, your knee is no longer snug is slipping around, right, that’s too much mobility or too little mobility, let’s say you have frozen shoulder, you should be able to raise your elbow, but you can’t. So you can have too much or too little mobility, and not enough stability, meaning the muscles whose job it is to protect that joint can’t. And that allows pain to happen. What that breaks down to almost every time is the presentation has type things and weak things. Yeah. So once we realize they’ve got tight things, which are limiting their ability, their movement, right? And if movement is limited, that means by definition, they are being forced to move abnormally, right? If they’re in right, they don’t have normal range that therefore everything they do is abnormal, that and that means it’s a riskier way to do that thing and more likely to hurt

Justin Trosclair 16:27
because if you’re still doing it, it’s just compensated. Yeah, like an athlete.

Unknown Speaker 16:31
Exactly. But this applies to an 18 year old grandmother who’s trying to bend down and pick up something off the floor. You know, if she’s only got 20 degrees of hip selection. Well, she’s got a strainer back in the process.

Justin Trosclair 16:43
I see a lot of 58 year olds waddling around instead of walking. It’s like they just bounce from Yeah,

Unknown Speaker 16:47
yes. And I will say type things, and we things of those to the type things are this big contributor, in almost every case, it’s usually like nine 10 90% of the problem is type things 10 or maybe at 20. It’s usually that way, right? So then, once I, this is my hypothesis, there’s only two kinds of problems you can have these are them. Once we assume that, then there are only three tools to fix things, stretches takes two things, they create more mobility, massage does the same thing by breaking up scar tissue and allowing more mobility and spinal minute, I treat adjustments like wd 40 for the spine. Yeah, if I if I if a patient should be able to turn 90 degrees to the side, and they can only turn 30. And I give them an adjustment. And they can turn further. That’s what it’s for. That’s how I treat it. It may have many other benefits, but that’s the way I use that tool. And then in the lead strength, the week thing side is all exercise. And I just plug into the missing things that I think there they can benefit from.

Justin Trosclair 17:52
So that’s my method. That’s awesome. And we’re talking about strengthening with exercise. Are we doing things you can see at the gym, there are bands, we will saw you working you be like, dude, I never thought of that before that’s really cutting edge.

Unknown Speaker 18:06
Yes, you can do them in a gym. No, you don’t need a gym. So you can kind of do them anywhere is what I mean. And in my rehab room. I have zero machines and zero weights. And yet we rehab you know, post op everything right? And just regular stuff headaches, and you know, back pain and plantar fasciitis, tennis elbow, I mean all that stuff, right? And the tools, the actual tools that you the equipment you need that I have, I have a tumbling mat to lay on. A man on the floor to do floor work with a Swiss ball, okay, are a couple of them, right? Those big balls that people sit on and study a stability trainer. So I use the Thera band, it’s just a piece of foam, you know about like this big, and it’s a balanced trainer. Okay. And foam roller, lacrosse ball, and elastic bands. Okay. Those are literally the only rehab tools I have. And coincidentally, all of them are super low tech and really cheap.

Justin Trosclair 19:07
Yeah, so the patient could do it at their house continuing.

Unknown Speaker 19:10
Exactly, that is the idea. Now it’s so happens that, you know, you can pay 100 grand for a new machine, which is super fancy neck, back rehab machine hundred grand for, or I can, I bet I can beat their results with the honeymoon with my you know, $20 form roller and stuff like that. So, and the patient doesn’t have a Hanoun that they can touch themselves up with in the future in the low tech, no tech stuff pays off bigger and is cheaper, and they can do it on their own.

Justin Trosclair 19:39
You know, if think we get excited for kettle bells, and we get excited to see people do certain things, especially at athlete, no athlete is just, we’re just stick with athletes, just because it’s easier, you can kind of see them saying look, I used to do this, I can’t do that. Now. Now I can do it again. And bands aren’t gonna get me there. But if you get really into band work, there’s different ways I’m sure like, you can do two or three bands. If it’s not strong enough, you can buy this floss by a centimeter thick, where you get massive resistance. You can get super creative with the different motions that you can do if you can just get into a position where they need it. You know? Yeah, just twist your body a little bit. Oh, there it is. Yeah, now do Oh, wow. Okay, I’m really weak there now can make you feel my guessing.

Unknown Speaker 20:22
Yeah. Oh, yeah. So that’s the thing, you’re, you’re right, they’re very versatile, you know, you can stand on them and do curls, you can wrap them behind your back and do presses. Now, I will say this, I only give my patients to band exercises, and I only use them for shoulder. In fact, in shoulder my shoulder rehab program only has two exercises. And they’re both done with bands. And the rest are things that require no equipment, okay. But the two exercises, I can tell you right now they’re a middle row, right, which is pulling and squeeze with chest out for a whole second and then release. And then something I call a goalpost, which is the bands are about chest height. And they pull back and pause in the position of a football goalposts for a whole second and then they lower their hands elbow stay up, which address those between those two extra those hit the two most commonly neglected muscles around the shoulder, which are retract or the shoulder which is this and external rotator is which is this. And if you think about it, and I know your listeners can’t see this, but you can. But if you think about it, most of our day was spent in the in the opposite position. So protracted, yeah, hunched over yes over computer. So it only makes sense that the muscles that do this hunched over position are relatively stronger than the opposite ones, and then the strong ones when we get slouching. But if you catch up the weak ones, not only does posture improve, but you get the support and protection back here that you were missing. So I just plug in the missing thing,

Justin Trosclair 21:54
basically, who didn’t see it, you know, when you flex your bike to the side, you either I’m so strong like set a goalpost pretty much the shoulders and elbows are both 90 degrees. That was the motion. So that’s pretty interesting. You know, it’s funny to see sometimes how complicated we make something. And then yes, obviously what you’re saying I think it’s a little bit probably simplified, because there’s always those know that you’ve learned over the last, you know, 20 years of actually, you know, it tends to be a little bit more complicated because you’re actually able to see what they’re doing. And then you modify and you modify something. So based on when we’re recording this versus when it comes out, Durant on the Warriors just ruptured his Achilles, who knows? We don’t know yet. Do you have any opinion about about that? And did you see it at all?

Unknown Speaker 22:37
I did not see that happen. It’s they generally call it a Achilles rupture. And I

Justin Trosclair 22:43
planted and yeah, so he step backwards, and then it popped, you can see the muscle just start jiggling. You like Ooh,

Unknown Speaker 22:51
yeah. And that’s the mechanism of injury for that injury, by the way. So what will happen is, and I’ve seen and treat, I’m diagnosed several on the football field, and volleyball is huge. Yeah, so the way it happens, and again, no one, the listeners can’t see this. But if you’re standing and if you imagine stepping back with one foot, like you’re going about to back up, and then bouncing up forward off that back foot all in one motion, step back, bounce forward, a lot of stress. It’s a sudden, and I guess perhaps unprepared loading of that tendon. That’s the way it happens. Now, I’ve soccer player recently who blew his and everyone, every patient you have that has this injury. When you when they come in and they say the head, they’re going to describe the feeling as someone shot them, or through a rock and hit them in the back of their ankle. They’ll all it always be they’ll turn around and look to see if somebody kicked them. They always are convinced that someone attacked them some in some way. Because it’s such a sudden, kind of crisp impact feeling. So the last soccer player I had to add Achilles rupture. He said I was dribbling along with the ball. And then he said someone kicked me and I turned around and there was no one around me. And I started yelling at people. They’re like, No, man, you were by yourself. And sure enough, he was he ruptured. Yeah. So it

Justin Trosclair 24:16
is do how to, like, prevent that, because you’re an athlete, and that’s an option.

Unknown Speaker 24:20
Absolutely just happen. So yes, there is the risky launch back launch forward or launch forward off the back foot that we just described, you know, maybe modify, avoid that don’t do accredits explosively. But think about Achilles tendon, right tendon is just, it’s the end of the calf muscle, so the calf muscle tapers down becomes the Achilles and attaches at the heel. So the tendon is just the way a muscle attaches to a bone so it can then move it and calves and an Achilles or any tendon need to have some elasticity to them. Now, the reason they need less disease, so they can soak up that impact, instead of just snapping like a brittle twig, you know. So remember, we were just saying flexibility problems are the number one problem for all patients with moving parts issues or musculoskeletal issues, which means they’re not elastic, so it just means they’re, they’re more likely to snap, then give and soak up the impact. So improving calf and Achilles flexibility. And there are two if two caster upper cash stretch and a lower caste wreck, which is an Achilles stretch that I tell patients to do. So that’s making sure that equipment can absorb the impact. That’s what that addresses. Now also, you can strengthen tendons themselves, meaning attendant has, like if you’ve ever been fishing, you know, you’ve got like 12 pound test, right? Right, you got fishing line that has a certain amount of weight, it will bear will tendons have a certain amount of weight that will bear to you can increase the amount of weight your own tenants will bear by doing he centric loading. So he centric is the down part of any movement, essentially. So if you were doing a curl, and you pulled the weight up towards your chest, that’s the concentric part. And then when you lower the weight back down towards your thighs, that’s the E centric part or people call it a negative. Yes, yes, yeah, the negative part of that movement. So what you do is you exaggerate the down part of a calf race, or a heel like a

Justin Trosclair 26:23
stair right, like if you’re stepping on the side of a stair, you’re

going to get lower.

Unknown Speaker 26:28
So for example, in our example of the Achilles, I would have them stand with a four foot one four foot on a step, holding on to something railing or something for balance, go up to full tiptoe height, and then spend six seconds lowering all the way down to a dead hang. And then return path level. Yes, to Yeah, so there, he’ll as low as it will go. And then stand all the way up to tiptoe, and then six seconds down again. And then I will have them do one set that ends when they can no longer reach full tiptoe. It’s a long time.

Unknown Speaker 27:06
It’s not as long as really, it’s not as long as you think 10 of those is a workout. Okay,

Justin Trosclair 27:13
I’m gonna do that today.

Unknown Speaker 27:16
It’s and, and I’ll have them do that once, maybe twice a week. And what you’ll find is that week over week, you can do a few more reps before you like first week, maybe you can do an eight, second week, maybe 10. And then 12. So essentially, you’re your calf is getting stronger, but your Achilles is getting stronger, too, which means it can withstand more load and is less likely to fail. So that’s a really long answer to your question.

Justin Trosclair 27:40
Do you find that it could be it’s partly it can be biomechanics is off as well?

Unknown Speaker 27:44
Absolutely don’t live in a vacuum? If one, right, yeah. So anything can contribute to anything else. And the closer the closer that their part is to the injured part, the more the bigger potential effect it can have. So you’re right, let’s say if you’re, if you had zero mobility in your knee, and you’re trying to run, well, what’s going to happen is you’re just gonna be bouncing off your calves everywhere off your toes, right? Because you can’t bend your knee, you have to get that movement somehow. So that’s an extreme example that illustrates your point. Which is yes, if my knee doesn’t track, right, or if I don’t, my glutes are too weak. And then I’m trusting my calves to propel me forward more. So essentially, yes, you’re absolutely right.

Justin Trosclair 28:24
That’s where the assessment comes into. You watch them do something, yeah, you can’t squat, you squat, and you need, you know, goes off to the side, like that’s not good, or it goes too far in you like that’s, that’s a problem, right? There is a foot, your foot hurts. But really, you got a whole other thing going on.

Unknown Speaker 28:41
So basically, my approach is they got an Achilles injury, I look at every possible contributor to that injury, which is basically from will say ribs down, hips, lumbar, spine, knee, quad, glute, all that stuff, IT band, calves, foot and ankle. And I just catalog any deficits that I see whether their mobility or strength, and then we just plug in the fix for those things. And then we have more workers online to cover for that injured part. Because if the rest of your muscles are stronger than the Achilles has to do less work, because it’s that workload is being shared across more workers, right? And then you get more performance because you got more workers and it’s less likely to hurt anyone spot because no one spot is doing that much. There we go. If that makes sense. Well, we definitely went on a rabbit hole today. And that is

Justin Trosclair 29:29
that I hope somebody learned something today, especially the, you know, I mentioned that in the pre roll. You’re like I really liked you know, the way the podcast set up for me new grads, but I think, you know, whoever’s listening to this, if they’re getting into more rehab and all that focus, like oh, okay, they just learned something to grab on to and learn more about, you know, sometimes you just, you gotta have something, sometimes you’re like, What are you talking about? Oh, I get that. Okay, now I know where to go focus my attention on YouTube, watch some videos, or take a course or whatever. And learn something. Yeah, very good. For doctors who were struggling, or just starting out, what are some of the things that they should do, it doesn’t have to be a lot like just one or two that you find after having so much experience that they should definitely look into.

Unknown Speaker 30:15
Now, there’s a couple ways you can struggle, I’m guessing, the most common cam that most people gonna be interested in is struggling financially, trying to keep the doors open, try to get enough patients to pay yourself and your staff and your rent. Right. So is that is that kind of what you’re meaning? Mostly? Behind your question?

Justin Trosclair 30:33
Yeah, that we can do that. Let’s go with it.

Unknown Speaker 30:35
Yes, starting off is the tough part, obviously, because you’re starting with zero patients. You know, we all that’s where we all start. I will say this for a new grad, or a soon to be grad do what I did, if at all possible, which is find an existing doctor in practice, who is willing to here’s what the doc did for me, he paid me to be his exam doc. So basically, I shot his X ray, I did his exams, I did, you know, therapies, on his patients, whatever. And he paid me, you know, whatever, three grand a month. And he said, in the off time, when we’re outside of our normal clinic hours, you can see and treat your own patients in our, in our office, using our staff to bill and all of our equipment, and so on. You can see your own patients during the off business hours, and build your own practice that way. And he said, in exchange for that I would pay him 40% of what I collect on top of was that make sense? So he’s paying me and then I’m paying him a portion of what I make from my patients. He’s paying me for treating his patients. And he’s allowing me to build my own practice. And then he takes a portion of that, which is a 40% is a great deal. Because if you think about if you were to go start your own, open your own shop, your overheads going to be way more than 40. I mean, it’s going to be close.

Justin Trosclair 31:54
That’s the normal I mother, I tell people when they ask about becoming an associate, or like, I’d been a contractor, when you should aim for at least 40. Because you’re not going to get much more than that. But you don’t want to go to like 20, because then you just you might as well just get a different job, because it’s gonna be way too much work to get a salary that you can survive on.

Unknown Speaker 32:12
Yeah, and I mean, on the first day, you open when you have no patients, your overhead is 100%. revenue, you know, but hopefully you work it down. But but so what that let me do was build a practice at a pace I could handle, you know, and not go broke and not get evicted from a place if I had my own place. And then I ended up outgrowing his office because my practice got big enough. And then I opened my own, which is I’ve had for eight years now. I guess I’m like that

Justin Trosclair 32:41
that’s really strange that he would like that, because normally, we’re always no compete, or at least like one mile, what can I grab on to legally that they can enforce? Those guys gonna just take all my patients, you know, there’s always that fear. And he’s just embracing it already saying, No, I expect that you’re going to do this. So the year right.

Unknown Speaker 33:01
And I think the non compete thing is kind of hard to enforce. It’s, it’s hard to enforce. Yeah, and but the other thing, too, is I didn’t take any of his patients, all I did was go open up my own shop with my own patients. And, and for him, he he should want he’s incentivized to want me to succeed while I’m in his office, because the more money I make, the more he makes, and it cost him nothing. You know, I’m just free money coming in. You want to work 70

Justin Trosclair 33:27
hours a week, but it go for it?

Unknown Speaker 33:29
Yeah. Yeah. So it cost him nothing. So it is a win win for both he and I. And if any of the any of your listeners who are soon to be grads or new grads, just approach these days times are hard, you know, they always are approach any established dog, especially if you have a rapport with them, or you know them or you respect the way they practice or looks like, especially if they have space, you know, someone you’d like to spend time with. And just ask them say, Hey, I’ll make this deal with you, or do you need an associate, or any associate job that comes up, and you’re considering, see if they will do that as well, you know, I hadn’t thought about, I can’t imagine why they would they just made me think too,

Justin Trosclair 34:06
we’re almost trying to be creative. And like, you know, maybe go work in a massage therapist clinic and start there, you know, start smaller rent space. And, you know, that’s an interesting idea. If you’re willing to work some strange hours, you might find a chiropractic office that you like that set up the way you would want it to be. And just approach them, you know, 5050, split 4060, split something after hours, and you just work on Saturdays. Now, your family life might be a little strange for a while, because you’re off until like six o’clock at night, you only work three, four hours a day, I don’t know how that would play out. But it’s something to get started. And you can experiment,

Unknown Speaker 34:40
it’s a swear there’s not the the risk of complete failure just around the corner at all times, which if you you know, if you get a lease on a place yourself, it’s going to be at least a six month lease, a year lease, you’re locked into that thing and you’re on the hook for that stuff. Even if you fail after three months, they’re going to come after you for the rest of that money. Now, you may not have it, but they’re coming after you anyway. So that all that risk is gone. If you do it this way we’re talking about and it’s a, it’s an easy, it seems like would be an easy sell for the hiring doctor, the hiring doctors and associate to do that. Because like I was saying it’s free money for them very interesting. I did work for a year and a half as as just straight up associate in a group practice right out of school, that’s what I did, I really do recommend that approach because it lets you get both some experience working with real patients and seeing how that they treat your you know, your, your attending your clinic director treats and how they want you to treat you’re going to develop your own thoughts on how you like things done, it may not be the way they’re making you do it, which was the case with me, I really didn’t like the approaches that we took. But it really informed what I did want to do going forward once I started on my

Justin Trosclair 35:54
own. I’m not I’m not opposed to the associates, you know, getting out of school and do that. Because like you said, there’s so much you can don’t know, or you could find to especially how to communicate, because my goodness, you could be a marketing machine, and they just run right out the back door because you don’t know what to tell them to make them understand this is what’s wrong with you. And this why should come in and I’m not knocking like no crazy 20 visit package, I’m just saying even four to six visits, if you don’t want to communicate what you’re doing, they might be going into. And that’s not great either. So you can learn that on somebody else’s dime. And I have so another soapbox. And I think a group that I’m in that we we say the same thing. You should be paying your associates well not like crazy well, but they shouldn’t have to worry about Should I go Barton after hours, because you don’t even pay me enough to cover my basic living. And that seems to be something that happens. And luckily, we are seeing the trend where you know, these doctors out of guests are waiting before they can say okay, I can afford it. Now, here’s 60 grand, or 55,000 or something like that, plus bonuses. And now we can you know, focus more on patient care versus Okay, what do I do this month? Because I can’t even cover it all. So it’s just frustrating to me, right?

do you market at all? Any tips for that?

Unknown Speaker 37:09
I rely almost, I’ll say super heavily on Yelp and Google reviews. And I will say that is the cheapest Well, there I mean, they are free, both of them. And it is a place that potential patients turn to more and more. I mean, you know, if you’re looking for who’s the best mechanic on my side of town, you know, you’ll go look at Google or Yelp. I don’t know Do you guys have Yelp there? In China?

Justin Trosclair 37:35
Oh, no, we have we got our own, they got their own everything they have got a knockoff of you can imagine.

Unknown Speaker 37:40
Okay, brother reviews.

Unknown Speaker 37:44
And, and basically my my, that’s the single best thing you can do is start accumulating reviews, because time is going to go by regardless, they come very slowly. But they will accuse me just

Justin Trosclair 37:56
looking I was like this guy must be paying Yelp a lot to

Unknown Speaker 38:00
keep them all current and not

Justin Trosclair 38:01
because I’ve heard yelps kind of crazy. But uh, you got a lot of reviews, or something like that. That’s, that takes effort.

Unknown Speaker 38:07
And it does. And guess what? I don’t pay them anything. And you’re right, that they don’t show. Let’s see, I think they don’t show. It’s all look here, but it’s something so it’s something like 80 reviews are hidden. So I think I have 70 something show 75 showing, but they’re at his a ton. So basically, I think yes, yes. So it’s very frustrating. But it is worth it. Just stick with it. Keep the ones you have. But here’s what I’ll say they’re the best practice to get them is when you release a patient from care and they are at their happiest. That’s when you send them a little short, I do a little form email. It’s just a it’s just a canned response in my Gmail, I just write the email once and basically says, By the way, so and so congrats on your recovery. You put in the hard work. I’m really happy with your results so far. If you have a second, would you mind rating us on Google or Yelp? Here’s how to find us. And of course, if you don’t have time, it’s no problem. Regardless, if you ever have questions, let me know. That’s the email and I just send it to every happy patient and they just start accumulating so on on

Justin Trosclair 39:18
you don’t even automate it is just I guys finished this girls finish up send. Yep, for the guests listening. There’s a couple of podcast episodes further back, that actually have people that do this, like 9099 you can pay people to have it all set up automated in case you’re like, I ain’t doing all that. I’m not supposed to remember all of that kind of stuff.

Unknown Speaker 39:37
I have the cheapskate version. It’s free my way. But it’s worked for me so

Justin Trosclair 39:42
far. Oh, I want to ask you. So you’ve made volleyball. I understand how you can get into that. Like if you’re in the volleyball, you’re at events, you already play it. You’re an athlete in that area, natural to start treating your friends, right friends know people and all of a sudden now you’re, you know, you’re hooked up a VP and you like, but the partner Justin is curious about is you do stuff with bands. Is that common? Was it just a one time thing? What is up with that?

Unknown Speaker 40:10
It’s kind of a fluky thing. So they called me out of the blue. So there are companies whose job it is to manage health care for roadshows like big bands that travel right, and then

Justin Trosclair 40:25
they get some carpal tunnel or something while they guitar picking.

Unknown Speaker 40:27
Yeah, and so they may get massage therapist, chiropractors or medical doctors, whatever. And so this person’s job is to locate and court get the health care that the band members need. And this case it was 30 Seconds to Mars, which here here in the US, their music is played all the time. It’s Jared Leto, who’s an Academy Award winner, by the way, Oscar winner and his brother Shannon lead. Oh, who’s the drummer for the band. And interesting story. So the lady just called me who runs this company. And she said, she said, hey, I’ve got the band in town. She’d actually called me for Trans Siberian orchestra also several years ago and said, we may need you. They’re going to be in

Justin Trosclair 41:11
town, a lot of people.

Unknown Speaker 41:12
Yeah, that would have been a job. You may need to hire. Right? And they ended up knowing they ended up needing me. So I didn’t get to go. But but they did this time. But she said, I looked around it looks like you’re the best chiropractor in town, would you want to do this job and it pays $250 for an hour’s work. So I was like, yeah, I’ll do that. Now, the interesting. So I guess she just looked me up online. So again, that goes back to review all those reviews. Yes. So that’s what you asked, how do you get these crazy gigs? It’s the reviews. Dr. Buckman. Yeah, and it down his butt. So I got there. And I worked on Shannon. He’s just wonderful dude. He’s super fit, super clean and everything. And really nice guy did some work on his shoulder. He had rotator cuff tendinitis. And then he said, he said, Hey, man, drumming is hard work. And I want to know if you would mind watching me play and just see if you have any tips or tricks for me. After I’m done. Like as to how I could protect my shoulder. I was like, sure. He said, Come on out with me. So I walk onstage with the band, Oh, my God. And he’s like, Here, you can stick you can stand right here. And then I’m standing right next to the drum kit. And then it is a packed arena laid before me. It was a surreal moment. And I stood there and listened and watch the entire concert. My good. So it’s, it’s if you develop a reputation, which again comes with time, more and more of these, these kinds of things just kind of fall in your lap, the abp they gave me a call for that, too. So the pro volleyball tour has been in Austin now three years in a row. And they call me every year when they’re coming and asked if I’ll do it. Of course I do. I don’t get paid anything for that. But I get to work on Olympic gold medalists and all my favorite athletes. And they we all know each other now we get to joke around and then I also get to do courtside medical, which is cool. And actually watch the players. You know, it stays.

Justin Trosclair 43:04
I mean, when I think about that all the work that you got to do a potentially could do in a weekend, when you’re not going to get paid? Do you get to put like a VP preferred doctor, you know, like New Orleans Saints prefer, you know, chiropractor type of stuff in answer to that and call that. Yeah, like, like advertise censorship spot? Yeah, like you get the ability to put that on stuff.

Unknown Speaker 43:27
No, in the wording you gave me they’re actually very strict about how we can describe it. So basically, I describe what I do, as I’m on the a VP medical support team. It’s a different different team in every city. So like on our team for and I can say that. I can’t say that I’m an official, a VP, doctor. I cannot say official anything. But I can say I’m a doctor on the abp medical support.

Justin Trosclair 43:56
Okay, so you can use that for some advertise? Oh,

Unknown Speaker 43:58
yeah. And then certainly,

Justin Trosclair 44:00
yeah, absolutely. You know, I almost did that for the little bit do tour like snowboarding, for the X Games and stuff like that they were you can apply and do all this kind of stuff. And at that point in my career, I was like, yeah, I’m not. I’m not ready to work on Shaun White, or something like that. I was like, Nah, know where I’m at?

Unknown Speaker 44:20
You know what, you know what? I’ll tell you, man, next time that happens, just do it. You’re going to be there if I will. Okay, yeah, he would. Who gets an opportunity like that? Just do it. That’s what I did. I took on tons of stuff I was not qualified for. And I was terrified. But once you do it, you you really care about doing a good job. And you’ll learn from it. And then it makes you want to learn more how to fix that same thing when the opportunity comes again. So it’s a great motivator. And also once you do the scary thing and you don’t die, then it becomes next year, the next. Okay. I didn’t die. That’s true. Yeah. Oh, my goodness. Hey, what’s what’s exciting you for the future, what you got you got any five year goals that you’re looking forward to? I do, I’m actually taught two courses to CE courses for the ACA, the American chiropractic Association, on their learn ACA platform. So they have I’ve taught to rehab courses, my low back rehab program is on there. And I get no money for that there were they were webinar formats, but you can watch them on demand, and ACA gets all the proceeds. So it’s just kind of me helping them out. But it’s also fun for me to do. It’s a resume builder. Yeah. And I’m starting a series of live seminars that that’s the thing I’m most excited about, because it’s to have three, their low back, neck and shoulder and knee rehab protocols, and they’ll be live hands on. And I know this, this is effectively a plug. But you asked what I’m most excited about. And I am most excited about this. They’re all going to be in Texas for now. But I’d like to expand that. But there live hands on and we’ll take you from consult, to report of findings to our exam report of findings. And then it takes you all the way through each step of the patient encounter all the way through the rehab, process the progression, and then return to play prevention, and release from care. So and every everything that I do with patients we will all do together. So every exercise, every stretch, every bit of massage and myofascial release, everyone will get to do and have hands on experience with that. So I’m excited about spreading this approach. So that all chiropractors can use a new physical therapist they want to come to but that’s the thing I am most excited about. Now, I would also I want to be your my first podcast I’ve ever been on. And I’m super stoked. That was you were one of my goals, by the way to be on a podcast. And you graciously invited me. And so I thank you for that. I do want to be I want to be on Joe Rogan. I want to be on Joe Rogan. I want to do a TED talk. So I mean, my goals are like they’re they’re up there. And who knows if I’ll achieve them. But those are those are the things that I want in the next five to 10 years.

Justin Trosclair 47:09
Well, Ted Talk seems to be doable. Yeah. If you watch enough, you can kind of almost say hack the system, but you can definitely find a way to do it. We’ve had two on the show, inadvertently Why? I got on from marketing. One guy got on for chiropractic. And he had like he was was interesting. He had a, like a innate intelligence ish type, which I’m not a big fan of that word. But yeah, I was able to package that for kids and have a talk about that. And I was like, Huh, and you present something. So just give them that encouragement that, you know, that’s what you want to do. There’s those TEDx events. I’m pretty sure there’s an Austin when you may have to go to someplace else. Austin might be too intense for the first time. But

Unknown Speaker 47:50
right. You know,

Dr. Justin
Trosclair, DC
you know, Austin’s a hotbed. They got so much stuff going

Unknown Speaker 47:54
on. Right, right. We’ll see. I’ll be terrified. But if I get a chance.

Justin Trosclair 48:00

Unknown Speaker 48:00
Yeah, said you gotta do? Yeah. Hey, Jim.

Unknown Speaker 48:04
I am need to know.

Justin Trosclair 48:07
You need to know, the seminars that you’re going to put on. Sounds to me like you show up. I don’t know if it’s a two day or one

Unknown Speaker 48:12
day, but one day eight out

Justin Trosclair 48:14
Monday, eight hour, one day, perfect. Monday morning, you’re gonna have a lot of notes. But you can really just hit the hit the ground? Yes. It sounds to me like it could be somebody who’s looking to get their feet wet. Maybe they were an innate intelligence doctor. Maybe they’re like, Ah, you know what, I need to change. I need to do rehab, I need to be more evidence based. My patients deserve better. And they’re like, What do I do? Like, I don’t know where to go, what to start with? Maybe I need to go check this guy out. It’s only one day. Yep. And then from there, they can actually build if they feel like, Well, yeah, couple months later, maybe I need to build more on it. Okay, cool. There’s all these seminars you can do are not feel great. Let me do this for a few years and get people better,

Unknown Speaker 48:52
right. And that’s exactly having your right, it’s either for someone who’s been, you know, maybe they’ve just worked on spines, and they’re really good at fixing backs and necks and so on. But they want to add some more tools in their tool bag that they can use to fix patients, either their current patients, or a whole new population of patients that wouldn’t come to them for knee pain, for example, or for, you know, post op anything. So you can grow your practice and profitability and the benefit that you can give other patients in the community if you have more tools in your tool bag. And that’s kind of how the that’s how I think about this. It just, it lets me choose a more precise tool for things rather than just final nip. And just you know, and then the electro stem, ultrasound, traction, heat, nice stuff, which those have usefulness, but their usefulness is low, lower than some of these other tools that are available, maybe like you should be doing to very, very much couple visits, some nice them and then, you know, move on.

Justin Trosclair 49:53
Yeah, that’s kind of how it looks at it. Yeah. And we’d be remiss without saying doing, they might already be doing some time rehab, because they know they get paid for it. But if you’re doing real, some real stuff, and you can feel confident like you’re doing a real service, you can double your practice right there, because that’s a whole nother charge. Yes. And extremities is another charge.

Unknown Speaker 50:10
You right, and insurance companies pay way more for the rehab stuff like the therapeutic exercise, for example, they may pay 30 bucks for that. Whereas for, you know, Eastern, they’re going to pay what six $4? Something like that.

Justin Trosclair 50:24
Yeah. So a little more time, but you get way more money.

Unknown Speaker 50:27
Yeah, so the reason the insurance companies pay more is because this bed is more effective that those Yeah.

Dr. Justin
Trosclair, DC
Are you a cash practice? do you encourage insurance? What’s your thoughts?

Unknown Speaker 50:37
We’re almost will accept cash, but we’re mostly insurance base. So it’s probably something like 90%, insurance, major medical,

Justin Trosclair 50:49
are you happy with that? You feel like, if you could do it over, would you get out? Or at this point? What do you thoughts?

Unknown Speaker 50:55
You know, yeah, you’re right. So So of course, there’s benefits in drop. So each I fantasize about a cash practice. I will say that, because everything is so much simpler. You know, you need fewer staff. Like right now, I only have one staff member. And she’s amazing. And she’s a certified billing specialist. And she’s great at what she do. She doesn’t she’s worked for me for 12 years. But that’s impressive, but I pay her a lot of money. You know? And if I would, you know, I’m not looking forward to let’s

Justin Trosclair 51:27
need one person,

Unknown Speaker 51:29
we should have one person you do. But do you need a $60,000 year person? Or do you need a $30,000 year person to answer phones and schedule? You know what I mean? So, so that would be the difference between an insurance versus cash base. You can hire like a high school intern or you know, someone who’s not specially skilled and therefore requires a bigger salary to answer phones and book appointments with cash practice, and it plus you get your money immediately. You can you can make deals and practice and prices, you don’t have to worry about contract prices and all that you don’t have to worry about audits, you know. So it is very attractive, but it’s it’s in my it’s my background that I think about, we’ll just see how the healthcare landscape shapes up going forward. Of course, it’s kind of getting crazier and crazier, as far as major medical coverage and Obamacare and all that,

Justin Trosclair 52:20
are you finding that you can take insurance, that’s great. Back in the day, it was a $20 copay. But these days, they’re pretty much going to be paying the full price because they have the deductible that has to be Miss. Yeah, this

is just an easier conversation. Like, look, you need six visits, your insurance won’t cover, you know, you got to pay to meet your deductible. So you’re still gonna come out about 75 bucks a visit. And once it’s met, it’ll drop down to your 20% or whatever it is. But yeah, you’re still looking at $75 a visit?

Unknown Speaker 52:45
So are you asking is it easier to be able to since the deductibles are so high? And everybody knows that is used to that?

Justin Trosclair 52:52
Yeah, cuz everybody ends up being the back to you’re coming to the fact to cash practice because of the high deductibles are you noticing that it affects treatment plans are people having a hard harder time committing to the care for

Unknown Speaker 53:03
us, not as much as I think other PT shops or chiropractic offices that have bigger plans. So just so you know, my my average, I looked over 2018, I looked at every single patient that had and by the way, in 2018, I had 660, or 80 new patients, and our average treatment per patient or visits per patient was 2.69. The thing that’s

Dr. Justin
Trosclair, DC
six is great.

Unknown Speaker 53:35
And so because but that’s my release for criteria, by the way, is the patient is 80%. Better, they’re equipped to get the remaining progress on their own, and they’re equipped to not need me again. And once I feel they’ve they’ve reached that, then I released them so so we’re going to well really fast. You do like a follow up

Justin Trosclair 53:50
in a couple and like a two months to make sure to know where they’re at. I usually

Unknown Speaker 53:54
don’t I usually don’t I do tell them that they all my patients have my personal cell phone and they have my email and they are have orders to call or email me if they ever have questions. I tell them email, and most of them are good about that. And then if it looks like it’s just if they have a problem, the email means it’s a little tweak, I just send it to them as not as they come on in. But my point to answer your question, our average collection per new patient per patient is $255. Okay, it’s a terrible, it’s that’s a lifetime, visit average, I think that’s what it is. Our average collections per patient is $255. So with a cost that low, pretty much anyone will agree to do that. So we don’t have a lot of drop off because the high deductibles just because like you said it is effectively it’s a de facto cash practice already. And they like will invest that for when you when you can say, hey, three visits, you know, right point six. I mean, some people got four. Yeah. And some people only had to, you know, so there’s

Justin Trosclair 54:57
so there’s definitely Okay, I didn’t guy he goes blogging was better and for are coming home or something like that. And that’s what he was theories. He was like, if I can get you seen results, or whatever and four visits, he’s like, I’m not doing my job, right.

Unknown Speaker 55:11
I like that approach. That’s a different

Justin Trosclair 55:13
viewpoint than a lot of places where it’s come a lot.

Unknown Speaker 55:18
Well, and that viewpoint you just quoted there happens to be the very thing the patient cares most about is they came to you because they don’t feel good, and they can’t do things. All they really care about is I want to feel better and be able to do things. And if that happens to be your goal as well, and you’re measuring your effectiveness on that scale, they’re going to love you because they’re like, hey, this guy wants exactly what I want.

Justin Trosclair 55:42
So I’m going to do whatever he says, and your system does have like a like a pre check. And then you know, two visits for visits, whatever it is, they’re they’ve met the goal that we want it now that might take eight visits because you had a torn torn Achilles, that’s obviously will take more than two visits. So there’s some way to Yeah, yeah, quantify this?

Unknown Speaker 55:59
Yes, there is you? That is an excellent question. So I use an outcomes assessment tool for that. So there are many many, right there’s a neck oswestry, in the low barriers, what I forget all the name, Roland or whatever. Yes, and I use the p s. f s, which is the patient specific functional scale. It was recommended to me by the head of research at PCC, her name is Cheryl Hawk. And I was asking her for the best tool to kind of quantify my results that I get with patients, she said this one, and it happens to be super easy to administer patients get it. And it’s, it’s, it’s it, I do it right there. And my patient notes. So the way it works is day one after console. But before exam, you ask the patient, what are the three activities you are most limited from because of your pain. And so let’s say if they have their their for low back pain, it’s going to be putting on pants and shoes and socks in the morning, getting up and down from a chair or putting clothes in the dryer perfect, for example. So those are three common activities that are painful. And I’ll say now, give me a score for each of those for how well you can do them zero is I cannot do them at all 10 I can do those things as easily and comfortably as I ever have. So low number is worse. So if zeroes can’t do it all and they say, Oh, I can, I have to have my wife put my pants and shoes on for me then that’s and I’ll say it too, right? So then you get three numbers, you add them together and divide by three. So let’s say it was a two, three and four, with the scores they gave us. So that means the average is going to be a three. And I believe if my math is right, so that’s their initial functional score. Then when I wrote the day I released them, I asked them the same questions. And let’s say they’re like, it’s a 789. So then the average there is an eight. So they went from a three to an eight. So they had an improvement, five functional points, which is actually a really big improvement on that scale. And then I track all those, I’m kind of obsessive, but I track all those in a spreadsheet on Google Sheets, and I’m keeping data on them. And then I want to publish a case series. On my results. Once I get I’m up around 100 and hundred and 20 patients so far that I’ve been doing this 120 new patients,

Justin Trosclair 58:25
that’s starting to be pretty good number there, some nice little in sample value.

Unknown Speaker 58:29
Yeah, nice in number. So I want to wait till I maybe get 200 and then publish a case series on it. And these are all injuries, all body parts pre post op, knees, neck, shoulders back, wherever I’m lumping them all together, because I’m using the same treatment method for for all. So I’m trying to evaluate my treatment methods versus say, physical therapists or other chiropractors or

Justin Trosclair 58:51
they choose you can compare this Achilles person versus the other 15 to Kelly’s persons treated this year. And why does half of those not get better? Are they only improve to like, What’s up with that?

Unknown Speaker 59:04

Justin Trosclair 59:06
evaluate yourself to you like, Oh, I changed something halfway through the year, or I learned something or whatever. And Absolutely. Well, let’s switch gears. You ready? You got the questions ahead of time. Personally, you ready for this? Sure. You’re in the great city of Austin. They say keep it Weird, huh?

Unknown Speaker 59:24
They do say vacation.

Justin Trosclair 59:27
vacation? And are you able to take any? What do you what are you doing a disconnect from the office?

Unknown Speaker 59:33
So I did in February, I went to Puerto Rico, actually. And I use actually was a very cheap trip to so what I did is I

Justin Trosclair 59:45
you do a timeshare where you had to listen to an hour presentation. No,

Unknown Speaker 59:48
but that can work. I’ve done that before. I went all that on an overnight state to the Bahamas on one of those. Yeah, just

Justin Trosclair 59:55
just keep saying no.

Unknown Speaker 59:57
Yes, just keep saying no. They have to give it to you. So I have done that. But not I didn’t do that on this time. But I signed up for a card to Southwest Airlines chase card. And if they had a special going, if you sign up for the card, they give you 50,000 miles with a lot on the right. And then all I do is I buy all of my gas and groceries and for a while at let me pay my rent that way. So I got tons of miles. So I got my airfare free and I’ve got like, it’s just piling up. I have tons of airfare and you can use it for rental cars and stuff too. So that was really cheap, and spend a week there and then stayed in Airbnb, which are cheaper than hotels by the way more comfortable, typically more comfortable and you get to live like a local and then we prepared our own food. We didn’t eat out as much as we might usually. So that ended up being an affordable fun getaway. And it’s really a lot Puerto Rico’s Yeah, so that’s something and then I also like little staycation I call them or other people call, which is maybe go camping. Like there’s place called inks Lake, or a campground somewhere and may go there and camp out just you know, on a Saturday night and then wake up and grill over the fire, that stuff is fun, or go to being down the river, for example, which is cheap as well,

Justin Trosclair 1:01:19
there we go. I like it. The idea is that you don’t have to go on these extravagant vacations, you know, to have a good time. You know, I think with Chase, I don’t with my own card that I have. If you booked through their website, you can get 20% more value on your points for airfare. But I was January times, I was like, that’s great. But it wasn’t even cheaper. So I was like, if I used kayak, I can actually get a better price versus yours. But every now and then it’s not the case where you just you know if you do two churches want to get 20% more points value. The other one is just okay, that doesn’t count. So I’m gonna just get the car. Yeah, points overlooked, I think.

Unknown Speaker 1:01:57
Yeah, yeah. And some cards have better deals than others, but, but I’ve been very happy with that. They just keep piling up. So all my airfares are going to be free. Yeah, I don’t fly that often.

Justin Trosclair 1:02:10
This is random to just phone we’re talking about with my card. If you knew like, I’m going to go shop on Walmart, I’m gonna go shop and buy some Bose speakers are a whole but like there’s like 200 stores, you actually go through their portal through chase or whatever. But you know, you probably have the same situation. And you click that and you go to buy whatever you’re going to buy on that. For every dollar you spend. You can get to 510 points extra. Yeah, so Home Depot. So check that

Unknown Speaker 1:02:36

Justin Trosclair 1:02:38
Yeah, cuz like I think Home Depot, Lowes. That means you just get 10 times the points for the same dollar that you spent and you all you have to do is inconvenience of a little bit instead of just going on Amazon.

Unknown Speaker 1:02:49
Okay, I’m gonna definitely check that out. That’s all I’ve been leaving on the table. Thanks, man.

Justin Trosclair 1:02:54
Yeah, so random. home work life balance, hobbies, volunteering, what you got for us.

Unknown Speaker 1:03:01
So, first of all, I have a very easy schedule. So I set my own schedule, obviously. So I work five days a week, but only two of those are full days. The rest are just mornings. So Monday and Wednesday on 730 to six, Tuesday, Thursday, 730 to noon, Tuesday, Thursday, Friday,

Dr. Justin
Trosclair, DC
what do you do the rest of the day?

Unknown Speaker 1:03:23
Man, so I can like I went to the gym earlier, I shot some videos for my YouTube channel, which that’s another great marketing thing that I didn’t mention when you were talking about and you just getting started with it. Yeah, so I would recommend, but I shot like five or six videos for my youtube channel that I’ll be posting over the next you know, week. And I caught I talked to my mom. I mean, you just do the stuff during the day during a weekday that you don’t always have an opportunity to do. So sometimes I’ll take a nap. Or I’m playing I played volleyball. So I usually play on Thursdays and Fridays. And then I played a to volleyball turn last Saturday,

Justin Trosclair 1:04:00
a real quick, these short hours, you’ve been in business for quite a while. Is that something that someone in the first year two men should do? Or should they just work long hours?

Unknown Speaker 1:04:09
That is a great question. Now I actually adopted this schedule, because that is the same schedule. The senior Doc, who I was working with initially that told you that let me build my practice for 40%. Those are the hours he chose.

Justin Trosclair 1:04:22
So your after hours were the afternoon. It wasn’t even six to nine o’clock at night. Exactly.

Unknown Speaker 1:04:26
Exactly. So I had in that case, I had Tuesday, Thursday, Friday afternoon and Saturday. If I wanted a Saturday morning, I wanted it.

Justin Trosclair 1:04:39
That’s a question I should ask.

I’m assuming it’s between six and 10 o’clock at night. And you’re like, no, it just the normal afternoon shift. Yes,

Dr. Justin
Trosclair, DC
I’m young, I’m hungry. Why would I go home and do nothing?

Unknown Speaker 1:04:51
So and I’ve just kept I’ve kept those hours because we haven’t filled them. You know, I’ve expanded them a bit. You know, we used to open at eight started open at 730 used to leave at noon and come back at 230. Now I’d like to leave and come back at two. So we were starting to fill up and get more. I mean, I think this week, I have 15 new patients this week. Today’s Tuesday yesterday, I had five new patients yesterday, and they start filling up, you know, and so once it gets to the point where Hey, we’re staying pretty busy every week, let’s add another 30 minutes slot. And that’s, you know, two patients I can see or one new patient. Gotcha. So you’re not just sitting around at your office all day like no, let’s just

Justin Trosclair 1:05:32
these are the hours I want maximum out if we’re getting too busy or waiting list. We’ll just add some more hours. And I’ll just work another couple hours one day and go from there.

Unknown Speaker 1:05:41
Absolutely. Yeah. It does suck to sit in your empty office hoping someone does moralizing for I remember those days. I remember those days. It’s it’s there the longest days? Are you always

Justin Trosclair 1:05:56
answering your phone or somebody answering your phone though?

Unknown Speaker 1:06:00
Have someone who answers it for me?

Justin Trosclair 1:06:02
As long as it’s covered because you call a chiropractor on a Tuesday at three o’clock. He expects somebody to answer the phone.

Unknown Speaker 1:06:08
Yep, we got it.

Justin Trosclair 1:06:11
Okay, tomorrow. Yeah. Okay. Do you have any favorite blogs, podcasts or books that you would recommend and they can range from business to pleasure?

Unknown Speaker 1:06:20
Okay, absolutely. I will say podcast wise, I’m following you. And I also really like and highly recommend the forward thinking caravan Alliance. I don’t know if you’ve heard that one yet. Bobby, maybe, Bobby, maybe he has some heavy hitters on there. He has those three guys I told you about. He has really long podcast interviews with great cook and Craig leaving.

Unknown Speaker 1:06:46
Now I will say they’re not all great. As

Unknown Speaker 1:06:54
as far as books go, I read a book by an author named Catherine Rahman r a. m i in I believe, and she wrote a book called crooked and it’s about uncovering, I think corruption or something in the in the back pain field. And so I really liked your book. She’s very thorough. God bless her. She had back pain for a long time. She’s been she basically Chronicles her pain and all the people she software and all the different approaches including chiropractors. Yeah. And it’s it’s a very interesting read. So I actually reached out to her and emailed her and we ended up Skype talking and stuff like that, too. And I gave her some of my, I kind of took a little console with her and gave her some stuff. It’s difficult to do telemedicine that way, but I did give her some stuff and but her book is really good. for pleasure, right. And right now I’m reading the Mark Twain’s The Adventures of Huck Finn.

Justin Trosclair 1:07:55
Okay, the classics.

Unknown Speaker 1:07:57
And this is called totally off healthcare at this point. But there’s a book called The Name of the Wind by Patrick Roth office. It’s a trilogy. And it’s a kind of a fantasy, but really well done. It takes it gets a little bit of a slow start, but if you like anything, if you like Harry Potter, if you like any even Marvel, or any of the fantasy stuff at all, it’s fantastic. And I predict it will become a series of movies. It’s that good movie on the inside track, sir. Yes, yes. Right.

Justin Trosclair 1:08:32
Well, Dr. Daniel Bachmann, how can more people get in touch with you? What’s the websites and all of that?

Unknown Speaker 1:08:38
Absolutely. So first of all, I welcome anyone, if anyone if you’re a student, and I’ve already talked to the student, American character, the second student American character Association, that are to Texas tools and said, any of your students who want to talk to me or bounce cases off me or shadow me in my office, you’re more than welcome. There’s no charge or anything. I just like, talking you guys. And I’ll make the same offer to your listeners. I’ll give you my cell number. And it’s 512-589-2820. My email is Dan at Bachmann technique, calm so bachman is spelled B as in boy, OC k. m, as in Mary, a and N, and then technique. So Bachman, technique calm. Now also, you guys are welcome to check out my YouTube channel, which of course is also free. And it’s, it’s where I answer common clinical questions I get from patients or other people, and also talk about my rehab approach. So you’ll find that on YouTube, if you search Bachman technique, again, it’s Ba, Ck ma n n. So feel free any and all I mean, including you yourself, Doc. If you have cases you want to collaborate on, I’m happy I love talking about this stuff, being the detective and trying to work together to crack a case you

Justin Trosclair 1:09:58
know, it’s needed, right? Back when I really appreciate your time and opening up with a lot of how to and some of the numbers and all that just makes you feel like like, this guy’s a real guy. He’s approachable. You know, it’s relatable. And we really feel your passion in what you’re doing. So I really do appreciate you taking the time and coming on the show.

Unknown Speaker 1:10:18
Man, Doc, thanks for letting me come on. And you have yourself great day.

Justin Trosclair 1:10:25
That was a powerful interview, like always say please listen, critically, think about it, and then implement. I know a lot of people don’t always make it to the end of the episodes. But I encourage you if you made it here, and you can you talk to your friends about it, encourage them to do it. I think the family and vacation and the home life balance part at the end is important. It’s something that I didn’t get on a lot of those other podcasts that I was listening to. So check them out Minnesota Thursdays and Saturdays, those come out, let me know what you think about that. If you have an episode that you want me to do for the audience, just send me a message on Facebook, Justin Trosclair. MCC is the official page of everything about me. You can find the books that accurate puncture, no needle book, The today’s George’s tomorrow’s health book that talks about weight loss, exercise, dieting and financial health, you can get free chapters at.net slash chapters or slash in a protocol. So that way you can experience the book before you buy. And if you’re interested in in the interviews that I’ve been a part of where the roles have been reversed. It’s dot net slash as heard on the resources page on the website as all the products that I recommend, and there’s some deals for some of those. So check that out. And as always, if you click any of the hot links in the show notes page for books, we get a piece of that, and we appreciate that as well. the.net slash support is the web page if you want to buy the host a cup of coffee. And lastly, reviews are always always appreciated and so grateful when you get them. So that’s a doctor’s perspective. NET slash reviews.

You’ll have a great week.

We just went hashtag behind the curtain. I hope you will 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 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

About the Author
Dr. Justin Trosclair, D.C., an expert in Chiropractic Care, has been focusing on back and neck pain relief for over 12 years and has delivered treatment to more than 6000 patients. With advanced training in treating disc derangement conditions, you can count on him to keep up to date with the latest research in physical medicine for spinal pain. He has 5 years of hospital experience in China, is currently working in Germany, and had a private practice in Colorado for 6 years. Dr. Trosclair hosts a doctor to doctor interview podcast called ‘A Doctor’s Perspective‘ with over 220 episodes. During his free time he wrote 3 books. Today’s Choices Tomorrow’s Health (rebooting health in 4 categories), a Do-It- Yourself acupressure book for 40 common conditions called Needle-less Acupuncture, and a step by step guide to look like a local for Chinese dinner culture called Chinese Business Dinner Culture. If you have kids, you may be interested in his 6 series tri-lingual animal coloring book series (english, spanish and chinese).