After 25 years in business I hesitate to calculate the tuition I have paid. Tuition to high school, Grinnell College, and Washington University was not insignificant but the real tuition was paid after I started my business. I have spent a considerable sums on continuing education, books, equipment, technology, personal development, business development, marketing, rent, and staff.

The cost of my rent and utilities during my career is over a million dollars. What would I have paid if I chose a different building? Would I have lost business without a stoplight to enter and leave the development? Would the building have flooded three times in the past decade? Saving money could have cost me money in build-out, repairs, and business volume.

I bought a gym full of equipment and when a lease fell through, the equipment sat in two storage lockers for a year. I only had space for a fraction of the equipment when I finally moved in and sold the excess for pennies on the dollar.

The wrong therapist hire has lost me patients and referral relationships. The wrong person at the front desk meant copayments and deductibles were not collected. It meant visits were not pre-authorized and not reimbursed. It was a painful few months as the full cost became apparent after the mistakes were corrected.

I was on the phone with a friend discussing his business. Hundreds of thousands of dollars were spent on a website that never went live. They shrugged it off and moved on.

If I had a coaching program or something to sell you, this is where I would start pushing hard and questioning how much are you investing in yourself. Then I would reach for your wallet. I am not trying to sell you anything today. Instead, I want you to look at how your are spending your tuition and what lessons you are receiving with that investment. If you think you are not spending any money on tuition, you are wrong. Make appropriate investments in your education. And stop the leak of money from the investments you didn’t realize are in.

Tom

John O’Leary spoke at the Physical Therapy Private Practice Section meeting several years ago. As part of his fantastic presentation he suggested everyone in the audience take a few minutes to do something extra for somebody.

I am certain my old client never heard O’Leary speak but I really appreciate her taking the time for us. A Christmas card arrived at the office today and it was welcome news. She is a client battling Ehlers Danlos and Postural orthostatic tachycardia syndrome (POTS) and sent pictures of her fur-babies and a message of how well she is doing.

She had two major surgeries to address her issues. One immediately followed the first’s catastrophic failure. In physical therapy, we worked on strength, endurance, activity tolerance, exercise capacity, tissue quality, posture, with lots of encouragement and emotional support. She left us to return to college and we have not seen her in a few years.

Before surgery her GPA in college was a 1.9. After surgery, her GPA was a 3.5. She graduated and is working at an internship while she pursues a Master’s degree and a career in counseling.

Life is definitely going better for her now than it was four years ago. It is great to know that I was part of that transformation and that my contribution meant enough for her to reach out three years later.

I hope you get a late Christmas card too.
Tom

I was a new physical therapist sitting in Pulmonary Rounds twenty-plus years ago. One of the Pulmonologists told a story from his residency.

A child was brought to the emergency room after swallowing a jawbreaker and getting it stuck halfway down. He was moving air around it and in discomfort but his mom was the one in the greater distress.

They decided to take him back to a procedure room to try to remove the jawbreaker. The doctor was wheeling his bed while trying to calm the mother. The hallway was a long downhill ramp ending in a T-intersection. The doctor turned to calm to the mother, stumbled, and lost his grip on the bed. It took him a moment to recover and the bed was now accelerating downhill.

He looked at the bed. He looked at the mom. The bed. The mom. Finally he sprinted after the now speeding bed. He caught up to it grabbing it just as it slammed into the wall.

The kid jerked up and coughed the jawbreaker out.

The mother caught up screaming and yelling.

The doctor remained calm. “Ma’am. Ma’am. You are really very fortunate.”

“What? How?”

“Sometimes we need to do this three or four times.”

The moral of the story: Take credit when things go right because you are going to be blamed when they don’t.

With credit to Dr. Cohen,
Tom.

You are a physical therapist. You have been helping a client conquer their knee pain. He wants to return to running but he hasn’t been able to walk without pain for three months. You have helped him finally break through and he has been walking without pain for the past week.

Now, he comes limping in to his appointment. “It felt so good I went running and now I am hurting again.”

“How far did you run?”

“Five miles.”

Five days walking without a limp and he thinks a five mile run sounds like the right thing to do.

What did the patient do? He experienced a temporary reduction in IQ. He is a smart person but he was stupid for a moment. What should you do as a therapist?

First, don’t call him stupid. Acknowledge that he did more than his tissues can handle.

Second, map out his return to running. He needs a criteria-based program of progression. When he can do three sets of 30 lateral step downs holding 20 pounds in his opposite arm without pain, he can run a mile. After he runs a mile five times without pain, he can run two miles.

If A, then B.

If he fails to follow the plan, he doesn’t have a temporary reduction in IQ. He is just dumb.

Good luck,
Tom

Have you ever hit the wall with your training and workouts? Your training readiness has zeroed out. You don’t want to exercise today, tomorrow, or this week. You need a break. But if you take a break, what happens to all the progress you have made the past several weeks and months? What should you do?

Forgive yourself. Allow yourself a break. You ran out of gas. You are going to be okay. Criticizing yourself for responding to a workload with appropriate fatigue is not going to help you recover.

Take a pause and examine why you are exhausted. Look over the past few weeks and your family stress, work stress, social stress, sleep, diet, caloric deficits, exercise workload, exercise variety, and exercise intensity.

With intense exercise we don’t just need cellular recovery, our endocrine and neurological systems need recovery also. Muscular fatigue and exhaustion can recover in 48 to 72 hours. Neural and endocrine systems can take up to two weeks or longer.

When you lack explosiveness or pop, that is a sign of neural fatigue.

Emotional changes and emotional lability can be symptoms of endocrine fatigue. Look for warning signs in your training log that can act as signs to program in more variety, restoration, and recovery in the future.

Take small bites. What can you get done in 30 or 45 minutes? What strength and skills are priorities to maintain if not sharpen? Work on your priorities in a 30 to 45 minute block and call it a day. Train again in two days. Or train again tomorrow if you have the desire. When your training readiness returns, add volume and frequency.

When you start to feel sharp, quick, solid, and strong, you are ready to dive back in.

Good luck with your training.
Tom

I have been a physical therapist since 1996. I have tried to be an athlete since 1985. I have long thought I was too busy to put out articles and videos. I would see other people putting out daily videos and know they didn’t see eleven hours of clients that day or any day. They were in a different business than me.

After repeated talks with friends I decided that I am different from the other people online. I decided I would add my voice to the conversation. I’m going to talk about movement, exercise, fitness, health, physical therapy, strength training, personal training, running a business, and balancing it with your family life.

So in 2021 I am going to write and shoot videos about things I believe, things I know, things I do, things I am trying to figure out, experiences I have had, and resources and equipment I have used and use in my life and business.

I hope you find a few gems that help you.

Sincerely,
Tom