Wanting to get better vs Getting better

My friends often joke with me that I “bend elbows and knees for a living.” While I certainly will “bend” an elbow as part of a treatment plan, what physical therapy offers goes much deeper. As with anything in life, the more you put into it, the more you will get out of it. I hope this month’s blog post can help you not only decide if we are a good fit for therapy but also help you dig layers deep to understand, am I truly ready to get better?

I have a strong passion for this profession and I absolutely enjoy what I do. I feel comfortable saying that patients I have treated would all say something very similar, “It shows how much Ryan loves what he does.”

For those of you that don’t know about the path to becoming a physical therapist (PT), I plan to share some insight into the journey we all take. The goal is not for you to think of all of us PT’s as “smart” but rather that we are the movement specialists, and there is no greater gold standard than working with a PT to improve your pain, impairments, and performance, in sport and everyday life if you are ready to make the change.

Becoming a PT requires a 4-year Bachelor's Degree followed by a 3-year Doctorate Program, and then a final board exam to receive licensure. During those 7 years, the amount of sacrifice, student loans, and knowledge gained is so much more than I ever expected as I began this journey to achieving the goal of becoming a physical therapist.

Upon graduation, you enter the field full throttle with the mindset that you now get to change people’s lives and put purpose to all the hard work and sacrifice. Throughout schooling, you are continuously pumped up by your professors and peers that you get to become a difference-maker working from the trenches. You have all the tools and knowledge to make people feel better. You have been battle tested to the point it’s almost too easy to do a thorough evaluation and diagnose what it is that the patient is dealing with.

However, one factor is left out, and it is without a doubt the most important piece. We are working with humans. Humans are complex. Everyone has different things going on in their life. Most of what we decide to do, or not do, is driven by emotion. What is driving that emotion plays an even bigger role. Understanding that emotion and giving it purpose is a challenge. But without that challenge of giving your emotion meaning and purpose, it limits our ability to reach the desired goal.

Take me for example. During PT school I put on roughly 30-40 pounds. I quit working out, started eating unhealthily, and was not addressing my mental health. I made the excuse I didn’t have time. After graduation, I told myself it was time to get back in shape. I’d kick butt on a new training program and diet for about a month or two and then fizzle back out, essentially resulting in a net change of zero weight lost over the course of the next 3 years. During that time, I would get frustrated and think, “What the heck, I am doing all the things right, this isn’t fair, I should have lost more weight.” Those irrational thoughts led to poor behavior that would make me think, “What’s the point then?”

Upon graduation, I landed a great job at an outpatient orthopedic facility, which is exactly what I had been pursuing. While I enjoyed the facility and the people I worked with, I could feel deep inside me the lack of fulfillment. It wasn’t the job itself that led to the lack of fulfillment but more the stranglehold that the insurance model put on me to be able to provide the care that my patients deserved. I would often come home, complain about a new policy that was driven by insurance reimbursements, lack of patient commitment, and a lack of autonomy with my treatment.

I struggled with this even as I was finishing my last clinical rotation. My supervisor at the time was the smartest PT I still have ever met to this day. I can remember I had a new patient come in that was living with low back pain. She came in complaining how her low back would hurt and how she was going to have to quit her job of cleaning houses because the pain limited her ability to bend down to the floor and climb stairs. With a full head of knowledge, I did a comprehensive evaluation of this lady. The fix was easy. I knew exactly what was going on and the steps to fix it. Repeatedly within a session, I could do hands-on techniques, educate her on exercises, and as a result reduce her pain levels to the point she could walk 2 flights of stairs in the clinic without any pain. However, the issue was that between her sessions there was a clear lack of carryover. Was that lack of carryover because of a poor training program or because of poor compliance from the patient? During the sessions, the patient would text on her phone, nonchalantly take phone calls and giggle into the phone, and close her eyes as if she were resting while I was doing hands-on techniques. If you are catching my drift here, my training program was sound, but there was clearly a lack of commitment and compliance from the patient. Well, what the heck? PT school didn’t help me with this. This lady claims she doesn’t want to be in pain, but clearly wasn’t taking all the steps and measures that were required. I educated her up and down and poured everything I had into the patient; I was so excited I could change her life. Well as the story goes, she began to cancel and no-show me and started coming to therapy less frequently. How can this lady expect to improve if she only comes once a month? Clearly, she wanted to be better but was not truly ready to be better. My supervisor then told me something I will never forget: “Ryan, you can’t be giving every patient 110% if they are going to only give you 50% back. You will burn out. It’s time to talk to this patient to tell her that this isn’t working and that she should come back to therapy when she’s ready to make a change and commit.”

It’s easy to complain and it’s even easier to do nothing about it. Did I see myself doing this for 5 more years? I would tell myself “No, but what I have is good. I should be grateful for a stable job surrounded by good people. I love being a physical therapist and a move to a different clinic is nothing more than a lateral move”.

Then an opportunity arose. I believe this opportunity didn’t happen off pure luck, but rather from my willingness to put myself in advantageous situations. The offer and idea was there; I can quit my current job and open my own practice and treat patients on my terms. At first, I made excuses for why not to do it and why It wouldn’t work. However, very smart, and important people around me were all giving the same messages: 1. Don’t let fear of failure be the reason you live with regret. 2. There is no better investment than investing in yourself. 3 The grass is greener where you water it.

To do this, I had to go all in or “burn the ships” as they say. I couldn’t be like the patient I had during my last rotation. If I wanted to change, I needed to be fully invested and put all the effort in. I listened to dozens of podcasts, read books, surrounded myself with other business owners, and hired a coach. Perhaps the most important thing I learned on this journey was I needed to change and work on myself and understand WHY I even wanted to change jobs. The way this was introduced to me was through the “5 Why’s strategy.” By asking yourself why it becomes very clear what the root purpose is. I encourage each person reading this to do this. You want to lose weight? Why? To be healthier? Why do you want to be healthier? Watch where this will take you, it is so powerful. It will give you so much more meaning and drive. I have used this strategy many times over the last handful of months. I don’t work out daily and eat healthy because I want the scale to say a lower number, I do it for a deeper root cause that I am trying to be a role model for my daughter. I am once again addicted to working out and eating healthy and am down 25 pounds since I shifted my mindset. I don’t follow any fad diets or take any pills. I use what I want my daughter to see as she grows up as my motivation.

Now that I have my own practice, I have worked with some of the best patients I have ever worked with in the last 4 months compared to the previous 4 years. Yes, you pay out of pocket, but the idea is you get a type of care you didn’t know existed. The overarching goal with each patient is to bring meaning to why you are in physical therapy in the first place. You have my full attention and 110% of my effort. I have put myself in a position where I won’t burn out because I am only working with people who are giving me 110% back. The insurance model cuts you off as soon as your pain is less and you are moving better. Why does it stop there? I recently listened to Peter Attia’s podcast where he had a guest named Lewis Hawes on. Lewis brought up an interesting fact. As you become more successful, your journey usually requires more coaches. Take someone such as LeBron James for example. He is the pinnacle of basketball. There has been nobody better over the last decade. As he became more successful, so did the need for more coaches in their area of expertise. We as people think about it from a completely opposite mindset. I would assume many people reading this have zero or maybe one coach that is helping them through life. If LeBron James is already the greatest and has a team of 50 coaches, why do we have zero? Saying “cost” is nothing more than an excuse.

Physical Therapy is more than bending elbows and knees. It is the building of a relationship with a professional that is the gold standard for the treatment of pain and movement with a goal-oriented purpose. A PT is someone to help you understand all the variables that are contributing to your pain such as diet, sleep, breathwork, mental health, physical health, and so much more. The journey doesn’t stop when the pain is gone after session 3. That is the easy part. The true reward is becoming committed over time and making the change you never thought was possible and being able to accomplish your goals whether you are 16 or 85. I’m done letting insurance dictate that for me.

If you want to get better, ask yourself why, and then go 4 layers deeper.. If you have tried therapy in the past and it did not help or are unsure how to dig to that deeper root, please reach out and let me be a professional that you can trust and be there with you. It is my career, and it is what I love.

Thanks for reading!

Dr. Ryan