Well, if you are reading this then I made it: I turned 30 today. I am not a huge birthday person, I think that they are really just another day. However, I am trying to be more introspective and reflect upon lessons that I have learned. I usually don’t absorb information the first time I am exposed to it, so I have been going back and looking at what I have learned and trying to put it into context. I wanted to challenge myself and come up with 30 lessons I have learned: 10 in PT, 10 in strength and conditioning, and 10 in business. I hope to come back to this list and update it as I learn and grow. I can definitely say that I have changed my mind on a lot of things over the last few years, and I’m sure that will continue to happen. Let’s dive in:
10 Things in PT
Listen more than you talk. I used to want to impress every client with my bountiful knowledge. Then I realized that a lot of problems can just be solved by listening to their symptoms and complaints. I do a lot more listening than I used to.
Be patient with recovery. I am a bit of a perfectionist and I want things to work quickly or I get frustrated. When I have clients come to me in pain, I want to fix it quickly and send them on their way. Setbacks happen when you are too aggressive and I find myself being more cautious now. Missing one extra game is better than rushing back and being out for a few more weeks.
Manual therapy helps. There are a lot of prejudices against manual therapy right now online and in person. Some coaches and PTs will think that passive therapy is useless because it doesn’t transfer. I disagree. If I can help someone feel better then there is buy in to what I am doing and the client understands that their pain can be changed. That’s a powerful thing.
Follow up your manual therapy with something to maintain your gains. Benefits from manual therapy are transient, they do not last forever and you need to take advantage of them. Teaching a client how to move and showing them that they can do it with little or no pain sets the table for recovery.
Give time for recovery. Most of my clients are in school. We discount how draining it is to be in school, have practice, and then do homework and study. Sometimes kids need a break. That doesn’t make them weak. Go easy on a kid who needs to use the compression boots or Marc Pro instead of hammering out a few more sets in the weight room.
We usually aren’t making grand changes to tissue. Fascia, muscles, tendons, and everything else in your body is resilient. By scraping, needling, massaging, stretching, etc. we are not really changing the nature of it. However, we are giving novel inputs to the nervous system and changing pain sensitivity. These are powerful tools, but not in the way we used to think of them.
The ultimate goal is to get back on the field. It is great if a client has no pain on the table. My job isn’t done until they are pitching or running pain-free. Whatever their goal is, I want to see them from the starting line to the finish line.
If an intervention doesn’t work, move on. As I progress as a PT, I get a lot more tools in my toolbox. I will usually take the simplest route first and then move on from there. So, if a shoulder is tight, look at the shoulder muscles and see if they need to be mobilized. If that doesn’t work, then look at other areas such as the neck, thoracic spine, rib cage, etc.
The simplest intervention that the client can replicate is best. When I first started, I utilized dry needling a lot more than I do now. I also wanted to have people perform the sexiest exercise possible to show them my amazing knowledge. Then I realized people were confused and couldn’t replicate the exercise at home. Now I keep it much more simple. If they aren’t impressed by my knowledge that’s ok.
Injuries are an emotional and mental drain more than they are a physical one. It’s important to understand a client’s viewpoint about their injury to properly treat them. Are they scared, upset, or depressed? This will dictate their recovery more than which rotator cuff muscle was injured!
10 Things in Strength and Conditioning
Experience matters, but so do certifications. If someone has good results training clients for 20 years, then he or she probably knows what they are doing. However, getting my CSCS showed me that there were some fundamental holes in my knowledge that might not have been addressed if I never took the exam.
As a PT, it is easy to underload clients. Most people are stronger than we give them credit for. If we do not push clients then they will either not push themselves or they will not be prepared to return to a normal strength and conditioning program.
Limit your cues to 3 at the very most. I read a study at some point that I can’t remember and it mentioned that once you cue someone with more than 3 things they become too confused to perform an exercise properly. In my experience, it is typically 2 or fewer cues before someone is too distracted to perform an exercise. If you can’t correct it in a couple cues, move on because you picked the wrong exercise.
Not everyone needs to be able to do every exercise. Some people anatomically struggle with squats or deadlifts (hey I wrote a post about that here). There is a lot we can improve from a physical perspective, but not everyone is cut out for back squatting or traditional deadlifting and that’s ok.
That being said, the “classic” exercises work for a reason. Unless someone gives me a reason, I am going to have people squat, deadlift, lunge, push, and pull. These exercises give you the most bang for your buck in most cases and there is a reason a whole bunch of people do them.
Explain why someone is doing an exercise. It’s a team effort with strengthening and if you can tell a client how a certain exercise will get them stronger hips, but also help them hit the ball further then you have buy in. After all, they are the one having to lift the heavy weight so they deserve to know the rationale.
Learn from other fields. Honestly this could have gone in any of the categories, but I threw it here. I have learned so much online and in person from pitching coaches, trainers, strength coaches, PTs, chiropractors, and various other professionals. Sometimes we need to come out of our box and learn from others.
Not giving someone the wrong exercise is more powerful than giving them the right exercise. Early on, I would show someone an exercise and think “well their form isn’t great, but they will figure it out”. Then they show up a week later and the form got much, much worse. Now I am a lot more judicious with prescribing exercises.
Have a short term plan, but be willing to adjust. Each time I see a client, I know roughly how I want the session to go. However, I have to be flexible if something takes longer than expected, causes pain, or just isn’t working. Early in my career I was too inflexible and didn’t listen to the person in front of me.
Have a long term plan, and be more rigid with it. A lot of athletes that I see now jump from various coaches and trainers with no long term guidance. They get to the off-season and rest a little bit but also work out a couple times a week and throw off a mound once a week. They need a planned deload, but also an idea of how they will build up for the season. It is easy to get lost throughout the year, but if you have a long term plan it can provide some guidance.
10 Things in Business
When you start your own practice, you are a business owner. This seems silly, but it really didn’t hit me right away. We started Eclipse because I wanted to treat clients on my own terms and that is still my main motivation. However, there are a lot more things that go into running a business than treating clients. I have learned to enjoy some of it, but it’s definitely not my favorite part.
If you own a business then you are an entrepreneur. Every business is looking to stand out in a crowded field. In Northern Virginia I can throw a rock and hit 3 PT clinics. How do you stand out? I find myself listening and reading to more information from entrepreneurs and business owners in other fields than I thought I would. There are lessons we can all take from successful companies.
Money is as awkward as you make it. Eclipse is an out-of-network practice, meaning that our clients pay us and then can submit to insurance if they like. In all the other PT clinics I worked in, I never had to have very many money talks with people. In the beginning it was weird. I felt awkward and apologetic for telling them how much we charge. I realized that the awkwardness on my end made it harder for them. The more confident I am, the more they will trust me and the better the experience is for everyone.
You set your own worth. This relates to the previous item. I have had numerous clients ask if I take their insurance. When I explain that I do not for my benefit as well as their’s, some understand and others do not. I have turned away many people and it kills me each time. However, I know my own worth and if I compromise it for one person then I lose respect for myself. This can still be an awkward conversation that only gets easier with practice.
I have partners not bosses. I will sometimes partner with facilities, coaches, etc. These can last for a couple days or for a long time. In general, I appreciate when I can provide a service for other people and they can help me out. However, I have had several people who want me to work for them. They want to control aspects of our business that I am uncomfortable turning over. This may not be a problem for some people, but it is for me.
Work like a lion not a cow. I read this from @naval on twitter and it stuck with me. He discusses how too many people work all day aimlessly and get nothing done. True work comes in spurts when we are motivated. This newsletter was a result of me being motivated and it has allowed me to learn more by writing while also interacting with a new audience. We did not start Eclipse to write a newsletter, but I love it and grow from it so I will keep doing it.
Owning a business can be lonely. There is a benefit to being in groups of like-minded individuals whether that be on Facebook, Discord, or other communities. Seeing that others are going through similar issues can be motivating and empowering. I sometimes take a step back and realize thousands of people have created PT businesses, why can’t I?
Sometimes it feels like 50% of my job is sales. I am asking people for money and I don’t work if people don’t pay for my services. This can be a tough thing to wrap your head around and it can make you jaded. However, I do believe that if I am honest and forthcoming with people, then Eclipse will continue to grow and thrive.
Sometimes it feels like the other 50% of my job is marketing. You think that just planting your flag in the ground and declaring you have a PT practice will bring clients? It doesn’t. I have had to walk a fine line of getting my name out there without feeling like I am turning all of my relationships into transactions. The idea of a small business owner can transition into hitting up your friends and family to buy your stuff pretty quickly. That’s a scary thought because I don’t want to sacrifice relationships for Eclipse.
Don’t forget why you started it all. I have just laid out nine things I have learned about business and they may paint a bleak picture. However, it is all worth it when I get to meet people and help clients get back to where they want to go. Don’t be afraid to be proud of what you have accomplished and why you did it in the first place.
If this helped you in any way please reach out to me at danny@eclipsewellnessnova.com and if you are interested in working with me for physical therapy out of our office in Sterling, VA then definitely reach out!