In this episode, I’m joined by Lisa Chase, PT. She’s the Co-Chair of the Functional Manual Medicine Certification Program at Michigan State University, former Medical Director of the WTA Tour (professional women’s tennis), and owner of Back 2 Normal Physical Therapy in St. Petersburg, FL. She describes how she’s spent her career looking for “game changers” in the physical therapy profession. The first she found was the Michigan State treatment model, including the manual therapy techniques in the curriculum that she now teaches. She discusses some of these concepts and techniques, including muscle energy, biomechanics, and manual therapy. Her most recent “game changer” has been the NEUBIE, and she shares how she’s been able to use the NEUBIE to amplify the benefits of her manual therapy plus exercise treatment model, and also help people who would have been more difficult to treat manually because of their neurological guarding. With some of her stories from professional tennis and other clinical pearls, this episode is jam-packed!
Garett Salpeter (Speaker 1) (0:03)
Welcome to the NeuFit undercurrent podcast. And today I am super excited to welcome Lisa Chase. And she is a physical therapist in the St. Pete Florida area now, but also has reached at Michigan State University where she is a clinical instructor in the osteopathic medical school, and she runs a really cool program that several osteopath and physical therapists have been going through and other professionals in in manual therapy. So technically she’s the co-chair of the functional manual medicine certification program. She also has a wonderful practice called back to normal has experience in professional tennis, working for many years touring with the, with the athletes, and has a variety of expertise in osteopathic manipulation, biomechanics, various soft tissue techniques, and also with the Neubie, so I’m excited to dive in with you, Lisa, and explore all of that. Thank you so much for being on the show.
Lisa Chase (Speaker 2) (1:08)
Well, thanks for having me. This is great. I’m excited to have a chat and explore some different things that we’ve been doing.
Speaker 1 (1:16)
Yes I love it. So let’s start with your experience. I know this is a big part of what you do go into Michigan State a few times a year and teaching these continuing education courses. So it’s part of the do the osteopathic program at Michigan State? And can you talk about some of some of what you’re teaching there? And then, of course, that’ll be a good lead into to some of these techniques that I know you’ve been using that you love that you I know, in our previous conversation, you called them game changers. So.
Speaker 2 (1:49)
Yes. Throughout my career, I have, you know, look and search for those game changers. Well, let me take you back for you know, when I was first starting to practice, and I was in a spine center, and this was fairly early in my career, and I felt like I just did not know how to treat the spine. And I was working with all these incredible physical therapists and they were getting all these really difficult patients better. And I’m like, what is your secret? How are you getting them better? And they all said, you have to go to Michigan State. And I was like, okay, Sign me up. I’m in. So that began my journey of going to Michigan State. And it literally I talk about this all the time when I teach to new therapists that it is absolutely the number one game changer because it gave me a framework. So the program is in the College of Osteopathic Medicine. And they have faculty members that are working with the osteopathic students. And then they have adjuncts like myself, and others that are PTS DEOs, and MDs that come in to teach and usually it’s anywhere from a three to a, like four and a half day course. And you really learn the foundations of looking at the whole system, and figuring out you know, what are the best techniques to use to restore function, and so much of that is linked to the nervous system. And that’s why working with the Neubie has been so much fun, because it’s just another piece and another layer, where we can tap into the nervous system and make really profound changes.
Speaker 1 (3:38)
That’s awesome. I love that multidisciplinary approach with DEOs, MDS and PTS. And that emphasis on the manual therapy. So when you when you talk about that program and how it’s impacted you, can you share for everyone listening here, some of the either assessment or treatment techniques or you know, I mean, probably both obviously, it’s got to you got to start with the assessment and know where to go. I know that’s a big part of what you’re doing. But can you share some of the techniques that really have moved the needle have been those game changers for you? And just give it give everyone a little bit of education on what some of those are and how they work?
Speaker 2 (4:16)
Yes, absolutely. So, like you mentioned, you know, it’s the manual types of techniques. So part of the certification course, is not only going through the foundational course, but going through various courses like muscle energy, so muscle energy is one cranial sacral is another joint mobilization myofascial so these are in that of course, our exercise course which blends much of it all together. But the thing that I would say is the biggest game changer is muscle energy. And when I talk to faculty like Mark who you know, he is my partner and the rehab links, Mark is just a wealth of information in his taken all sorts of various courses. And every time we’d meet, I’d always say mark, like, if you can only have one tool in your bag, what would it be? And it’s always muscle energy. So muscle energy is an amazing tool that really it switches the nervous system. So it’s looking for a segmental dysfunction. Somewhere along the spine, it can be, you know, in the pelvis, it can be in the extremities. So you’re looking at the muscles that are attaching around that joint, and you are working within the binding ease of that joint and the muscles that are attached to it, and being able to just give very gentle muscle contract, relax, relaxation types of cues to the patient, and then you move to the next barrier. And even my clients that come in, they all kind of know how I do my assessment. They’re like what is this, this is just, and I’ve never had this before. It’s just unbelievable how, you know, you just do like the littlest thing, and all of a sudden, I can move again. So it’s super powerful, definitely the making the diagnosis and figuring out what is the best level to address. And then as soon as you do that, and you work with those the muscle muscles, which ultimately are working with the nervous system, it flips that switch, people can move again, we get muscles that are inhibited to now fire, and muscles that have too much tone to quiet down.
Speaker 1 (6:40)
And when you in order to in order to figure that when you’re doing your assessments, are you doing observation of gait? Are you doing manual muscle testing? Are you feeling tissue tone manually? What are you?
Speaker 2 (6:52)
So I do want to look at how people move globally, because am definitely not somebody who is what’s to say, a purist. I like to use various systems. So I also have done some teaching with SFM, a and FMS, where they’re looking at more global movements. And so I combined that with looking at how people move in various different, you know, directions. And then I look at how the joint mobility at the different joints. So is there something that restrict is restricted? Once I kind of hone in on the main areas and figuring out is it truly a mobility issue?
Or is that a stability issue, because if it’s a stability issue, I’m going to go down a different road. So I like kind of determining, okay, if its mobility, then I’m going to mobility test the areas that I anticipate to be restricted. And part of my assessment is looking at the firing patterns and the movement patterns of different muscles. So say, for example, you know, glute max, just looking at the overall firing, not just as the glute max firing, but looking at the overall pattern. And then if that just that is a dysfunctional pattern, then looking at what could inhibit the glute, you know, is it you know, a hyperactive hip flexor or tight anterior capsule? You know, is it l five s one, you know, is it you know, something, you know, sometimes it can be something in the viscera, that can be restricted. So I want to figure out, what is why that’s inhibited, or what’s inhibiting it. And that’s where I love the exercise course, in complement with muscle energy, because it allows us to look at movement patterns, and quickly go, okay, how can I get the biggest, quickest outcome, which is by you know, treating those areas that are going to influence that inhibition or that tone? And then I love to use the Neubie right after because, again, just reintegrates, that movement pattern.
Speaker 1 (9:06)
Awesome. So thank you for that description on assessment and muscle energy, in terms of muscle energy. So when you’re doing you said there’s subtle contractions and relaxations, more like isometric contractions, and would you be providing light manual resistance or cueing.
Speaker 2 (9:24)
Yes you’re going it’s really, it’s very, really pretty light, because what we’re trying to do, particularly in the spine is we’re trying to get those real small, like the multifidus to fire. So if they do a real big contraction, which you can do in the, in the pelvis, where I want to create more of a, you know, a bet bigger, stronger contraction to get a bigger bone to move. But when we’re talking about this fine, it’s going to be a smaller, much smaller, gentler range of motion where I can get localized activation. So I can change what’s happening at two segments.
Speaker 1 (10:03)
That’s awesome. It does feel like a manual way of using the Neubie getting that more kind of precise. I love it. Yeah. Can you also share you mentioned some of these other techniques, myofascial cranial, can you share a little bit about just at least at a high level, what those are and how they work?
Speaker 2 (10:25)
So the cranial system, so you’re evaluating the cranium, right? So there are these little, I’m showing you as if they can actually see me. But these little sutures that are within the spine, so I’m sorry, with that, or within the skull, there actually are some movements in there. So it’s more the, the fluid balance that you’re trying to influence, and you can actually influence the joints. So these are very gentle techniques that can impact not only kind of a head and neck, but they can influence other parts of the body, like I’ve had people come in with low back pain. And because of the Dural connection, from the occiput, down to the dura down to the sacrum, you can make a change all along that so sometimes you’re treating sacral mechanics and influence headaches, sometimes somebody has headaches and neck pain. And in your treating the head and neck, and you can influence back pain. So those are very gentle techniques, myofascial your, you’re working within the fascial system. Again, these are also very gentle techniques.
I will you know, this is just using the hands and feeling where there’s a restriction, and then you’re just moving with that tissue and trying to get that the fascia to release, I couple that with, I did some training called melt, where you’re using foam rollers and small balls, to then give some tools to the patient to take home so they can decompress their joints, they can rehydrate their fascial system and maintain from session to session.
Speaker 1 (12:22)
That’s awesome. Excellent description there. And then the other thing that you mentioned a couple of times here as part of that curriculum, and one of the real impactful techniques for you or approaches for you is, in that exercise. Class. And exercise, you know, obviously, is a very broad topic. So can you tell us a little more about what that means to you? And what’s being covered in that portion of the curriculum?
Speaker 2 (12:46)
Yeah, so when I took the muscle energy, like I said, it was definitely a game changer. But then you know, you come home, you’re doing these muscle energy techniques, which are great. But then once again, how do you maintain what you’re doing from session to session, and in the exercise course, we look at the upper quarter and the lower quarter. And there’s a series of movement patterns that we evaluate. And with each movement, we help you identify, Okay, for example, if the lower trap is inhibited, what might what might inhibit the lower trap, and then we’re going to look at very specific manual techniques that we can do that will turn that lower trap back on, then once we turn it on, then it’s selecting the right exercise, to get that muscle to fire and or to keep, for example, that lower thoracic spine to extend because we find that when that lower thoracic spine gets more flexed, and it gets rigid, which you know, when we’re sitting and started typing on a computer, that’s a very common, you know, thing to happen. So we give things to help self-mobilize that thoracic spine and then do the muscle activation. Because a lot of times I find that patients are doing exercises that just reinforce and I’m sure you see this with Neubie as well, right? It’s reinforcing the wrong pattern or the wrong activation. So it’s great that you know, we can have a technique that one restores motion in a joint or tightness in a muscle or fascia or scarring, and then you know, gets muscles to reactivate or to quiet down, and then we can pair that with, you know, an exercise then that they can go home with and they can maintain, and then we will teach techniques of how to do self-mobilizations. How to teach patients for example, we use the pelvic clock and a lot of people don’t know about the pelvic clock. Mark actually took the pelvic clock to the next level, where he looked at How the therapist and eventually you can teach the patient this, how you can tell where there are certain restrictions in the spine by moving around the pelvic clock. And so by doing that, you know, even after I’ve treated somebody, I will always go back to the pelvic clock to see is there still a restriction in, you know, in the pelvic clock, and sometimes it’s more motor control. And other times, it’s still more mobility. So that’s always my final check to see if they, I always tell my patients, I’m going to clean your clock. So you know, by making sure that they’ve got a clean clock, I know that their motor control is good, as well as their mobility, and the spine and pelvis are moving the way they need to. And if not, then I teach them, okay, if this part of your clock is restricted, you’re going to self-mobilize, and then retrain. And then you teach them how to, you know, take care of themselves. And so, I mean, I’ve used that a ton, I had a client who was a big marathon runner, and she went, she and she hated the pelvic floor, when we first started doing the clock, she’s like, I just hate the pelvic wall. And I said, I trust me one day, you’re going to thank me for the pelvic clock.
And she was in London, running the marathon, a marathon there. And she emailed me and she’s like, now I get it, I love the pelvic clock, because she was able to figure out while we were in different time zones, and, you know, she could look at the pelvic clock, see where she was restricted, and she can get herself moving again, get those muscles firing, you know, right before you know, she’s getting ready for a big race.
Speaker 1 (16:40)
So if people are listening to this and thinking, that sounds fascinating, what is the pelvic clock, can you give us a quick description of?
Speaker 2 (16:47)
so the pelvic clock, so if you think of somebody is lying on their back, alright, and if my, if you’re looking straight on to the pelvis, and if you use the belly button, right, as a marker, above the belly button is the top part of the clock, that would be 12 o’clock, and the bottom is six. Okay, so if I have my hands on the front of the pelvis, and I think most people listening would know what a posterior pelvic tilt is. So if I move into a posterior pelvic tilt, and I’m rolling my spine towards the table, that is selection. So I’m looking from an osteopathic perspective to say Can the facetted open, if I’m going down into six o’clock, I’m looking at can they can they close. And then if I start to move into the other quadrants of the pelvic clock, so let’s just say seventh and eighth, and, and they’re stuck, and they can’t go into seventh and eighth, well, that is challenging the spine to side bend and rotate to the left. So I know something is stuck, and can’t move on that left side. So now I can either use a manual technique to correct the mechanics or I can give them some exercises to do to free up the restriction and then retrain that control. So that’s, so it’s looking at the different components of 12, and six, three, and nine, and then going all the way around the clock, and making sure that everything is, is moving well, both from a mobility perspective and a motor control.
Speaker 1 (18:31)
That’s great. Thank you. For that description. Want to make sure we’re all on the same page? Everyone understands that? A couple of things that you mentioned about that exercise approach. I mean, of course, I totally agree with that, in terms of wanting to maintain the work that you do in practice helping people get the right, the right cues and specific movements to activate the right muscles in the right way and do all that. And it was interesting, you mentioned, you want to make sure you’re doing it right, because you want to train the correct or optimal improved pattern rather than doing it wrong. And how the Neubie might play into that. And there’s kind of two perspectives. So it’s an interesting, interesting little sidebar discussion here. But if you’d looked at it, it was there’s two ways to do it to look at it. One is you can say okay, yes, you definitely want to be sure to make maybe extra certain to make sure that the patient is moving well with the Neubie and because there’s so much sensory input so much of this a Farrant signal going, that it’s going to accelerate the process of motor learning. So if they’re moving poorly, in principle, at least you could you could potentially cause them to learn to learn a poor pattern more quickly. The I think then, fortunately, that’s countered by the mapping process and identifying where the deficit is, and by providing the input in an area of deficit, you make it much more likely that the movement patterns will be beneficial will be more optimal, will you will be more along the lines of what we’re looking for.
So since you since you brought that up, I just wanted to share a couple of thoughts there because it’s it that that in and of itself is an interesting topic of conversation because there’s a few points there.
Speaker 2 (20:12)
And I would say, you know, sometimes what happens is patients come in, and they’re in so much pain that sometimes it’s hard to even really do any manual work. And so that’s where I love to go, I pull in the Neubie, so then I might reverse it, and do Neubie, first mapping them, try to get some of that, you know, threat bucket reduced, and then go in and do some of my, you know, manual treatment. So, I can really go both ways.
Speaker 1 (20:41)
Yeah, excellent perspective. Thank you for that. I think people listening will appreciate that, that walk through their curriculum and that program that influenced you, and that you’re now teaching and sharing with other professionals. So I appreciate that. And let’s, let’s transition now, into a little the next phase of your store, you know, another part of your story. So can you can you share with everyone listening, your experience in professional tennis?
Speaker 2 (21:11)
Yes. So again, a connection to Michigan State, I was teaching at Michigan State and several of what we call the primary health care provider that was the role when you’re on the tour. And they came, and they were taking some of my courses. And at the time, the person who was heading up that department was really looking to expand the skill level that the players were asking for were therapists that had really high level manual therapy skills. And Michigan State is, you know, I think one of the superior programs that really gives those, those tools. So several of the therapists had come to the course and you know, at that time I had worked in, in sport, but never professional sports. And so several, the therapists after that course, said, Hey, we got a tournament in Amelia Island, I lived in Jacksonville at the time, you know, you want to, you know, come and check it out. And I was like, Okay, sure. So I went and, you know, was in the training room. And you know, at the time, I’m not an athletic trainer, so it isn’t, it is a very different environment than when you’re in the clinic. And so they asked me to start treating some of the players. So I started treating some of the players and they loved it. So then I was invited in the US Open, which is a whole other eye opening experience, you know, to be at a very big event like that. And shortly thereafter, they asked me to come and join the tour. So that started my journey on, you know, really integrating much more, you know, sports medicine, you know, athletic training on the field. So, and I use these Michigan State techniques, there’s lots of pictures that are out there, you know, from me at Wimbledon, on Sen. Core, you know, let you know, you can see I’m doing, you know, some specific evaluation techniques that we learned at Michigan State. So you can use these techniques on the court very quickly or in the training room. But, you know, essentially, you had a team of people that, that traveled around the world, and we both, you know, would set up the training room and we help, you know, our players get ready for, you know, preparing for their matches. And then obviously, you know, after their matches, if they had an injury on court, we were the ones that went on board. And, you know, within a very short period of time, three minutes or last year, you’re having to kind of figure out what’s going on and, you know, implementing some kind of quick treatment strategy or taping technique.
So they can, you know, finish their match, and then it’s managing, you know, if they have a serious injury was certainly happens in professional sports, it’s following that that player through helping to make sure they’re getting the right care wherever they are in the world, making sure that they’re, you know, seeing the right therapist and on track for when they’re going to be returning. You know, we also conducted physicals, which would happen once or twice a year, at different tournaments, where we would, you know, provide a service where we would have a whole team of people that would come in to do those physicals and help, you know, guide the therapists on, you know, any kind of health and wellness kinds of recommendations. So, yeah, it was, it was a great experience and, you know, got to work with, you know, some of the best athletes in the world and an amazing sports medicine team that you know, where you’re, you know, you’re working with physicians and you’re working with, you know, practitioners from around the world, which is really fascinating. You know, I think many of us, right, we’re just used to being in the United States and treating here, but it’s a whole different perspective when you have to communicate with different cultures and languages and, and just different philosophies. And on top of it dealing with the media, and you know what that means to be in a very highly visible sport. So it was a great experience. And I learned a lot and there’s a lot of fun.
Speaker 1 (25:42)
That’s great. That’s great. I like there’s a little bit of a tennis theme on this podcast about five or so episodes ago before this one we had John is neuron who’s been Yes, one of the highest ranked American tennis player for the last many years.
Speaker 2 (25:58)
I heard that was great. It’s a great podcast. Great to see that he’s utilizing that. Yeah. Good for him.
Speaker 1 (26:06)
That’s cool. That’s great. Great to hear your story as well here. And I like it’s fun to get those glimpses into professional sports generally, and tennis, because it’s a unique, you know, it’s a unique, more of an individual than a team sport. Different dynamics in terms of travel, staying in one place for longer periods of time. And just some interesting nuances in tennis as well.
Speaker 2 (26:28)
Yes, absolutely. Being an individual sport, it’s definitely unique in that way.
Speaker 1 (26:35)
Yes. And you mentioned, the, essentially, the collaborative nature or the team care, nature, team care dynamic that you had there, where you’re working and coordinating with other professionals and things like that, and knowing, you know, our conversations and, and your perspective on your private practice. And in St. Pete, Florida, I think that’s a good segue into talking about back to normal, because it there’s, there’s echoes of that same sort of Team treatment, dynamic, collaborative, collaborative team, team, you know, structure dynamic there. So can you can you tell us now a little bit about your private practice, introduce us to what you’re doing at back to normal?
Speaker 2 (27:20)
Absolutely. So you’re correct. So, you know, my experience on the tour, you know, plus experience that I had previously, but certainly working in a team environment, and working with professional athletes, where it’s not just about the injury, it’s so much more, you’re treating the whole entire athlete. So, you know, my vision for back to normal is, you know, promoting whole body healing to get you back to normal. And so everything that we do is, is looking at the whole person. And when I started off, I started off just myself, but my vision was always to have a team of professionals in house plus a team of professionals outside in the community that we can collaborate with, because sometimes physical therapy is not what somebody needs. And it’s important to me that I help to try to give some direction for, for my patients, if I’m not the right fit for them. So within our practice, so obviously, we have physical therapy, and that is how most of the clients come to see us. And a lot of times it’s you know, patients who have been in they’ve been out other places, they’ve either had other physical therapy, they’ve had chiropractic, they’ve had injections, they’ve had surgeries, and they haven’t improved. And so oftentimes, they kind of come in very skeptical about well, what are you going to be able to do to help me because I, you know, I don’t you know, and I’m sure you’ve experienced the same thing with new because certainly having Neubie as a tool is a big influencer on how much you can impact somebody’s recovery in their pain. So from that it grew to bringing on nutrition, I feel is a really big important component. I’ve had several patients that I’ve seen that came in with what seemed like musculoskeletal pain around their abdomen and ribcage, and it ended up being their diet. And so being able to listen to somebody’s story and to figure out you know, where things are coming from, and that’s a big part is, you know, for us here is looking at, well, is it the musculoskeletal system? Or is it Are there other influences and then being able to have we have a functional nutritional therapist who can really look at you know, gut health I mean, to try to strengthen the core and the gut is very, you know, Day You’re the you know, the abdominals is hard if you have gut issues, so being able to have a professional on our team who can address that, and with each evaluation, they get a complimentary, you know, session with that nutritional therapist, we have Pilates instructors, and Pilates is a big part of how we help people regain positive movement experiences, and integrate the core and those muscle activations. And we will pair that with Neubie, which is a lot of fun, health coaching and fitness, as well is, you know, so it’s working with them while they’re in rehab, and then transitioning as they move out of rehab. And, you know, and it’s, and it’s looking at, you know, even the stressors, and, you know, we know, with COVID, and all the things that’s happened in the last couple years, I mean, stress has certainly been a huge piece, and, you know, thank you for, you know, your work with, you know, the threat bucket, and, and how maybe plays a role in that I use that every day to explain to patients, how, you know, these various, you know, stressors are going to impact their pain, their ability to recover, how much we can impact their training, so, so we really, you know, do utilize that now, Jason was, you know, a shout out to him, he’s the one who introduced me to New Beat him and I had been colleagues for a long time, and we’ve shared technologies back and forth. So he’s either calling me or I’m calling him going, Hey, have you heard about this? We heard about that. And so, you know, he introduced me to the Neubie, and also his heart rate variability testing, which we implemented, and that’s just been an eye opener, and, and really great to be able to pair with the Neubie and master reset, and knowing you know, and then actually seeing how much changes we can make, not only in heart rate variability, but you know, and getting people out of pain.
Speaker 1 (32:16)
Yeah, that’s great. I’m so glad you brought that in are working on that. And I think that’s a missing link in many physical therapy treatments. And I’m just so glad to hear you say that. And one other interesting dynamic about your practice, correct me if I’m wrong, but I believe it’s all cash, no insurance. Is that right?
Speaker 2 (32:35)
Yes, you’re correct. So when I first opened up my practice, I remember sitting down with all the faculty member at Michigan State who were all in insurance based models, to physicians and a couple physical therapists. And they all looked at me and they said, you need to do usually you just do cash. And I was like, really? Are you? Sure? That’s kind of scary, you know, because this is back, you know, many years ago, right? In 2010, is when I first opened up, but before it was cool, and before it was cool? And now everybody’s doing it. So yeah, so I did, it’s fully its cash base. And, you know, we, you know, just, you know, have worked with that model where we really can spend that, you know, one on one time with patients, we don’t have to have insurance companies dictating, you know, what we can do what we can treat, if somebody comes in with low back pain, you know, I’m probably going to be treated in the neck. And so it gives you the freedom to treat the whole person, and to give them what they need to get well, and then we assist them with giving them invoices and whatnot. So they can submit to their insurance company, and, you know, possibly get some reimbursement. So, you know, that’s always an option.
Speaker 1 (33:56)
And part of that is, in order to in order to make that work, obviously, you’re able to have more freedom to do what you do. But there’s also a component to that, where you have to convince people to pay out of pocket, right? So.
Speaker 2 (34:11)
Absolutely, yes. And so that, especially like I said, we get a lot of people that call that are like, well, like what are you going to do for me, right? Because they’ve been other places. And so we a lot of times, you know, when patients call if they’re apprehensive about that, the first thing that we do is one of the therapists just gets on the phone and just has a conversation with them, you know, just you know, listening to their story, and, and helping to answer questions and to determine, well, are we a good fit? And I always tell patients, and you know, I always emphasize this with our, our front office staff is that, you know, when somebody comes in within a couple sessions, certainly by the fourth session, they should be feeling it difference, they should feel a difference in how they move. Now, sometimes pain can take a little longer, but usually there is a change. And I can tell you that I’ve caught more things than not when patients don’t respond. And one of the faculty members that I teach with a Michigan State, Dr. Carl Steele, he started off as a PT, and then you know, became a do, and he’s the chair of our muscle energy course. And he taught me so much, but he always said, you know, if, if you treat something and it doesn’t respond the way you would expect it to respond, then you should take a step back. And I have always done that. And I’ve had, I had a member, a guy that came in that I treated for tennis elbow a year prior with tennis elbow, and he got better, he came in a year later, same symptoms, I did the same kind of treatment, but he got worse. And after, you know, one or two sessions, I was like, okay, timeout, something’s not right. And I referred him and he ended up having a tumor in his elbow.
So those stories have definitely come up, and, you know, so that, so we try to reassure our clients to say, look, it’s not like, you’re going to have to come in for six months, you know, obviously, unless somebody’s had major surgery, and, you know, there’s other things might maybe that are going on, but you know, for the most part, we expect to see a change and an improvement, and I’m not going to just keep seeing somebody, and that’s where I’ve tried to develop a really good network of other clinical practitioners, you know, sometimes it’s mental health professionals that we need to have assistance with, or it’s, you know, specialists and, you know, PRP and bone marrow, you know, types of injections. So, depending on, you know, what the patient needs, then we try to work with our partners and people in the community that are on the same page as us and, and, you know, get them to collaborate and see if we can help in that way.
Speaker 1 (37:15)
That’s a great approach. And I especially like that, that concept of expecting to see results within the first few sessions. I mean, not only do you want to deliver value to patients, but like you said, it also has that diagnostic value, because you can tell how much of it is, is truly a musculoskeletal injury, or issue or, or orthopedic caused pain, or is it something else like a tumor. So the fact that you’re using things that that work well enough that you actually expect to achieve results? I think that’s crucial. I think that’s a big point. And I want to hit home, hit that home for everyone listening. And it’s also a good, good segue into the Neubie, and I know you’ve mentioned it a couple times, to talk to a few different ways about how it can how it helps you how you incorporate it, can you can you just share a little bit you also mentioned, you know how you learned about it from Jason was trying it out? Can you just talk about the process of fitting it in how it’s how it’s fit into your treatment process? And overall flow? And back to normal?
Speaker 2 (38:21)
Absolutely. So, you know, like we kind of spoke about at the beginning of the segment, you know, I like to look for game changers, and especially when you’re in a cash based practice, you know, you really want to know, well, what are the game changers that are getting get you the best outcome. So Michigan State, for sure, the training there and learning that model would be you know, number one, the Neubie, obviously, is the other and then a stem that know that there’s lots of instrument assisted types of treatments that are out there. I have found a stem, just, you know, I want to want to work did some work with Major League Baseball, the therapists that I’ve worked there, with, had introduced it to me and then Dr. Severe, who’s the one of the orthopedic surgeons, who was on a team of people that developed a stem, I got to spend some time with him and really understand, you know, treating the whole kinetic chain, you know, which is, you know, again, the whole body and the whole system is really important. So, what I really do is, I will utilize, again, my Michigan State model, because I want to kind of wide view, look at the whole system. I always say to anybody that, you know, when I’m teaching the mysteries in the history, so listening, you know, to the history, and, you know, kind of just figuring out Okay, are there any red flags, what’s going on? What are the main areas and then getting into your exam where you can really figuring out where am I going to have the biggest impact? How am I going to make this change? And then from there, you know, I’m looking at, okay, you know the difference between the joint mechanics and the soft tissues. And where do I think I might get the biggest impact. So I can use my muscle energy or my manual techniques, I can also use some dry needling to release any trigger points. And then I like to do the Neubie, and I love to do the mapping process.
And oftentimes, where those muscles are hyper facilitated, maybe where there’s trigger points, that’s where the Neubie is going to pick up those hotspots. So now I’ve you know, now I’m going to reintegrate through movement and using, you know, Neubie, to help reset the nervous system, and re integrate those movement patterns. And then afterwards, I’ll do my a stem, and I’ll do my a stem, and then do a little bit of loading of the tissue, you know, if needed, you can add some taping, and then you know, send them home with the best exercise that is going to complement what we just did, right. So, you know, if, you know, I want to get the boot to fire and I want to open up, you know, the front of the hip, I might do some self-mobilizations, you know, using some band work to open up the front of the hip, so they can do some self-mobilizations. If I feel like the spine is restricted, I might do some pelvic clockwork. And then, you know, get the best glute exercise, it’s going to turn that on, then once they kind of move forward with okay, they’re moving well, muscles are firing, I see that things aren’t being inhibited. Well, now I can start integrating full functional, you know, movements and move into the strengthening that we can do with Neubie, or even, you know, for mobility, I love using the new V on muscles that are hypertonic. And just doing some mobility work, I mean, it just totally frees up the system. And I love the stuff that you taught in the advanced course, I’m just going to make my way through the advanced course on the breathing techniques. Because we do a lot with breath and you know, conscious breathing and using the relaxed later. But I love how you use the Neubie on the you know, the last, the serratus and working through some of that breath work. So that’s super, super effective if I’m trying to further integrate getting those flexion extension patterns. Re integrated is to use the Neubie now with breath work.
Speaker 1 (42:46)
Awesome. I’m so glad you enjoyed that and coming from you. I appreciate that feedback on the course there. That’s wonderful. In terms of in terms of using the Neubie, are there any other kinds of particular cases or stories that that stand out in terms of, you know, best use cases or just kind of highlights of the application?
Speaker 2 (43:08)
Well, you know, we recently had a patient that came in with a stroke. And he had already gone through a lot of rehab. And he had a tremendous amount of flexor tone in the arm, as well as the leg. And he had a drop foot. So one of the doctors that I I’ve treated personally referred him and said, hey, maybe Lisa can, you know, do some things to help. And I actually reached out to one of your therapists to kind of collaborate with them on you know, best practices. And just after one session of like, for example, using the glove, I was able to change his tone. And that’s like incredible because as you know, like tone is very hard wired and hard to change. And we really couldn’t do much with strengthening right or trying to get activation, we wanted to deactivate the muscles. So mapping so I mapped his upper quarter and I use the glove on his hand. And within one session, you know, he was he was really flexing, you know, anytime I would ask him to do the movement of anything, he basically would flex his upper and his lower quarter will after that first session. He wasn’t even I didn’t do anything to the leg, but he wasn’t even pulling in his leg and the arm was you know, more relaxed and the second session, he was no longer stuck in that flexion pattern.
You know it His arm was more relaxed. So that I thought was just you know, that was that was really incredible. You know to see an obviously getting people out of pain and getting people moving. Getting people to touch their toes is always fun, right? When they’re like, you know, I’ve never been able to touch my toes, you know, and I always laugh and I’m like, Okay. I should make a bet with your right to see if I can get you to touch your toe. So, yeah, so it’s great to integrate, you know, obviously, to when you get that tone to quiet down, whether it’s something from a neurological insult, or, you know, just that neurological, you know, input like the hamstrings, right? I mean, the hamstrings are rarely an issue that it’s tight, and you have to stretch it, it’s more why there is so much tone in the hamstring. And when you figure out that, then you can figure out, okay, the best treatment and home program and things that they can do to maintain it. I actually had a patient just yesterday, she came in and she couldn’t touch her toes. And she had that fear, right, she didn’t really have any pain. But she had hurt herself from doing lots and lots of heavy training. And she strained with, she had some tendinitis, tendinosis of her and her hamstring attachment. But she would not she like went down. And you can tell like, there was this fear, and anybody who’s been in pain, and I’ve been there, I had a herniated disc. And I know exactly how this feels where you do something just right in your brain just goes off, and it’s like, nope, not going to do it. So then I late I was had her on her back. And she was able to do a beyond 90 degrees of straight leg raise, and I can have her sit and touch your toes. So I knew it was more the brain that was the problem. Right? So we did 10 minutes, you know, we did mapping and some exercise, we, you know, I did, you know, a little bit of, you know, treated one or two mechanical things, she got up and touch your toes. And she looked at me and she was like, whoa, what just happened? So, yeah, so those are some ways, you know, that we’re integrating obviously, with, you know, the heart rate variability. And using master reset, we combine that with the bio mat. So we have a bio mat and a bio acoustic mat. That is, you know, really wonderful. And we’ll combine that with a master reset, and people just float out of here, you know, and they sleep better. And, you know, sometimes, you know, when somebody comes in, and they’re just in so much pain, I will, you know, I will do the master reset. And then we use essential oils, and I do a treatment called the aroma touch that helps with, you know, improving the immune system helps with pain and inflammation, bringing the body back into homeostasis, and kind of de stresses that autonomic nervous system. And we know when you know, the autonomic nervous system is imbalanced and you got too much of a sympathetic load, then you have too much pain. And there’s been several patients that, like, they just they were so distressed, and their third their sympathetic were so lit up and their heart rate variability was so low, that just doing that, like that made a huge impact. So you know, we can also use it in that way.
Speaker 1 (48:38)
That’s wonderful. Thank you for sharing that. And one, one quick follow up question with the athlete you mentioned who was at the apprehension around bending down to touch her toes? I’m treated you said you did mapping with her founder hotspot. So out of curiosity, because I’ve seen several different ways that can go were her spots on the hamstring any of the hamstring muscles themselves or are synergist antagonists where were they?
Speaker 2 (49:03)
Her MA and see it was? Actually I think it was low back and glue.
Speaker 1 (49:11)
Okay. Yeah. Interesting. Yeah. So sometimes you’ll find something on medial or lateral hamstring. Sometimes you’ll find that something on a synergist or muscle, you know, same chain there.
Speaker 2 (49:22)
Sometimes I do see it on the hip flexor because a lot of times an over facilitate hip flexor will, you know, will lock up the hamstring too. So.
Speaker 1 (49:32)
yeah, and that’s what that’s one of the cool things of following the process going through the mapping is you’ll figure out you may you normally if you were thinking of using some sort of electric modality likely would put it on the hamstrings for hamstring, you know, tendinitis, tendinitis, tendinosis injury, but the fact that you did that and had that great outcome, of course, if you have that outcome that tells us You did the right thing. You gave the right inputs in order to get the right outputs and changes there. That’s great. So.
Speaker 2 (50:00)
Okay, I think that’s a great point. So if you don’t get a good, you know, outcome, you know, then one or two things, either A, you didn’t follow kind of, you know, follow the system, whether it’s like our Michigan State model or the, you know, the new the mapping process. You know, I know, when therapists are first learning, you know, Neubie, it’s like, you know, they’re used to just being able to put the pads on, right? Like, oh, the mapping process kind of takes a while, and I’m, like, just follow the process. Because if you do, you know, then you’re going to get, you know, your chances of getting a great outcome are much better. But if you don’t, you know, one is asking yourself, you know, am I, you know, am I following those things? Am I in the right area? Or, you know, is this something that really shouldn’t be in physical therapy? And is it more of a referral, you know, out of the clinic if it’s not responding?
Speaker 1 (50:55)
Yes. Great, great perspective. I’m glad you said that. And, as we transition to the final moments of our time together here today. Can I let’s segue to one other place to talk about rehab links. So can you share, share with everyone who’s listening what rehab links is?
Speaker 2 (51:16)
So, Mark Book Out is a physical therapist that developed the exercise course, at Michigan State. When I started teaching, I knew because I had already taken the exercise and the muscle energy, I knew I wanted to be teaching in both of those courses. So I started teaching with Mark. And, you know, Mark put together this amazing manual, and at the end of the manual, and had all these exercises, that patient, the therapist could take home, and photocopy. Well, I knew that where we were going was away from paper and into technology. So I talked to Mark for years about we really need to take this and put it into, you know, a system where it can be, you know, set an exercise where you can see the videos and, and the exercises, you know, more easily to prescribe to a patient.
So we worked with a company called physio-tech, and Mark and I went to Montreal, and we filmed all of the exercises in the exercise course. And we basically cloned physio-tech into at that time, we have links, where any of the therapists could get that system and use kind of the terminologies and the different ways to identify if there was a problem. So for example, what we call an FRS dysfunction. So a segment that’s flex, side bend and rotated, we you could actually search, what are the exercises that would that would improve that. So after you’ve treated that dysfunction, what can I give us an exercise, so therapists could go in and they could, you know, pick that and then it would shoot out the exercises, and you can email it to a client. So we initially develop that. And then I always knew I wanted to bring more of the exercise course, online. So during COVID, when we couldn’t obviously teach in person, Mark and I worked together to develop rehab billing systems, which now is an online course. And initially, when we put it together, I wasn’t able to do a lot of the videotaping and the filming. But that is the goal is to I actually love the level two certification, I think I want to set it up similar to that you give very small snippets of information, and then kind of testing the knowledge of what you just learned. So I think that was really well done. And I’d like to take it to that level. But there’s an upper and lower quarter. So either somebody who wants to learn about it can go and just sign up and start to learn about the movement patterns. And then what you can do to you know, restore mobility, get muscles activating again, and then what are the best exercises and things that you would do. So you have that and then there’s a membership, where you can actually there you can go in and we have an exercise library there. So if a therapist is like not 100% Sure, they can pick the movement pattern, and then then you can say, Okay, with this movement pattern, what manual techniques would be best and most effective, and then it’ll shoot out the manual techniques or what’s home program should I give, and you can use that to help you figure out you know your truth. Been strategy as well as the HOME program. We also do some mentoring, and do clinical pearls and a variety of different things. So we’re continuing to try to develop that. So even people that have taken the exercise course, as you know, like I, that’s why I love your online course, it’s great to be able to go back, right, so you’ve taken a course and you only can, you know, digest so much information, then you come back, and it’s great to have that as a resource. So you can go back read through, you know, look at, you know, how some of the exercises are done, look at some of the videos and helps to give you that, you know, that reinforcement to keep utilizing that information.
Speaker 1 (55:44)
Awesome. The system for suggesting exercises and kind of has that having that algorithm built in. And then the educational resources, it’s really powerful. Excellent, excellent resource resources. And if anyone wants to learn more about that, the website is rehab links. System.com. So there’s, two S’s, its rehab, LINK’s, and then systems. So two s’s there.com. And if anyone else wants to wants to check that out, or follow you on social media, or visit your website, what are some other places to find you?
Speaker 2 (56:23)
Yep, well, they can certainly go to back to number two, normal pt.com. That’s our website and all our social links are on there. So our YouTube or our Instagram and our Facebook. You can go there or like you said that we have links. So those are the best places to follow us.
Speaker 1 (56:45)
Wonderful. And it’s definitely worth checking out if you’re interested in in what Lisa shared here. I spent a wonderful trip through the Michigan state curriculum, your experiences your perspective, I really appreciate you coming on. And I think this this episode is offering a lot of value to everyone who’s listening. So I’m really grateful to you Lisa for not only being part of NeuFit Nation generally but for coming on the show today and sharing your wisdom and knowledge. Thank you very much.
Speaker 2 (57:13)
Well, thank you for all you’ve done with Neubie and you know, bringing this amazing technology to us so we can help more people get better.
Speaker 1 (27:23)
That’s right. It’s it takes teamwork to make the dream work. Got it? Yes.