FCEs and Balance Testing with Josh Schuette

In this episode, ADJUSTED welcomes Josh Schuette Director of National Workers Compensation Sales and Account Management at Brooks Rehabilitation. Josh discusses FCEs and balance tests and what role they play in recovery.

Season 8 is brought to you by Berkley Industrial Comp. This episode is hosted by Greg Hamlin and guest co-host Mike Gilmartin, Area Vice President, Sales & Distribution, for Key Risk.

Visit the Berkley Industrial Comp blog for more!
Got questions? Send them to [e-mail]
For music inquiries, contact Cameron Runyan at [e-mail]

Episode Transcript

Speaker 1 (00:11):
Hello everybody and welcome to Adjusted.
I'm your host, greg Hamlin,coming at you from Sweet Home,
Alabama and Berkeley IndustrialComp, and I'm excited to share
with you today this rebroadcastwith Josh Schuette.
Josh is the original legend.
Anywhere you go at anyconference I'm sure you'll run
into Josh.
He's a legend in the industry,really focused on functional

(00:36):
capacity exams and helpingpeople return to work who have
gone through very difficultinjuries, and one of the things
that we had not talked about inthe time that I've been doing
adjusted was where functionalcapacity exams fit and what
balance testing is.
And I think that there may bemore familiarity with functional
capacity exams than balancetesting, and so I wanted to dive

(00:58):
into both of those with Joshand have him really dive deep
into how to utilize those tofigure out where people are
functionally so that we can workto have them successfully
return to work.
So I hope you enjoy this oneand if you see Josh at a
conference, tell him I saidhello.

Speaker 2 (01:16):
Hello everybody and welcome to Adjusted.
I'm your host, greg Hamlin,coming at you from beautiful
Birmingham, Alabama, where theskies are so blue, and with
Berkeley Industrial Comp, ofcourse, and with me is my
co-host for today, mikeGilmartin.
Mike, I'll let you introduceyourself.

Speaker 3 (01:33):
Yeah, I'm happy to be back, greg.
This is Mike Gilmartin.
I'm coming to you fromGreensboro, north Carolina,
where it is sunny and 70 degrees.
Can't get much better than that, man, I know.

Speaker 2 (01:43):
Absolutely love this time of year.
That's my favorite part aboutthe South is, I feel like the
fall lasts for like ever, and,coming from Michigan and Indiana
, it's like you blink your eyes,the leaves change and then
you're fully in the season ofthe sticks and then snow.
So, anyhow, well, we've got ourspecial guest today, josh
Schuette, who's a doctor ofphysical therapy and director of

(02:04):
the National Workers'Compensation, sales and Account
Management at Brooks Rehab.
That's quite the title, josh.

Speaker 4 (02:12):
Yeah, they keep adding to it every year and I
can't fit it on the name taganymore.
Sorry, it's on audio, but yeah,if you see my name tag, even
with size six font, they can'teven fit it anymore.
It just makes me feel betterabout myself.

Speaker 2 (02:23):
So, yes, Well, I just like to say Josh is Superman,
so we'll just call you that.
But I've met Josh at theNational Workers' Compensation
Disability Conference in LasVegas and reconnected at WCI,
and I was actually hearing himspeak on.
One of the things he wastalking about was functional
capacity exams and balancetesting, and that really made a
little light bulb go on for me.
I thought you know we have notdone a topic on functional

(02:44):
capacity exams and balancetesting.
And that really made a littlelight bulb go on for me and I
thought you know we have notdone a topic on functional
capacity exams and balancetesting.
And I felt like this issomething that is really an
important piece to a lot ofdifficult workers' compensation
claims, so I wanted to have anexpert on to talk to us about
that today.
So you're our expert, josh.
Thanks.

Speaker 4 (03:02):
I can't wait to tell my mom and dad.

Speaker 2 (03:11):
They'll be Josh.
Thanks, I can't wait to tell mymom and dad.
They'll be proud.
Thanks, I can promise that theone person I know that listens
is my mom and she listens asshe's getting ready to go to bed
.
So I always say I put her tosleep so we'll try to keep her
up.

Speaker 4 (03:17):
All right, I'll try to liven it up this time For
your mom.
I'll do it.

Speaker 2 (03:26):
Thank you, josh.
So I wanted to start at thebeginning.
How did you decide to end up inthe medical field?
Did you know you wanted toenter into physical therapy as a
kid, or where did your intereststart with that?

Speaker 4 (03:33):
Great question there, greg.
Actually, to be honest, if youwould have told me at 18, I was
a physical therapist now, Inever would have believed you,
because I originally went intoschool to be a strength and
conditioning coach for like afootball team, and that's what I
want to do.
I always lifted weights as Iwas younger.
It was kind of the classicstory of like the scrawny, puny
kid trying to build himself up.
So I got into lifting weights,competed in powerlifting I go, I

(03:55):
would love to make this acareer and had a few friends
used to do that job as strengthand conditioning coach, you know
, just making athletes bigger,faster, stronger.
And then what happened was allmy friends that were in that
field, in exercise science, werelike I'm going to go into PT,
physical therapy.
I said no way, I do not want todo that.
And kind of a roundabout kindof like.
Even you know how you get inwork comp where it's not what

(04:16):
you choose, but you ultimatelykind of fall into it.
Long story short is I wasworking with athletes but at the
same time I had to take a classwhere I held back kids with
disabilities outside and Ireally got into that, just
trying to make those kids, rehabthem and just showing the joy
and the beauty of how you can beincluded in different physical

(04:36):
activities.
And I went back and got amaster's in exercise therapy.
And then, next thing you know,I got accepted into the
beginnings of the PhD program inspecial ed.
But I was kind of going brokeat that time and go.
I did a Google search literallyone night and said how do I get
into helping kids withdisabilities and make money?
I think it was my Google searchand physical therapy came up

(04:58):
and I applied that night, gotaccepted the next day and the
rest is history.

Speaker 2 (05:02):
That's awesome.
That's an awesome story, Josh,and I remember and you're going
to have to correct me if I'mwrong on this that your was it,
your father, that was a footballplayer, collegiate football
player.

Speaker 4 (05:11):
Yes, okay, yes, that's my Indiana University
connection.
He is a first team All-Americanin Indiana.
He always points out, though,that the team was always one in
10, all four seasons he wasthere, and then they finally
went to the Rose Bowl the seasonafter he left.
But he did really well.
I don't think it was because ofhim, but first-team
All-American very proud of himand then played 11 years in the
Canadian Football League.

Speaker 2 (05:33):
Well, I would say that sounds about right for
Indiana 1-10.
That's about what we do.
We're pretty good at that.

Speaker 3 (05:39):
Now I know why Greg invited you.

Speaker 4 (05:47):
It to know why Greg invited you.
It's all making sense now.
Hang out after Mike, we'regoing to watch.
Breaking Away just to hang outBreaking Away at Indiana
University starring Dennis Quaid.

Speaker 3 (05:52):
Yeah, that's an interesting story.
I don't know that I everGoogled like how do I make money
in insurance before I chosethis profession.
I just kind of fell into it.
But tell me a little aboutBrooks Rehab.
What do you guys do?
What do you focus on?
You know, give us, give us alowdown on what you guys do.

Speaker 4 (06:06):
Yes, Brooks Rehab, we actually we hit our 50 year
anniversary a year ago butcoincidentally of course, it
happened during COVID.
So then they had to carry itover and make it a two year
celebration.
So it actually meant somethingto somebody.
But right now we've got a bunchof facilities.
When I met Greg, the biggestthing I was actually there to
talk about was a rehab hospitaland we have two rehab hospitals
now located here in Jacksonville, florida.

(06:27):
I can't quite celebrate theweather like you guys it is
muggy and hot, like it is 361days out of the year, but we
make the most of it.
We basically see catastrophicwork, comp or any kind of
injuries from around the country.
So major multiple trauma,spinal cord injury, brain injury
, amputees, those major injuries, patients coming from all over.
But we've got two rehabhospitals and it's going to

(06:49):
sound like the song, you know apartridge in a pear tree when I
finish up but two rehabhospitals, two skilled nursing
facilities and a sister livingfacility, 45 plus outpatient
clinics and a home healthdivision with a bunch of
specialty programs.
But we basically treat you knowthe worst of the worst injuries
and we try to make thosepatients, those injured workers,
feel whole again.
So I'm very fortunate to havethis job and help people out

(07:10):
every day.

Speaker 3 (07:11):
It sounds like your Google search paid off from what
you just said.

Speaker 4 (07:16):
I definitely got to say I'm blessed.
Even though I don't work somuch with kids anymore, I do see
a lot of kids every day in thewaiting room and I make great
friends with them and it'sawesome and actually I get to
take them out running.
We got a great organizationcalled Ainsley's Angels where we
take kids with disabilities andrun them in 5k races here
locally and it's a nationalorganization, so I'm loving it.
Just did it over the weekendactually met some great kids

(07:37):
that were able to help out andhelp me out.

Speaker 2 (08:05):
That's awesome.
So, josh, when it comes tophysical therapy, I think we all
know that sometimes surgery isall want to be able to push a
button, have a surgery, getbetter and then move on.
We're so used to everythingbeing now and fast that
sometimes this piece I thinkit's underemphasized the role of
it and I would love for you totalk about what you've seen and
how it plays into people'srecovery.

Speaker 4 (08:25):
That's a great stage, you said there, greg.
I totally agree with you.
And in this day and age, it isto be honest with you it's a
tougher sell for a lot of peoplebecause like, hey, we sent you
for physical therapy, why isn'tmy injury work?
Or why?
Or you know, or even thepatients you haven't worked out
in five years, and then withinone week, 10 days going, why
don't I have the body of anAdonis right now?
It takes time.

(08:50):
I mean you get out what you putin and it does take time.
So in this day and age ofinstant gratification it is much
tougher.
But to go back to your question,physical therapy can be very
appropriate for a lot ofinjuries.
I mean I've been fortunate tohelp out.
I still treat even today, butmostly on the functional
capacity evaluation side.
But for neurologic injuriessomebody's had a brain injury,

(09:11):
spinal cord injury thosepatients, those injured workers,
need that rehab to be able towhat you set the stage for
earlier the balance, to get thatbalance right, to even get
weight bearing right.
If you've got somebody that'sbeen bedridden for weeks or
months, sometimes they're notjust going to get right up and
get up and move out the door.
It's going to take step-by-stepsafely to get there.

(09:32):
And then going back to yourpart about surgeries if
somebody's had a shouldersurgery, if we're talking about
an orthopedic condition, theyneed that shoulder rehabbed a
little bit at a time, becausethey can't go from shoulder
surgery, that shoulderimmobilized for weeks on end and
all of a sudden be like, hey,now you're ready to throw a
football.
I mean, you look, that's whathappens.
I always compare work comp tojust what you see on the

(09:53):
athletic field.
Athletes get injured, they goto rehab.
They are not back out in thefield, typically the very next
day.
Sometimes, depending on theinjury, it could take a full
season before they come back,because you want them to come
back right.

Speaker 3 (10:06):
You hit on something really interesting there and I
have to admit, my sister isactually a physical therapist
and runs a clinic in Maryland,multiple clinics in Maryland.
So her and I talk about thisall the time.
But you know, athletes they dothe therapy.
It takes them a while to getback and they're kind of the
best of the best in terms ofjust their physical abilities
and everything else.
You see it all the time wheresomebody might go to one or two
visits and they come back to theadjuster, whoever they're like.

(10:28):
I'm in so much pain.
It's not working.
I feel worse.
You know all that kind of stuff.
How do you, as a physicaltherapist, kind of combat that?
Right Cause it's, it's, in myopinion, it's kind of common
sense.
You're going to go, you'reworking on working out an injury
and doing movements that aregoing to push you a little bit
but in the end are going toactually make a difference and

(10:48):
help.
How do you manage and coachthrough that so that it's not to
your point?
Well, I just want it fixed now.
I want it fixed now.
How do you deal with that?
Because it is interesting.

Speaker 4 (10:58):
No great point there, mike.
That's where communication Ithink that's going to be the
underlying answer for a lot ofthe things that we'll probably
talk about today Communicationis key, whether it's me talking
to you guys or me talking to theinjured worker, which is you
know I mean it all comes back tothe injured worker.
Without them, we don't have ajob.
So when that injured worker,that patient you know if they're
coming in for commercialinsurance comes in and speaks

(11:19):
with me, I'm very upfront andhonest.
I tell them hey, I'm going totell you some things you
probably don't want to hear,because sometimes they're like,
hey, I thought you were tryingto sell me on this and I go well
, the one thing I don't want todo is set your expectations
where I can't achieve them.
If I come in and go, hey, it'sgoing to be, I tell them upfront
you're not going to walk out ofhere without some pain.
I just want to lay that on.

(11:40):
Is, people sometimes stop me inthe middle of the conversation
when we first start and they goJosh, should I stop when I'm
hurting and I go?
I'd be lying to you if I toldyou yes, and here's the reason
why Because you're likeeverybody else that's walked in
the building here over the lastthree months, three years,
you're already hurting to somedegree.
So I said stop when you'rehurting.
We'd already be done at thispoint.
So you're already in pain, andnow I'm going to take that body

(12:03):
that's already that joint orwhatever, is hurting, and now
I'm going to try to take andmove it a little bit farther.
There's going to be some paininvolved with that, so I'm not
going to lie to you.
However, we're going to keepyou under that injury threshold.
So the one thing I always tellthem I'd be lying to you if I
said there was no extra pain.
However, I'm not here to makeyou injured again.
I'm not.
We're not here to re-injure you.
So we're here to keep you safe,we're here to build into it.

(12:23):
But the other thing I point out, though, is if they do not
exercise that body part like,let's just say, right now, all
they could do is, you know, pickup their cell phone, and that's
the heaviest thing they canlift without hurting.
If they quit even doing that,imagine what's going to hurt for
them.
You know just.
You know, basically even movingtheir arm without holding
anything is going to hurt.

(12:43):
So you got to get in and movethe body to some degree, or else
even those basic movements aregoing to start hurting.
So I'm just upfront and honestwith them.
I'm like, hey, you're going tohurt some, we'll keep you under
the injury threshold, but yougot to move, or else it's going
to.
You think you're hurting now.
It'll be even worse than thefuture.

Speaker 3 (12:59):
It all goes back to Greg and I talk about this on
multiple podcasts settingexpectations.
Man, it's as simple as the samething for an adjuster when you
first call an injured worker andoutlining what they can expect
and when they can expect thingsto happen, and like it's just
funny to hear it's the same inevery profession, like set

(13:19):
normal expectations andreasonable expectations and in
general, it's going to set youup better than than you would
have.

Speaker 4 (13:25):
So, absolutely, yeah, I mean, it's just like you.
You got to set everybody up oryou're setting yourself up for
failure when it's all said anddone.
So I'm just like.
I remember even trying to bringon the same lines of it my
patient's family member becauseI was their family member was
debating on coming to thehospital, you know, or having
their loved one come to thehospital, injured worker, major
injury and I remember meetingthat loved one and I said hey, I
want to ask you some questionsup front.
I started like asking, like,how long do you think your loved

(13:47):
one's going to be here?
How long do you think the rehabprocess is going to take?
And she literally stopped me.
She goes what are you doing?
I go.
Well, I want to figure out yourexpect.
I want to find out yourexpectation.
She goes this is weird.
She goes.
I've been to three otherhospitals and everybody
immediately tried to sell me onthe hospital, didn't even give
me a chance to speak.
They just kept saying they gotthe best outcomes, they're the
best, they're the best of thebest.
Now you're almost not sellingme on it.

(14:08):
I go well, here's the thing Igot to follow you and your loved
one all the way through thisepisode of care.
If your expectations, if you'rethinking one thing and I know up
front I can't meet that, you'regoing to be hating me three
weeks from now.
So I need to lay all that outon the table.
Find out what you're lookingfor, because if you think your
loved one's going to be done intwo weeks with a major brain
injury, it's not going to happen.

(14:31):
So I want you to know you'reprobably going to be sitting
here for maybe two monthswaiting on that recovery that
you're expecting in two weeks.
So I'd rather lay that out toyou.
And it was interesting after anhour long conversation she
actually said I appreciate whatyou said, I actually trust you,
because everybody else just kindof gave me a guarantee that my
loved one would be better in twoweeks and you're actually
laying it on the line, sayingit's not that easy.

Speaker 2 (14:48):
So, coming back to the stages of recovery, I think
that that makes a hugedifference and I agree with both
of you that you know, settingthe expectations is so important
if you're going to getcooperation, which is to me
really important for recovery.
So, josh, when you one of thethings that and this is me maybe
admitting, confessing here Ihurt my shoulder it's probably

(15:09):
been 15 years now and my primarycare doctor sent me to some
physical therapy and they gaveme some TheraBand, that physical
therapy.
They sent me home with them.
They told me what I wassupposed to do and I'm going to
be honest, I wasn't verycompliant in doing what needed
to get done there and I think itreally did impact my recovery,
you know.
So I know home exercise is animportant component.

(15:31):
I guess there's two thoughtsthat I wanted you to talk about.
One, how does it play a role?
Because obviously you have thevisits where you're going to the
physical therapist and you'rebeing worked with with a
physical therapist or atechnician of some kind, and
then you have the home exerciseprogram, which should be
happening on its owntheoretically.
So two things, I guess.

(15:51):
Talk a little bit about homeexercise.
And then, what are yourthoughts on just the general
compliance of home exercise fromyour experience?

Speaker 4 (16:01):
No, that kind of hits the nail on the head.
As far as somebody recovering,I appreciate your honesty.
I think I've got my own storylike that, greg, so we'll just
kind of lay it all on the tabletoday as far as our backgrounds.
But I'm a big fan from thebeginning, even when I tell
patients, I'm a big fan of whatI call value-added care, and
this is across the medicalspectrum.
What I mean by value-added is,if you come in to see me, you

(16:22):
better be getting something youcouldn't do for yourself at home
.
So let's just talk about a homeexercise program.
There are those people that Imeet and you can tell they're
just go-getters.
You know they could be that,that athlete that's trying to
get back to um, you know.
Or just that busy mom, busy dad, they got 20 other.
Hey, I got five kids at home.
You know, I got all this otherstuff.
Josh, tell me what I need to doand I will do it, and we'll do

(16:44):
a little test run there, and ifthey can do it, boom, you don't
need to come in and see me.
There are those other ones,though, that are just you know,
you can tell like they havenever really, and I'm not
judging on you, greg, because Idon't even know you that well,
buddy, but I'm just saying thereare those people that I see
where you're going there, josh,yeah, yeah, pile on, pile on for

(17:08):
you, for you, buddy, I just metyou but I'm already trusting
you now.
But there's people he meet andyou do like during that first
initial eval.
A lot of it's just thatinterview where you're just
trying to find out what makessomebody tick, and that's the, I
think the coolest part about myjob is find out what makes
somebody tick.
Certain Certain people you'relike I meet them.
I'm like dude, what motivatesthis person?
Certain people are motivated bymoney.

(17:29):
Certain people are motivated byfamily.
Certain people, you know, wantto look good in front of others.
I mean, you got to find outwhat makes somebody tick.
So when I'm talking to somebody,there are certain ones that
it's just like I can't even tapinto it, just feel like the
second.
They leave me, they're going togo home and you know what.
They're motivated by Nothurting at all.
So they don't want to push, youknow.
And when I say not hurting atall, I'm talking even emotional

(17:50):
pain or any kind ofpsychological pain.
So they're the kind of peoplethat are going to, you know,
just totally just go into theircocoon If they have a problem
with their kid.
They're not going to confrontthe kid because they're like
dude.
That's going to cause like ashift here.
It's going to cause me somepsychological, some emotional
pain.
Today I'd rather forego thatand just totally avoid the
conversation and I'll just golay on the couch, play video

(18:11):
games and drink beer.
Tonight and I've had patientsliterally say that I play video
games to escape.
You know, I don't want to dothe chores, I don't want to take
care of my kids, I want toavoid all that.
So that person there for valueadded, the value added might be
making them come in and see meso I can make sure they're
actually doing it.
So the good part is these daysI know there's some technology
out there.
I know I've talked to some ofyour team, greg, about some of

(18:32):
the technology out there thatcan actually monitor patient
compliance when they're not inthe clinic, which I think is key
.
Because, again, for value added, should somebody come in and
see me if they can do it all ontheir own?
No, but if they're just notmotivated at all.
But the cool part with the newtechnology is at least we can
track them, track thatcompliance.
So that kind of comes in to theone part there as far as just

(18:55):
kind of making sure that thepatient's actually compliant.
But as far as value added, ifthere's another reason for a
patient to come in and see me,mike, I might go back to like
we're talking about a surgery.
Another reason for a patient tocome in and see me, mike, I
might go back to like we'retalking about a surgery.
After that shoulder surgery,the only way to really get that
injured worker and that patientmoving again is they have to do
what's called passive range ofmotion, which means somebody
else a skilled therapistactually has to move that arm
for the patient.

(19:16):
This can't be addition off tothe family member.
The worker themselves can't bedoing it.
So that is value added.
But once they get past thatstage, if they're independent,
let them go home and do it ifthey're motivated, but otherwise
, if they're not, they mighthave to come in and see me.
So I'm a big fan of value added.

Speaker 3 (19:33):
So I guess my big question is I agree with Greg a
little bit you see a lot ofpeople who you know it's the
doctor should fix it for me orthe PT should fix it for me.
Why do I have to do stuff on myown?
And I guess I mean I agree withyou and those people you
probably want to see them moreoften.
But if you're doing everythingyou can do as the PT and you're,
you're working them out as bestyou can and they're still not

(19:53):
doing what they need to do athome, how do you I mean is, can
you then make up for that?
Like in the office, or is itgonna like I guess you see it
all the time where people arelike, well, I'm not getting any
better, and the PT will write inthere well, you're not doing
your home exercise program,you're not doing the things that
, to your point, continue to getthe motion better and continue
to get you feeling better.
How do you deal with that?

Speaker 4 (20:15):
And first I want to go on record.
I heard you say you agree withGreg, so I don't know how often
that happens, but we just wantto go ahead and document that
right now it's very rare I'mdefending you, brother.
I got you so anyway, that'sIndiana right there.
So to go back to that, the onething, mike, that's a great

(20:35):
point there, and you know,coming back to that is I always
come back to the time equationand again I'm just kind of a
basic guy, kind of like I said,I like to find out what makes
people tick and another one ofmy concepts is value added that
I always go by.
Another concept is the timefactor and that is this I tell
people let's just say you comefor a typical physical therapy
prescription three times a week,you know, for an hour each time

(20:57):
.
So what is that?
That's three hours total.
Look at how many hours we havein a day 24 hours in a day,
times seven days a week.
So we're talking over 100 hours.
It doesn't, I mean, it doesn'tmatter what I do in that three
hours.
It does some to some degree.
But if somebody does everythingwrong for those other 23 hours
in the day and that other day ofthe week, it's totally going to
undo that.

(21:17):
So the patient, the injuredworker does have to be compliant
, and I always look at it.
They got to start.
You got to take care of yourbody throughout the day anyway,
even when you're sleeping.
If somebody you know wakes upand their arms up by their head,
you know, after the shouldersurgery it's good.
I mean eight hours on a painfulyou know, in a painful position
could totally undo whatever Idid for an hour that day.
Eight hours is going to trumpone hour any day of the week.

(21:38):
So there does have to be somedegree.
And that's where, again, itcomes down to that communication
part.
And I'll sometimes lay it outwith a patient.
I'm like, and I'll literally dothat math equation and go how
many hours a week am I seeing inthree hours I can try to do
everything.
I will give you all I got forthose three hours.
I can assure you that.
That's all I can guarantee.
I'll give you all I got forthose three hours.
Call me those three.

(22:00):
You got my time.
But look at what if you go homeand you do everything wrong in
the next 23 hours, is that onehour going to trump the other 23
?
And when people get that, thenI'm like that's why you got to
take care of yourself.
You got to.
I mean, that's why I'm a bigfan of a lot of these athletes
that are getting older andreally taking care of themselves
.
They realize I mean, look atTom Brady, you've got to do,
whether you like him or Scott.
The guy is doing activitiesoutside of the typical realm

(22:24):
that he gets just in coaching.
He's doing the nutrition.
He's doing the sleep.
I mean you never heard athletestalk about sleep 10 years ago.
But they realize you got togive all, you got for all 24
hours no-transcript.

Speaker 2 (22:37):
Great points, great points, josh.
Well, one of the things and youtalked about this a little bit,
but I know we've all seen itthat's been handling workers'
compensation injuries issometimes you have injured
workers that they're in physicaltherapy a long time, like maybe
they've either had surgery orthey haven't, and you've already
had 36 visits of physicaltherapy and now they're
recommending 48, and then the 48get approved, and now they want

(22:59):
another 12.
Recommending 48, and then the48 get approved, and now they
want another 12.
And so at a certain pointyou're wondering like, okay,
well, is a different surgeryneeded?
We're not really seeing gainsanymore.
Talk a little bit aboutfunctional capacity plans and
where they fit in the recoveryof an injured worker to maybe
help diagnose or, from adiagnostic standpoint, look at

(23:20):
where this patient's at, becauseI think that's some of the
things that we struggle with.
Obviously, our goal is to getpeople back to work and back to
life, and we want that for them.
And sometimes there can bepsychosocial components that
maybe are layered in there.
There can be actualmisdiagnosis, where maybe they
need a repeat surgery or there'ssomething else wrong that's

(23:41):
been missed.
There's so many differentthings and figuring that out is
sometimes the challenge oftrying to help somebody recover.
So where does functionalcapacity exams fit in all that?

Speaker 4 (23:53):
Great question as far as that.
I mean, I know there's going tobe kind of a spectrum there as
far as an ideal time.
But the one thing one of thestatements you made earlier one
of the words was diagnosticdiagnosis.
The one thing I'll tell you isan FCE is not, by the true
definition, diagnostic as far asan actual physical diagnosis.
And that's something else Icommunicate to the patient up
front because they're an injuredworker, because a lot of times

(24:15):
the injured worker will come inand be like I've been to three
different specialists, fivedifferent physical therapists.
Nobody's telling me what'scausing my pain.
So I expect you to tell metoday and I go oh, we're going
to lay this on the table too.
This is not diagnostic innature.
This is not me finishing thistest and going.
You know what?
Somebody missed that rotator orthe slap lesion you got on your
shoulder or that torn meniscusyou got on your knee.

(24:37):
This is not what the test isabout.
It's more diagnostic in thefact of where is that injured
worker right now as far asfunctioning?
So it's more diagnostic interms of functioning.
But it can also give someinsight in terms of consistency
and inconsistency brought forthby the patient or injured worker
and what I mean by that isclassic example is an injured

(24:58):
worker comes in and I'm like,hey, can you bend over for me?
And I'm using a bunch ofdiagnostic tools, inclinometers,
goniometers I'm trying tomeasure it to the exact degree
because I want to be objectivewith everything I do, and I'll
get some injured workers maybe.
Give me like 20 degrees, whichmeans all they can do is barely
touch their thighs.
That's as far as they can bendforward.
And all of a sudden we'llfinish up the exam and they'll

(25:21):
go out in the waiting room andthey'll talk to somebody else
that's coming to pick them upand they'll have a bag on the
ground.
They will bend all the way overand pick up that bag.
So 90 degrees of flexion.
They went from 20 degrees whenI asked them to give it all they
got.
Now all of a sudden they'repicking up a bag and 90 degrees
and they head out.
That's an inconsistency.
I asked them to give me allthey could when they're back in

(25:45):
the room and now I didn't evensay give me all you could when
you're out in the waiting roomand they can triple the range of
motion.
So it also helps out as far asoutlining what are
inconsistencies.
Now here's another part about it, though Greg is.
I'm not.
I mean again, I'm not apsychologist.
I'm also not diagnosing whythose inconsistencies happen,
because sometimes I get I usedto get an angry case manager
we're always good friendsoutside but she would definitely

(26:06):
get angry with me, one of thoseones.
I've been doing it for 35 years.
You know that feel and startyelling at me and she goes how
come you never put it?
You know she used some,definitely some great language
there regarding my anatomy.
Why don't you have the to putyour nickel down and say that
the?
You know the injured worker isa malingerer.
And I told her.
I said do you want me to makethis paper, this 20-page report,

(26:28):
null and void?
Right now I can write they're amalingerer.
And it just made it null andvoid.
Why is that?
Because the malingerer isactually a psychological
diagnosis.
It's not me as a physicaltherapy diagnosing that injured
worker, because I'm just sayingthat the patient's inconsistent.
The part about malingering isimplying intent.
I don't know what the intent is, why that injured worker was

(26:49):
inconsistent.
I mean, I had a guy the otherday.
I said walk as fast as you canfor 100 yards.
It took him over two minutes,and this is at the beginning of
the exam when he claimed hispain level was lower.
At the end of the exam, heclaimed his pain level was lower
.
At the end of the exam, heclaimed his pain level was
through the roof.
And I said hey, man, test isover, you're free to go.
I hit my stopwatch and then Iwatched him go all the way out

(27:12):
to his vehicle.
He could walk 100 yards faster,walking out to his car, than he
did earlier in the test when Isaid walk as fast as he can.
That's an inconsistency.
Now I don't know why he walkedout to the car, because I mean,
for malingery, he literally hadto.
Hey, why'd you walk faster?
And him yell back to me oh, it'sbecause I want to get a better
claim, because I want to makemore money.
That's why I'm faking you out.
No injured worker is going totell me that.
So all I can basically dothere's two main things.

(27:33):
I'm diagnosing as far astheirencies or inconsistencies.
That's where, if there areinconsistencies, we probably you
know in some patient Greg hasgone on and received 80 physical
therapy visits.
It's probably more involved.
At that point you might need toenlist, you know, some other
specialists.

(27:53):
You know, if you want to findout intent, you might need to
get psychology involved, eventhough not everybody's always
into that.
But you really want to get afew other people involved to
really diagnose that.
Because I tell everybody, ifsomething's going on a year,
it's probably not going to besolved in a day.
You probably need a couplepeople to really look into this
if you really want to get a goodbenefit out of this.

Speaker 2 (28:12):
Great points.
And I'm glad that you correctedme on the diagnosis piece
because that's important.
But I guess the other thingmaybe for people who don't know
what a functional capacity examis what are the kinds of tests
that you're doing in afunctional capacity exam?
What's all involved?
How long does it take frombeginning to end, Just to give
people a general idea of whatthat is?

Speaker 4 (28:34):
Now to go back to it.
Yeah, functional capacityevaluation.
It's a detailed, objectivephysical measure and I tell the
injured worker or the patientI'm here to see today what your
maximum safe physical abilitiesare on this given day.
So I also emphasize, on a givenday.
This is not, you know, it's notprognosticating either.
I mean, people are like youthink this is where I'm going to
be two years from now.

(28:54):
I don't know.
You know I don't have a crystalball for that.
But on this given day, the examitself one-on-one typically
lasts me four to five hoursone-on-one with the patient.
That's not including the finalwrite-up.
The exam literally starts.
The second I see that injuredworker if I see them out in the
parking lot, the test startsthen.
If I see them when they firstcome in the waiting room, the

(29:14):
assessment starts then.
Because a big question that youknow I'm asked is how long can
the patient sit for, stand for,and it's amazing how often I'll
see an injured worker out therein the waiting room sitting for
30, 40 minutes filling out theirpaperwork no shifting, no signs
of pain.
But the second I bring themback to hang out with me,
they're shifting within thefirst minute going.

(29:34):
Do I have to sit here all day.
You're killing my back, but yetI saw him out there, no problem
.
So the test starts the second Isee them, the test ends the
second they finally get in thatvehicle.
In the last second I see themBecause, again, a lot of the
stuff I can see out in theparking lot is very, you know,
diagnostic in terms of howthey're functioning in nature
too.
But basically what I'm here tolook at is any kind of physical

(29:56):
functioning.
So I know in the state ofFlorida we have a sheet that DW,
dwc 25 form division of workcomp form.
It says sitting, standing,walking, lifting, carrying,
pushing, pulling, bending,squatting, kneeling, reaching,
grasping.
I got to look at all thosedifferent physical functions.
And then what is that injuredworker, what is that patient
capable of doing across thosespectrums?

(30:18):
So how much can they lift, howoften?
That's what I'm here to see.

Speaker 3 (30:21):
I did not realize they take that long.
I assume it was like 30 minutes.

Speaker 4 (30:25):
You come in you do a couple of tests and you move on.
No, that's a great point, mike,and the reason why it takes so
long.
I always tell people you cansee, I mean I've seen a lot of
injured workers, you know, andagain, I'm looking at
consistency across hours and Iget some people that can come in
and they can shift around thewhole time for the first half
hour hour.
But it's amazing, like threehours into it, four hours into

(30:46):
it, that's when I can really see, because that's when the person
starts fatiguing a little bitand kind of gives up any kind of
maybe pretense they had before.
I can actually see what they'recapable of at that point.
But the other thing about it istoo, mike, is there are so many
different functions I got tolook at and they're asking me
how can they do over an eighthour day?
So that's why it takes so long.

(31:07):
So, yeah, four to five hoursone-on-one.
The write-up usually takesanother couple hours, so it's
almost a whole day thing.
But the absolute record for thelongest FC I've ever done, not
including the write-up, was 10and a half hours.
That was the most extreme one.
That did not include lunch,that was straight.

Speaker 2 (31:23):
Oh my God.

Speaker 4 (31:25):
You know how I knew it was going to be an extreme
one.
I went to market one day and Idon't do a lot of marketing
because now it's just likepeople are used to me.
They're like hey, we got aninjured worker, we'll send them
to you.
But I remember one time Brookssays, hey, we're doing this big
thing at a local orthopedicgroup, we'd love if you were
there.
I said, sure, I show up.
Now, most of the time you'regoing to market to somebody,
they're not like oh, love to seeyou.
They're just like what do youhave to offer?

(31:46):
Get out of here, give me yourfood.
You know that kind of thing.
But that one there.
I remember that day I walked in,everybody was welcoming me with
open arms, what?
And I'm like you're seeing themfor an fc, right?
And I go, yeah, I'm seeing themnext week, oh my god.
And then they go grab peoplefrom the back office and
everybody's like, almost likehuddled around me and I go,

(32:07):
what's going on here?
And they go.
We've been dealing with this guyfor a year and he uses up a lot
of our resources.
We've actually had securityescort him out twice in the last
two visits.
If you do this test, we won'tsee him.
So you're like a hero to us andI go guys, please don't tell me
anymore.
Again, I don't want to bebiased going in, but they did

(32:28):
give me one piece of advice,which is this, which I really
appreciate they go, Josh, if youwere planning on seeing anybody
else during that day, cancel it.
You're going to be there allday because this guy's going to
give it to you.
And, sure enough, 10 and a halfhours later, I finished and he
kept calling me for the nextthree days and wanted to make it
go even longer.
And I'm like the test is over,brother, we are done.
That's wild, yeah yeah.

(32:52):
The write-up was like at leastanother four hours.
So it was like I mean, we'retalking like a 14 and a half
hour day.

Speaker 2 (33:07):
I was like brother the report's in.
I'm done, I can't do anymore,I'm tapped.
And this is me with Supermanenergy.
I'm tapped, I'm done.
You pushed me right over.
Yeah, well, one of the thingsyou mentioned when I was at WCI.
At the conference, you talkedabout balance testing.
And this is something I'd neverreally heard of and wasn't very
familiar with, so I wanted youto talk a little bit more about
what that involves when to do it, when maybe we should ask for

(33:27):
that test and who's qualified todo it.

Speaker 4 (33:31):
No great point and this is something I've actually,
greg, uncovered more and more.
This is probably the last fewyears and it kind of became out
of necessity With socialcapacity evaluation.
I'm kind of riding a fine linehere because I'm still a
physical therapist through andthrough.
I'm here about patient safety.
Fces, functional capacityevaluations are great for like
orthopedic injuries maybe andsome neurological, just depends.

(33:55):
But if somebody's sending me apatient, an injured worker,
where the question is balance, Idon't typically like to see
that injured worker until thebalance part is balance.
I don't typically like to, youknow, see that injured worker
until the balance part iscorrected.
And the reason for it is thisan injured worker comes in and
let's just say the question isJosh, I want to know how
consistent or inconsistent he iswith his balance.
So patient maybe comes in awheelchair and you know, and I'm

(34:16):
like, okay, so if the patientstands up, the injured worker
stands up and let's just say upand let's just say, if I keep my
hands on them, I won't be ableto tell how consistent I am
right, because a lot of timeswhen you put your hands on
somebody, they might just goahead and drop for you right
there, right, because they feellike, hey, he's got a hold of me
, I'm going to drop.
So that kind of goes againstthe nature of being a physical
therapist.

(34:36):
I should be safety number one.
But now all of a sudden I'mstanding back trying to see what
can they do.
What can they do If thispatient literally just goes?
Hey, you know what, this guy'sstanding back for me.
I just want to drop right now,just for the heck of it.
What can I document?
At that point I'm filling outan accident report.
I don't know if it wasconsistent or inconsistent.
So I used to tell people I'mlike please don't send me any
more of those patients until youcan kind of uncover what is the

(34:58):
underlying cause of the balance.
Is it consistent orinconsistent?
So, of course, good point.
People threw it back on me andgo well, josh, do you know a
test that can actually test that?
And what we found is there's amachine called the Neurocom
Balance Master.
We got a couple of them here atsome of our facilities, not at
every facility.
It's a pretty specific piece ofequipment, but just real basic.
It's an actual you kind of stepin on these platforms and

(35:20):
they're moving platforms.
So it actually measures.
You know their force platesthat the patient is standing on,
and then it's got like a TVmonitor in front of them and
it's got they're kind of boxedin three ways the only part
that's open is behind them andthey're harnessed in.
So the patient is harnessed, soif they fall at all they're
caught right away.
But what it does is it actuallyhas some built-in consistency

(35:45):
measures in that test.
So, mike, for instance I knowGreg heard like when I was
giving the one part of thespeech but, mike, for instance,
one of the things we do is whenthe patient is standing on the
force plates initially, andwe're just hooking them up to
the harness, we're actuallytesting that patient at that
point.
So because they're already onthe force plates, we can tell if
they're losing their balance oranything.
All we're doing is hooking up,you know, the harnesses.
At that point, the first test ofconsistency or inconsistency is

(36:08):
the second.
We say this, sir, ma'am, thetest is starting right now.
And what you see sometimes isthe second.
We say the test is starting.
The patient will literally fallright then Because all of a
sudden they go okay, the test isstarting Now, it's time for me
to fall.
But keep in mind, for the lastminute or two they were standing
on those force plates.
No signs of imbalance.
So again, that's one of thesigns of inconsistency built in.

(36:32):
Another test is, as the testgets more challenging, I mean
it's pretty cool the forceplates move underneath the
patient as it gets tougher.
The whole, you know, basicallythe whole platform moves around
them.
So they're getting.
I mean, because your balancecomes from three main areas of
your body your eyes I mean allyou got to do is basically not
recommend you guys stand that ifyou're feeling off balance
right now.
But if you stand there, closeyour eyes, do you feel a little

(36:52):
shift?
Yeah, you're relying on youreyesight comes from your inner
ears, because you hear aboutpeople with an inner ear
infection.
If you guys ever had one, youfeel off balance with that.
And it also comes from yourfeet.
That's somatosensory they callit there.
It's the bottom of the feet.
So this balance master looks atall three individually but to
test that it maxes out what thatpatient has to do.
So it actually shiftsunderneath them and moves

(37:13):
everything around.
The vision's screwed up and whatyou'll see sometimes is a
patient that was falling before,when the test was easier
because they're like oh, this iseasy.
The only thing that's happenedis the box is moving.
I'll just drop right now.
All of a sudden you'll seetheir balance improve when
everything's moving, because nowthey're legitimately in fear of
falling at this point.
So they'll actually get betterbalance as the test gets more

(37:33):
difficult, which again shouldnever happen.
If you had problems balancingthen you should have problems
balancing before.
You should not be terrible atthe beginning and all of a
sudden, as we increase thatdegree of difficulty, you get
better.
So again, that's another signof that inconsistency.
So I'm a big fan.
So to go back to your question,greg, is like when to do it and
everything.
I'll be honest with you.
If you got a patient withbalanced issues and let's just

(37:56):
say you get through I don't know, 20, 30 visits and it comes
down to that question of youknow, and you actually have good
communication with thetherapist you ask them that
question what's going on here?
Is the patient getting better,you know, are they consistent?
And if they're like, I talkedto one of our therapists the
other day, I asked him that too.
Those two questions with abalance patient, I go is he
getting better objectively?
And, second of all, do you feelhe's consistent objectively?

(38:19):
And the answer I got to both ofthose were you never want to
hear this.
When somebody starts off as welland I'm like, oh my God, I'm
like yes or no, yes or no, andthen they're like well, and I'm
like okay, if you get that kindof answer, that would probably
be a good time to do thatbalance master assessment.
That's why I recommend it tothem, because the cool part

(38:40):
about mean it's just like youbarely.
I mean it's not FCE, I'm seeingsomebody for like again five,
10 hours at a time.
So that is obviously going tocost a little bit more because
we're seeing them longer.
But that balance master can bedone in 30 minutes.
It's just part of the regular PTpart.
So if a clinic has access tothat balance master, I would
suggest doing it right then,because at least that way you'll
get some kind of context andsome kind of idea in regards to

(39:03):
the consistency or inconsistency.
At least you can help build,because it's not only the
consistent or inconsistent, it'salso.
Can we use this to helptreatment going forward?
So what is actually going on?
Can we actually treat that andwhat can we do from here on out?

Speaker 2 (39:18):
I mean, I'm fascinated by the whole thing
and I you know, I'm wonderingyou know how you even go about
making a referral for that, justbecause it means it's something
that most physical therapistswould have if we were looking at
major physical therapy network.

Speaker 4 (39:34):
I would think, because a lot of clinics now are
at least like physical therapykind of networks or big physical
therapy settings.
There's ones that are just pureorthopedic, you know, they're
like they're doing your totalknees, your shoulder problems,
your knee surgeries, elbows,wrists, but then this is more of
a neurologic, you know machine.
So obviously it costs more, youknow.
So typically I would look ifyou have one of those big

(39:55):
physical therapy settings or ornetworks that you're using, find
out if they actually have one.
I would just ask ahead of timethere, I mean because, like I
said, it's a good.
It doesn't always get used, soit's good there for the help out
, for diagnosis purposes andthen also treatment purposes in
the future too.
So I would just ask I can sendit to you guys, but I believe
the company's name it's Neurocom.

(40:24):
It's a Neurocom Balance Master,awesome, and we're actually
just to jump into it.
The one thing about it is that'smore for static balancing.
But there's static balancingtrying to stay balanced in one
position.
There's also dynamic balancing,which is trying to keep your
balance on the move, and thecool part is with technology now
there's actually sometreadmills out there that are
actually we're looking to see ifthey can do the same thing with
the dynamic balancing somebodywalking and see if there's
consistency or inconsistency,the same way we do with the

(40:45):
balance master when they'restaying in one spot.
So hopefully that's somethingwe can report back to you in the
future, because we're lookingto see if we can get one of
those treadmills to actuallystart looking at consistencies.

Speaker 2 (40:56):
And then, as far as the functional capacity exam
goes, is it you know we talkabout balance testing and FCEs
is this something that'sstandardized Meaning like?
Is there one type that when youdo a functional capacity exam
you're going to get the samesort of thing no matter where
you go, or is this somethingthat can vary from facility to?

Speaker 4 (41:17):
facility.
It can vary facility tofacility.
I've found this out just evenfrom my referral sources,
because a lot of them just comeback and ask for me because
they'll be like I went somewhereelse, they didn't do this, they
didn't do that.
I remember I've done a coupleof different.
I teach the course.
I actually got to go teach thecourse in one of the
universities later today on FCEs, but I lay it out there.
I'm like it's still kind of ayoung science.

(41:39):
I believe it started in theearly 80s, but they're still
trying to look for a goldstandard.
As far as FCEs, if you type inkind of like my earlier Google
search there, mike, where I wastrying to type in how to make
money I think I actually wentthe opposite extreme, because I
was buying it for a companywhere I was like evidence-based
FCE testing that costs less, orsomething like that.
So I went the other extreme,though, because I had to look
out for a budget, and I stillthink I got 30 different

(42:01):
software companies or trainingcompanies out there that do FC
training and, as we know withmarketing, does any of them say
we got the fifth best results orthe 18th best?
evidence they're all the best.
They're all the gold standardright, even though there is no
gold standard.
I got 30 different goldstandards out there because some
doctor recommended it.
It's all the best.

(42:21):
So, with that said, what Iusually tell people is a couple
of things to look for for an FC.
You know, these are just somebasic questions.
Number one how long has the FCevaluator been doing it?
Because it ultimately comesdown to not only the technology
but the evaluator.
If somebody has only been doingI mean, everybody's got to.
You know, learn the hard way,and I'm not saying there's
anything wrong with somebodythat's only been doing a couple

(42:43):
months.
But, however, if you're lookingfor somebody to really get that
challenging patient case wherenobody knows what's going on,
I'd recommend something that'sbeen doing it a while, because
you ultimately want what'scalled a thinking evaluator.
They're not just relying on thedata but they're also relying
on thinking it through, lookingat what they see, because
there's so many different thingsto take into account here.
So, somebody that's donemultiple trainings too they just

(43:04):
didn't go to one of those 30,but they actually probably did a
few different trainings tolearn kind of what's best from
each one.
Because if you see a goodtraining course, we'll say, hey,
we're not the end, all be all.
I'd recommend also going toso-and-so and so-and-so and
learning from them and combiningthese techniques.
So, overall, the other thing Iwould say is time too, because,
mike, to go back to it, thereare people out there because I

(43:29):
know there's certain ones thatit's just a diagnostic code for
them, so they will literallybill like they're doing the full
FCE and they only spend in 45minutes.
Cause I've had to do a lot ofredos for people around my area
and I'll see the injured worker.
I'm like you had one of thesebefore and they'll be like my
interview takes longer thantheir whole eval.
Like you spend an hour and ahalf talking to me.
My last eval only lasted 45minutes and I'm like whoa.
So I mean I would say timeexperience of the evaluator,

(43:51):
their training would be a lot ofthings coming into play there.

Speaker 2 (43:55):
Great points, Great points.
So, as we kind of wrap thingsup, looking at one of the
questions and I feel likethere's often confusion about
this is the difference betweenwork hardening?

Speaker 1 (44:07):
and work conditioning .

Speaker 2 (44:08):
And I'm not sure that I could, even today, in this
moment, tell you the difference.

Speaker 4 (44:13):
I don't know.

Speaker 3 (44:14):
Greg, can you tell us the difference?

Speaker 2 (44:18):
No, that's not what I want to ask this question so
it's been explained to me before.
I know there's a difference,but I don't want to lead us down
the wrong path.
Josh, I'm hoping you can tellus the difference between these
two things.

Speaker 4 (44:31):
I'm hoping I'm giving the right answer.
Maybe somebody will send us anupdate after I'm done and be
like dude Josh is way off.
I did go to the AmericanPhysical Therapy Association
website.
What's interesting is, I knowin the state of Florida, I know
when we're billing it'sbasically the same billing code
for work conditioning and workhardening, which, I mean, also
makes things a little bit morenebulous, a little bit more
confusing.
But the definition of workconditioning you're almost

(44:53):
looking for, you're looking forthe similar outcome, right,
you're looking to.
I always tell people you gotgeneral physical therapy, you
got general occupational therapy.
You know, or you're getting it.
You know.
One hour a day, three, you know, three times a week.
I look at work conditioning.
Work hardening is like therapyon steroids.
You're now seeing that patientevery day for multiple hours per
day.
Cause cause again, it goes backto that time equation I was

(45:15):
saying about earlier.
It's very difficult for us toextrapolate.
Oh man, I got this patientwho's supposed to be a railway
worker.
He's got to lift a trainknuckle that weighs 83 pounds.
I got this.
Any kind of hard labor jobwhere somebody needs to be able
to do a very heavy physicaldemand level.
It's very tough to extrapolatein that one hour a day, three

(45:36):
days a week, after they come offa shoulder surgery to go.
Hey, I think this guy's readyto go back to work full duty.
How would you know?
I mean, they may do really wellGoing back to your point there,
mike, about the shorter exammay do really well like kind of
like a highlight reel for thatfirst hour, but who knows that
they start really just kind oftheir endurance is weak and they
just really look bad four hoursinto it.

(45:56):
So work conditioning, when Ilooked it up in the American
Physical Therapy Association,it's basically, first of all,
it's one discipline, so it'susually just like physical
therapy and it's four hours.
It can go up to four hours aday, up to five days a week
still working on work relatedactivities trying to get that
injured worker back to their job.
Now, work hardening can go upfive days a week but go up to

(46:18):
eight hours a day, okay, andtypically it's more than one
discipline in nature, whichmeans you know they're getting
physical therapy andoccupational therapy.
I remember with one of theprograms I used to have would be
physical therapy and they alsoget psychology too, because the
question was like things aboutfear avoidance and trying to get
that you know that injuredworker over the psychological

(46:39):
part, over that hump of hey,you're going to have to lift
more, You're going to have toget used to this, we've got to
talk you through it.
So a lot of those fear avoidance.
So typically the maindifference is, from what I've
seen, the max time per day goeslonger, with work hardening
versus work conditioning, andthen also it's usually
multidisciplinary in nature.
So more than just PT, they'realso getting another discipline
Perfect.

Speaker 2 (46:58):
Perfect, perfect, perfect.
I'm going to whenever I havethis question, I'm going to come
back and I'm going to listen tothis little segment right here.

Speaker 4 (47:06):
I just hope nobody shoots me down there for you,
Greg, I feel bad.
So I'm glad that guy was wayoff.
So like find a new guy tointerview next Monday.
Oh, you did great.

Speaker 2 (47:14):
Well, one of the things I'm doing this season as
I wrap up this year is you know,last year we we talked about
people's happiest moments.
This season, I wanted to focuson what's your favorite part of
what you do every day.
Obviously, there's large partsof people's days that have to
happen, but they might not bethe moment.

(47:35):
So what gets you up in themorning with what you do every
day, Josh?

Speaker 4 (47:41):
I love it and I hope you guys don't mind, I want to
hear a little bit from you tooto get me fired up for the day.
But I'll go ahead and starthere.
But the biggest thing for me isI get to do a couple different
things with my job.
I get to sometimes treat, dothe functional capacity
evaluations as a physicaltherapist.
I do the sales role which youknow again, helping come in.
And then also I also get helpout program development,

(48:02):
creating new programs.
But then I also get to help outsometimes a case management as
an injured worker goes throughdifferent settings.
I sometimes help out with thetouch points there, getting them
set up from inpatient toanother clinic, so maybe setting
up work conditioning.
So I'll actually use this onethat has everything involved.
So my happy moment generally isthis to be able to see an
injured worker that I meansometimes could literally be on

(48:25):
death's door when I first getthe call and we're not even sure
if we can get them to thehospital because we're not even
sure if that injured worker isgoing to live.
But they stabilize, we get theminto our hospital and then
seeing them six months, a yearlater I do the FCE on them and
they return to work.
And that is probably the thing,because it's like that's why we

(48:50):
do what we do.
So real quick one, if you guysdon't mind, just for about one
minute here.
One time I did get a call.
I was doing an FC on anotherinjured worker at another clinic
and they called me and they go.
We got a guy he literally hadlike a tree fall on him.
We're not even sure if he'sgoing to live.
I mean, this is how bad it was.
And they go.
If you bring him in, do youthink you could handle this?
So I make a bunch of calls, goback in see my injured worker,
hear about it.
A week later we bring him inand he finishes up and it's
three months of intensive rehab.

(49:11):
This guy's got to get, but bythe time he, after the tree
falling on him, everything'skind of shattered for him to get
up and move again.
This guy was so the endurancejust wasn't there.
So he started off with basictherapy and he was having
trouble with that.
And then they go Josh, can youtrain us at this other clinic
how to do work conditioning?
So I showed him how to do workconditioning and I kind of
forgot about things.
But then about three monthsafter we started the work

(49:32):
conditioning, or probably twomonths they go Josh, can you see
him for his FCE?
And I'm like all right, Ididn't know what, in months I
think it was basically almostsix, seven months to the day
from the time I got that call todoing the FCE the guy did the
FCE and he actually aced it.
He could return to full dutywork.
So I mean it was amazing and Itold him that.
I said I said I, you know causeI'm pretty much uh, just talk

(49:55):
the way I talk.
I was like brother, you knowcause I'm here, I'm sounding you
did, man.
I was like I remember youbarely lived seven months ago
talking to your wife and familyand weren't sure if you're going
to make it, and you just dideverything to return to work.
This is amazing.
He goes.
Yeah, man, I was like he goes.
It's kind of set in with me too.
So I think that is like one ofthe highlights.
It's like why we do what we do,cause to be able to see that

(50:16):
that comeback.
That's what you want to see,that's what gets you up in the
morning.
That's why I feel like WWEwrestling, where I have to throw
my laptop off here, but anyonehear me finish, guys.
So that one and I had anotherguy recently who I saw for his
FCE.
No, it's actually a couple ofyears ago I saw for his FCE.
But he decided to switchcareers and he got so inspired

(50:38):
by the therapy he got.
He's actually he.
I mean talk about a leap offaith.
He didn't have the money,didn't have the resources,
because he hadn't settled yet.
He put everything on his creditcard and had to actually even
take food from his food bank athis church.
He is now a therapist with us.
He's totally switched careersand he's now helping out.
Other people started workingwith us two months ago.
So that's why I do.

(50:58):
What I do is awesome comebackslike that.

Speaker 3 (51:01):
But guys, tell me what gets you up in the morning.

Speaker 2 (51:09):
Please, mike, greg, fire me up right now.
Greg, you first man, I'm notfollowing that.
Well, I'll tell you for me, Ilove feeling like I'm making a
difference and so when it comesto workers' compensation, when I
know that one, we're doing theright thing for people and we're
helping people get back to workand we're helping businesses be
able to stay in business thatand then watching my own staff

(51:30):
grow from when I came to where Iam now.
You know those little steps andthen watching their lives
change, people that arerecruited and brought in that
did not have workers'compensation backgrounds.
One instance was customerservice working at a Publix and

(51:53):
he made the transition toworkers' comp.
Watching him get his insurancelicense, watching him develop
and then seeing him be able tohave the freedom because of
working more normal hours to beable to do what he loves.
He's leading praise sessions athis church.
It's great that he's able togive back to other people
because he has freedom, a littlebit more freedom in his work
schedule to do what he does.
So those things and then, ofcourse, seeing our injured

(52:15):
workers succeed for me is whatit's all about, and you know I
want to when I'm done here andhang it up, feel like not only
did we do the right things, butwe also changed the way people
think about workers' comp, andso hopefully, between the
podcast and the other thingsthat we're trying out with our
empathetic resolution model, weget to a point where we help

(52:37):
people see workers' comp alittle different, and if I can
achieve that at the end of allthis, it'll be worth it.
I definitely think you could,greg.
All this.
It'll be worth it.
So there's, I definitely thinkyou could.

Speaker 4 (52:45):
Greg, I definitely think you guys will help change.
Just a quick shout out to you Ihad a call with some of your
teammates there recently and itwas definitely a breath of fresh
air.
I mean, they were trying to goabove and beyond to help out one
injured worker.
Just from every which waybiopsychosocial they are truly
living the model and they didn'thave to do that and it was just

(53:06):
amazing because ultimately,we're about we're in the
business of people helpingpeople, and it was just a breath
of fresh air.
So I definitely feel like youguys are on the right track and
can definitely.
You know, that's how we make achange one person at a time.
So I really appreciate yourvibe.
But of course, mike, you got tofollow that up, brother, you
got to take it.
You got to finish us up strongman.
I got faith in you.

Speaker 3 (53:25):
Look, I'm going to go a completely different
direction because you guys havebasically taken all the work
stuff.
I could have said I'm going togo completely outside of work.
I'll be 100% honest.
I think my biggest thing thatgets me up every day, that makes
me feel maybe accomplished.
I don't watching.
I have a very young daughter.
She's four years old.
Watching her develop, likeevery day she learns something
new Every day she says somethingdifferent Every day.

(53:45):
She's like she'll say somethingYou're like where did you, how
do you know that?
I think I say how do you knowthat?
Like 17 times a day.
And so I mean it goes back toall the stuff you guys are
talking about have been the sameas your guys.
Honestly, I'm like Greg.

(54:05):
Watching people develop,working with newer people,
figuring out what makes themtick, figuring out what's going
to make them grow and their workis big for me.
But I think that probably takesthe cake is watching such a
young person figure out how tolive life is kind of wild, and
it's it's what keeps me goingevery day for sure.
That's awesome, is that youronly?
Yeah, we got one four years old.

(54:26):
Her name is ellie, so good deal, congratulations there, my,
that's awesome thank you, Iappreciate it.

Speaker 4 (54:31):
I don't have six like greg so you got, you got
multiple kids, right I do I do?

Speaker 2 (54:36):
we just wrapped up homecoming and I had three in
high school and they all wenttogether as siblings with their
date, which is really cool.
Awesome, bro.
Yeah, so life is good, life isgood.

Speaker 4 (54:46):
I'm very fortunate too.
I got, uh, my son's gonna turn13 this week and, um, yeah, we,
uh it's like I said, this pastweekend we all went out, ran
with the kids together and itwas just great vibes, so I'm in
total agreement with you too.
I I realized the questioninitially is works?
I don't sound shallow and I wasjust yeah it's a combo package.
I mean you got to love what youdo, but definitely family, you

(55:08):
know, I mean without that dude,I mean.
So it's definitely what helpsget me up in the morning.
But, guys, I really appreciatethe opportunity.
You guys are both awesome andthe whole team on here.
But I know we got some people,you know, riding out back there,
you know, just helping us out.
So thanks, so much.

Speaker 2 (55:28):
Thank you, josh.
It was great chatting with you.
It's always good to see you.
I know our paths will crossagain, different conferences and
hopefully with some recovery ofsome patients down the road.
And I just remind all ourlisteners our motto to do right,
think differently and don'tforget to care.
And catch us every other weekas we release on Monday as a
reminder that on the off weekswe do have a blog, so if you
prefer to read your media ratherthan listen, that's an option

(55:50):
as well.
So thanks again to everybodyand we'll see you next week.
Thanks guys, thank you.