and what you can learn about how to market your Physical Therapy practice in 2023.
Tim Ferriss is somewhat of a celebrity. You can read his biography HERE, but what’s important to this topic is his his regular podcast where he does a deep-dive exploration of (among other things) health and fitness. Ferriss interviews the most remarkable experts in the field, and has enough background knowledge to ask relevant questions. His appeal to the broad public comes from his clear explanations and his ability to simplify complex concepts. He is also adept at interrupting his guests, to ask them to go back and explain an idea in more detail for the listener. His podcasts have been downloaded more than 900 million times.
Which is why I found it fascinating that on August 4, 2023 he chose to interview Shirley Sahrmann on his show. Dr. Sahrmann needs no introduction to those of us who practice physical therapy, and the 2 hour interview reveals only a few secrets on clinical practice. What I found more interesting was how Mr. Ferriss questioned Dr. Sahrmann, and what exactly he was attempting to find out from her. Ferriss represents the curious public - the mass of hurting people who want help from us, as physical therapists. So where exactly is the public starting from? What do they think it is that we do, and how do they think we can help?
You can find the podcast HERE, but even without listening to it, you’ll find some interest in my thoughts below. My interpretation of the interview comes from the viewpoint of the general public - especially the Tim Ferriss fans who are looking for the most advanced, best-evidence approaches to a healthy lifestyle. These people are looking to extend their healthspan, and our physical therapy caseloads should include lots of these folks, if we want to be busy and efficient. So what do these people want to learn from a legendary expert Physical Therapist? And how can we exploit that in our practices, and in how we market to our potential clients?
Here are a few moments from the interview with Tim Ferriss and Shirley Sahrmann.
A. It’s not how much or how far you move that matters. It’s simply how you move.
Early in the interview, Tims explains that he brought her on the show because some of the smartest fitness experts he knows reference her as the guru. He asks her ‘what is it about your approach that you think appeals to these guys?’ She starts by referencing her early years in the profession (when she was seeing polio patients before there was a vaccine!) She reminds Tim that there was a time when we considered that pathology (stroke, polio, arthritis) was the cause of impaired movement. We thought that one acquired osteoarthritis, and that caused them to walk with a limp. Her approach opens up the other side of the coin, in that movement (when suboptimal) can be the cause, over time, of pathology. And then she makes a tragic comment on that principle:
“This insight has not yet been adopted by the majority of PTs”.
I wonder. What are they doing instead?
*poking holes in muscles with small needles?
*applying shock-waves to injured tendons?
*teaching the Big-3 McGill core exercises to everyone?
*scraping the skin and underlying tissue with expensive stainless steel tools?
*applying traction to the spine?
Each of these techniques has some merit. But what if that’s the only thing you do? I know some well-respected PTs in my region who chart “IMS and heat” as the only treatment provided, over and over again.
Ok, here’s the take-home message: The most discerning health consumers (the ones who listen to guys like Tim Ferriss) are starting to recognize that movement-based therapy might be the holy grail to really extending one’s healthspan. These folks are your potential clients. And they want a rehab professional who can evaluate how they move, identify the impairments, and teach them how to correct them for the long run. If you want to draw in these clients, you need to speak that language in your marketing.
B. Humility. The true masters are always humble.
At one point, Sahrmann is explaining to her host the idea of pelvic asymmetry, and one iliac crest being higher than the other. She describes the altered load that this posture may place on the vertebral motion segments, leading to tissue breakdown over time. Then, as she tries to explain the reason why she would recommend a certain remedy for this, she makes this profound statement:
“To be perfectly honest, I haven’t quite figured it all out yet.”
Think about that. She’s been a physical therapist since 1958. Her resume is impeccable. She has written the book on movement impairment syndromes. And she hans’t quite figured it all out yet. That should be so encouraging to us. That kind of humility is remarkable, and it tends to define the very best masters in any field. There is a combination both of extreme competence, and of curiosity that allows them to acknowledge ignorance.
Are you feeling distress from the “imposter syndrome”? Do you feel like you need to pretend you’ve figured it all out already? Did you know that it’s ok to acknowledge that you don’t know everything? When was the last time you answered a patient’s question with “I have no idea.” I do think there’s some power in that concept. Your patient might respect you more, and feel a stronger sense of connection if you, at times, acknowledge the truth. Even the best of the best have not figured it all out yet.
C. Un-training suboptimal movement patterns is hard work.
Ferriss asks an excellent question regarding the process of teaching a person how to change their movement habits. Again, here is where his deep curiosity and insightfulness shines. They’ve been talking about the ‘path of least resistance’: the reality that our bodies will move in the easiest pathway, which, in the presence of suboptimal adaptations isn’t always the best. This may have been occurring for years and years. He asks how does Sahrmann teach these folks to step out of a deep groove and learn a new way to move?
This is so relevant to those of us in practice who are trying to convince a patient that a simple exercise (for example: supine shoulder flexion overhead, without allowing lumbar hyperextension) is vital for helping them to have less pain when they go about their life. That is admittedly a hard sell on some patients.
Sahrmann breaks it down into 3 steps:
Acknowledge to the patient that it will take time. In other words, set their expectations right. In my practice, I do this by offering them a choice. I might tell them that we have 2 options: we can provide some temporary relief through hands-on treatment only, or we might fix the underlying problem so that they won’t need anyone to provide treatment, in the long run. If the patient is agreeable to this, then it’s not hard for them to understand that it will take time.
Find their barriers to optimal movement, and then learn exercises to reduce them. Isn’t this the hardest thing for us? It really takes some focussed observation and experimentation to look for. Sometimes it takes so much time, that we don’t even want to start, because we have a limited time with the patient, and we don’t want to spend it all on examination. We know they expect some treatment too. Maybe we need to book longer sessions with some patients. Maybe we need to find a way to examine for some (but not all) movement impairments each session. At the end of the day, doing this is worth it, as Sahrmann tells us:
“Changing the way we move optimizes tissue health and allows the body to heal.”
If that’s important to your patient, then make it a priority in your treatment sessions.
3. Learn to use the new, optimal movement patterns during functional, meaningful exercise. This really takes creatvity on our part. We need to first ensure that the patient understands how to move differently (and more optimally) in a controlled position, like sitting, or supine lying. And once they’ve mastered that, we need to have them show us what movements they do in their day that are painful, and teach them how to use their new movement skills during those tasks as well. Some of the best physios I’ve seen are in the gym, having their patient perform daily activities while they place their hands on the patient and guide them into those optimal patterns.
If we really want to attract good-quality, dedicated clients to our practice, we need to know what they are looking for. Following social media, and the podcast universe is a great place to be. When we listen to what questions the media are asking people like Shirley Sahrmann, we can better understand what matters to them, and how we should approach them in our marketing, and in our practices.
At the end of the day, we are the ones who best know how to help patients live healthier lives by optimizing their movement system. But the more we understand their motivations, and their basic assumptions, the better we can communicate our role to them.