TomNuzum.com

I received a solicitation to work for a company I will call the Uber of physical therapy. They provide outpatient PT visits at your home or work. They gloss over everything on their website because reimbursement is easy (it is not easy).

In their world. it is simple. They charge $125 or more for a visit. Pay the therapist $80. If the therapist does 25 visits a week they make $2000 a week. Great money for most therapists. And it is all on their schedule. (No it isn’t. Patients want appointments when it works for them, not when it works for you in this proposition).

$45 a visit covers a lot of Silicon Valley overhead. No clinic to pay for. Documentation and billing run through a unified nationwide system. Scheduling is between the patient and the therapist. The company doesn’t have to deal with any of those issues. Do a million or two visits and gross $300 million, net $100 million or more. Now do ten times that. You are a billion dollar company overnight. Get 20 times net earnings valuation and your stock after the IPO gives you a market cap of 20 billion or more. The VC firm and founders are new billionaires in three years or less.

Well Uber of PT, welcome to St. Louis: the armpit of reimbursement. Your commercial contracts pay $50 to $63 dollars a visit here. Are you taking a $17 to $30 dollar loss a visit but making it up on volume? Oh, you are paying your therapist less. Now your proposition is not so sweet. $40 a visit and 25 visits a week is $1000 a week. Good luck finding therapists in Saint Louis. Your sweet offer just lost its sweetener.

I need a new event to train for after competing today.

I achieved my goals.

I got 11 reps with the golf cart bench press.

I got ten reps with the car deadlift.

I completed the three car push in the allotted 90 seconds.

And my grip strength failed my quickly with the Hercules Hold. Apparently you cannot build back up your grip strength in three weeks. I need to challenge my grip strength more often in my training.

I am exhausted and ready for bed at 7 PM.

Now to find another event to work towards.

I Have The Best Wife

My wife rocks. She sat through six hours of strongman today. She sat through six hours with about four minutes of my activity.

I have sat through many of my kids games and hurried from place to place along a marathon to cheer on my wife. If one of their events took six hours with only four minutes of action, it would have been challenging to fit in my schedule.

My wife made it through the day with encouragement and a smile. I have the best wife.

Resting Is Not Easy

Resting should be easy. But it isn’t. You have acclimated to the strain and load of exercising several times a week.

With your competition coming up, the load is decreased and you may even have days off.

A lack of confidence can mean a return to the gym and overdoing it and blowing your peak. Trust in yourself and your programming and know the work you have done will pay off.

The other problem will be the ache of the taper. You have become accustomed to being tired and sore. Now you are sore in a different way. You are not pushing and pumping blood through tissues so your body is sending you new messages your body might interpret as soreness and ache.

Relax. Eat. Sleep. Taper. Recover.

Warm up on competition day and enjoy how sharp, strong, and explosive you are. You earned it.

The legs arrived for the kitchen table and I assembled them. I drilled for the threaded inserts and installed them. I shortened the bolts and straightened the threads with the tap and die set.

I disassembled the old table and moved it into temporary storage.

I connected the table top to the legs and leveled it.

And the new kitchen table is ready to go.

No paperwork. Nothing else to do but enjoy dinner tonight on it.

At least until I am told I need to change something,

There is tremendous joy in a completable task.

I did my car pushes yesterday. The first round went well. Then I changed the set up.

I did not see much incline in the parking lot but it was there. I started pushing my wife’s car and it did not move.

“Are you on the brake? Is it in park?”

I pushed and it pushed back. I finally turned around and tried backwards. It moved. Barely.

My confidence is gone. Sunday will be interesting. Six days and counting.

I am a week out from my strongman competition. There is little I can do to perform better and a great deal I can do to ruin myself. I need to get in two or three workouts this week. I need to push a car. I need to get in some practice using figure-8 straps for the car deadlift. I need to sleep.

If I push too hard I will be tired and sore Sunday. If I push too hard a sore muscle can become an injured muscle. A sore back can become an injured back.

My week will be spent tapering, resting, and polishing.

I entered the contest to get in better shape with the accountability of this deadline. My press is up. My pull is up. My bodyweight is the roughly the same but I have moved in another belt loop.

Next Sunday will be about having fun and doing what my body lets me do. I hope the weather is nice and the parking lot and equipment are dry. The adrenaline of competition will be pumping. Time to push a car.

Blood Flow Restricted (BFR) Exercise is the use of straps, cuffs, or bands to impede venous return of blood in working muscles. Loads at 30% of 1 Rep Max are used for high rep (30) exercise with limited rest (30 seconds) between sets. Three sets and you are done. Studies show comparable or better results as compared to normal loads.

One of the benefits of using BFR is aggressive strengthening injured or post-surgical populations with limbs and tissue that cannot yet handle 1 rep max loads.

I have been using BFR exercise for accessory muscle groups for the past several weeks. I have been hitting my triceps to bring up their strength to improve my bench press and the car bench press at my upcoming competition. My lifts are increasing steadily and I have great results in my 1 person study thus far

I started doing squats in a BFR manner to accelerate my leg strength development . I have avoided doing it earlier because I was hellaciously sore for several days after trying it in the past and wanted to be able to walk much less get regular workouts in during the week. I have found the advantage of BFR with squats after you get through the soreness of the first session is the achievable task.

The unspoken benefit to BFR is loading tissue when you do not have the emotional and mental energy to lift heavy loads. I am not saying strapping yourself up and lifting a light load numerous times is a short cut to massive strength. Lifting the right load for three sets of 30 in a BFR environment will hurt and drain you. When you are nicked up and tired, knowing you are done after six minutes of work and rest makes it an achievable task. A short effective workout is usually better than no workout.

My strongman competition is thirteen days from now. I have not gotten the number of workouts in that I hoped but I have gotten in some quality ones. I think my car deadlift is on target for a decent showing. My car bench press should go okay. The car push will put me on my back, as it should. The Hercules Hold will last but a blink before my grip gives out.

Grip strength is difficult to develop in a short time period. Overtrain your grip and you risk straining a tendon. I need my grip at work. At least, that is the story I am telling myself.

I am stronger and fitter. My lifts are up and my training intensity is higher. That was the goal of entering this contest. So, even thirteen days out, I have already succeeded.

I am going to step out on a ledge and lay out my goals for the contest. If I get at least eight to ten reps of car deadlift it would be solid. Passing eight reps in the car bench press would make my day. Finishing the car push would be fantastic. I have no expectation for the Hercules Hold.

Five more workouts to put some polish on the meet. Thirteen days, Tick Tock.

My daughter injured her knee playing soccer. I am concerned about the integrity of her ACL and meniscus. She had an appointment with an orthopedist Thursday and a MRI was scheduled for Friday at 11 AM. She walked out of the office with the belief that he would be notified when the MRI was available to be read and contact her or us that afternoon.

When the afternoon arrived and nothing was heard, I contact the doctor. He had not been told when her MRI was scheduled for and said it would be Monday before it would be read.

I am not expecting him to go in on a day off and read it but the expectation of Friday afternoon results was set by him and his office, not by me.

What expectations are you purposely and accidently setting with your clients? Follow-up phone calls that are never placed? Contact with doctors that is never made? Is a patient walking out of your clinic thinking something will get done that you are failing to do?

Find where you are unintentionally screwing up and stop. Your business will thank you later.