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IndeFree MiamiOctober 17-18, 2009
Automation: reproduciblequality, care, and profit where
you are never putting out fires.
Goals need to be clearly definedGoals are dreams with a
deadline
Courtesy referral is anotherchannel of revenue
Response is the key to theirattitude (what theyre feeling)
Not dependent on one referralsource
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Decrease level of dependency =decrease size of doormat
Get staff to do what you aredoing
PUTTING OUT FIRES?
Fireman = owner putting outfires
Fire = do now or get burnedDont hire employees who create
fires
Anyone can open up a privatepractice, but it doesnt mean
that it will be independent and
free
AUTOMATING PRIVATE PRACTICE
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Automated private practice iswhere the business run without
you having to make it happen
Automate and duplicate1st step is focus on $300/hr tasksFocus on automating practiceTreat 20 hours a week or lessDo storms come?Turn foundation into rockIf you left for a month your
practice would collapse
The goal is to only be working 2hours a month
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Then you know if you really wantto treat
Until youre automated, youdont really know if you want to
treat
You dont know whats fun untilyou dont have to do it
EVIDENCE OF AUTOMATION
AutomaticWithout effortHigh quality
High revenue
People who need you haveaccess to you
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Ability to offer affordableservices will determine how
much humanitarian work you
can do
Different fee schedule than clinicDo the right things, people will
bring in family
Separate fee schedule for JamesIf you want to see James this is
how much its going to cost
To see our staff therapist this ishow much its going to cost
Which would you prefer?
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Non-automated practicesplateau by year 5 and then goes
down
No toolSimple task becomes impossible
AUTOMATING PHYSICAL
ENVIRONMENT
Automating proceduresAutomating teamsTeam buildersAutomating selfNew You = New Principles
SUBCONSCIOUS SELF-SABOTAGE
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SSS = easy, redundant, we dothem, things, because were
trying subconsciously to fail
We want to pay for pastmistakes.
Until you let go, you pay for yoursuffering
Today, not judged by past, butby ability to trust another human
being
Allow for mistakesExpect them to make mistakesLet it goBecome a new you that
embraces new principles
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Daily basis
Make decisions at $300/hr level
Rule as CEOLive at $300 levelMost business owners live at $40
or $15/hr level
Apply it!TEAM TRAINING
Team trainings from 12 to 2 pmevery other wed
Talk for 15 minutesSTAFF TRAINING
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Training staff should beautomated too
Use training videos4 week reviews = review
everything
A year is too long to know ifsomeone is good for their
position
Reviews happen automaticallyNo one has perspective you doKeeps admiration and respect for
you
TOOLS FOR AUTOMATION
Employee punch clock
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FINDITAT:http://www.vertitatasksoftware.
com
Steady stream of businessWEBSITE
Everyone must have a websiteBusiness must have internet
presence
Need internet hub where staffcan click in
TEAM HUB
Important for automationDAILY PRODUCTIVITY SHEET
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How often should you know howmuch profit you made?
Every dayLet administrative assistant or
receptionist do it
Have them email productivitysheet to you
Hate storage units with patientcharts
We scan our stuffPPO&HIGH DEDUCTIBLE
What do you say?
Point of contact
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Biometric employee punch clock
Punch in with thumb
DOING THEWRONG THING
Most people do the wrong thingbecause its easy to do it
Most of us will do the wrongthing if given an easy
opportunity
Dont make business that makesit easy to do the wrong thing
THE INSTANTThey DoSomething Wrong Against You,
They Sabotage You In Other
Ways
P.O.SSYSTEM
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Get rid of hand written receipts
Get rid of cash box
Stop spending money on copymachines and toners
NCRFORMS
Sublease for first yearHow do you get those out there?Success is in the follow upNo one sleeps with you on the
first date
Train marketing assistant thisway
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Use metaphors that help peopleremember
$12/hr task = ordering US gelSits in your mind and clutter itGenius knows what not to
remember
Have enough space for theunimportant things
Successful practice knows whatnot to do
Petty bank account with an ATMcard
So you dont have to do itLet the employees do it
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The way your paperwork looksleaves an impression
Entire company system onlinefor employee access
WEBSITE CRITIQUE
Whats the biggest thing on thispage?
No one care about your logo(ego)
Until they get to know youLeft hand list
Its all me, me, me
Things below the fold dontmatter
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If you dont get them up thereyou lose them
Whats here for me?What words are here for me?Phone # on every pageYou want them to call youLogo needs to be modest or
small
Video testimonialsCommon causes of painCouponsBe wary of
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Self help
Adding foot massage = thatssmart
Do the right things = you willsucceed
MONEYMAKINGATTITUDE
Volume = human resourceThink of growing before
shrinking
How do I make more vs how do Imake less
Economys down, I need to cut,cut, cut
70% close
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How do I make more money?
Run promos on Fridays
This paper productivity sheet iseasier
What did I do to allow this tohappen?
I failed to have this systemCant delete or void mailHANDLING CASH DEPOSITS
I like to hold cashAll deposits come to me via mailSending cash in priority mail
envelope
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Dont want money sitting aroundfor a week
I dont like to deposit cashNO-SHOWS
Identify those days you dontmake money
Cant make decisions if you dontknow
No shows = 3%No shows is an indicator of how
well your staff is doing in
maintaining customer
satisfaction and loyalty
% no shows = employeeperformance
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How well staff is creatingperceived value
No one should know how muchemployees make
Outside book keeper doespayroll
If I see 3% no shows in sameweek
I work my staff to pick it upHow do you prevent no shows?Now shows cost a lot of money
Its what you staff does in theirinteraction that decreases no
shows
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Maintain same eye level
What you think is not
If patient sits, you sit etc.#1 thing patient hates?WaitingIf you dont track it, staff will be
taking patients back late
3/100 taken back late>10 min late = wait for next apptIf they dont have to wait it helps
to increase perceived value
Dont want book keeper to knowmy staff
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Pay him $20/hr for 2 hours aweek
Quick books is of the devilGive all receipts to accountantPUNISHING EMPLOYEES
Employee discipline formCritical to automationPunishing employees is
important
More important than rewardingMost employers dont know howto punishPoor attitude gets written up
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Poor attitude is cause fordismissal
My employee files is right nextto my desk
Only owner has access toemployee files
WarningMonetary penalty$5, $20, $100, up to a weeks
pay
Dock in pay until they earn itback
SuspensionTermination
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Hostile response to beingapproached
Get off my back!Are you sure you want me to get
involved?
We have an open door policy iffired
Are there any questions?Were only going to talk about
this once
It was like a cloud was lifted
It was almost like you removed apiece of cancer
What James says, he does
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Stabilizing effect when youpunish
If theres any grounds for firingGiving you a chance to correct
something
And they respond with Get offmy back
Indifference leads to love dyingGet off my back = biggest
offense
Confrontation = opportunity tomake things right
Judge by their response, not themistake itself
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Might get what you ask for
Any employee can write upanybody
If youre not going to own up toit, Im going to get James
involved
Staff works it out amongst themselves
Staff does hiring and firingYou have to set that exampleEveryone is an authority of their
position
Physical Therapist cant go up tothe receptionist and tell her
what to schedule
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Receptionist is the authority ofscheduling
Everyone is an authority in theirrole
Technician can wrist up atherapist when therapist doesnt
have documentation completedon time
Trend of violation leads to apattern of behavior
Never write up for just one thingNo shows are high in one day, I
ignore it
Cant jump to conclusionsGive them benefit of doubt
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COMPLAINING VS.
COMMUNICATING
Do not complain in publicWhat a complaint isA complaint is Im tired, or
Im hungry
Can I go lay down?Thats communicationComplaining is grounds for
termination
Her teammate confronted herShe said, Leave me the hell
alone
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BIOMETRIC EMPLOYEE PUNCH
CLOCK
You only pay 8am to 5pmThey have to sign for itNever shows if they punched in
early
But it shows if they punched inlate
Allow receptionist to be up to 45min past close
SCHEDULING PROFILES
40 mins face to face =comprehensive (1/hr)20 min = intermediate (2/hr)
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5-10 min = limited (3/hr)
Hi and bye = brief (4/hr)
P.O.S.CASH REGISTER SYSTEM
Go to nurol.comGet cash register and roll paperCRE cash register express
software
Touch screen monitorRECEPTIONISTOut And About
Talking To Patients About
Everything
$500 touch screen monitor
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Have a system that managesmoney well
When you have the right toolsits easy to go to the moon
NCRFORMS
New Client RegistrationKEYTO LOYALTY
Will they break the rules? Yes.Gives you an opportunity to
exercise forgiveness &
compassion
Key to loyaltyHow do you know your spouse is
loyal?
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List of things that are given
Never give loyalty until itsearned
I will sacrifice my needs for youI will die for youHard to cheat on someone who
has shown you forgiveness? Yes.
Have to outline the wrong in therules
Theres nothing you cant forgiveat least once
Have no right to expect ordemand loyalty if you havent
shown forgiveness
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PHYSICAL ENVIRONMENT
Front deskPhone systemsFax systemsGo to
http://www.phonepeople.com
ACTIVATION SPECIALIST ROLE
Activate and ConvertIt cant be the receptionistHandling the people already in
the system
8 min on phone
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New people need time
Only reason they put up withyou is
Because the MD referred themto you
First impression is the mostlasting
Front desk phone for returningpatients
How does somebodys poorattitude reflect on you?
You never told them its badTo them, all they know is poor
attitude
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Assume responsibility
Never make assumptions
Like youre talking to a 6th graderCLINICALAREA/GYMS
Have 15 bins for per 1000 sq. ft.Will save you millionsFollow the path of that patient
until they walk out
Make the path very nice, warm,and unobstructed
Dont have ice when they firstcome inWalk right into the gym
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Make it feel like a factoryassembly line
Place bins next to each stationChart goes in the binCHARTING COUNTER
Spot where you can see the mostFind the geographic center in the
clinic
Patient needs to see that you arethere
Patient loves interactingPhysical Therapist has to be
standing
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Computer Solutions
To be completed bins
How automated are you going toget?
If you dont have the right toolsYou cant pound a nail into the
wall
Wait 2 weeks = oh they must begood
Create good energy in yourfacility
1,000 sq. Ft. = $40,000collections/month
COMPUTERS
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For every physical therapist
Unless net work
3 computers minimum orlaptops
1 physical therapist = 4computers
Front desk computerPrivate room computerGym computerShould not buy a server and get
an IT guy
Servers can get stolen, broken,etc.
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Servers are vulnerable
1 tera byte hard that is net workcapable for backup
PAYMENT PLAN POSTER
Sends a good messageOwing money puts a dark cloud
over someones head
WEBSITE DESIGN
Gentle Compassionate CaringDoesnt that sound nice?SolutionsDont like structured
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Like gently guided
Whats special about your Pilatesprogram?
Put info into one wordPrecision & Pilates dont go
together for common lay person
Gentle yet effective pain reliefDont like the flashingGetting the info you need to get
across
No where do you see me, me,me
Everything is about you
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Things you can use
Make it more about them firstthen they will want to know
about you
Secondary pageDont need to scrollNot drawing out too much
emotions
Need to draw out moreNeed more connectionStrength/flexibility programPicture of someone that looks
really happy
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No one will buy until they canget a discount
Nice pictures in bioIncreases perceived value for
patient
Photoshop your pictureMake you look gorgeousI want you in top 5 on GoogleHow do I get to your website?Already Im leaving you and
going to someone else
Have a picture of someonehaving a great time
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http://www.absoluteptf.com
Im not sure Im crazy about thename
Its creating some confusionWhat a name shouldnt doDoesnt cause confusionDoesnt conjure up wrong
associations
Absolute Physical TherapyTaglinePain Free Solutions And FitnessMake some changes in your
identity
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Why absolute?
Where did that come from?
In todays business dont need toalphabetize
All of you should have a tag linePersonalized Pilates ProgramIndeFree Physical Therapy & Pain
Center
Add pain center at end of namePeople will come in off the streetDo you sound like what theyneed?
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Tag line: empoweringindependence and freedom
Would it screw up a lay person?Wheres your fitness?Names says fitnessWe know?No one needs or wants physical
therapy
They need and want solutionsThey want pain reliefWe know youre in painWe know what its preventing
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We know your suffering
We care
We know you tired of drugsTheres nobody smiling in the
pics
Subliminal messageThey feel smiling is not
associated with you
CHOICEIs A Very EmotionalThing
Let them know what it is thatthey want
Flashes 3 things but they canclick it
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PAIN, Is It Preventing You FromEnjoying Life?(6 Words)
Connect with themThis, I dont connect withWhere does it hurt?Click on bodyDecrease size of body pictureBiography: what you like about
job
They need to feel a connectionwith you
Automate MarketingCant define who you are
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What youre offering
Self actualizing process
Whos really good for what youoffer?
Very introspective processMARKETINGIs About Caring
About Who You Are And Caring
About Who They Are And What
They Need
Pregnancy ProgramPost Natal Program
R & D: survey your area
Fingers on the pulse of yourcommunity
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10-15 mins to do quick survey
MDs love talking about whatthey know
Now they are doing somethingthey enjoy
Let the MD talkLets start a total knee classYou become more the expert$12/hr task, pay someone to do
it
How many live in your area?How many females?Top Industry
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Demographics
Help you better understandwhere you live & what the needs
of the community are
AdvertisementsSending messagesPromotionsFun, exciting way to get message
out
1 hr Free ClinicHow many $5,000 programs do
you want to sell a month?
Why dont you have one?
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You dont get $5,000 becausedont have one
With high deductible they canopt to take this $1,000 program
Sounds better than this programover here
Use 52 modifiers to lower theprice of any codes
Super bills dont workUse fee flipsSave you on an audit
They cant try to take moneyback
Trei and Rachel from Florida
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Can have a $10,000 program
There are people who will pay
If you write out the value ofwhat you do, they will pay you
Train a marketing assistantGive them the tools to introduce
you to the community
Public relationsWhos going to meet and greet?Put a face to the name$15-20/hr jobThey have to be likable
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Speak with good articulation
You have to enjoy talking tothem
Are they an appropriateextension of you?
UNLAWFUL POSTERS
Nice gift to send to MDsIts something they need and
want
Helps collect co-paysFront desk is a physical
environment
Phone system
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Fax system
Activation Automation
Know what to say to get thatHMO as a patient
Tap into the 97% of thecommunity that needs what you
have to offer
Use a training video to walkthem through
Never hear them say WelcomeTo
HOW TO RESPOND TO FAQS
Tried to better understandwhats wrong with me so he can
give a focused answer
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Try to understand their needs
People dont like a manly mananswering the phone
Good gay guy can conveywarmth and compassion
Use people and tools toaccomplish goals
Some of you should paysomeone to meet MDs
Ego to ego is not goodACTIVATION
Everyone needs to hear $40
$10 tx, $90 tx
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HEARDThe Possibility Of $40
Got them in the door
8 visits, $40/tx for financialhardship
Im going to activate the patientWhats wrong?What do they hear?See?Think?BASED OFFWhat You Told MeWhats the .Not now too available
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SOUNDSDesperate Subliminally
Medium, little, or a lot (Pain)
Where can I call you in the next30 min?
Call them backWe have an opening in 30 min
due to a cancellation
Go straight into Whats WrongWith You?
You sound like a great candidatefor this program
Based off the complexity of yourcondition
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Always ask: Do You Want ToSchedule?
ACTIVATEThat PersonThis is how good you can getReceptionists position is crucialMore important than physical
therapist for developing loyalty
#1 reason why they bring infamily & friends
New receptionistAUTOMATEBy Training
Somebody To Do Their TaskWith The Right Training And
Tools
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Check whose birthday is comingup
Birthday cards mean a lot topeople
Simply do it for theconsideration
Someones got to manage andupdate
Have a marketing assistant to dothose things
HOW TO REACTIVATE
End of year promotionsBenefits about to renewRemind them
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Send a letter in September
Send via post card
Dont combine with newsletterSomething they can stick on the
fridge
How much money did you makewith that brochure?
Good tools pay offAutomate supplyBANKACCOUNTS
3 bank accountsMain account
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PURCHASE ORDER SYSTEM
Local newspaper for older bookkeepershttp://www.paycycle.comDo from homeBilling liaisonIn vs. outsource make more
money
Hands are in the billing too muchFor the time & money, its not
worth it
You shouldnt be looking at billto make sure its accurate
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Losing money for the time spent
Put a $5,000 program together &sell that
Focus on selling expensiveprograms
Tapping into the communityMaximize reimbursementWho was sent a collection
letter?
Who was sent to collections?Get those appeal letters sentEOB Explanation of Benefits
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Responded too, need 2nd levelappeal file bin
Pending file binNeed letter file binsCondition of being a member,
have to help other members
http://www.paytrust.comUse for personal & businessOnly $12.95/moUse for paying billsAnything you dont like to do,pay someone else to do itWhy be unhappy?
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Things I cant pay for
Encouragement, sex, upliftingme
Focus on things you like to doSimpler is much nicerBuying solutions that are betterPaytrust.comdont know your
bank account
Automation is not commonsense
Do it one at a timeDO THINGSThat Stand OutAppealing right away to get paid
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Learn more, implement more
Self, tools, physical environment,procedures, team
TeamSee the next stepGet to next levelDont need to see the whole
picture
Job description (standard &officers)
Orientation criticaldevelopment step
Check off each statement
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I will represent my team well bynever complaining in front of
them or others
Stand the test of audits thesedescriptions
Make enough money they willaudit you
RecruitingDont know howCan waste money and timeAdd a phone call
Group interview face to face
Group interview is the mostimportant step
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This ad produced the bestcandidates
This produced good pools ofreceptionist
I had one receptionist who mademistakes, but was so lovable no
one cared
Put this on Craigs list for non-licensed staff
Youll get a good number 20-200Do a phone screenGroup interview give an option
of 2 dates and times to attend
Do about 10 people
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See who responds and how
LOOKING for Who Do YouLike?
Who do I seem to like here?Different mind-set when they
work for you
FIRSTImpressions AreEverything
Nothing will cost you more thanhaving the wrong person in a
position
Try to narrow down to 2-3 whoyou really like
Its a heart and mind decision
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Ask, I want to give opportunityto give feedback in this group
setting
This is what I liked about youThis is what I didnt likeIt sets the toneThey leave with a totally
different impression
If you dont get picked, call us inthe future
For physical therapist advertiseon monster.com
Costs $400
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Recruitment post cards andbrochure
Advance PT for therapists andassistants
1-2 years of solid performance =% of shares
Anyone who would like to talk inprivate?
Its very respectful to allow themto do that
Never hire on the spotOne on one interviewStaff gets to ask them questionsWhat did you like or not like
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First impression lasts forever
Your business becomes a vehiclefor producing great people
Hiring who they work withSends a powerful messageThis is my teamHire via email or letterCongratulations.Thats how you bring a person onDo they want to bring this
person on?
Whats the opposite of love?
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Indifference
You care enough to notice
What you didnt likeI dont like working with people
who dont have an opinion
Everyone has to give an opinionReview orientation checklistEach section done by different
staff members
CompensationLittle things go along waysTeam building
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OFFICE ROLES
Officer role positionHuman resource officerLiaison to youLogs and records absencesYou managing employee
scheduling is non-productive;
just busy work
Approves or denies time offHuman Resource Officer is a
technician
Someone has to be assigned tohold people accountable
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No queen bee mentality;everyone is an authority
Facility Improvements OfficerThese office roles are a privilegeDo you care about your
organization?
What is the company?The people in itThey may be asked to perform
some officer roles
Physical Therapist is the PatientCare and Loyalty Officer
Makes sure that ultrasound gelgets stocked and ordered
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Lost respect for the pesky owner
When they do it amongstthemselves it runs like popcorn
If you dont delegate officerroles then you have to do the
work
4 months are peer &competency review
Create rewards & bonuses basedon their ratios
Start peer reviews tomorrowReview OfficerWhat people are saying about
you
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Peer review is powerful
Owner review is so negative
They dont have the right toreview the owner
Always have an open door policyBut youre not part of this review
process
Patient chart reviewA patient shouldnt sit in room
for >20 mins
Physical Therapists should makethemselves available
Physical Therapists need tomanage patients and techs
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This helps produce a team thatsvery together and competent
300 pt/wk = 1.5 therapist + 1assistant + 2 techs
Limited & brief & intermediatepatients = 90%
CVAs, Bells palsy = 40 mins faceto face
Patient limited tasks defined byyou
Medicare wont define it for youTime based bill lawWhat I would imagine.Its got no legs to stand on
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Be able to justify why you do itthat way
Medicare auditors are trained tocome back with money
Really define what patientrelated tasks is
Its not a science, not an artLaurie Feinberg wrote the lawThat sounds logical to meTheres no law that specific on it>2 or 3 bill as group for MedicareOnly bill MT and TE and gaitCollect cash for laser tx
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No modalities: no ES, US, HP, ICE
Standard joint mob or STM
Im still going to bill a unitIf it takes me 5 mins to do a joint
mob and reduce their pain,
should I get paid less than a new
grad who take more time but
with less results?
Document I did Manual Therapyand their pain went from an 8/10to 3/10
I cant get paid even though Imbetter and faster because of a
therapist who cant do better
WORDS OFWISDOM
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First 30 min. of every Mondaymorning
10 min words of wisdomWhats that mean to you?Need to look at your
opportunities differently
Apply new principlesHow can we apply that this
week?
Need to let go of these things:billing, book keeping, ordering
What went good, how toincrease that
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What went bad, how to decreasethat?
Last 10 mins generalannouncements
Every other Wednesday12 to 2 pmReview codesReview things & train, train, train2nd Monday of each monthReview stats of last monthOnly number from me is payrollA healthy organization is made
up of healthy group of people
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Wont assign officer roles until3
rdtime at class
In 24 hours how many hours wasspent on training?
To be the best, have to allow fortraining
Create stability & consistency forTuesdays and Thursdays
In the beginning open Monday,Wednesday, and Friday
Market on Tuesday and ThursdayBreak it up so were busy on
Tuesday and Thursday
NO-SHOWS
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NO SHOWSAre The PoorestReflection On Your Staff
No shows are very disrespectfulTEAM (CRITICAL POSITIONS)
Personal AssistantAdministrative AssistantMarketing AssistantCritical for your successMail, book keeping, dry cleaning,
oil change
So you can focus on $300/hr jobsPosting EOB payments
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If you dont schedule time foradvertising, marketing,
promotions, it will not get done
Physical therapist treats 20hours or less until reach = 50/wk
Hire assistant or therapist @>50/wk
@100/wk hire a therapist fulltime
Do activation for first 3 weeksThen train assistant how to do itKnowing what not to remember(definition of genius by Einstein)Know what not to be doing
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NO MANAGER; Everyone IsTheir Own Boss
No right person until position ismade right with the right
training and tools
Small things matterJUDGENot The Mistakes But
Their Response To Being
Confronted
Every other Wednesday 12-2pmstaff eats together 2x a monthBe considerate of peoples
feelings
Find things you should not bedoing
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For now, whos going to beresponsible for that?
YOUREValuable For CreativeThings
ITS HOWYou Make People FeelThat Matters Most
We have a way of discountingsomeone
Even though you say its all right,you make the person feel small
FORGIVENESSIs Not Just SayingI Forgive You
ITS Making The Person FeelForgiven
Xerox 272 documate
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Hi speed scanner
Scan card feature
Important tool for front deskautomation
Refer a Friend PosterPeople dont like being boughtDont give something too bigWorking on selfAttaining the toolsStart automating my
environment
Start automating the procedures
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Team set up that self-sustaining,self-caring, self-learning, self-
managing
Nothing will cost your businessmore than hiring 1 wrong
employee
CODES FOR CALLING IN
Urgent post-op = 0-48 hoursUrgent impaired = 0-72 hoursCan wait up to 2 weeks if not
urgent
The way you deliver it is the waypeople receive it
Does perception create thereality? Yes.
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Humans ruin things
Receptionist can ruin things
So be wary!Perception is everythingPreserve the quality of itRequires trainingWhat I do, patients love, they
benefit, etc
You are an extension of thequality I provide
You have to talk to youemployees and tell themWORDS NOT TO USE:
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Im sorry
Unfortunately
I dont understandYoure a diamondThis job is a circleThis doesnt fit youDont cut corners during hiring,
screening, etc
#1 thing employees hate mostWhen they feel they are not well
trained or prepared to do theirjob
No one likes feeling like a fool
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There are some things peopleare willing to forego in order to
work for you
Team meetingDEFINE CONFRONTATION
Its not what you thinkWhats the opposite oflove?IndifferenceYou know what, I dont careIts not worth itYou need toConfrontation = opportunity for
improved relationship
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When I confront you, thenyoure good
If you dont have thisconversation with your
employee, they will not accept
criticism
Whats going on, whats with thebehavior?
Do you care about theorganization? Yes.
IF ONEPerson Fails Its A LinkedEffect.
HOWThey Respond Is How YouJudge Them
Poor response, poor attitude,not willing to take responsibility
are grounds for dismissal
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Your business, your people arenot automated if youre not able
to walk out of your facility and
have things still run smoothly
EMPLOYEE TRAINING = creatinga culture of rewards and
punishment, of teams, of a
group of authorities,confrontation and forgiveness,
accountability
What they like most aboutworking at IndeFree
#1 answer:I love my be job because theres
no one looking over my shoulder
I am the authority of my position
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Employees are given ownershipof their roles
This leads to a high caliber ofperforming
I want them to feel: Imbecoming a better person
Im growingIm holding myself to a higher
level
Money will come and goBUSINESSIs A Vessel For Making
Great People
That vessel is what made adifference
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TAKE ONPeople & Show ThemWhat It Means To Be
Accountable, To Forgive, To
Accept Criticism, To Be
Compassionate
If you going to give yourself atask, its not going to happen
A New YouBETTERUnderstand If You Want
Something Done, Assign
Someone Else To Get It Done
THATSLetting GoTHATSWorking On SelfI never say this is what the job
pays
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Keep in mind, you like thisperson
Youre offering them $38-42/hr;they want $45/hr
The moment of control with youremployee
Do you want to be in a positionwhere that employee is over you
because they are coming in at
lower pay but with higher
expectation
Youre willing to let go someoneyou like for $180/mo?
Youve been chosen under 1condition
Bring in me one new patient amonth on your own effort
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Store the info under the folder ofthat perspective
Change the angle of sight, youcreate a new folder
Market who you areWhat your message isWhat you are offeringWho your best customers areAlways go back to square oneMold the mind of your therapistPaperwork molds and conditionstheir thought processPaper Work = Thought Process
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YOUCan Forgive Someone, ButThey Never Feel Forgiven;
Doesnt Mean Squat
Clinical ExcellenceITS How You Make Them Feel
That Counts
Without this you will never haveclinical excellence
Its not what you think it isITS CAREThat Inspires A Patient
To Unlock The Healing Power
(Potential) From Within that
results in family and friends
being brought to you
THEYCant Unlock The HealingPower Within
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Nothing you do will get thembetter
HOWDo You Give Them CareThat Inspires Them To Unlock
The Healing Power Within?
GOAL OF EXAM is to hear this:Thank You, I Already Feel LikeIm Getting Better
IF THEYFeel Like They AreGetting Better
What are they getting?Getting betterWe are so clinicalThats our mentality
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[Type the document title]
Get eye level, make eye contact
Use a tone of voice thatsauthoritative yet gentle and calm
Use words that are inspiringStop asking like that; have you
ever had physical therapy?
Instead, ask have you everparticipated in a physical therapy
program?
You are going to take controlGo to the active with words
Actually want to touch thepatient
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You want proximity, physicalproximity
Place diplomas right behind yourhead in the most expensive
frame you can find
Poster that conveys you aregoing to be active again
Every therapist should have theirexam room
TO UNLOCKThe HealingPotential Within, It Is A Somatic-Sensory Experience
ITSTactile, Auditory, And VisualThey view you as someone who
is caring and compassionate
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Thats when you should do therehab potential from the profile
Most therapist approach thepatient this way
Whats their rehab potential?Next visit: better, same, or worseTell me whats going on, talk to
me
Comfort themYOU MUSTGive Rehab Potential
Based On Their Motivation To
Get Better
REHABPotential Is Not BasedOn Diagnosis
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ONLYLimiting Factor Is TheirDesire To Get Better Or Not
Identify motivating levelWhat you learn in school is notFOCUSOn Profiling That
Patients Motivational Level
PATIENTIs Not Getting WhatThey Need To Become
Motivated
PROFILINGIs Critical To AnExam
PEOPLEAre Good At DeceptionAnd Manipulation
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Most common cause of noimprovement, but they are
motivated
WHATThey Are Not Doing OnTheir Own At Home
Spend 2% towards gettingbetter, will they get better? No.
Tell them to do this and they do= clinical skill
When do you start to thinkabout what structures are atfault?
I dont even care what structuresare at fault
FINDThe Patients MotivationalLevel For Getting Better
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IDENTIFYDestructive Forces
You want to educate: but not toomuch
BLANKSOr Question Marks OnThe Pre-Exam Form Indicate
They Are Not Motivated
IF THEYWrite Too Much =Mental Issues
WHATAre The PotentialDestructive Forces In ThisPersons Life?
DO NOTAllow The Subjective OrObjective To Change Your
Profile Too Much
DONTAllow The Patient ToFocus You
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They Google it and take it backto the MD
MD will never send you anotherpatient again
MD will call you and yell at youDo you want confrontation? Yes.They still love youThe society, learn wrong things
about confrontation
Confrontation = an opportunityto make things right
First of all, thank you for bringingthis up
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They were not going to expectyou thanking them
WHATCan I Do To Help Make ItRight?
Words are very importantEducational part of examDO NOTEducate On Anatomy
Or Pathophysiology
Cant do it in 5 minutes (teachanatomy)
How does it relate to outcome?
FEARIs Not The #1 Way To GainCompliance
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DOESScaring Them UnlockHealing Powers? No.
EDUCATEThem To IDDestructive Forces
THEWord Is IssueNEVERSayTearConjures up too much fearUSE TERMSLike Muscle Issue,
Joint Issue, etc
Patient RolesTell them to write this downThis is how you care for youDefine their roles
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Do's and Donts
No excessive walking on unevensurfaces
Always be definitiveEvery 20 mins get off feetEvery 20 mins stand upEvery night ice for 15 minsWhy twice a day?Get up and go to sleepNever say 3x a dayCant do things 3x a day
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2x = get up and lay down tosleep
DONTSet Someone Up To FailGUIDEThem Through A Program
For Success, For Healing
Clinical excellence is notcommon sense
FAILURETurns Off The HealingPowers
BASEDOn Those Things (TheDestructive Forces)
WILLDetermine How MuchTime I Spend With Them
Discharge (D/C)
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Why D/C necessary if unable toremove destructive forces?
CANTFollow Any Part Of HisProgram
No chance of successUNABLETo Remove Destructive
Forces On Affected Structures
WHYWalk Into A Pit Just ForThe Sake Of Moving Forward
MINUTEThey Feel They AreFailing, The Healing Power Shuts
Off
At least he knows what he needsto do to get better
Cannot cut corners
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TRUSTYour Initial Instincts
Grades for STM
Forgetting it because youre notdoing it
Starts with reference number of3 = 50% into tissue
1 = myofascial layer2= 25%3= 50%4= 75%5= into the boneInfraspinatus Pressure Point
Release
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TRACKING THEIR PAIN
Be careful of putting 0/10Critical d/c visit most prime to
send a friend
How does patient feel about youhere? (At time of d/c)
They think you are awesomePoint at which they will refer
family
Find that pain never let it getto 0/10
Become predictor for D/C
Say, How is therapy going?
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Are you ready to start managingthis at home?
2 comparable signs check itevery day
NEVERLet The Reason ForCaring Reach 0/10
Have you found thatmeasurement to be reliable?
HBBWith Thumb, Right VersusLeft
Tight Posterior CapsuleVery reliableImportant for patients
perception of you
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BECOMEA Master OfDeveloping Comparable Signs
GETThe Difference InMeasurement
IF YOUDont Tell Them WhatTheir Progress Is They Wont
Realize It
HBHwith middle fingerwhatcan they touch?
Patient cannot cheat this testSingle leg hopSide to sideFront to backDiagonal
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Run 10 mins on even surface
LOOKAt Proprioception
ABILITYTo Control Limb InSpace
SINGLELeg Hops Is VeryComparable Functional Sign
KNEE COMPARABLE SIGNS
Single Leg Bridge on HeelTests hamstrings and posterior
knee
Minimal, moderate, severeVMOFIRING/RECRUITMENT
Tests anterior knee
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Tone is 25%, 50%, 75%, or 100%compared to good side
To bike: single leg squat withoutpain; 110 degrees knee flexion =
you can ride up to 5 mins
Is 110 degrees knee flexionextreme? Yes.
Its the last 30 degrees of therange
Yes (100%), no, and why?If you say go ask your MD they
lose respect for you
L/S (hinge from anterior toposterior)
SQUAT ON HEELS
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How far can they go?
Pain level at that range
SPINEMECHANICS
T/S hinges from side to sideL/S hinges front to backFlexion/extension; thats the
direction its supposed to move
C/S hinges in horizontal planeTHEMEANING OF PAIN
Dont make them in painNever leave worse; always better
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Dont need to inflict pain todiscover root cause (rule of
thumb)
Treatment is always painless,always
You giving them pain sends thewrong message
Pain means = there must besomething wrong with me
If youre good at one thing, yourgood at everythingTHE DISC CONTINUUM
Everything starts in the spine,everything
Does it make sense?
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Its always the disc
At what stage is the disc?
Disc lost integrity = facetproblems
In children: 99% with low backpain have no disc herniation
1% congenital basis of herniationDescribe a moderate DDD?This is why we dont own the
community market
How do you open up spinalforamen?
Transverse abdominal type stuff
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Disc Continuum
WNL
25%= mild DDD50% = mod DDD; radial tears;
disc is mushy
Spontaneous restabilization asbody starts to dump calcium to
protect the nerves
Patient starts getting better atrestabilization all of a sudden
Lay down every hour for 2 mins
Get them on board
75% = bulge/herniation; brittle;severe pain
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Should you walk with bellybutton in?
100% = sequestered/stenosis;broken up into pieces; got to
separate it; fusion
5 years scan chart and throwaway
ICD-9 list on fee slipDoing great, great; if not, why
not?
Always have signed plan of careIf MDs are looking at your
progress notes, youre
communicating
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If use IndeFax, then dont needland fax line
Patients perception of you asclinical excellence
#1 complaint at most facilities =paperwork
45 min eval (apple in activationsequence)
Pre-exam form & subjective (doboth = 10 mins)
70% straight forwardsprain/strain stuff
20% challenging stuff10% crazy stuff
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Face to face = 15 mins
Dont give any tx usually
Indefax = 2 minIn exercise log record no shows
or reschedules
See DN = daily notesAdjust goal once a week for
Medicare
Lumbar a exercise logProne press upPrayerSL Bridge
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I= instruct on next visit
5
th
visit = critical d/c visit 4
th
tx
Tx program done after evalD/C few quick testsAsk! Do you know of anyone
who might benefit from our
services?
Give the cards and brochuresBest memoryTeach exerciseHold them accountableShow me what you are doing at
home
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Continue at home for next twoweeks
Do I need to teach bridging onesingle limb? No, have techs teach
it
Were not a gymYou do it once, do it twiceNow do it at homeTeach 1 exercise at a timeGet better doing 1 or 2 exercises
well every day at home for next
2 weeks
I dont type up an exam and sendit when the MD ask for it
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They only want progress notes
CAIRTHOUGHT PROCESS
C = control the destructive forcesin work, play, and sleep (do's and
donts)
A = apply appropriate forcesI = impose challenging forcesR = restore maximal functional
forces
Dx = ankle fractureC = dont jumpDo alphabet; dont let swelling
increase; do use ice
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A = stretching, closed chainisometrics
I = single limb hopping ortrampoline
Baps board stuff, front and backR = running, figure 8s, up and
down hills
Running on side of hills, cats, zigzags, play soccer
Treatment plan sucks notreatment plan progression
No decent thought processAt D/C ask can you do me a
favor?
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If you dont ask, they wont do
If you ask at the right moment,they will do it
The people they bring in listenbetter and pay more
D/CCRITERIA
S: 2/10 during ADLsO: 80% or better functionalA: Self care/HEP independentClinical measurement 80% or
better
Functional impairment 80% orbetter
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Clinics have this thing wherethey subconsciously dont want
to D/C
Discharge certificate ofachievement
Fill out surveyDont underestimateFor some, this is 1st time
achieved goals
Zero out accountGet info to marketing
2-3 weeks after D/C, pt shouldget some money back for $12-18
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Round up on collections sendsurplus back
ASSESSING PROPRIOCEPTION
Sense of awareness of L/S andother body parts; holds all
contractions
Good test forLumbar spineFlatten your backToes upSqueeze kneesPush heels downBreathe
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Fair = loses it when they breathe
Poor = cant hold it
Contract and hold them whiletheyre breathing
Notes when they lose itPush; hold it x 10 seconds (HEP)Use for comparable sign & HEPPilates gaining awareness of
the body in relationship to the
other parts
Yogaworks good with bodysnervous system
Bed lasts 1 year for every $100spent
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Anywhere you spend 8 hours
Physical therapists haventaddressed where we sleep
C/S disc memory foam pillowwith curve
Right Infraspinatus is modthickened near the spine of
scapula
PPR followed by stretchLow C/S and upper T/SDont really need to mobilize C/S
with C/S mob
Have to get them into flexion
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Stretch into flexion; usecontract-relax
Palm on cheek boneOpposite hand on temporal boneIts not fast or hardPush downRadial deviate and pull on
ring/pinky finger for C/S pain
(block wrist)
Partial squat & stomach in agood for L/S firing gluts
Side lying: hip abduction withknee bent
Keep side off bottom hand
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Keep waist off ground
Psoas stretch extend arm up;ipsilateral lunge in standing
Prayer stretch gluts on heel;feet flat (plantar flexed) on floor;
finger walk forward; finger walk
to side; hold belly button in