IndeFree Miami 2009

7/30/2019 IndeFree Miami 2009

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IndeFree MiamiOctober 17-18, 2009

Automation: reproduciblequality, care, and profit where

you are never putting out fires.

Goals need to be clearly definedGoals are dreams with a

deadline

Courtesy referral is anotherchannel of revenue

Response is the key to theirattitude (what theyre feeling)

Not dependent on one referralsource


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Decrease level of dependency =decrease size of doormat

Get staff to do what you aredoing

PUTTING OUT FIRES?

Fireman = owner putting outfires

Fire = do now or get burnedDont hire employees who create

fires

Anyone can open up a privatepractice, but it doesnt mean

that it will be independent and

free

AUTOMATING PRIVATE PRACTICE


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Automated private practice iswhere the business run without

you having to make it happen

Automate and duplicate1st step is focus on $300/hr tasksFocus on automating practiceTreat 20 hours a week or lessDo storms come?Turn foundation into rockIf you left for a month your

practice would collapse

The goal is to only be working 2hours a month


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Then you know if you really wantto treat

Until youre automated, youdont really know if you want to

treat

You dont know whats fun untilyou dont have to do it

EVIDENCE OF AUTOMATION

AutomaticWithout effortHigh quality

High revenue

People who need you haveaccess to you


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Ability to offer affordableservices will determine how

much humanitarian work you

can do

Different fee schedule than clinicDo the right things, people will

bring in family

Separate fee schedule for JamesIf you want to see James this is

how much its going to cost

To see our staff therapist this ishow much its going to cost

Which would you prefer?


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Non-automated practicesplateau by year 5 and then goes

down

No toolSimple task becomes impossible

AUTOMATING PHYSICAL

ENVIRONMENT

Automating proceduresAutomating teamsTeam buildersAutomating selfNew You = New Principles

SUBCONSCIOUS SELF-SABOTAGE


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SSS = easy, redundant, we dothem, things, because were

trying subconsciously to fail

We want to pay for pastmistakes.

Until you let go, you pay for yoursuffering

Today, not judged by past, butby ability to trust another human

being

Allow for mistakesExpect them to make mistakesLet it goBecome a new you that

embraces new principles


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Daily basis

Make decisions at $300/hr level

Rule as CEOLive at $300 levelMost business owners live at $40

or $15/hr level

Apply it!TEAM TRAINING

Team trainings from 12 to 2 pmevery other wed

Talk for 15 minutesSTAFF TRAINING


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Training staff should beautomated too

Use training videos4 week reviews = review

everything

A year is too long to know ifsomeone is good for their

position

Reviews happen automaticallyNo one has perspective you doKeeps admiration and respect for

you

TOOLS FOR AUTOMATION

Employee punch clock


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FINDITAT:http://www.vertitatasksoftware.

com

Steady stream of businessWEBSITE

Everyone must have a websiteBusiness must have internet

presence

Need internet hub where staffcan click in

TEAM HUB

Important for automationDAILY PRODUCTIVITY SHEET
http://www.vertitatasksoftware.com/http://www.vertitatasksoftware.com/http://www.vertitatasksoftware.com/http://www.vertitatasksoftware.com/


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How often should you know howmuch profit you made?

Every dayLet administrative assistant or

receptionist do it

Have them email productivitysheet to you

Hate storage units with patientcharts

We scan our stuffPPO&HIGH DEDUCTIBLE

What do you say?

Point of contact


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Biometric employee punch clock

Punch in with thumb

DOING THEWRONG THING

Most people do the wrong thingbecause its easy to do it

Most of us will do the wrongthing if given an easy

opportunity

Dont make business that makesit easy to do the wrong thing

THE INSTANTThey DoSomething Wrong Against You,

They Sabotage You In Other

Ways

P.O.SSYSTEM


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Get rid of hand written receipts

Get rid of cash box

Stop spending money on copymachines and toners

NCRFORMS

Sublease for first yearHow do you get those out there?Success is in the follow upNo one sleeps with you on the

first date

Train marketing assistant thisway


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Use metaphors that help peopleremember

$12/hr task = ordering US gelSits in your mind and clutter itGenius knows what not to

remember

Have enough space for theunimportant things

Successful practice knows whatnot to do

Petty bank account with an ATMcard

So you dont have to do itLet the employees do it


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The way your paperwork looksleaves an impression

Entire company system onlinefor employee access

WEBSITE CRITIQUE

Whats the biggest thing on thispage?

No one care about your logo(ego)

Until they get to know youLeft hand list

Its all me, me, me

Things below the fold dontmatter


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If you dont get them up thereyou lose them

Whats here for me?What words are here for me?Phone # on every pageYou want them to call youLogo needs to be modest or

small

Video testimonialsCommon causes of painCouponsBe wary of


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Self help

Adding foot massage = thatssmart

Do the right things = you willsucceed

MONEYMAKINGATTITUDE

Volume = human resourceThink of growing before

shrinking

How do I make more vs how do Imake less

Economys down, I need to cut,cut, cut

70% close


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How do I make more money?

Run promos on Fridays

This paper productivity sheet iseasier

What did I do to allow this tohappen?

I failed to have this systemCant delete or void mailHANDLING CASH DEPOSITS

I like to hold cashAll deposits come to me via mailSending cash in priority mail

envelope


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Dont want money sitting aroundfor a week

I dont like to deposit cashNO-SHOWS

Identify those days you dontmake money

Cant make decisions if you dontknow

No shows = 3%No shows is an indicator of how

well your staff is doing in

maintaining customer

satisfaction and loyalty

% no shows = employeeperformance


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How well staff is creatingperceived value

No one should know how muchemployees make

Outside book keeper doespayroll

If I see 3% no shows in sameweek

I work my staff to pick it upHow do you prevent no shows?Now shows cost a lot of money

Its what you staff does in theirinteraction that decreases no

shows


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Maintain same eye level

What you think is not

If patient sits, you sit etc.#1 thing patient hates?WaitingIf you dont track it, staff will be

taking patients back late

3/100 taken back late>10 min late = wait for next apptIf they dont have to wait it helps

to increase perceived value

Dont want book keeper to knowmy staff


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Pay him $20/hr for 2 hours aweek

Quick books is of the devilGive all receipts to accountantPUNISHING EMPLOYEES

Employee discipline formCritical to automationPunishing employees is

important

More important than rewardingMost employers dont know howto punishPoor attitude gets written up


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Poor attitude is cause fordismissal

My employee files is right nextto my desk

Only owner has access toemployee files

WarningMonetary penalty$5, $20, $100, up to a weeks

pay

Dock in pay until they earn itback

SuspensionTermination


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Hostile response to beingapproached

Get off my back!Are you sure you want me to get

involved?

We have an open door policy iffired

Are there any questions?Were only going to talk about

this once

It was like a cloud was lifted

It was almost like you removed apiece of cancer

What James says, he does


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Stabilizing effect when youpunish

If theres any grounds for firingGiving you a chance to correct

something

And they respond with Get offmy back

Indifference leads to love dyingGet off my back = biggest

offense

Confrontation = opportunity tomake things right

Judge by their response, not themistake itself


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Might get what you ask for

Any employee can write upanybody

If youre not going to own up toit, Im going to get James

involved

Staff works it out amongst themselves

Staff does hiring and firingYou have to set that exampleEveryone is an authority of their

position

Physical Therapist cant go up tothe receptionist and tell her

what to schedule


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Receptionist is the authority ofscheduling

Everyone is an authority in theirrole

Technician can wrist up atherapist when therapist doesnt

have documentation completedon time

Trend of violation leads to apattern of behavior

Never write up for just one thingNo shows are high in one day, I

ignore it

Cant jump to conclusionsGive them benefit of doubt


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COMPLAINING VS.

COMMUNICATING

Do not complain in publicWhat a complaint isA complaint is Im tired, or

Im hungry

Can I go lay down?Thats communicationComplaining is grounds for

termination

Her teammate confronted herShe said, Leave me the hell

alone


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BIOMETRIC EMPLOYEE PUNCH

CLOCK

You only pay 8am to 5pmThey have to sign for itNever shows if they punched in

early

But it shows if they punched inlate

Allow receptionist to be up to 45min past close

SCHEDULING PROFILES

40 mins face to face =comprehensive (1/hr)20 min = intermediate (2/hr)


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5-10 min = limited (3/hr)

Hi and bye = brief (4/hr)

P.O.S.CASH REGISTER SYSTEM

Go to nurol.comGet cash register and roll paperCRE cash register express

software

Touch screen monitorRECEPTIONISTOut And About

Talking To Patients About

Everything

$500 touch screen monitor


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Have a system that managesmoney well

When you have the right toolsits easy to go to the moon

NCRFORMS

New Client RegistrationKEYTO LOYALTY

Will they break the rules? Yes.Gives you an opportunity to

exercise forgiveness &

compassion

Key to loyaltyHow do you know your spouse is

loyal?


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List of things that are given

Never give loyalty until itsearned

I will sacrifice my needs for youI will die for youHard to cheat on someone who

has shown you forgiveness? Yes.

Have to outline the wrong in therules

Theres nothing you cant forgiveat least once

Have no right to expect ordemand loyalty if you havent

shown forgiveness


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PHYSICAL ENVIRONMENT

Front deskPhone systemsFax systemsGo to

http://www.phonepeople.com

ACTIVATION SPECIALIST ROLE

Activate and ConvertIt cant be the receptionistHandling the people already in

the system

8 min on phone
http://www.phonepeople.com/http://www.phonepeople.com/


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New people need time

Only reason they put up withyou is

Because the MD referred themto you

First impression is the mostlasting

Front desk phone for returningpatients

How does somebodys poorattitude reflect on you?

You never told them its badTo them, all they know is poor

attitude


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Assume responsibility

Never make assumptions

Like youre talking to a 6th graderCLINICALAREA/GYMS

Have 15 bins for per 1000 sq. ft.Will save you millionsFollow the path of that patient

until they walk out

Make the path very nice, warm,and unobstructed

Dont have ice when they firstcome inWalk right into the gym


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Make it feel like a factoryassembly line

Place bins next to each stationChart goes in the binCHARTING COUNTER

Spot where you can see the mostFind the geographic center in the

clinic

Patient needs to see that you arethere

Patient loves interactingPhysical Therapist has to be

standing


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Computer Solutions

To be completed bins

How automated are you going toget?

If you dont have the right toolsYou cant pound a nail into the

wall

Wait 2 weeks = oh they must begood

Create good energy in yourfacility

1,000 sq. Ft. = $40,000collections/month

COMPUTERS


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For every physical therapist

Unless net work

3 computers minimum orlaptops

1 physical therapist = 4computers

Front desk computerPrivate room computerGym computerShould not buy a server and get

an IT guy

Servers can get stolen, broken,etc.


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Servers are vulnerable

1 tera byte hard that is net workcapable for backup

PAYMENT PLAN POSTER

Sends a good messageOwing money puts a dark cloud

over someones head

WEBSITE DESIGN

Gentle Compassionate CaringDoesnt that sound nice?SolutionsDont like structured


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Like gently guided

Whats special about your Pilatesprogram?

Put info into one wordPrecision & Pilates dont go

together for common lay person

Gentle yet effective pain reliefDont like the flashingGetting the info you need to get

across

No where do you see me, me,me

Everything is about you


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Things you can use

Make it more about them firstthen they will want to know

about you

Secondary pageDont need to scrollNot drawing out too much

emotions

Need to draw out moreNeed more connectionStrength/flexibility programPicture of someone that looks

really happy


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No one will buy until they canget a discount

Nice pictures in bioIncreases perceived value for

patient

Photoshop your pictureMake you look gorgeousI want you in top 5 on GoogleHow do I get to your website?Already Im leaving you and

going to someone else

Have a picture of someonehaving a great time


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http://www.absoluteptf.com

Im not sure Im crazy about thename

Its creating some confusionWhat a name shouldnt doDoesnt cause confusionDoesnt conjure up wrong

associations

Absolute Physical TherapyTaglinePain Free Solutions And FitnessMake some changes in your

identity
http://www.absoluteptf.com/http://www.absoluteptf.com/


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Why absolute?

Where did that come from?

In todays business dont need toalphabetize

All of you should have a tag linePersonalized Pilates ProgramIndeFree Physical Therapy & Pain

Center

Add pain center at end of namePeople will come in off the streetDo you sound like what theyneed?


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Tag line: empoweringindependence and freedom

Would it screw up a lay person?Wheres your fitness?Names says fitnessWe know?No one needs or wants physical

therapy

They need and want solutionsThey want pain reliefWe know youre in painWe know what its preventing


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We know your suffering

We care

We know you tired of drugsTheres nobody smiling in the

pics

Subliminal messageThey feel smiling is not

associated with you

CHOICEIs A Very EmotionalThing

Let them know what it is thatthey want

Flashes 3 things but they canclick it


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PAIN, Is It Preventing You FromEnjoying Life?(6 Words)

Connect with themThis, I dont connect withWhere does it hurt?Click on bodyDecrease size of body pictureBiography: what you like about

job

They need to feel a connectionwith you

Automate MarketingCant define who you are


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What youre offering

Self actualizing process

Whos really good for what youoffer?

Very introspective processMARKETINGIs About Caring

About Who You Are And Caring

About Who They Are And What

They Need

Pregnancy ProgramPost Natal Program

R & D: survey your area

Fingers on the pulse of yourcommunity


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10-15 mins to do quick survey

MDs love talking about whatthey know

Now they are doing somethingthey enjoy

Let the MD talkLets start a total knee classYou become more the expert$12/hr task, pay someone to do

it

How many live in your area?How many females?Top Industry


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Demographics

Help you better understandwhere you live & what the needs

of the community are

AdvertisementsSending messagesPromotionsFun, exciting way to get message

out

1 hr Free ClinicHow many $5,000 programs do

you want to sell a month?

Why dont you have one?


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You dont get $5,000 becausedont have one

With high deductible they canopt to take this $1,000 program

Sounds better than this programover here

Use 52 modifiers to lower theprice of any codes

Super bills dont workUse fee flipsSave you on an audit

They cant try to take moneyback

Trei and Rachel from Florida


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Can have a $10,000 program

There are people who will pay

If you write out the value ofwhat you do, they will pay you

Train a marketing assistantGive them the tools to introduce

you to the community

Public relationsWhos going to meet and greet?Put a face to the name$15-20/hr jobThey have to be likable


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Speak with good articulation

You have to enjoy talking tothem

Are they an appropriateextension of you?

UNLAWFUL POSTERS

Nice gift to send to MDsIts something they need and

want

Helps collect co-paysFront desk is a physical

environment

Phone system


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Fax system

Activation Automation

Know what to say to get thatHMO as a patient

Tap into the 97% of thecommunity that needs what you

have to offer

Use a training video to walkthem through

Never hear them say WelcomeTo

HOW TO RESPOND TO FAQS

Tried to better understandwhats wrong with me so he can

give a focused answer


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Try to understand their needs

People dont like a manly mananswering the phone

Good gay guy can conveywarmth and compassion

Use people and tools toaccomplish goals

Some of you should paysomeone to meet MDs

Ego to ego is not goodACTIVATION

Everyone needs to hear $40

$10 tx, $90 tx


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HEARDThe Possibility Of $40

Got them in the door

8 visits, $40/tx for financialhardship

Im going to activate the patientWhats wrong?What do they hear?See?Think?BASED OFFWhat You Told MeWhats the .Not now too available


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SOUNDSDesperate Subliminally

Medium, little, or a lot (Pain)

Where can I call you in the next30 min?

Call them backWe have an opening in 30 min

due to a cancellation

Go straight into Whats WrongWith You?

You sound like a great candidatefor this program

Based off the complexity of yourcondition


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Always ask: Do You Want ToSchedule?

ACTIVATEThat PersonThis is how good you can getReceptionists position is crucialMore important than physical

therapist for developing loyalty

#1 reason why they bring infamily & friends

New receptionistAUTOMATEBy Training

Somebody To Do Their TaskWith The Right Training And

Tools


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Check whose birthday is comingup

Birthday cards mean a lot topeople

Simply do it for theconsideration

Someones got to manage andupdate

Have a marketing assistant to dothose things

HOW TO REACTIVATE

End of year promotionsBenefits about to renewRemind them


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Send a letter in September

Send via post card

Dont combine with newsletterSomething they can stick on the

fridge

How much money did you makewith that brochure?

Good tools pay offAutomate supplyBANKACCOUNTS

3 bank accountsMain account


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PURCHASE ORDER SYSTEM

Local newspaper for older bookkeepershttp://www.paycycle.comDo from homeBilling liaisonIn vs. outsource make more

money

Hands are in the billing too muchFor the time & money, its not

worth it

You shouldnt be looking at billto make sure its accurate
http://www.paycycle.com/http://www.paycycle.com/


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Losing money for the time spent

Put a $5,000 program together &sell that

Focus on selling expensiveprograms

Tapping into the communityMaximize reimbursementWho was sent a collection

letter?

Who was sent to collections?Get those appeal letters sentEOB Explanation of Benefits


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Responded too, need 2nd levelappeal file bin

Pending file binNeed letter file binsCondition of being a member,

have to help other members

http://www.paytrust.comUse for personal & businessOnly $12.95/moUse for paying billsAnything you dont like to do,pay someone else to do itWhy be unhappy?
http://www.paytrust.com/http://www.paytrust.com/


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Things I cant pay for

Encouragement, sex, upliftingme

Focus on things you like to doSimpler is much nicerBuying solutions that are betterPaytrust.comdont know your

bank account

Automation is not commonsense

Do it one at a timeDO THINGSThat Stand OutAppealing right away to get paid


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Learn more, implement more

Self, tools, physical environment,procedures, team

TeamSee the next stepGet to next levelDont need to see the whole

picture

Job description (standard &officers)

Orientation criticaldevelopment step

Check off each statement


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I will represent my team well bynever complaining in front of

them or others

Stand the test of audits thesedescriptions

Make enough money they willaudit you

RecruitingDont know howCan waste money and timeAdd a phone call

Group interview face to face

Group interview is the mostimportant step


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This ad produced the bestcandidates

This produced good pools ofreceptionist

I had one receptionist who mademistakes, but was so lovable no

one cared

Put this on Craigs list for non-licensed staff

Youll get a good number 20-200Do a phone screenGroup interview give an option

of 2 dates and times to attend

Do about 10 people


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See who responds and how

LOOKING for Who Do YouLike?

Who do I seem to like here?Different mind-set when they

work for you

FIRSTImpressions AreEverything

Nothing will cost you more thanhaving the wrong person in a

position

Try to narrow down to 2-3 whoyou really like

Its a heart and mind decision


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Ask, I want to give opportunityto give feedback in this group

setting

This is what I liked about youThis is what I didnt likeIt sets the toneThey leave with a totally

different impression

If you dont get picked, call us inthe future

For physical therapist advertiseon monster.com

Costs $400


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Recruitment post cards andbrochure

Advance PT for therapists andassistants

1-2 years of solid performance =% of shares

Anyone who would like to talk inprivate?

Its very respectful to allow themto do that

Never hire on the spotOne on one interviewStaff gets to ask them questionsWhat did you like or not like


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First impression lasts forever

Your business becomes a vehiclefor producing great people

Hiring who they work withSends a powerful messageThis is my teamHire via email or letterCongratulations.Thats how you bring a person onDo they want to bring this

person on?

Whats the opposite of love?


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Indifference

You care enough to notice

What you didnt likeI dont like working with people

who dont have an opinion

Everyone has to give an opinionReview orientation checklistEach section done by different

staff members

CompensationLittle things go along waysTeam building


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OFFICE ROLES

Officer role positionHuman resource officerLiaison to youLogs and records absencesYou managing employee

scheduling is non-productive;

just busy work

Approves or denies time offHuman Resource Officer is a

technician

Someone has to be assigned tohold people accountable


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No queen bee mentality;everyone is an authority

Facility Improvements OfficerThese office roles are a privilegeDo you care about your

organization?

What is the company?The people in itThey may be asked to perform

some officer roles

Physical Therapist is the PatientCare and Loyalty Officer

Makes sure that ultrasound gelgets stocked and ordered


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Lost respect for the pesky owner

When they do it amongstthemselves it runs like popcorn

If you dont delegate officerroles then you have to do the

work

4 months are peer &competency review

Create rewards & bonuses basedon their ratios

Start peer reviews tomorrowReview OfficerWhat people are saying about

you


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Peer review is powerful

Owner review is so negative

They dont have the right toreview the owner

Always have an open door policyBut youre not part of this review

process

Patient chart reviewA patient shouldnt sit in room

for >20 mins

Physical Therapists should makethemselves available

Physical Therapists need tomanage patients and techs


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This helps produce a team thatsvery together and competent

300 pt/wk = 1.5 therapist + 1assistant + 2 techs

Limited & brief & intermediatepatients = 90%

CVAs, Bells palsy = 40 mins faceto face

Patient limited tasks defined byyou

Medicare wont define it for youTime based bill lawWhat I would imagine.Its got no legs to stand on


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Be able to justify why you do itthat way

Medicare auditors are trained tocome back with money

Really define what patientrelated tasks is

Its not a science, not an artLaurie Feinberg wrote the lawThat sounds logical to meTheres no law that specific on it>2 or 3 bill as group for MedicareOnly bill MT and TE and gaitCollect cash for laser tx


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No modalities: no ES, US, HP, ICE

Standard joint mob or STM

Im still going to bill a unitIf it takes me 5 mins to do a joint

mob and reduce their pain,

should I get paid less than a new

grad who take more time but

with less results?

Document I did Manual Therapyand their pain went from an 8/10to 3/10

I cant get paid even though Imbetter and faster because of a

therapist who cant do better

WORDS OFWISDOM


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First 30 min. of every Mondaymorning

10 min words of wisdomWhats that mean to you?Need to look at your

opportunities differently

Apply new principlesHow can we apply that this

week?

Need to let go of these things:billing, book keeping, ordering

What went good, how toincrease that


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What went bad, how to decreasethat?

Last 10 mins generalannouncements

Every other Wednesday12 to 2 pmReview codesReview things & train, train, train2nd Monday of each monthReview stats of last monthOnly number from me is payrollA healthy organization is made

up of healthy group of people


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Wont assign officer roles until3

rdtime at class

In 24 hours how many hours wasspent on training?

To be the best, have to allow fortraining

Create stability & consistency forTuesdays and Thursdays

In the beginning open Monday,Wednesday, and Friday

Market on Tuesday and ThursdayBreak it up so were busy on

Tuesday and Thursday

NO-SHOWS


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NO SHOWSAre The PoorestReflection On Your Staff

No shows are very disrespectfulTEAM (CRITICAL POSITIONS)

Personal AssistantAdministrative AssistantMarketing AssistantCritical for your successMail, book keeping, dry cleaning,

oil change

So you can focus on $300/hr jobsPosting EOB payments


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If you dont schedule time foradvertising, marketing,

promotions, it will not get done

Physical therapist treats 20hours or less until reach = 50/wk

Hire assistant or therapist @>50/wk

@100/wk hire a therapist fulltime

Do activation for first 3 weeksThen train assistant how to do itKnowing what not to remember(definition of genius by Einstein)Know what not to be doing


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NO MANAGER; Everyone IsTheir Own Boss

No right person until position ismade right with the right

training and tools

Small things matterJUDGENot The Mistakes But

Their Response To Being

Confronted

Every other Wednesday 12-2pmstaff eats together 2x a monthBe considerate of peoples

feelings

Find things you should not bedoing


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For now, whos going to beresponsible for that?

YOUREValuable For CreativeThings

ITS HOWYou Make People FeelThat Matters Most

We have a way of discountingsomeone

Even though you say its all right,you make the person feel small

FORGIVENESSIs Not Just SayingI Forgive You

ITS Making The Person FeelForgiven

Xerox 272 documate


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Hi speed scanner

Scan card feature

Important tool for front deskautomation

Refer a Friend PosterPeople dont like being boughtDont give something too bigWorking on selfAttaining the toolsStart automating my

environment

Start automating the procedures


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Team set up that self-sustaining,self-caring, self-learning, self-

managing

Nothing will cost your businessmore than hiring 1 wrong

employee

CODES FOR CALLING IN

Urgent post-op = 0-48 hoursUrgent impaired = 0-72 hoursCan wait up to 2 weeks if not

urgent

The way you deliver it is the waypeople receive it

Does perception create thereality? Yes.


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Humans ruin things

Receptionist can ruin things

So be wary!Perception is everythingPreserve the quality of itRequires trainingWhat I do, patients love, they

benefit, etc

You are an extension of thequality I provide

You have to talk to youemployees and tell themWORDS NOT TO USE:


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Im sorry

Unfortunately

I dont understandYoure a diamondThis job is a circleThis doesnt fit youDont cut corners during hiring,

screening, etc

#1 thing employees hate mostWhen they feel they are not well

trained or prepared to do theirjob

No one likes feeling like a fool


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There are some things peopleare willing to forego in order to

work for you

Team meetingDEFINE CONFRONTATION

Its not what you thinkWhats the opposite oflove?IndifferenceYou know what, I dont careIts not worth itYou need toConfrontation = opportunity for

improved relationship


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When I confront you, thenyoure good

If you dont have thisconversation with your

employee, they will not accept

criticism

Whats going on, whats with thebehavior?

Do you care about theorganization? Yes.

IF ONEPerson Fails Its A LinkedEffect.

HOWThey Respond Is How YouJudge Them

Poor response, poor attitude,not willing to take responsibility

are grounds for dismissal


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Your business, your people arenot automated if youre not able

to walk out of your facility and

have things still run smoothly

EMPLOYEE TRAINING = creatinga culture of rewards and

punishment, of teams, of a

group of authorities,confrontation and forgiveness,

accountability

What they like most aboutworking at IndeFree

#1 answer:I love my be job because theres

no one looking over my shoulder

I am the authority of my position


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Employees are given ownershipof their roles

This leads to a high caliber ofperforming

I want them to feel: Imbecoming a better person

Im growingIm holding myself to a higher

level

Money will come and goBUSINESSIs A Vessel For Making

Great People

That vessel is what made adifference


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TAKE ONPeople & Show ThemWhat It Means To Be

Accountable, To Forgive, To

Accept Criticism, To Be

Compassionate

If you going to give yourself atask, its not going to happen

A New YouBETTERUnderstand If You Want

Something Done, Assign

Someone Else To Get It Done

THATSLetting GoTHATSWorking On SelfI never say this is what the job

pays


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Keep in mind, you like thisperson

Youre offering them $38-42/hr;they want $45/hr

The moment of control with youremployee

Do you want to be in a positionwhere that employee is over you

because they are coming in at

lower pay but with higher

expectation

Youre willing to let go someoneyou like for $180/mo?

Youve been chosen under 1condition

Bring in me one new patient amonth on your own effort


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Store the info under the folder ofthat perspective

Change the angle of sight, youcreate a new folder

Market who you areWhat your message isWhat you are offeringWho your best customers areAlways go back to square oneMold the mind of your therapistPaperwork molds and conditionstheir thought processPaper Work = Thought Process


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YOUCan Forgive Someone, ButThey Never Feel Forgiven;

Doesnt Mean Squat

Clinical ExcellenceITS How You Make Them Feel

That Counts

Without this you will never haveclinical excellence

Its not what you think it isITS CAREThat Inspires A Patient

To Unlock The Healing Power

(Potential) From Within that

results in family and friends

being brought to you

THEYCant Unlock The HealingPower Within


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Nothing you do will get thembetter

HOWDo You Give Them CareThat Inspires Them To Unlock

The Healing Power Within?

GOAL OF EXAM is to hear this:Thank You, I Already Feel LikeIm Getting Better

IF THEYFeel Like They AreGetting Better

What are they getting?Getting betterWe are so clinicalThats our mentality


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Get eye level, make eye contact

Use a tone of voice thatsauthoritative yet gentle and calm

Use words that are inspiringStop asking like that; have you

ever had physical therapy?

Instead, ask have you everparticipated in a physical therapy

program?

You are going to take controlGo to the active with words

Actually want to touch thepatient


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You want proximity, physicalproximity

Place diplomas right behind yourhead in the most expensive

frame you can find

Poster that conveys you aregoing to be active again

Every therapist should have theirexam room

TO UNLOCKThe HealingPotential Within, It Is A Somatic-Sensory Experience

ITSTactile, Auditory, And VisualThey view you as someone who

is caring and compassionate


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Thats when you should do therehab potential from the profile

Most therapist approach thepatient this way

Whats their rehab potential?Next visit: better, same, or worseTell me whats going on, talk to

me

Comfort themYOU MUSTGive Rehab Potential

Based On Their Motivation To

Get Better

REHABPotential Is Not BasedOn Diagnosis


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ONLYLimiting Factor Is TheirDesire To Get Better Or Not

Identify motivating levelWhat you learn in school is notFOCUSOn Profiling That

Patients Motivational Level

PATIENTIs Not Getting WhatThey Need To Become

Motivated

PROFILINGIs Critical To AnExam

PEOPLEAre Good At DeceptionAnd Manipulation


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Most common cause of noimprovement, but they are

motivated

WHATThey Are Not Doing OnTheir Own At Home

Spend 2% towards gettingbetter, will they get better? No.

Tell them to do this and they do= clinical skill

When do you start to thinkabout what structures are atfault?

I dont even care what structuresare at fault

FINDThe Patients MotivationalLevel For Getting Better


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IDENTIFYDestructive Forces

You want to educate: but not toomuch

BLANKSOr Question Marks OnThe Pre-Exam Form Indicate

They Are Not Motivated

IF THEYWrite Too Much =Mental Issues

WHATAre The PotentialDestructive Forces In ThisPersons Life?

DO NOTAllow The Subjective OrObjective To Change Your

Profile Too Much

DONTAllow The Patient ToFocus You


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They Google it and take it backto the MD

MD will never send you anotherpatient again

MD will call you and yell at youDo you want confrontation? Yes.They still love youThe society, learn wrong things

about confrontation

Confrontation = an opportunityto make things right

First of all, thank you for bringingthis up


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They were not going to expectyou thanking them

WHATCan I Do To Help Make ItRight?

Words are very importantEducational part of examDO NOTEducate On Anatomy

Or Pathophysiology

Cant do it in 5 minutes (teachanatomy)

How does it relate to outcome?

FEARIs Not The #1 Way To GainCompliance


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DOESScaring Them UnlockHealing Powers? No.

EDUCATEThem To IDDestructive Forces

THEWord Is IssueNEVERSayTearConjures up too much fearUSE TERMSLike Muscle Issue,

Joint Issue, etc

Patient RolesTell them to write this downThis is how you care for youDefine their roles


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Do's and Donts

No excessive walking on unevensurfaces

Always be definitiveEvery 20 mins get off feetEvery 20 mins stand upEvery night ice for 15 minsWhy twice a day?Get up and go to sleepNever say 3x a dayCant do things 3x a day


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2x = get up and lay down tosleep

DONTSet Someone Up To FailGUIDEThem Through A Program

For Success, For Healing

Clinical excellence is notcommon sense

FAILURETurns Off The HealingPowers

BASEDOn Those Things (TheDestructive Forces)

WILLDetermine How MuchTime I Spend With Them

Discharge (D/C)


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Why D/C necessary if unable toremove destructive forces?

CANTFollow Any Part Of HisProgram

No chance of successUNABLETo Remove Destructive

Forces On Affected Structures

WHYWalk Into A Pit Just ForThe Sake Of Moving Forward

MINUTEThey Feel They AreFailing, The Healing Power Shuts

Off

At least he knows what he needsto do to get better

Cannot cut corners


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TRUSTYour Initial Instincts

Grades for STM

Forgetting it because youre notdoing it

Starts with reference number of3 = 50% into tissue

1 = myofascial layer2= 25%3= 50%4= 75%5= into the boneInfraspinatus Pressure Point

Release


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TRACKING THEIR PAIN

Be careful of putting 0/10Critical d/c visit most prime to

send a friend

How does patient feel about youhere? (At time of d/c)

They think you are awesomePoint at which they will refer

family

Find that pain never let it getto 0/10

Become predictor for D/C

Say, How is therapy going?


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Are you ready to start managingthis at home?

2 comparable signs check itevery day

NEVERLet The Reason ForCaring Reach 0/10

Have you found thatmeasurement to be reliable?

HBBWith Thumb, Right VersusLeft

Tight Posterior CapsuleVery reliableImportant for patients

perception of you


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BECOMEA Master OfDeveloping Comparable Signs

GETThe Difference InMeasurement

IF YOUDont Tell Them WhatTheir Progress Is They Wont

Realize It

HBHwith middle fingerwhatcan they touch?

Patient cannot cheat this testSingle leg hopSide to sideFront to backDiagonal


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Run 10 mins on even surface

LOOKAt Proprioception

ABILITYTo Control Limb InSpace

SINGLELeg Hops Is VeryComparable Functional Sign

KNEE COMPARABLE SIGNS

Single Leg Bridge on HeelTests hamstrings and posterior

knee

Minimal, moderate, severeVMOFIRING/RECRUITMENT

Tests anterior knee


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Tone is 25%, 50%, 75%, or 100%compared to good side

To bike: single leg squat withoutpain; 110 degrees knee flexion =

you can ride up to 5 mins

Is 110 degrees knee flexionextreme? Yes.

Its the last 30 degrees of therange

Yes (100%), no, and why?If you say go ask your MD they

lose respect for you

L/S (hinge from anterior toposterior)

SQUAT ON HEELS


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How far can they go?

Pain level at that range

SPINEMECHANICS

T/S hinges from side to sideL/S hinges front to backFlexion/extension; thats the

direction its supposed to move

C/S hinges in horizontal planeTHEMEANING OF PAIN

Dont make them in painNever leave worse; always better


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Dont need to inflict pain todiscover root cause (rule of

thumb)

Treatment is always painless,always

You giving them pain sends thewrong message

Pain means = there must besomething wrong with me

If youre good at one thing, yourgood at everythingTHE DISC CONTINUUM

Everything starts in the spine,everything

Does it make sense?


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Its always the disc

At what stage is the disc?

Disc lost integrity = facetproblems

In children: 99% with low backpain have no disc herniation

1% congenital basis of herniationDescribe a moderate DDD?This is why we dont own the

community market

How do you open up spinalforamen?

Transverse abdominal type stuff


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Disc Continuum

WNL

25%= mild DDD50% = mod DDD; radial tears;

disc is mushy

Spontaneous restabilization asbody starts to dump calcium to

protect the nerves

Patient starts getting better atrestabilization all of a sudden

Lay down every hour for 2 mins

Get them on board

75% = bulge/herniation; brittle;severe pain


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Should you walk with bellybutton in?

100% = sequestered/stenosis;broken up into pieces; got to

separate it; fusion

5 years scan chart and throwaway

ICD-9 list on fee slipDoing great, great; if not, why

not?

Always have signed plan of careIf MDs are looking at your

progress notes, youre

communicating


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If use IndeFax, then dont needland fax line

Patients perception of you asclinical excellence

#1 complaint at most facilities =paperwork

45 min eval (apple in activationsequence)

Pre-exam form & subjective (doboth = 10 mins)

70% straight forwardsprain/strain stuff

20% challenging stuff10% crazy stuff


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Face to face = 15 mins

Dont give any tx usually

Indefax = 2 minIn exercise log record no shows

or reschedules

See DN = daily notesAdjust goal once a week for

Medicare

Lumbar a exercise logProne press upPrayerSL Bridge


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I= instruct on next visit

5

th

visit = critical d/c visit 4

th

tx

Tx program done after evalD/C few quick testsAsk! Do you know of anyone

who might benefit from our

services?

Give the cards and brochuresBest memoryTeach exerciseHold them accountableShow me what you are doing at

home


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Continue at home for next twoweeks

Do I need to teach bridging onesingle limb? No, have techs teach

it

Were not a gymYou do it once, do it twiceNow do it at homeTeach 1 exercise at a timeGet better doing 1 or 2 exercises

well every day at home for next

2 weeks

I dont type up an exam and sendit when the MD ask for it


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They only want progress notes

CAIRTHOUGHT PROCESS

C = control the destructive forcesin work, play, and sleep (do's and

donts)

A = apply appropriate forcesI = impose challenging forcesR = restore maximal functional

forces

Dx = ankle fractureC = dont jumpDo alphabet; dont let swelling

increase; do use ice


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A = stretching, closed chainisometrics

I = single limb hopping ortrampoline

Baps board stuff, front and backR = running, figure 8s, up and

down hills

Running on side of hills, cats, zigzags, play soccer

Treatment plan sucks notreatment plan progression

No decent thought processAt D/C ask can you do me a

favor?


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If you dont ask, they wont do

If you ask at the right moment,they will do it

The people they bring in listenbetter and pay more

D/CCRITERIA

S: 2/10 during ADLsO: 80% or better functionalA: Self care/HEP independentClinical measurement 80% or

better

Functional impairment 80% orbetter


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Clinics have this thing wherethey subconsciously dont want

to D/C

Discharge certificate ofachievement

Fill out surveyDont underestimateFor some, this is 1st time

achieved goals

Zero out accountGet info to marketing

2-3 weeks after D/C, pt shouldget some money back for $12-18


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Round up on collections sendsurplus back

ASSESSING PROPRIOCEPTION

Sense of awareness of L/S andother body parts; holds all

contractions

Good test forLumbar spineFlatten your backToes upSqueeze kneesPush heels downBreathe


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Fair = loses it when they breathe

Poor = cant hold it

Contract and hold them whiletheyre breathing

Notes when they lose itPush; hold it x 10 seconds (HEP)Use for comparable sign & HEPPilates gaining awareness of

the body in relationship to the

other parts

Yogaworks good with bodysnervous system

Bed lasts 1 year for every $100spent


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Anywhere you spend 8 hours

Physical therapists haventaddressed where we sleep

C/S disc memory foam pillowwith curve

Right Infraspinatus is modthickened near the spine of

scapula

PPR followed by stretchLow C/S and upper T/SDont really need to mobilize C/S

with C/S mob

Have to get them into flexion


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Stretch into flexion; usecontract-relax

Palm on cheek boneOpposite hand on temporal boneIts not fast or hardPush downRadial deviate and pull on

ring/pinky finger for C/S pain

(block wrist)

Partial squat & stomach in agood for L/S firing gluts

Side lying: hip abduction withknee bent

Keep side off bottom hand


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Keep waist off ground

Psoas stretch extend arm up;ipsilateral lunge in standing

Prayer stretch gluts on heel;feet flat (plantar flexed) on floor;

finger walk forward; finger walk

to side; hold belly button in

Documents

IndeFree Miami 2009