[00:00:04] Justin Farnsworth: I'm super pumped for this new clinical stuff that we're rolling out because we all know therapists like we're really good at the stuff we need for our boards, but we're not so good at applying the strength and conditioning principles that we know are missing from therapy. Evidence tells us over and over and over we under load patients
[00:00:29] PODCAST INTRO: Welcome to “In The RACK” podcast, where we provide you with the practical framework for breaking PRs in all facets of health and wellness. We are just a couple of bros giving you the simple house in a world of complex wants. No filters, no scripts, no rules, just straight talk, talk tune. Now, let's get into the rack with your hosts, Dr. Chad and Dr. Nick.
[00:00:55] Chad: Alright, everyone. Welcome to another episode of “In The RACK” podcast. I'm your host Chad and with me is my co-host and fellow physical therapist, Nick. Nick and I have another great episode today, we have another guest speaker on the show. And this guy goes by the name of Justin Farnsworth. And he is from PPSC, which is the Pain-Free Performance Specialist Certification. It's a course that we are actually hosting this weekend. And he came up a day early. So we can not only prepare for the course, but we wanted him on podcast because he's a wealth of knowledge. And we wanted to ask him a few questions kind of not only about PPSC, but a little bit about himself as well. And he is a physical therapist himself. So the course that we will be hosting will not only be the PPSC but it's more on like the clinical side. So it's got some good clinical pearls associated with it. So we're super excited to have him here and excited for this upcoming workshop in next couple of days.
[00:01:54] Nick: And he came to work together but, Chad, conveniently has to take get.
[00:01:58] Justin Farnsworth: I told, Chad, that it was like day. As soon as I said that, it was like, you know what, kid’s are at school.
[00:02:06] Chad: It was close to that order. Actually, what I said was dude, you got Nick, you're gonna like match really, really well.
[00:02:13] Nick: The kids actually had school today, but he was like, kids, you're not going to school. Come on, it's a snow day. I gotta take you home later.
[00:02:19] Chad: Busted. I was caught red handed. It's true. The kids have a snow day and we will be leaving wrap.
[00:02:24] Nick: Which is kind of crazy. Because there's not even an interest now right outside of it.
[00:02:29] Chad: Dude, it's wild. I'm only a half an hour from here. And there's three inches, still doesn't want no school. But that's just kind of the world we live in now which I'm sure we're gonna talk a lot about today.
[00:02:40] Justin Farnsworth: More time with your kids.
[00:02:42] Chad: I agree. I think it’s great.
[00:02:44] Justin Farnsworth: I was gonna say this earlier. And you've heard this from everyone but they grow up fast.
[00:02:47] Chad: They do.
[00:02:48] Nick: I’ve heard from everyone. It's true. And the parents are dichotomy. It’s kind of crazy, because Theo is four months old as of the other day, and it feels like it's been four years, but it also feels like it's only been a month, which is the craziest sensation, it feels like he's been here so long, but it hasn't been that long, but it's also flown by.
[00:03:10] Justin Farnsworth: But also, you probably always feel like you could take a nap two in the afternoon. People are like, what's it like being a new parent? Like, you could always take a little nap.
[00:03:19] Chad: That's true.
[00:03:20] Nick: That's that is true. That's a good way to describe.
[00:03:22] Chad: For sure, that is true. And then when you get older, you can't nap at all. The kids are just wired all day. So Justin, why don't you tell us a little bit about yourself? I know you're a physical therapist, but tell us like a little bit about your journey as to kind of what got you here today.
[00:03:37] Justin Farnsworth: How much time we got?
[00:03:38] Chad: You got as much time as you need.
[00:03:42] Justin Farnsworth: My journey to therapy, it's funny, I was a strength coach before was a therapist. So I'm telling the story tomorrow. I love record right here right now. That's like my first job was at 13 and strength conditioning. On my first client was Ryan Miller, one of the father’s hockey gold medalist, NHL player for a long time. The facility I worked at was owned by a soccer coach of mine and was 13 year old doesn't want to go in and train athletes, because I got some athletes who want to come in and train and then you can just train for free. And here I am, I want to play professional sports athletes sounds great. So I walk in and I think I'm the new guy. You're gonna get like the little seven and six year olds like no one wants to deal with and I walk in and it's your work with Ryan Miller today. Can my jaw hit the floor which is kind of crazy that I was the one doing that, you probably should have been someone else but let's facility random. We had some kickass stuff there too. We had one of those skating treadmills. We have one of the running ones I think it was a video of Stefon Diggs a few years ago hitting 24 miles on the freak the name of the company crappy acceleration or something, so we had that stuff. So I trained high level athletes for the first five years of my career. From there, I was soccer player, played soccer all the way through college as an All American played professionally after as well. And then just got a little burnt out, you work so hard to get to the thing. And then you're 19, 20, 21 years, you're like, I'm just kind of tired. So decided, I want to go work with people. And I think I'd rather do it the physical therapist route, like talking to people not passed out, knocked down on a table doing surgery, just face to face communication. I like that stuff. So went to Upstate Medical and Syracuse. From there, my wife and I actually moved around a little bit. So we're Western New Yorkers, and the winter sucks, we don't see the sun for four to five months, it's pretty depressing. And we decided to move to Arizona, just like out of the blue out of the whim, what place in the country has the most sun, we're gonna move there. 363 days of sun, lived and worked there for three years. A lot of good experiences, the bosses I had there. It was a lot of function, whatever the heck that word means. Like functional stuff, we'd have minimal to no table work. We did our dry needling, we did cool things. But my bosses were great friends with Gary Gray. So we did a lot of Gary based things and that really affected me early and how I look at and how I like to work with people. I think there are lots of roads to get there. And I'm biased on like putting your foot on the ground. But that really biased me early on. And we did a lot of cool stuff. We had professional athletes out there, we had every AAA player out there, we had Border Patrol, we had firefighters, the guys jumping out of airplanes to put on forest fires, there's an Air Force base right there. So we had Special Forces come in, because the Air Force and military can't, they don't have enough therapists to manage all their people. We had a lot of high level people. And it was cool, because in those people, the job is to get them back safely to their job as fast as you can. And they don't really care what their pain is. Their job is to be there for their team for their people. So it was what would maybe be considered aggressive therapy. And I'm just like, this is just regular therapy is like walking to facilitate and seeing the fucking belt squat, squat racks kettlebells and being like, this isn't aggressive place. And it's like, this is just how it should be like. Therapy people should leave better than they came in. Because how they came in is why they're here in the first place. So we did that. And then we actually decided, let's do another bucket list thing. Let's go to move to New York City, and we did that. So we lived and worked in New York City, worked for a very well-known physical therapy company who's known nationally, while we started there, they had five offices now they have 40. When I was there, New York City was a cool place. Because in a city like that, when you're there, and you're great in there, there's a lot of good medicine. And it's very competitive. And I remember on my interview, I walked in and talk to the lady who eventually hired me, her name's Cathy Campbell. And Cathy looks at me and she's like, “What do you want to do when you're here?” Like, what do you want your goal to be? And I'm like, I want to be the ACL rehab guy in New York City. And she straight up laughed in my face. So that's a good goal.
[00:07:52] Chad: You can’t niche down, it's down. That's crazy.
[00:07:53] Justin Farnsworth: One year later, 98% of my referrals were direct ACL rehab. I had a lot of good time up at HSS met all the docs. I put in a lot of hours to try to get that and worked really hard. And fortunately, by the end, it was all athletic shoulder, and athletic knee. That's all I wanted to do. And that's all I did for three or four years. It was awesome. And it's funny, back pain is the thing we all see. Like, everyone sees it. I personally hate trading it. I've never enjoyed it. I like helping people but as a diagnosis. We all have the things we like. So we had a back pain guy in my clinic. I miss the back pain for years. I just saw elbows, shoulders was awesome. Anyway, we ran through that. And then we decided to start a family. So we moved back to Western New York, Rochester. And from there, I worked for a company called Agape Physical Therapy. Actually, my wife actually hired me. So she was my boss for few years. She had me open up an office, grew it from myself to about five therapists. So we felt daunting. You show up at seven and you leave at seven. You're treating all the patients and you just grind it out for a year because that's what it takes. Very proud of that. Honestly, that wasn't super enjoyable. But it was in the sense of when you accomplish something hard. You're like, I actually did that. So we did that. And then I got an opportunity of a lifetime. Honestly, John called me up probably about two and a half years ago. For those who don't know John Ruskin, he's the founder of the PPSC certification company they work for and he asked me on full time, so Cathy want to go teach for us full time. Yes, I do. So I still treat patients kind of on the side. I'll do it for cash based stuff. My full time job is traveling the country meeting awesome people like you putting on his whole kick ass education. And really trying to not only better just like the coaches in the room, but also I'm super pumped for this new clinical stuff that we're doing. Because we all know therapists, like we're really good at the stuff we do for our boards, but we're not so good at like applying the strength and conditioning principles that we know are missing from therapy. Evidence tells us over and over and over under load patients, patients don't have great outcomes. Now whether that's like they showed up, they were compliant the insurance game, they didn't have enough visits, I get all that. But in the end of it as a therapist, we should be pushing that. We should be pushing harder. We don't because we're not confident. There's actually a study that came out last year 2021. It was a systematic review. And it was basically surveys of therapists in like 51 different countries on basically how confident do you feel a prescribing exercise? So 89% of therapists, and you guys can cross check me, it'll be on the screen. I think it was 89% of therapists say we should be prescribing resistance exercise, strength training. 50% said they actually felt confident doing that.
[00:10:45] Chad: I believe that. And even I wonder if it's lower.
[00:10:49] Justin Farnsworth: Some of the people are just like, I feel confident. I got this, but I don't. And I think there was an another step in I think it was less than 50% of physical therapists could actually state the minimum recommended exercise time per week, by the ACSM. 150 minutes, it's not that hard. And then it's like, do you have a physical practice? Are you that Doc, who's like, don't smoke while you're outside smoking?
[00:11:19] Nick: We see it all the time.
[00:11:20] Justin Farnsworth: That's a long story about my background. But that's like some of the stuff that really gets me excited about, like being able to do what I do, and coming in here and seeing what you guys do, because no one does this. And look where our health trajectory is going as a country, it's not getting better. I put a stat out today, the United States healthcare system is the largest entity in the country. And it's going to be growing by 16% in the next decade. So United Healthcare is number three on the Forbes 500 behind Apple, Amazon and Google.
[00:11:57] Chad: That’s crazy.
[00:11:58] Nick: We're not even top 10 in healthiest countries. We're not in top 20 which is crazy. We spend the most but we're not even up there. I said this before we handle a cute emergency traumatic situations. We hope people survive through those. But as soon as something is beyond acute, we are very bad.
[00:12:21] Chad: We just like to prescribe medicine. And I just got off the phone with my mom like an hour ago that this whole blood pressure thing. I know, I'm not gonna dive into super deep. But basically, she's been having blood pressure issues since her last COVID booster shot. I have to say it, though. Because it was for you, you're not crazy. Anyways, nobody wants to hear it number one. Number two, nobody knows why it's happening. Nobody can tell her why it's happening. What do they do? They just give her more blood pressure medication. They're like, “It's still up, just increase the dose”. It's like, this is not the answer. So this is just the system we live in. Unfortunately, it's after PT, this is how it's been done since 1985. So this is what we do.
[00:13:09] Nick: This is also how our clinic gets paid because we prescribe a certain percentage of this medication and that's bad too.
[00:13:10] Chad: Well, we get paid more describe direct versus manual therapy. So everything is driven off exercise.
[00:13:21] Nick: I think that's time. We just talked a lot about why we transition to that space. And that's a big piece of it. A lot of it is, we want more time with patients, but the insurance company is basically dictating based on finding finances what we do with people.
[00:13:35] Chad: They're still reimbursing for ultrasound. It's never shown to be effective, even since it came out. But we still get reimbursed for it.
[00:13:45] Justin Farnsworth: That machine over there in the corner. You could not even plug it in. And you'd get the same result.
[00:13:48] Nick: Dude, I don't even know if that ultrasound where exactly. It's there. You have to have it.
[00:13:56] Chad: You have to. It's like a picture of art on the wall. It's this conversation piece. It's kind of cool.
[00:14:04] Nick: $5000 conversation piece, it doesn’t work.
[00:14:06] Chad: We don't have any ultrasound gel. That's expired a long time ago.
[00:14:08] Nick: A couple months ago, someone asked me to do it. And I was like, I don't know how to do that.
[00:14:12] Justin Farnsworth: What eventually use ultrasound for, you can use it as a nice diagnostic practice.
[00:14:17] Nick: We have used it that was probably the last time I use that.
[00:14:20] Justin Farnsworth: I think that's when I used it more. Like that's the only time I use it. And that means like, twice a year.
[00:14:27] Nick: This is true.
[00:14:32] Justin Farnsworth: So the patients I have that come in, and they're repeat offenders. And maybe they saw something, that wasn't me. They saw someone else. And they're like, I saw Bob and Bob did ultrasound and it helped me so much. I'll do it on that person. I'll do it that one or two times until they can trust who I am? Because it's funny in our profession, and I gotta be careful. I live on social media, that's part of my job. So I see the pendulums all over the place. The pendulum has just swung from like, no manual therapy, manual therapy is literally useless. All you do now, every physical therapist has to be a strength coach. Everyone has to barbell back squat and rehab, because that's the superior squat lift, you can load it more and don't be a fear monger. And I'm like, there's still this middle ground where all the time you read the evidence, manual therapy and exercise is superior to exercise and just manual therapy.
[00:15:32] Chad: And we talk about it all the time, there's a huge mental component to the rehab process. Like you were just saying, like, this patient really responds well to ultrasound. What's the worst that can happen? We obviously know it doesn't work. But does it make him feel better? Yes, it does. So I think you can be the best physical therapist in the world. But if you can't connect with your patients, it doesn't really matter how good you are. It doesn't matter at all. Because if you can't get them better than you’re useless.
[00:15:57] Nick: Full time out real quick. 20 minutes and in the podcast, Chad, has not touched his food.
[00:16:11] Chad: So I've got oatmeal here as opposed to workout. And if I start eaten it, I don't want to get on the mic. It's gonna just get all.
[00:16:18] Justin Farnsworth: So what I want to know that this is a fun ethical question. Because I remember getting asked this in grad school 10, 11 years ago. Is it ethical to bill for the placebo effect? My answer is “Yes”. If the patient says I feel better, I had a symptom of eight, and is now a four. Is that really a placebo effect? If it's positive, it's still positive. We get caught up.
[00:16:47] Nick: And so number one, going back to what you were talking about before everyone wants to be an extremist now. They want to say the thing that is going to get the most views get the most likes, whatever. So when you say something extreme, people usually open their e a little bit. But the other thing is, is because we put research on such a high pedestal and research is important. You have to study objective things. When you're setting subjective, they don't really know how they felt. But I think that, like we sweep that under the rug so much where we say, we want to see these objective measures go up how you feel, it's lower than that. I think that's on top how are you feeling? If you're feeling good, let's go, let's keep rolling with what we're doing.
[00:17:27] Justin Farnsworth: That's my favorite is you have like the dash or the left, these little outcome measures. And there's some insurance companies that make you give it every two weeks. I would expect it's getting a little better, but I'm not expecting the minimal clinically important difference jump. What is it on the LTFS, like 10 points? I think 10 or more. And they just had a fracture. And most of the stuff is there's like, can you run? Can you jump? Can you hop on one leg? It's like, dude, its baseline.
[00:17:56] Nick: I still can't do that. What about the people we're filling out, they're like, I don't run. Like, what if you had to run? I don't run. I don't want to answer this one.
[00:18:06] Chad: It’s an objective but it's really not. It's a big subjective measure.
[00:18:11] Justin Farnsworth: Well, now they have those with the patient specific functional scale. So they can like put in their own activity and then they can rate it. So we used to use this company, for a documentation where it was all automated. So it'd be automated on the computer, and it would fill out your note for you. That was awesome. So I would spend less than five minutes doing notes. So they would come in. And if the person has reporting, they have back pain, why do we ask them that on the chart? And then ask them that again to document why can't they fill it out and then it's automated in my notes? So you would have all the subjective done. And then you would have nice little click boxes for assessment ACLR (An Anterior Cruciate Ligament Reconstruction) and then all the things that typically go with that just clicking in range of motion, loss, hearing loss, yada, yada, yada, that's crazy. Some of those measures, I get the idea, but insurance companies want to see him every two weeks.
[00:19:04] Chad: I know. That's what we were sick of.
[00:19:05] Justin Farnsworth: That's pretty wild. And then you go through all that and here's one visit.
[00:19:09] Chad: Thanks, man. Appreciate that.
[00:19:10] Justin Farnsworth: It's been an hour and a half on hold to get a peer review. And they're like, they're a flight attendant pain. But the flight attendant last, that's discharge. I know Bobby 16. And he wants to play high school sports, but he can walk five minutes without knee pain. So we don't cover the rest of that. So all of a sudden, you took someone who was functioning here, hi. And you're bringing them down. Now they're lower, and where do you expect them to go? And the craziest thing talk about how much money we spend on chronic disease. So 95% of US healthcare dollars, and older adults is spent on chronic disease. Guess what predicts your physical activity level when you're older, your physical activity level when you're middle aged. So like, if you're taking even that younger person and like knocking them down, and they're like, Man, I can't play sports anymore. Where are they going to go from there? Unless they find good people, which could be it's hard to find.
[00:20:04] Chad: It's hard. Now it's true. I like this conversation. This is such an honor. We love it, you're on the same page as us. So, now that we're talking about this, I think it's good to kind of talk about now I know that the PPSC is obviously designed to not only bring awareness, but also kind of drive the profession in this direction, but also make people feel confident with driving in that direction. So where do you see the vision of PT going in terms of whether it's performance based, whether it's PPSC stuff getting into college curriculum that kind of stuff, because obviously, there's a disconnect between what we get in college and what we see when we get out, I know that the internships and stuff help but what could we do better to prepare these kids when they get out of school that kind of stuff and then drive this profession in the right direction.
[00:20:59] Justin Farnsworth: It's funny, you say the internships help because one of my internships I saw 40 patients a day. So it helped me figure out how to burn myself out, still getting my paperwork done. And seeing 40 patients a day, they didn't do anything crushed me. And I'm like, this is going to be the rest of my career and this is my opinion. So people are going to disagree with me on this, that's fine. If you're still taking insurance and 10 years, I don't think you're going to exist or you're going to have to see so many people, that you're just not going to have a high quality of like what you do. So if you are privately on outpatient practice, unless you're in a state or just kind of middle of nowhere where like reimbursement high just because there's not a lot of people. I think those are gonna be gone. I think it's all gonna be running through a hospital. And hospitals don't care if the patients there don't care seem to care. They don't know any better. My first experience with outpatient hospital therapy 17 years old, we're playing soccer again, got taken out from the side. My niece was sworn up. No, at that time, it's like shit, like I tore my ACL. I couldn't walk on it. I was on crutches for a couple of weeks. I went to go see the docs at a local hospital in Rochester. They yanked my knee around all over the place. ACL is fine. You definitely pull your meniscus. So you did something there. So went downstairs to see a therapist sat in a chair. I think they looked at my knee going flexion extension. And maybe watch me walk in. That's it. And then I proceeded to leave and go back to my gym that I was a strength coach at and deadlift and squat and like this kind of hurts. I'm just like finagle around that like do all that? I don't remember my home exercise program was repeating it might have been like some leg lifts.
[00:22:44] Nick: It was all four ways.
[00:22:48] Justin Farnsworth: I go back and visit number two. I walk in my therapist is like, I'm with a patient right now what she was with about seven other patients. There's a treadmill and just go like take a little jog on the treadmill warm up. In my head, I have my first ever preseason coming up in six weeks. What's our fitness test? So Cooper test, whether that's good or not, it's stupid for soccer players, but it is what it is. So two miles in under 12 minutes. So in my head, I want to go run that. So I ran an 11 minute two mile with like Indy that felt like fairly good because I had just been working out just not doing stuff that hurt. And I remember she comes over and I'm like, sweaty, she's like, how fast did you run? And I told her, I was proud of myself. I’ve passed my fitness test and she started parading me. Like, why did you do that? I never told you that. I'm like, you didn't tell me to do anything. You're just go warm up. I can literally do all this on my own. She then proceeded me had to deadlift, the heaviest kettlebells they had, which is like 50 pounds. Literally, later that day, I left went to the gym and dead lifted four or five, four sets of five and I never went back. That being said like that, literally ingrained within me. I think school, every curriculum, every therapist should go spend time with the strength coach.
[00:24:03] Nick: I agree.
[00:24:04] Justin Farnsworth: Just because you have a doctoral degree doesn't mean everything. In fact, I think the more we learn, the more we realize we don't know anything. And we aren't super great at applying, just strength conditioning principles. Let me ask both of you. I know when I was in grad school, no one ever taught me how to squat or bench either you get that?
[00:24:22] Chad: No.
[00:24:23] Justin Farnsworth: What did you get? Here's the blue band. The blue band is 30 pounds at this level of pole here. The red band is 20 pounds at this level of pull. Here's how you set up the EMG. Like all that has value Sure. But people got to just learn how to get strong like and we just don't get taught that and we don't get taught how to coach like you do not. Therapists are notoriously poor in my opinion at actually like coaching people through exercise. Here's how you do it. Here's what you should feel and how you should feel it. And then if it hurts, how do I tweak that? We're just not good at.
[00:25:05] Chad: No, we are not. I would question whether and I don't know about your program, Nick, because Nick went to Springfield and everything.
[00:25:12] Nick: So I was just gonna say something.
[00:25:13] Chad: But our professors for the better part, not practicing for a long period of time. They were great, great professors. They knew their stuff. But let's just say that it was probably not taught because it was probably not known. It was just a lack of knowledge. I don't know what your experience was but that was mine in college.
[00:25:35] Nick: We had Springfield. So similar, a lot of the professors were out of practice for a while. But Springfield is very well known, probably more so for their exercise science and physical education programs. So they're in terms of division three, I played basketball there. So the varsity weight room is like a division one weight room, versus the other schools we go play against. They don't even have a varsity weight room. And then the athletic training room is eight times the size of the other schools. But nonetheless, great exercise science program grad, every varsity team has their own strength coach, like that's how good the division three program is. We did nothing with them. In PT school. We were so far removed from them, we almost got the sense that because we're in the, like, health sciences building, we were just like up on this pedestal, but we never. Like, one day, we went to the tea room. And use some of the equipment there. But we never went to the gym, which is insane. Because I was going through playing basketball, I was going through lifting programs with the coaches. So I was in there. And I'm like doing this stuff. And I'm learning it myself. Because it was really the first time I had done any kind of structured strength training. I'm doing that, and then I'm going back to class, and it was just total polar opposites and it was crazy.
[00:26:56] Justin Farnsworth: This is gonna get me into trouble. My professors were super nice, good people. Why do you get in physical therapy? Why do you get an education? Well, you either don't know how to run a physical therapy business, someone bought you out, but you failed as a clinician. It's, I hate to say it, but it's true. I wouldn't mind having a cushy job of being an education and like getting tenure. Honestly, I had some free time, that's wrong. But I remember the guy who taught like any birthday or x classes, I'm like, bro, you can't even squat your body weight on a bar. Again, I am biased towards strength and conditioning. I'm sure there are plenty of therapists that never have a patient touch, like a 10 pound dumbbell, even and those patients do five and my question is, do they come back? But do they stay fine? And is absence of pain, absence of a problem? No. And really, what are we trying to do? It's not just the knee person in front of me. It's like trying to improve their lifespan, and their physicality through their lifespan. I remember just kind of sitting there chuckling a little bit of just being, you are 120 pounds soaking wet. Like you don't even look strong.
[00:28:07] Nick: I love the fact that in your head, you're calling a professor, bro.
[00:28:11] Justin Farnsworth: Maybe not in grad school. Like, in a grad school you're kind of scared. If you're on time to class, you're late. Coming out of it a little bit, you're just laughs, I wish I could go back to grad school, I would have had a lot more fun.
[00:28:25] Chad: For sure. I go back now, knowing what I know. And we can rag on the professors all day long. But when you graduate? Where does the responsibility lie? It lies on the provider. You need to do your due diligence and do your research and figure out where you need to be. Because how many conferences that we've gone to where we've been the only PT’s there filled with personal trainers, and they were like, what are you doing here? It's like, we want to know. We want to get better at what we do. Perfect example, raise the bar last year, they were three PT’s. They're actually four if we include Justin, and that just wasn't supposed to be. So technically three, and technically this is sad. And it's just the responsibility really lies on the provided and make it more feasible for them to or maybe it's more awareness or something, whatever. But you should come to this, it could really help you and it just as it travels, we hope it gets better.
[00:29:28] Nick: And PT programs can make this a mandatory part of the curriculum. All it takes is a weekend. So they can easily adjust.
[00:29:36] Justin Farnsworth: And the funny thing is too is like not to rag on the school is what's the school's job to make you a really good generalist to make you own the doctor title in terms of like, I don't think this is musculoskeletal. I need to refer you out and to get you to pass the boards. That's it. But then when you get the row where you are it's kind of on the school a little bit like that. And when I say how many students you guys had? Where they are coming? And you're spending your third year student, you should be able to handle your own caseload which third year student ever can. I don't even think a PT, I don't even think you're comfortable till you're five years into just treating it. But they come into how much time are you spending, just like teaching them the basics of how humans generally with the understanding there's differences, how we should move and low just like loading principles, like basic loading one on one. We spent a lot of time doing that. And it's kind of sad. Like, it's funny. I think I know. I like I tell I'll give Cliff a shout out because you probably have. Actually, I'll make him listen to this. Because I'm giving. I'm giving him give me a compliment. I always tell Cliff like someone Cliff who's been in the industry for a while, as an excellent coach, and I’m like, “Dude, you're probably one of the best therapists I've ever met”. It's pretty simple. It's like, if ‘X’ hurts, just don't do that and find a way to still train that thing while not making ‘X’ hurt. And then gradually re-expose to the position that hurts. Like that's really what we all do, minus post-operative things. Like kind of our non-traumatic stuff that's not operative. That's kind of what we do. Well, we're starting to work that in a different way, until that doesn't hurt anymore. And then we expose you to that, and then build competence and volume on that. So you're ready for it the next time it happens. So the loader breaks you down. It's a motion to prepare. That's what we try to make people ready for.
[00:31:23] Chad: We say the same thing. Like even Taylor, she's one of our trainers, but she's been with us for so long that I would put her put her up against any traditional PT, like, maybe not on the assessment side, because she hasn't had that, but exercise progression, she'll crush every one of them.
[00:31:38] Nick: But even the assessment, she could do better than she totally.
[00:31:42] Justin Farnsworth: It’s also the cool thing too, it's like you think about like the raise the bar example. And we live in our silos. I'm a strength coach, and therefore I hate therapists, because every therapist tells me that I hurt my clients. How did you hurt your freaking shoulder, you're stupid trainer. And then men trainers want to play doctor. And then we have the opposite. It's like, we should just be a team. It's like this team for that person through the health span. So I know, for me, it was huge trying to find who are the best personal trainers in and around my area? So when you're done with therapy, I have somewhere that I can recommend you go. Because like, the end of me is like the start of your health journey. It's not like, my pain is gone. I'm going to do three sets of 10 bird dogs and bridges every day for the rest of my life, I'm going to try to eat a little bit better. And then hopefully, I want to get back in again. Like, that's just not how it works.
[00:32:33] Nick: And that's why we created the motto we have here because we do a lot of that transition that you were just describing, oh, I want to find some good trainers to send out we do a lot of the rehab, and then we transition people to three months of training with us. So then that's that bridge that gap. And then we have other trainers that go beyond that in the area. But we just noticed over the first couple years that in that in between areas, people were either just stopping because they're like, I don't feel or I'm not competent yet. And they will just completely stop or they would end up back and be like you did too much in that little window there.
[00:33:08] Justin Farnsworth: So even every coach needs a coach. I agree for sure. And you all know your shit. And you're like, I started with coach. So imagine just your normal lay person who's 40 year old, maybe has five pounds to lose his back day. Like they don't know, they try.
[00:33:24] Chad: For sure. How much respect you get though for that, like our clients and patients like what you have a coach, not only do I not know everything, but it also takes the bias out of my training. It also takes the bias out of my nutrition, everything. Because I am very creature of habit with some of the things that I did. Which is probably one of the reasons why get stuck in these plateaus, but it's they love it, they love to hear give them the idea.
[00:33:52] Justin Farnsworth: That's cool. I think to answer your question, 10 minutes later that's where therapy is going. I think therapy in outpatient, not Hospital has to transition to a continuum of care where you can discharge from therapy. And now we can train to do wellness. But if you're gonna do that, and like everyone wants to do that, it looks cool. We could tie down squat rack, we need to have some rogue freaking gym balls. We get to have the rhino’s belt squat. In order to do that, you have to know how to use it. Because you want to present yourself well. Strength coaches are awesome, I love them. They've been in the industry, like they learn by being in the industry. But in terms of musculoskeletal education, therapists should be able to access the top of the food chain in terms of being able to do that. We just don't have the basis of strength work. And in the gym work that I think makes us successful long term.
[00:34:43] Chad: I agree. And I feel like you said, this is a cool setting. This is what I want to do. I think that's cool. And I think that if that's your motivation, and that's your passion, and that's your vision, I think it's great, but you can't just walk into that you have to earn that. You have to earn that through experience, you have to earn that through going through the motions like whether it's you do work for insurance for a while to know what the other side's like, whether it is you have a great mentor, like, you don't just walk and just say, I'm going to open up my own clinic. How many kids get out of school, and just go right up into open up their own clinic that I think is the dumbest idea ever. Like I give you guys props for that. That's cool. But I still think that you are missing the boat on some things like you're missing out on that mentorship aspect, you're missing out on the experience, like of things that could take your business to the next level. But you're probably now going to be now stuck into business ownership and not progressing yourself like clinically, to the point where you can manage both.
[00:35:38] Justin Farnsworth: That's an interesting point. I think if you look now, that's what's being promoted not through maybe schools, but through social media. So you don't have to have 20 years’ experience to start your own business and they're right. And to a fairly confident PT, you probably could just start your own business and do further.
[00:35:54] Chad: Yeah, there are people that do it, and they do well. But I wonder how much they're missing, what are they doing or, could they be doing better if they had more time before they actually versus like working on their business. Because I hate to say it, I still treat but I have to be a business owner first and a therapist second. Unfortunately, it's just how it is. That's the role. That's what it is. But for people that I feel just get stuck as being a therapist, and also have to run a business, they put therapists first and their business suffers, and that's just what it is. And that's why these people grind for so long. As a solo practitioner for years, I can't do anything else. It's like, you can't do anything else. Because you don't know how to run a business. Like you're too busy being a therapist, which is nothing wrong with that.
[00:36:41] Justin Farnsworth: Physical therapists are horrible business owner.
[00:36:45] Chad: 1,000%. I agree.
[00:36:47] Justin Farnsworth: And it's funny because we're at this altruistic, I'm going to be a therapist.
[00:36:51] Chad: And they're like, “No, this is morally right. This is ethically right”. You are right, that is true. But you also have to run a business, but you learn how to do math. And that's the other thing, I did so many years. I never took. I finally joined a Business Mastermind two years ago, which I just finished up with. But before that, it was conference after conference building my clinical skills here, built building my clinical skills there. And I'm like, my business didn't grow. Like, it could have grown. It's doing well now. But like, it could have done way better. If I had spent more time on the business side earlier on, after it already, because I had eight years’ experience before I even opened up this place. So it's like, already had that. But yet, I wanted to continue my education, which is fine. But I think I missed the boat on the business side too. And I remember when I had my first call with Danny, for all you that don't know him, he's kind of like, the leader in the PT’s, like cash base realm. And he was like, “Dude, how much continued education do you do on your clinical skills?” I was like, in the last year, I don't know, like a shit ton. Because how much business started to do? I said, zero. That's why I'm talking to you because it's sucking time for out. So I think a lot of people kind of get stuck in that rut, not to get kind of like down the rabbit hole. But that's a big pet peeve of mine. When so many people reach out to me, and they're like, I want to open up my own clinic. Cool, how many years you've been out? I just graduated. How about you put your time and you don't? That's like, the first thing that I say. I'm like, don't waste your time. Even though I'm happy for you. I think it's awesome, but I want you to become a better clinician first before you have to become a business owner. Just can't do both.
[00:38:32] Justin Farnsworth: What's the image that what's the biggest if you could give someone advice in terms of like, business? Like, what's like the biggest takeaway you've had owning a business about business? I know that's a tough one.
[00:38:47] Chad: Don't do it. So I would say, I'll tell you so I've always had a hard time managing personal and business life, there's there has to be a balance there. And I always would put business first sometimes I still do, it's a snow day. So I get I get to have my cake and eat it too today. But I think that was my biggest downfall is not preparing myself for not taking the initiative to figure out how to make a better balance between life and work. And not only will your business hurt, but your personal life hurts So, that was my biggest realization, not knowing how much it was going to affect my personal life when I opened up the business because it consumes you, but that's why you need to find people like Nick and Taylor, that can take these duties and delegations off of your back so that you can have that balance. Because otherwise, you're doing it all on your own.
[00:39:50] Nick: Which is interesting, because a lot of people open up their own business so they can free themselves up more.
[00:39:56] Chad: I just want to open up a business because I want to have more time with my family make my own. Now I want to just replace my income and have more time with my family. Well, I did that but I want more. But I want it's always you want to bring it to the next level. And you forget about the main reason why you started the business in the first place. So it's just how it goes. It's just the nature of the beast. It's the hustle. I enjoy the hustle. I still get shit. Many hours worked, you do enjoy the hustle. I love it. And like so many of the people that I work with are like colleagues of mine. They're working like 12 to 15 hours a week. And I'm still sitting here working 3540 hours a week. No, like, what are you doing that for? I was like, I enjoy it. And I have the people I have the infrastructure that takes care of all the other stuff. So I don't have to worry about that stuff as much. I feel useless. I tried it. I did try it. I went down to 25 hours, and I was home and I was bored as shit. I feel like I'm not contributing to myself.
[00:40:52] Nick: It was also I'm so popular in the area too that my schedule was so full.
[00:40:59] Justin Farnsworth: Like this grinder mindset that. If I'm not busy to this level, I just feel like I'm doing nothing. I like I know that feeling like not in a way owning a business. But just like when we go on vacation my job, technically is like 24 hours all the time. But I have a hard time just kind of vacation Anyway, like I have a hard time like not working. When we're gone. I can travel for it a lot. But I'm like, it's just kind of an hour and a part of the nature. But it's fun. I think with the business thing too. A lot of people are like, I'm gonna start my own business to have more time. You get that time, like 5 years down the road, 10 years down, but you don't get it while you're building your business. Because like shit you're in, you're in it. You are the business.
[00:41:41] Chad: That's it. That's the brand. It's fun. But you do come to a realization where it's like, you'd like you get that burned down kind of feel. And that's when we made that transition to cash. And I honestly, my stress levels been way less ever since we made that. It was not less than the beginning, we made that transition. But now that we're made the transition, and everything is kind of going in the right direction, it's a lot less stress on the back where we can have stuff like this. I love being able to have courses like this, I love being able to go to courses and just enjoying it. I never used to enjoy it. I used to just sit there and just think about okay, I need to get as much as I can out of this now, who can I meet at this next place? I love that. I love the networking aspect of it more than anything. I love the content too, but that's just what it is. Did we miss anything? I had questions here and we really need them. We just went through a whole intro just to ask all my questions. So I don't really know. I do have one. This is the one that we normally pass on saying hit some of those. Hit that one. Think of the best bang for your buck exercise.
[00:42:55] Nick: You can only do one exercise?
[00:42:57] Chad: Only one exercise. What do you pick? What would it be?
[00:42:58] Justin Farnsworth: Trap our deadlift.
[00:43:03] Nick: We haven't had a chance. I know we haven't had any.
[00:43:05] Justin Farnsworth: It's savage reason why. I think when it comes to best bang, like it's not would you squat or only deadlift for the rest of your life. But if you look at a deadlift, I think it just pulls on enough anterior posterior chain that you can kind of get a nice and you can change it you can hand your deadlift you can squat a deadlift. It's your mask. Your shoulders are neutral like, what feels fucking better than pulling some average? I'm also sick too and squatting with the bar feels like shit.
[00:43:40] Chad: Trap bar is my favorite. I will pick a trap or over a barbell any day.
[00:43:43] Justin Farnsworth: I feel like all the all the broken people like the trap bar.
[00:43:47] Chad: Totally, that's true. I am so broken. They have no idea. It's also a close favorite exercise. So this was actually a question that I had now that you brought that up because you just dug at Cliff. Every time, whether it's like I put up something or Justin puts up something they're always shitting on each other and hardcore, but they always come after you. John comes after you and then Cliff tag teams. And then every time I watch these videos where you guys are all lifting weights, you're always the one that's lifting the most amount of weight.
[00:44:16] Justin Farnsworth: Thank you for saying.
[00:44:17] Chad: Let it be known it's recorded. So you're over here in your basement or wherever you are lifting like for 15 and cliffs over here doing some rotational with like a with a 20 pound kettlebells and John, if I have to watch another video of him doing a rear foot elevated split squat. So I'm like, why are they thinking? I know they're just doing it to joke with you but I think it's kind of funny. Like, where did this all stem. He has worked out one time or something?
[00:44:48] Justin Farnsworth: Maybe I guess I'm just an easy target. This is what I feel like I feel like what do you troll someone you never troll down. You're not gonna make fun of them. You're gonna make fun of the next guy. John, so he's just a bald guy like John. It was essentially funny, I will say the one time we all lifted together. So we did bio-fit 2020, our first course post COVID. Every single coach we brought in was there. And Cliff, he doesn't lift bilateral lifts above his knee and some other stuff but that guy is strong. But then when we do bilateral lifts, he wins. So when we were we were deadlifting. I pulled like 540. And then Cliff pulled like 550 just to do it. And then his knees been hurting ever since for the record. We're gonna train here in a second. Like, I like how Cliff trains in a sense of like, let's be athletic. He's like, I don't want to exercise to be the best exerciser. I want to exercise to be like, the best functional doofus human. And it's funny, we've all done it, I've done. Like, if you want to be a power lifter and compete, you go do that. But whenever I've done that, I feel like shit. I feel stiff and my joints don't feel good. I don't feel fat. But I just feel and I put on this summer, I was like 218. I'm 205 right now. I was pulling, I can get six up on the trap bar and get five on the straight bar, I could squat about four, my hips would never go to squat. And I could bench about 330. I felt like I didn't feel good. And doing more stuff that's non barbells. That's on one leg, that's in different ranges has really felt good. So I think there are multiple ways to get stronger. We all know this, you've been training for a while. I've been training for a while. You were trying for a while at some point, you can't lift the car. What do I do next? I think volume, volume is a cheap way to try to make gains. Actually, I think volume always when you do more volume, you always just your intensity always drags. So there are multiple ways to do. But as I keep the intensity high, work in different ranges and do that. Every time we train together, John always loses. I know if I said that. He just said, that's fine.
[00:47:18] Chad: That's cool. Now, I'm excited about the course this weekend. I think it's going to be great. I'm excited for the people that are coming. I think it's gonna be a good group. So I think the conversation is gonna go in multiple different directions, which is the reason why I think it's gonna be awesome.
[00:47:34] Justin Farnsworth: I'm honestly hoping we don't even go through the course content. That's what I love about that course. Like we have, here's what we teach. I just love what questions come up? It's funny, if you've ever taught a course before people look at you like you are the expert. And in a way, you are. I've taught this course, 150 times so I know the course. But how much you experienced? So we have in the room. What can we learn through this from the people in the room that should have been doing longer? So that's the exciting part to me.
[00:48:07] Chad: Totally. But to your point as well, I think they're here because they want to know more. They don't know everything. So that's that whole, like confidence thing to where should I be up here? I don't know. But at the end of the day, experience doesn't always mean everything and I think it's good. Even though you're going to have a lot of experience in the room. I think a lot of the people in the room are going to know each other. So I think that's going to open up the door for even more questions, which is going to be even better.
[00:48:38] Justin Farnsworth: And the nice thing we always get the feedback from these courses. I was already doing this. But now you just made it really systematic, my thought process is cleaner and clearer. And then when you have kind of new grad therapists, or just new coaches who you're just like, deer in the headlights are like, you helped me just organize what I should be doing versus just like throwing shit at a wall and hoping something sticks.
[00:49:00] Chad: Some people need system.
[00:49:03] Nick: It's huge, because we actually treat it from a physical therapy perspective, a lot of the strength coaches in the area, and that's the biggest thing that between the conversations we have. Sometimes I just feel like I'm like, I'm kind of on the right track but it's not all there. It's not all coming together, so this type of the system is great because it gives them that that systematic approach. So they see it a little more cleanly, and they're not just grabbing from all different angles there.
[00:49:30] Justin Farnsworth: 100%
[00:49:36] Nick: Chad’s gonna go home and take kids home.
[00:49:38] Chad: I got to eat cold oatmeal. I gotta back up.
[00:49:45] Nick: It might actually be good. Now. I might kind of be like a machine, it's actually ice cream.
[00:49:53] Chad: It's for the gains. It doesn't really matter which way it goes down
[00:50:04] Nick: I'm good with anything.
[00:50:07] Justin Farnsworth: You're about to get 10% stronger.
[00:50:08] Nick: I just love it. I love it. You're gonna have to tell me exactly what artist I need to look up.
[00:50:16] Justin Farnsworth: We’ll combine hip hop and rock. We'll play some Hollywood undead started the same thing.
[00:50:22] Chad: There you go. Let's do it. Well, thanks, Justin for being on the podcast and we look forward to this weekend.
[00:50:27] Justin Farnsworth: Thanks, guys. Appreciate it.
[00:50:31] PODCAST OUTRO: Thank you for joining us “In The RACK” this week. Make sure to subscribe so you don't miss out on any future episodes. You can also find us online at proformptma.com, or on social media at ProForm PTMA. And remember;
“If you train inside the rack, you better be thinking outside the rack”.