Create a Winning Niche with Julie Eibensteiner | CashPT Lunch Hour #4

Okay. Hello, this is Dr. Aaron LeBauer with Labour Consulting and the Cash PT Lunch Hour. Thank you guys for joining us today. Today is Wednesday at 1pm East coast time. And just chime into the chat room and let us know if you can hear us and get our volume. Okay, because this is a live recording, I'm just going to write you a message. And let us know where you're calling in from. All right. So on the call and on the live webinar today, I have with me Julie Ebensteiner. She's a physical therapist and sports sports performance professional and a soccer coach. And her business is Laurus Rehab and Performance and it's a 100% cash based physical therapy practice. And I have her on today to talk to us about her niche and welcome, Julie, thank you for joining us today.

Thanks, Aaron. Thanks for having me.

Awesome. So one of the things I wanted to do is bring you on to talk about your niche, but I want to get some background information from you. So tell us a little bit about your history in physical therapy. How did you get into physical therapy? How did you decide that was going to be your career and then how did you go from there to cash based physical therapy?

Oh, wow. Well, I grew up in athletics, so I've got two older brothers played sports from I basically did everything they did. So as soon as they were playing sports, I was tagging along. Long story short, I ended up playing soccer at the University of Minnesota. Was very always interested in the human body and sports and movement and exercise. And I actually had thought about going the athletic trainer route at first and then ended up going the physical therapy route and then played five years there. Actually got an opportunity to coach college soccer the following year after I graduated. Actually went and did that. Came back to Minnesota a few years later, enrolled in the physical therapy program at the University of Minnesota. And then I started working with an outpatient orthopedic group in Minnesota, private practice owned by physical therapists. Very, very good organization, great people. But I got into that and it was the 30 minute, 30 minute treatment times with patients and it was 15 to 20 patients a day and it was a small clinic and it's very hard to treat athletes when you're just working in a clinic space. And it was frustrating and I knew that there had to be a better way to do things. And then a plus of mine, I'd been actively coaching this whole time too, and a player of mine had suffered an ACL injury and there was some financial situations with the family at the time. They had asked me, you know, could you help us with this? And I said, absolutely. And I got to actually, you know, try a lot of the stuff I wanted to be able to do without the constraints of insurance. And I was able to do that and got to see like, wow, this can be way more effective. And from there on I left my job at the orthopedic practice and then started out on my own. Very small, small overhead, small amount of patients, was supplementing my income with coaching at the same time. And you know, it's just kind of grown from there, so. It's really grown from there, so yeah, yeah, that's great.

Was there something like a pivotal point that you decided physical therapy versus athletic training or physical therapy? Was there something like that was like, oh, physical therapy is the right one versus coaching, athletic training or any of those other options that you had back?

Well, I'd done the hours, I had been putting in a lot of hours as a student athletic trainer at the University of Minnesota. I, I. Athletic trainers are such an important part of the puzzle and their job is so important, but the hours they put in, and especially just the hours late at night and on the weekends and that sort of thing, that wasn't something I necessarily enjoyed. So then I ended up the physical therapy part. It got a little bit more into the rehab side of things. A long term rehab. There was a little bit more you could do as far as, you know, working with spinal cord patients or working. There was just a lot more different avenues that were available or seemed to be available that I knew about. So I really decided that I wanted to go to the doctorate of physical therapy route.

Awesome, awesome. And when did you graduate from PT school? 0909. Okay.

Yeah.

So it's not been that long. It's like six years.

Yeah, yeah.

Awesome. And how long after you graduated, how long did you work at this other job before you decided to start?

Less than a year. And people thought I was nuts because they're like, well, you don't have enough experience that you need to see other things. How are you going to get patients? And those are all valid points and definitely valid questions, but I have learned, I have been able to since I left that and went to a cash based model. I've been able to spend a lot more time researching the things that are really important to me and try to master one thing that I'm really good at, then try to just spread my resources and my time and try to be everything to everyone. And that's just my personality. I want to. If I'm going to do something, I want to do it well. I don't want to just do something for the sake of doing it. So the move really fit my personality with stuff.

Awesome. When you were transitioning and you were treating this patient, he's like, okay, this is possible, and I can get more out of spending more time with people.

Yep.

Did you then say, okay, in a month from now, I'm gonna just quit my job and do this? Or did you plan. Did you write a business plan? Did you do, like, what was your preparation for starting a new practice?

Well, it didn't take me long when I was. When I was working with the orthopedic group that. I mean, constantly, every day going through my head was, there's got to be a better way to do this. There's got to be a better way to do this because you don't feel like you're connecting. You're not connecting with the patient as much as you want because you're so rushed to get through stuff, and then you're, you know, you're thinking about the next patient on your schedule. So the whole time I was working there, it was. It was a constant, like, well, if I could do this different, how would it. You know, how would I do it? And just kind of brainstorming stuff. And then that injury with my. With my player just came at that time. So then, yeah, I mean, I got to try stuff. And then it was. It was finally. I didn't really have a set timeline in my. In my mind. It was just more kind of just one day. It was like, you know what? I'm just taking the leap. I'm gonna do it, and I'll find a way to make it work. So probably not the best way to do a business plan, but I'm a big. I'm a really big believer on. You gotta follow gut feelings on stuff.

Right, Right. Did you. Did it. Did it cost a lot of money and you put a lot of money into your new space or new business?

When I first started, yeah, when you first started, no super low overhead. And I think that's gotta be the key. So I had actually, I had worked with a couple sports performance facilities in the Minneapolis area, and I ended up paying them a per. I ended up paying them a monthly fee per patient and just kind of worked out a partnership with them where, you know, I'm getting. I'm getting people into their facility. Maybe they otherwise wouldn't be there, you know, and then I'm getting access to their facility. So it was a bit of a win win. So I did that at first and then I slowly transitioned over actually into the facility I'm at now, which is a very elite sports performance facility called ETS Gym, which is in Woodbury, Minnesota. Ryan Engelbert owns it. He's a very smart guy. He does great things with high level athletes. So it really tied into my niche as well. And he asked me, he's like, hey, I'm moving to a bigger facility. What do you think about having an office in there? And I went and checked it out. I'm big on surrounding yourself with people who are high quality and have a similar way of going about things. Ryan's a very high quality guy. The stuff he does is very good. It's very specialized. So it really fit the way I wanted to do rehab too. And I've been there now three years and it's been great so that he can. We've traded ideas on stuff. Some of his force performance stuff has involved, has started to incorporate some of the preventative rehab stuff that he's seen me do. And then I certainly get the benefit from seeing a lot of his movement training and strength work that he does too. So it's been a. I'd like to think it's been a really good partnership that way.

So that's great. It sounds like a big win win for everybody.

Yep.

Now, are you still doing a monthly fee per patient or have you moved to like a flat fee, that type of. What kind of scenario?

No, I pay monthly rent for the clinic space within Ryan's facility, and then I have access to the whole facility. Obviously, we make sure that we're respectful of each other's spaces and I certainly still am a guest in his facility and it's worked great.

Do you have a private treatment room or a smaller space that's like your space or is it all.

Oh, no, I. I have my own. I have my own treatment room there. Yep.

So give me like a quick rundown of like, you know, what is, what is your equipment that you have there? Like, like your printer. Do you have like, did you, did you. Or, you know, table, or are you. Do you have any exercise equipment that you own or is it all his stuff?

Well, as far as office stuff, I got a treatment table, got a area for a desk. Most of my other stuff, printer, that sort of stuff is in my home office. And then equipment wise, you know, he's got the squat racks, free weights, all that stuff. Big turf area. My rehab is very low. It's Very. It's very low equipment need for the most part. There's a lot of functional movements, and I hate to always use the word functional because it means million things to different people, but there's not a lot of sitting in machines. There's not. There isn't any sitting in machines. It's. It's very. You're getting athletes back to being on two feet as quick as you can and getting into movements, you know, that are. That are useful and relevant to them. So there's not a lot of equipment needs as far as that goes.

Okay. Okay. Awesome. And then are you like, tell me about your patient flow. How long are you treating patients right now? Kind of. What are some of the things you do with them? And how many patients do you see a day?

Yep, I see about four to six a day, depending on the day. I treat them for an hour, but sometimes it spills over into an hour and a half, you know, depending on what we're trying to get through that day. And depending what my schedule is that day. I charge $110 for a session, you know, and I see every. I see people. About 85% of my patients are ACL injuries, and I'll see them at various points. I'll see them just yesterday. I've had three people come in wondering if they had torn their ACL over the weekend. So I'll see them sometimes when they get injured or right after they get injured, and they're wondering, you know, my knee's unstable, can you take a look at it? Or I'll see them after they've had a confirmed MRI and an orthopedic consultant, a surgeon, sent them over. Or I'll see them after they've gone the insurance route, and they said, I still don't feel like I. And where I need to be. So I see them at different phases. So depending on that. But, you know, usually it's, you know, sitting down, seeing how things are going, having a conversation with them, you know, where are. Did they have any problems with what they were, what was going on? And then depending on where they are in the rehab, it's either range of motion work early on, or it's getting right into, you know, retraining, movement, neuromuscular control, and getting out on a turf area and doing that sort of stuff. So it kind of just depends on where they are.

Awesome. Awesome. So tell us, in Minnesota, do you guys have direct access and do you have any limitations for direct access out there?

Yeah, we have direct access up until 90 days. So I can see a patient for 90 days, and if it's longer than that, then I need a doctor's referral at that point. But with ACL injuries, they're usually. I mean, people are seeing a surgeon, so that's not too big of an issue. And if I'm seeing someone longer than 90 days and I can't help them, they should be. We should be getting a second set of eyes on them anyways. So, you know, that. That really hasn't been an issue for me at all.

Okay. How many patients are you seeing with an ACL rupture who are not getting it repaired?

I. The Greater majority, over 90%, just because my. The population I'm working with is competitive athletes and usually in a cutting, pivoting sport. So the majority are getting surgery for it. You know, I have had patients where they've had a hobby, you know, whether it's skiing or something else, where they've where they have torn their acl, but they really just want to get back to a linear activity like running or biking. And, you know, then we've gone the conservative route with them and then see if, if they're having issues or not. If they're not having issues, well, then, you know, let's, let's. Let's not just do a surgery for the sake of surgery.

Right.

But, you know, if they are still having instability, we got to start taking care of that or they're going to have bigger issues down the road.

Okay. Okay. Yeah, that was more my own curiosity kind of question.

Yeah, that's a good question. Yeah. Yeah.

Okay, so you. So one of your niche and is ACL rehab now. How did you decide that? I'm going to see. I'm going to be the acl, you know, queen, you know, I'm going to do, you know, I'm going to specialize in this. So where did that come from and how did you get into that?

It goes back to the athletic thing and then my soccer background. So soccer players typically have more lower extremity injuries. And it's interesting because a lot of my time in PT school doing my clinical rotations, I was. One of my clinical rotations was under a very, very, very good shoulder specialist. So I got this. I got a lot of hours doing shoulder stuff. But then when I got into practicing and just being around soccer so much, there's not a whole lot of shoulder injuries in soccer. And the majority of the people who know me know me from either. Well, really coaching circles initially, but when I first started practicing, so Then they were sending soccer players. So it was just a. The ACL is the long, you know, ACL is a long rehab. So it just made sense. And I really enjoy the coaching aspect, but my coaching background helps me more through doing ACL rehab than anything else. Just because you're learning, you're learning and you're using your skills to be able to cue people correctly, how to move and, you know, athletes want to be more coached through a rehab. They don't necessarily care about all the scientific stuff, so. So you treat them more like, hey, and I've said this more than once with some of my patients, like, hey, we're not doing rehab right now. You're at soccer practice. Okay, this is what I need you to do. Just to get their mind off of some of the other stuff and just getting them the psychological part back.

Right. Okay.

And I'm not just working with soccer athletes, but a lot of them are.

Yup, yup. And. Or is it. What percentage are female versus male?

Oh, gosh. Female athlete. A ton of female athletes. Just because people. Female athlete. There's more ACL injuries overall in male athletes, but in similar sports, soccer, basketball, female athletes are having ACL injuries at, you know, three to eight times, depending on the study you look at more. So I. 70% of my, my ACL patients are female.

Okay. And are you marketing specifically to soccer teams or basketball teams or women's programs and saying, hey, I'm the ACL specialist, or are you programs for them? And what are your, what are your like. Like what is your perfect patient? And what are these top marketing strategies that you're doing that are working for you?

You're right. Marketing. I have not really focused any energy on marketing. I've done a couple things where I've sponsored fundraisers for groups more out of, you know, just really want to help the group with a fundraising effort. Not necessarily for the marketing reason. My greatest, my greatest referral source, my greatest marketing strategy is word of mouth. So being able to only see about six patients a day and being able to be very personalized with them, get to really know them, you tend to over deliver compared to what a big box PT place can do where they're seeing so many patients. So last year, 93% of my patients had been referred to from a previous patient or from a previous patient. So the word of mouth things more powerful than anything else. So I haven't, I haven't gone out and marketed to anyone as far as, as far as the rehab piece goes, as far as the perfect Patients, you know, people that just are motivated. So people who want to either either really care about the health, they understand and they, they get like you're gonna, you know, you're gonna need your knees for the rest of your life, or you need your lower, you're need your human, your body for the rest of your life. And then the ones that are willing to work for it and aren't just looking for a quick fix. Very rarely in the last five years have I had to have a conversation with someone saying, you know what, this type of rehab maybe isn't for you, or you're wasting your money and my time. I've had to do that twice. But other than that, people end up coming to me because they are invested in their rehab and they want, you know, they want to get pushed through their rehab and they want to want someone who understands them. So it's all just, all of it's just kind of been a perfect storm in a very good way.

Awesome. Now did this word of mouth network just build right from the beginning or did you have to do anything to stoke the fire, you know, and nurture it at all or.

Well, I think with anything in life, if something happens very quickly, you know, it usually doesn't last very long. So I'm, you know, I think if, and overnight success, people a lot of times don't see all the work that's gone in behind the scenes that people don't know about. But in those very early years I had a small group of patients and to this day, if you do your work well and you do quality and you over deliver it, they will tell other people about it. And it's just been a slow, it's been a slow sustained growth. And I would rather have slow and sustained than to have big peaks and valleys and inconsistency. So it hasn't been just an overnight thing by any means. It's been very slow and growing, but it's been good.

Awesome. And you just mentioned over delivering a couple times. What do you do in your practice to over deliver to your patients?

It's nothing really conscious, it's just, it's common sense. You know, you sit down and you have, you spend time with them, you know, you actually, you take some interest in who they are, first of all, as a person and take some interest in what they're trying to get back to and what's important to them, and then take some interest in kind of what makes them tick. Like, you know, do they, do they do better with positive feedback? Do they want to be, do they want you to be a little bit more picky with them? Do they, you know, what's their learning style? So just getting to know them and then being accessible. Every single one of my patients has my cell phone. I don't get calls all the time by any means. And I know a lot of practitioners are worried about giving out cell phone numbers and that sort of thing. Everyone's been very respectful of it. But always tell them like if you need to get ahold of me, get ahold of me because I would rather you have a question and we can figure it out. Then, you know, you let something linger and then all of a sudden we got a bigger problem. So I've been very personal, you know, personalized and approachable that way and available to my patients and then being very upfront, cash, being a cash PT practice, very upfront about, you know, this is a, this is what typically what the cost is. This is what's involved. Here's the timeline and laying out. I refer to it as a roadmap. You lay out the roadmap and this is what it look like. Here's how we have to get there and this is what it's going to cost and delivering on that. And if anything changes in there for whatever reason, you communicate it.

So is there a. So with the rehab patients, are you seeing them multiple times a week or for a specific duration and are you doing anything for like prepayment or packages? If someone knows they have to, they're going to be coming in for a certain longer amount of time.

I. And again it all depends on the patient. So typically when someone comes in and they, we sit down to have a meeting and I usually tell them like let's, let's come in and have, and just talk about things if you're unsure of it. So I'll give you an idea of what, what's all involved but it's, it depends on their situation, what they're trying to get back to. So you know, if you have a national team caliber athlete that needs to get back to, into a national team camp at six months, maybe not saying full go yet at six months, but getting into a camp like setting things are going to be a lot more accelerated. It's going to probably involve more sessions per week than somebody who has nine months to get back into maybe a club setting type of thing with a youth athlete versus somebody who's an adult and more of a weekend warrior type person, but wants to get back to that, but has a work schedule and doesn't have as much availability to get in and that sort of thing. So it varies, but typically it's about early on, it'll be two to three times immediately after surgery. I'll usually see them once before surgery, sometimes twice, but usually just once before surgery. Two to three times immediately after surgery. They have their entire week planned out for them. So I will give them a schedule of, you know, Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday with their specific rehab schedule all detailed out on that. And then they'll get into a middle chunk of their rehab where it's very strength based once they have their full range of motion. And then the middle chunk will be more strength based. Some of them will come in and do that with me. Some of them will do more of just long distance check ins to make sure they're on target with stuff. And then when they come back, usually around the 10 to 12 week mark, depending obviously on, you know, if there's bigger things that went on with the surgery. But if it's just a straight ACL 10 to 12 weeks, they typically are going to start running at that point. Closer to 12 weeks when they're in the running plyometric phase and starting getting into the change of direction, they'll start seeing me two to three times a week again, typically more two times a week. But you know, if some people have more financial constraints, and I think you've probably found this too, is that people seeking out cash pt it is not just the white suburban country club crowd, you know, the upper income people. It's, you know, I get people from all different backgrounds and all different financial situations. So people that are that value good rehab but are concerned about the price, you know, I work something out with them and tell them, okay, well maybe we reduce the amount of sessions. But then you have more on your plate as far as your responsibilities away from here. So just everything's very open communication as far as what the plan is.

Great. Do you do like, do you have like specific packages at all or is it just individualized for each?

No, I try, I try to get away from the packages. I don't, I just, I really am big on, you know, very straightforward, black and white. You saw me for a session, you pay for one session. You know, I just, I don't, I don't ever want to be known as the person that tries to string people along into all these extra sessions they don't need. So I typically, well, I do only just bill for what they get. I don't do packages. And then I lost my Train of thought as far as the. Yeah. Oh, I know what I was gonna say. The billing part of. Some people want to pay every single visit at the end of every visit, and then other people would rather get it chunked together in time. So I either invoice the day of and we do payment the day of, or I'll invoice them, like, at the end of the month. Yeah, I haven't ever had a problem with somebody not paying, so.

Awesome. And I want to go down a little. Another little tangent with this. Do you have a. Like, do you have a cancellation policy? And do you. And how do you enforce that? You know, I don't.

Yeah, I don't have a cancellation. I am so, like I said, I'm so simple. It's kind of. It's kind of funny. But, no, I don't have a cancellation, obviously, if I've. I really don't have a problem with no shows either. And I think that goes back to you. If you build a relationship with the patient, they're gonna be respectful of stuff. So I have had people that have. From. From time to time, I've said, hey, something came up or I'm sick or whatever, and it's been the day of. And it hasn't been a problem. There's only really been one time where someone has consistently been late or hasn't shown. There's been, you know, there's been one time where someone hasn't shown. And, you know, we talk about it then, but I haven't had the cancel. I try to get away from as many policies and procedures as I can. I had a patient actually tell me. They said, you know what I heard? We were talking about payments and stuff, and they're like, I would rather pay you, because I actually. I would rather pay someone I see and feel like I know then I can wait on the surgeon bill till later because that's just sending it to a billing department. They won't worry. They won't miss it. So.

Right, right.

Personal relationship piece is big on so many fronts. So.

Yeah. Yeah. Are your patients getting. I mean, do you know, like, are they're getting reimbursed for your care and what. What level they're getting reimbursed and everything like that?

I provide them. I provide them with the. With the invoice, with the. With the coding on it and marked paid. I tell them up front. And again, this goes back to being very open with the communication at the forefront of. Especially of a big, long rehab like an ACL injury. I tell Them check with your insurance company. I said, some patients do get reimbursed, some people don't. I can't explain why one doesn't and one does. But I said, check with your insurance company and ask what they're out of network coverage is, and then. And then find out what the deductible is, too. I said, but I will provide the documentation if you want it. Some people are like, forget it. I'm not going to deal with the insurance company. Other people are like, yeah, can you, you know, can you send me all my invoices? And then they'll try to submit to insurance. So some people have gotten stuff completely covered and other people haven't gotten anything covered. So it's just kind of what it is.

Yeah.

I don't promise anyone anything, though.

Right. I do the same. And I'm never aware of, you know, what, what everyone gets reimbursed if they. If they look for it or not, you know?

Right. I haven't. I haven't followed up. I only know if they tell me or I know if the insurance companies end up sending me documentation on it too, which they will from time to time.

Right. Do they ever. The insurance company ever sends you a payment?

Yes, they've sent me a payment once. And then I've had to go through the whole thing of like, no, you can't pay me.

Right?

Yeah. That's a whole nother debacle. I love sitting on the phone with insurance companies. It's a lot of fun.

You know, they call and they say, hey, we need your. This. Like, we're trying to negotiate a rate for the patient. And I'm like, but the patient's already paid me. They're like, what do you mean, patient's already paid? So it's interesting. They sometimes just don't get it.

A lot of times don't get it. I've had insurance companies call me and say, hey, we're denying this claim. And then I'll ask, why? And they said, because if an insurance company contacts me on behalf of a patient, I will try to call them back if it doesn't involve a lot of my time. But I've had one time where they said, hey, we're denying this because there's not. We need more information. And I said, okay, well, what's the information? Well, we need date of birth. And I go, well, look on the invoice. And they're like, oh, there it is. Yeah, well, that's why they're denying. I mean, they'll find every way to deny stuff for people.

Right.

They just try to wear you down.

Yeah, yeah. No, it's ridiculous what their game is. And yeah, conflict of interest. It's not in the best interest for the patients usually.

No. Right.

Real quick, what do you. A couple other nuts and bolts about your practice. And I got a couple. Then I got some other things I want to get back on track with that.

Okay.

What are you using for documentation?

Pen and paper right now. And then I'll turn it into a Word document that I'll store up in a secure cloud. But pen and paper, right now I'm looking into EMRs. It's on, you know, it's. But I haven't been able to find anything. Most of the EMRs have so many checkboxes and they're so insurance based. You're like, well, I can't use. I have no use for half of this stuff. It makes it too complicated. So I really am trying to find something where I can really customize it down to really make it efficient for documentation, for ACL stuff. So I'm still in the process of looking, but right now it's pen and paper.

If you find something, let me know.

Because it's simpler though, pen and paper. You find things easier.

Yeah, I use pen and paper. I circle and check things and it works really well.

I got my own little code for writing stuff that nobody would understand if they ever looked at it. But yeah. So everyone's got their system.

Yeah. Awesome. And okay, so tell me. I'll get back on my brain. I wanted to ask you, you've been posting some things on social media about your move to a new facility. So tell us about, tell us about what's this new facility? When did you. But first, when did you decide that, okay, I need to move. I want to do something a little different. What are you doing with that?

Well, yeah, May 15th. Now, it was supposed to be May 1st, got pushed back a little bit because of construction, but May 15th, I'm moving to a 7,000 square foot facility that's going to be just mine so no one else really sharing space out of there. It's going to focus on rehab and then I am expanding into the performance side of things. The drive to go into the new facility where I currently am. I am on the very east side of the Twin Cities area. So my patients, for the most part, 80% of them aren't coming from the east side. They're driving all the way across town. And I also live, I don't live on the east side I live more north central of the Twin Cities area, so I don't necessarily enjoy my long drive every day either. But so the new location is going to be extremely central. It's about five minutes from the University of Minnesota, which is pretty much the centerpiece of the Twin Cities, or almost the centerpiece of the Twin Cities. So everybody has pretty much equal access and being able to get there. So that was a huge thing was the location piece. Just because be able to serve more patients that are coming to me, I wanted to be accessible to them. The second thing was I have always wanted to start adding in more technology for the ACL stuff. The new place will have a force plate along with high speed motion capture. And that is something that I want in my own facility to be able to, to control what the environment is in there. Obviously it's expensive equipment, but to be able to control the environment and being able to do that. So when you're in somebody else's space, it's a little bit tougher to be able to say, hey, this is my space and I need to be able to work there consistently. So that was a big piece of it too. And then the last part of it was I get a lot of patients because my rehab, I take them either before surgery or right after surgery, but then they're, then they're going all the way up to full return to play. So there's not like a big drop between when they're done with PT and when they're getting reintegrated in with their sport or their activity. So if it's a team sport, I will get them fully reintegrated back into their team. And those, those patients have said, I'm in the best shape of my life now, but. But now what? And then I get asked, well, can you continue to write programs for me? You know, and it's hard to do that and you don't want to. I don't feel comfortable asking people to Pay, you know, $110 to keep coming in all the time. So I wanted something where there would be a natural transition for them to go in a sports performance type of setting. So now the new place. Well, and on the flip side, all these injuries that are happening, and we can get into that in a second too, but can we prevent these things from happening to begin with? And the strength training, and not just strength training, but the movement piece, the strength piece, the conditioning piece, the recovery piece, all those things, if we can get those more in line, especially with a lot of these sports or A lot of these athletes just doing one sport for so long, can we get them involved earlier so that these injuries aren't becoming a problem. So I'm trying to get athletes before they get injured and then giving them a place to go after they get injured to get them back to purely the sports part of it. So the new place they will have with the performance, the rehab side will stay the same. I'll still do individual ACL rehab, I'll have some better technology to do stuff. And then there's going to be the performance side of stuff where athletes will pay a monthly fee and then they will get completely custom built strength and conditioning programming in a very small group, very individualized setting. And they're going to have any. Every single person who walks in there will have an eval by me first and then the under any underlying issues or red flags they have is going to get dealt with really early. So hopefully we're building the strength piece, the power piece, the movement piece, the speed piece on top of a really solid foundation instead of really not knowing what that foundation is. And then all of a sudden we got problems.

Right. Awesome. Do you plan on having other performance trainers working with you in the facility or is it just going to be you right now?

Oh no, I've, yeah, I've hired, I've hired full time staff on the performance side. Sylvia Broughton is going to be the director of performance on that side, who in my opinion is actually a former patient of mine, believe it or not, and is a very, very bright mind in the strength and conditioning field. You know, she had been talking about getting into more college type stuff and I had to keep working at her to get her around to this idea, this new facility and what I wanted to do. And then finally she agreed to it. But her attention to detail on things is unbelievable and the philosophy is very similar. So she's going to be in charge of the entire performance side. So I'll have oversight of it, but that's her thing. And then Jake Schauer I've hired to work with her as well. So those two are going to be the main employees on that side. The rehab side is going to be me for right now. Probably will be hiring a PT down the road. Don't know when, but I would just want to make sure the quality is really high before, you know, you start expanding. I'm big on the quality piece. I don't want, I don't. A little bit of a control freak that way. But you know, as soon as you start expanding out Then everything gets watered down. And that's completely the opposite of everything that I value as far as getting, you know, moving forward with the facility. I had the performance piece back when I started. That was something I had envisioned, which is part of the name of the company. But I never. I needed to grow first to make sure that this cash model was going to work. And then I didn't want to. I didn't want to just put a, you know, put a job posting out there and see who would apply and try to get someone to fit. I really wanted to make sure that I found a person I'm big on. You need to find good people. So then when I had come across someone I felt was beyond excellent to be able to fit that role, then I ran with it, so the timing was right.

Do you do anything? And I was thinking about this before, and you just mentioned it. Are you doing any programs or are you planning on programs for teams to come in or individuals to come in to screen them and make sure that they're doing, like, pre. They're doing pre ACL injury prevention type of programs. And you mentioned that. But that's what you're planning on doing. Are you currently doing that now with anyone?

Yeah, the injury prevention piece. Well, with those that sign up for the Loris performance, they're all going to get screened by me. That's part of their very first meeting. So we'll get that. That's going to get built into their programming for people that, you know, for teams or individuals that approach me, you know, and just want, you know, like, hey, we've got six ACL injuries on our team. What can we do? I do get those questions then. You know, I've met with clubs to talk about why are these injuries happening. So education is such a huge piece, and then going over what are some of the key things you can do to prevent. And there's some very good things out there. But typically people don't care about injury prevention until after they're injured.

Right.

And it's very tough with coaches to try to get them to care about it because. And I understand it, I'm a coach. Your time, especially in Minnesota, we have winter, and then a lot of the teams are going into domes in the winter. And you are very on the clock with how much dome time you have before the next group walks in. So time is of importance there and valued. So coaches don't want to waste a whole portion of their day with that. So I get that. But there's a way to do it if you can just educate them properly. So I don't go out and sell injury prevention stuff to people because that is something that doesn't work. People don't care. But I do try to get the education piece around, whether it's through social media or whatever. And then those groups that do start asking me questions, I'm more than happy to come out and screen them and, or do more of an education piece with them.

Okay. Okay. So what are the two things or top things that athletes can do to prevent, you know, reduce their risk for acl? I mean, you know, what's, what are the keys here?

I would say, I would say there's, there's really three things. The, the best, a good, really solid strength and conditioning program that accounts for strength and different and understanding sport of trying to balance the body out because athletes will use a certain group of muscles when they do whatever sport they're doing. Can we balance it out with the strength, the strength piece to also make sure that we're working with the other group of muscles that maybe aren't necessarily used all the time. I use the car analogy a lot with, you know, if you drive your car 200,000 miles, it's gonna wear a certain way. So let's keep things tuned up. So the strength and conditioning piece is huge. And then along with the strength and conditioning piece is the management of fatigue. And because a lot of these kids are getting run into the ground and between the CrossFit culture and for some reason a lot of especially sport coaches just want to run their kids in the ground, the fatigue issue in managing that is a problem. So if you, if you pay attention to ACL injuries, a lot of them are happening in preseason when kids are super tired or they're happening at the, in the second half of the game. So fatigue is definitely a player in that. The second best thing in my opinion is cross training. So get in a sport that, that makes you move in a completely different way and that's fairly easy. It doesn't require signing up for strength training. But it's time consuming being able to cross train sports and there's so much pressure now with kids specializing and that sort of thing. And then the third thing is a good neuromuscular warm up. So there's not one out there that's the best sort of thing. But the stretching has not been shown to really do anything. A program that involves certain strength pieces, but more importantly the neuromuscular control with some plyometrics and balance and paying attention to body position. On things. Those things have been wildly successful in research. But either people don't know about them, they vaguely know about them, or they just don't want to implement them because they're time consuming and they don't know what proper. They don't know how to coach it. Right. And I've had coaches. I said, hey, this is no different than for a soccer coach. If you got a kid who's shooting a ball over the goal, you got to address the technique, you got to fix that or don't be surprised when they shoot the ball over the goal in the game, you know, I said, same thing. You just got to find out what the mechanics are of the form and a little bit of the psychology and just address it and you teach it just like a skill, like anything else.

Right, Right. So getting back, getting out there and just kicking the ball five times isn't a good, good enough warmup, right?

Yeah. Touch your toes and off you go.

That's awesome. Well, you have a, like a neuromuscular warm up like program for sale on your website. Can you tell what is that. That. What's that called? And can you tell us about that?

Yeah, so the, it's. It's called the. The LARP team prep 1.0. So Morris athletic re in performance and then it's a. It. It honestly it evolved for me coaching teams and it evolved from not even the injury part of it. It was the I back to the whole dome thing in the winter with Minnesota athletes. So we would, I would have my athletes show up 15 minutes before our scheduled dome time. We would be on the side of the field in a tiny little part of space and I just wanted to work on more movement stuff with them because I wanted to win and I wanted us to be able to be better athletes. So we would work on a ton of agility stuff at the beginning of practice, but just in a 15 minute time slot. Well then I got into PT school, started learning more things and then just slowly evolved. So it really started as a performance thing and now it's just, it's evolved to incorporate some of the best research on injury prevention. And then I had a lot of people start asking about it. I'm also on coaching staff for Minnesota Youth Soccer. So I do, I teach coaching licenses. And then I get that question asked a lot when they find out I'm a physical therapist, well, how can you prevent this stuff? And then sometimes I'll show them the warm up or show what a proper warm up should look like. And then I Get the question of well, do you have this thing written down somewhere? And I never did. So then finally I was like, well okay, I'm gonna put the whole thing, I'm actually gonna sit down and videotape everything and explain everything and get it all written down. So that's what I did last year. And now online, if you go onto my website, you go online, there's a, it's like a 45 minute video. It takes you through every single exercise, the progressions, the regressions of stuff. And then it also shows I actually videotaped one of my teams last year doing the warm up. It takes 11 minutes and just over time of what does this look like in a real life setting and how do you need to cue it and set it up? So it's very practical for a coach. And then along with that it has a 25 page ebook with it that explains everything on it but more importantly explains to coaches how to set this up so it isn't taking up your entire practice and how you can cue it and just take some of the, some of the intimidation factor of this physical therapy warm up away so that they can implement it. But it's not just meant for coaches. I've had physical therapists, I've had parents of athletes purchase it. I've had European soccer professionals, their physios and their strength and conditioning people purchase it. I've gotten really good feedback on it. But yeah, it's just. So take 10 minutes of your, of your warmup and, or take 10 minutes of your practice and this is what you can do. It's reduced ACL injuries in my athletes by 80% so and the athletes that have been, most of them are four to five years into college now and they haven't. There was one contact ACL injury of those groups of players but other than that there haven't been any non contact acls for those groups.

Yeah, that's great. I put up a link to, just for everyone listening for to Julie's program and she's offered us a really generous 50% discount off of it. So you can click on it and it'll be available as a discount. Just enter in the discount code LABOUR2015. And what I want to do Julie now is kind of ask you some questions from the audience that we've had come in and I'm just going to read them off. So this is kind of like lightning round time because we've got 12 minutes.

Okay.

Okay. And I'm going to try to get through a few questions and Then I got a couple other things I want to check in with you about. Okay, so have you seen a distinct advantage and this is from David. Have you seen a distinct advantage to obtaining your cscs? And if so, how has it benefited you versus before getting certified?

Yep, I got certified. My as soon as you need a bachelor's degree to get certified. So as soon as I had that in hand, I got certified. So I had that before. So I don't really know what being a physical therapist was before that, before being certified, because I've always been certified. My rehab is very strength and conditioning based, so it really feels. Well, initially we'll do the range of motion and getting quad firing, all that sort of stuff and gait retraining. But once we get through that phase, it's very strength and conditioning based. So my athletes say this feels a lot more like a college level workout than it does that I'm at rehab. So it's been hugely beneficial. But along with that, as I've tried to going back to being inside ETS gym and working with Ryan and then other people in the strength and conditioning field, I paid almost more attention now to what they're doing with stuff because I think that's a huge piece that's missed in the ACL rehab is knowing what other especially the strength and conditioning field is doing. So I think you need to, you know, that's, it's been great. So. But like anything, you can have a driver's license and be a bad driver. So, you know, having your CSCs doesn't mean you're the end all be all about strength and conditioning either. So you gotta, you gotta learn.

Right? Right. You gotta learn and keep up with all the trends and recent research and everything. Okay, Colin. Colin is listening. He asked, do you have any tips for communicating with physicians and what do you find that they want to know about from you or hear about from you or see from your patients in terms of function?

Yeah. I think the best communication you can have with physicians is send back a patient who is all gung ho about their rehab and doing really well without problems. But keep it simple. They really want to know about, you know, big issues. They want to know, you know, how's the patient doing, do you have any concerns and then what is your plan going forward? So you know, they're not going to sit down and read an entire, you know, document on every little thing. So keep it very simple, be very proactive with communication and, you know, make sure that they know that you have a plan in mind. Of where they're going. And then just make sure you're on the, you're on the same page. It's got to be collaboration. And that goes all the way through the whole sports medicine train chain from the athletic trainer who may have, you know, may have encountered the injury on the field, all the way through the. Well, through the surgeon and then certainly through the coach that you're sending them back to. So keep, keep stuff simple and then make it relevant to him.

Yeah. Okay. Awesome. All right, Andrew has two questions. Two questions and one real quick. Do you see patients that are non ACL patients?

Yes, I do. A small percentage. I'll get a lot of anterior knee pain type stuff. I'll get some ankles, I get some hips, hamstring type stuff, some back stuff. And then if people do come to me and have some sort of upper extremity stuff, I have kind of my go to people I refer out to one of them being at my old employer. Back issues. Got my go to guy there. So. But yeah, I do see some. But not, not everyone's an acl.

Right. And the, the other question you had, and I want to phrase this in the right way, is there a difference in your patients coverage for insurance or, or just the way you treat them if it's returned to sport versus a daily function type of, I guess, homeblower outcome that you're looking for?

Right.

Well, you know, like, do they stop paying because they can function versus they're not able to play at the collegiate level yet?

Right. Yeah. With the return to sport, there's a vigorous and a lot of layers they have to get through a lot of hoops they need to jump through and criteria they need to meet to get back to playing. For people that are just trying to get back to daily activities, I'm still asking them what's important to them. And a lot of them are doing. They're coming to me because they're runners or they're whatever. But then at that point we're looking a lot more at function of stuff they can do and pain and are they having any problems with stuff. But if they're getting back to anything that's a cutting, pivoting sport, there's a certain group of criteria they need to jump through. But I try to treat everybody fairly similarly as far as that goes. Like, I don't want to, oh, you're not an athlete, so then, oh, you're just not as important. No, they got their whole life to live or whatever else. So I try to get their knee Just as, you know, well back as anyone else.

Do you know if their insurance programs are denying them once they reach a certain level of function at all?

Oh, I don't know because I don't deal with insurance. But I do know from before that typically it's like, oh, 12 visits, you're done, or oh, you can walk again. We don't really care, you know, we don't really care that you're a, you know, a college level soccer player or basketball player or whatever. You know, they just care that you can, you know, get to the bathroom and feed yourself.

Right, right, right. Awesome. And then, let me see, I'm just looking at the questions again. I think we got, I think I got most of them answered in what we're doing. Can you, do you have any like, advice or thoughts for someone who wants to start a practice? Because a lot of people that not only listening who own a practice, but are trying to start one. So what's your best advice for people who want to start a cash based practice or even just a practice? A physical therapy practice.

Right. The two biggest pieces of advice, keep it simple. So start small. Don't get yourself drained in overhead right off the, right off the bat. And then the other part of it is the, well, I guess there's really two more parts to it. The education piece. Don't try to be everything to everyone. So find something that you're passionate about and then start educating yourself. I learned more. I learned more. Now I think the day you think you have it all known, you better watch out. So I mean, I'm trying to learn every day and I try to question myself and what I'm doing every day too. So I think that's important. So you know, the education piece is huge and you're going to need to do that if you're going to go cash based because people are paying out of pocket and you better know what you're doing. You better be effective. However someone wants to define effective. But you know, you better be effective and connect with your patients or you're not going to be in business very long. But then the last part is focus on quality. So the quality, like we said before, the quality will grow. The word of mouth referrals are your most important, most valuable thing you can have. So don't get too caught up in the whole marketing thing. Be patient and then things will work out. If you're delivering on stuff.

Awesome, awesome. And then if someone wants to contact you after this webinar, how do we find you online and how do we get in touch with you?

My website is www.lorisrehab.com, so you can find me there. My email address, this is the long one. J E I B as in boy E N S T E I n e r dot com. Or they can call me 651-592-1625. All that stuff's online, so if they go to my website, they can find how to get ahold of me. I'm on Twitter, LorisRehab.com I'm on Facebook, too. All that stuff's connected through my website, so. And I get questions. I get a lot of questions from people. And if I have the time, and I usually can find time, I'm more than happy to try to help people out.

Awesome, awesome. And I'll put links to Julie's website and Twitter and other resources we mentioned in the show today on my blog when I publish this video to my blog.

Perfect.

In the meantime, look her up and lift up your shirt so we can see your logo. Or lower your thing. Yeah, there it is.

There you go.

Rehab. Yeah, that's Rehab. Awesome logo.

Yeah.

Well, Julie, it's been really wonderful having you today to join us, and I really appreciate your time and your knowledge and sharing your information and a little bit about you with us.

Thank you. Thanks for having me.

Yeah. It's been great getting to know you. And just for everyone else watching, I've got another great guest coming up in May, so stay tuned. And this is Aaron LeBauer with labauer Consulting and the Cash BT Lunch Hour. Thank you so much and enjoyed spending time with you. And hopefully you're done with lunch already. I'm already full. All right, adios.