Building A Three Therapy Center

Hey there, and welcome back. I'm Dr. Vince Leone, executive producer and co-host of the Practice Builders Podcast. With my partner in crime, Dr. Kyle Pankinen, we deliver proven strategies to help you grow fast, specialize with confidence, and build profitable staff-run practices. Let's go ahead and dive into today's episode now.

Well, welcome, doctors, to today's episode of the Practice Builders Podcast. I'm your Co-host, Dr. Kyle Pankinen. Dr. Leone is doing a solo mission today, and I'm gonna do a solo mission. So sometimes we can work it out where we can be together to do these podcasts, and sometimes the weeks are just so busy that it doesn't work. So today I'm gonna do a solo mission, and I'm excited about the opportunity to do that. We love bringing these episodes to you. We're getting a lot of good feedback from doctors that are— listening on their drives to and from work and in the shower and all kinds of interesting places. So, uh, we hope you're getting some value out of it. And we put a lot of effort into these, and we're just trying to deliver for our profession and hopefully guide you on a path of expansion and growth, especially in the world of niches and cash. Based Services. So today's episode, kind of a long title, but it's, it's called Building a 3-Therapy Center: Why Spinal Decompression, Class 4 Laser, and Shockwave Therapy Work Better Together. So as clinical director of specialized practice, I get lots of questions from our docs that have these, all 3 of these therapies, and The challenge that they run into in practices sometimes, and the questions they have, is how to implement each therapy. When it's— which therapy should I use in certain situations, in certain conditions? And they sometimes don't understand the technology that they have and the best uses for it. So most chiropractors make one of two mistakes. The first one they make is they're trying to make one technology solve every problem. They hear about the classic one in the world of shockwave therapies. Everybody talks about the, the Stemwave or the Softwave or the Omniwave or the big— the new kid, the new toy. out there and like, well, if I get that, that'll pretty much take care of everything I need to have for therapy. And those are wonderful, wonderful therapy devices, but you're not going to solve all problems with one therapy. It helps to have multiple tools in the toolbox, as I like to say. And so we love at Specialized Practice decompression. We love Class 4 laser. We love shockwave therapy. And by the way, We're agnostic as far as the, the table, the shockwave unit, or the laser unit. We have our favorites or ones that we like, but all the technology behind all of these is good. And there's— when you look at decompression tables, it's not like there's been a head-to-head study, doctors, showing, oh, Here's the Triton table and here's the DRX-9000, and here's a head-to-head study of what patients' response was. Those studies haven't been done. So you got a $12,000 table versus a $60,000 table. You might think, well, the $60,000 table obviously is going to get better results. Well, maybe or maybe not. I talk to doctors all across the country and in Canada that have the Triton table, and some have the Hill DT table, which is kind of middle of the road as far as price goes, and some have the DRX 9000 or the AccuSpina, you know, which are $60,000 plus. And you know what they all say to me? I really like my table, doc. We get really good results. It has more to do with the protocol that you build around the table than it does the actual table itself. Okay? And all the tables work. Some may be a little better than others, but they all work. They can all produce results. It's more to do with the doctor's expertise, exuding confidence into their patients. And having a beautiful protocol built around the table. So, so the first mistake is making one technology solve every problem, or trying to make one technology solve every problem. The second is buying technology without having a clear clinical system. They, they got this technology, it's the, the new bright shiny object in the clinic, but they don't really know and understand When and when not to use it. So sometimes you gotta ask not which therapy is best, but you gotta ask which therapy is best for this patient's condition, or even more specifically, which tissue is involved? What is the primary pain generator? And every therapy has a job. It's kind of like a football team. where you got quarterback and running back and linemen and wide receivers, and everyone has a certain role to play and a specialization. You wouldn't want 11 quarterbacks, all right? You want one quarterback, and then you have specialists at other positions. And so, let's talk just briefly about each therapy, and then we'll talk about how we can kind of combine those together. into programs that can help patients get the best possible results. And just to kind of get you in the mindset of thinking about these, so of course spinal decompression, it's the right tool in the toolbox for what? The most challenging, the more— your more challenging cases. So Chronic discogenic pain, facet osteoarthritis or arthrosis, that's chronic pain from facet. Obviously, disc conditions come into play there. So these are, maybe it wouldn't be the first thing you think for just a garden variety, oh, I'm a weekend warrior and I strained my back. Okay, but it's, it's a powerful tool in the toolbox that you're going to really start thinking about. Do I pull this tool out for this particular spine condition? Okay, now you can reuse spinal decompression for your average everyday routine cases, and we're actually teaching a lot of our doctors, especially if your table's not busy. Start incorporating it in with smaller packages, singles or doubles, with just some of your more routine cases. And but where spinal decompression is really gonna shine in your practice is obviously those more challenging conditions. What is spinal decompression really doing? It creates an environment. where healing becomes possible by reducing intradiscal pressure and gapping facet joints and, and changing pressure within the disc. And it, it sets up an environment where the spine can, in a sense, breathe a little bit and the body can start to do some healing. Class 4 laser. So when you think of laser, I tend to think more, where is this gonna shine the most? Where it's gonna be more for the acute condition. And don't get me wrong, laser can be powerful for chronic conditions, but it's gonna shine best with more acute conditions. Laser has 3 primary effects. And I tell this to patients frequently. What does this laser do, Doc? They always ask. And I keep it very simplistic. It's gonna help reduce your pain. It's going to reduce your inflammation. And most importantly, it's gonna help to stimulate healing. And then you have shockwave therapy. Shockwave therapy is going to shine. In more chronic conditions. It can also be used in some acute situations, but chronic is where that's its wheelhouse. So each one has different effects and different times when you're going to utilize and pull that therapy out. And as we go through some of these, these Conditions will also show when there's times maybe to use both of them. So decompression, it changes mechanics. It helps improve the environment for healing. Laser changes biology. It reduces the inflammation and it helps stimulate healing. Shockwave works on regeneration. So together they can become an extremely powerful package. And individually, you have these tools that you can use when they're used at just the right time. Wow, what powerful healing modalities they can be. So what you have to do, whatever condition walks through your door, You have to start thinking about, one, it's important to establish the right diagnosis. That's why we teach world-class exams. We teach cervical, lumbar, we have a world-class knee exam. And I actually have recordings on world-class exams for every area of the body as far as joints go. But what you're trying to do with that exam Is you're trying to determine what tissue is the primary pain generator and what tissue is most involved with this case. So if you have a person come in with, say— let's just go through some examples of different areas of the body and conditions so that you can think about how to utilize these 3 powerful therapies.

Okay.

So somebody comes in with shoulder pain. Well, you have to work that shoulder up and determine, one, is it an acute condition or is it a chronic condition? Acute conditions would maybe be an acute flare-up of bursitis or a rotator cuff injury in sports, or an older person, a lifting injury where they injured their rotator cuff. You make that diagnosis, it's acute, it's— there's inflammation, uh, they're swallowing, all those things. What are you thinking? You're thinking laser. Laser is going to shine in a case like that. Conversely, you might have that shoulder pain patient come in and you work it up and it's, it's chronic tendinopathy or it's abduction Impingement syndrome or frozen shoulder. It's a more chronic condition by nature. What are you thinking? You're thinking shockwave therapy for a case like that. Okay, let's look at an example of a lumbar disc herniation. They come in and they got raging sciatica down their leg. They've maybe had a new MRI and shows a Posterior lateral disc at L5-S1 compressing the S1 nerve root. Well, obviously you're thinking decompression, right? But what are you gonna pair with the decompression in this case? I think laser becomes the obvious choice. How about a case where they come in with chronic discogenic pain? Pain, maybe not leg symptoms involved. They just have chronic everyday back pain that they've had for months or years, or they've been diagnosed— so they got degenerated discs, or they have chronic facet arthrosis and chronic facet syndrome, or they have spinal stenosis. Well, obviously this will be a decompression case, but what, what, what therapy or therapies are you going to pair with it? And in this case, shockwave would be a really good choice. Here's how I usually do it though, is I usually with spinal decompression always pair it with laser, at least for the first half of the program. And then the second half, if I'm not seeing the results that I hope to see, where we're not making some reasonable progress, that's when I pull shockwave therapy in. And I've seen that in chronic cases where, boom, that was the breakthrough that the patient needed. So there's— in some of those cases, there's opportunity to apply both therapies. Or you could do a program where you start out, you do a 24-visit decompression protocol But maybe twice a week you do laser and once a week for the duration you do shockwave therapy in addition to the laser, or maybe with that one visit per week in place of the laser. You can sort that out however you see fit, but some of the more chronic challenging, there's definitely application to use both therapies.

Okay.

Let's talk about plantar fasciitis. Plantar fasciitis, by the way, docs, is a nice little niche. Lots of people have it, and you have the tools. If you have laser and shockwave, you have the tools. So a case walks in of plantar fasciitis. It's been bugging them for 2 weeks. They're a runner. Uh, they, uh, but it's fairly recent onset. You can palpate into the heel.

Ooh.

It's pretty tender. And there, sometimes you can actually see a little pocket of inflammation in around the heel or coming up on the medial side of the heel with that. It's exquisitely tender to palpate. You're thinking laser in that case. But then you get the case that comes in and they've had it for months. Sometimes I've seen cases, I've had patients with plantar fasciitis, they come in, they've had it for a decade. Unbelievable. And they just lived with it, a lot of them. That obviously is going to be a shockwave case or a combo case where you're going to do some sessions of shockwave and some sessions of laser. Maybe you start with, you know, 6 to 12 sessions of shockwave and finish with 6 to 12 sessions of laser.

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Those are good options to do. What about cervical radiculopathy? Same would go with this, with a low back condition. The more acute, decompression combined with laser. The more chronic, decompression combined with laser and addition of shockwave in some of these cases. Where are you gonna apply the shockwave? Well, chronic radiculopathy, they generally have what? They have trigger points, myofascial trigger points, a lot of times in the infraspinatus, teres minor area, in the rhomboid major, sometimes in the scalenes. Shockwave can help to neutralize some of those trigger points. The laser will help to reduce nerve root inflammation. And the decompression, of course, opens the spine up, reduces the intradiscal pressure.

Mm-hmm.

And helps set up the environment for the healing to take place. Chronic Achilles tendinosis, I'm treating a really tough case of this right now. I'm doing both on that case, uh, where you combine laser and shockwave on the same visit, especially the really challenging ones. But generally, That again, the more chronic it is, the more you're gonna think of shockwave's gonna be in your equation with almost all of your chronic conditions. What about failed back surgical syndrome? By the way, a little rabbit trail, brand new study out on failed back surgical syndrome. First-time spine surgery has— A 26.2% failure rate. Failure rate. So that means about, it has conversely about a 74% success rate. Interestingly, also a fairly new decompression study came out this year, showed a 90.5% success rate. Folks, folks, these are treating roughly the same types of conditions, right? Spinal stenosis, disc herniations, chronic discogenic pain. And so non-surgical treatment has a better success rate than surgical treatment, treating roughly the same conditions. Now, surgery, you could argue, maybe treats a little bit more challenging because that's gonna be your, maybe your— Caudae quina cases, or the worst of the worst that maybe failed conservative treatment, but still it has a 26% failure rate. So always, always, always talk to your patients about statistics like that, know those statistics, and try to convince patients or educate patients, better word, Hey, you wanna do spinal decompression first before you consider surgery. Surgery is a last resort. And just letting them know to exhaust all their nonsurgical options first, except in what? Cases if there's any cauda equina symptoms or if there is progressive neurological deficits. In other words, they're getting worse. Those, yeah, they need to have surgery. Interestingly, studies show only about 2 to 4% of people need spinal surgery for spinal conditions. So 96 to 98%, they need the type of care that you and I offered. So failed back surgical syndrome, this is a classic example of a— Combination of all 3, where they need decompression if they're a candidate for it, if you've ruled out anything that would be precluding them from getting it. Okay, most cases though of failed back surgical syndrome, or they call it now today post-surgical continued pain syndrome, uh, decompression, laser, and shockwave would be a beautiful— package for this type of case. So when combining these therapies, it increases case acceptance. You know, patients don't care which machine you own. They don't call up and say, oh, I want that, uh, DRX 9000 treatment. No, they want— they're looking for a protocol. They care whether you have a plan that can help them with their condition. So say things like this: Mrs. Jones, based upon your examination, your disc is compressed, your nerve root is inflamed, and your muscles have become weak and they're full of trigger points. Our treatment addresses all 3 of those. The decompression is going to work on the compressed nerve. The laser's gonna work on the inflamed nerve. And the shockwave is gonna neutralize the trigger points in those muscles. That's what they really sell, that your treatment is comprehensive. It addresses all these things. You see, patients are buying a solution. They're buying a solution, they're buying an outcome. They're not buying decompression treatments or laser treatments or shockwave treatments. Think of an orthopedic surgeon. They don't just perform surgery and stop. They combine usually what? Physical therapy, maybe some pain medication. Maybe some bracing for a while, and they put this patient through a rehabilitative process. There's many tools that they use that all work together to produce the best possible outcomes. So what you wanna do when you have these tools is you wanna build packages or programs. So an example would be, Here is— this is my lumbar disc recovery program, and this is what it includes: 24 sessions of decompression and laser and stabilization exercises and orthotics. And you get the idea. You put a program or a package together. You could have your heel pain recovery program. Well, obviously it's treating plantar fasciitis, but You call it your heel pain recovery program, and here's what is in that program to address this challenging condition. Finally, you could have your shoulder recovery program. You can make niches out of just all these different things, Doc. It all depends what you're interested in, but if you have these tools— You can make a program for just about any area of the body. So your shoulder recovery program for acute, shoulder recovery program for chronic, you get the idea. So what you wanna do is make programs and packages for these things. You know, 6-visit package, 12-visit package, 24-visit package, singles, doubles, Home runs, depending on what the clinical exam and history dictate a person needs for care. And this, from a financial impact, can be huge because all day long, all week long, all year long, you are converting patients, selling, however you order, phraseology you want to use. to packages, to programs to help them to recover from their shoulder pain, their heel pain, their chronic back pain, their chronic knee pain. And if you have these 3 tools in your toolbox, there's basically, there's really nothing that would walk through your door in the world of Neuromusculoskeletal medicine that you can't help. So think of yours— your practice as a— you're the director of a comprehensive neuromusculoskeletal recovery center. Every patient who walks through your door has tissues that need one or more Of 3 things. They need better mechanics, they need better cellular healing, they need better regeneration. Spinal decompression restores mechanics, Class 4 laser accelerates healing, and shockwave therapy restarts regeneration. It's a beautiful thing. It's a beautiful thing. So when you understand how these therapies complement one another, You're no longer selling technology, you're delivering a complete solution that improves outcomes. It builds patient confidence and naturally grows a profitable cash-based practice. So when I started in the world of cash-based services in 2014, so I've been at this for—

8 years.

12 years now. At that point in my practice, I was 90%, 95% insurance-based and 5 or 10% cash. Flip that ahead to now and we're 50 to 60% cash and 40 to 50% still insurance-based. So And we've more than, more than doubled our practice. And I had a successful practice by chiropractic industry standards before I started cash-based services in 2014. I was above average in every metric, whether it was patient volume, total collections, things of that nature. We had a good practice, but when we started adding these cash-based services and started doing programs or packages tying this all together, that's when the explosion took place and we more than doubled. And now, you know, praise the Lord, we have a clinic that's in the top 1% of the profession. But there's nothing special about me. It's just implementing. It's implementing. If you have these therapies, In your practice, you have the tools you need to hit the ball out of the park, if you will. And these therapies can help you to build and grow like you've never grown before. And it's time to do away with old therapies like ultrasound and some of those that was used for years. One, that's been so— it's so outdated compared to shockwave and laser. It's not even in the same ballpark. And people aren't gonna pay cash for ultrasounds 'cause insurance covers it for one. And it's just, it's an unimpressive therapy, but laser, shockwave, things like decompression, they are very impressive. And people can see the results, they can feel the results, and it will set you apart. So start thinking about, what I really wanna leave you with is this, is start thinking about programs. You got maybe your decompression program. That's great. That's your kind of your flagship program. But then you could start a shoulder program or a foot pain program or a knee program. And really the sky is the limit. And that's really what I've been able to do over the course of the last several years is just build out These programs. And every week we're just signing people up for these program packages. And it's, it's been a beautiful thing and we're helping a lot of people. It's a lot of fun. And we're, from a financial point of view, doing way better than I ever dreamed possible. So hope that gives you a little inspiration for today. Give us a like, share it with a colleague, and these episodes, and just get the word out. And we wanna elevate our profession. So thank you for joining me for today's episode of the Practice Builders Podcast.

Hey, it's Dr. Vince again, and hope you enjoyed that episode. And if you're ready to grow your practice fast with high-value decompression therapy, decompression patients, then the Decompression Accelerator could be a phenomenal option for you. This is our 90-day sprint to help you scale with proven systems, staff-driven protocols, and full marketing support, and it's all guaranteed. Spots are limited. Head to www.decompressionaccelerator.com to learn more.