Episode 65: Radical Accountability: Why Your Rehab Outcomes Are Your Responsibility

Have you ever had a patient fall off their rehab plan and thought, "Well, they just didn't do the work"? In this episode, Mike and Michael challenge that mindset. They dive deep into the concept of "Radical Accountability," explaining why a patient's failure to follow through is ultimately the clinician's failure to communicate and set clear expectations.
Mike reflects on his four years of running a solo practice, discussing how his business mindset has evolved from blindly following advice to trusting his gut. The guys also break down the myth of the "6-8 week plan of care" pushed by traditional insurance models, and share a story about a retired golfer who was overcomplicating his routine with "neurological resets" when all he really needed was basic strength and plyometrics to get back on the course.
In This Episode, We Cover:

• Business Mindset: Mike shares his journey of learning to filter out business advice that feels "gross" and building a practice that aligns with his ethics.
• Radical Accountability: Why you have to look at a patient's lack of consistency as a communication breakdown on your end.
• Vetting Clients: Why turning away people who aren't a good fit is crucial for your sanity and their success.
• The 6-Week Trap: Why traditional clinics prescribe 6-8 weeks of care (hint: it's what insurance covers, not what your body needs) and why true tendon healing takes 6-12 months.
• Overcomplicating Rehab: The story of a golfer doing complex "mobility" work when he really just needed to jump around and build basic strength to walk 18 holes.

Resources Mentioned:

• Concepts: Radical Accountability, Tendon Healing Timelines, Play/Plyometrics for Aging Athletes.

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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: 0:00

The last time when I tried we're targeting more like young Um, when the I changed it the episode it was, I started going I reverted right back. Like I actually had it I just went right back to how it I was like, fuck, like that Hey, cheers to our first live Cheers, I love it. Or in person, I should say. And for people who don't know, I with someone right here. Episode sixty. What, sixty five? Yeah. I'm not sure what episode this Having this microphone just makes me feel like fifty cent or something. Yeah, hold on a second. I just want to be. You want a rap battle at the end Well, this thing says right air. I don't know what that means. It's better than wrong there, am It's going. Yeah. It's going. We'll figure it out. There we go. Oh, this is cool. This is. I feel so official right now. Yeah. Get a little bit closer to your What? The microphone. That's a crazy thing to say. Okay. You. This is this is better. I feel like this is too loud. Well, that's what I need. Oh, okay. Yeah. Like people people can hear you Keep talking for me. Talk, talk, talk a little bit Yeah. People love seeing us Yeah. I feel like we should make a separate bloopers thing for this part. Yeah. No, it's just all gonna end up So where are we talking about You tell me. Dude, you're the brains of the Yeah. All all three cameras going on I want to talk about just, you Um, how do we go about, like for How long have you been doing Three years. Four years? Yeah. I'm in the beginning of year So how has your mindset changed to finish from at least running I really like that question. So at first I was actually in a, in a business group where it was like kind of turned my brain off and just like, listen to what they said. They were very good at what they And I was just like, okay, Basically, whatever you guys say goes just like get dumb and, you know, like, help me build my business. And it worked. It was very, very helpful at the beginning and moving forward, I've seen so many different like people who operate very similar to me, do it in so many different ways and all be successful that I actually met this PT early on and it always stuck with me because she was very like yoga into that, like, call it like the crunchy kind of vibe. And she was like, you have a lot Like you got a at one, at some point you're going to want to like shut it off and just kind of like, do what feels right for you. And throughout my whole like were some things that I was Other people have had success And for whatever reason, it just Yucky in like in a way. And I was like, all right, well, I know it's it works because I see so many people being successful with it, but for whatever reason, it's like internally, like giving me like agita ethically, you still felt like it wasn't like it wasn't bad. It wasn't wrong. It just like wasn't a, it didn't Like, that's not how you would Right? My style is very different. And, and like, especially with stuff, they'll say like, this is It's not the only way. Yeah. So like, take it for what it's use it, adapt it kind of thing. So over the years, me being able turn the business into something doesn't give me any of those know, it's, it's always going to The reason why I love owning a forces so much personal growth, become a different person in the And if I had a just like a normal job, I don't think it would have made nearly as much progress. Yeah, I, I feel like you constant self-reflection and kind of have to because you know, if you're working a you're so in the weeds of like, organization or like, even like focused on like, how do I treat you aren't now, but like your have to wear so many hats as, as Yeah. That it can get, it's very hard So because you have the clinical brain where you have to do all this stuff, then you also have the business brain because even if you have the perfect program for someone you know, you can help them. If you can't communicate that in environment, they're never going going to agree to work with you, guaranteeing like the closest like, oh, I know I can help you communicate it to them to work with you. And that person's going to for way longer. I used to beat myself up a lot know I can help you, but I'm not to be able to help get to help. Help me help you essentially, there, you know, just at the end a person, like a person and Everyone's different. So if you have a, a style of with whatever person's in front to adapt on the fly. And I've seen that even in like like out with friends or like gotten so much better at doing My dad calls it a social able to adapt to the person that It's just going to make you an overall better communicator, for sure. I don't know, I, I don't think people, especially when I was in personally had to like if I I had to walk in and like in my and just start asking people communicate with them. And then like always, just one think about is like, it's all Like just keep asking about And so that, that way, like, that's like a very easy way to gain trust one hundred percent sense. You're being the, the microphone It was a weird hold. I had to switch the hold. Yeah. Um, being especially on like an introductory call where like for me. I'm interviewing them as much as So they're trying to figure out who's going to be able to help them best. I have to also be like, like I because if I just let anyone doctors pick the best patients. So if I and me being low volume If I bring someone in who's not very committed, um, even if they're like willing to like, quote unquote commit to the entire program, I've had people commit on the front end and then fizzle out through the fizzle out. And I didn't establish good They got confused or frustrated were expecting to feel pain free we didn't have those on the front end. And they got frustrated. They stopped like being program and all this stuff. And we didn't get the outcome made like a, a hard, I had to conversation and make a hard And I always call it radical though that person didn't do hundred percent my fault. Because if I communicated that they would have either been Like, I don't want to work with And that would have been a Or they're like, okay, like, I I'm very clear what I have to And like, I know that's what I'm So if you have the full and you mess up, like then But like, I didn't communicate Yeah, I think and that's, I think we both do the radical accountability. Like it's just you have to look what you could have done like it's in your like, it's It's easier because then it's in If you always put it that, oh, couldn't run today. It was raining. Oh, I, I couldn't do the lift. Uh, the baby got up too early. I was too tired. Like, like you can't like, like for you, it's like, okay, they stopped doing their program, but I didn't communicate well enough with them to say, hey, this is what you needed to do and whatnot. Yeah, yeah. Um, even like I have, I have stoner like I'm helping with the running program. Dude, I'm just kidding. There's no pain, no stoner. What's up dude? Stoner. Um, but it's like, that's one of And he's been great. Like he's essentially guinea That's also just his last name. It doesn't have anything to do in a long time. He doesn't smoke weed for his employers who don't listen to his podcast. That would be so funny. I mean, if we get if we get you Yeah, I hope. I hope he sends us a message. Um. Any user? The. Yeah, as far as communication That is the driver to Because if you have the perfect setup and the perfect program and that person's not communicating clearly and you're not communicating clearly, it's not going to be nearly as effective. Yeah, it's, I feel like the more be like a negative Nancy on like feel like the specific depending on how well you accountable they are. Mhm. Like, and obviously it all stuff that goes into it. But like I would say, there's a lot in the, especially in the chronic pain realm because it's such a multifaceted thing that like, it really just comes down to communication and accountability. And like, because even on the communication side, it could be, you know, we were talking earlier off the pod about like someone being in pain and they just kept on going through the exercise and they didn't know any better. It's like, I don't know, it's If they communicated it and you exercise, that's just like, Yeah, we gotta have a, we gotta And a lot of the times I've been Oh, shout out to my wife. What's up Rick? Everything's still recording. I think so, yeah. Um, the I had a conversation the other day with a new client or, um, a guy who was very skeptical. He's like, hey, I've spent bunch of different things. None of it's worked, blah, blah, And I'm like, all right, well, doing right now. And he's majoring in the minors And what I mean by that is he's doing all these specific optimization exercises. these neurological resets, the And I was like, all right, thank What is your workout routine He's like, nah, I'm a lot of So he's just is he just seeing after a day or two and then There's yeah, there's no plan, no consistency, and it's all below the threshold that he needs. So like, I was like, all right, if all that fancy specific stuff would have worked would have an effect, it would have worked by now. So you're just like generally you want to do. And he basically just wants to holes of golf. He wants to walk for a full Yeah. And back pain is really like lighting him up and he, he's like slowly seeing golf being taken away from him, which is scary because that's like retired. It's like the only thing that he that every day. If you can't do it, then what Exactly, exactly. So I told him like, especially I like to think about it like being like a kid, being more playful. So like the exercises that you do obviously have to meet where you're at and you have to know your baseline, but jumping around, being able to have that like plyometric input, I feel like that's the older you get, the more that gets lost for sure. And also there's like science to Like type two fibers go very Yeah. Like tendon elasticity, all the, all these like very specific things. The from a general general strength standpoint and a, I call it like bouncy, like plyo standpoint. I was like, you just need that meet you where you're at. And then like slowly progress And he went like he, his mindset totally flipped from like, I don't like, I've worked with everybody. Like I was like, dude, I'm not even trying to get you work with me. I'm just telling you what you And he's like, oh, can you help Like as soon as you. Be blunt. Might be the wrong word, but Well, people are like, just It's also like, that is way Yes. Than to say, oh, you know, your stimulation, like you're not You can't roll anymore. We got to work on that. And like, that stuff probably does help people like because it is just general getting up, getting moving and things like that. But yeah, it's like you got to be able to put a system in that they understand one hundred percent. You got to cut the fluff for for people get people can get very they want to do. If someone who has like that authority to them, whether it's a doctor or whoever who's like, hey, it's unsafe to, it's unsafe. Never run again. It's bad for your knees. Yeah. Like every runner has bad knees. No, that's not true. So you have to be able to. Maybe you have back pain right who just started with me who's to ever run again? Like, absolutely. We just have to do it in a like, work smarter, not harder kind of way. So the way that we taper and back, we will have hiccups and It's not a straight line up. It's not a straight line up into Like we have all of these good days, bad days, work, stress, sleep, all of these other things play a huge factor into that and that's okay. Be prepared like you will have And that's me being able to be very upfront about the that it's not a cakewalk, I think has been able to be very helpful for my clients to be able to weather the storm. Trust the process and ultimately get to their outcome a lot faster because they know they're expecting to roll with the punches versus, um, as soon as they have a setback, they're like, ah, like throw your hands up and like, I'm back at square one. Well, it's also a little So like. Right. Most of the people you see, they So you go into PT chiro. You do the initial evaluation, like a what's the common. Week six to eight week plan of Is that typically like what you Maybe. Yeah. Or like not for what you do right now, but back when you were working. Oh. Twice, twice a week for six Um, is usually the prescription Box physical therapy. So think about that. So people are expecting to see In six weeks. Right. And crazy. That's not gonna happen if it's if we're talking tendon injuries. Yeah. Or tendon pain like research tells us is six to twelve months. Like if it's very, very. Well documented. Yeah. And the reason and that's another reason why I went out on my own. Did. Did it my way, so to speak, is that, hey, six to eight weeks is not because that's what this person needs. It's that's what insurance will Yeah. So they want to get you in as use all of your sessions because then try to make as much If you think about it from a foundational standpoint, the goal at first is always symptom relief. But that's just to get us to the Most people treat getting symptom relief as the finish line, which is so frustrating from my perspective, because when you see someone get symptom relief and that use that as their finish line, you know, the increased risk of them being right back at that point, maybe six months to a year later is so much higher. When you're out of pain, it's Now I can like actually make Hit all the stuff from a how to work smarter, not harder Then from there, you have those Then you can start ripping the whatever performance means to on the floor with your kids, I always. At first I was because working in the soccer world and stuff like. The term athlete got thrown And I had a lot of people who they're like, they didn't They're like, oh, I'm not an So I'm very picky and choosy Because in my mind, if you are a retired guy playing golf three days a week, you are an athlete still. It's just you're not on the PGA That doesn't make you an Like, come on, like, I have a physically fit for his age and tournaments where he's like in like twenty year olds. Like he is legit plays tennis. Like he has a very full and travels around and stuff. I'm like this, like if I could package up, if I can clone him and make one hundred clients like that, like that would be my business ultimately. Like, you know, I go, we go down I'm an athletic trainer. Like I believe that athletic health and like, right. Trying to, you know, me new. Um, I work in high school full person at a time. But ideally, I would want everyone to be like that client, everyone to get out sixty years old. They're always still being physically active, doing all the stuff. And it's like, how do we Like, how do we get more people Um, so that's really like, I It's like, how do you actually get more people to think that way? As opposed to kind of what you It's like you, I like for me personally, I'm like, everyone's an athlete, like, but everyone's their own different shades of gray. Yeah. And for people who it's interesting, the type of person you attract based on how you operate. So this guy, as an example, was because it's like, I call it one I'm testing out chiropractic for the committed right and committed being. This guy is committed to playing golf, playing tennis, being active as long as possible, right? He wants to do everything in his power that's going to keep him doing that. So if you walked into a session a very high level, we knocked He's got really good He looks like a guy like training for the PGA tour like we have. We have so many high, high level and he's a savage. Like he really gets after it. He tries really hard and he's And if he went to like he had a was a guy that he was seeing for the chiropractor was just, you putting a hot pack on, you know, work and sending him on his way. And he was like, I just need So being able to have the, the duality of the hands on component where it's like, hey, if something does pop up because you being active, they're gonna be. Yeah, there's always that risk because you can't control for every factor. Yeah, exactly. Like if you're going to be have sore days or like pain pop It's being able to manage that. That's the most important part. And then when you're feeling good, like let's continue to rip it, like we want to push that boundary. So he's like dialed in like VO2 max and like all these, all this stuff. It's so cool. I, uh, I've talked with athletes It was actually a high school He came in, it was, it was whatever, just, I, I deal with a lot of kids that just, they get sore pain for the first time ever. They just don't know what it is. And I had a cross country runner I was like, hey man, I'll be perfectly honest with you, I run. And if I didn't run every time I felt something, I would almost never run. Quit being like, like, but like, You have to make them Like pain is just a signal like You could do that too. Yeah, but it's like a lot of people just don't even understand that. Yeah, it's in a it's an alert. It's a like a on the dashboard. It's like something pops up. Doesn't mean the engine's gonna You just it's something to keep Um, when I was in a high school rotations in undergrad, this she worked in the theater didn't play a sport. She was in drama. Yeah. Drama. And they were in charge of setting all the like, basically like moving all like the big heavy stuff and setting stuff up and whatever. So like, she wasn't used to doing really any sort of physical activity. And she came in hysterically in She's like, my legs are burning, I'm like, you just got a quad Like that's, that's yeah, that's Welcome to Doms. Yeah, yeah. It is so funny. The different levels, like I Uh, I think it was Paul. Like, I talked about the high can't do that, kid. I mean, knowing and like, I give he'll see someone and, and like, where like, I see someone and I, someone and understand their And it's like, hey, if that's But like your mindset, if we are going to have success together, your mindset has to look like this. Is that the mindset? Is that what you want? Or do you want to stay stuck where you are to keep getting the same results that you're getting? Like if they want to stay stuck, they're like, that's not my responsibility to move them there. It's my responsibility to be Like, do you want to do that? And if they're like, no, then Like they're not fit to work And that's okay. I had in my niche. I guess there's a lot of you get the yeses are like hell yeses. And that is. I would much rather that where Chiropractic for the committed. I'll say it again. Right. They're so committed. Do you want to say a third time Um, we have chiropractic. Uh, the, uh, the, um, what's the And it's not committed to me or It's, they're committed to And that type of person will with me, it with life. Because if they can't find it what they learn from me and then it and move it. And they're always moving They're never staying in the Yeah, I, I think it's funny you say you niche and, you know, look for your own avatar, stuff like that. It's like, I think too, you kind yourself most of the time where of me because I've changed jobs Like I jump from one thing to And it's like, it's not because maybe it's part of it's boredom, but part of it is like, well, I just want to strive to do something more. Like that's like, that's kind of Like, right. You want to see your six year He's like, like, I want to be I want to be more, I want. Yeah. Like I want to do more. I want to be able to like, I'm if he's like, dude, yeah, like, good, pretty good. Like, but like, yeah, you gotta right now it's running. Although like I would say my training and whatnot, but my up left and right between all, there's still like a, well, I'm more and see how much can I put? Because you also look at it, like, I feel like it'd be boring be mediocre at everything. Normal is boring. Yeah. Normal is boring. Yeah, like I don't. And what's really cool about entrepreneur world is For you am very sensitive to. When I see other people do it an identity that's very fixed oh, I'm not a runner. I don't, I don't do that. It's like you can like, like if what I mean? Does your dad listen to this? Uh, yeah, go ahead, go ahead. Cause cause I it was like it was after, and we were talking about feel terrible every time I run, Yeah. It's like, well, there's a way to run and not feel terrible like that. There is like a, but that's a people to say. So it is like some people get, do it, can't do it. And I'm like, it's like, I'm All humans are supposed to be this is what we're supposed to Whatever you tell, whatever you or can't do, you're gonna be personally, I'm not a swimmer. That's what I say. I'm a little. I'm a little bitch. All right. It's just like I never like. I always had this fear of One of these days, I, I I'll never forget it was, uh, Matt Armistead. Shout out Matt Armistead. What's up man? Because so he does, uh, he was I don't know, he does Yeah. And so every college I went to was just like, nowhere close. Freaked, like couldn't really So I just, like, gave up in two Yeah. But eventually, hell, yeah, I Hell yeah. I want to do like you can. Now my issue is time. But like, if I get to a point where I got the time, like I will commit to swimming, like I, I will, I will almost drown myself a couple times to figure it out. It's amazing what the body can go through when you have the right mindset. And some of my favorite cases to to work with is I've had people come in and be like, oh, like I'm broken. And like, that's their And when they leave their mindset that has changed about them. They're like, I am no longer And it's not like we fixed It's like the main thing we did was show them what they were capable of and help them change their identity, and that is something that no one talks about. But that is such that is where Because if you identify as a sedentary person and you do something that changes that identity to now you're an active person, that's where you see those guys who are like five hundred pounds overweight, and then they turn into ultramarathon runners. Like they have a fundamental And that's, that's the really Yeah, that's really cool. I had a guy who was very like feeling better and was like And the thing that worked the best for him was just being outrageously simple. And I was like, okay, like, go Like you would, you would see is so much common sense. But me giving him direction, knowing that he had to report back to me from an accountability perspective. There were these things that we were able to like, fit his lifestyle and plug into his life, where we didn't have to do anything dramatic to start seeing results. And then like once we got that into specifics and like, really But it's funny when anytime, like I feel like I write out like a running progression for someone, I'm like, this feels so simple, but like first baby, but then the other person's always like, oh, oh, yeah, that really makes sense. Okay, I would never have thought I had like every time, I've percent, like just increased minutes a week. Like I, I didn't do much. Yeah. You put for me. I'm like, I'm not gonna tell you You put the target on the wall steps to get there, right? If we make a little detour. It's my job to get you back on of that, right? But if you want to run, if you want to run like a race in a like, okay, maybe we have to set like, that might not be ever going to completely take say no at the start. If we have a couple weeks on we're not seeing any changes. Like that's when you put your You have an adult conversation. But my goal is to focus on what you can do, not what you can't do. Yeah. Even from that planning So like, we kind of go back to So many people want things to happen right away and even like the majority. So even go back for you, like planning, I essentially told you where like a lot of programs are programs and like, oh, starting so early? And it's like, I'm really So I need that base. But like some people will start Sixteen weeks and send it like thing to do. And I was eighteen. Like, I legitimately was just fully prepared for that. And I think a lot of people just But it's like if the kind of what we talked about before, if you actually like, hey, this is how much time it's going to take. This is why we're going to work I think people see it and go, Also, I think people should feel better about it because like, if you go, hey, you need six months, not six weeks, they'll be like, oh, I feel like it should. Like, oh, that makes more sense. Like six weeks felt like I was Yeah, six weeks definitely feels Um, there's time. Like time is time can be on your in the right way. If you like. Oh yeah. Two weeks and. No way. Like like the amount of progress Think about anything. Learning, learning. Because really what we're doing behind the veil is skill acquisition. We're learning new skills. Think about the first time you at first, then you got better, of pain is no different. Like you're going to suck at it get more competent, and then build on your foundations, build whatever you want to call it. That's, that's all it is. At the end of the day, we just way where we can hit milestones you're in a video game. And as long as you you can, you can feel that you're making progress. And we can track from like a data standpoint that you're making progress. We can keep taking steps and you want to go. Yeah. Go. No, I don't know. I really want like another That might sound bad. You want to pause, this is this I mean, I got a P so let's I Part one. How do we want to synthesize What did we just learn here? I mean, it's just I feel like Like the, the mindset behind the mindset behind everything for us. Like, even like if it's young set that mindset up that like, things take time and you got to allow yourself to suck. At first, I feel like that's not I feel like I say that all the skill you've never done before. People get frustrated so easily. Like, I don't get the exercise. Like I'm not feeling it in the You're telling me to. I'm like, you've been doing it Yeah, like it's okay to suck suck for a while. No, but you have to be able to give yourself that grace for sure. Paul's pause. I, I don't even know how to do