Episode 53: Stop Guessing with Your Health Part 2-The Final 7 Signs of Quality Care

We are back with Part 2 of our deep dive into the signs of high-quality healthcare. If Part 1 was about setting the foundation (patient-centered care and red flags), Part 2 is about the process.

In this episode, We cover the final 7 points from the British Journal of Sports Medicine review. They explain why a 5-minute exam is a major red flag, why "feeling good" isn't a good enough measure of progress, and why blanket statements like "don't ever run again" are often just doctors covering their own assets.

In This Episode, We Cover:

• The "McDonald's vs. Steakhouse" Exam: Why a proper physical exam takes 30+ minutes, not 5.
• Outcome Measures: Why your provider should be tracking objective data (strength, range of motion, etc), not just asking "how does it feel?"
• Education vs. Dependence: Why a good provider teaches you to "fish" so you don't need them forever.
• The "Hardware vs. Software" Problem: Why surgery fixes the part, but rehab fixes the programming—and why skipping the latter leads to re-injury.
• Manual Therapy Myths: Why massage and adjustments are just a "window of opportunity" to do the real work.
• The "Don't Do That" Fallacy: A story about a client told never to bend down again, and why avoiding movement is often worse than the injury itself.

Disclaimer: Although we are healthcare providers, we are not YOUR healthcare provider. Content is for educational purposes only. Please consult your physician before making lifestyle changes.

Transcript

Speaker: 0:01

Welcome to the podcast. A podcast by healthcare on how to navigate your health The podcast is hosted by Mike Bruno, a chiropractor and athletic trainer, and me, Michael Stanton, an athletic trainer certified strength conditioning specialist. Although we are healthcare providers, we are not your healthcare provider. We will discuss general health interventions in this podcast, but you should not take that as health advice that works in every situation. Before doing anything on your changes, please consult with This podcast and views from this podcast are separate from our full time jobs and our own opinions. If you're enjoying the podcast, please leave us a review on your listening platform and or subscribe to our podcast at YouTube. Links to our show can be found in the show notes on any platform that you're listening to today. Part two. As promised of signs of quality that's that's a good title. Yeah, yeah, I'm I'm with it. I'm with it. I think that's why I called the We obviously are recording this The episode comes out tomorrow, So the first episode comes out So yeah, I'll hold you to that. Oh, it's already scheduled. Don't worry. So I just can't remember what I Yeah. Um, classic. So let's how about we dive right So. Right. We were kind of reviewing the recommendations that we should Uh, we went through the first There's actually another six or interlap with each other and sense to us, but maybe for oh, that does make sense. Like, even so, start off with Number five. It's that you should undertake a includes neurological screening, or muscular strength. And what I'm going to really evaluated by buy some wood. It shouldn't be a five minutes. Click clack. Boom. Here's your plan of care. See? You. Like right. Like if you're if someone's truly looking at all three of those things, you're looking at thirty minutes of just hands on assessment. Yeah. I mean it's one of the main reasons I opened my business and practice the way that I do is because, like you and me both, like we've both been in the in the sports world for a long time. And if anyone noticed my my stuff going on here today. But like working in these type doctors and the speed that you the depth that those providers have the time. The that is that is this typical healthcare is like this, you know, not not even on the screen. It's yeah, it's it's such a gap, because for us, like we've seen Mhm. So I go in and some guy tweaks He's seeing he's seeing every He's seeing the athletic He's going getting imaging if He's getting treatment. All of that's happening in the And I was like all right I'm Like let me like do this for like my local community and like get people access the pro level athlete experience. Like let me give that to them And it's been great. It's been super rewarding. And the people who love it are like the people who come in here who've experienced this, like that low bar, come in here and they're like, oh, there is another option. There is a different choice. Like, I can get higher quality It's the time and attention and Like usually if you have five minutes it's like, okay, your back hurts. Let me do something for your Mhm. Versus like, hey, if we have a hey maybe your back pain isn't Let's take a deep dive and Yeah, I think a lot of times And we've said it before, it's not like it's not that the people that you're going to are bad clinicians. Sometimes it's just the It's they don't have the actual creative with you, or I want to They'll go, well, I do these patients, and seventy percent of So I'm just going to stick with Well, I mean, yeah, if you think about it as like like, uh, like McDonald's versus a steakhouse, right? Like, if you have five minutes, because it's quick. But there's trades to that, It's more healthy blah blah But if you're going for a super big celebration, you're probably probably going to steakhouse. So there's trade offs that each Right. So some people are like, we'll you know, five minutes to get my right back to doing whatever. It's like, if that's truly the case, then, like, we are not a like here. We're not a good option for you. And that's okay, right? It's just like knowing knowing what your limitations are and like being aware of like what you're trading is like the big thing. It's like, okay. Like, you know, and you don't If that is your restraint, then doesn't take a lot of time isn't Like, are you okay with that? Yeah, I like I like the steakhouse comparison because you're more likely to talk about steakhouse than a steakhouse meal, than your McDonald's meal as well. Um, exactly. But like like you think about it from like, a place where you have more control is like, if you're making yourself lunch one day, right? And you have five minutes to unlimited time to make lunch, Which lunch is going to be Yeah. Better for you. Better quality. Which one do you enjoy more? Like, you know, I'm a big Yeah. You just threw like five right Um, moving on to the next point. Six on this list. Patient progress should be evaluated including the use of outcome measures. So and I think right. We're trying to avoid the hey Okay. Let's start running where it Hey. Have you hit the appropriate coming off an ACL? It what's do you psychologically is there a you know they're called patient reported outcome measures proms. Um is there a patient reported your where you have the patient some stuff that they're feeling they're having with activities Um, do they have kind of, like I Do you do like a functional test prior to them returning to whatever it is that they want to do. Um, so like the ACL world is big in this because how how big of a surgery it is and, you know, they gotta hit certain strength numbers. They gotta be able to do some They should probably hit some cardiovascular endurance stuff prior to like returning to sport. Um, and I'm sure like you go through it too with like, hey, we can't start doing like, even for you. I don't know what you do with, like, sometimes you might take and go, hey, we need to hit this prior to kind of building it There's there's always three First is the rehab stuff. And that's usually gaining range Um the second phase is like positioned the way that we want And then once we add enough strength to that, then we're talking about skills and performance. So like activity specific right. So the I like the ACL comparison in here, you didn't have an ACL. We tied it together. And now you have to function Especially in people with You haven't been through That tends to get lost. And that makes no sense to me, Yeah, I hear people all the time squat five hundred pounds in the And it's like, okay, what did It's like a little bit of this, They stretch me, they hate me, And I was like, those two things don't yeah, does not equal the other. So how do you, from a clinical light band or body weight doing something super active. And now it might be a step in Yeah. Usually what I see is when that phase of care, it's like, get out of pain, right? That's usually our starting point because that's when all the real progress happens after that. But people usually get there and they're like, hey, I feel better. And the, uh, the other like you're out of pain. Symptoms are gone. Cool. Just like good luck. And and and they're not taking Well, did their strength Did their range of motion Like, their pain could have improved for a multitude of reasons. Did you actually track it right That's part part of the issue. Um, do you actually have an hey, from since I've started was in certain number. Let's say your your bench was fifty pounds and that's all you could do. And now you're at seventy five Right. And I think having that number that oh we've been working on big for them. Oh yeah. That's and that's especially why It's like hey does it feel It's like, ah, maybe a little Um, and it's not super obvious. We don't like credit that. So when we're looking at interventions, especially early on, it's like that stuff might take time multiple times of you doing it. Perhaps building the confidence, building the like the learning like the the software not the hardware. Learning how to do stuff to make So it's like in the meantime we standpoint, hey, your range of Now it's twenty. Like even though we can't tell measurement that tells us, hey, direction, which is good. And then success metrics on the perspective is they're like, my my knee is a nine out of ten. I want it to be four out of ten. Cool. Okay. Then I want to be able to lunge. Great. Then I want to be able to run It has to happen in steps. Mhm. And that's what that's what blows my mind. Yeah, because it's a lot of one time, or they want And some things can. But a lot of times it's you Yeah. But people think about it like a It's like, okay, here, let me go drop my back and like, pick it up later. It's all fixed. Hey. Good luck. It doesn't work that way. Yeah, even a mechanic, I'm sure will tell you that, but probably. Yeah. Uh, I'm going to move on, into the next point. Provide number seven, provide patients with education, slash information about their condition and management options. And I think it's funny because a lot of the research, too, has gone big into the education side. There's even some research says do you do? Almost don't matter if you don't your injury, how to deal with Like that part actually ends up being a bigger piece of the pie than like your specific intervention. I love that there's the I always versus give a man a fish, right? So if you're reliant on going in a massage whenever you're be, um, out of sorts. Like what happens if the doctor like, then what do you do? Feels like a marketing strategy, And then the it's like, okay, in the short term, yes, we will help you do all the hands on stuff to like get the ball rolling. But the whole goal of this is you to have the skills to ten, like, oh, last time I hurt my get out of pain. Let me do that again. Or like, hey, I'm feeling good. I want to stay feeling good. I know I have this big thing I'm going to do this X, Y, and Z sure I stay feeling good and it's it's not your you're not twelve weeks of care. You're investing in your next Because those skills, no one can take skills away from you, right? Like business is closed, things Like if you learn it and you own Sweet. Now. Yeah, I think that's the. Yeah. Education management like. Yeah. Like you don't want to like. Right. I think we've talked about this It's like right. As a healthcare provider, you You want to be the app that's The person that gets that's But like, you don't want to be like having to rely on on I had a client text me, um, and she was like, we're just like, you know, just like catching up and stuff. And she was like, hey, like, I you, but like, you were actually So, like, I don't need to come That's that's the point. Like, yeah, if we want to go, like, get a workout or like meet for coffee, it's like cool, right? Yeah. I don't want to have to see you That's not the point. Yeah. Yeah, exactly. Alright. Moving on. Point eight provide management, addressing physical activity and or exercise. I think we kind of touched upon Right. It's the. All right. You're feeling better in clinic. Um, you can now you can start describe the progression of the progression of walking or, don't describe how we're going throw a baseball. Like if you just said, here you go, you can start throwing program and like you give nothing and you don't monitor it whatsoever. That's how everything kind of Yeah, most people don't. Most people don't break it down have the conversation. They don't have the time to have a conversation or they just aren't experienced with that thing. So it's like, hey, good luck. Like if your goal is to squat making you squat in the session. Like that huge red flag. Yeah, huge red flag. So the ability to be able to, conversation about like, hey, the end goal is to run. Right now we're not running at But you literally have to walk There's a strength training Yeah. And like talk about running. And then even then we need easy We need hard days like because let's say you're an avid runner. You. Right? Right. You if you had no idea what was going on and your you hurt your knee, you were out for six months. And then day one you're like But you go running like you did Oh. Terrible idea. That'd be too little for too recipe for disaster. Yeah. Um, yeah. I don't know if I have actually anything more I want to want to talk about on that, because it's. I don't know, it's just it seems think it's because and I've seen post-surgical protocols and jump is made in the protocol for And it's just like, all right, we've been doing, you know, we've been doing some, some kind of functional training in, in PT and you can run and they haven't even like worked on gait mechanics. They haven't actually like Like, like just missed And they just kind of send it My favorite analogy for that is So in an ACL construction, or surgery or has some sort of It's like, hey, it was supposed And now it's like this. There is a like a something is That Has its own rabbit hole, gets overlooked is the software. Right. So it's like, yeah, your brain about how to like, get correctly, how to hit the ground All of that stuff is probably stage of rehab. It's always the latest one because you need the foundation set from the rehab and strength component. But most people get to the point of daily living and stuff and And then they'll go out there. That's when you hear people play tennis, like they play And then they've been like a they're like, oh, let me go pick And they tear an Achilles out of Mhm. That's. Yeah. So cool. Moving on. Point nine apply manual therapy evidence based treatments. Um, right. And I think like we like me and And hey, the manual therapy over the hump. If the only thing you ever get done is manual therapy and they go go back to sport or something, you're probably going to continue to get to stay in pain. Yeah. No one's on the field like playing your sport. Yeah. I mean like the the hands on stuff I always say is a window of opportunity to then go do the important stuff. Yeah. It could be a very important If hands on stuff could be a very important part of the process, because it helps us get ready and prepared to do the important stuff. But it is always the the pre. It's never like the main thing. Yeah. Yeah. So I think that's pretty I think that's just like if you, if you go to someone and all you get is a massage for ten minutes and then it's like all right, you're good to keep doing what you're doing. Or if you just get kinesio tape first, like, because I've seen that a decent amount of time where it's like kinesio tape is like the way to get treatment afterwards, whatever. Um, yeah. Just don't do that. Um, I mean, also just like end of the day, like, like massage therapists are really It's like if you're going to a like, want the hands on stuff. Like, I'm not expecting that person to go do exercise with you. But the, um, like the expectation going in there is like, hey, like this is a feel good modality. Like, this is not meant to like, of your overall solution, but thing that is going to get you Yeah. So moving on to point ten, or e.g. red flag condition offer care prior to surgery. Right. If we're talking about, like, happened, like you don't you just started having pain. The first option shouldn't be If you ever go to someone and first, you should always end up It's like the number for most to even considering it. Yeah, there's a lot of stuff managed from a conservative Even stuff that is quote unquote So bulging discs, um, arthritis, uh, like muscle strains, ligament muscle sprains, ligament strains, like all of those types. I caught myself. Yeah. All of those things, um, can be like, some people are like. Oh, no, like I need surgery or I Yeah. So yeah, I think I would So on to our last point. Eleven facilitate continuation think what's big about that? It's like, right. It don't go to someone who goes, you shouldn't do this ever again. Or hey, we're just going to write you out of work for two or three weeks and hope that it gets better. Not and not actually trying to, like, guide you in the process to get back to what you need to do. I love blanket statements so so smart when I just like take My favorite one is, uh, a client Uh, her doctor told her never bend down ever again because it bad. God. And she was she lived like that know, she, like, trusted his expert, um, at the time. And I was like, here, like. And this is like, obviously like after you build rapport and all that, but. All right, hear me out. How do you tie your shoes? Like, just show me. Yeah. Like immediately. That's awesome. Dude. Come on. Yeah. And even me, like, I had a so, so with my dad, he had three back surgeries. He had two lumbar fusions and Uh laminectomies. And so he was told never to lift more than fifteen pounds ever again. It may have actually been ten, Right. It was the same thing. He was like making kettle corn. He was lifting heavy weight and just like, didn't think about it. But because of that pound And so he didn't bowl for ten And then like, you know, try the last year before he passed away he he just like I'm going to go bowl again. And and he he's just started And he was like, wow I think I could have done this the entire time. And like and that sucks because just a surgeon who had who just was like didn't really understand activities of daily living. He understand his surgeries, obviously, like he knows what he's doing from a surgical standpoint, but didn't understand what actual stresses occur at the spine with certain movements. Yeah. Your body is a very adaptable Yeah. People say don't run, it's bad lift weights because it's bad So like there should always be yourself doing both of those things. Sure. If you're like if you have no idea what you're doing or you're doing it recklessly and carelessly. Yeah. The important thing is just approach to going from your line, your goal point. Yeah. So there should be an attempt to get you back to what you want to do. It shouldn't just be a you to do this thing ever again. Now obviously with surgeries and like maybe like maybe you don't get there, but like there's always a chance, like, right, you always gotta work on it first. So the like this is where I of the inception point of this point of like, doctors don't detail to get into everything. So this doctor is going to see you basically one time, maybe forever, right? Maybe one time in the next year, And they're like, okay, what's maximally reduce their risk? It's like, hey, just don't do Which is horrible advice for us. But we could see people weekly, for like a couple months. And it's like, we know that's not true because like, we're we're in the trenches with you, like doing the thing a lot more frequently. And because of all those touchpoints, it's like, no, I absolutely know you can do all those things. And if that doctor was here with he had the time, I would bet he Yeah. Oh yeah. For sure. So yeah. Yep. It's like, what do they say first at first do no harm, right? Yeah. But apparently it's also wrong That's the Peter Attia book where it's like he was misquoted. Hippocrates or whatever his name Yeah. The Hippocratic Oath is what it Yeah, for at first do no harm. So, yeah, like the doctor wants Because if that person goes and, like, goes running again and, like, hurts their knee and they're like, hey, like I got a bad surgery. It's like, no you didn't. You ran. I told you not to. Like, it's kind of like a cover So when you get like I. But the spectrum of people who. I think the reason why is because, like, if you get, like, a new hip, it's like, okay, cool. Like we replace the tires, we And these people will go right back into a high level of activity. Yeah. Respecting the progress that it they can get themselves into Yeah, that exists too. Like, I worked with a former football coach who told me he was like, oh yeah, I had my ACL done. And I decided I was going to start doing like, agility and drill ladders at six weeks post-op. Guess what he did? He blew out his patellar tendon. Yep. So that he had to get a second His career was over. Yeah. So there's you know, there's you But like sometimes there are the like any attempt. Right. That's like that's clinician They're more worried about them the patient centered part. Yeah. It's it's reduction reduction of like, hey, I don't want you to It's like, hey, I don't want to Hey, I don't want to get sued. Yeah, yeah. Like what it is. Yeah. So cool. All right, that was it. Those are our points. Bing bang boom. If you listen to both episodes next time you go to someone, all your head every single forty between the two episodes. Oh, I love it. It's actually probably longer, All right, take us out. Alright, alright. Go fix yourself.