#93 - Unlocking Elite Performance with Dr. Tom Teter, Part 2

Hi guys, it's time for another episode of The Factor Podcast. I'm your host, Jessica Riddle. Welcome and thank you for listening. I'm recording today from Valencia, Spain. I'm actually in the airport as we speak, meeting up with our guest instructor for today's episode, Dr. Tom Teeter. He and I are on our way to the International Instructor Meeting for Dynamic Tape, a company we've worked with for many years. So stay tuned for some exciting announcements in the coming weeks regarding live course dates we'll be launching throughout Europe. 2025 will be a big year of global expansion for us with Factor and many of our other in-person courses. So I'm super excited to tell you about that coming up shortly. But aside from that, I think it's very fitting that in today's podcast episode, We're going to be wrapping up part 2 of our series with Dr. Teeter entitled Unlocking Elite Performance: Strategies to Transform Your Sports Practice. If you've been a listener for any length of time or have attended any of our live Factor monthly webinars, then you know that anytime Dr. Teeter comes on the show, he delivers a ton of great information and shares a different perspective and approach to treating athletes and active patient populations. In part 1, he went over the 6 stages of rehabilitation from acute management to fundamental capacity. And we talked about the importance of ensuring a patient has what Dr. Teeter refers to as a full performance readiness instead of just stopping care once pain has been resolved. Today, we'll discuss the importance of athlete involvement in their recovery, how to build a multifaceted skillset. And the necessity of having a robust support system. Be sure to bookmark this episode and come back to it more than once. This is one you'll definitely want to take notes on. Let's cue the intro music and dive in.

Once we get them out of motor control, we, we have to start reloading tissue. So we're going to go into functional integration. This is where we go into fundamental patterns of movement. We're going to work on whatever specific type of strength they need, whether that's maximal strength, dynamic strength, submaximal strength, or repetitious strength. And we're going to do that by using the appropriate progressions and regressions. You can see PRE number 24. We're going to use the right progressions and regressions of exercise in resistance training of the upper extremity, trunk and spine, and lower extremity. And then ultimately, we're going to couple that with starting the process of obtaining aerobic endurance. So if we look at functional integration, this is traditionally what we would just call general physical preparation, right? We're getting them out of rehab, but ultimately rehab is the whole process from going from acute management to fundamental capacity. But historically, we're getting them out of rehab and we're starting to get them into loading tissue. Now, once we've started the process of loading patterns and working on general physical preparation, now we're going to start working on rate of force development. How fast can you produce force, and how much power do you have? So this is progressive kinetics, and we're historically going to do things like explosive power, which is a one-time rate of force development. We can do things like recycling power, number 30, which is multiple bouts of power output that's consistent over time. And then we're going to do that through the means of working on either sprinting, jumping, throwing, and/or Olympic lifting, right? Now, I, in my practice, and when I teach this in our course, we don't necessarily teach Olympic lifting. If your sport dictates that you have to do Olympic lifting as part of your recovery or, or for training for performance, then obviously that's something you do in progressive kinetics and rate of force development. But we typically will stick with sprinting, jumping, and throwing because I think it has the most carryover to the individual sport, and it has the shortest learning curve. It takes people about 10,000 hours to get really awesome at Olympic lifting, and I can teach you to sprint in a couple weeks and have you back to doing that relatively fast. So I think that has a bigger carryover to their sport. But nonetheless, in progressive kinetics, we're working on rate of force development and power. And then as we progress to that last stage of care here, on fundamental capacity, we're going to start working on things like reaction time. We're going to work on sport-specific skill and motor skill acquisition, so reteaching them how to do their sport. We're going to work on agility. COD number 38 is change of direction. And finally, the last thing we're going to do is work on work capacity. How, how long can you output force relative to the demands of your specific sport and/or position? So if we look at all of these stages of care, now we've not only taken the stages of care, but we've taken all of the interventions that could be done within those stages of care and plotted them out on this diagram. One of the things I love about this diagram is it really shows you where your blind spots are. Meaning, if you're a traditional chiropractor who's worked in sports chiropractic, and maybe you have a— let's say you do cold laser and dry needling and joint manipulation— well, you now see a bunch of blind spots you have in your treatment process that you either have to go out and learn some new methods and techniques Or you have to find other practitioners that you can work with that can fill those holes for you, because there's going to be a point in time in the work with athletes where they're going to need some of these things that you might not be able to do. So I love looking at it from this perspective, not only because it lays out specifically what we need to do to get them from point A to point B, but ultimately shows us who else we need to work with or what else we might need to learn. And really, when you look at this, the majority of what we would classify as traditional sports chiropractic falls in the acute management and movement categories, meaning if we go back to what we discussed, that they— most sports chiropractors only have the skills to manage about 40% of the recovery process. They are typically missing things like the application of fitness, load management, and/or specific recovery strategies. So at the end of the day, our skill set should focus on the ability to manage the process of rehabilitation in acute management, movement, fitness, load management, and recovery strategies. That's our shift in skill set. And then finally, and last but not least, we have to go about how we express our abilities. So the last thing we're going to change is the way we express what we do. And once we've changed our identity, revised our intent, clarified our focus, improved our skill set, now we need to find the right environment to be able to fully express our abilities and providing care for athletes. Now, in most cases, in my experience, a lot of chiropractors work in solo practices, and this means that they're really expected to do everything in-house to be able to treat the athletes to get them back to activity as quickly as possible. The main problem with this is one person cannot be everything to everyone. If we're going to really focus our efforts towards managing the recovery process, we need to understand that we cannot do everything in rehabilitation ourselves. What I want you to get out of this is I want you to recognize that it is necessary and often required to need other professionals involved in the recovery process to ensure that we are moving through each stage of rehabilitation appropriately and not skipping any steps in the athlete's recovery. We do not need to be the person that's providing care during each stage of rehabilitation. But what I want you to understand is all you have to do is be able to understand the stages of care. The goals of each stage and what specific interventions need to be used during each stage. So you know what you can do within your scope of practice and what other professionals you need to get involved in the process. So in order for us to fully express our abilities, we need to understand the stages of the rehabilitation continuum that we've just discussed. We need to understand what interventions are needed within each stage, and we need to build relationships with professionals that can provide care in areas where we're not trained to do so. So this brings us to really the last part, which is building an integrated support team. In order to best serve our athletes, we need to have a group of people, and these people must have dialogue in order to operate efficiently. Now, it is imperative that we have honest and consistent communications between all people that provide care for the athlete, and each person's role on the team is really dependent on their individual licensure their professional education, and the individual needs of the athlete at any specific time during their recovery process. But most importantly, when you're building an integrated support team, we need to make sure that everyone involved has a seat at the table and everyone knows the expectations of their specific role as a member of the team. So the question becomes, what does that integrated support team look like? Well, ultimately it comes down to these 6 categories, what we have termed We— when you're looking at building a team, you need management, medical, movement, fitness, skill, and sports science or monitoring. These are the things you need or the people you need on your team. As far as management, when you're looking at this idea of integrated support team, management are usually— when you go into an environment, it's usually your general manager for professional sports team, or if you're working in a collegiate environment, these are your athletic directors. And these people are the chief executives. Their job is to create the culture of the organization and oversee operations within the system that we've created. Once you get past management, now we're getting into medical. Now, there's multiple parts to medical. The first part to medical is your athletic trainer. Now, athletic trainers are some of the most underlooked and underutilized people in sports medicine. These are really your triage. This is, this is some of the most important people you're going to find. The athletic trainer's job is triage. They're looking— they're the person that runs on the field. They're going to perform a quick clinical diagnosis. If someone needs emergency services, they're going to send them there immediately. And if they don't, they're going to be the point of contact for referral to other people on the integrated support team. And when time allows, they're also going to be involved in providing therapeutic intervention, whether it's in acute management, foundational kinematics, or during the restoration of motor control and rehabilitation. So your athletic trainer, in my opinion, is like the most important part of building your medical team in a sports environment. Then the next people on the team are your medical doctors. These are people like you have— in some instances, you're always going to have a general practice provider, and their job is to reduce pain and inflammation, typically in the form of giving you medicine to ingest, medication. And then you're usually going to have an orthopedist, and their job is to repair structure when it's broke. They're going to fix it. And a lot of times they will either inject you with medication if necessary and/or incision, which is surgical reconstruction. So again, if it's broke, if it's torn, if it's damaged, these are the people that are going to surgically reconstruct your knee to fix it for you. The other ancillary medical staff that we need in order to achieve optimal sports performance is a nutritionist or a dietitian, because their job is to restore nutrients and enhance recovery. And they're going to provide specific dietary recommendations based on their health status of the athlete and create fueling plans for sport-specific populations. Then ultimately, a psychologist we need for improving mental health and well-being. They're going to assist athletes in prioritizing mental health strategies and teaching skills to improve stress management. So these are all of our medical staff. Now we're going to move on to the movement staff. In movement, you need a manual therapist, And/or a physical therapist. Now, your manual therapist is typically the form of like a chiropractor, and our job is going to be to restore mobility and/or atheric input by using all of the things we can do in acute management or foundational kinematics, usually in the form of joint mobilization and manipulation and/or soft tissue mobilization. And then in a lot of athletic environments, you're also going to see a physical therapist for the restoration of motor control, and they're going to use graded exposure exercise to Improve stability and efferent output. Now, this being said, that doesn't always have to be 2 people. It depends on the environment where if you're a really well-trained chiropractor, you can come in and fill both of the manual therapist and the physical therapist. I hate saying it that way, but you can work on restoring mobility and motor control. But depending on your environment, if you're working with professional sports teams, a lot of time they will separate those things out for the delineation of work. So in the movement staff, you're going to have a manual therapist and a physical therapist. Then we're going to go into fitness, and this is your strength coach. These— their job is to improve capacity for the improvement of physical preparation, and they're going to work on things like mobility, speed and agility, power, muscular strength, muscular endurance, and/or work capacity or conditioning. So this is your fitness staff. Then, as we continue on our integrated support team, if you're working in a high-level athletic environment, you're going to need skill staff. This is your coaching staff, and their job is to help you acquire motor development. Now, they do 2 things. They're going to teach you technical aspects of your sport on how to do your sport and motor skill acquisition, and they're also going to teach you tactical situational awareness, or when to do those things in your sport. So when you're talking about the skills staff, This is the coaching staff for the individual sport. And then ultimately, we're going to tie all of that up in a nice little rainbow and having a sports science staff. And these are people that are responsible for helping us maintain homeostasis, meaning they're going to quantify and monitor stress and load that go into the athletes and help everyone on the team come up with a way to appropriately manage recovery so we can keep everyone healthy and performing well. So when you're talking about building and expressing your abilities, we need to do that within the confines of an integrated support team. And our integrated support team is going to have things like management, medical, movement, fitness, skill, and sports science and monitoring. So again, the expression of our abilities must be within the framework of working within an integrated support team. So all of that being said, The one thing— the things I want you to take away from this conversation is all we're talking about is shifting your mindset. And we do that, and if we want to make sure that we help our athletes reach their peak physical potential and perform optimally in their sport, we need to change our identity to that of really being a human performance practitioner. Our intent must be on helping them acquire the physical qualities necessary to perform the specific tasks of their sport. Our focus must be on managing the process of all of the stages of rehabilitation, all the way from acute management, foundational kinematics, motor control, functional integration, progressive kinetics, and fundamental capacity, getting them from point A in acute management all the way to point B in participation in sport. And our skill set must evolve beyond just the ability of doing traditional chiropractic to having strategies for fitness, load management and recovery. And then finally, in order to do this optimally, you need to be able to express these abilities within an integrated support team. We cannot do everything on our own in our offices, so we need to make sure that as we're managing that process, we have relationships with other providers that we can pull in during the process at specific times. And we know that we have everyone on our team, whether it's people you have relationships outside of your office or people you bring into your office that you hire as employees or contractors to fill these roles so that we're optimally making sure that we're not skipping steps in the process and we're getting people all the way from acute management back to fundamental capacity and competition. One of the biggest challenges— again, we're talking about bridging the gap— is the gap exists typically because in most settings we focus on treatment And we're going to release people from care. If we have that knee patient who's a soccer player, we're releasing them from care after motor control, typically, and we don't go through reloading tissues, working on rate of force development, and letting them be able to produce and absorb forces at the rate they do in their sport. And we don't give them the fundamental capacity to be able to do that for the duration that they need to participate. So if we don't do this, we're really setting our patients up for reinjury and ultimately not letting them optimally perform in their sport.

You can complete your certification in functional nutrition, chiropractic, acupuncture, or clinical human performance with immediate access to get started learning right away. To learn more and get started, click the new certifications link in our show notes or visit online.sports-seminars.com today. Oh, and one more thing. If you have no idea what a CE plan is or why you should have Don't stress, we've got you covered. Simply check out episodes 26 and 27 where Dr. Tom Teeter explains what the rehab continuum is and lays out a plan for developing and expanding a strong clinical skill set through CE courses. Now back to the show.

So that being said, if anybody has any questions, I would be happy to answer those at this time.

Wonderful. Thank you so much, Dr. Teeter. That was a great presentation. And wow, just a ton of really great information, information, and certainly a new way of looking at things. So one of the questions we received was in regards to if you're a new practitioner just starting out and you decide that you want to be a sports provider, where do you recommend they start on that rehab continuum in terms of building their skills? What are some foundational type courses or trainings or skill sets they need to develop first? And then how do you kind of decide what to progress with from there?

That's a really loaded question because there's a thousand ways I can answer it. But I think what you need first and foremost is an assessment model. And I, in the course that we talk about in Rehab to Fitness, there's a multitude of assessment models. And even within different professionals, Dr. Riddle and I have different opinions on which assessment model works better than others in certain situations and scenarios. For me, and I'm only going to speak for myself, I use an assessment model for painful patients. After I've done all my orthopedic and testing and looking for red flags, I will typically do the SFMA and look for painless dysfunction. I want to know why the knee hurts and what's dysfunctional that's causing the knee to hurt. So one of the first things you can do is get a really good assessment model. I don't care which one you use. I have found in my practice that the SFMA works really, really well. Now, that being said, after you have a really good assessment model, you need an assessment model for people who have pain, SFMA. You also need an assessment model or a screening model for people who don't have pain that just want to do activity. And in that instance, I use the FMS. These are not the only ways, and I'm not paid in any way to make these suggestions. These are just things that I've used in my practice. So I guess to answer that question, first, get a really good assessment model, become good at finding out why they have a problem. Next, after that, then obviously you want to start going into the individual categories. So what I would tell you is take that diagram and start— if you're a new, new student coming out of school, After, after you have— it's way back at the beginning— the periodic table is once you come out of school, get an assessment model, and then start plugging away any individual course you can take that fills those buckets. So for instance, there may be a time that you need to use dry needling. Well, find a really good dry needling course and take that. And over time, what you're going to find is you start checking off boxes in each of those categories. So I think you need a good assessment model. Really, we're chiropractors. So what we need to do well is be good at using our hands. So be good at manipulation. There you go right there. Be good at soft tissue mobilization. I would tell you one of the courses I've found, and I'm going to be very careful how I suggest this, that really checks off the most buckets for new grads is the FACTOR course with Dr. Todd Riddle. I think originally when FACTOR was created before Dr. Riddle became one of the co-owners, It was mostly an instrumentation course or instrumentation with movement course, and it has expanded to where a lot of the things— the last time I took it, a lot of the things that he's teaching are teaching you things from acute management. It's teaching you foundational kinematics, and it's teaching you a lot of things in motor control. So where you don't necessarily have some of these experiences, that's a really good course that's going to help you fill a lot of those buckets in those 3 categories. So get into a good assessment model. Start to take some of these individual courses. And then the other thing that I would tell you is if you want to really do this at a high level, you have to understand the application of progressive overload. So find a great course. I know one of the things that's always suggested is taking the CSCS, Certified Strength and Conditioning Specialist. I think that is a really good fundamental course to help you start into the world of strength and conditioning. But what it doesn't always do is teach you when to apply any of these strategies with individual people and how to program those things. It's great at teaching you the fundamentals of strength and conditioning, but you need something else on top of that. So one of the reasons why we created the Rehab to Fitness course is to fill those gaps. So in our course, what we talk about is functional integration, progressive kinetics, and fundamental capacity. So we're going to show you—

Yeah.

All of the exercises we use for the resistance training in the upper extremity, trunk and spine, lower extremity. We're going to go over sprinting technique and exercises. We're going to go over plyometrics and jumping and throwing, and then obviously different elements of motor skill acquisition, work capacity. So whatever you choose, just start to find a really good assessment model, start to get really good at specific interventions. I would recommend taking a factor course. It's a great course. And then obviously on the back end, either take the CSCS and then take— shameless plug— Rehab to Fitness. Another thing that we often get is people talking about the CCSP. I think that is a fantastic course. That being said, I'm going to make this disclaimer. In my experience, I think the CCSP is really good about teaching people— I don't want to call it sideline work, but it's really teaching people how to be good at triage, acute management, and Some of the sideline stuff that we typically would see. What it doesn't teach you is how to progress people through all of these stages of care. And I can use an example— Dr. Todd Riddle, who I know is working with the Olympic gymnastics team. I know when he goes that they have people that are doing all those things, and I know that whatever environment he's in, they have given him a specific role, mostly because he knows what he's doing, but he knows the process. And so there's a roundabout way to answer the question. Get a good assessment model, start to take a course like FACTOR, fill in the blanks of where you don't— where you have deficiencies on the chart, and then take something like the CSCS, Rehab to Fitness, Certified Functional Screen Coach, and then start to progress into more things like the CCSP. That's my long-winded answer.

That was a great answer. Thank you. Very thorough. We had another question come in that Someone was asking if you have any specific outcome assessment questionnaires or milestones that you prefer to use for those patients that are pain versus those that are more performance patients.

So that's a sticky question. There are a lot of outcome measures that I think are extremely effective. I never use them a lot because what I would typically do is we have a set of standards that we use for exit criteria For each of these stages of care. This is one of the things you talk about in your course. So for instance, with acute management, we have a series of exit criteria or tests that we would do. We have exit criteria for foundational kinematics, motor control. So I know Dr. Riddle, when he talks and teaches his FACTOR course, he talks about specific outcome measures and questionnaires that people use. I didn't use those a lot because I just used the very specific exit criteria we have for each stage of care. And then I coupled those with a lot of the best practices we're seeing out there. So, for instance, like, what's the best practice for exit criteria for an ACL injury? And we kind of built those into our own exit criteria for each of these stages. And that's what I typically use with athletic populations is the stuff that we've built in based on best practices and historically what we've known that's worked over the time that we've been doing this over almost 20 years. So, to your point, there are a lot of really great outcome measures. I didn't use those a lot because we built a lot of those things into our own model.

Okay. Thank you. One of the things that you really emphasized here was trying to find great ways to work with other members of the team that manages an athlete or in a sports arena. You do, you have, as you mentioned, kind of the executive management level, you have your coaches, you have other healthcare providers. Do you have any tips or advice for If you are the newest team member in that team that's managing that athlete, how do you typically initiate those conversations to co-manage care of those athletes? What have you found works really well in terms of communicating as they progress through care with you?

So those are 2 different questions. So let's start with the first one. Honest and open communication is the best thing you can do. So what I've typically done is I used to teach at an undergrad university, and I got asked to come in and help with sports medicine, sports performance stuff. So the very first thing I did is I went in and had a discussion with the athletic director. It's like, what are your expectations of me being part of this team? So I knew right off the bat what the parameters of what he was gonna let me do and not do, because he's the one that makes the decisions. And if you get him at the top to buy onto what you're selling, It's going to be smooth sailing. Now, that being said, it doesn't mean it's always easy. So I would always go to the athletic director, just have real casual conversations. I'm really happy to, to be able to work with your team. What do you expect from me, and how can I best help you? Then what I would do is I always would go to the athletic training staff because they're the ones that are really the pulse. And I'm specifically talking about a collegiate environment in this instance, but they're the ones that are the pulse of sports medicine team. And most, depending on what level you're working at, they may be all they have. So what I always do with that conversation is I say, can you tell me what you guys currently do and what you currently have, and tell me how I can help you fill in the gap? So for instance, when I was working at this university, they had an athletic training— they had management, they had medical, but their medical was in-house athletic training. And they had some referral with orthopedists in case someone needed for specific injuries. But with athletic training, they were treating 400 athletes with 2 athletic trainers and only 1 full-time person. So I was like, what holes do you have? Well, they didn't have movement. They didn't have foundational kinematics or motor control. And then they had no strength and conditioning staff. So what I did was I go, look, if you'll let me, I would like to fill this role for you, meaning you have acute management. I can do the financial kinematics and motor control with movement, and then we can transition into strength and conditioning if necessary. And if you frame it in that way, the way— what I would suggest is saying, what do you currently do? And what holes can I help you fill? Because then it's not seen as threatening to them, like you're trying to come in and make me look bad. which I've had happen in some environments, or you're trying to take my job. It's, look, what you're doing is working. But obviously if we go back to those 6 buckets of an integrated support team, like all you have is management and medical. They had skills coaches. So they had management, medical, and skill. Well, they had deficiencies in movement, fitness, and sports science. So I go, well, which of those would you like me to fill? And because I had blessing from the athletic director by just asking the question, Thank— I'm thankful to be able to work with your teams. What are your expectations of me? How can I help you? If you frame it in that way, it's a lot easier. And then from there, when you're talking about communication and collaboration, just have really candid conversations. We would get in instances where, again, we had a knee patient where this female soccer player had knee pain. They would do their triage and say, look, this person does not have An orthopedic injury, we, we're going to send them to you as the movement professional, and we want you to determine why their knee is painful. And then you can report back to us what your findings are, and then the 2 of us can have a conversation about who's best meant to treat it, whether that's them doing some of the things in acute management that we think that might work, and me doing some of the things in movement or motor control, or us doing those at the same time. So it wasn't uncommon where I would be in the athletic training room on certain days They would come in and maybe they're doing cold laser on the person's patellar tendon, send them directly over to me. I might manipulate their ankle, do some instrumentation on their quadricep, and then start doing some motor control exercises. So if you use the system of the stages of care and have open communications of all the people on the integrated support team, it's not that hard. The last piece of advice I would give you, and I know Dr. Riddle would agree with me when I say this, is you've got to put ego aside. It is not about you. Don't go in trying to show off all of these things that you know and do, because that's going to be intimidating. It's going to piss people off. I take the opposite approach. I will even go into situations and say, I see you do this thing. Can you explain to me why you do that and maybe teach me what you're doing? Because then it becomes less threatening. So just have open, honest communication and dialogue. And I think that goes a really long way.

I love what you were saying there about starting out proactively by saying, what gaps do you have? What holes can I fill? There are so many different overlapping scopes of practice when it comes to that sports medicine team. So I agree with you. And we've heard that several times, like know your lane, but then you have to identify what that is based upon the needs they have.

Even think about this example we're talking about within my, the college I worked at with athletic training. They had 400 athletes for 2 people. They didn't have time to do thorough biomechanical assessments or real manual therapy and rehab. Like, they were just putting out fires, doing triage and putting out fires. So if you can go in and say, hey, you guys are doing great at that, how can I help? What can I do to help you? They're like, well, we don't have anybody that can do movement kinematics and motor control. Cool, that's where I live. And then all you have to do within that team is just fall in those categories and do a really good job and just be honest and communicate. So that's the best advice I can give working in an integrated sport team is just be honest and communicate really well.

If you were a student that was looking to get some exposure to working with sports teams, some experience in working in this arena, What advice would you have for them in terms of should they seek out a mentor? Should they work with the club at their school to try to make some relationships with area teams? Like, what is the best way for them to kind of get their feet wet, so to speak, and start experiencing these type of environments?

So the first thing, yes, I would say absolutely get a mentor. Find, find someone that you, you like what they do. You like their style of practice. You like them as a person. I had a great mentor early in my practice who just so happened to be, oddly enough, my wife's chiropractor when we met. And he was an open book. And typically see in chiropractic in general that we typically eat our young. Like it's a contest because I need to do more than you, or I have to know more than you. This guy brought me in and I asked him a thousand trillion questions and he was kind enough to answer everything I wanted to know. And he actually helped teach me a lot of the things that I currently do. So find a good mentor. Outside of that, the best thing I can tell you to do is start offering your services for free. Now, as a student, there's very little you can do, but what you could do, and depending on what situation you're in, is go to a college and say, hey, I'm a student at this chiropractic school and I would like to come in and volunteer my services in the athletic training room so I can see how this works in real time. Now, there might not be a lot you can do right off the bat, but you can help with some triage stuff. You can help with some taping. Like, there's other things that you can probably do that they will allow you to do within the scope because you don't have a license yet. But just volunteer your time. I know what I did is I started working right out of school. I started volunteering my time at a local college, and then also I found a sports club, a soccer club, that I went and started volunteering my time with. And what ended up happening is not only did I get a lot of practical experience learning, But when I was able to graduate and, and actually see patients, a lot of those people, because they were familiar with my face, would come see me in my clinic. So you're gonna have to get out and meet people and volunteer some time. But I think a really easy way to do that, go to really small colleges in your town, even go to high schools. One situation I did for 2 years, my first 2 years in practice, I volunteered one day a week at a local high school that was like half a mile from where my office was. And I would just go in and do really simple things for them, taping, pick up the slack here and there. But a huge chunk of— I got to see how that operated in real time with different types of sports. And then ultimately that led to a lot of other positive experience of being able to treat some of those people when I actually got my license. So find a really good mentor and then go seek out opportunities to volunteer your time, or even go find chiropractic offices in your city that are doing some of this stuff. It's hard to find everyone that's doing all of it, but go find someone that's doing some of it and just say, I would like to come and watch. I'll tell you, when I was in school, I spent a good 9 months before I graduated twice a week for a couple hours at a time. I would go into my mentor's office and just watch him practice and ask questions and try to figure out what I was doing. That goes a long way and it goes more than you think. So find a good mentor and find opportunities where you can volunteer your time to learn.

I love that. Absolutely. One of the other elements that you had mentioned when it comes to, you don't quite have every skillset yet, or every certification or every treatment modality that you have here on the rehab continuum, is that you could seek out other providers who may offer things that you don't. How do you select area providers? You mentioned, for example, having a mental healthcare professional as part of the team, which I think is a great recommendation. Knowing what we know about mental health and its effects on performance and even things like pain and physical pain. What do you recommend in terms of how you select those area providers that you would want to form those referral relationships with? What criteria did you use, you know, in practice for that?

So some of it was my own personal experience with having providers, but then like one of the things I could suggest is When I started having patients come in on my intake forms, I asked them, like, what medical providers are you seeing? And just tell me their names. And if I started seeing multiple— the same name over and over and over again with multiple patients, I'm like, okay, if a lot of people are seeing this person, I probably need to know who they are. Then I would look them up. I want to know about their practice. And then finally, what I would do to help bridge that gap is I would send them an email or I would call their receptionist and be like, hey, I have a patient that I'm treating that also sees Dr. So-and-so. Would it be possible for me to go over and find a hole in his schedule where I can just come over and introduce myself, tell him a little bit about what I do, and ask him if I can refer patients to him when I have these people come into my office? So it wasn't so much going to ask them to refer to you. It's like, hey, I have these people that come in. Like, one of the great examples is I formed a really close relationship with the best hip surgeon in Kansas City. And I had all of these people that were coming in with, I used to treat a bunch of triathletes and runners, and a bunch of them had massive labral tears that absolutely needed surgery. Not everyone needs surgery, these people did. And so they would all go see Dr. Carlisle. And eventually when I saw enough people, I was like, hey, can I just come over and introduce myself? I have a lot of people that you've done surgery on that come to me for rehab and whatnot. And every time I get a hip patient that I think needs surgery, is it okay if I just send them over to you and we can just communicate on what's— what do we think is the best course of action? And from that, not only when I would call his receptionist, at one point it got to the point where I would just call his receptionist and they wouldn't have to go through the waiting process of getting an appointment. They would just put them on the schedule. And then whenever they would see that patient, his receptionist would call me and tell me kind of what the general diagnosis was and kind of how we could formulate a plan. So. Find it— the easy thing to do is put it on your forms when they come in the office, ask them who they see right now. And then also just word of mouth in the community. The other thing I will tell you, and I think this is something we get away from and shouldn't, one of the best relationships, or a couple of the best relationships I had, were with other chiropractors. I had a good friend of mine who— and I am not formally trained in McKenzie, I have some knowledge of it and I do some stuff that I think is effective. But I've never been able to yet get to a McKenzie course. And I had people that I thought would really benefit from that particular technique. So when I had those people come in, I had a good enough relationship with my patient and a good enough relationship with this other chiropractor who became a friend of mine. I was like, hey, I'm going to send you over to Dr. Tom. He's going to perform this stuff that he does, and then he's going to send you back to me if necessary. And if not, you can continue Doing McKenzie with him over there. But if you need something else, obviously feel free to reach out. And they always came back to me. So it was a, it was a referral and vice versa. I did a lot of rehab stuff that he didn't do in his office. So when he had someone that came into his office, it's like, hey, you really don't need the stuff that I do. I'm gonna send you over to Dr. Tom. He's gonna do this rehab. And the one thing I will tell you is you have to be very honest with these people and don't try to poach their patients. I would just fill the role. Like, he sent me— sent you to me for knee rehab. I'm going to do that, and then I'm going to send you back to him for whatever else you need. And that works because we can't do everything. I had another colleague who was an athletic trainer who does dry needling. He's great at dry needling. I don't do dry needling right now. It's one of the holes in my treatment plan. So whenever I would have someone that needed dry needling, I would refer to him. And he would do dry needling on them and send them back. So just because we have other providers that are in musculoskeletal care, it doesn't mean we can't also refer to them, because that's helping fill these holes. For me, all I care about is you get back to point B as fast as possible, and you win. The only way I can get you to win is if you need dry needling and I can't do it for you. I better find someone who can, or you're going to go seek that out on your own. I'd rather refer you to my colleague who's gonna treat that problem for you just in that bucket of care and let me do everything else. And that is the true essence of co-management. So go out and find these relationships, either whether it's through people that are consistently your patients are seeing, or people who have a good reputation in your community. And if your community is small enough, you know what other people are doing, and you'll be able to form those relationships relatively quickly.

I love that. And I think that's a great way to end our live webinar today. Thank you so much, Dr. Teeter. This was phenomenal.

That's it for today's episode, and it's actually also time for me and Dr. Teeter to continue our journey. Be sure to tune in in our next episode for an update on our time in Spain and in Greece, and to join us as we begin a brand new 2-part series with Dr. Rob Silverman. On protocols for longevity, optimizing healthspan and human performance. You won't want to miss it. Be sure to visit the show notes to download our comprehensive guide to athlete care and performance, and learn more about Dr. Teter's new clinical human performance practitioner certification program. We'll see you next time. Ciao for now from Spain.

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