What Physical Therapists & Chiropractors Wish Physicians Understood

[0:00] Kathy: Hey, Jason, you ever get a referral that says shoulder pain, evaluate and treat, and then the patient comes in and they’re holding onto their left knee? Jason: All the time. Yeah, today we’re talking about what PTs and chiropractors wish physicians knew. Cuz sometimes we need a decoder ring. Kathy: Amen to that. And sometimes physicians need to know that we’re not, in fact, just massage therapists with extra paperwork. Jason: That’s right. Let’s clear the air. Kathy: Mhm. This is the PTCH.

[0:30] What happens when a chiropractor and a physical therapist get together to make a health and wellness podcast? Jason: But chiropractors and physical therapists don’t like each other. Kathy: Oh, think again. I’m Dr. Kathy Lynch, physical therapist who likes to help people move and get stronger. Jason: I’m Dr. Jason Young, an evidence-based chiropractor who uses humor just as much as adjustments to help people get better. Welcome to the PTCH Podcast. Kathy: Remember, there’s no I in PTCH. Hey, y’all. Welcome back to the PTCH Podcast. I’m Dr. Jason Young. And I’m Dr. Kathy Lynch. Yes, and look at us.

[1:02] Jason: Look at us in our handsome shirts. Kathy: Yes. Yes, this says NARD. Yes. Not a real doctor. Oh, yes, the PTCH Podcast logo. Hey, Kathy, can just anybody get one of these? Kathy: Anybody. Jason: Yes, you don’t even have to be a real doctor to wear a NARD shirt. Kathy: Great Christmas or Hanukkah gift. Jason: Absolutely. Yes, Christmas, Hanukkah. I don’t do Kwanzaa. I don’t. But Kathy: Festivus. Jason: Festivus for the rest of us, right? So, um, or, you know, you don’t need an occasion, right? Like my wife

[1:33] and I did that thing where it’s like, “Hey, listen, we’re not going to get each other gifts this year, right? Our love is enough.” Kathy: Yeah. Jason: And so I was like, “Well, wait a minute, I already bought you something.” She’s like, “You don’t need an occasion to give me a gift.” So yeah, you don’t need an occasion, y’all. Just go to ptchpodcast.shop/swag and you can get a NARD shirt. It comes in three colors, right? There’s lots of other good stuff. Kathy: Yes. Jason: Black. This is black, right? So if you’re not watching our video

[2:04] podcast, which is in the top 15% of video podcasts on Spotify, then we just need to tell you the color of everything. My iPad case is white. Kathy: Jason: Her MacBook is silver. Kathy: Okay, let’s get into the show. Jason: I am an African-American man and she is a white Irish woman. That’s right. So, yes. Well, tell me — this episode was your idea.

[2:36] Kathy: And I was all in on it. Jason: Oh, love it. Perfect. Let’s go. Kathy: Was real-time responding to this as the text message was flying through the air. Jason: Yeah, so what were you thinking with this one, Kathy? Kathy: Well, really what I was thinking — I kind of want physicians to know what we know. Jason: Yes. Kathy: Because then it can help them to refer to us, and then — because not that we need a referral. We don’t need a referral. However, when a

[3:08] physician refers to us and says, “Hey, physical therapy’s really going to help.” Guess what? The outcomes are way better when the doctor says it’s going to help. Jason: Yeah, totally. And do you work for the physician? Kathy: I do not work for the physician. Jason: Right? You are a colleague. Kathy: I am a colleague. Jason: Not a subordinate. Kathy: We’re peers. Jason: Yes, we are. And so I think that people may not understand that there’s kind of this dynamic that exists within healthcare.

[3:38] And I feel like lately it’s a dynamic that has had gasoline tossed on top of it, where you have a lot of — well, when I say medical doctors, I mean medical doctors and DOs. Kathy: Right. Which, disclaimer, first of all, we love all of you. Jason: We do. We do, yeah. We’ve had doctors on the show, right? And we value those relationships and they’re good, and most of these doctors we get along very well

[4:08] with. But there’s just kind of — I don’t know. We don’t know what you’re talking about in the break room. Kathy: Jason: We don’t know what you’re talking about behind closed doors. But there’s kind of this sentiment that exists out there where I think that there’s a lot of medical doctors where they kind of feel attacked. Kathy: Yes. Jason: You know, or like maybe their territory is being encroached upon as other types of healthcare providers have expanded scope, expanded responsibility. And so let’s clear the air about some of that. Kathy: Yeah, we just want to be a

[4:38] team. Jason: Totally. I’m a team player. Kathy: Yeah, and the patients deserve that, right? No patient gets value out of us beefing about things, right? And so it’s like, yeah, we can talk all day about what’s wrong with Mrs. Jones, but if she doesn’t get the healthcare that she needs, then we’re all idiots. Jason: Yeah, all of us are useless. Kathy: All of us are useless, so. Jason: Yeah, I think one of the things — first of all, maybe that we could talk

[5:09] about is the whole doctor title. Kathy: Yeah. Okay? Jason: Yeah. Cuz it’s, you know, new and fairly controversial in the world of physical therapy. Kathy: Yeah. Chiropractors, we’ve had that doctor title for a long time, but one of the criticisms out there is that, “Hey, chiropractor, when you call yourself a doctor, everybody’s thinking medical doctor, and then they want to listen to your advice, but you’re not giving medical advice. So you need to stop it and call yourself something

[5:39] else, literally anything else. And you, physical therapist, you’re not a doctor, Kathy: No. Jason: right? You’re not a real doctor. Kathy: Real NARD. Jason: You’re not a real doctor. So, what do you think about that? What’s your response to that type of thinking? Kathy: Yeah, well, my diploma says doctor of physical therapy. And one of the reasons the profession went this way was we wanted autonomy. Jason: Mhm. Kathy: We want to kind of get away from the

[6:09] hierarchical scaffolding that had been set where the medical doctor says, “This is what you got to do,” and the physical therapist has to do it. Jason: Yes. And one of the problems with that is medical doctors don’t know what physical therapists do. Kathy: If they did, Jason: That’s right. Kathy: they’d be doing it. Jason: Yeah, they would be doing it. Yeah, and I think that’s one of the myths about physicians. Now, don’t get me wrong. When it comes to healthcare, there is

[6:39] nobody that is even close to as well trained Jason: Right. as a medical doctor, especially a specialist. So like a surgeon or something like that. Nobody even comes close. I don’t have half the education, or maybe approaching a third, right? And so it’s an incredible commitment, they’re incredible resources, but the issue is that they don’t study what I study. They don’t study what you study. So they don’t know everything,

[7:11] and we all need to help each other, right? Kathy: And what — mostly what we’re talking about is more of the primary care or internal medicine physicians who don’t get a lot of musculoskeletal training. Right. Jason: Right. You know, orthopedic surgeons, you know, osteopathic docs, you know, obviously they’re getting a lot of musculoskeletal training. Kathy: Mhm. And so for the most part in this episode, we’re mostly speaking about

[7:41] those primary care physicians and internal medicine. Jason: And I think so, too. And you know, even with the DOs, they do get more musculoskeletal training, but they still don’t get as much as we do. Kathy: No. I think one of the little-known facts about chiropractic school is we actually get pharmacological training. Jason: Mhm. And it is about, you know, 10 hours of education. Kathy: Mhm. And so that is definitely not enough to earn me prescriptive

[8:12] rights anywhere. But the reason we have it is because we need to be able to keep people safe. And so if you come in to my practice and I’m looking through your medication health history, not with the purpose of saying, “Oh, you should take more of this or not that or anything like that.” Because that’s outside of my scope. But like, for example, I need to know if somebody is taking a fluoroquinolone. Jason: Yes. And I need to know what that is. Kathy: Yes. Because it’s a type of antibiotic that is going to affect the quality of your tendons and ligaments and

[8:43] everything. And so if I don’t understand what a fluoroquinolone is, then I could be putting a patient at risk, right? If I take your blood pressure and I see that you’re not on blood pressure medication, Jason: Right. I need to know to refer you to your physician. Kathy: That’s right. You know, to have that conversation, do those things. And so we had a course in pharmaceuticals as well. Jason: Yeah. For the same reason, right?

[9:13] Statins are known to cause a lot of musculoskeletal pain. Kathy: Right. And so that’s something I learned in PT school. Jason: Exactly. If someone’s on a statin, not that I’m going to tell them, “Hey, don’t take the statin.” But hey, go ask your doc and see if you can find a different statin that may help you with this pain. Kathy: Yeah, and I’m going to go so far as to say that — because we’re not all the chiropractors, we’re not all the physical therapists. And so we don’t have control over what some of the dummies out there are doing.

[9:43] Jason: But no, so if your chiropractor is like, “You need to get off that statin or you need to quit taking this or you need to quit taking that.” Do not listen to that chiropractor. Kathy: Do not listen. If your physical therapist tells you, “You need to quit taking this or you need to start taking that,” Jason: Yeah. do not listen to that physical therapist. Kathy: No. Because that’s not in our scope. Jason: It’s not in our scope. Kathy: So, we should be saying, you need to go talk to your doctor. Jason: Yeah. Preferably the doctor who prescribed you the medication. Kathy: Yes, that one. And we can help give you some useful tips in terms of, here’s a question that you ask, and things like

[10:13] that. But, doctors, we’re not trying to step on your toes. Jason: Not. But, the reason I bring up the pharmaceutical classes is because that is pretty close to the level of education that we get about pharmaceuticals. That’s pretty close to the level of education that an MD is getting about musculoskeletal problems. Kathy: Right? Jason: That’s right. Kathy: That is why so many of you are being diagnosed with strains and sprains. Jason: Whenever you go to your medical — oh, you’re just having back spasms.

[10:43] Kathy: Yes. Right? Just a spasm. Jason: Oh, you sprained your shoulder. That’s it. Kathy: Yeah. No doubt. No doubt. So — that’s water on the knee. Jason: Yeah. So, and that is why we exist — because physicians can’t do it all, right? And it wouldn’t be reasonable to expect them to. General practitioner, I — hats off to you. I respect you. I think your job’s a nightmare, honestly.

[11:13] Kathy: Such a hard job. Jason: Yeah, you’re expected to know about everything. And culturally, when we think about medical doctors, like, think about some of these TV shows like Grey’s Anatomy, House, ER, all these kinds of things, St. Elsewhere, Kathy: General Hospital. Jason: You know, our culture says that the medical doctor has to have an answer. Kathy: Right. Jason: They’re expected to be able to find the solution, and it has to be in 30

[11:43] minutes. Kathy: 22 with commercials. Jason: 22 with commercials, right? And what an incredible burden, because that is the culture that is put on physicians. And when you look at those types of things, it is almost exclusively the doctor descending from above with the shot or the pill or whatever. But, you ask a general practitioner, how often is it that you are talking with somebody, and the solution to their problem is a shot or a pill? Yeah. Most of them are

[12:14] going to tell you, it’s not that often. Kathy: Right. Like, they use it a lot, it’s cool, but a lot of it is about the conversation, giving people confidence in themselves, their ability to take care of themselves. And that’s not different for you and I. Jason: Right. Yeah, and going back to the training, I feel like I’ve told this story before, but Colorado — we took two 16-week terms of cadaver lab. And so, one was in our first year, where we kind of dissected down to the muscles and the nerves and, you know, had to

[12:44] identify all the muscles and nerves and — and so, second-year med students were the teaching assistants for those labs, and that was great. And then in my second year in PT school, we were in cadaver lab, and this time we dissected down to the joints, so we could actually see like, how does that knee move? How does the tibia and the femur articulate in the shoulder joint? And what we found a lot of times was —

[13:14] we’re in the cadaver lab the same same time as some of the first-year PTs and the medical students were TAs, and they didn’t have the answer to like one of the first-year’s questions, and they’d say, “Hold on. Let me go ask the second-year PT student.” Cuz it was a musculoskeletal question, you know. They’re like, “Mm, I think I know somebody else that can answer this question.” Yeah. So, yeah, we got way more training in the cadaver lab with muscles, nerves, joints, yeah, than

[13:45] than the medical students did, and they knew it. Yeah. Right?

Jason: Well, some of them know it.

Kathy: Well, you know, if you go on social media. So, on social media, there’s this lady on there who she’s a med student, and she loves saying things like, “Well, as a med student, I have more training than any chiropractor, blah blah blah.” And so, she just goes out finding videos of chiropractors who are, you know, acting crazy, and you can find them. They’re not hard to find, right? And I think there’s kind of a trend right

[14:15] now, medical doctors going out and they’re like, “Oh, I’m going to find a video of a chiropractor, and I’m going to rip it apart.” And it’s like, the whole reason they do it is because it’s engagement farming, right? They’re going to get a lot of comments. Yeah. People are like, “Oh, I hate chiropractors. Like, a chiropractor murdered my family.” Came in and adjusted everybody, and like, we found them by the fireplace.” Yeah, it’s like silly stuff like that, but it’s just like, the audacity of this med student. And it’s like, listen, if we sat down and we talked musculoskeletal stuff, I guarantee you,

[14:46] med student who is going into radiology, you don’t know what I know, right?

Kathy: And so, I think some of that isn’t her fault. I think some of that is just instilled in her. But we’re having this big kind of health care war that we don’t need to.

Jason: No. Because here’s the fact,

Kathy: Yeah.

Jason: there is not enough of any of us

Kathy: None.

Jason: to deal with the current demand.

Kathy: No. We all need to band together. Absolutely.

Jason: Hold the line. Yeah. I mean, I don’t even know how it

[15:17] happened. I mean, there’s more people than before, but I — well, I actually — so, there are — COVID took a lot of health care providers out of health care. We lost a lot of nurses, lost a lot of doctors. They’re not dead, they just burned out. Yeah.

Kathy: And so, on the other side of that, we have fewer and fewer health care providers, and they’re not being trained any faster.

Jason: Right. No. I think that there’s been a movement to kind of beef up the

[15:48] number of PAs out there. Which a PA is a great and sometimes terrible idea.

Kathy: Yeah.

Jason: So, PAs, it’s like, you’re doing doctor stuff with 2 years of training.

Kathy: Yeah. With the understanding that, you know, you’re working with some supervision, which is great, and it makes sense from the standpoint of we need front-line health care people. I’ve met some PAs who it’s like, wow.

Jason: They’re that good. Yeah, that’s what I meant. They’re — I’m like, wow, just 2 years.

[16:19] Just 2 years, huh? And that’s more the exception than the rule.

Kathy: Right. Right. Right.

Jason: But, there’s also medical doctors out there that you’re like, wow, you’re just that good. And that’s all. No better.

Kathy:

Jason: So, we’ve all got them, right? I think every profession has people where it’s like, yeah, this person’s kind of an embarrassment.

Kathy: Right. So, fun fact though, did you know — and some people are like, “Well, you’re not a physician, you’re a chiropractor.”

Jason: Yes. So, do you know who gets to say who

[16:52] can and cannot be called a doctor or a physician?

Kathy: Ooh, no, tell me.

Jason: So, that is decided state by state.

Kathy: Oh.

Jason: Yes, it is decided by your state legislature.

Kathy: Oh.

Jason: So, sometimes people are like, “You’re not a doctor, you’re a chiropractor.” I’m like, “Well, go to Salem.” Go to Salem and tell them that, because I mean, they’re the ones who told me that I can put on my card ‘chiropractic physician.’”

Kathy: Well, but you’re not a physician.

Jason: Okay, go tell them. Don’t tell me. Yeah. Right? And so, any state that you’re in, there are rules — it’s typically in your state it’s going to be called the doctor’s title act. And there are rules around who can use that title ‘doctor,’ who can use the term ‘physician,’ as specifically as it pertains to health care.

Kathy: Yeah. And so, in the state of Oregon, for example, you are not allowed to call yourself ‘doctor anything’ without also identifying the type of doctor that you are. So, when I was on the state licensing board, this is a very common citation that we would give to people

[17:55] is in their advertising, they’d just be like, “I’m Dr. Smith-Johnson, and you should come see me.” And it’s like, “Okay, what kind of doctor are you?” And sometimes they just leave it out. Sometimes, I don’t know, the accusation is that you don’t want to say that you’re a chiropractor cuz you want to trick people, and it’s like, bro, eventually they’re going to find out.

Jason: Yeah, to know. It’s like probably around the time that it comes to pay a bill or something, they’re going to figure out that you’re a chiropractor. And I get it. It comes

[18:26] more in the realm of like, I’m putting advice out on things like that. But, yeah, so your legislature in your state gets to say who gets to be a doctor. In Oregon, like, if I’m going to tell you I’m Dr. Jason Young, like, when you hear the PTCH Podcast, I say like, I’m a chiropractor, right? And we follow it up with that. The only people who don’t follow that rule, like, often, medical doctors. Yeah. Right.

Kathy: That’s a really good point.

Jason: Yeah. Well, and I understand

[18:56] why. It’s because culturally, when you think about doctor, you’re thinking medical doctor. Like, Jill Biden. Yeah. Doctor. Do you remember that?

Kathy: Oh, man. The uproar. Can we go back to those days?

Jason: Yeah. They’re like, “Well, Jill Biden isn’t a real doctor.” No, she’s not. We should send her a shirt. We should send her a shirt. Yeah, she’s a doctor of education. It’s like, yeah, you guys were saying that she helped people. She knows how to do mouth-to-mouth. Right. She probably does — now I’m doing CPR. You

[19:26] were saying that she could remove an appendix. No, no, she’s a — she’s a doctor of education, and still a doctor. Still. Mhm. Yeah. She’s not a real doctor. No, her diploma says doctor. She’s the truest of nerds. She is. She’s the nerdiest of nerds. The nerdiest nerds. The nerdiest nerds of them all. So, well, jeez, I feel like — I feel like I need a drink of water. I’m going to get a drink of water. Okay. I feel like we got a lot out of our chat. I feel like I probably just spilled that all over my shirt.

[19:56] So, this is a good time to point out that — I mean, you might consider this a blooper, right? We have the premium subscriptions coming, and then like you can see — you can see the stuff — like you just saw I put water all over myself. So, get a premium subscription to the PTCH Podcast, coming soon to an internet near you. All right. All right. So, some things we wish physicians knew. What — one of them is we would prefer that they refer to us sooner rather than later, than waiting like, hey, take these meds

[20:26] first, see if it helps. Mhm. Then — then call. Then try physical therapy — where we would — hey, how about if you want to give them the meds — and yeah, send them to PT or to a chiropractor. Yeah, like what kind of meds are you talking about? What do you — what you got? What you got for me? Muscle relaxers. Muscle relaxers. Yeah. Commonly prescribed. Yeah. Because they want to give them something. They do. Yeah. They want to try to help. Mhm. And you know, opioids luckily are falling out of favor. Right. Yeah, so

[20:57] we’re going muscle relaxers. Mhm. Yeah. Well, and you know, we brought this up before — that most — like, well, we talked about it in the context of back pain, but I would say like a lot of musculoskeletal things they’re just going to resolve on their own anyway, right? So, there’s a certain percentage of those — by the time somebody goes to see a doctor, they are looking to get better quickly. And so, it’s like understanding that — just figure out where

[21:27] you are on the timeline, and if it’s pretty early on, then yeah, maybe tell somebody like, go — yeah, go take an ibuprofen, and then like if it’s not resolved in a week, then yeah, get us in the game, right? And bad news — your muscle relaxers, they’re going to be sitting down at the end of the bench, really. Yeah. Yeah, they’re not getting in the game. I can’t remember ever having a conversation with a patient being like, you know what would be really helpful to help get you better quicker? Why don’t you go see your medical doctor, see

[21:57] if they’ll give you some cyclobenzaprine, right? Uh-huh. No, that is not — if you just had a little bit of Flexeril — like, are you — yeah, I don’t think I’ve ever had that conversation with somebody. No. And like, that’s a patient that a general practitioner typically just doesn’t even want to see, right? And so, just send them over. We’ll take good care of you. And the first thing that I do whenever somebody is referred by their medical doctor —

[22:27] Kathy: Yeah. And this is funny too, because online people are like, medical doctors don’t refer to chiropractors — like, okay, I probably get like four or five a week.

Jason: Yeah. Yeah. And here’s how I do it. You want the secret? Okay. When — let’s say you get referred to me, and I have a doctor in town who sends a ton of people, and I can almost even spot the people that she sends at this point. I was like, oh, I’m betting — so whenever they come in they’re like, oh yeah, the doctor sent me

[22:58] here, blah blah blah, and I’m like, oh, who’s your doctor? And they say, oh, it’s so-and-so. Like, okay. Well, first of all, they’re smart. They know what they’re doing. Like, this was the right move. Like, this is a good thing to do. And I tell them — it’s not a good thing that they sent you to me because she doesn’t know what she’s doing — I tell them this is a really good move because we’re going to work together on this, right? We’re going to be communicating and we’re going to help you get better together, because a multimodal approach is superior in just about every case. What do you — how do you talk about people’s doctors with them?

[23:30] Kathy: Who, that guy? Yeah, oh jeez. Yeah. Uh-huh. That one would slip. Uh-huh. No, um, yeah, I kind of have the same conversation with them. We’ll talk about — I will ask like, hey, what did the doctor say to you? Because I want to kind of hear what they heard from the doctor. And sometimes what they heard isn’t actually what was said. Yeah. But —

Jason: Yes. Oh my gosh. So, I want physicians — this is something I want physicians to know — that

[24:02] I know that some of the crazy things that are told to me, you didn’t say that. There’s no way you said them. Right? Like, some of the things — my doctor said he saw this on the x-ray — it’s like, your doctor said that? No. No, no, no. Yeah, so I want physicians to know I got your back. Yeah, totally. That I won’t refute it to the patient, but I don’t believe them. Yeah. And it’s not the patient’s fault either,

[24:32] because how would they know? Like, you know, there’s big words and all kinds of stuff, and yeah, so the goal is never to make a doctor look bad. Well, I should say our goal. Our goal. Now, I do know some chiropractors out there that that’s kind of their MO, and I’m kind of not mad at that because it makes it really easy for me to look good next to them. But yeah, I mean, there’s certainly some chiropractors and PTs out there that will be like, oh, well, this guy doesn’t know —

[25:03] don’t listen to him, blah blah blah. And it’s like, I know that there’s probably some medical doctor out there that’s like, see, I told you. But medical doctors — aren’t you doing the same thing to us? Oh, that’s just a physical therapist, or oh, a chiropractor — yeah, I never send anybody to a chiropractor. I was like, we don’t have to be that way, because who does that serve? Right. Nobody. Well, it certainly doesn’t serve the patient. No. Right? Right. And it doesn’t matter if it’s not serving you or it’s not serving me or it’s not serving that

[25:33] Jason: It’s about serving the patient. So, we got to be nicer to each other. We have to hold the line. Hold the line. Sure. Sure, let’s just hold the line. One of the other things — you know, I want physicians to know that we know — is we kind of know how to talk about pain. Kathy: Mhm. Jason: Because we do it all day every day. Yeah. We know, and they probably do too, but guess what? We have a lot more time. Yeah. I get to spend 45 minutes with my

[26:05] patients and they get 10 minutes. Yeah. And so I can follow up on pain education. Because we’ve talked about in the past how complex pain is, and it’s not always a tissue issue. Yeah. And so that tissue is between your ears. Kathy: Jason: That’s right. It’s a brain issue. Yeah. So I want physicians to know that when I’m talking to patients about pain, I’m not equating pain with damage.

[26:35] Kathy: Yeah. And I think that’s an important thing for people to understand, because people immediately think, “Oh, I must have torn that muscle. I must have ripped it.” Jason: Yeah. I sprained it. Yeah. No, it’s not always — you’re not going to always see it on imaging. We just had a whole episode where we talked about early imaging. Yeah. And you’ll have to go back and listen to that one. Kathy: Well, I think that’s an interesting thing too, because sometimes that language is coming from

[27:06] the doctor. Right? Sometimes they say, “Oh yeah, you just tore this,” or “you just ripped this,” or, “that’s damaged.” And so, first of all, are you wrong about that? Maybe not. Jason: Right. But is that language useful? Right. Often not, right? So what I see a lot is doctors who are doing x-rays of patients’ backs. PS, look at the guidelines on when you

[27:37] should be doing imaging for musculoskeletal problems. If there’s not a trauma, or you know, some other indicator, you don’t need to do x-rays the first time somebody comes in for lower back pain or neck pain or something like that. So follow the guidelines on early imaging. And then the other thing too is, when you see degenerative changes or bone spurs and things like that, do not say the A word, which is arthritis.

[28:08] There’s a certain percentage of patients that you just ruined. It makes it so hard for them to get better because they hear, “Oh, my doctor saw arthritis on my x-ray.” No, he did not. No, she did not, right? She didn’t see arthritis, because arthritis is joint inflammation. You cannot see that on an x-ray. So stop saying it. We get it — it’s easy to say, it’s an accessible concept that patients have heard about — arthritis — but just

[28:39] take a second and say, “Look, there’s some changes to the bone.” And if they’re over 40, 50, something like that, tell them it’s probably associated with age, and a lot of these don’t end up being symptomatic. Congratulations, you made it to 50. Kathy: Yeah. Yeah. Happy birthday. Jason: Look at your x-rays. They’re awesome, right? Yeah, you got gray hair, you got the arthritis. Kathy: Yeah. It’s just a given. Jason: It is — gray hair of the spine. Kathy: It is. Yeah. But it’s just really easy to say, especially I think when you need to get to the next patient. “Look,

[29:09] you’ve got arthritis. We’re going to give you some meloxicam and hopefully that fixes it,” and you move on. And again, nobody’s trying to do a bad job. Jason: No. But it’s an overwhelming job where there’s a lot of people, and sometimes shortcuts are taken just because that’s not your area of expertise and focus and training. So why not get somebody involved who wants to see that kind of patient? Kathy: Yeah. Yeah. Yeah.

[29:39] Jason: Oh, this one’s one of my favorites. Kathy: Jason: Don’t you just give people TheraBands? That’s it, right? Yeah, you just give them a TheraBand. They’re good. Kathy: The yellow ones. Here’s like a couple TheraBand exercises. Jason: Yeah. Oh, you just need to stretch. Kathy: Yeah. Yeah, just stretch. Jason: Just stretch it out. Yeah. Are TheraBands useful? Sometimes. Kathy: Totally. Could TheraBand be a sponsor? They would be a great sponsor.

[30:09] Jason: An amazing sponsor. How many TheraBands would they sell here? Kathy: So many. Jason: I mean, we have 10 listeners and each of them probably needs like, what, three TheraBands? Kathy: Yeah, well, six — all different colors. Jason: Uh-huh. Kathy: Yeah. And I like to give out a good TheraBand as a Christmas gift or whatever, so yeah. I mean, TheraBands are useful in the sense that people don’t have dumbbells at home and they don’t want to join a gym. So we got to give them some kind of resistance training. Yeah. So we’ll start there. If you’re traveling, is it easier to

[30:39] take a Shake Weight Kathy: Yeah. Jason: or a TheraBand with you? Right? I mean, we got weight limits. Kathy: Well, what’s more fun? Jason: Okay, that being said, Shake Weight — we do not want you as a sponsor. Yeah, we’ve discussed it and no, thanks. Kathy: Sorry, the board has — Jason: Yeah, out. Okay, so you ever get

[31:09] a doctor that refers somebody to you, and really what they’re telling the person that you’re going to do is just massage? Kathy: Ooh. Yeah. Yeah. Go see — yeah, go see this physical therapist, she’ll give you a massage. Jason: Mhm. Yeah, and I think that that’s another really important thing to talk about — and this comes down to networking. Networking is how you and I know each other. We’re in the same networking group. And if you’re in Corvallis, come check

[31:40] out Corvallis Business Network. Great networking group. Just leave us a comment, we’ll give you the information. Or you could just go to corvallis.business. There it is. Now they’re sponsoring this episode, so we’ll just collect from them later. Good news, guys. No, but networking is so important. It’s critical because, like, let’s say that you’re a medical doctor listening to this, and you’re like, “Yeah, you know what? I do need to refer to some physical therapists, some chiropractors,

[32:10] whatever.” And like, where do you start? Who do you send them to? Kathy: Yeah. And so the ability to connect with people and network — I think it’s really important that, like, I’ve had the most success whenever I approach anybody, whatever kind of provider they are, and I’m asking, “What do you need? Like, what’s something that I could give you or do for you that would be helpful?” Jason: Mhm. Right? And sometimes they ask things like, “What do you

[32:41] do? What could you do?” Right? And like whenever I started working with athletes at Oregon State, I had that conversation with the medical director there. I was like, “So, what do you think I could be doing that would help?” And he said, “One of the things you could do is — could you show our athletic trainers how to do manipulations?” And I said, “No.”

Kathy:

Jason: You’re going to pass on that.

Kathy: No, no, it takes like hundreds and hundreds of hours of practice to to

[33:12] figure it out and so, no, I’m not going to do a like a short work. I was like, “What’s something else that I can do?” But I think that that’s an important conversation to have because it’s like, “Why would a medical doctor refer to me?” And they have a picture of what it is that they think that I do and more than likely the main thing they’re thinking of is I’m going to give that person an adjustment, right? I’m going to be selling them some crack, right?

Kathy: You’re a crack dealer.

Jason: But

[33:45] that is one tool in the toolbox, but it’s not my only tool.

Kathy: Right. Right? So, when a doctor refers to a physical therapist, like what is it in their mind that they think that you’re going to be doing and how does that contrast with your whole tool set?

Jason: Mhm. Yeah. I think it’s funny. I’ll have patients that see their — even an ortho physician — and the ortho physician’s giving out exercises.

[34:16] And I’ll say, “Can I see those exercises?” And I look at this sheet and I say, “Mhm. Okay. Yeah. Are these helping?” Oh, goodness.

Kathy:

Jason: No. Yeah.

Kathy: Surprisingly, they’re not helping.

Jason: Mhm. Huh. That’s interesting. Well, let’s go over some of them and maybe we can, you know, alter them a little bit. Yeah. So, I do think that physicians send for just exercises.

[34:46] They think I’m just going to do exercises with them.

Kathy: Right. And those exercises are going to be just a little bit better than their standard printed sheet

Jason: Yes.

Kathy: of photocopied exercises that they give to everybody. Right? Like I’ve seen those sheets, too. Right? Like people — they’re like, “Oh yeah, you know,” — they end up having what turns out to be like a disc herniation. Yeah. And I look at this sheet of exercises that their doctor gave them and it’s like, “Yeah, you just need to spend some time bending forward and touching your toes.”

Jason: You’re wrong. No, that’s the opposite.

[35:17] The literal opposite of what you should be doing. And so, it’s like, yeah, it’s having an understanding of the resource that you could be. So, I refer a lot to you, right? And I also give exercises and I can give exercises, but there is a specific reason that I’m sending people to you.

Kathy: Right. Part of that reason is because your skill set is not just around telling people do this exercise, right? Anybody could do that, right?

Jason: Right. But part of your skill set is

[35:48] helping people go through the puzzle solving, the problem solving steps of how do we work up to a good amount of load, right?

Kathy: Right. How — I need to be able to do these skills, can you help me be able to do these skills? Like what are the muscles that need to be working for that? And like how will I know if I’m ready in order to go out and do that in the real world? And so, there’s much more of a skill set than somebody can just see on like, “Oh, here’s a piece of

[36:19] paper.”

Jason: Right. And I send people to you because of the way that you communicate with people. There are some physical therapists that I don’t send patients to and it’s because by and large they aren’t communicating with patients. They show up and they’re like, “We did our evaluation. Here’s the exercise I want you to do. I’m going to hold this clipboard, type on this laptop while you go and do that and I’ll observe you.” And it’s like, no — you’re a coach, you know? And that’s why I send people to you is because you’re good at coaching people and

[36:49] that’s part of the skill set. So.

Kathy: And we said this before, too, like we’re taught in PT school how to do manipulations. Like it’s in my scope of practice. I can do it and I do it once in a while, but I send them to you because you’re the expert. Like the velocity with which you have to perform a manipulation is a skill that you learned over time and I just don’t do it enough to be that good at it. Right. Can I do it? Sure, but it’s not going to be as good as the way you do it. And there

[37:19] are some PTs out there that are great at manipulation. They’re really good at it, but again, it’s like you said, we have a finite amount of training that we can do. And so, it’s like why wouldn’t you find somebody who has a skill set that your patient needs? Not that I need that — my patient needs. Why wouldn’t you send them to that person?

Jason: Right. I think a really easy reason is pride. Right?

Kathy: Yeah, people — I can do it all.

Jason: Yeah, people don’t like admitting that they don’t have all the answers or sometimes they don’t like admitting that

[37:49] they’re wrong. Sometimes people will just try and cram the same old solution down your throat.

Kathy: Mhm.

One thing — and again, I don’t understand the competition sometimes, but one thing that’s amazing to me is whenever I have physicians that will try to dissuade people from coming to see a chiropractor because they’re like, “It’s dangerous.

Jason: Mhm. You’re going to die, right?”

Kathy: Which again, on social media we see this

[38:20] and it’s kind of funny — well, it’s not funny, but it’s interesting. I’ll say it’s interesting. There’s nothing funny about it, but it’s interesting that you will see a social media post and they will tell the story of somebody who went and saw a chiropractor and then they ended up paralyzed, right? Or they had a stroke.

Jason: Right. And if you read these carefully enough, there’s a good percentage of them where if you look at the story, one thing that you’re going to notice is

[38:50] that there was no malpractice claim that was paid out or even filed. And the reason was because the chiropractor found out that the person was having a stroke, sent them to the hospital. They get to the hospital, they’re like, “Who sent them? Oh, the chiropractor sent them? Oh, the chiropractor caused it, right?”

Kathy: Which — if you want to know, and you can go look this up, the rate at which people experience a vertebral artery dissection or a cervical artery dissection, which is a stroke that some people like to pin on chiropractors, the

[39:22] Rate at which patients have those at a chiropractor or chiropractic clinic is exactly the same as the rate at which they have them at their primary care. Kathy: No way. Jason: Yeah. And so, it’s so rare. It’s so incredibly rare, but when you talk to some of these physicians about, “Oh, like, would you — should I go see a chiropractor?” They’re like, “No, it’s so dangerous. You could have a stroke.” One in 5 million.

[39:52] Okay, so if I had a quarter here and I was like, “Let’s flip this coin, and I want you to get heads.” How many times in a row would you have to get heads in order to get to one in 5 million? Kathy: Oh, many, many. Jason: It’s 20 times in a row. Kathy: Yeah. Jason: Yeah, if you can do that, awesome. Go to Vegas. Like, stop listening to the podcast. Get to Vegas right now. And so, it’s extremely rare. But, they talk about it like we’re sending about five or 10 people to the hospital every week with strokes. Absolutely,

[40:24] absolutely not true. Kathy: Right. Absolutely not true. 20 years of practice, I’ve had zero serious adverse events. Jason: Yeah. And it’s because it’s a really safe form of health care. You know what it’s safer than? Medication. Kathy: Yes. Jason: It’s safer than ibuprofen. Kathy: Ibuprofen. You know how many people die from ibuprofen every year? Jason: How many? Kathy: 16,000. Jason: Oh my gosh. Kathy: You know how many people die from chiropractic every year? Jason: How many? Kathy: Well, if you look in the literature, cases of death associated with

[40:56] chiropractic, there’s maybe two, three dozen. Jason: That’s in the 130-year history of chiropractic. Kathy: Oh, in the whole history. Jason: In the whole history. Yeah, if you look in the literature. Kathy: Mm-hm. And so, yeah, but by all means, ibuprofen. It’s yeah, like they sell it at Fred Meyer, you can get it anywhere. Ibuprofen is killing people like crazy. Comparatively. Kathy: Compared — right? But, is ibuprofen safe? Jason: No. Kathy: Yes. Jason: Why? I’ll let you tell me. Kathy: I think it’s pretty safe. I think it’s

[41:27] pretty safe. But, comparatively, like nobody thinks about — nobody talks about that, right? And they’re like, “Well, you know, you should be disclosing to everybody that they could have a stroke if you manipulate them.” Are you disclosing to everybody that if they take ibuprofen, then they could bleed out and die? Jason: Yeah. Kathy: They aren’t, but it’s like it’s because it’s safe, right? And chiropractic in general is safe. Do we have people that commit malpractice? Absolutely. But, sure, so does everybody. Jason: Sure. Right? Yeah. Yes. So, okay.

[41:57] Jason: It’s so good to get that out. I’m just so — Kathy: It’s just so glad to get that out. Thank you. Jason: Feels good. Feels good. Now, what I do is really, really safe. And it’s easy to protect people. But, we just have to decide to work together. And I think it’s really about the relationship building. Kathy: Yeah. You just got to find people that you trust. Jason: Yeah, we have really good — I think we’re lucky in this area, too. The physicians in this area really seem to trust PTs and chiropractors.

[42:27] Kathy: I think so. Because we get a bunch of referrals from physicians that are great. Jason: Mm-hm. Yeah. You know, I don’t know if that’s the same throughout our great nation of ours. Kathy: It’s not. Jason: Definitely not on social media. Holy smokes. But, I would say in the valley here, the physicians here really trust and value — Kathy: They are. Yeah. It’s an excellent place Jason: Yeah, it — to practice this. Kathy: Yes, we’ll be hiring soon, so Jason: It’s a great place to be a PT. Kathy: Yeah. Yeah.

[42:57] Jason: You know, there’s one other thing that I was going to say. Maybe it’s not important, and that’s why I kind of blacked out on it, but — oh, I think it’s this: that in health care, there are bigger fish to fry Kathy: Mm-hm. Jason: than other types of practitioners. Right? Like, let’s fix iatrogenic MRSA infections, right? Iatrogenic means it was caused in the hospital. Kathy: Yeah. Right? And there are some people

[43:27] that go in with nothing, and they leave with MRSA, and they die. Kathy: Yeah. Jason: And so, it’s like — and I’m not — it’s an incredibly difficult problem to solve, but it’s solvable. And let’s focus our efforts on things like that, things that are actually hurting people. There is not an epidemic of people that are being hurt or injured by people who are non-MD doctors. Kathy: Right. Right? Dentists — dentists are pretty safe. They’re not really hurting — well, actually, they hurt people

[43:58] all the time. That’s kind of their job. Never mind dentists. We’re leaving you out of this. Let’s go to optometrists. Kathy: They’re great. Jason: So great. Oh, yes. Screw you, dentists. Optometrists, you’re amazing. Chef’s kiss. Kathy: Jason: Yeah, anyway. Kathy: I have the best one. Jason: Now, we’re probably never going to be able to get a dentist on this show. Kathy: Probably — Jason: Closed that door forever. Kathy: Yep. All right. That’s fine. Jason: We have so many dentists in Corvallis, too. Kathy: We have a lot. Jason: Yeah, and I feel kind of bad because

[44:29] I’m friends with a lot of dentists, and I think some of them are like, “Bro, how come you don’t come see me?” I’m like, because the other guy was first, I guess. Kathy: We have a lot of dentists. Jason: A lot. We do. And they’re all great. Love all you dentists. Kathy: Yep, they’re great. Just kidding. No, I’m just kidding. I do. All right, is it time for a game? I’m very excited — Jason: Oh my gosh. Kathy: I am running this game. Jason: Holy crap. Yes, I know. You told me. You’re like, “I got the game.” Kathy: Yeah, I got the game. Jason: And so, all right. I think last

[45:00] time that you ran a game, like I was really on the hot seat. Kathy: Yeah, now this one — I think you’re — it’s right in your wheelhouse. Jason: Okay. Is it — yeah. Kathy: It is trivia. Jason: Yes. And even better, movie trivia. Kathy: Movie trivia. Jason: And even better, Christmas movie trivia. Kathy: Christmas movie trivia. Jason: Okay, so all questions about Die Hard? Kathy: Well, maybe. Okay. All right. Let’s do it. So, I’m going to read a quote, and you have to name that movie. Jason: All right, you filthy animal. Let’s do

[45:30] Jason: That was already one of mine. Okay. I’m winning already. I don’t know what movie that’s from, though, but okay.

Kathy: You don’t? I think I do.

Jason: Oh, okay. Yeah. It’ll be one of the questions. Okay. Number one. “I want an official Red Ryder carbine action 200-shot range model air rifle.”

Kathy: Yes, that is A Christmas Story.

Jason: Yes. Ding, ding, ding, ding. Just a wonderful movie.

Kathy: Starting off easy for you. Okay. Okay, here’s a good one. “Every time a bell rings, an angel gets his wings.”

[46:01] Jason: Mm, yeah, I hate that movie. Gosh. It’s with that old guy. Yep. It’s a Wonderful Life.

Kathy: Yeah, very good. Oh, man. My mom used to watch that. “You should come watch this with me.” I’m like, “What is even happening in this movie?” Like, I had to guess that one.

Jason: My ADHD would not let me consume any of that, yeah.

Kathy: Oh, yeah, you were not engaged in that. All right, ready?

Jason: Yes.

Kathy: “Jelly of the

[46:31] month club, Clark, that’s the gift that keeps on giving the whole year.”

Jason: Oh, vacation. Christmas Vacation.

Kathy: That was great.

Jason: Way, my favorite probably of all Christmas — oh, man, those poor Griswolds in their — in their pool that didn’t happen. Yeah, that’s such a — that’s a wonderful movie. “Right? She’s a beaut, Clark. She’s a real beaut.”

Kathy:

Jason: Okay. “I passed through the seven levels of the Candy Cane forest, through the sea of swirly, twirly gumdrops, and then

[47:01] I walked through the Lincoln Tunnel.”

Kathy: Oh, not even a challenge. I was in this — I was in this show. I was, yes.

Jason: It. This is Elf. I was in Elf the musical. Yes, I played Black Santa.

Kathy: Yeah.

Jason: Which, that’s not how it’s scripted, but when I’m Black and I’m Santa, yeah.

Kathy: And in Corvallis, that was a shocker. You know what, I think I’m going to do is when we have our premium subscriptions with this episode, I will have pictures of me in makeup, like getting into my Santa thing. But, yeah, I was a mall Santa, the one who smells like beef and

[47:31] cheese. Oh, great movie. Elf. I bet you heard that a lot.

Kathy: who are probably listening to this while they’re driving. They’re like, “Oh my gosh, Spotify just switched over to the Elf soundtrack.”

Jason:

Kathy: What happened to the PTCH podcast?

Jason: Authentic. Okay. “You know the best way to spread Christmas cheer is singing loud for all to hear.” Okay, anyway. That’s on the — all right. This is such a great game. Thank you.

Kathy: All right, keep going. It was in your

[48:01] wheelhouse. Okay. “Will you please tell Santa that instead of presents this year, I just want my family back?”

Jason: Oh, that — that is Home Alone.

Kathy: Yeah. Yeah, okay. All right. Which, I hate that movie. I do not like Home Alone. But, yeah, I — that one made sense. Yeah. Okay. That’s a tough one. Okay. Well, you’re going to get this one, but it’s one of my favorite quotes,

Jason: Mhm.

Kathy: so I got to say it. “You sit on a throne of lies.”

Jason: That is also Elf. Oh, yes.

[48:31] Kathy: That’s one of my favorite ones.

Jason: Mhm. All right, this one’s going to be a little bit harder. Okay. But I think you got it. “And why is the carpet all wet, Todd?” “I don’t know, Margo.” Why is the carpet all — Raul’s over there nodding. He knows it. Why is the carpet all wet, Todd? I don’t know.

Kathy: Julia Louis-Dreyfus. Did you know she was in that movie? That’s why I like this quote.

Jason: Oh my gosh. I think I just missed a trivia question.

[49:03] What is it? It’s Christmas Vacation. Is it?

Kathy: Oh, yes. Comes through the — oh, comes through the window. And it melts, and she just — knows how the window’s broken. That is — that is her. Oh my gosh. “Todd.” Yeah. Gosh. Oh, man. Okay. Good one. “You’ll shoot your eye out, kid.”

Jason: That is also A Christmas Story. All right. Last but not least.

Kathy: Okay.

Jason: “Yippee-ki-yay, mother trucker.”

[49:34] Kathy: That — that is the Christmas movie. That is Die Hard.

Jason: Yeah. So, I see where you stand on that debate.

Kathy: That is definitely a Christmas movie. Absolutely. Okay, I got one for you.

Jason: Oh, oh gosh. Okay. Dusty Dinkleman? That’s the name of a character in it. Is that a Christmas movie?

Kathy: I’ll sing you a song from it. Oh. “And I swear by the moon and the stars in the sky.” This is a Christmas movie?

[50:05] Jason: Uh-huh. Starring Ryan Reynolds.

Kathy: Oh, I don’t know. Really? Just Friends.

Jason: Oh, oh, okay.

Kathy: Mandy and I watch that every year and yeah, and people — people forget that that is a Christmas movie.

Jason: Okay, yeah, I didn’t know that. Have you seen it before? No. It’s — oh my — oh my gosh. Yeah, you’re welcome. That is — that is my gift to you this year is go watch Just Friends. Oh my goodness, it’s funny. It’s a funny one. All right, take homes. Okay, take homes. I wish physicians knew

[50:36] how we can educate people on pain. Okay. Yeah. And I wish physicians a Merry Christmas

Kathy:

Jason: and a happy New Year. So, which one of us is going to get a referral? No.

Kathy:

Jason: Good one.

Kathy: No, I — good one. Networking — networking is the key. We just got to get to know each other and it’s difficult because everybody’s busy, but that’s one of the things I actually love about doing the podcast is we’re able to make some really good connections with some

[51:06] other providers and it takes down some of those walls and so I feel more comfortable sending people to them and vice versa and at the end of the day it’s patients who matter and it’s patients who win. That’s

Jason: That’s what matters. Yeah. Yeah. Yeah. Yeah. Oh, one more thing.

Kathy: What’s that? What’s that?

Jason: There’s no I in PTCH.

Kathy: