#40 - 10 Things Every Clinician Should Understand about Orthotics, Part 2

FAKTR, spelled F-A-K-T-R, stands for Functional and Kinetic Treatment with Rehabilitation. Over the past decade, this unique approach to treating pain and dysfunction has been utilized by healthcare providers on 6 continents. Serving as a framework that guides clinical decision-making in patient visits around the globe on a daily basis. With this podcast, our goal is simple: to bring the best and brightest in clinical education to the forefront and empower practitioners with cutting-edge, evidence-based content that improves patient outcomes and inspires healthcare providers to continually evolve their approach to treatment. In each episode, we will feature a training or interview with some of the top minds in healthcare in a short format that is easy to consume. to digest with actionable information that you can implement into practice right away. Let's get started. Hi guys, welcome to a new episode of The Factor Podcast. I'm your host, Jessica Riddle. If this is your first time tuning in, welcome and thank you for listening. Today we wrap up our 2-part training titled 10 Things Every Clinician Should Understand About Orthotics. With Dr. David Wedemeyer. Dr. Wedemeyer is a chiropractor and certified pedorthist located in Laguna Niguel, California. A native of Newport Beach, he graduated from Cleveland Chiropractic College in Los Angeles and then returned to Orange County to open his practice. With a keen interest in the foot and ankle, Dr. Wedemeyer began investigating the different methods available to fabricate and dispense CFOs, or Certified Fitter Orthotics. To date, he is the only chiropractor to have served the Medicare diabetic shoe bill as a supplier of diabetic footwear, insoles, and AFO braces. Through his podorthic training, he garnered the trust of local orthopedic foot and ankle specialists and enjoyed beneficial referral relationships with medical providers throughout his career. In 2018, he retired from chiropractic practice to devote his time to operating Soleutions Orthotic Lab and to educate his colleagues about foot orthoses and pedal biomechanics. In today's episode, we will discuss the differences between a 3D volumetric cast and 2D methods and how they impact the finished orthotic device. We will also learn about the marketing and myths that entice doctors to buy generic brands. Buyer beware, not all custom orthotics are what they seem. If you often encounter patients with feet, ankle, and gait issues, this training is for you. Let's cue the intro music and dive right in.

So this section, and I could go on all day, in this section because a custom functional orthotic is really designed to address specific conditions. And what do I mean by that? When I see a lot of providers ordering orthotics, we have a sheet that we give them, and it's basically an order form that probably looks like Greek to a lot of providers. My goal will be in seminars that we will be giving both online and eventually live is to expose you to that so that you understand that form and can make those decisions. As I said, right now, I tend to make those decisions for providers, but eventually we'll offload that to the individual provider. You'll be able to fill it out and understand it and decide what's best for your patient. So some specific conditions that I don't expect everyone to know today, but we can discuss, I have a lab group, by the way, Solutions Orthotic Lab Discussion Group, and maybe Jessica can put that up. It's on Facebook. I have 7 or 8 of the biggest names in podiatry and research on the subject in there to help out. They know a lot more than I do. I stand on their shoulders and it will become a very useful tool. But you're looking at conditions just like with a lot of chiropractors, basically, are you seeing a facet syndrome, a disc injury? Not just terming it a subluxation, or in this case, providing an orthotic that's very generic. So forefoot valgus and varus, these are examples. Hallux limitus, plantar fasciitis, probably the most common shin splints or medial tibial stress syndrome that I'd love to do just a solid webinar on what we feel is causing that today. Achilles tendonitis, Sever's disease, and Adolescents, and there's even some low back pain that it will help. Howard Dannenberg, who's in that discussion group, just did a wonderful presentation at Parker, I understand, about his theory of sagittal plane dysfunction relating to sagittal plane blockade because of inadequate function of the first ray. Posterior tibial tendonitis— tendon dysfunction, which I saw a lot, its sequelae is adult acquired flatfoot. And just general arch pain. This is an equinovarus foot. This gentleman, because of a congenital clubfoot, his right foot could not reach the ground. And so I built him an orthotic over here that has a very large heel wedge and really helped him out. But that's a very custom orthotic that you won't see common as a chiropractor. This woman had a dramatic— if you look at this, this is a representation of her left foot. The heel is vertical off weight-bearing, but look at that very large forefoot valgus, that angulation towards eversion of the forefoot on the rear foot. Could not run. 18, 19 years old, was headed to college at USC to be a competitive runner. She would run for 1 mile and experience such dramatic foot pain she had to quit. She had a bag of orthotics she brought in. They were all inappropriate. I wedged her appropriately. With a simple forefoot valgus wedge, pain went away immediately. She did not take my advice and break in the orthotic. She ran 6 or 7 miles, I believe, her first day out, and her problem was solved. Basically relieving the tension on her peroneal tendons. This is a real common issue. And by the way, you will see very, very little forefoot varus in practice. You will see a lot of forefoot valgus. Just a tip. This is the trifecta. Here's a gentleman who presented with hallux valgus, onion formation. He has an adult acquired flatfoot due to the attenuation of his posterior tibial tendon. I don't have his orthotic up here, but it's not important. This is a very complex case, complex orthotic. I told him, would you be okay with me maybe improving 50% of your gait function and pain? He said, yes, I like to come in low, undersell and overdeliver. He was about 80-90% the last month or two that I spoke to him and has ordered subsequent orthotics from me. You'll get— when you do a good job, you will also get a lot of repeat orders. And we keep these scans, even if we did it by hand, which we will do when people ask, we scan it in and keep it in our system. We used to keep it for 3 years. I believe now we keep them indefinitely. So pronation, quote unquote, pronation is normal. It's normal from heel strike when you start loading the foot through mid-stance at heel off, there's a resupination and supination of the foot. And then there's a compensatory repronation of the foot to allow the body weight to now travel over the hallux, which accepts 60% or more of the weight of the Body into propulsion, so just everything is based on pronation with that one company. With the shoe industry, you've seen motion control. Problem is, like I said, posting medially or medially biasing shoes can cause more problems than good. And so I despise terming everything. Oh, they pronate. Yeah, they do. Following Merton Root, McPoyle. And Hunt, I believe, in 1995 presented a paper introducing tissue stress theory. I'm not going to go into it a lot. We're running out of time, it looks like, for my presentation at least. But tissue stress theory really challenged Merton Root and his theories. I think it's a very valid paradigm to look at the foot. And essentially what you're doing in a very, very— this is a very simplified explanation, but I just want to introduce it. There's a paper that I can provide that discusses it and many subsequent geniuses that I have learned from about tissue stress. And I shifted the way I looked at my evaluation and orthotics and everything. So some of these patients, I will only look at them from the paradigm of tissue stress, and it's really, really improved my practice. Essentially, you're just locating the injured tissue and finding a way to mediate offload or reduce stress or strain on that tissue so that it can heal. And that is a very, important function of an orthotic. I don't think it's mutually exclusive from a lot of the other theories out there. There's probably 3 main ones of foot function, but I find tissue stress, it's applicable to chiropractic. So an example, like I said, is reducing load on the medial band of the plantar fascia through Kogler studies. A medial wedge happens to lower the amount of muscular force that is used to engage the windlass mechanism. And we'll go into that later in something called twisted plate. I'm going to do a whole webinar on that, which is fascinating, tells you why I used orthotics with a certain design feature and would like to design some others for over-the-counter use. It comes down to you have to reduce this tissue stress As opposed to, I'm just going to put rearfoot posts in every orthotic to reduce inversion of the heel varus. I found that didn't work. I use very few medially posted orthotics these days. So I think it goes hand in hand with what you're trying to achieve with orthotics and may have some guest lecturers come in a webinar in the forum and present that. I have some that have done this before in physio forums and it's just enlightening. The last thing really is appropriate coding and billing. I can make this available. On your first visit, you would bill an examination, examine that foot. The second visit would be when you get your orthotics back. There's a specific method to coding, specific codes you use. You have to bill a right and a left orthotic. So actually it says R in there, but it would be RT, right, LT, left. You would also bill for orthotic management and training on the same day, and then subsequent events, orthotic follow-up, maybe a couple of those weeks or months apart to evaluate that patient. These are all codes that many insurers will pay for. We'll go into later, or maybe you can ask in the Q&A, my experience with billing for orthotics and being a chiropractor. It's an eye-opener. So I'm going to put up here, this is how you can contact me. I hope you enjoyed this. It's not a lot of time to present this subject. My contact information again, Dr. David Wedemeyer. You can address me any way you like. You can email me at our lab, Solutions Lab. And as you can see, it's solsolutionslab@gmail.com. I've put the phone number of the lab and my personal cell number. Feel free to call me. If I don't get back to you, I will. I spend all mornings talking to colleagues and I love answering questions and interacting. I'm always available on Pacific Standard Time, keep in mind. Let's see, anything else? Visit our web or add me as a friend, David Wedemeyer DC on Facebook. And I hope you enjoyed this webinar. If you ask Jessica, I will do more. I have no problem giving away my knowledge for free and educating Colleagues, and I wish you well.

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And let's go to Jessica for Q&A. Thank you very much.

Thank you so much, Dr. Wiedemeyer. We have gotten a few questions. So first off, someone was asking, How you compromise between a stiff device and patient compliance? So I'm not sure if that is kind of a question about training the patient on— now they have this new device, how do you help them break that in and become comfortable wearing those on a daily basis?

Great question. Let me show you. This is a composite device, so we'll call it graphite. Carbon fiber we use most commonly. It has a certain amount of flex. I love the feel of this device. So when you're talking about comfort, let me show you. I just love props. This is polypropylene. It's the most common. There is also a certain flex to this, but this is a thicker shell. And this is the kind of thing that I wear, or a very thick composite device. So yes, if the shell is stiffer, And keep in mind, a lot of times what we do to the medial arch will determine the flexibility and comfort of the device. If you look at the medial arch as a function of a parabola, the higher the medial arch, the more stiffness in the device. We can control that. So this is old school, an old plaster device, POP device that I made, and we can control that. And now we do it digitally on a screen, but in the old days, we would pour Plaster into this, flip it over, take that plaster device out, we would have something we would mold, but we would add a little bit of plaster expansion to the arch. That's a big factor in controlling it. So you need to know, do I add standard arch fill? How much arch fill does the lab add? So the height, and in my case, was this done off my foot? I have a really high medial arch. And I need to be careful about the type of— well, in my case, I can use a really stiff device, but we would control it by mediating the millimeter or depth of the device. And if this was a standalone, we determine the comfort level through that. This is a hybrid. So here we have a thinner polypropylene shell and we have Poron on the bottom. So we use that a lot. This is a running-specific device. We have a forefoot fill, a little bit of— to help the metatarsals. That is lacking because the orthotic shell actually ends behind the metatarsals. The rest of it's just the top cover. But in this one, and this is very common, we have a lot of chiropractors who only order this device because of the comfort level. And with the patient, I would initially have them wear The device, 1 to 2 hours the first day, add an hour a day. In truth, most patients do not listen, especially mine, and they would wear it for hours or all day. And the bottom line is it's a guideline. It doesn't always happen. I will tell you this, when they— you get them in their office to dispense it and they stand on it, if they're comfortable right away, I can guarantee you, you're not going to have a complaint.

That is great advice. Thank you. Definitely some great guidance there. Another question here was, what are your thoughts on EVA versus polypropylene carbon fiber plastic shell?

Well, they're dramatically different and it's kind of an old classification. And I want to show you just to— I don't know if I have an EVA device, but that question Pertains specifically to this plastic polypropylene material, which is the most common material used. EVA is also the foam material. This is not EVA, this is Poron. A lot of orthotics can be made or milled out of an EVA device. So EVA is really a material that you find on the bottom of your running shoes. And we have different densities of it so you can control the comfort of an EVA device simply by the density of the EVA, just as you can the thickness of the orthotic shell. These are all things— their weight and activity is the major determining factor. If this were EVA, you can also have, like I showed before, a thinner shell, more flexible shell, and an EVA base. And this— an EVA base and flexible shell— this is really Comfortable. So a lot of patients do well with those. The bottom line, a functional device is not a hybrid. It contains— typically it's semi-rigid, it's termed. I don't like that term rigid because it's not, but it always has some give. The EVA device is an accommodative device if it's solely EVA. The plastic-only device would be called a functional device. The Purpose of a functional device is more control. One of the main features of things like that is a deeper heel cup. So we can make this different depths and offer different control. All these factors factor into control. Is it purely a functional device, which is what I wear and most of the patients that I made them for? You're trying to change things and control the function of the foot through the device or guide it. With an EVA device, it's more accommodative. So a lot of my diabetic patients, you had a layer of EVA, a layer of Poron, and a top cover called Plastazote that reduces shear. There are so many variations, and this is why I would love to give live seminars eventually and pass around the materials and get you familiar with them and their function. So I hope that answers your question.

Absolutely, thank you. Now let's chat a little bit about some of the functional uses or indications for using orthotics. Would the device change, or would the materials be different for wearing an in-office shoe versus a running shoe, for example? Or what if you had an ultramarathoner that has peroneal and Achilles tendonitis? How would those vary in terms of either the materials or the type of device that you use?

Well, like I said, let's say if you have the young lady I showed that got a running device. So that's a running device. So the shell actually ends behind the metatarsal heads, but this is specific for her sport. So often you'll have people order more than one device. It's simply not always easier to order something like this and get it in a dress shoe, especially for the ladies. So A lot of times, if they're not a runner, we're going to make something to fit in their daily footwear, look at all the indications and parameters for comfort. As I said, it's not always a soft device that's going to be most comfortable. It's really going to depend on your exam on mainly on foot flexibility and weight. So if we get someone with peroneal tendonitis and we decide, well, what is causing that? Is there a lateral column overload where they just supinate more? than they should, and we can use some lateral control of the foot to have ground reaction force push that foot into more pronatory motion. Maybe we could have, in the case of my runner, peroneal tendonitis, which is very commonly caused by forefoot valgus, which is very common, unlike forefoot varus that you see everyone— I mean, there are labs out there, and there's one that I'm really familiar with. And he's known in the chiropractic community. Every orthotic I've seen by him is posted medially. There's a medial bias or a forefoot varus wedge. I've remade a lot of those where those failed and we had success. Not that I'm smarter, I just, I think I look at it a little differently. And at any rate, if you then find the reason that that tissue is being overloaded, And can provide a reasonable basis to modify that orthotic, boom, you have success. So I would definitely— you can see dress shoe, and there's different lengths to these top covers. So it could be this length, which is metatarsal, this length, which is sulcus, and then this is full length. So you can design the orthotic for a runner. Let's say you're an ultra marathoner. needs help in the office and wants just an insole they can slip into their shoe, this is not going to fit in their daily use shoe. This is specific for their sport. There's a lot more cushion, and with EVA or pour-on base fill, it's going to be thicker. So my reasoning would be, yeah, they may need both devices, and that's just the reality. Now, what I used to do is I charged a premium. It's not for the orthotic, it's for my time and decision-making. And you should too. Bottom line, a lot of people buy 2 or 3 pairs of orthotics. So I would make them at my regular cost or price and then give them a little bit of a break on the second ones because now we have all the decision-making and everything done. So that ultramarathoner would probably get 2 devices from me, or if it only happens during their marathons, I would just make that device.

You were in one of the different examples that you showed. Why would you use the Poron under the shell as opposed to on top of the shell? Is there a reason as to why you would do it one way versus another?

Well, I don't even think I have to show you. Poron base layers are quite a bit different than the Poron we put between the shell of the orthotic, this being just a shell with a top cover, vinyl top cover. A lot of times we will put a thin layer of Poron in here to absorb forces and increase comfort. Okay? So in a device like this, if we had a thin layer of blue Poron in between, that's merely a feature to aid comfort. That's a thin layer of material. It doesn't have a shape to it. It conforms to the shape of the shell. If we used Poron beneath the shell that— see, there's a shell material in here. This is just a comfort orthotic, thinner shell, Poron base layer. You're using an increased density EVA or Poron, same thing, different material. You're just using that underneath the shell for increased comfort accommodation. So that's the difference. You can get Poron as a very thin layer. Beneath the top cover sandwiched in between to help your aid and your comfort. These are all things you— boxes you can tick on an order form.

Wonderful. So going back to, in clinical practice, how practitioners are identifying patients that need orthotics, what are some patient complaints that most people may not necessarily think right offhand would indicate orthotic use, but ones that you have seen make dramatic improvements after having orthotics prescribed for?

Let's go to plantar fasciitis first, which I covered a little bit, but obviously pathognomonic, first step pain out of bed in the morning, feels like a spike at the medial anterior calcaneus. So that's where the medial band of the plantar fascia attaches to the calcaneus. And that's, you know, you talk about heel spurs, and by the way, heel spurs are almost never the cause of their pain. It's just a finding. It's actually an overload of that tissue. So what I would do with those patients and decision-making process, I would use low-dye taping, which is a figure-8 configuration. I can make that available to your listeners, subscribers. But I would low-dye tape the foot and have them walk. And if they had an immediate improvement in pain, I knew they needed some kind of support. So would that be— Always, we should look at their footwear. A lot of them are wearing horrible shoes, unsupportive shoes. A lot of this is due to loading. A lot of it is due to improper function of the first ray and flat feet because it takes a greater amount of muscular force to stop lowering of the medial longitudinal arch, to wind up the foot and heel off and use that stored energy, the fascia, the—

Fascia.

intrinsic muscles to propel the foot. Bottom line, with plantar fasciitis, if I found that they did really well with taping, it's an indication that they could at least have an over-the-counter orthotic to try out first. Then you look at their foot and you, if you notice inadequate first ray function, could we change that with an orthotic? Is it a functional hallux limitus where I'll probably have wonderful success in changing the function of that foot? Is it a forefoot valgus or varus causing this problem? So all these things, when you learn the examination and the biomechanics, watching their gait, what could I improve? All of these things add up to, should I use a custom orthotic? I'm going to say something that will probably blow a lot of minds because I earn my living making orthotics, customs. Not every patient needs a custom orthotic. Let me repeat that. Not every patient needs a custom orthotic. I'm not here to sell a product. I'm here to hopefully share knowledge. And if through that I earn your trust and you use my lab, great. So that's how I'm going to approach this, and I want to teach you the skills to evaluate that patient and make that decision. It's your decision ultimately.

Wonderful, thank you. In terms of the design, one of our attendees was saying they didn't fully understand the point about the transverse metatarsal arch. When I visualize a fallen TMA with increased callusing under those met heads or thinned tissue under the met heads or pain in the met heads, would you still respond with met pads or a met bar or excavations depending on the situation?

I didn't expect that question. I have to go. No. It's a really excellent question. And obviously, this is someone that has a little bit of experience, I think, with orthotics. So let me try to run through this. The whole point behind it is they're using it. It's not true. There is no transverse metatarsal arch. There's too much evidence to the contrary. If you took a foot and loaded it and put pressure pads beneath pressure sensors to evaluate how much function, and you'll never convince me or any of my The people that I learned from and that I communicate with, that there is a transverse metatarsal arch at the level, okay, of the metatarsal heads in the human foot that is not a rigid cavus foot or a Charcot foot, etc. It doesn't exist. So if you're using that to sell orthotics, what are you teaching people? That's just not Me, that's— a lot of people tell you I'm just really no-nonsense. That's your whole mantra. That's all you're giving people instead of being here discussing as we are things that we can expound upon and learn. So what would I do different? If they have metatarsal pain, there's a lot of things that you can do different. Most chiropractors are probably used to met pads and met domes. They help a lot. They're not the be-all end-all. One of the things I will do with metatarsal pain is when we make orthotics, this where they end right proximal to the metatarsal heads, you will have these beveled down to a certain thinness for comfort because you don't want to feel that. Sometimes with metatarsal pain, we will keep this, we won't bevel that down. And so basically the metatarsals will hang over That area and it will offload it. There may be other reasons. Is it just one metatarsal? If you're seeing callus, is it because you have a plantar flex first ray, which would— if this is your first ray and it's dropping down, okay, is it a flexible one or a rigid deformity, which would affect a lot of other things and tilt the foot and gait? Do you now have someone that's had tailor's bunions? Have they had a 5th metatarsal fracture before? There's so much to go into. I wish I could just go on and on for an hour, but obviously we completed the webinar. I want to know if that answered your question. There's a lot of different factors. If you communicate with me, I would help you with that. That non-beveling of the anterior edge of the orthotic device would have a huge and dramatic effect. And then as the patient got better, we could grind that down and Wonderful, thank you.

Another question we had here, you went a little into diabetic patients, but for older semi-active diabetic patients such as walkers that experience some neuropathy, would you suggest a particular material for their orthotics?

Yes, anytime you have a diabetic, you have to be really careful, and I don't want to use absolutes and say you should not use semi-rigid materials because When I first started out, one of the reasons I became a pedorthist was I was the only chiropractor in the country crazy enough to become a supplier for Medicare for the diabetic therapeutic shoe bill. That happened because I saw a woman with gangrene. She wasn't being well managed. I couldn't believe what I saw and smelled in my office. And this was really early on, and I had seen one other in the clinic, Actually, that was not as progressive. So to me, I thought, my God, if I'm going to go down this road and become more expert in the foot, I need to look at all aspects. So I started learning about the diabetic bill, became a supplier, and like I said, what it afforded them was an approved shoe, pair of shoes every year. And 3, this is a very custom that we manufacture diabetic product. You could either have the shoes in one of these every year or 3 customized but kind of built on the same platform. Blue layer Poron. We actually have a shell in ours, a very thin functional shell, and you can see there's quite a bit of flexibility. And then on top is Plastazote, and that material is there to protect their feet. So I did a lot of these patients. I would fill their orders every year. If you have a patient, you're not going through Medicare because I had to be certified. They changed it. Chiropractors could— people that were not pedorthists or trained could no longer provide those patients. So I became the pedorthist partially as a reason to keep my status as a supplier. I don't expect chiropractors to get involved in that, but your patient with diabetic neuropathy, this will certainly make their life better. We don't advocate you seeing diabetic patients unless you are providing this for them, unless you have some training. It's pretty dangerous. That woman that came to me, she ended up with a transmetatarsal amputation due to her uncontrolled diabetes. I got her with obviously an orthopedic surgeon that did the surgery, and then we had to make basically one of these with a covering here that met the stump of her foot, and Medicare provides for those. So forget about all this stuff that gained me a lot of experience, but you don't need to know. I would always put a diabetic in something like this or a completely soft accommodative material. Yes.

Thank you. One of our attendees was saying that they are unable to bill or examine for orthotics currently. So for those docs who aren't able to spend the time or have the resources to evaluate, how do they provide those resources to their patients so that they can be evaluated properly? How does that process work for your lab?

I don't understand why they would not have time. Maybe they can follow up to evaluate. Look, I don't think every chiropractor out there should dispense orthotics. Some will, some won't. It's great. I'm here for the ones that want to do a good examination, want to maybe upgrade. And I believe all chiropractors are capable of— if I am— of upgrading their skills a little bit and doing a better job for their patients. And if you want to utilize me, pick my brain, this is my life goal. I want them to elevate themselves. So I kind of don't understand the question. Or maybe the way it's phrased, maybe they could—

I think it may be due to sometimes practice constraints, especially if you work for a chiropractic group or a chiropractic company that doesn't necessarily offer that as part of their offerings or their services. This person was saying that they essentially bill PT bundle codes because they work for a company. That's primarily what they do in practice is more of the PT codes. So they were asking, if I have a patient that this is indicated for, is there a resource that I can provide them so that they can still get that evaluation they need to get those custom orthotic devices?

Well, and I don't mean to be flip, but based on the question, you should just refer it out. And I would find a podiatrist or someone that I've trained or something like that who does provide the service and bill for it. Billing's a whole different thing. Hopefully we get a question on that because I have something to share, but I would say in your case, it sounds like you need to refer it out. If you're not going to or able to spend the time evaluating that person, let's get them to someone who can. One of the problems I think with the orthotic market is that an orthotic itself is such a generic term. They are, because an orthotic could describe a TSLO brace or cranial vault. But specifically for foot orthoses, if the provider they're going to doesn't have any training, they just look at it as an orthotic. And that's fine if you're not trying to help someone, if they don't have pain and dysfunction, and that's the majority of what we see. So I would refer it out and get to know, make a relationship with a good practitioner, a chiro, a PT who's trained in this, or especially the real experts, orthotists, podiatrists, and pedorthists. And if I can help in that way, as I get these seminars out there and get my base providers out there, we'll probably provide a list.

Dr. Wedemeyer, thank you so much for this presentation and this discussion today. It's been incredibly informative and we really appreciate you taking the time.

And I really appreciate you doing this. You guys are wonderful.

That's it for today's episode. Be sure to tune in for episode 41, where we kick off a brand new training. Our fabulous and incredibly talented producer and editor of The Factor Podcast, Marissa McCool, will be stepping in front of the mic to teach Podcast 101: How to Leverage Your Expertise to Build Your Practice. In this 2-part training, we will break down the process of getting a podcast started from square one. And walk you through how to develop your ideas, where to go, what to buy, and what to do before you ever think about posting the first episode. You won't want to miss it. Episode 41 drops in 2 weeks. In the near future, we're also planning to bring back a few of our past instructors for Q&A sessions. So be sure to click on the link in our show notes, ask any burning questions you may have. They might be featured on a future episode. You can subscribe to The Factor Podcast on Apple, Spotify, iHeartRadio, or the podcast app that works best for you. Please give us a 5-star rating to help us grow the show. Every little bit helps. And last but certainly not least, be sure to visit the show notes for a link to download the PDF of today's full presentation, as well as learn about any special offers that we featured in today's episode. We'll see you next time. Hey guys, if you like what you heard today, I encourage you to visit our website at factor- That's spelled F-A-K-T-R-store.com to find out more information about all that we have to offer. We have a variety of online offerings as well as our hands-on Factor Rehab System course scheduled in cities around the globe. Be sure to also check out our event calendar and bookmark any of these upcoming live webinar dates coming up in the near future so you can join us live. And of course, the biggest The biggest compliment we can receive is for you to help us spread the word to your friends, colleagues, and classmates. You'll find all the important links as well as info about our sponsors in the show notes, so be sure to check those out.