Touch: the most powerful technique in physical therapy

[00:00:05] Welcome to The Aaron LeBauer Show. This is the number one show for passionate

[00:00:09] physical therapy and healthcare entrepreneurs looking to level up their

[00:00:13] income and impact on the world. If that's you, then you're in the right place. So

[00:00:18] sit back, chill out, and let's get into the show. Hey, welcome back to The Aaron

[00:00:27] LeBauer Show. So right now what I want to do is talk about the number one thing

[00:00:32] most physical therapists get wrong and exactly how you can make sure patients

[00:00:37] know that you are the right person to see for their problem. So my name is Dr.

[00:00:43] Aaron LeBauer. If you're listening to this, you've probably listened to other episodes,

[00:00:47] but when I was a massage therapist first and then went to PT school and then I

[00:00:52] started cash practice and I became a business coach. When I was a massage

[00:00:56] therapist, I loved working as a massage therapist. One of the most frustrating

[00:01:00] things is people would say to me, it's frustrating and complimentary, people

[00:01:03] would say, Aaron you're the first person ever touched me where I hurt. You're the

[00:01:07] first person who's actually ever helped me. I've been to see other massage

[00:01:10] therapists, chiropractors, physical therapists, have been to the orthopedic

[00:01:13] surgeons, I've had the injections, had the surgery and no one's ever touched me

[00:01:17] there and that's exactly where it hurts. I've just been waiting for someone

[00:01:21] to do that. I was like, I mean after a while I was like okay cool great like

[00:01:28] cool that's why people pay me $85 an hour. And that was in early 2000s.

[00:01:33] 20-something years ago people pay me 85 bucks an hour and the sad thing is

[00:01:37] PT's right now are making less than 85 bucks an hour. Look I didn't have a job

[00:01:42] and if you're making 50 bucks an hour you're working in a job. I mean but I

[00:01:45] also had four or five patients a day and I had a lot of freedom doing it and I

[00:01:49] had a lot of ups and downs so there's a trade-off. But at the same time I was

[00:01:53] making 85 bucks an hour as lowly Aaron the massage therapist. Yes I graduated

[00:01:57] from Duke but massage therapy is a certificate program. Wasn't even licensed

[00:02:01] in California because you didn't need to be. But people were still saying I've been to

[00:02:06] see all these medical professionals and you're the first person to touch me where

[00:02:08] I hurt. So what I want to do today is you know without sitting you in a room,

[00:02:12] sitting you on my table, putting my hands on you, try to give you these insights

[00:02:16] as to how we help patients and the three-part framework that we use in our

[00:02:21] clinic and that I use to help our patients get a treatment and experience

[00:02:26] they can't get anywhere else but also help our therapists create an experience

[00:02:30] that's very similar even if they have a different treatment philosophy. So here's

[00:02:35] the number one thing most physical therapists get wrong when treating

[00:02:37] patients. That you just don't touch patients. You're not touching them and

[00:02:43] you might not be a manual therapist, you might be manual therapies hogwash. Well

[00:02:47] if you are a manual therapies hogwash type of person you're probably not

[00:02:50] listening to my show because I don't really resonate with a lot of those guys

[00:02:54] but you know what? You know I mean maybe you are or maybe you do and maybe you

[00:03:00] feel like oh whoa Aaron's a manual therapist yeah I was a massage therapist

[00:03:03] I studied MFR with John Barnes and I've done trigger point therapy well before I

[00:03:09] did dry needling and one of the really cool reasons I liked to dry needling

[00:03:13] with Jan Domerholt in my opinion was that he's teaching dry needling through

[00:03:18] the philosophy of Janet Travelle and Janet Travelle is whose books we used

[00:03:24] when I was in massage therapy school as part of our like I think you call it

[00:03:28] like neuromuscular therapy massage maybe nowadays I call it more of like a

[00:03:31] medical massage it was trigger point therapy and I get to dry needling I'm

[00:03:35] like wait I already know all this stuff not only that I was a PT but like I know

[00:03:38] where the trigger points are I just had to like learn how to put the needles in

[00:03:42] what the what that technique was and the contraindications and wearing how to do

[00:03:47] it I didn't have to learn anything about the trigger points I had done it a long

[00:03:50] time but most people are not getting touched and here's why this is a problem

[00:03:55] that's because you've come in oops I'm playing with my pen fidget most people

[00:04:01] come into a clinic and they're sat on a bike there they get some ice packs they

[00:04:05] run through some exercises they've just never even been touched I learned this

[00:04:11] from one of my clinical mentors Bob Duvall we have to meet our patients

[00:04:16] affective needs a effective affective needs and what that means is they need

[00:04:22] to feel confident that we know exactly where the problem is and one of the ways

[00:04:25] to do that is to touch them where they hurt you have to touch patients where

[00:04:29] they're hurt even if we don't really believe that people need more than 30 to

[00:04:32] 45 seconds of hands-on care which is what my professor said when I was at PT

[00:04:37] school in Elon and she said that and I raised my hand right away I was like I

[00:04:41] didn't wait for a call me I was like I just have to say that I want to make

[00:04:46] sure everyone else in this room knows that I made my career as a massage

[00:04:49] therapist because that's the way PT's think oh she Debbie was mad I could see

[00:04:54] it in her face but I could not let the other 40 people in class think that that

[00:04:59] was the way it was because that's how I built my business those people were not

[00:05:04] being touched in PT so here's what I'm saying is like people are going to

[00:05:07] orthopedic surgeons PT's etc and look I'm hitting the trigger point in the in

[00:05:13] their traps their infraspinatus their quadratus lumborum their piriformis

[00:05:17] gastrocnemius I mean these aren't like hard to reach places these aren't like

[00:05:22] like crazy you know like oh my god like Aaron's deep in a psoas or something in

[00:05:29] a diaphragm or who knows what like working on the high I mean I'm not like

[00:05:34] working on someone's hyoid and doing the like even the pterygoids like that's

[00:05:38] hard to get to once you figure it out it's easy but we're not even talking

[00:05:42] about that we're talking to like simple easy you know temporalis I didn't hard

[00:05:46] to touch sounds like I paint in my face well you have to know a little bit about

[00:05:50] trigger point therapy but you really just have to use your hands and explore

[00:05:53] so here's how you do it here's how you touch someone where they hurt you say

[00:05:57] hey point to where it hurts they point okay what does it feel like great let me

[00:06:01] take a look at you you put them on the table or a massage chair even just this

[00:06:04] they can sit on a couch and you just kind of gently rub your hands into their

[00:06:10] muscle and you're just feeling to engage the muscle like it's really hard to say

[00:06:13] in words without showing you my hands but if you're a physical therapist you've

[00:06:16] done some of that and what you say the patient is this you say hey I want you

[00:06:22] to let me know when I hit the right spot like let me know if like I hit a spot

[00:06:26] that takes away the pain or it makes it worse or even just like oh my god

[00:06:29] that's it like just let me know because if you're right on a trigger point you

[00:06:34] know someone's on a tree running oh oh my god oh that's it like you're right on

[00:06:38] it but it can't be super light touch and it can't be forceful what we want to do

[00:06:43] is match what their body our patient or clients body is giving us we need to

[00:06:47] match it match it with the pressure not over pressure and over force it it's more

[00:06:52] of can we meet their body where it is and then treatment is to me really easy

[00:06:58] oh I found the spot okay cool take some deep breaths breathe right into it and

[00:07:01] see if you can soften and I'll just let them soften and a lot of times just

[00:07:04] finding the trigger point helps deactivate it a little bit and you can

[00:07:08] argue with me on trigger point theory or not I don't really care like that's not

[00:07:12] why we're here and side note people are like Aaron how do you know that what you

[00:07:17] do works I'm like well no people pay me 250 bucks an hour for me to do it I'm

[00:07:21] pretty sure that means it works you know and why are they dropping out of you

[00:07:25] know traditional physical therapy why are there all these apps built you know

[00:07:30] to increase compliance and traditional in network practices because you don't

[00:07:35] have time to touch people where they hurt you're not meeting their affective

[00:07:39] needs you're not doing anything they feel is helpful because you probably

[00:07:42] don't have the time it might not be that you're bad therapist just the model you

[00:07:46] don't have the time so you kind of have all these things to keep them compliant

[00:07:49] you know create some skepticism but that's it it's just you kind of explore

[00:07:56] and find out you don't even have no trigger point there be a point to where

[00:07:59] it hurts okay and then you just press around push press soft use your hands

[00:08:05] use your energy use like wide flat firm hands pressure and touch and you can

[00:08:12] take your thumbs your elbows your fingers and just explore the muscles and

[00:08:16] see is there a tender tight spot that gets that patient to be like Oh twitch

[00:08:21] or move or go off and what you have to do is just give them permission to

[00:08:25] communicate with you that you're in the right spot or say tell me is it higher

[00:08:29] lower cuz I feel like you're close to it just go down left right and just don't

[00:08:34] be afraid to explore with your hands that's what we learned in massage

[00:08:38] therapy school they did not teach us in PT school so this is what most physical

[00:08:44] therapists are getting wrong most providers are getting wrong is that

[00:08:47] you're not touching your patients I mean straight up you know you're not

[00:08:52] touching your patients where they hurt when you can touch your patient where

[00:08:55] they hurt they will know he gets me he understands my body he knows where my

[00:09:00] problem is they'll still question whether it's you know right or like the

[00:09:05] root they'll still get to this point where they're like I need to know the

[00:09:07] root cause of the problem because you and I don't have x-ray vision because

[00:09:12] they're impatient with the process because healing is a process not an

[00:09:16] event and we have to get that across to patients as well because they think oh

[00:09:19] he's found it great why ain't it gone well this takes time I need to get the

[00:09:24] MRI and some surgery and they'll be gone they promise will be gone right away

[00:09:27] which we all know that that's bogus so there's still these expectations if we

[00:09:32] can meet their effective needs and get them to know that we understand and we

[00:09:36] can repeat back to them what they've told us and and help them in a way test

[00:09:41] retest like move in a way that makes it hurt press on them moving away and be

[00:09:45] like oh it feels better great like no imagine the results will get if we

[00:09:50] actually get you through a plan of care or maybe it makes it worse okay great

[00:09:54] like this just means that you know it's a different dosage or maybe the problem

[00:09:59] somewhere else I need to run you through a full evaluation maybe it does nothing

[00:10:02] okay so maybe it's a referred pain from you know I don't know an internal organ

[00:10:08] kidney stones okay like but we'll know that after a few visits because of the

[00:10:14] patterns we recognize but if you can't touch them exactly where they're hurt

[00:10:17] that doesn't mean you can't help either and sometimes pain is not related to a

[00:10:23] muscle or a joint and it's more diffuse and there's other things there but if we

[00:10:29] can change people's experience we can provide some input to their body into

[00:10:34] their system to change what they're feeling good bad you know I know that

[00:10:38] we're in the right place maybe there's cases where we need to bring another

[00:10:42] provider in or get a second opinion but I know if I can change your pain your

[00:10:47] mobility your experience like I can help you and if I can't help you maybe I'm

[00:10:51] looking in the wrong spot and that's really where I need some time to look

[00:10:53] and seek oh gosh even though their pain is in their neck in their head you know

[00:10:58] there's a referral from somewhere in the thoracic spine maybe thoracic rotations

[00:11:02] locked up and you do some mobs but I need to test it first okay so here's why

[00:11:07] cash practices are better than in network clinics this is the only reason

[00:11:11] this is maybe the bonus but there's one more piece it's uh is why it's better

[00:11:16] guess what I have the time to explore and find out and I am under no pressure

[00:11:21] to do a quick manipulation and quick exercise and move on to the next person I

[00:11:26] don't have that pressure and maybe some of you are in network clinics where you

[00:11:29] see one person one-on-one for a half hour okay imagine if you had an hour

[00:11:33] okay maybe you see people one-on-one and you still see four people an hour and

[00:11:37] it's great and you get great results cool there's a subset of people that

[00:11:40] won't be served by that and that's the subset that comes to me for sure okay

[00:11:47] that's not only people that come to me but in a cash practice we have

[00:11:52] basically unlimited time to figure out what's wrong with our patients if I tell

[00:11:57] a patient that I don't agree with what your physician said this is what I see

[00:12:02] it is what we're doing like there's no reciprocation like there's no I'm not

[00:12:07] worried about them not reciprocating like never referring to me again because

[00:12:12] I disagreed with the orthopedic surgeon okay but if you are an employee and

[00:12:18] you're getting patients better faster you might get reprimanded like Tyler did

[00:12:23] or maybe you own in network clinic and you disagree with the surgeon and you

[00:12:27] have to tread carefully because if a patient if it gets if patient tells the

[00:12:30] surgeon it gets back to them they stop sending you you know ten people a week

[00:12:34] well that's limiting your ability to help your patients that's to me why cash

[00:12:40] practice is better but really it's allows me to get to the root cause of

[00:12:44] the problem and touch patients where they hurt and so here's how here's the

[00:12:48] framework I'm gonna finish with the framework then I use in my clinic and

[00:12:51] feel free to use this in yours just if you teach it to someone else let them

[00:12:56] know where you learned it from but the framework that I use with Derek Tyler

[00:13:01] Kaitlyn Chris you know who the physical therapists have worked for me is this

[00:13:06] it's listen touch and empower okay now what I do it for my employees is I do

[00:13:13] train them myself I send them to an MFR course a dry needling course and SFMA

[00:13:19] and with those three starting skill sets we treat patients in this framework we

[00:13:26] listen to our patients when they come in and at the beginning of every visit we

[00:13:30] ask specific questions we're not asking how are you feeling today you know we're

[00:13:35] not asking do you still hurt yes or no what's the rating risk your your pain

[00:13:39] so we listen to them we get feedback from them we we acknowledge them they

[00:13:45] know that we know where the problem is we use active listening techniques we

[00:13:49] touch them where they hurt and every visit they get touched even if it's

[00:13:54] just as part of the evaluation or maybe it's only a handshake I've had some

[00:13:58] patients not really want manual therapy it's fine I had one patient who really

[00:14:02] wasn't into it and we just did education in and lifestyle changes some exercise

[00:14:07] and he still got better yeah but that's very rare so we touch our patients at

[00:14:12] least 15 minutes of some hands-on therapy at the very least do a suboxy

[00:14:17] release people go what are you doing you just say hey close your eyes take five

[00:14:20] deep breaths and in in three minutes in five minutes tell me what I did and then

[00:14:26] we empower our patients we always give our patients one or two exercises to

[00:14:32] take home with them not a ton just one or two that change their symptoms help

[00:14:37] them get better and help them feel in control of what's going on right because

[00:14:42] it's not my job to keep patients forever I want to empower them to take

[00:14:45] control of their own health that's why we work with patients who want to take

[00:14:49] control of their own health people that want us to just passively do to them and

[00:14:52] fix them and without doing any work they're not really our patients and they

[00:14:56] don't get the results because they're not doing the work same with my coaching

[00:14:59] clients you gotta want to take control and take action right listen touch and

[00:15:04] power that's what we do every visit there's something that we empower them

[00:15:08] we educate them we give them tools to feel more in control of their health

[00:15:13] versus having it having their choice taken away by a surgeon saying you know

[00:15:16] we can always do surgery surgery is just rude it's just routine surgery and

[00:15:20] scared shitless out of it and hearing that just always bugs me so just to wrap

[00:15:28] this up touch your patients if you need a good course to learn how to touch

[00:15:33] patients there are a bunch of them out there and it's not just my nips and

[00:15:36] pivots and pavums soft tissue go take a massage therapy course go do like

[00:15:41] trigger point therapy don't just needle people you know touch their skin skin to

[00:15:46] skin get in there you're physical therapist darn it if you're just an

[00:15:50] exercise only physical therapist cool you know someone hurts somewhere press

[00:15:56] on it be like is this it yeah okay great you know take a couple deep breaths

[00:15:59] turn your head left and right even just do it as the evaluation then get your

[00:16:02] exercises in but don't be so like I can't touch people I've touched naked

[00:16:06] people I've worked on a lot of naked people they had a sheet over them but you

[00:16:10] know get over that part I don't know why people don't want to touch people cuz

[00:16:13] patients love it people would just sometimes just pay you to be touched

[00:16:17] because people are deprived of touched in their life in their daily life that's

[00:16:21] one of the most beautiful gifts we can give someone is compassionate touch at

[00:16:27] the very least if you work in the hospital get a new pair of socks take it

[00:16:32] to your patient put them on there and give them a little five-minute foot

[00:16:34] massage no matter how stinky their feet are then go wash your hands get over the

[00:16:38] smell because I think that more people in hospitals need to be touched people

[00:16:43] that are dying need to be touched people that are living probably dying

[00:16:47] inside because they're not getting the touch and if you're that person to give

[00:16:49] them some compassionate touch oh my god they'll pay for it you know no they will

[00:16:55] they do I've had that experience I've paid for it I've been touched by

[00:17:00] hundreds of people I've touched probably thousands of people touch is really

[00:17:05] powerful and if you're not using it in your practice you're missing out and if

[00:17:09] you're not using it as much as you think you could go take some courses get some

[00:17:14] opportunities to be more go get some body work yourself be more in touch with

[00:17:19] touching people and touch them because people love it and that's it for today

[00:17:25] I'll see you on the next episode hey what's up it's Aaron thanks for

[00:17:30] listening to show if you enjoyed the episode and you'd like to help support

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[00:17:41] me follow me over on instagram at Aaron Labauer thanks again and I'll see you

[00:17:45] next time