When the cost of delay is measured in millions of dollars and operational readiness, guesswork isn’t an option.
In this episode, we sit down with Josh Kidd, physical therapist, researcher, residency director, and embedded clinician working with special operations personnel and fighter pilots. Josh shares how directional preference plays a central role in clinical decision-making when time, performance, and safety all matter.
We explore what directional preference actually is (and what it isn’t), why it should be viewed as an assessment rather than an exercise, and how inconsistent definitions in the research have led many clinicians to misunderstand or abandon it altogether.
Josh also walks through real-world data from a tactical setting, where his team has used directional preference to help service members return to duty 36% faster, while empowering patients to self-manage and reducing recurrence.
This conversation connects research, clinical reasoning, and performance-based care—challenging clinicians to rethink not just what they do, but how they think.
???? In This Episode, You’ll Learn:
- Why directional preference matters beyond the spine
- The most common misconceptions clinicians have about directional preference
- How inconsistent research definitions affect real-world practice
- How directional preference can guide prognosis and return-to-duty decisions
- What clinicians can learn from high-stakes military performance environments
- One mindset shift that can immediately improve clinical reasoning
00:00:00 --> 00:00:00 There we go.
00:00:00 --> 00:00:01 All right,
00:00:01 --> 00:00:03 when most people think about physical
00:00:03 --> 00:00:05 therapy, they picture injury,
00:00:05 --> 00:00:07 something that happens after the damage is
00:00:07 --> 00:00:07 done.
00:00:08 --> 00:00:09 But for Josh Kidd,
00:00:09 --> 00:00:11 physical therapy lives much earlier in the
00:00:12 --> 00:00:12 story.
00:00:12 --> 00:00:14 Josh works with people whose jobs leave
00:00:14 --> 00:00:15 very little room for error.
00:00:16 --> 00:00:17 fighter pilots,
00:00:17 --> 00:00:19 special operations personnel,
00:00:19 --> 00:00:21 while recovery and performance and
00:00:21 --> 00:00:23 decision-making all have real
00:00:23 --> 00:00:24 consequences.
00:00:25 --> 00:00:26 He's also shaping the next generation of
00:00:26 --> 00:00:27 clinicians as a faculty member,
00:00:28 --> 00:00:29 researcher, and residency director.
00:00:30 --> 00:00:30 Lately,
00:00:30 --> 00:00:32 his work is focusing on a concept that
00:00:32 --> 00:00:33 sounds simple,
00:00:34 --> 00:00:35 but carries big implications,
00:00:36 --> 00:00:37 directional preference,
00:00:37 --> 00:00:38 how the body responds to movement,
00:00:39 --> 00:00:40 and what that response can tell us about
00:00:41 --> 00:00:43 healing, readiness, and performance.
00:00:43 --> 00:00:44 Today,
00:00:44 --> 00:00:45 we're talking with Josh about what
00:00:45 --> 00:00:47 directional preference really is,
00:00:48 --> 00:00:50 why it matters beyond the spine,
00:00:50 --> 00:00:52 and what the current evidence reveals,
00:00:52 --> 00:00:54 not just about treatment,
00:00:55 --> 00:00:57 but about how clinicians think.
00:00:57 --> 00:01:00 So let's get Josh Kidd in the studio.
00:01:00 --> 00:01:01 Josh, welcome to your episode.
00:01:02 --> 00:01:04 Hey, thanks.
00:01:04 --> 00:01:05 It's a pleasure to be here, guys.
00:01:05 --> 00:01:06 I mean, setting the bar pretty high.
00:01:06 --> 00:01:07 That sounded pretty cool in the intro,
00:01:07 --> 00:01:08 right?
00:01:08 --> 00:01:09 Let's go back first.
00:01:10 --> 00:01:12 How'd you get to do all that stuff?
00:01:12 --> 00:01:13 And we'll get to the stuff.
00:01:13 --> 00:01:13 But like,
00:01:13 --> 00:01:15 what was sort of the thirty second career
00:01:15 --> 00:01:16 arc to get to where you are now?
00:01:17 --> 00:01:18 Yeah, it's funny.
00:01:18 --> 00:01:19 I think you really overhyped the bio,
00:01:19 --> 00:01:20 so I appreciate that.
00:01:21 --> 00:01:21 No, it's funny.
00:01:22 --> 00:01:23 Like most BTs,
00:01:23 --> 00:01:25 I started off and wanted to go into
00:01:25 --> 00:01:25 orthopedics.
00:01:25 --> 00:01:28 I wanted board certifications.
00:01:28 --> 00:01:29 Started to go that route just as a
00:01:30 --> 00:01:32 basic clinician in a normal outpatient
00:01:32 --> 00:01:33 orthopedic practice.
00:01:33 --> 00:01:34 Had the opportunity to buy in,
00:01:35 --> 00:01:36 become an owner in that practice.
00:01:36 --> 00:01:38 So started to grow in that realm.
00:01:38 --> 00:01:40 And I'm like, man, I love outpatient.
00:01:40 --> 00:01:42 I want to continue to foster this.
00:01:42 --> 00:01:43 We're bringing in a residency program,
00:01:43 --> 00:01:44 bringing in mentors.
00:01:45 --> 00:01:47 um in in residence and enjoying my time
00:01:47 --> 00:01:48 and then these funny things called
00:01:48 --> 00:01:50 third-party administrators started to come
00:01:50 --> 00:01:52 around right and then my administrative
00:01:52 --> 00:01:54 burden started to scale and i'm like i
00:01:54 --> 00:01:56 don't know how i feel about this so
00:01:56 --> 00:01:58 much and so i decided um hey i'm
00:01:58 --> 00:01:59 gonna get out of this and i wanna
00:01:59 --> 00:02:02 my thought was go cash pay i'm like
00:02:02 --> 00:02:03 i want to go cash pay i want
00:02:03 --> 00:02:04 to set my fees i want to treat
00:02:04 --> 00:02:04 patients i want to treat them
00:02:06 --> 00:02:09 And so sold my practice and was doing
00:02:09 --> 00:02:09 that route.
00:02:09 --> 00:02:10 And I got a phone call from a
00:02:11 --> 00:02:12 good colleague of mine who was,
00:02:12 --> 00:02:13 I knew he was doing something with the
00:02:13 --> 00:02:13 military,
00:02:13 --> 00:02:14 but I didn't really know what it was.
00:02:14 --> 00:02:16 I thought he was just hanging out and
00:02:16 --> 00:02:17 chatting with a few guys.
00:02:17 --> 00:02:18 And he calls me up and says, hey,
00:02:19 --> 00:02:20 I work with the military.
00:02:20 --> 00:02:21 My company's growing.
00:02:21 --> 00:02:22 I need quality assurance.
00:02:22 --> 00:02:24 I know you run residency programs.
00:02:25 --> 00:02:26 I know you have a solid foundation and
00:02:26 --> 00:02:27 I want to practice the way,
00:02:27 --> 00:02:28 I want all of our guys to practice
00:02:28 --> 00:02:29 what you do.
00:02:30 --> 00:02:33 and he says um and I said okay
00:02:33 --> 00:02:35 um and he goes but I know that
00:02:35 --> 00:02:36 you're busy he didn't know I saw my
00:02:36 --> 00:02:38 practice he goes I know that you're you
00:02:38 --> 00:02:39 know you're occupied your business so do
00:02:39 --> 00:02:40 you know anybody that could do this and
00:02:40 --> 00:02:42 I said well actually I do and he
00:02:42 --> 00:02:44 said who's that I said it's me you
00:02:44 --> 00:02:45 know what he did
00:02:46 --> 00:02:46 He hung up on me.
00:02:46 --> 00:02:48 He goes, I got to call you back.
00:02:48 --> 00:02:49 And it was so funny.
00:02:49 --> 00:02:49 I get home.
00:02:49 --> 00:02:51 I talk to my wife and I'm doing
00:02:51 --> 00:02:52 this cash pay transition thing.
00:02:52 --> 00:02:53 And I said, hey,
00:02:53 --> 00:02:54 I got a call from Randy today.
00:02:54 --> 00:02:56 And he goes, and she goes,
00:02:56 --> 00:02:56 what do you want?
00:02:56 --> 00:02:57 I said, well,
00:02:57 --> 00:02:59 he wanted to pitch me a job to
00:02:59 --> 00:02:59 work for his company.
00:03:00 --> 00:03:02 And she said, well, what'd you say?
00:03:02 --> 00:03:02 And I said,
00:03:03 --> 00:03:03 I told him I was interested.
00:03:04 --> 00:03:04 What do you do?
00:03:04 --> 00:03:05 I said, he totally hung up on me.
00:03:06 --> 00:03:07 I didn't get it either.
00:03:07 --> 00:03:09 So he calls me two days later and
00:03:09 --> 00:03:11 he says, hey, he goes, I'm sorry,
00:03:11 --> 00:03:12 I just couldn't process all that.
00:03:12 --> 00:03:14 He goes, I was looking for one thing.
00:03:14 --> 00:03:15 And then when I found out it was
00:03:15 --> 00:03:15 you,
00:03:15 --> 00:03:17 I had just told this big gamut of
00:03:17 --> 00:03:18 things I wanted to do.
00:03:18 --> 00:03:18 He's like,
00:03:18 --> 00:03:19 I want you to come work for us
00:03:19 --> 00:03:20 and I want you to run this thing.
00:03:20 --> 00:03:22 And so it just kind of happened by
00:03:23 --> 00:03:24 happenstance how I fell into it.
00:03:24 --> 00:03:26 And I would say it's probably the coolest
00:03:26 --> 00:03:26 job in the world, man.
00:03:27 --> 00:03:27 I mean,
00:03:27 --> 00:03:30 the population we get to serve is amazing.
00:03:30 --> 00:03:32 Our teams are usually set up what's called
00:03:32 --> 00:03:33 an HBO team,
00:03:33 --> 00:03:35 so a human performance optimization team.
00:03:36 --> 00:03:37 And foundationally,
00:03:37 --> 00:03:38 it's usually about five different types of
00:03:38 --> 00:03:39 providers.
00:03:39 --> 00:03:40 So there's a PT,
00:03:40 --> 00:03:41 there's an athletic trainer,
00:03:42 --> 00:03:43 there's a strength coach,
00:03:43 --> 00:03:44 there's a sports psychologist,
00:03:44 --> 00:03:46 and there's a nutritionist.
00:03:46 --> 00:03:48 And we're basically embedded within a
00:03:48 --> 00:03:49 special operations unit.
00:03:50 --> 00:03:51 And our job where I'm at is to
00:03:51 --> 00:03:53 take care of sixty four special ops guys.
00:03:54 --> 00:03:56 And we get all the toys and we
00:03:56 --> 00:03:56 get all the time.
00:03:56 --> 00:03:58 So I don't have to bill anything.
00:03:58 --> 00:03:59 I treat I mean,
00:03:59 --> 00:03:59 I got a guy right now.
00:03:59 --> 00:04:01 He's going he's got a quad tender repair
00:04:01 --> 00:04:02 and I'm with him for like three hours
00:04:02 --> 00:04:02 a day, man.
00:04:03 --> 00:04:03 Wow.
00:04:03 --> 00:04:05 So the ability to practice at the top
00:04:05 --> 00:04:07 of our license has been pretty special and
00:04:07 --> 00:04:08 it's been rewarding.
00:04:08 --> 00:04:09 And again,
00:04:09 --> 00:04:10 I don't have to deal with those pesky
00:04:10 --> 00:04:12 third party administrators anymore.
00:04:12 --> 00:04:15 So that's been the original shift into
00:04:15 --> 00:04:16 kind of the human performance realm.
00:04:17 --> 00:04:17 And it's been fantastic.
00:04:17 --> 00:04:18 All right, good.
00:04:18 --> 00:04:19 We've got context.
00:04:19 --> 00:04:20 But now let's drill into for the
00:04:20 --> 00:04:21 clinicians out there.
00:04:21 --> 00:04:22 Let's drill into this.
00:04:22 --> 00:04:24 You're working with special operations
00:04:24 --> 00:04:25 fighter pilots.
00:04:25 --> 00:04:26 We sort of set the stage there.
00:04:27 --> 00:04:27 Yeah.
00:04:27 --> 00:04:28 These people do not have time for
00:04:28 --> 00:04:28 guesswork.
00:04:29 --> 00:04:31 The first time someone ever framed when I
00:04:31 --> 00:04:33 was a PT student with this podcast,
00:04:33 --> 00:04:34 his name was Rich Westrick.
00:04:35 --> 00:04:36 Rich said, listen,
00:04:36 --> 00:04:38 if you train triathletes,
00:04:38 --> 00:04:39 you know when the race is,
00:04:39 --> 00:04:40 what time of day,
00:04:40 --> 00:04:42 likely what the weather's going to be.
00:04:42 --> 00:04:43 You know the exact course.
00:04:43 --> 00:04:45 He goes,
00:04:45 --> 00:04:46 people don't have that in operations.
00:04:46 --> 00:04:47 You don't know when the bell's going to
00:04:47 --> 00:04:48 ring, right?
00:04:48 --> 00:04:50 So these people do not have guesswork.
00:04:50 --> 00:04:52 Where did directional preference become
00:04:52 --> 00:04:55 something so central to your clinical
00:04:55 --> 00:04:55 thinking?
00:04:56 --> 00:04:56 How'd that happen?
00:04:57 --> 00:04:58 Yeah, it's how we came into the unit.
00:04:58 --> 00:04:59 So I sat down with the commander basically
00:04:59 --> 00:05:00 day one and I said, okay,
00:05:01 --> 00:05:02 where can we have the biggest change?
00:05:03 --> 00:05:04 And he broke it down and they track
00:05:04 --> 00:05:04 everything.
00:05:04 --> 00:05:06 Every metric is tracked on these guys,
00:05:06 --> 00:05:06 right?
00:05:06 --> 00:05:07 And they said, hey, you know,
00:05:07 --> 00:05:07 believe it or not,
00:05:07 --> 00:05:09 my biggest problem is back pain,
00:05:09 --> 00:05:09 neck pain, right?
00:05:09 --> 00:05:11 And so my background, you know,
00:05:11 --> 00:05:13 I'm the director of the McKinsey
00:05:13 --> 00:05:14 Institute's residency program.
00:05:14 --> 00:05:15 So that's kind of the Kool-Aid,
00:05:15 --> 00:05:16 a little bit of the Kool-Aid I'm drinking
00:05:16 --> 00:05:17 for preference here.
00:05:17 --> 00:05:18 And so I said, okay,
00:05:18 --> 00:05:20 we have a specific way we can target
00:05:20 --> 00:05:20 this.
00:05:20 --> 00:05:21 And I said, let's just start tracking.
00:05:21 --> 00:05:22 Let's look at metrics.
00:05:22 --> 00:05:24 Let's see if we can change the prevalence
00:05:24 --> 00:05:24 here.
00:05:24 --> 00:05:24 And so
00:05:25 --> 00:05:27 Based on what the unit leadership wanted,
00:05:27 --> 00:05:28 we said, okay,
00:05:28 --> 00:05:30 let's go after spine pain because that was
00:05:30 --> 00:05:31 similar to outpatient.
00:05:31 --> 00:05:32 Everybody thinks it's going to be all
00:05:32 --> 00:05:33 different.
00:05:33 --> 00:05:34 It's spine pain.
00:05:34 --> 00:05:35 And a lot of times it's when they're
00:05:35 --> 00:05:38 not doing their training and doing their
00:05:38 --> 00:05:38 missions, right?
00:05:38 --> 00:05:39 They're not really getting hurt out there
00:05:39 --> 00:05:39 too much.
00:05:39 --> 00:05:41 It's more when they're back home and
00:05:41 --> 00:05:42 they're more sedentary and less active.
00:05:43 --> 00:05:45 we um we started to look at the
00:05:45 --> 00:05:47 data and we said okay let's utilize
00:05:47 --> 00:05:49 directional preference as an avenue to
00:05:49 --> 00:05:51 assess but then also determine prognosis
00:05:51 --> 00:05:53 and we've actually been collecting some
00:05:53 --> 00:05:55 pretty cool data on it which i'm happy
00:05:55 --> 00:05:56 to share with you as we move forward
00:05:56 --> 00:05:58 here but that's really what's at the stage
00:05:58 --> 00:05:59 sit down with commander he says i got
00:05:59 --> 00:06:01 a problem with spine related issues you
00:06:01 --> 00:06:02 know we have we've had high level
00:06:02 --> 00:06:04 therapists in here before taking this
00:06:04 --> 00:06:05 approach i said well let's let's try
00:06:05 --> 00:06:07 something different here and see what we
00:06:07 --> 00:06:08 can do and you know we've got four
00:06:08 --> 00:06:10 years now of training down and it's
00:06:10 --> 00:06:11 actually trending in a pretty good
00:06:11 --> 00:06:11 direction
00:06:12 --> 00:06:13 What's that commander's background,
00:06:13 --> 00:06:13 just briefly?
00:06:13 --> 00:06:16 Is it a healthcare background or not?
00:06:16 --> 00:06:17 No, no, man.
00:06:17 --> 00:06:18 The reason I ask is it sounds pretty
00:06:19 --> 00:06:19 damn informed.
00:06:20 --> 00:06:20 Yeah.
00:06:21 --> 00:06:21 Well,
00:06:21 --> 00:06:22 his job is to take care of those
00:06:22 --> 00:06:22 guys.
00:06:22 --> 00:06:24 And so he works side by side with
00:06:24 --> 00:06:25 the HBO team.
00:06:25 --> 00:06:26 He's worked side by side with the flight
00:06:26 --> 00:06:27 docs, right?
00:06:27 --> 00:06:28 And in flight medicine.
00:06:28 --> 00:06:31 And so he needs to keep status on
00:06:31 --> 00:06:33 who's green-lighted and who's red-lighted
00:06:33 --> 00:06:34 on his teams because he'll have to move
00:06:34 --> 00:06:35 pieces around.
00:06:35 --> 00:06:36 One guy's not operational.
00:06:36 --> 00:06:38 He's going to have to swap somebody into
00:06:38 --> 00:06:40 that unit because everybody has a sniffing
00:06:40 --> 00:06:41 role within the unit, right?
00:06:41 --> 00:06:43 And so it's his job.
00:06:43 --> 00:06:44 It's his job to stay on top of
00:06:44 --> 00:06:44 it.
00:06:44 --> 00:06:46 And the crazy part is he actually has
00:06:46 --> 00:06:48 overall say of if this guy gets to
00:06:48 --> 00:06:48 go or not.
00:06:49 --> 00:06:50 Right.
00:06:50 --> 00:06:50 With no medical background,
00:06:50 --> 00:06:52 it was fascinating to me.
00:06:52 --> 00:06:53 But, yeah, I mean,
00:06:53 --> 00:06:55 that's his job to to make sure he's
00:06:55 --> 00:06:56 on top of every one of those guys,
00:06:56 --> 00:06:58 both from a physical, mental,
00:06:58 --> 00:06:59 family style.
00:06:59 --> 00:07:01 I mean, operational style.
00:07:01 --> 00:07:01 I mean,
00:07:01 --> 00:07:02 across the gamut on each one of these
00:07:02 --> 00:07:04 guys, he basically has a profile.
00:07:04 --> 00:07:05 All right, you mentioned Kool-Aid.
00:07:05 --> 00:07:06 Let's talk about some Kool-Aid and
00:07:06 --> 00:07:07 different flavors, right?
00:07:07 --> 00:07:08 We'll get a little bit into the Kool-Aid.
00:07:09 --> 00:07:11 For someone who's heard the term but maybe
00:07:11 --> 00:07:12 never fully got it or maybe they need
00:07:12 --> 00:07:13 to hear it from you one more time,
00:07:13 --> 00:07:16 how do you define directional preference?
00:07:17 --> 00:07:17 Yeah.
00:07:17 --> 00:07:18 So directional preference, you know,
00:07:18 --> 00:07:19 I look at it,
00:07:19 --> 00:07:20 a lot of people will look at it
00:07:20 --> 00:07:21 as, you know,
00:07:22 --> 00:07:23 an exercise and we look at it as
00:07:23 --> 00:07:23 assessment.
00:07:24 --> 00:07:24 So for us,
00:07:24 --> 00:07:25 what we want to be able to do
00:07:25 --> 00:07:26 is, is when you,
00:07:26 --> 00:07:28 when you look at it at the basic,
00:07:28 --> 00:07:29 basic foundation,
00:07:30 --> 00:07:32 it's directional preference is a specific
00:07:32 --> 00:07:33 movement.
00:07:33 --> 00:07:35 You can move any joint.
00:07:35 --> 00:07:37 Most research is on the lumbar spine,
00:07:37 --> 00:07:37 some on the cervical spine,
00:07:37 --> 00:07:39 but a specific direction,
00:07:39 --> 00:07:40 you can repeatedly move a joint.
00:07:41 --> 00:07:43 to end range in which you will see
00:07:43 --> 00:07:43 two things happen.
00:07:43 --> 00:07:46 You'll see an improvement in pain and
00:07:46 --> 00:07:47 you'll see an improvement in mechanics or
00:07:47 --> 00:07:48 function.
00:07:48 --> 00:07:49 So range of motion, strength,
00:07:49 --> 00:07:50 their ability to do something that was
00:07:50 --> 00:07:51 previously painful,
00:07:51 --> 00:07:52 and now that pain resolved.
00:07:53 --> 00:07:54 But that movement has to,
00:07:54 --> 00:07:56 that improvement has to last, right?
00:07:57 --> 00:07:58 And so it's not, hey,
00:07:58 --> 00:07:59 I can move you around a little bit
00:07:59 --> 00:08:03 and get some exercise-duced hypoalgesia,
00:08:04 --> 00:08:05 and you're going to feel better, right?
00:08:05 --> 00:08:07 Exercise-duced hypoalgesia.
00:08:07 --> 00:08:08 It's not just that, right?
00:08:08 --> 00:08:09 It's not just, hey,
00:08:09 --> 00:08:10 I move a little bit, I feel better.
00:08:10 --> 00:08:12 It's moving you in a specific direction
00:08:12 --> 00:08:13 that makes you feel better.
00:08:14 --> 00:08:16 And a lot of that's ascertained from the
00:08:16 --> 00:08:16 history in the exam.
00:08:17 --> 00:08:18 So now let's go the opposite.
00:08:18 --> 00:08:19 Now that we know what it is,
00:08:20 --> 00:08:21 what are some of the most common
00:08:21 --> 00:08:23 misconceptions clinicians have about it?
00:08:23 --> 00:08:24 What are the things that,
00:08:24 --> 00:08:26 that Josh is most of the time correcting
00:08:26 --> 00:08:27 and saying, well,
00:08:28 --> 00:08:29 actually not that it's actually more like
00:08:29 --> 00:08:29 this.
00:08:30 --> 00:08:31 Yeah, no, the big thing, I mean,
00:08:31 --> 00:08:33 I think a lot of people think it's,
00:08:33 --> 00:08:36 you know, for some things to be,
00:08:36 --> 00:08:37 and this is where the limits of the
00:08:37 --> 00:08:38 nuances,
00:08:38 --> 00:08:39 we can talk about the research we've
00:08:39 --> 00:08:39 looked at,
00:08:39 --> 00:08:40 because there is some discrepancies about
00:08:40 --> 00:08:41 the definition of it.
00:08:41 --> 00:08:43 And that's what we aim to try to
00:08:43 --> 00:08:44 clear up with some of our stuff we
00:08:44 --> 00:08:45 were looking at.
00:08:45 --> 00:08:47 But, you know, a lot of people think,
00:08:47 --> 00:08:47 hey,
00:08:48 --> 00:08:48 You know,
00:08:48 --> 00:08:50 if I move in one direction makes me
00:08:50 --> 00:08:50 feel better.
00:08:50 --> 00:08:52 I got to move them in the opposite
00:08:52 --> 00:08:53 direction and it's got to make them worse.
00:08:54 --> 00:08:55 And you don't always see that.
00:08:55 --> 00:08:56 And sometimes with specific patient
00:08:56 --> 00:08:57 demographics,
00:08:57 --> 00:08:58 you will and you won't see that.
00:08:58 --> 00:09:00 So that's necessarily not always the key.
00:09:00 --> 00:09:01 And then there has to be a lasting
00:09:02 --> 00:09:02 change.
00:09:02 --> 00:09:02 Right.
00:09:02 --> 00:09:03 I mean, for example,
00:09:03 --> 00:09:04 I have low back pain.
00:09:04 --> 00:09:04 Right.
00:09:04 --> 00:09:05 I'm a general person.
00:09:05 --> 00:09:06 I have low back pain.
00:09:06 --> 00:09:08 What do I normally like to do?
00:09:08 --> 00:09:09 My back's hurting.
00:09:09 --> 00:09:09 I want to lay down.
00:09:10 --> 00:09:11 I want to put some pillows under my
00:09:11 --> 00:09:11 knees.
00:09:12 --> 00:09:13 I want to get a recumbent position.
00:09:13 --> 00:09:14 I'm going to feel pretty good.
00:09:14 --> 00:09:14 Right.
00:09:15 --> 00:09:17 that directional preference and i say no
00:09:17 --> 00:09:19 because what happens once you come out of
00:09:19 --> 00:09:20 that position you stand back up what
00:09:20 --> 00:09:22 happens pain comes right back right so
00:09:22 --> 00:09:24 there has to be some lasting change and
00:09:24 --> 00:09:26 carry over and what you should see is
00:09:26 --> 00:09:27 you should see this gradual progression to
00:09:27 --> 00:09:30 improvement as i continue to do more of
00:09:30 --> 00:09:31 the movement i get better and better and
00:09:31 --> 00:09:32 better not hey it feels good when i
00:09:32 --> 00:09:33 do it and then it kind of comes
00:09:33 --> 00:09:34 back so we kind of got to do
00:09:34 --> 00:09:36 it again and then it feels better but
00:09:36 --> 00:09:37 you go through this repetitive cycle
00:09:37 --> 00:09:38 that's not it right so it's got to
00:09:38 --> 00:09:41 be lasting and it's got to be sequentially
00:09:41 --> 00:09:41 improving
00:09:42 --> 00:09:43 Yeah.
00:09:44 --> 00:09:44 Uh,
00:09:44 --> 00:09:45 you're jumping into some research with
00:09:45 --> 00:09:47 some pretty big names, right?
00:09:47 --> 00:09:48 Part of a recent scoping review in
00:09:48 --> 00:09:49 physical therapy.
00:09:49 --> 00:09:49 What,
00:09:50 --> 00:09:52 what question were you trying to answer
00:09:52 --> 00:09:54 and how that, what, what,
00:09:54 --> 00:09:54 what answer did we get?
00:09:54 --> 00:09:57 Yeah, that's a good,
00:09:57 --> 00:09:58 I think like similar to most scoping
00:09:58 --> 00:09:59 reviews, I think you're going to find out.
00:09:59 --> 00:10:01 So we were, we were,
00:10:01 --> 00:10:03 when you look at the clinical practice
00:10:03 --> 00:10:04 guidelines and you look at systematic
00:10:04 --> 00:10:06 reviews around directional preference,
00:10:06 --> 00:10:07 it's all over the board.
00:10:07 --> 00:10:08 Some systematic reviews say, Hey,
00:10:08 --> 00:10:09 this is beneficial.
00:10:09 --> 00:10:10 Others say, no, it's not.
00:10:10 --> 00:10:11 Some say, Hey,
00:10:11 --> 00:10:12 this is good for chronic pain.
00:10:12 --> 00:10:13 Maybe a Q, some say, no,
00:10:13 --> 00:10:14 it's not good for anything.
00:10:14 --> 00:10:16 And so our aim was to look at,
00:10:16 --> 00:10:17 you know,
00:10:17 --> 00:10:18 when you look at previous scoping reviews,
00:10:18 --> 00:10:20 they looked at your level of training and
00:10:20 --> 00:10:21 being able to identify it, right?
00:10:21 --> 00:10:22 Is this generalizable or do you have to
00:10:22 --> 00:10:24 go so far down this rabbit hole that
00:10:24 --> 00:10:26 it's not even going to be beneficial to
00:10:26 --> 00:10:26 do that?
00:10:26 --> 00:10:27 And so we just want to look at
00:10:27 --> 00:10:28 the definition.
00:10:28 --> 00:10:29 We want to say, okay,
00:10:29 --> 00:10:30 maybe it's not the level of training.
00:10:30 --> 00:10:31 Maybe it's how people are defining it.
00:10:31 --> 00:10:33 So what we did was a large scoping
00:10:33 --> 00:10:33 review.
00:10:34 --> 00:10:36 And we looked at all the research that
00:10:37 --> 00:10:38 used the word directional preference.
00:10:38 --> 00:10:39 And we want to know,
00:10:39 --> 00:10:40 how do you define it?
00:10:40 --> 00:10:41 Like, what was it?
00:10:41 --> 00:10:41 If you're saying, Hey,
00:10:42 --> 00:10:43 it has no effect or, Hey,
00:10:43 --> 00:10:44 it has this amazing effect.
00:10:44 --> 00:10:44 Okay.
00:10:45 --> 00:10:46 How did you define it to say,
00:10:46 --> 00:10:47 to determine what it was and what you're
00:10:47 --> 00:10:48 doing?
00:10:48 --> 00:10:49 And we found out, I mean,
00:10:49 --> 00:10:50 there was a mishmash.
00:10:50 --> 00:10:51 I mean, we,
00:10:51 --> 00:10:53 we started off with a fifteen thousand
00:10:53 --> 00:10:53 studies, right?
00:10:53 --> 00:10:56 Broke it down and went into full review
00:10:56 --> 00:10:58 on one hundred and forty nine studies and
00:10:58 --> 00:10:58 of those hundred forty nine.
00:10:59 --> 00:11:00 We found that people had there was one
00:11:00 --> 00:11:03 hundred fifteen different definitions that
00:11:04 --> 00:11:04 is all over the board.
00:11:05 --> 00:11:07 And in twenty two percent of them didn't
00:11:07 --> 00:11:08 even have a definition.
00:11:08 --> 00:11:10 They said we do directional preference,
00:11:10 --> 00:11:11 but we're not going to tell you what
00:11:11 --> 00:11:11 it is.
00:11:11 --> 00:11:11 Right.
00:11:11 --> 00:11:12 Wow.
00:11:12 --> 00:11:14 So which we found intriguing.
00:11:15 --> 00:11:15 Right.
00:11:15 --> 00:11:15 So what does that mean?
00:11:15 --> 00:11:16 I mean,
00:11:16 --> 00:11:17 I think it means that we need to
00:11:17 --> 00:11:19 look at what is a more concise definition.
00:11:20 --> 00:11:21 And I think there's different ways to go
00:11:21 --> 00:11:23 about looking at that to determine, OK,
00:11:23 --> 00:11:25 how do we actually define this?
00:11:26 --> 00:11:27 And then how does that definition
00:11:28 --> 00:11:29 translate into clinical practice,
00:11:29 --> 00:11:30 but also research?
00:11:30 --> 00:11:31 And I think, I mean,
00:11:31 --> 00:11:32 we see this all over the board.
00:11:32 --> 00:11:32 I mean,
00:11:32 --> 00:11:33 I know there are similar studies have been
00:11:33 --> 00:11:35 done looking at what is manual therapy,
00:11:35 --> 00:11:35 right?
00:11:35 --> 00:11:36 Because that's still some of these things
00:11:37 --> 00:11:38 that's ill-defined, right?
00:11:38 --> 00:11:40 And so we've tried to follow along those
00:11:40 --> 00:11:41 same lines.
00:11:41 --> 00:11:42 So hopefully if we can get a more
00:11:42 --> 00:11:43 uniform definition,
00:11:44 --> 00:11:45 then we can research it and then we
00:11:45 --> 00:11:47 can also use it as a clinical tool.
00:11:47 --> 00:11:51 You almost maybe half already answered my
00:11:51 --> 00:11:52 next question, but I got it queued up.
00:11:52 --> 00:11:53 So I'm just going to answer it anyway.
00:11:54 --> 00:11:56 How did those inconsistencies in research
00:11:56 --> 00:11:57 you were just talking about,
00:11:58 --> 00:11:59 how do they show up?
00:11:59 --> 00:12:01 What do they look like in everyday
00:12:01 --> 00:12:01 practice?
00:12:01 --> 00:12:02 If we don't even know what,
00:12:02 --> 00:12:04 if we're not even agreeing on terms here,
00:12:04 --> 00:12:04 there's no,
00:12:05 --> 00:12:06 we're not going on the same dictionary.
00:12:06 --> 00:12:07 So I'm using a word one way or
00:12:07 --> 00:12:08 a term one way and you're using another.
00:12:09 --> 00:12:10 How's that show up in practice then?
00:12:11 --> 00:12:11 Yeah.
00:12:11 --> 00:12:11 I mean,
00:12:12 --> 00:12:14 I think when you it can cause people
00:12:14 --> 00:12:16 to potentially abandon it early and say,
00:12:16 --> 00:12:16 hey, sure.
00:12:17 --> 00:12:17 Right.
00:12:17 --> 00:12:18 I mean,
00:12:18 --> 00:12:19 we looked at some of the studies and
00:12:19 --> 00:12:19 some of the studies.
00:12:19 --> 00:12:19 I mean,
00:12:21 --> 00:12:23 when you look at let's just say the
00:12:23 --> 00:12:24 treatment based classification systems.
00:12:24 --> 00:12:25 Right.
00:12:25 --> 00:12:26 They have different subgroups.
00:12:26 --> 00:12:26 Right.
00:12:26 --> 00:12:27 We have this manipulation subgroup.
00:12:28 --> 00:12:29 We have the stabilization subgroup that
00:12:29 --> 00:12:31 are based on some clinical prediction
00:12:31 --> 00:12:31 rules.
00:12:31 --> 00:12:33 And then we have this exercise specific
00:12:33 --> 00:12:33 group.
00:12:33 --> 00:12:33 Right.
00:12:34 --> 00:12:35 Which is essentially based on directional
00:12:35 --> 00:12:36 preference.
00:12:36 --> 00:12:37 Well, in their study,
00:12:37 --> 00:12:38 what they would do is they would say,
00:12:38 --> 00:12:39 okay, if you had pain down your leg,
00:12:40 --> 00:12:42 you do ten forward bends, ten back bends,
00:12:42 --> 00:12:44 and if it didn't change the symptoms,
00:12:44 --> 00:12:45 boom, you're out of there, right?
00:12:45 --> 00:12:46 We looked at other studies,
00:12:46 --> 00:12:47 and we're like, no, we did that.
00:12:47 --> 00:12:48 But then we lay the person down,
00:12:48 --> 00:12:51 and we would do that prone press-up that
00:12:51 --> 00:12:52 everybody is synonymous with,
00:12:52 --> 00:12:53 like McKenzie.
00:12:53 --> 00:12:54 But then they would be moving the hips
00:12:54 --> 00:12:55 and doing these gapping techniques and all
00:12:55 --> 00:12:56 these different movements,
00:12:57 --> 00:12:58 and they were finding a higher prevalence,
00:12:58 --> 00:12:58 right?
00:12:58 --> 00:13:00 So the question is like, okay,
00:13:00 --> 00:13:01 we're not even doing this the same.
00:13:01 --> 00:13:02 And so if you look at one of
00:13:03 --> 00:13:03 these studies and say, okay,
00:13:03 --> 00:13:05 I'm going to bend them forward ten times
00:13:05 --> 00:13:05 and back ten times,
00:13:06 --> 00:13:07 If that's the only one study you read,
00:13:07 --> 00:13:09 you're probably going to abandon things a
00:13:09 --> 00:13:10 little early versus you read that other
00:13:10 --> 00:13:11 review and it says, hey, no, wait,
00:13:12 --> 00:13:13 there's so many different movements that I
00:13:13 --> 00:13:15 need to implore before I can move on
00:13:15 --> 00:13:15 from, hey,
00:13:15 --> 00:13:17 this isn't going to exhibit directional
00:13:17 --> 00:13:17 preference.
00:13:17 --> 00:13:18 Right.
00:13:18 --> 00:13:21 And how it's defined.
00:13:21 --> 00:13:22 Also,
00:13:22 --> 00:13:23 we saw some variability in the clinical
00:13:23 --> 00:13:26 practice guidelines for the low back pain.
00:13:26 --> 00:13:26 I mean,
00:13:26 --> 00:13:27 we looked at the first one guidelines that
00:13:27 --> 00:13:29 came out and directional preference had
00:13:29 --> 00:13:30 this A level evidence.
00:13:30 --> 00:13:30 Right.
00:13:31 --> 00:13:33 And then when you looked at the revision,
00:13:33 --> 00:13:35 it had this B-level evidence, right?
00:13:35 --> 00:13:37 So we broke down those studies that they
00:13:37 --> 00:13:39 looked at and we found varying themes
00:13:39 --> 00:13:41 within those definitions as well, right?
00:13:41 --> 00:13:44 So we basically identified a few specific
00:13:44 --> 00:13:45 themes that must be present.
00:13:45 --> 00:13:47 And if based on the research and then
00:13:47 --> 00:13:49 also based on this thematic analysis we
00:13:49 --> 00:13:51 did in addition to our scoping review.
00:13:51 --> 00:13:54 And so depending on where you're looking
00:13:54 --> 00:13:54 and how they're defining,
00:13:54 --> 00:13:56 it's going to clinically going to drive
00:13:57 --> 00:13:58 what you do or how quickly or don't
00:13:58 --> 00:13:59 quickly abandon it.
00:13:59 --> 00:13:59 Yeah.
00:14:01 --> 00:14:05 um so how does this approach how does
00:14:05 --> 00:14:07 directional preference let's bring sort of
00:14:07 --> 00:14:10 both of the things that you do together
00:14:10 --> 00:14:11 the research directional preference and
00:14:11 --> 00:14:14 working with athletes or you know tactical
00:14:14 --> 00:14:16 athletes tactical operators what does this
00:14:16 --> 00:14:18 approach offer when time matters i mean
00:14:18 --> 00:14:20 you just said you operationally this is
00:14:20 --> 00:14:22 money this is effectiveness this is
00:14:22 --> 00:14:24 readiness what does that approach offer
00:14:24 --> 00:14:25 when time matters with those types of
00:14:25 --> 00:14:26 people you're working with
00:14:26 --> 00:14:26 Yeah.
00:14:26 --> 00:14:28 Let's put some context around that.
00:14:28 --> 00:14:30 So within the unit for our guys,
00:14:30 --> 00:14:31 depending on what level of training they
00:14:31 --> 00:14:31 have,
00:14:32 --> 00:14:35 it's going to cost between one point two
00:14:36 --> 00:14:37 to about one point nine million dollars to
00:14:37 --> 00:14:38 make one of these guys.
00:14:38 --> 00:14:38 Right.
00:14:39 --> 00:14:41 Government has a down to a dollar figure
00:14:41 --> 00:14:43 in its four thousand three hundred twenty
00:14:43 --> 00:14:45 dollars and some odd cents per day that
00:14:45 --> 00:14:46 these guys aren't operational.
00:14:46 --> 00:14:48 OK, so they track this.
00:14:48 --> 00:14:48 Right.
00:14:48 --> 00:14:49 And they look at the cost of not
00:14:49 --> 00:14:51 being ready and they know.
00:14:51 --> 00:14:53 And so there's huge incentive to get these
00:14:53 --> 00:14:55 guys back to duty quickly.
00:14:55 --> 00:14:57 And every one of these guys has to,
00:14:57 --> 00:14:59 no matter what service you're in,
00:14:59 --> 00:15:01 they have to be able to pass some
00:15:01 --> 00:15:03 sort of operator fitness test, right?
00:15:03 --> 00:15:04 And every branch is a little bit different
00:15:05 --> 00:15:06 to be on status to be operational.
00:15:06 --> 00:15:08 And so if they can't pass that due
00:15:08 --> 00:15:09 to pain, due to whatnot,
00:15:09 --> 00:15:10 they don't get to go, right?
00:15:10 --> 00:15:12 And then they start costing money for the
00:15:12 --> 00:15:12 government.
00:15:12 --> 00:15:13 And so...
00:15:14 --> 00:15:15 the intent for us was like okay how
00:15:15 --> 00:15:17 do we get these guys back right now
00:15:17 --> 00:15:19 when you look at you know it's basically
00:15:19 --> 00:15:21 sports specific PT we have this whole
00:15:21 --> 00:15:23 battery of tests we can use for a
00:15:23 --> 00:15:24 lower extremity injury right like I hurt
00:15:24 --> 00:15:26 my knee um you know I can look
00:15:26 --> 00:15:27 at hop testing I can look at Y
00:15:27 --> 00:15:29 balance I can look at all these different
00:15:29 --> 00:15:30 metrics say okay you're ready to go okay
00:15:30 --> 00:15:32 you've passed this let's put you in the
00:15:32 --> 00:15:34 test let's make sure you're set same with
00:15:34 --> 00:15:36 the upper extremity right but the question
00:15:36 --> 00:15:37 is like they already told us our biggest
00:15:37 --> 00:15:39 problem is spine related issues
00:15:40 --> 00:15:42 what return to sport testing is there for
00:15:42 --> 00:15:44 spine related issues, right?
00:15:44 --> 00:15:45 Nothing, right?
00:15:45 --> 00:15:46 And so what we started to do was,
00:15:46 --> 00:15:46 okay,
00:15:47 --> 00:15:49 let's see if we can use directional
00:15:49 --> 00:15:53 preference as a performance metric to get
00:15:53 --> 00:15:54 them back.
00:15:54 --> 00:15:55 Because what we were doing is we were
00:15:55 --> 00:15:56 defaulting back to more of this
00:15:57 --> 00:15:58 traditional pathoanatomical diagnosis.
00:15:58 --> 00:15:59 They come in, we say, hey,
00:15:59 --> 00:16:00 you got a grade two,
00:16:01 --> 00:16:02 you got a grade one or two lumbar
00:16:02 --> 00:16:02 strain.
00:16:03 --> 00:16:04 you know you're going to be shut down
00:16:04 --> 00:16:05 about three weeks to six weeks depending
00:16:05 --> 00:16:07 on the severity of it right well now
00:16:07 --> 00:16:09 what we've done is okay let's put you
00:16:09 --> 00:16:11 through our exam right we do a basic
00:16:11 --> 00:16:13 ompd exam looks nothing different than
00:16:13 --> 00:16:15 anybody else going to do and then we
00:16:15 --> 00:16:16 throw in this repeated movement testing
00:16:16 --> 00:16:18 with it and if they exhibit directional
00:16:18 --> 00:16:20 preference we actually use that as their
00:16:20 --> 00:16:22 guideline to if they're ready to return
00:16:22 --> 00:16:24 back to duty right and so
00:16:25 --> 00:16:25 We know that, like we said,
00:16:25 --> 00:16:28 directional preference is moving them in a
00:16:29 --> 00:16:30 specific direction that reduces pain,
00:16:30 --> 00:16:32 that decreases their pain and improves
00:16:32 --> 00:16:34 their function.
00:16:34 --> 00:16:36 So what we've done is we've basically
00:16:36 --> 00:16:37 broken down component movements of their
00:16:37 --> 00:16:39 fitness tests that they have to pass.
00:16:40 --> 00:16:41 And once they come in,
00:16:41 --> 00:16:42 if they exhibit directional preference,
00:16:42 --> 00:16:43 we get the pain resolved,
00:16:43 --> 00:16:44 we get the mechanics restored.
00:16:45 --> 00:16:48 We then go test specific parts of that
00:16:48 --> 00:16:49 test.
00:16:49 --> 00:16:50 And if they pass that without a
00:16:50 --> 00:16:52 reproduction of pain or a loss of
00:16:52 --> 00:16:54 function, we green light them.
00:16:54 --> 00:16:56 And we've been tracking the data now for
00:16:56 --> 00:17:00 four years and we're getting our guys back
00:17:00 --> 00:17:03 to duty about thirty six percent faster
00:17:03 --> 00:17:05 than we were four years ago.
00:17:05 --> 00:17:05 Yeah.
00:17:06 --> 00:17:07 I mean, it's you know, it's upwards of,
00:17:07 --> 00:17:10 you know, eighteen to twenty two days.
00:17:10 --> 00:17:10 Right.
00:17:10 --> 00:17:11 And so you can times that number.
00:17:11 --> 00:17:11 Right.
00:17:12 --> 00:17:13 So, you know, so in that same tent,
00:17:13 --> 00:17:15 cause these programs cost the government a
00:17:15 --> 00:17:15 lot of money.
00:17:15 --> 00:17:16 So it's like, okay,
00:17:16 --> 00:17:18 how do we incentivize to keep these
00:17:18 --> 00:17:18 programs?
00:17:18 --> 00:17:19 Cause they're so valuable.
00:17:20 --> 00:17:20 Um,
00:17:20 --> 00:17:21 but they have to demonstrate some sort of
00:17:21 --> 00:17:23 value, right?
00:17:23 --> 00:17:24 Now I'm going to make you think an
00:17:24 --> 00:17:26 answer bigger, no pressure,
00:17:27 --> 00:17:30 but if the profession did a better job
00:17:30 --> 00:17:31 leveraging directional preference,
00:17:32 --> 00:17:33 what could change you?
00:17:33 --> 00:17:34 That was my question that was queued up
00:17:34 --> 00:17:36 a minute ago, but you sort of, you're,
00:17:36 --> 00:17:37 you're putting numbers to this.
00:17:37 --> 00:17:38 You're like, well,
00:17:38 --> 00:17:39 if these guys are four grand a day,
00:17:40 --> 00:17:40 um,
00:17:41 --> 00:17:42 It might be smaller if you're just a
00:17:43 --> 00:17:44 podcast host, right?
00:17:44 --> 00:17:45 But to me, that's a lot.
00:17:45 --> 00:17:47 So what would you imagine or how would
00:17:47 --> 00:17:49 you explain it to a student if the
00:17:49 --> 00:17:50 profession did a better job leveraging
00:17:51 --> 00:17:51 this?
00:17:51 --> 00:17:53 Man, what would that look like?
00:17:55 --> 00:17:55 Yeah, I mean,
00:17:56 --> 00:17:58 I guess I'll say the caveat, right?
00:17:58 --> 00:17:58 So, you know,
00:17:59 --> 00:18:00 a little bit of bias here, right?
00:18:00 --> 00:18:01 Because I teach for the Institute.
00:18:03 --> 00:18:04 I'm going to put that out there.
00:18:04 --> 00:18:05 But, you know, I think,
00:18:05 --> 00:18:06 like I tell all my students, I say,
00:18:06 --> 00:18:07 you know,
00:18:07 --> 00:18:08 this method works for me because it makes
00:18:08 --> 00:18:09 sense in my head.
00:18:09 --> 00:18:10 It doesn't mean you need to do this
00:18:10 --> 00:18:11 method, whatever.
00:18:11 --> 00:18:14 framework works for you that that you want
00:18:14 --> 00:18:15 to implore your patients that you can
00:18:15 --> 00:18:17 that's that's evidence-based do it all i
00:18:17 --> 00:18:19 encourage people to do is yeah just put
00:18:19 --> 00:18:22 in repeated movements and identify if you
00:18:22 --> 00:18:23 can look for directional preference based
00:18:23 --> 00:18:26 on these criteria because if you do i
00:18:26 --> 00:18:28 mean a patient is going to get better
00:18:28 --> 00:18:31 i mean when you look at there's again
00:18:31 --> 00:18:32 you look at the guidelines it's still a
00:18:32 --> 00:18:33 to b level evidence so there's a high
00:18:33 --> 00:18:35 level evidence for this right nice part
00:18:35 --> 00:18:37 about it is a lot of it the
00:18:37 --> 00:18:39 patient is able to do independently on
00:18:39 --> 00:18:39 their own
00:18:39 --> 00:18:40 Right.
00:18:40 --> 00:18:41 And so you're starting to build this
00:18:41 --> 00:18:43 self-efficacy for the patient.
00:18:43 --> 00:18:44 You're starting to empower the patient.
00:18:44 --> 00:18:45 Right.
00:18:45 --> 00:18:46 To be able to treat themselves.
00:18:46 --> 00:18:48 So we're looking at decreasing, you know,
00:18:48 --> 00:18:49 more chronic related problems.
00:18:49 --> 00:18:50 We're going to look at decreasing
00:18:51 --> 00:18:52 recidivism of problems because they're
00:18:52 --> 00:18:53 self-managing it.
00:18:53 --> 00:18:53 Right.
00:18:54 --> 00:18:55 The cool part about the system, too, is,
00:18:55 --> 00:18:55 you know,
00:18:56 --> 00:18:58 it's this cause and effect check recheck
00:18:58 --> 00:18:59 system.
00:18:59 --> 00:18:59 Right.
00:18:59 --> 00:18:59 I mean,
00:18:59 --> 00:19:01 patient tries to bend forward and they got
00:19:01 --> 00:19:02 pain shooting on their leg.
00:19:02 --> 00:19:03 They do repeated movements.
00:19:03 --> 00:19:04 Also, they bend forward.
00:19:04 --> 00:19:06 Hey, it's not my leg anymore.
00:19:06 --> 00:19:07 You think the patient's happy or not?
00:19:08 --> 00:19:08 Right.
00:19:08 --> 00:19:09 they can feel an immediate change.
00:19:10 --> 00:19:12 And you don't have to create much buy-in
00:19:12 --> 00:19:13 for that, right?
00:19:13 --> 00:19:15 And so one, the ability to,
00:19:15 --> 00:19:16 like we're demonstrating to accelerate
00:19:16 --> 00:19:19 recovery, but two, to empower the patient,
00:19:19 --> 00:19:20 to decrease recidivism.
00:19:20 --> 00:19:21 So we're looking at decreasing overall
00:19:21 --> 00:19:22 healthcare costs.
00:19:22 --> 00:19:24 We're looking at decreasing overall
00:19:24 --> 00:19:26 chronicity of problems and more downstream
00:19:26 --> 00:19:27 related issues that we know are so
00:19:27 --> 00:19:28 associated with that.
00:19:28 --> 00:19:30 So I think there's power in it, right?
00:19:31 --> 00:19:33 If, and like I tell everybody, I'm like,
00:19:33 --> 00:19:35 just put it in, you do you,
00:19:35 --> 00:19:36 but just throw it in your exam, man.
00:19:36 --> 00:19:37 And you will start to see,
00:19:37 --> 00:19:38 you'll start to see change, right?
00:19:39 --> 00:19:40 and then you just see what that fits
00:19:40 --> 00:19:43 within your own treatment system if you
00:19:43 --> 00:19:45 could leave clinicians we'll do your we
00:19:45 --> 00:19:46 call it the wow your words of wisdom
00:19:46 --> 00:19:48 if you could leave clinicians with one
00:19:49 --> 00:19:52 shift in how they think not just what
00:19:52 --> 00:19:54 they do as much kool-aid as you want
00:19:54 --> 00:19:56 in this answer that's that's allowed after
00:19:57 --> 00:19:59 this episode what would it be what would
00:20:00 --> 00:20:01 one shift in how they think that you
00:20:01 --> 00:20:03 would you would suggest not just in what
00:20:03 --> 00:20:04 they do but how they process
00:20:04 --> 00:20:06 You know, I think the biggest thing,
00:20:06 --> 00:20:06 you know,
00:20:06 --> 00:20:06 and I try to do this all the
00:20:06 --> 00:20:08 time is be open-minded, right?
00:20:08 --> 00:20:11 Understand that one thing doesn't fix
00:20:11 --> 00:20:11 everything, right?
00:20:12 --> 00:20:13 If there was one thing to fix everything,
00:20:13 --> 00:20:14 we'd all be doing the same thing.
00:20:14 --> 00:20:14 Sure.
00:20:14 --> 00:20:15 There's all these different things out
00:20:15 --> 00:20:16 there, right?
00:20:17 --> 00:20:18 But we tend to be closed off and
00:20:18 --> 00:20:20 have our own confirmation and internal
00:20:20 --> 00:20:21 biases, right?
00:20:21 --> 00:20:22 Hey, I did all this training,
00:20:22 --> 00:20:23 so I'm going to do this, right?
00:20:24 --> 00:20:26 be open-minded, try other things,
00:20:26 --> 00:20:27 you know,
00:20:27 --> 00:20:28 that hopefully have some level of evidence
00:20:28 --> 00:20:29 behind them,
00:20:29 --> 00:20:31 fit them in your system because, you know,
00:20:31 --> 00:20:32 there's value in what I do,
00:20:32 --> 00:20:34 but I take so much from everybody else
00:20:34 --> 00:20:34 as well.
00:20:34 --> 00:20:35 I'm like, okay, how does this fit in?
00:20:36 --> 00:20:36 Oh my gosh,
00:20:36 --> 00:20:38 this was the last little piece I needed
00:20:38 --> 00:20:39 to help this population that I've
00:20:39 --> 00:20:40 struggled with.
00:20:40 --> 00:20:42 So, you know, obviously I'm biased.
00:20:43 --> 00:20:44 I'd say take a course, try it out,
00:20:44 --> 00:20:44 but,
00:20:45 --> 00:20:46 be open-minded about it.
00:20:46 --> 00:20:48 Don't, don't just throw it out because,
00:20:48 --> 00:20:49 Hey, I did a couple of these things.
00:20:49 --> 00:20:49 I tried it once.
00:20:49 --> 00:20:50 It didn't work.
00:20:50 --> 00:20:51 Understand a little bit more,
00:20:52 --> 00:20:53 understand it's more complex than what
00:20:53 --> 00:20:54 people might think.
00:20:54 --> 00:20:55 It's not just simple, straightforward,
00:20:55 --> 00:20:57 forward bends or backward bends and, um,
00:20:58 --> 00:20:58 explore a bit more, right?
00:20:59 --> 00:21:00 Cause you will see, you will see change.
00:21:00 --> 00:21:01 Uh,
00:21:01 --> 00:21:02 what would some of those things that
00:21:02 --> 00:21:04 you've tested and tried and, and,
00:21:04 --> 00:21:05 and taken some things from,
00:21:05 --> 00:21:06 this is where you can throw out just
00:21:07 --> 00:21:07 names of courses.
00:21:07 --> 00:21:08 We're not saying you're endorsing them,
00:21:08 --> 00:21:10 but what are the things that you've tried
00:21:10 --> 00:21:11 that you're like, Hey, I've tried these,
00:21:11 --> 00:21:12 these different flavors of Kool-Aid I've
00:21:12 --> 00:21:13 drank.
00:21:13 --> 00:21:14 Yeah, I mean,
00:21:14 --> 00:21:16 the nice part about the government is they
00:21:16 --> 00:21:17 like to spin us up on everything.
00:21:17 --> 00:21:18 So if there's something out there, I mean,
00:21:18 --> 00:21:20 you know, I've been through BFR, you know,
00:21:20 --> 00:21:22 I've been through dry needling.
00:21:22 --> 00:21:22 You know,
00:21:22 --> 00:21:23 I'm a I'm a strong first kettlebell
00:21:23 --> 00:21:24 instructor.
00:21:24 --> 00:21:25 I went through my USAW search.
00:21:25 --> 00:21:25 You know,
00:21:26 --> 00:21:28 my fellowship had a Maitland and Saruman
00:21:29 --> 00:21:29 flavor to it.
00:21:29 --> 00:21:29 Right.
00:21:29 --> 00:21:31 So I do look at some MSI stuff.
00:21:32 --> 00:21:33 You know,
00:21:33 --> 00:21:35 I did take a master's in medicine.
00:21:36 --> 00:21:37 orthopedic manual therapy that was more
00:21:38 --> 00:21:40 osteopathic based right so you know
00:21:40 --> 00:21:42 there's all kinds of stuff out there and
00:21:42 --> 00:21:43 that's why i know this other stuff works
00:21:43 --> 00:21:45 right um but sometimes you know i know
00:21:45 --> 00:21:47 prior to i was probably before going
00:21:47 --> 00:21:49 through a lot of that training and being
00:21:49 --> 00:21:50 around these other highly skilled
00:21:50 --> 00:21:52 clinicians i was a little closed office
00:21:52 --> 00:21:53 you know and i would just shut other
00:21:53 --> 00:21:55 things down like no that's not right but
00:21:55 --> 00:21:57 yeah there is such an application i think
00:21:58 --> 00:21:59 the more and more you you get better
00:21:59 --> 00:22:01 at your craft the more you recognize hey
00:22:01 --> 00:22:02 these other things do work you know it's
00:22:02 --> 00:22:03 like every time i go to am and
00:22:03 --> 00:22:05 i'm i'm learning so much from all these
00:22:05 --> 00:22:07 other people right and um like okay i
00:22:07 --> 00:22:08 can definitely see what that fits within
00:22:08 --> 00:22:10 my system and why that would work but
00:22:11 --> 00:22:11 then at the end of the day i
00:22:11 --> 00:22:12 think if we're just nice to our patients
00:22:12 --> 00:22:14 a lot get better too so you know
00:22:15 --> 00:22:16 We need a course on how to do
00:22:16 --> 00:22:16 that.
00:22:16 --> 00:22:17 Josh,
00:22:17 --> 00:22:18 you're going to lead that course on how
00:22:18 --> 00:22:19 to be nice to our patients.
00:22:19 --> 00:22:21 This is one of the reasons you just
00:22:21 --> 00:22:22 highlighted without me having to ask,
00:22:23 --> 00:22:25 why do we sit down with microphones and
00:22:25 --> 00:22:26 put these things on YouTube and share them
00:22:26 --> 00:22:27 and let them...
00:22:27 --> 00:22:29 This is outside of membership as well as
00:22:29 --> 00:22:31 this is show more than tell what the
00:22:31 --> 00:22:32 value of membership is.
00:22:32 --> 00:22:34 You're looking at a snapshot of Josh here,
00:22:34 --> 00:22:34 but...
00:22:34 --> 00:22:36 Someone like Josh goes to Aometer as a
00:22:36 --> 00:22:38 member because they understand the value
00:22:38 --> 00:22:38 in those things.
00:22:38 --> 00:22:40 And those things are intangible.
00:22:40 --> 00:22:42 I try to make this as tangible as
00:22:42 --> 00:22:43 a podcast or a video could be.
00:22:43 --> 00:22:45 Make it as tangible as you can because
00:22:45 --> 00:22:47 that's where the value, in my opinion,
00:22:47 --> 00:22:50 really is.
00:22:50 --> 00:22:50 Right.
00:22:50 --> 00:22:50 Awesome.
00:22:50 --> 00:22:51 Well, hey, Josh, appreciate the time.
00:22:52 --> 00:22:52 Hurry up.
00:22:52 --> 00:22:53 Get back to work.
00:22:54 --> 00:22:55 You're costing the government some money.
00:22:55 --> 00:22:56 Get some people back.
00:22:57 --> 00:22:58 And we appreciate your time here on Hands
00:22:58 --> 00:22:59 On, Hands Off.
00:22:59 --> 00:23:00 Hey, thank you so much.
00:23:00 --> 00:23:01 It was a pleasure to be here.