E 174 Identifying Biomechanical Failure Patterns Rob Pape DC Quadrant Analysis

a doctors perspective 174 quadrant analysis rob pape dc
Dr. Rob Pape, DC talks to Dr. Justin Trosclair, DC on A Doctor's Perspective Podcast

Quadrant analysis helps practitioners navigate treatment based on a subclassification system breaking down biomechanical failure into traceable patterns.

Dr. Pape was evidence based and patient centered before these were buzz words and before the internet made it easy to collaborate. It was like being on a chiropractic island and taking trips with different professions to iron out what he was seeing work.

What is the reason that some doctors blame the patient when they don’t get the results that the doctor assumes you would get?

Should this be taught in schools with diagnosis and student clinic so they can apply these concepts (not cookie cutter programs)? This can help bridge the gap from being excellent at diagnosis and bridging all the techniques you know with practical application based on what the patient presents.

Test – Treat – ReTest

Are they hyper-mobile?
Do they have Systemic Inflammation? (abdominal sub-classification)
What’s their motor control with dynamic stability like?
Regional interdependence also plays a part

We really are missing key components to injury and relief if we only focus on the area of chief complaint.

When asking about ‘magical’ areas that tend to be overlooked… what is his answer?

Can we say mechanical dysfunction and drop the ‘subluxation’ word?

Dr Rob Pape may not have easy answers but he has easy ways to ask better questions.

Do you want a n=1 shirt, hoodie, mug etc? Then head over to my spreadshirt account and pick one up.

Codifying how you process and work on patients, while actually working on patients is a difficult endeavor but he managed to compile the quadrant analysis system and hopes you will see it as a way to be more efficient and effective with your patients.

Pain with normal range of motion could be hypermobility or random pain all over, tender to touch, massage and exercise may make it worse could be systemic inflammation are just a few of the ideas you learn about in quadrant analysis.

Relationship Advice:


When you are having important conversations, slow it down and really listen and actively listen to fully understand what the other person is saying. The thing you are UPSET about, if you slow down, is probably something on Your End that You need to Own.

Take time off – build a practice and a lifestyle that you can pre-plan vacations for the year.

Here are links to his Quadrant Analysis courses.

We discussed the anterior neck and here is a video on Practice Mechanics showing the basics of how Dr. Rob Pape approaches that. https://practice-mechanics.com/anterior-neck-manual-treatment/

As a summary and bridge to southeast seminars here is how all 3 fit together. You would take Dr. Riddle’s FAKTR course to learn the myofascial release, cupping, bands etc and then transition the patient into rehab to fitness and functional loading with Dr. Teter. However you would learn Dr. Pape’s Quadrant Analysis (breaking the body down into traceable patterns) to make a diagnosis and find functional deficits and patterns to apply those other two seminars to get the results.

E 85 Rehab Focused Chiropractic Professor Dr. Todd Riddle DC
Tom Teter E 175 Functional Loading Rehab Blueprints Tom Teter DC Rehab to Fitness www.adoctorsperspective.net/175
Other episodes mentioned in the show that would enhance this whole topic are:
E 115 Eradicate Chronic Pain GRIP Approach Benjamin Fergus DC
E 169 Shared Decision Making in Patient Centred Care Chris Chippendale DC
E 106 Cash Practice PT, Modern Manual Therapy, G Suite EMR, EDGE Rehab EQ Dr. Erson Religioso III DPT
www.forwardthinkingchiro.com/
Book list from all the past guests book recommendations

Show notes can be found at https://adoctorsperspective.net/174 here you can also find links to things mentioned and the full transcript

a doctors perspective 174 quadrant analysis rob pape
Full Transcript of the Interview (it will have grammatical errors and mistakes). Just Click to expand. Thanks audioburst!

Episode 174 identified by a mechanical failure patterns Hills. Dr. Just entrust off today with Dr. Rob keeps perspective during 2017 and 18 podcast, award-nominated, host, and best-selling author on Amazon as we get a behind the curtain. Look at all types of doctor and get special TV box here, a doctor's perspective. Happy belated Easter, everybody. I hope you had a fantastic time, reconnecting with family and friends and of course celebrating the awesomeness of forgiveness today on the show Doctor paper is a part of the umbrella of Southeast Sports Seminars, the head honcho. That is dr. Todd riddle. And his wife, Jessica. And there were a lot of people mention on this episode. For instance, if you want to know more about South these seminars, you can listen to episode 89. And that is Jessica, riddles episode, we talked about wage. Factor, which is dr. Todd riddles brainchild. That's episode 85 and the day, quadrant analysis, episode 174. And then the next episode actual is dr. Tom Teeter, with rehab to Fitness and his is 175. We also mentioned doctor, Benjamin Fergus with grip approach that episode 115, dr. Chris chip and damage with patient-centered decision-making and communication. That's episode 169. And also doctor person. Originally also episode 106 about modern manual therapy, cash, practice therapy type of stuff. And, of course, the ftca which is the forward-thinking Cairo, Alliance. So in essence, you would take doctor riddles, Factor course to learn the myofascial release the copying of bands, and all that, then you can do the transition of the patient into rehab into fitness into functional, loading with dr. Peters course and what you learn with Dr. Pipes quadrant analysis, which is Breaking the body down into traceable, patterns, and that's going to show you how to make the diagnosis and find functional deficits and patterns to apply. Those are the two seminars to see the results. So how do you analyze and examine the patient? Not just them, but first visit but also each visit test Street retest see, there's an improvement. But the treat part that's where the factor and the we had the fitness can kick. All right, so that's a really long introduction. Also a big thank you to dr. Rob on the show, he mentioned in equals one and that that we have T-shirts with that, actually on it. So if you visit a doctor's perspective. Net / t-shirts, you too. Could be the proud over of a in equals one shirt or some other Chiropractic or Louisiana themed shirts. Really like this guy, we had a nice discussion after the interview as well. It's just, it's just a really good guy. So I really appreciate him, appreciate his heart, appreciate what he's doing for the profession. Before we jump in last week, Our Guest Steve Anderson who creates dental office. Yes, he does. The build-out. He didn't know about that. He has an amazing book and has episode discusses some of the pitfalls and things to look out for, when building a clinic anyway, he had some nice things to say about me and the show off, so we'll play that and then we'll, we'll jump in. You do a great job of engaging and keeping the excitement going and sometimes you kind of Wonder of the, the host is still there. If you're interested in any of the books that any of the past, guess have mentioned, just go to a doctor's perspective. Net / Baptist, you can purchase those directly from Amazon and it'll help support the show with the little percentage coming to me. Okay. The transcript and all of the show notes can be found at a doctor's perspective. / 174. Let's go hashtag behind the curtain. Lot from Germany and New York today on the show dog. A guy that's a Rob, he's been around for a while and he's had practices in California in New York and Florida and he actually jumps around he spends time in both and I don't know how he does that. But somehow, he has also found time to create a analysis movement system called quadrant analysis and a few other fun things that he'll touch on. And so please welcome to the show, dr. Rob paper. Hey, it's great to be home for having me. I am just excited because I was looking back at all the energies that I've done and as far as the I guess the forward-thinking Cairo group that we have a a part of we've had factor and we've had wage Peter and now yourself and a few other people here and there that have some kind of approach that's unique and different and there's just there's so much that we can learn. Sometimes we have to say, okay, what's the best for me? You know, I'm right and so give us the breakdown of where you were and then how this kind of developed and then we'll jump into some more specific questions and things. Okay? Quadrant analysis which is what I thought. All this approach is isn't a technique system.

00:05:02 – 00:10:07

It's sort of more of a way of thinking and organizing certain details and it develops. Well, I mean, I'm in my twenty fourth year of practice near my covet brain thinks it's the 24th year. So I've been around for a while and I've seen a lot and I went to a sublease school and while I was in that subject school I did like a year and half of them at neurology program and then I got out of public school and quickly realized that subluxation. Based care was only really meeting my patients where they wanted to be like 30% of them, right? Like there's only really fully helping maybe thirty percent of the people and then maybe it was partially helping another twenty or Thirty per-cent of the people and then there was like forty percent of the people who said, they needed something else. And so I had to start figuring this stuff out and I'm old so that this is free internet, right? Like there's no resources wage I could just go online and take courses and figure stuff out, right? So I drove into all the massage therapy books I could and and trained with a bunch of massage therapists off soft tissue approaches. And then I started working with an acupuncturist and then my brother, and my sister, both became acupuncturists. And so I got into that world. Some and I know you, you have a needling book that you've reached that you put out, right? So and then my wife became a personal trainer back in the early aughts and she was, you know, training under these amazing physical therapists, How Long Will Clark and great cook and whatnot? And so absorbed, all of that information. And now I'm working with these people and we're all combining this stuff and little by little overtime, my approach to sub classifying patience and then my approach to practical mechanics developed a little by little. But I was out on an island Chiropractic Lee speaking by myself because I was, I was evidence-based guy in my mind who thought through problems and tried to meet people where they were in this patient-centered way, my goal with action is their goal, right? So my practice is very patient-centered. People can see me for however, you know, whatever reasons they want to see me. Their goals are my books, right? Just crazy in the eighties and nineties, right? And not, so I'm in Oakland California, which is subby heaven and it's I just practiced way differently than everybody else. So I don't have anybody to talk to about this stuff and so I'm talking to other professionals foul. I'd health professionals about this stuff and I'm learning from them and they're learning for me and I'm learning to talk across these different professions. And then I got on to somebody a dog in France, actually told me about the ftca. I'd never heard of it. In 2015, I believe this So I got onto ftca and my whole world changed because I didn't realize there was a whole, a whole world of evidence-based practitioners who went to different schools and did things differently and looked at them in different ways. And that was spending time there over the years and being really involved in that in that group and and putting my heart and soul into slapping people. And, and saving help improving myself was an amazing benefits of a right? What what, what a resource to have. So I've I've lived in, you know, both of these wage and, and worlds in between with all these other practitioners. And so, I see both sides of it along the way. I I, I started to teach, I wanted to teach in California. I wanted to touch base of the Life West kids, some of the Practical mechanics that are utilized and well, what I realized over time and talking to more chiropractors, and nobody was seeing the body, quite the way I was seeing it off. And then you know, I'm working with these kids from Life West and and you know I'll ask them a question. Like okay. Well you've got an apple. He's under. That's a please one. That's that's diminished on one side versus the other and you've got on the opposite side. You've got an apple used to or apple is over. That's diminished. What do you thinking mechanically speaking? Like how would you approach that? And their answer like a hundred percent of the time. Was I did just their subjects and and so then I'd ask them what if this person is kind of tender everywhere. But what if this person is, you know, has tremendous pain but the range of motion is Great song and their answer was Blanket. I'd suggest there subluxation not do some deep tissue, we're not doing some instrument. Assisted not do some rehab, some sort, it was just crack a bank, right? And so, I realized, I needed to give these, I mean, to me, they're kids, they they're, they're young adults. I I hate when I do that, that's not only does it show my age. But like, when I was younger, I hated when people do suck. I got to stop that, but anyways, I needed to give them a window into the physiology of people for whom, adjusting isn't the primary thing problem and they don't think that's the case.

00:10:07 – 00:15:01

Like everybody will get better or maybe 10% won't, right? Or, you know, and then they go, well, that's a limitation of matter, you know, they blame the patient a lot of times. And those doctors said and practices, I've been, you know, birth on interned and have Associates ships and some of these high volume practices and math. So anyways, that's little by little starting back in June 2015, 2016. I guess I had. Do you know who Noah volts is all adults? Majid real smart guy. He was at Life West, he was a little active in Ft long. He has his own podcast and thing on on YouTube. He's a smart guy. But anyways, he came to my office to Shadow me and he's watching me. And he goes, what are you doing in between patients? He's like what time? What is that? What are you doing? Yeah. And I'm like, what do you mean? He's like, you're combining a bunch of different types of manual therapy with exercise therapy, and, and giving advice that like a patient that's come in here. You've treated them differently and there seems to be some sort of method to this. Can you teach it? I was like, well, I guess so sure the rights and things down off, that's how it started. So I give no votes to correct. Okay, that's how it started. So then I started to codify things and put things together and that was and uncomfortable. Suck, cuz then you don't like nail it down. Like if you do this and do this, this, this should happen. Oh crap. It didn't always do that. Right? Well and duck. Just imagine, I mean, one of the things I about quadran analysis is that choice? It's all based on Concepts. There's no cookie-cutter to it at all. Oh, okay. The whole point is that it's not cookie-cutter. I think what, what I'm teaching should be, should be taught in schools. Quite honestly, it should be taught with birth. Diagnosis classes or right before diagnosis, classes, and before, and during well, in student clinic. So they can apply these Concepts because the sub-classifications relate to diagnosis, he's bought the diagnosis. He's like, I'd Mentor young doctors home. I caught myself. They're young docs from evidence-based, schools and their diagnosis is their abilities. Their skills are great, but they have no idea what to do when they get that diagnosed. I know a lot of techniques, right, they know techniques and they know the diagnosis but there's nothing Bridging the two. There's no, there's no conceptual knowledge and and practical knowledge. Bridging, the two that they can say, okay, well I see this patient. I'm going to put them in this Basket in terms of your subclassification, that tells me about their physiology and it tells me kind of where I need to to be thinking, but it doesn't give me a cookie cutter protocol gives me ideas, which I can then trial and error. Right? Test retest. And then here's the mechanics, we're okay. If I see a mechanical mechanical issue within dead This subclassification, I can prioritize it one of two ways so from my standpoint it's got to be a hundred percent practical. Yeah it's gotta be practical. I've taken so many courses that give them using information but then you leave those courses and you don't know what to do with that information. Would you say this is sort of if someone was into learning a system whether it's sfma or DNS and things is this, another category that they would want to investigate before they went to a seminar like these three or oh these are really good now. What do I do with it or what even factor for that matter? Are you like competing in a sense with those people? No no no, no, I'm not and actually my my course is split up in two locations. Okay, I have for the states, I've got six hours of continuing education for the states and I believe Parts Canada, and some credits are available internationally through, and it's on factors site. It's with Southeast SportsCenter. You guys, typically like connect again with the riddles? Yeah, well, Todd riddle. Doctor off. And I we you know what, last we talked he's like and we were talking about this course. He's like, man, I do my work because I'm just trying to make the profession better and that's what I said to him. I go look man, putting all this work into into this Thursday, it's not for my good, right? Right. Because I want. To be better. I want us all to be able to help that one extra person, right? So from my standpoint and a Quadra analysis, it can be, it's going to dovetail with whatever it is, you do. Whatever your skill-set is. I mean, my wife uses these Concepts and she's a personal trainer movement therapist. I know massage massage therapists use these Concepts. They can't use all the things I teach because their scope is different. But for chiropractors and physiotherapists, I think all of this stuff is applicable but the fact of the matter is, is it's going to dovetail with. It's going to help you a joystick what tool do you use and what situation? So that you start out in the right place and then you can you can Branch out from there. So let's see this. If you go to Southeast, Sports seminars. Whatever., I think. If you just log, Or someone who's like, I'm not that great at myofascial release, I've seen these bands, there's some news types, where you wrap an arm, there's cupping.

00:15:01 – 00:20:06

I'm not really sure what instrument of assisted you could take the factor, learn all of the stuff off of you. Can you can take dr. Peters rehab to Fitness and learn how to actually take somebody from an injury to recouping to Fitness to all of that stuff. The rehab part. You still have that one is missing, so maybe you're the piece that's missing to actually analyze what is going on with the exam. So that now you can actually pick the stuff, you learn from factor, and from rehab the fitness and make it all work together. That's, that's why I wanted. My course, exactly. Okay, so you you're you're the course that we need to have a starting point to evaluate cuz I saw your graphs your pictures and on the which is nice. As I mean they blow up just thought. All right. What's going on here? The way I looked at it, I was like okay there's some shade and colors shaded muscles and some on shaded muscles and so I have got I'm guessing that if there's something going on this side you may. Over these these muscles, you might want to consider and these muscles. You would consider based on the presentation that they have. And so you may have to work on certain muscles with in that quadrant to get the results that you're looking for. Yeah, early age, it gives you a pieces to the puzzle so you can start putting them together. I mean, at the end of the day, I want people to be able to Think Through problems and ask the right questions, I'm not giving anybody any there's no cookie-cutter answers in practice thousand, right? So even the best diagnosis slash protocol combinations. We have are only going to work for 10 people come in with that and have that diagnosis that cookie-cutter protocols only going to work with so many of them. So let's do an example. Thirty-four, year-old female office work, maybe she's a lawyer, doesn't matter, but she gets headaches. What are we what are we shooting for here? What are we looking at? What we want to figure out first? Are they? So here's the for stubble sub-classifications. We want to set, we want to with that person. I'm thinking are they hypermobile do they have some sort of genetic joint hypermobility? I feel like this is a, this is Jeff. Thing that is missed and Chiropractic over and over and over again, they'd crack their own neck every day or they want to come in and have you crack their neck over and over again because it just, it relieves it even if it just for an out, our page. So many of my, and I missed this for a long long time, until I figure it out often times, they're the patients that want to come in two or three times a week to get that crack. But is that really what what's, what's going to serve them best? It's not, it's not. So we want to know. We want to know that we want to look for that. We want to see if they have systemic inflammation and we have, we Define hypermobility and systemic inflammation, which I call abdominal subclassification in quadrant analysis, partially because we do abdominal. Palpation is one of the clues to see if there's systemic application, amongst a number of others, we want a sub. Classify and see if they're in that area. And then from a mechanical standpoint we want to, we want to sub classify and see what's their motor control Dynamic, stability. Like, are they just week and we have money? They're overcompensating or do they have good Dynamic stability and they just have mechanical dysfunction without the other sub-classifications and they're going to do great with manual therapy and adjusting. Most people have more than one subclassification. The easy cases, get a little easier because you figure them out a little bit quicker. Hopefully, and the hard cases, and this is really where, where the rubber meets the road gave me is that 20, you know, every you've heard this before. They're like eighty, 80% of the people who come in, you could slap them in the boat with a, with a shovel and they'd get that. Right. Right, right. Well, okay, well what about them 20% and that's, that's what I feel like, that's where we make our bones. That's where we, if we can Excel what that 20%, we change the game, we we start to now you can build a practice just on that 20%. Because if you solve problems and nobody else had been solving because a lot of these people had been around the block that they've been, they've been to all the cars and the physical therapist. And by the time they show up into your office, you know, somebody made them, go their wage. Had given up hope a lot of times. And if you can help that person who so you might be looking at a but issue for a headache, it might be, you know, there's a great story that some of the old timers tell about wage doctor Lewis, okay, and dr. Lewis examining this patient who has headaches and does this very thorough examination of the musculoskeletal system and then finds a spot in there. Left College puts a needle in it and the headache goes away. I've heard some people talking about that, right. You know what we call Regional interdependence? Now that's the real thing. The whole body is interconnected and it was really really common that we're missing things are for only looking at the area of Chief complaint. And I this is an issue. We have in the evidence-based side of our profession where we've become so lazy focused on the area of pain that we're not seeing the whole person, not just mechanically, but otherwise as well, oftentimes cuz I think the subluxation people they're going to do the flying 7 whatever they want to call it so they kind of touch. Yep. Everything. And so sometimes this evidence people like oh no no no you said low back pain we're not going to go up to the shoulders and look at that, right not indicated and actually if you have a system to evaluate somebody.

00:20:06 – 00:25:03

And you can find out what that is absolutely okay. Well would you say maybe some common hidden dysfunctions are things that we miss a lot? That's like like you find, I work on these couple areas in. Wow, it's just lack of education on the magic man because I do these couple things that usually the anterior. Part of the neck is a magical location. If I had a patient who had chronic problems and they'd been to a lot of other chiropractors, I would bet that the anterior neck would be a good location or make you scared to work on those scalenes and clavicles and things. Yeah, longest coli, the longest capitis wage, you know, getting up in under that jaw. Hm, right? Like that. There's a lot of buried treasure in some different locations. And again, the whole body is in play. Right? Is dr. Day has taught us anything. It's that we're dealing with a closed kinematic system and everything, affects everything else. If if somebody's walking on an ankle that has mechanical dysfunction, their Gates on a second, if it's going to affect the rest of their body, right? Yeah. They're sitting behind a desk all day and they're mousing with their right hand and they get up and walk away. And there's, they're short in their pronators on there, right side and shoulder in a rotators, that's going to affect the rest of your body. Could that create back pain? It sure, could be a contributing factor. And when I was in school, the old timey, subu chiropractors, who were awesome. They were awesome. They, they were whole body, they weren't dogmatic, they were lifestyle oriented in a specific way. Not in a come. Take my, you know, you have to bring bring your spouse and come take these classes or was it was patient center in a different way. Back in the day before the the practice management companies really took over in the nineties. But they I remember these Old-Timers would say to me that say if dead You could just figure out how like a system to find the primary area of dysfunction and interviews. They do subluxation determine, I'll use subluxation in my course, because it's a synonym for mechanical dysfunction for a large part of the profession even sub. A lot of subject, chiropractors, they just mean mechanical dysfunction, it's some sort of mechanical lesion, right? It's an easy way, lane it. Yeah, that's what, that's what they say. If we could find this area, this primary area that unlocks the rest of the body, then where their pain is becomes easy, I think quadrant analysis just moves us towards that. Okay quadron, Alice moves moves towards finding the hidden non-painful location, that doesn't fit with the rest of Life, pattern of the body. That usually is an old injury where the pain just went away, they never had any treatment but they'll oh yeah, I'd really bad pain and not right hip for like two or three weeks like two years ago. Just went away and okay. Well, then what happened? Well then like, 6 months later this, this next shoulder pain started and it hasn't gone away and that was two years ago, classic. Okay. Well, it's, you know, but Faith don't evaluate the whole body, you don't find that hip cuz they don't put it on their health. History course, they don't even represent it, it doesn't hurt. I was a big activator guy when I first got out of school, for whatever reason. So that was Monday. My my Niche working with people who were afraid to get their neck Twisted, it was okay, it actually worked. Well, I mean, I felt like the I used and abused in like the impulse instruments versus the activator instruments. But anyway, going through and taking these seminars and things. You know, the kind of touch on everything there. I kind of zoned in on some of the hip stuff, you know, interesting rotation and things like that, like some C5 stuff, and tym stuff. Anyway, as I went on with my continued education, I started going to some other seminars and like and people start mentioning hips this area that area and I was like I didn't know about this job. Like, it was my little one, my little hidden tricks to help so many people that they were struggling with. And I'm not seeing on like the best chiropractor. Anything. But there's just like little things that I, why are you struggling with that? And then like, oh my gosh, the hips thighs. Yeah, the hips of course, but he talking about, I don't know. It just seemed right? It was kind of cool that the experience that. Yeah, I mean, it's let's broaden our Horizons a little bit. If anybody should be the masters of full body mechanics, it should be chiropractors and physical therapists, and I don't care if you're a movement based chiropractor, I don't care if you're a manual therapy, based physical therapist that, you know, there's so much crossover between the professions now, but we should understand basic subclassification physiology and we should understand practical mechanics at a level, like nobody else. It should be it. Should she magical what we do? What we do? Should see, magical two people. Yeah, that's how good we should be at it and it shouldn't be accidental me, ask you this. It shouldn't be. It shouldn't be. Throw a dart at throw a dog. Well, and see if you hit the right, we should have a thought process to it. Compared to like a brand new graduate versus someone who's I've been say six or seven years.

00:25:03 – 00:30:01

How long would it take to get good at Q way home? That's a good question. I mean, if the course is in its infancy, so I have people who've been studying it for a little over a year. Now, there's for my beta test people, and each of them are doing just extraordinarily well with it. And it's, you know, every, you know, every every two or three days, we have a Discord group that we discussing and discuss things and, and every two or three days, they, you know, they come in and and describe a case and they're like, I would have never have. I would have never have seen this this way, and I would have probably, you know, spent four to six weeks doing this, this or that. But because I see it differently. Now, in the first visit I was able to give them relief that there's no way I would have been able to give them before and then they came back and that really stayed and you know, like stuff like that. So I think if something He did the course and really took it on. I think here. Okay, is reasonable, there's going to be a little bit of a learning curve with what you're doing but Implement as you go. Absolutely crazy. It's it's, I think the hardest part about it is, we are conditioned to think the way we were taught to think in school and we want cookie cutter. We don't want to think we want easy answers dead and I, I really don't have the answers. What I have, are easy ways to ask better questions, okay, questions that lead to a hypothesis that can lead to a trial that can lead to an immediate re-evaluation of that trial and you can progress more quickly. I'm, I'm a dogged practitioner, like, I want to solve problems and I want to solve them as quickly as I can. I, I grew up playing competitive Sports. I'm a really competitive person in certain Realms of my life and my practice is where I compete and off. Always trying to get better faster and more valuable and that's what I want for people. I want them to what what they used to do in a month time frame? And consider maybe a week time frame. Yeah. Mom look like how long are your visits? Are we talking ten minute visits? 30 minutes? It depends going to be Insurance based like, well, we have enough time to do all of it. Absolutely, absolutely it the style of practice that you have doesn't really matter, okay, you can do trial and error. However, you do it. You, you know, I had a practice in California, that was more insurance-based. And so, I saw three or four people in an hour and thought I'd see people two or three times a week up front, but my trials would always be two weeks Max and I'm re-evaluating really on every visit. Okay, people seem like they haven't really long treatment times each time you like how do you stay open because insurance is typically don't pay for that many rehabs for a chiropractor per visit. So like your kind of limited in what you can do per day off. Per hour and we have to have bills to pay to Absolute. You can take the knowledge, the QA ideas, and, and and knowledge. You can apply it in that type of practice or you can apply it in a, more of a package type of practice, which is what I have in New York. I Do by time in New York, I'll do 30, 45 minutes, 60 Minutes of people book me up up to an hour and half it works. Well. In this setting too, it's one isn't really better than the other. I've had cash. Practice pts before on the show, had a whole series on them. One of the drawbacks they said about having time is, if they pay for sixty minutes and your life. Let's do it. Only needed $15 to someone. People would say, an ethical dilemma. Do you cut them loose or do you make it go for an hour? Or do you find that you kind of dictate? I only booked you for 30 minutes because we had an hour last week and you really made some progress. I don't expect to need the more than that time with you. If we if somebody books an hour and it's clear that they don't need an hour that day then they pay me for whatever they need you know I'm not we're not going to ten more years. All swings, you know? No, no, it's not. I'm not, I'm not a rep counter at all. My practice is much, more manual therapy based than it is movement therapy based. I do rudimentary wage movement therapy with my, when my patients. But if people need and a more intense movement therapy scenario, I have people that I met that, I co-managed one but you could both I could somebody was really into it. Like, yeah, we have to do a little bit of this, but that's the first two weeks. And then we're gonna switch into the act of rehab part with the QA system at play. Absolutely. Absolutely, you know, so if if ten ten different people come in to see me with low back pain they're going to get ten different things and if the same person comes to see me 10 different times of low back pain, they're probably going to get ten different things on different visits. Okay. I'm asking people where they are, I'm treating them there. I'm evaluating for changes and then moving forward based on what I've seen whether there's Improvement or not mechanically in terms of performance job, Or function. Yeah, a golfer with a little back pain versus a construction, worker with low back pain. They're going to need different treatments based on what they're trying to do.

00:30:02 – 00:35:07

Exactly. Exactly. And you know ten different golfers with low back pain, might need ten different protocols. Now there's going to be a commonality there obviously, but they, they're still they're all individuals. We got a what with any equals one is is what we got to be thinking. Every time somebody comes in the door, I I try not to and this is hard for all of us, me included, I try not to assume things based on don't judge the book by its cover kind of right. Right because that's where I get like oh gosh we've gotten two weeks into this care and I completely missed a detail of this person's history or their their physiology cuz I didn't examine them fully cuz I just assumed that they're like the last person I saw who came in. It was this demographic that does this for work or this for for sport? Yeah, you know, I'm trying, I'm hopefully trying to move people away from home. And put put people in very individual boxes rather than who boxes. Yeah, if you do want to judge a book by a cover or a t-shirt, I do have in equals 1 t-shirts for sale. Oh, to you. Do I need to know about this? Yeah, I have some, some designs of like a an atlas in the in equals one and a few other like cutesy mixed towards. You know, they call us a Cairo mix stores. So I have some shirts with that on there. They're not like big best sellers or anything like that, but if someone was on red shirt, they would, they could find some stuff that I've created any way. I feel like I absolutely need an N equals one shirt. Yeah, I'll send you a link, please. Do you just, you just, you just made a sale, my friend before, or after somebody takes this wage, they need to take any technique classes, or would you recommend anything before? And after we have already touched on the Southeast Sports seminars that they have available but you know, you're like, you should definitely have at least this song, You're no. I think like I said, I think there should be taught in school. Okay, I think that should be. I think that should be protected. Could we just have one class and try eight or nine? Where it like matches up your system and somebody else's system and you can, like three weeks off each to expose people that the stuff? Well, I think, if you understand what I'm what I'm teaching, then all this other stuff. Becomes much easier to put into practice and you understand how to use it in a slightly different way that will make it more efficient. I'm really just trying to create an efficient practitioners at this point. Yeah. All these techniques are amazing. You know, this, this isn't a technique like, I mean, wage if that tire drills teaching is, that's genius level stuff. Yeah. But he even said to me, he's like, from a mechanical standpoint, what you're teaching is going to help my people do better with my technique. That's, you know, that's that, that was sort of the conversation we had and I was like crazy. Yeah, really I purchased cuz that guy is way smarter than I have. You talked to Benjamin, Fergus our doctor Fergus before with the Republic. Yes. Yes. Yes. Song. Other super bad guys, on another plane. That guy. Wow, you gotta take his classes. Probably twice. Super duper smart. You know, it's really interesting like when I was trying to codify this stuff and and honestly, I have KO defying, the work. That one does like watching yourself work. While you're working, is a really disconcerting process to go through. Why don't I do that job, right? And honestly, I felt like I was cheating my patience because my attention wasn't fully with them because it was me Examining myself. Hm, while I'm doing it, like, often. If you're a baseball player in your in your while you're swinging, you're evaluating your own swing. You're not going to be as good at it. You overthinking it to it that point. Yeah, you've got to be in that moment. You've got to get into a, you know, a flow state law or not thinking you're just, you're, you're using muscle memory, right? And there's a thing in practice where we get when we get good at this. A lot of stuff. Becomes we make connections that we don't log. Think about it. Something we haven't thought about for like months or years. Yeah. Just comes back. So Massey. Mike masse and I put together a practice mechanics during during this pandemic here. And so resource site for chiropractors inexpensive, it's $29 a month. I've got the rest of my practice mechanics stuff on there. So I've got six hours with with the Southeast Sports seminar, folks, and then I've got another like twelve hours on practice mechanics and then Michael Massee has all his administrative stuff, and then we've got a bunch of other practitioners who have given us great stuff, Chris Chippendales as given us some patient communication stuff series on page communication. We have a a concussion series, and a neurological exam series and and Rehab stuff from Trevor saw. This really cool stuff by smart people but so in this time, dr. Massey, who's been in practice longer and I have thirty years. He's been studying quadron else's. Hm, and he comes to me one day, and he goes quiet or analysis home. Hide things together for me that were disparate in my practice that I didn't see connected and it's making me more efficient because of it and he's thirty years of practice and he's a really, I mean, that's very successful practitioner.

00:35:07 – 00:40:08

So it's not just for the new docks. It's also for connecting. Yeah, it's also for I have docks or, you know, eight, ten years in practice, who are in the same boat where they're like, oh, okay, well, I've taken all these soft tissue management courses. And it's taken these movement about, they could just be bored. Like the kind of, you know, they're just doing the same thing for the last three years. And like, man, I got a job to do something for myself because I'm just getting so bored in here. What can I do? And then you start approaching things at different way. I feel like people start to Plateau with with what they have we all do and we want to learn new thing and we should you know I'm still learning new stuff all the time. You can't stop learning. I feel like at the end of the day, if I can help people utilize the skills, they've already spent time energy wage Money to learn practice and perfect. If I can make those skills, 10% more useful, 20%, more useful than I've done my job. If they can help one or two thousand extra patients a week, it's not ten or Twenty extra patients a week that they wouldn't have helped unless it would. They got lucky. Then I definitely done my job and I've definitely quadrant Alice's definitely gotten me. God not as a profession where I want where I want us to go. Have you heard of erson? Religioso, the physical therapists with modern manual therapy. He put out a lot of different products and we were working together for like, the one-sheets and the CVS that I do and he's like, I might want to give you a course which one you want and he had like an upper lower extremity twelve to eighteen our class and just all this crazy stuff and he just kind of muscle work and I was really interested in that but instead I took the blood cuff restriction course, which was a much smaller, much, less expensive, Less hours, but I was interested in it and the point being dead. When you're interested, you have to take continuing it anyway, take something you care about or interested about don't just go to your State Association and not come out on one weekend and not care at all. Yeah, that's about it. I get it, I get it. You know I mean a lot I think I feel like a lot of people. They're so busy that to take the time to learn something. It's really challenging. Yeah, these days. People are overwhelmed the data to use a pain science metaphor. Their cup is full. Right? So the easy cheap credits just to check the box, I get it, I really do and if you have a little bit of bandwidth then yeah, I agree with you. You got, you gotta take something that is going to stretch your mind a little bit and hopefully give you something. That's valuable that you can take back to your practice, maybe not that next week, but something that you can continue to study so that when you start to have the AHA moments with it, and that's my favorite song. With the folks who are studying the doctor studying quadron house. This is when they come to me and they go oh you know I had one the other day go pain in the presence of of good range of motion is a sign of hypermobility o or if you know like a pain in multiple locations recurrent wage doesn't seem to follow any sort of pattern, tender to the touch and much multiple locations exercise and manual therapy can often times make the pain worse. Oh, that's, that's systemic inflammation. That's abdominal subclassification. And I could palpate their abdomen and that might help me explain it to the patient better. So I get buy-in from them to, to maybe we're not just going to adjust away, this pain, may be something lifestyle oriented, you know, I'll give I'll give this sub. Use credit many of them focus on lifestyle really nicely, but they focus on Lifestyle the same way for every patient that comes in wage. Yeah, not every patient needs to say sells vitamins, though. It does show the power. I worked. I worked at a practice my first year out of school. Then this guy sold thousands of dollars of vitamins a month. Unbelievable. There's chiropractor recommended this product on the MLM, there's always somebody that's good at selling. Yeah, it was a thing. It was Faith disturbing to watch. But anyways, yeah, those aha moments and the best for me, the, the, where they, they see a. They see it in a patient and they go. That's the first off I recognize that. And I only recognize it cuz I took your course. And now, I'm able to help this person and I know looking back, just in the last month. I've had three or four of the people like that and I completely missed the boat on it. I wish I could have much back. Let's switch gears a little bit. Is it the last part of the interview where we kind of switch gears completely, you have your own Clinic, your wife has a clinic, let's just call it that a process of some sort. Sure. Sure. How do you Market we do? Okay, we don't, we don't Market, it's, we're all word-of-mouth. Word of mileage Point girl word-of-mouth. Yeah. All right. What about the stuff that you're doing the, the key way, the practice mechanics anything for that? Well, we're about to start marketing, you know, just with organic stuff on social media.

00:40:08 – 00:45:12

We have a marketing person. We brought aboard. Okay? And, you know, we'll, we'll do talks and stuff, but I'm doing your your, your podcast. You know how long it will get exposure, you know, organically as much as possible. Hopefully, okay, so this one typically we have some kind of significant other, maybe we have kids but people make success, they get divorced and I don't see their kids. They lost half their wealth. How or what can we do to keep the love alive? I love that question. That's a great question, you know. My my wife and I have been to a couple of therapy and off whenever we get emotional about a thing that really we need to be talking about calmly. He'd look at us and go. Okay now stay there but slow it down and so dead. My Mantra and my my this has been my Mantra actually in practice to is slow it down. Slow it down and feel the sensation and somebody and feel the thought that's connected to that sensation and see what's going on in. Because a lot of times the thing you're upset about isn't about the other person dead, it's yours and if you can own that, you can communicate better and with yourself first. But then with your partner as well, and hopefully have a chance at success and relationships are so hard cuz we say some stupid things, sometimes in the moment. Well, you know, we have bad habits. We, you know, we were all brought up by people who are dead. We're human and flawed and have blind spots in their, their emotional intelligence, and that's where our blindspots live, generally speaking. And, and if we can figure those things out, will be better. Spouses job. Be better practitioners will do it better friends will be better business partners. Yeah, slow down pretty good vacation there. Got different schedules, you live in different cities. Sometimes like are you able to ever get back? You know, this move that we made to Florida from California. Was supposed to be like early retirement where she just works from home. She does all virtual trainings now off with her clients and I I was just going to be, you know, in in New York, you know, too long weekends out of a month so work. So I'm working, you know, 6 8, 10 days or a month. Yeah. Oh, that's great. Yes, I think I think vacation is really important and, and it's something that in our profession, we're such hard workers. Generally speaking, wage that we don't take time for ourselves. We don't plan vacations and we really need to and playing them in in advance before our cup is overflowing, we we need to plan these things out. To give ourselves breaks these, this is the advice we give to our patients, we should use it for ourselves, right? So yeah, vacation for sure, sick days, like chiropractors will. And I don't know if after the pandemic. Anybody else going to do this again? I hopefully not but chiropractors and I've been guilty of this too. It's just, it's just a, it's just a cold. No big deal, you know, borderline flew in the clinic, right? I think you'll do that. Never again. I will never ever do that again, but take time off. Take time off. Build a practice and the lifestyle and have your monthly nut your your, your life, you're living expenses to be low enough that you've built in this time to rehumanize yourself so that you can be a better person and a better practitioner. Because if you're constantly burnt out. You're not and I mean, what are we doing? Highly. Yes, although patients here in Germany you know the last sometimes like oh you were in China and stuff and was all about covid-19 thing. The thing about China because they're so pass. Like you know, there's so many people. If you get sick you still got to go to work. Of course. So you wear a mask on the train? Yeah, some people were the mass because they were afraid to get sick from other. People who maybe weren't so con self-conscious home. It's not uncommon to see people wearing a mask and of course, when I was in the hospital, not everybody wore a mask. But there were certain types of doctors, you know, the Specialties that you'd always would wear a mask in front of patients and everything, so it got really normal for me and I was just glad not to have to wear them and then when covid-19 sike Asks yeah now you know things aren't quote. Unquote over here yet folks are seeing the light at the end of the tunnel. My Hope Is that we adopt some of these things a little bit more as long as a regular habit, like like they do in China, you know, they're like they opened up, they don't have to work, but guess what? You still can wear it.

00:45:12 – 00:50:00

It's not saying you can't. It's just saying that you don't have to. So if you want to wear it you can wear it. Yeah, I mean it's just a piece of cloth over your face. You know, if if if God forbid, you have to go in and get brain surgery and it's a, it's a 12 or 14, our surgery, all the people operating on your brain. Have been wearing a mask off the whole thing that whole day. Yeah. And that whole time, where they're working on you, it's not going to hurt you. It doesn't rob you of life. It's just it's to me, it's a kindness thing. It's like, even if you're not afraid of getting them afraid of getting sick. Well, be kind for other people, so that maybe even if you're carrying it, you're not going to potentially pass it on to somebody else. That's, that's really it from my standpoint is, it's kind of a kindness me off. Like but I think we can get better at as a culture. I tell you this I was at the park maybe I was at the park want to self incriminating myself here, but in the park you supposed to wear masks and I wear a mask and the police catch you. That's a potential 140 Euro fine. That's fine. But things are a little different in Europe. Yeah, yeah. So yeah, not so much here, not something like that there, but I was like anyway. So last question, last question, books, anything that you think we should look at? It could be relationships marketing's a business or Chiropractic, whatever you want. Now, you know what I'm going to? I'm going to go back to the slow it down thing, right? So, most of the self-help books that you end up reading and any good book on technique any, good course on Tech is about wage self-evaluation, right? And you can't evaluate yourself unless you're slowing it down. So, when I was in California, Not only was I teaching students, Squadron analysis ideal job. And and practical and sort of information. But I was also teaching manual therapy adjusting and all this type of stuff and we we all want to rush to the end. We all want to rush the we want to be great adjusters today, I'm good at adjusting. I was good when I came out of school but twenty four years in. I'm way better. We all we all have levels, right? Yeah. And we can't rush ahead and I want us to when you're having a problem in with with your relationship. If you're not agreeing on something and you can't possibly fathom or your partner is coming from. If you have a patient that's stumping, you slow it down a little bit more introspective a little bit more evaluative. See if you're missing something start over, give yourself the time to do that and build that time into your life. So that it's a regular thing you do and you evaluate your, the different areas of your life, that way. And as you get better at slow down, Down it believes in to all those areas. Doctor paid, ladies and gentlemen. Another great interview has ended while you're on your phone, click that review button, right up a nice review for me. Five stars. If you could as everyone says an industry, it'll help other people to find us when we have enough faith, inkings not to mention, I'll mention you and your review on an upcoming episode. If you follow me at all on Instagram, you know, you only get one link. So I use a link tree and so it's a doctor's perspective. Net links with an S and that's going to give you everything you need to know the top episodes of 2017 and 2018, the podiatrist series, Dennis acupuncture series off a 2017 Financial series, how to write a review, how to support the show, like buying a cup of coffee getting Swag. Like t-shirts, the today's choices, tomorrow's health book thoughts blueprints for Better Health exercise, picking food, correctly and financial and then of course, bundle packs, which can get you the no needle acupuncture book, 40, and conditions, including the electric occupation. Ben had a great deal. The resources page has some of the products that I like, it's a affiliate style, so if you buy something from them, I get a piece of that just like on the show notes Pages. If you buy a book from clicking that link, I get a small piece of that as well, so I really appreciate that things like Screencast-O-Matic purevpn, missing letter, J Lab speakers provolone, Edge or hot, grips off. Once again, if you do need any coaching on how to improve them, your blood work, drop weight and a pro loan diet, fast mimicking diet, 5-day plan, let me know as soon as well as if you just need some coaching, whether it's Health, whether it's marketing, whether you need some practice growth, Etc, reach out Facebook. Justin trosclair MCC of course at a doctor's perspective. Net on the top right you got all the social media icons that you can. Imagine click your favorite and reach out. Thank you so much for tuning in. Please tell a friend pass it along.

00:50:01 – 00:50:51

You can go to. Net, it's just dead. Easy. It'll open up right in your app and don't forget, I appreciate you. Listen, critically think and integrate see you on the minisodes on Thursdays and Saturdays. Hope you're enjoying those. I'm definitely having fun summarizing these podcasts and less than 10 minutes for you. You get the Nuggets without having to waste your time. Have a great week off off, the insurance taken off.

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).