Undoctrinate Yourself - #9 - Shaun Astorga DPT

Episode Date: March 12, 2025

Dr. Shaun Astorga DPT is a finance person turned physical therapist. Shaun sustained a life-changing brain and neck injury in 2017 that opened his eyes to the shortcomings in the traditional medical world for people experiencing pain and injuries. After overcoming this injury, Shaun founded a physical therapy practice called AMP Performance Rehab in Chester, NJ that helps people struggling with pain and injuries stay doing what they love even when other medical professionals couldn't help them, and an education company for other clinicians and fitness professionals called AMP Education that teaches AMP's framework for sustainable fitness so that they can help their clients do the same.Find Shaun on Instagram @dr.shaun.astorga @amp_performance_rehab_Visit AMP's website www.ampperformancerehab.comFollow Dr. Alexis on Instagram @dralexisjazmyn Follow the podcast @undoctrinateyourselfpod Become a patron on Patreon: www.patreon.com/UndoctrinateYourselfPodcast

Hello, everyone, and welcome back to the Undoctrinate Yourself podcast. We took off last week, but we're back here this week with a very special guest. This is Dr. Sean Astorga. He's a doctor of physical therapy, and he operates AMP Performance Rehab based out of Northern New Jersey. In addition to that, he also operates AMP Education, which is an educational program to basically help train other PTs who are like-minded to understand the best way to treat their patients in an effective way and in a meaningful way. So I'd like to begin by just welcoming you, Sean. Thanks for coming on the show. Alexis, thank you for having me. Yeah, it's a pleasure. I was on your show a few months ago now, and we always have great conversation. So it was definitely at the forefront of my mind that we should have you on and talk about some really important issues within the physical therapy place

because it's just so rife with issues, to be completely honest. I would tend to agree with you on that one. There's a lot of areas of opportunity and things we can do. to improve for sure. Absolutely. And that's something that you're actively doing, which is incredible. And I thought we could begin by maybe hearing about your story. I know you started out in finance, which is like kind of something you wouldn't necessarily think that would relate to physical therapy in any way. So can you tell us about that progression and then also about the injury that really changed your perspective on approaching physical therapy? Yeah, yeah, for sure. Yeah, I would say a non-traditional

path to getting to where I am today. But it all fits together now. that I'm a business owner and everything, so it kind of worked out. Yeah, I would say in my high school, I wasn't really wanting to be too excited for school. So, like, all I cared about was really, like, playing sports and, like, video games, basically. And then when I went to college, I had no idea what I was going to study. And I took an economics course just as, like, my general, like, prerequisites or whatever. And I really liked the way that it challenged me to think, because my brain's very, like, analytical and logical and mathematical. how I think about things.

This was the first time I was able to kind of like use that in a way that actually applied to something. So I got really interested in economics and then realized like, what the hell am I going to do with an economics degree? So then I'm like, oh, I could just take a bunch of finance courses. So ultimately, like I graduated with a two degrees undergrad. And I worked in the finance world for about seven years or so. I worked in Wall Street for a little bit, switched to a corporate finance role.

And, you know, openly it just wasn't what I was looking for. I learned a lot in that field and a lot of valuable. skills that I didn't realize at the time, but I didn't really have like a meaning attached to it. So it was kind of got to a point where it was very hard for me to like get up and want to like get excited and go to work all day. I just felt like I was kind of like a cog and a wheel. And then at some point during that, I was always interested in sports and, you know, I had a bunch of injuries and stuff like that.

I was always in and out of like the athletic trainer room in high school or working with physical therapists or whatever it might be. And my girlfriend at the time, who's now my wife was basically like, like, dude, you're not getting any younger. So if you're going to do this, you know, let's go back to a. go back to physical therapy school. So that's ultimately what I, what ended up doing. I graduated in 2014 and have been a practicing physical therapist since. Amazing. Wow. Yeah. So I think Wall Street, I actually didn't know that about you. So that's like a very amped up sector to work. And what was

that like stress-wise or like for your nervous system? Was it very intense? Yeah. So it was basically like anti-me, everything about it. Yeah, I would say, yeah. So the environment is, I would say it's extremely competitive and in a bad way, though. And it wasn't really like competition like that I get out from like playing sports or like running or anything like that, not that kind of competition that kind of pushes me to be better. It was very like, I don't know how to describe it really. But there's a lot of things that I just didn't like about that environment. Part of it was that. Part of it was like the commuting. Like I live in, you know, northern New Jersey. So just for me to get to Jersey City like Wall Street, like wherever it was that I was at that. at the time. I was spending sometimes three hours, four hours commuting alone a day. And then some of the work days were just extremely long. And then at some point, I'm like, what am I kind of doing this for, you know? Like I'm using my skill set and my brain to like, you know, not that I have anything against people getting rich, but like I'm making rich people richer, you know? Yeah. What am I doing? You know, ultimately, you know? So yeah, I would say, yeah, it was just like

a lot on me. And interestingly enough, speaking about like nervous system, at the time, I was early 20s. I developed high blood pressure. I no longer have high blood pressure. I mean, I'm not going to say it was working on Wall Street. There were other lifestyle factors that went with that environment, I think, that contributed. But there's a lot of, yeah, I would just say a lot of things that made it very difficult for me to feel kind of like healthy and, you know, like how I feel now at least. Absolutely.

And so, I mean, if you're comfortable sharing about like your family history of high blood pressure, it would be so easy for somebody to just fall into the trap of being like, like, oh, it's just genetic. Like, this is just something that happened to me and I'm just doomed to be this way forevermore. And that clearly isn't your take on it at the time where you kind of just kind of like, okay with that fate? Or did you have the inkling that there might be something that you're doing that's causing this? Right. So at that time, I was not a medical professional. So I didn't really know better, right, in a lot of ways. And that's pretty much what I was told, you know, like one family history.

This is just kind of like is what it is. We're going to put you on this like low dose blood pressure medicine and we're going to monitor your kidneys and, you know, everything's going to be fine. And then in my head, it's like, well, you're going to monitor my kidneys. Obviously not, like, it doesn't mean everything's going to be fine. It means that like we're going to see how far we can drive this and get the outcome we want, you know, regardless of like, you know, what happens from like the health standpoint. So there were just things, yeah, like I didn't know better. But I kind of just did accept that as like, okay, maybe this is just kind of is. is what it is. I didn't really know about all the other factors, right, that that contribute to,

you know, whether someone has high blood pressure or some other kind of like noncommunicable, you know, medical situation. Yeah, super interesting. And so you mentioned you were in and out of the trainer's office a lot as an athlete in high school. What were your experiences like with PT back then? Did you have good outcomes or did you notice the shortcomings in the system at that point? Yeah. So that's a great question because, again, I didn't know anything better at the time. like a typical person who just told to go to PT. So I had a knee injury. I forget when this was. Like sometimes like high school or college timeframe. And I went to physical therapy. And I just kept going and going going and I never really got better. I did the same types of exercises,

the same types of treatments. And I just did it because I'm like, okay, this is what people do. When they get injured, they go to physical therapy. And then for some reason, I forget what happened. But after a few months of that, I ended up working with getting referred to another who like she like worked with athletes right in quotes like whatever that means but um she had a very different different approach um which was interesting because one she like kind of like like this is going back to we're talking like 2000 early 2000s now so she was you know a very objective with how she looked at things she like measured stuff like my range of motion and like my strength and we did a lot of like stuff that just felt like I was like training in a gym and I'm like oh wow interesting like

my knee pain doesn't isn't my knee doesn't hurt anymore right it's not painful so that was the first time, like, I got exposed to something that was very different than what I had previously believed, you know, and I'm someone, I'm very open-minded to, like, do things. Like, I might not understand, right? Like, okay, scientifically, why did this work? Or, like, what were the methods behind it? But I can at least acknowledge, like, I was doing one thing called physical therapy, and it was not getting me an outcome. And now I'm doing the same thing called physical therapy. And I'm getting a different outcome, right? So, like, it definitely, like, raised those questions. And that was probably, she's the person I attribute, like, my, me wanting to go back to

school and becoming a physical therapist too with that experience because I was like pretty I was in a pretty I'm not going to say like a I was yeah not in a great place because I'm like well I love playing basketball and now I can't play right and this person helped me right get back to doing that so from my perspective I'm like this is really cool like there was no medicine there was no like surgery there was nothing I was just like using my body to move better and do things in an efficient way and the fact that like okay cool that people can do this was like very eye-opening for me because you know ultimately like I'm like I mean, this aligns with all my interests and views on everything. So ultimately, here I am, you know.

Yeah. And I mean, the fact that you could see that that was possible for you by extension, then you could see, like, this is possible for other people, too, to achieve, like get out of pain and be able to enjoy the activities that they love. And it's such a good point when you said, like, there was this other thing that you thought was PT and it wasn't really working out. And then you went to this other so-called PT, but then it worked. And it just brings up the really important issue that,

just because something is called PT or a practitioner as a physical therapist doesn't mean that everybody's going to be the same and the approaches are going to be the same. There's so much variety in practitioner quality and practitioner attentiveness and skill and all of these things that make it so easy, I think, for people to get discouraged because they see one physical therapist and they don't get helped the way they need to and now they just think, you know, there's no hope for them. But in reality, shopping around for the right fit is going to be super. super important when you're trying to, you know, optimize your health or get out of pain or heal disease or whatever it is. Yeah, 100%. And that's like one of the biggest things like with

the way we run our practice now is, is really figuring out the best way to communicate that to each person that kind of finds us because we get a lot of people who, you know, they reach out and they're just like, we were referred to you because we heard you helped so and so. I've failed, I've already failed physical therapy. So right then, that's like a buzzword for me. It's like a red flag. It's like, well, they have a preconceived idea about what physical therapy is and what it means. So from our perspective, it's like, well, how do we get to like the underlying like the core of that belief? And then we can kind of start to like shift it a little bit and get them to that point where they think, you know, exactly what you just said, you know, that it's really the quality of the practitioner that matters, you know, then the field itself. Absolutely.

And I mean, it sounds like there may not be a relationship to like just a lay person, but like your belief systems and like just the way you're nervous. system is kind of focused or on or attuned to certain things is going to impact your results too because you literally need to have like cognitive flexibility in order to like create new neural networks and patterns in your body to create new ways of moving that can keep you out of pain and kind of functioning optimally. Yeah, 100%. Yeah. And the other thing too is like even that just like nature versus nurture, right? Like if you have a we have we hear it all the time like, oh, I have a bad back. It just runs in my family. It's like, well, like, I respect the belief. Like, I would never be like, no, stop right there, you know, of course. But like, I want, when I hear that,

I want to get to the underlying reason. Like, what do you mean by that? If you said this, can you please tell me more about that, you know, some of those things. Because ultimately, like, if we can't help the person's, you know, beliefs about the situation change, then the outcome, the ability to get the outcome that they're looking for is going to be a little bit, it's going to be an uphill battle. Absolutely. And I think, I think modern, like the traditional modern medical practice in general, like whether it's PT or, you know, standard medicine or whatever it is, like highly neglects like the biopsychosocial model of like the client, uh, patient or practitioner interactions. And it's just such an important piece if you're

actually trying to help people because their beliefs, their preconceived notions, it's all going to influence the way that their physical body is actually functioning too. So it's something that really can't be left out of the conversation if we're talking about actually helping people in a meaningful way. Yeah, 100%. Yeah, I couldn't agree more. Yeah, so I would love to hear a little bit about when you first started practicing PT, were you more like the mainstream PT model, and you kind of shifted after your injury,

which we can talk about as well, into like a more like holistic or like a deeper way of viewing things? Or what did that progression look like? Yeah, so I would say, how do I phrase this? The injury you're referring to, like, the head injury was the catalyst for a lot of things. But prior to that, I was already very open to a lot of, I had a lot of injuries. We'll just say that. Let me go back. So when I first graduated PT school, right, I didn't know exactly, like, how everything kind of fit together, which is, I would imagine is pretty common for like a new physical therapist or a new clinician in general.

It doesn't, you know, you're working with a lot of different people and you're trying to figure out how everything kind of fits together. But early in my career, I had a back injury. I was playing in a flag football tournament. And basically, my back felt weird. I didn't know what happened. And then I went to sprint. And I felt like someone shot me in the back and I had like pain down my leg, like all this kind of stuff.

And after that, I worked with a physical therapist who I was, you know, who worked with me at the time. And we were doing kind of like your traditional PT type of approach. Like a lot of like, you know, core training, glute training, a lot of like, you know, different types of manual therapies. And I wasn't really getting better. It was probably like a good six weeks and like I still had pain going down my leg. I was like treating patients with like a hot pack strap to my back.

Like it was ridiculous. Like imagine coming into that. Wow. This is looking good. This guy's really going to help me. But we rotated PTs on Saturday. So one Saturday I worked with a new PT. His name was Joe Myron.

He had just started around the same time I did, but he worked at a different office than I did. And he had gotten into, he's like, basically he's like, what you're doing, you're telling me he's not working. So do you mind if we try some other things out? I've been taking some PRI courses. I really don't understand how this all fits together yet, but if you're open to trying it, I'll try it. And we did some stuff from like a manual therapy standpoint, like moving my rib cage around.

And we did like your typical like progression, if you're familiar with PRI, like that everyone learns like a 90-90 hip lift and the left addictor pullback, right glumax. And it was like the first time that I felt like the pain go out of my leg. And it happened very quickly. I still was stiff. Like I don't want to paint the wrong picture.

like this was like, you know, a miracle here. But I'm like, okay, there's something, something more to this that I need to understand a little bit. So this was 2014, 15. So I started taking a lot of their coursework at that time. And it started kind of filling in a lot of things that I had observed. And then like, like, myself and with, with patience, you know, and it started like, you know, I was able to connect a lot of dots from that perspective. So I kind of got exposed to that very, very early in my career. And that kind of, I think made it easier for me to be receptive and open to new ideas, especially as it comes to human movement and what, like, my role as a physical therapist, all those types of things. So a long way to say, like, kind of traditional, but also kind of

not in terms of how I approach practice even from a very, like, early on in the career standpoint. That's incredible. And I think that's really a sign of a good practitioner when it's like, just because you're done with school doesn't mean you've stopped learning and exploring and being open to just new ways of doing things, new possibilities. So many people when they get the degree or whatever, it's just kind of like that's the milestone. They've hit it and then they're just kind of plateaued and they're not continuing their education. They're not still trying to grow and allow themselves to better help people, which is super important. And we had Rua on a couple weeks ago, who's also a big PRI guy and I've had a lot of success with PRI personally, just

with my own pain and imbalances and also just like movement optimization too. So I can totally also attest to how impactful some of their techniques and approaches are as well. So that was your first exposure to PRI when your PT at the time was working on you, on your back? Correct, yeah. And then from there, I just took a probably did overdid it a little bit, but I took every continuing education course I could take for like two or three years at that point. I took a lot of PRI stuff, but even a lot of other, you know, like typical kind of

three letter acronym courses like DNS, FMS, like all those types of things. And it was really that process, you know, just figuring all how everything kind of fit together. Because there are some commonalities. People won't like me saying that, but there are definitely commonalities between them all. And while they're like approaches a little bit different, there are things like underlying principles, I think, that hold true in all those, those kind of systems. And that I think it's useful. You know, it's useful to have different perspectives and all that kind of stuff. Yeah, I couldn't agree more. I think, I mean, the best thing that any of us can do when we're learning is like, we're each going to have unique experiences, right? And unique learning

experiences, life experiences, and there's like a golden thread that connects all them together. And if you can put the pieces together, then you generate this really valuable, unique perspective that no one else actually has. And so it can be so great to be able to share that with people because it's really going to offer a unique approach. And also the fact that there's commonalities between the different schools of learning is something that you would think actually would be the case because otherwise, like there's always going to be gems of truth in every system, even like the worst possible. system you can imagine there's going to be something that's probably a value or at least at some

fundamental level a truth. So it's awesome that you could, you know, combine those together and create your new and like unique perspective to share with people. Yeah, for sure. And even like, we talk about this in the mentorship program a lot. Even like the craziest idea, like it came from somewhere, right? Like it had to have worked on one person. So it's like for me, I'd rather just understand when that one time is, you know, than like write something completely all. And then like, write something completely off because it's like that nuance, I think, that is, is helpful to to appreciate. Yeah, especially if you're work, you know, you're working as a clinician, you're working directly with people, which is the end of one setting. It's not, we're not just

dealing with averages and what works on average. It's like the person in front of you, how can I help them specifically? And that requires a lot of nuance and a lot of attention to detail and just kind of diversity of thoughts and ideas to be able to help them in an effective way. I would love if you could share a bit about your life-altering injury. And oh, what I was going to also say before is that it's so funny and this is also the case for me. And so many of my friends who are clinicians or practitioners of some sort, it's that their own pain and disease was the catalyst for their transformation that allows them to now, you know, become the people who are really helping others. And I think that's just like such a common theme, like the wounded healer. It just

keeps coming up again and again. And this is especially the case for your neck injury. So if you share about it, I would love for the listeners to hear it. Yeah, for sure. There's definitely, there's 100% something to that because, like, I think, you know, and I don't know how off the rails we want to go here, but like I think that there are a lot of shortcomings. There's a lot of good stuff in the medical system, so I don't want to get taken the wrong way, but there's a lot of shortcomings, right? And for a lot of people, they're left with a lot of questions that go unanswered. And the way they find those answers is unfortunately, or maybe fortunately, by doing, you know, looking into things on their own and finding practitioners who can help them when others can't, you know.

So I think that there's definitely something to that because when you come out on the other side, right, you've learned a lifetime worth of information, right, that is extremely, extremely valuable and you can't replace that. You can't, and you can't discount that just because you might not have like a title or, you know, whatever it might be. So yeah, anyway, back to the injury. This was back in 2017. I was at work one day, like normal work day, and I was like just making coffee.

And I was looking down at the counter and I closed the cabinet door. And there were these two boxes. They're probably, I don't know, 15, 20 pounds each that were on top. And they fell and they hit me in the back of the head. And essentially, like immediately I had like pain shooting down both sides. Like, you know, cognitively I was fine for a moment. But then I went out and I went to treat a patient. And then I noticed like I lost my balance demonstrating like,

exercise and then like very quickly it got went like downhill. I'm like where am I? Like a lot of a lot of like acute concussion type type stuff. You know and that process like it was a little wild because it's a work the work related injury. So it goes through workers comp insurance process, which is designed to really protect employers from getting sued and like having to shut down their business and all that kind of stuff. So while yes, they will give you like the services you need. It is a very difficult time for a patient to make sure that they're getting the right recommendations and the right care. And I learned that very quickly from day one. The first doctor I went to is, well, actually, let me go back a second. This process is driven by an insurance adjuster,

so not even a medical professional necessarily, right? They go based on like recommendations, but with being real, like those recommendations aren't always, you know, with the patient's has to just some interest in mind. But the first doctor I went to was basically like he kind of like wrote me off a little bit. It was very like off putting experience. Like my mom had to come with me. I was like in my early 30s. She had to come with me. I filled out the paperwork because I literally like couldn't like read it, like interpret what it was asking me to do and like write it on the paper. I went into the room like the nurse was cool. She like did the lights for me. I was very light sensitive and the guy just came in turned the lights on. I'm like, oh sir, do you mind if we keep those off. I'm like I, I, I,

have a concussion. Like I feel like very light sensitive and his response was. Let's not jump to conclusions. I didn't even evaluate you yet. We don't even know if this is a concussion. I'm like, all right, well, this guy. How insensitive. Turn the lights on that write his notes. But it was very interesting because in his note, he wrote that the no further imaging is needed at this time. And clinically, right, in my head, I'm like, I had a traumatic neck injury. So this is very interesting. but because of that one line that he wrote in there, it took almost two years to get imaging on my, on my neck, two years. Oh my God.

Yeah, crazy process. But he was basically like, yeah, man, it's like a little concussion. You'll be better seven to ten days and we'll get you back to work. But that was the problem was everything was about we'll get you back to work. And I'm like, yes, I care about being able to like go back to work. But I also care about every other aspect of my life. Like I can't even walk to the freaking mailbox to get the mail out without like getting heart palpitations and all of these different things. And that process, the seven,

10 days, right? It was like then weeks, then it was months. Then, like, you know, ultimately I was out of work for almost, it was almost a full year. It was like 10 or 12 months that I was, was out trying to, like, kind of figure things out. It was crazy. Like, it was that process really was very eye-opening, too, because you get sent to a lot of specialists. Again, it's very insurance dictated. So you go to the balance person, like everything is about balance. You go to the vestibular person, everything's vestibular, vision person, everything's visual, right? So everyone's, like, in their silo. No one's talking to each other.

I'm telling the same story. They're, like, 30 different practitioners. And, like, there's no communication between anything. And then I just leave these things, like, feeling like, wow, everyone's telling me, one, everything is okay from their perspective. And two, I have, like, no answers. Like, what am I doing here? I'm getting, like, progressively worse.

I was even told, like, with a heart palpitations, like, by the neurologist was just like, oh, you must be prone to anxiety. Are you kidding me? bro i've never had aside from like i have a presentation tomorrow i'm a little anxious i've never fortunately experienced any type of like you know i don't have an anxious disposition like i just don't i don't know how else to say it so like it was just very like dismissive of a lot of things you know but that process taught me right this is like i thought i understood what my patients were telling me like when they were like oh my doctor told me this and i'm like just roll my eyes in the head i'm like

wow the doctor's an idiot i'm like wow it's actually like really bad out there this is like the typical thing that people are experiencing. But ultimately, like, it led me to find people that could help me, right? I learned from these people. And it's everything that went into, like, you know, what we do with our clinical practice at, you know, our physical therapy practice and performance rehab. And it's gone into everything that we teach in our mentorship program. So there was like light at the end of the tunnel kind of thing. But it was a long journey to get there, I'd say. Oh my God. It's like that kind of stuff is malpractice. And I mean, I've experienced, you know, as you probably know, just from our personal chats, but like, I've had a lot of personal pain

caused by the current medical model and just, like, on so many levels. And, like, the amount of medical gaslighting that occurs is insane. And I think a lot of that is actually attributable to that siloing that you spoke about. Like, there's all these different practitioners that are very much specialized in a very specific area. And so they just know their very niche area. And then if you're presenting with anything that kind of conflicts with. or their model can't actually like apply to, then it's just written off as something that doesn't matter, whereas somebody who has a holistic perspective and understands all the different levels that you could be affected by this injury will have way more insight and empathy and ability

to understand what might actually be going on and like to discount your lived experience, like just right off the bat with the doctor throwing the lights on and saying like, oh, you may not have a concussion, even though, like, you're literally telling him you're light sensitive. That's an objective fact. Like, the fact that he would just discount that's so mind-blowing and infuriating, to be honest. Yeah, the experience is very, very frustrating. Even, like, like, I'm a PT, right? So, like, we're taught, like, obviously I know, like, clinical signs of, like, upper cervical instability. If I'm telling every doctor I go to for two years that I have these clinical signs, like, I turn my head and there's an audible clunk. Like, I just,

put my head in a certain position and I feel like pain shook down my arms have like cranial nerve like symptoms in my face. I'm like for people to just ignore it and write it off because one dude wrote in his note that like no further imaging is needed or whatever he wrote, you know, it's just like very mind-blowing to me. And even like, like, so this is part of the workers comp process, but I got very fed up with the process because I wasn't really getting anywhere with it. Any help that I was getting I was paying for out of pocket because I'm like no worker's comp adjuster is going to approve some of the practitioners I work with, which is probably in and of itself. But when I finally, like to close out my case, which I wanted to do so I could just like move on from it, they wanted to get finally cervical imaging done. And they sent me to this guy, I picked them a cervical like cervical like a neurosurgeon, right?

Serpical with a cervical specialty. He got the MRI and he was like, if I saw this MRI, you know, when the injury happened, he's like, I'm probably recommending surgery. but at this point he's like I wouldn't let anyone touch your neck you know so I'm like the whole process I'm like one it taught me as a PT I'm like wow you know I know the humans are very adaptable but I'm like that's pretty wild because for someone to say that like an injury where most people are like putting you in like a stabilizer and like getting you to an ER like here we are two years later and like fortunate right I'm able to you know I'm trained to run a half marathon at the end of this week right so like it really really opened my eyes to even like how adaptable humans are and how

like sometimes the process we just don't give people we don't give them a chance right maybe they just don't have enough time doing enough of the right things to like get to a point where they could literally just recover and heal you know i forget where the original point i was going to make there but i think that was a good one so that's a very good one and especially with like the workers comp process where it's like everything is just geared towards the goal of getting you back to work like you said but just in general this opens just such a big can of worms where it's like people feel like they can't afford cash PT and get that help they actually need and or they assume that if they go through an insurance covered PT, they're going to get basically the same care. So it doesn't really matter.

They don't really know the differences. And we should definitely talk about this at some point, maybe not just yet, but like the differences between a cash based system and an insurance based system. And I mean, we all know we've talked about this on the podcast before, how like the insurance model really incentivize. is a poor status or poor caliber of medical care just because the doctors are kind of handcuffed in what they can do and recommend. And on top of that, the doctors are already like burnt out and in so much debt from all of their schooling and the siloing and all of that specialization. That's also restricting them in many ways. And then on top of that, you get this insurance model where it's like your care is dictated by kind of like a risk benefit analysis instead of what

may actually be optimal for somebody and their healing process. And then, like you said, things can just take so long because of all the red tape and, like, the bureaucracy of this paperwork needs to go to this person. And then, like, everybody's feedback needs to be compiled sent to the insurance. They need to approve it. And then then you have to select from this very, like, select few practitioners that are in network or whatever. And it's just a whole mess with regards to actually helping people heal. Yeah, 100%.

That's a topic I could probably speak for hours on. But yeah, it's a big problem. And it's a problem for clinicians because they're like you said, right, their tendency for PTs. We have like, I don't know what the numbers are, but they're insane how many people are going to PT school, racking up all this debt and then leaving the field just because they're burning out and they can't afford their student loans. Like that's crazy to me. But it's a big problem for patients as well, right? Because you don't really know if you're getting the best care.

You don't know if you are getting, and this is not to say that you can't be a great practitioner who works in an network facility. I don't want to come off the wrong way. But there are constraints of working in that system, just like there's constraints and problems working in a cash system, right? It's really just like what problem as the practitioner are you cool with, you know, is ultimately how I kind of look at it. But there are a lot of things that can be done to improve, right, the outcomes for people in just like a general health care sense. Yeah, totally. and like for medical doctors and for like DPP programs, you're going into all this debt to get the degree.

And then you're saddled with all this debt that like kind of will limit your ability to continue your education and pursue maybe PRI courses or other avenues of continuing your learning because you don't have the extra financial bandwidth to actually spend on those. And you're just basically worried about, you know, like you said, paying the student loan bills and keeping the lights on versus like actually growing and continuing to learn. And so you're really, for the majority of people going through these programs, they're just using the information that they took and like running with that and not even questioning whether or not it's limited in its capacity to help people. Yeah, for sure. It's tough. You know, it's like it's the financial constraint, but also the time constraint. Like a lot of PTs, right, especially if you're in like an insurance based practice, your volume is just going to be higher.

That is just goes with the territory. It's the only way like financially it can make sense from a business. business standpoint. So not a knock at all. It's just like is what it is. But you're taking home notes. So it is not uncommon for a PT to work an eight hour shift, probably not take a lunch and then go home and have to write notes till like 10, 11, 12 o'clock at night or maybe they just do them on the weekend. So then to like on top of that, go like seek out continuing education, go spend a weekend doing that when you normally would just be, you know, resting or hanging out with your friends or whatever. Like it's a lot to ask of a person, right? So it's very hard to,

to continuously, I would say, like, you know, to take the necessary steps to improve upon your clinical practice and do all of those, do all of those things. And the irony of that is all of the health care providers are literally put into this environment, both in their education and post education in the working world, in this environment that basically sets them up for disease and lack of health. So it's a bit ironic that these are now the people who are supposed to be helping you with their health and they can't even help themselves because they're constrained by all. all of these demands on their time and resources.

100%. Yeah. And this is interesting that you say that because I look at the time when I got injured. And leading up to that time, like, I definitely just comparing it even to now, right? Like now theoretically, I should be more busy, right? I own two businesses. Like, we're in the process. My wife and I of opening a third business.

And I feel like probably the best I've ever felt, like from like an energy. standpoint, like a health standpoint, like any like objective and subjective way you can, you can measure it. But prior to that, that head injury, I was 100% burning the candle from both ends. Like I was, that's when I had gotten into running. I was training for races. I was, like, hungry all the time. Like my sleep schedule, like, sucked because of just like work, just naturally, like how it was. I was working in these, like, fluorescent lights till like nine o'clock at night. Like it was just so many things when I look at it, high blood pressure, all of all of those signs were there. And it's just like, was I like even optimal?

They didn't even have a chance to like recover from that injury had I not been out of work. I don't even know because like the environment that I was like in was just there was just so much going on, you know, that that was not really conducive to how I view, you know, health for myself. Yeah. Yeah. I mean, that's something that I talk with clients with a lot. And it's definitely been the case in my life as well where it's these, I mean, as as in convenient and traumatic as some of these injuries or illnesses can be, they're really there to

teach us to slow down and pay attention to what's going on in our bodies. And it's, and it can be a gift if you view it in that way, where it doesn't become helpful as if we're viewing it from like the victim archetype of like, poor me, this happened to me. It's completely out of my control. And, you know, I'm just, you know, doomed to feel this way or, you know, things just happen. It's random chance. Instead of viewing it that way, it can really change your healing process and also your future trajectory, if you're viewing it from the perspective of like, what actually have I been ignoring, what, you know, have been things that I've just not been tending to that I know need to be tended to and what my body is actually experiencing

and how I can use that information to actually create a life that's more conducive to healthy living moving forward. Yeah, 100%. Yeah, it's, yeah, it's very interesting. Even like I'm thinking now back to that time frame, like when I, when I, when I, when I got injured and my health I mean I went to like shit like it was really bad like I put it I was managed away from everything though like literally don't go outside and exercise like my have an attorney telling me oh yeah don't don't go for like walks because if like someone sees you I'm like

get out of my god it was so the whole process ridiculous you know but I worked with you know Ben house yeah I do yeah so I worked with him at the time like I heard him speaking on like a podcast when I was going for a while and and he was basically talking about um I forget but people with like post concussion symptoms that are lingering for a long time. So I just like reached out to him. And he was the first person who who basically was like, what can you control? Like literally what you're telling me you can't exercise?

Like what's the minimum amount of exercise you can do? Can you go do like a circuit of 10 minutes on machines? And I'm like, actually, I probably could do that. You know, because I definitely had that mentality like, oh, why did this happen? Oh my God, this sucks. Blah, blah, blah, blah, blah, which is true. It did suck and why I wish it didn't happen at the time. But like then I had this person kind of giving me like,

freedom to just be like, hey man, like, you can just try shit out and kind of see what happens, you know, and that's what happened. And ultimately, I'm like, okay, wow, cool. Like, I can do some stuff. And then the next week I could do a little bit more. And then, you know, he helped me out with some, like, dietary nutrition stuff and like all that kind of stuff. But that shift in mindset was, was very big for me. And I mean, that probably was like the catalyst for turning a lot of things, things around. Yeah, I think that's so important. I mean, when people view themselves as fragile, It just is completely, it's going to change the way that they just function in their day-to-day life. And the body is very resilient and very, you know, incredible in its capacity to heal if it's given the right resources and enough time as well.

But absolutely, so important to just find the things that you can do and focus on that versus all the things that you can't do and your limitations. If you focus on that, that's what you're going to see. Basically, whatever, you're going to see whatever you're focusing on. And so if you can make the best of that, it's going to actually not only, from a psychological standpoint benefit you, but also with your healing process as well, because now you're going to be at least, you know, helping to maintain some of your muscle mass and your metabolic health, even in the face of, like, limited mobility and capacity to engage in physical movement. So whatever you can do is absolutely going to be beneficial. And I think

that's such an important point. Yeah. And, you know, and like just bringing it to like the PT world, like a lot of our patients, you know, like they're, they're kind of managed, it's very similar, right? they're like you go into a PT and sometimes it's very disheartening because it's like all the things you can't do don't do this don't do that don't do this right and it's like all right cool well like what what can I focus on you know so it's not very so like solution oriented it's just very like oh you got knee pain like you go imagine you have knee pain and you go to someone who believes that squatting is bad for your knees and you're like but I love squatting it's like well you're definitely at the wrong person you know but that's very very very common right and then when you um they come to us like we we always

talk about finding like the low-hanging fruit or like the thing that's like glaring where if we just change this one thing right there it's going to probably have like an exponential carryover to everything else the person is doing it a lot of time it's just shifting i shouldn't say just it's but it's shifting the their mindset around the situation like oh i'm allowed to go to the gym like yeah we might have to set up some parameters but like here's what that would look like you know like you know giving people that kind of autonomy is is goes a very very long way absolutely so after your injury your what did your healing process look like Like how up until how recently were you still experiencing issues from that?

Yeah, let's see. It's kind of a blur now. So I'm going to say I was doing a lot better. Let me think, get a timeline here. All right. So 2019, I was still having a lot of issues with just basic exercise, like day-to-day function. But I could function, but I still had a lot of issues. So for example, I had a patient on a treadmill running.

It was very hard for me to talk to this. them because I couldn't find, like, I had some visual issues still from the concussion. So I'd have to, like, look away. Like, a lot of that kind of stuff. If I exercise, I'd get, like, a lot of, like, neck pain, some kind of, like, tension down into my arm. And in 2000, I'll say, like, the end of 2018, beginning, 2019, I went to, it's called the intensive.

It's a, it's basically Bill Hartman. He's a physical therapist in Indianapolis. He shares his model of care with people. and he's just continuously kind of improving upon it. But I went there. I had met him at a PRI course, ironically enough, for a few years before. And that was the first time where I kind of like got a good understanding

of how everything really fits together. And it was at that point where I was able to start getting back into exercise. And I figured out like, okay, here's what's happening. And here's how I can kind of reverse engineer the process a little bit. But it wasn't really until maybe like last, maybe early 2022. So pretty recently, maybe a year and a half, two years ago. where I worked with my friend Mike Camporini, who is, you know, a mentee also of Bill Hartman's, who got me back to running. And that was kind of like one of the biggest hurdles I was having.

I couldn't handle any kind of like pliometric activity. And that process got me to the point pretty much where I'm at now earlier this year. You might know him. I'm drawn up lake now, actually. Rua actually referred me to him. Howard Hindon. Oh, yep. Yeah, Airway Deadpisk. And he has, I'm like, here's the things I'm doing. everything to me now points to like I just need some management at my lower my lower jaw like C1 C2 area

so that's where I kind of am like I've been able to run without you know any kind of appliance in my mouth like do all of these things and it's really just been you know kind of a process that's it's taking me in a lot of different directions I didn't think they would go oh but I think it was really like solving one problem right and getting to the next problem and then figuring out how to solve it is really you know where we're at right now but now I feel pretty much I don't know I don't really know if I have any real limitations, like physically, you know, at this point. So that's amazing. Considering all that you've been through in the past few years, it's quite an achievement. And thank goodness, what did Dr. Hendon work on? Did he use any appliances with you? Or I think you were getting fitted for one at some point, if I remember correctly. Yeah, yeah. So we were January or this year, I'm going to forget what, I don't know what it's called. Basically, it was like a lower jaw, like splint. I don't know what else you would call it.

I wore it pretty much all day unless I was eating. And then I'm probably on weeks. We got it to the point where like the relationship between my draw, my cranium, right, is, is holding, I guess we could say. So we're basically we switched over to an invisible line type situation where now I'm getting the teeth to support the structure. And I'm probably maybe a third of the way through that process. Amazing.

And then we're going to kind of see. He's like, I don't know what's going to happen next, but it might be done or we might need to. do a little more, you know, but at that point we'll kind of figure it out. But, you know, I'm at a point now where I never thought I would be without, you know, some type of assistance. So like, I'm just going to ride it out until it doesn't work anymore and then figure out what to do next. Incredible. Yeah. I mean, once the nervous system, we talked about this with Rue when he was on the podcast, but once the nervous system has this like new efficient pattern that it can default into,

then, you know, there's no reason that that can't stick necessarily. It's just a matter of getting it to a place where it feels safe enough to do so in a low threat situation. And actually, I think something that a lot of people don't realize is the relationship between the bite and their neck and also just like their whole body in general. Do you want to talk about that a little bit? Yeah. I mean, 100% I was just going to say like a lot of, you know, again, not a knock, but I'll just point out, you know, a common thought. A lot of PTs are very, very quick to hate on the airway, very quick to hate on any type. type of, I don't know, like dental or visual integration type stuff, but there's 100% a place.

I do think, you know, and this could be just part of the circles that I'm involved with. I do think that people jump to like expensive dental appliances way too quickly without getting the rib cage pelvis stuff under control first. But there's a time and a place for it. So again, the way I approach things is like I'd rather understand that nuance so that I can make a recommendation for a person when it does happen, right? Like a head injury seems like a very good time to make that recommendation, even if it's short term, because, right, everything is, I mean, it's all right there, right?

So your upper cervical spine is going to be very closely related to like your TMJ, for example, right? Your TMJ relationship to your cranium. Like, they're all very, very relevant. It's just really what's relevant for the person. So the relationship is all there. What I will say, just as this is how I approach practice, I think that, like I said, like a lot of people are quick to jump to that when they don't get the rib cage and the pelvis

situations kind of sort of. Once you get that, a lot of things kind of clear up. And it's really when the relationship between the rib cage and the pelvis and how a person manages pressure, when those things aren't sticking, then it might make sense to kind of go the, go a little more into like the quote unquote, like weirder realms of like vision and dental and that kind of stuff. But the airway, I mean, what is your body needed, right? It needs oxygen.

And it's going to, it's going to prioritize oxygen no matter what. Like, you just need it. So that's where you're going to see a lot of like weird compensations for people. we have someone in our mentorship program now whose son had what was it was a something like attention related I can't think of what

like some kind of like cognitive delays like a lot of crazy stuff they did an elf right and 90% symptom resolution wow like see I hear that stuff and I'm fascinated but a lot of PTs hear that stuff and they're like looking for all the reasons why it can't be biologically possible

but I'm like I don't know it's like there's something there that we don't understand, you know, and it's just, it's just fascinating to me. Absolutely. I mean, we know so intimately anybody can experience this themselves that the way that you're breathing, like your breathing mechanics is going to influence the way that you're feeling. And if you're getting a lot of shallow breathing, that's not really getting good ribcage expansion or you're not getting like internal oblique activation and managing your pressure, like you said, you're going to be more sympathetic. You're going to be leaning more towards, you know, anxiety and, you know, poor recovery, poor sleep.

and this also just all snowballs too. So it can really be so important for people to just really get the basics right and see a good provider who can help you make sure that you're doing that. And that's where like the assessment piece is so important because a lot of the times like you'll see things about belly breathing or just like random little tidbits on Instagram that are like woefully incomplete and or inaccurate. And then there's no like assessment piece. So would you be able to talk a little bit about like your assessment process and how

important that is when you're figuring out a good strategy to help people. Yeah, for sure. And what I'll say to that with the Instagram stuff is that it's exactly that. There's not, it's just know the medium, right? There's not really much nuance at all on Instagram. And that's why it gets frustrating for some people and why it's like the goal is to keep people on the app. So like you're going to have very polarizing ideas and then people are going to argue back and forth. That's literally like what it's designed for. So yeah, like it makes it very hard to find good, good and useful. useful information. But yeah, what I will say is our assessment process, you know, we, we, we always start with, it always has to have context, right? So it's always going to be related to the

person and the person's goal in their lifestyle. So we spend a lot of time understanding that. From like a physical standpoint, you know, the movement system is the lens that we view things through as a movement, movement professional. So we use a lot of like joint motion testing to get an idea of, you know, okay, how is this person managing, like, the things that they do on a regular basis? Where do they have restriction in their body that maybe if we ease that restriction, now they have some more movement options available, we can get them kind of feeling better. You said the word nervous system, right? So maybe we can have a nervous system that has a hard time, like dampening the sympathetics. Maybe we can help them dampen sympathetics. Maybe we can help them get

to a parasympathetic shift more easily, create some variability in their system. So we really look at things from that perspective. And we use the movement system as our proxy. That would be like the most overarching way I could kind of kind of explain it. I'm happy to go into any more detail though. That would be useful. Yeah. Amazing. I think maybe it would help to like backtrack for a second and talk about what changed in your practice after you had like your personal injury experience and had like so my eye opening medical interactions with other medical professionals and what were like the first things in your practice that you decided like this needs to change immediately. Yeah, the biggest thing for me has nothing to do with even like the assessment process.

It has to do with clarity. And and giving people a plan is basically it. Like people like we have like a letter that we send. We get a new patient. Let me go back a sec. We have like this new patient kind of package. We give them. So it's stuff that's going to be helpful with their rehab.

But it's also like a letter for me as the founder to them, right, welcome them to practice and we leave the message the letter with something to the effect of like we we never want you to not know what you need to be doing and what's happening and where where your plan is going you know and that's the biggest thing for us is being able to establish that for a person so that they have clarity on their on their situation and that they have a way to like that they're very open and able to ask ask questions so that's the biggest thing that changed for me because my experience was a complete opposite like I never knew if I was getting better I'm like I don't even know I'm just doing the stuff they're telling me to do and like crossing my fingers basically right so

it's really that and then being able to give them something objective to attach it to. So what I mean by that, I guess that would be like the assessment part is, you know, we kind of identify like the KPI or like the key performance indicator, whether it's a measure of, I don't know, force output or joint range of motion or literally my knee hurts when I go up the stairs, does it hurt now? Kind of, you know, that could be the KPI. But something where the person knows, okay, this is the thing that we're tracking and it tells us that we're going in the right direction because what my experience was and what

lot of our patient's experiences are, is that they don't have that. So they're like, oh, interesting. Like, you're, you're checking, like, my shoulder motion a lot. Like, do you mind telling me why you do that? My other PT never did anything like that. It's like, well, yeah, like, this tells us that we're at least going in the right direction, because otherwise, you know, I'm just kind of, kind of guessing. So I would say that's the biggest thing is giving people some kind of clarity and setting expectations for them. I love that so much. It's so important to be able to have, I mean, for the person, they have their subjective, like, you know, on a scale of one to 10, what's their pain like and maybe some other like nervous system regulation pieces, things that they can

sense in their body, but they're not necessarily measuring. But it can be so helpful to also have measurables to go along with that just to keep some level of like objectivity and consistency across people from a practitioner's standpoint, but also from the patient's standpoint, just being able to kind of objectively assess whether what they're doing is working, like you said. And also when you see that progress, it helps build momentum and like positive attitude to, too, which also can help with that whole, like, rehabilitation process. Yeah, for sure. And that's a great point. I was going to say, like, one thing that we definitely notice in our practice is we,

we're always refining, like, our customer, like our client journey. But if that is how engaged people are in the process. And I think it's because we have those checks and balances kind of set into the process. You know, we also use, like, tech, you know, like we have a CRM, like a, I always forget what that means, customer relationship management software. So we have like, you know, like emails are sent out at certain points in their plan of care and like all these different types of things. But they're very engaged in the process and like their outcomes are very good, you know? So it's like, you know, they probably all go together, right?

We're able to spend more time with people. They're very, have a very positive experience with the process. So that's going to all kind of play into them getting like the resolution that they're looking for. But back to the objective part, you know, one thing that I've been guilty of this in the past, PTs are definitely guilty of this. doctors are 100% guilty of this is pain, I don't think is a really good outcome measure to follow because pain is what? It's an experience, right? So it can fluctuate day to day.

You could have a couple of crappy nights of sleep in a row and like your pain feels like a little bit worse. So attaching it to something that is more meaningful like, you know, function, for example, or like I was able to run five miles. Now you can run seven miles. Like those types of things. It's also it just shifts the perspective of the person, you know, versus like always kind of focusing on the on the pain side of things not saying the pain doesn't matter it

a hundred percent matters but from an objective like measurement standpoint there are I think better ways that we can kind of gauge progress it does and also because like you're alluding to there is also like a bioseco social component of pain it's not strictly like biological mechanistic there's so many factors that can play into it being better or worse on a given day that make it kind of unreliable to track exclusively and if that's the only thing you're focusing on, then I mean, typically what you focus on is amplified. And so if you're really focused on that pain, that's really what you're going to be feeling versus if you're looking at like a performance metric, you can then say like, oh, I actually feel stronger.

Maybe my pain is consistent, but I'm actually feeling stronger in this movement, which can just, again, like, help with like the positive framing of your progress. And yeah, so I totally agree on the pain point. That's super important. And I would be curious to hear a little bit about what kind of clients and patients you typically work with. Do you have like specific demographics that you focus on or do you have like a pretty wide range? Yeah. So we like selfishly right, AMP was created to help people like myself, you know.

So I always say our, you know, our marketing is very much geared towards people who are very, very proactive with their health. They tend to exercise and like maybe they have long-term pain doing so. We tend to market in our marketing messaging, like we speak a lot to, you know, the ability to help you stay doing the things that you love, even if you've gone to a PT before, even if you've gone to like you haven't had a resolution before. So I would say that's like the typical type of person that we work with. We also have a pretty large population of student athletes just given the location that we're in. We're in a, you know, we operate out of a gym.

and they have a really, really good sports development program. So we tend to get a lot of that high school age kind of college college athlete as well. That's great. And I think I've talked about this on the podcast before, but it's just so pervasive among the, like, athletes I've worked with and seen. And also my brother is a retired pro basketball player. And I mean, I just see it time and time again that so many athletes are good at what they do despite what they're doing and not because of what they're doing.

And there's just like so much room for not just, just like, you know, injury remediation, but also just performance and movement optimization to keep them from getting injured. And do you work at all in like the preventative space as well? Yeah. So they, we work very closely with the coaches at the gym in that, in that capacity. Yeah, because you're right, right? Like compensation, movement compensation is not a bad thing at all. You know, it has like a, I think the connotation is kind of negative. But it's just what makes them good at what they do, right? If anyone watches like LeBron train, like you're going to be like, oh my God, this guy's like, you know, like, what is this guy doing?

But here he is, like 20 years playing basketball at a very high level in the NBA, right? So it's like, you know, being able to, you know, optimize how a person does stuff. Again, it's not going to predict, prevent injury, but it's going to definitely be helpful, you know, in mitigating kind of risk. So we work closely with the coaches at the gym that we're at in that capacity for sure. But you're right. Like, there is so much room for improvement in how like a person potentially expresses the thing that they're already kind of good at.

So there's definitely a huge benefit in that. Yeah, totally. And I mean, there can be like this misconception if, you know, you want to be a really good basketball player. You look at how LeBron trains. You're like, if I train that way, then I'll be as good as LeBron. But it's, I mean, it really doesn't work that way most of the time. And I think it's really important to maybe identify the things that he's doing

or any, you know, athletic performance, anything that you could be doing that can get you closer to where you want to be versus things that the pros are doing that. maybe are, you know, they're doing it, but it's not actually lending itself to benefiting their performance. It's kind of just, they're so good, like, genetically and, you know, their builds are just appropriate for whatever sport they're engaging in. It's kind of like the self-selection process where if you're, you know, super tall, you might go into basketball naturally as a result of that, or you might go into powerlifting if, you know, you're kind of naturally strong and, like,

enjoy lifting weights, like just the self-selection or like yoga. If you're flexible, you'll go more likely to be going into yoga just because you're kind of naturally good at it. So it's really important to like disentangle like the natural talent versus the acquired skill, I think. Yeah, 100% right. And one thing that we look at, like we call it a needs analysis, right, on a person. So structurally you're going to have people who like you said, right, they're just tend to be

good at some things and not as good at other. other things, right? So like you have a person who's very like muscular dominant, right? And they want to be a runner. Well, that's going to be very fatiguing for that person. So how can we like raise their floor a little bit by making them like a little more springy, right? So we're doing very like quick ground contact time, you know, like tendon type like elastic work, you know, like those types of things because that has huge carryover into like what they do. And we're not going to ever make them as like springy as like, I don't know, like the springiest person in the world. But we can move them a little bit in that direction and that might just be enough to to kind of change their you know how they

express movement. Absolutely. So we kind of alluded to this earlier, but I would love to hear a bit more of your take on it and that is the differences between the insurance base model and the cash PT and how and when you decided to go the cash route and the pros and cons of each, basically. Yeah, yeah, for sure. So up until I started AMP, I had always worked in an out-of-network insurance-based model. When I was in school, I had worked in-network insurance-based models, and I learned very quickly that that wasn't going to work for me.

The biggest constraint for, like, is always going to be patient volume, right? So if you're in an in-network insurance-based model, essentially, right, the reimbursements, I think average reimbursement in New Jersey is like $63 a session. Whoa. Yeah, so it's, and it's not going to get better. PTs want to like fight the man and like, you know, fight for larger reimbursements.

It's never going to happen because you have $100 million, $100 billion companies here, right? Where their goal is not to help providers or patients. Their goal is shareholders, right? So that's just how it is. You're a publicly traded company. So with that being what it is, right, they need to make up for that with patient volume. For me, seeing there is an upper limit to how many patients a PT or any clinician can see within a, a timeframe that where it's just not going to be effective.

And network, it happens very quickly because you're seeing three, four, sometimes six patients at a time. Wow. Your attention's divided. There's just no way you can be the best PT in the world and you won't do well in that environment. Out of network,

tendency is that you get reimbursed, you know, better, but not everyone has one out of network insurance. So they're paying self-pay rates anyway. And you'll tend to see like a little bit less, volume in New Jersey. In recent years, reimbursements have gotten cut. So you're still seeing a higher volume in that situation. Most places are three, three an hour. I've seen some that are four an hour, which again, at that point, you know, what are we doing? But not for me. I'm not saying you can't be successful in that environment. If you like, you know, bashing your head against the wall,

trying to see four patients an hour keeping up with notes, then more power to you. So that was basically what led into the decision, right, for us to open the practice the way we are. So we're out of network, mostly self-pay. And that kind of goes with the demographic, right, our ideal customer who we want to work with. And also the promise that we deliver, right? So our promise to our patients isn't like quick fix, like get you out of pain and you're going to feel good in a day. It's like a long-term result, right? So the only way we're going to do that is if we're, one, working with you directly and two,

that there's a period of time that we're working with you because it's not really fair for us to make that promise in my eyes and then be like, oh yeah, we'll just go, you know, we'll do a consult and then we'll see you in six weeks and like all that kind of stuff. It just doesn't work as well. So that was really the decision-making process for us was, is why we want to go into the cash-based kind of world. We have full autonomy with how we do things. You know, people will say that insurance doesn't dictate how you treat, but I think that the minute you're modifying a plan of care because your constraint is financial, that you're is dictating how you treat, right? So for me, I'd rather have the skill of being able to like tell the person, here's what I think you need, here's how it's going to happen

and then letting them make the decision is kind of how we approach it versus me kind of trying to dictate based on what I think that their views on, you know, money and insurance and all that kind of stuff are. I'd say those are the biggest things, you know, in terms of like actual practice. Yeah, I love that. And I think it's really important in general if we're looking about, looking at like basically preventative care or high quality care, that it's really important for people to understand, like, you're literally investing in your health, and you can pay more upfront to, like, you know, go to a really high-quality provider or, you know, buy the products or tools that you need to help support your health. Or you can pay, like, tenfold later in

medical expenses when you have these chronic degenerative illnesses or injuries that could have been prevented or mitigated if you would have made the smaller financial investment earlier on, but a lot of people don't, like, there's a lot of, like, short-term gratification and just like our mentality around finances in this culture is just kind of weird, but we don't really see the value in something that isn't really tangible. So it's like, we're just willing to hedge our bets that it'll be fine in the long run. Meanwhile, like, you know, you could be setting yourself up for disaster versus if you really understand, and this is also where it can be helpful to have, I mean, as weird as it sounds, it can be helpful to have these really negative.

injury or disease experiences earlier on in your life because then it really makes you understand the value in your health and like you've been on the other side you know what that feels like and you don't want to go back to that and so that is at least for me and you can you can share if that's the case for you but i mean for me it's like a really big motivation to invest in my health now so that i don't have to deal with these problems later on and that's really where the cash PT system lies in my mind it's like you're investing in yourself and in your future 100%. I mean, that also goes to like just, right, person's perspective on health, right? Because I'm very much thinking the same way as you. I mean, you probably know that about me, right? That's literally why I ask some questions all the time. So, but yeah, 100%, right? It's like, like, what would be an example? Like a surgery, right?

Surgery has no guaranteed outcome, right? Except that at some point, hopefully, like, the physical tissue heals. But like, that's the only, it doesn't guarantee you're going to be better from pain. We have people that have hundreds of thousands of dollars worth of, you know, expenses from back surgery that have the same or even are worse off after the surgery is done. And guess what? They still have to go through the rehab process, right? So it's like there's no, there's no guarantees of any of these types of things. So if you're someone who's like looking for a provider, like the most important thing is that they understand, understand that process and can at least give you information that

is as unbiased as possible where you can kind of make a decision. And that's all we really do. People always ask like, I have a lot of friends who run like their own practices. But like, how do you charge so much for physical therapy? I'm like, well, well, I just put a price tag on it and I don't really sell physical therapy, right? I'm like, I have to have a conversation with the person. They might not literally be the right fit for what we even do, right? But there has to be something that they care about and that they value. I'm not, my job is not to convince a person of anything. Like, no one's going to line up. We're not going to

have like the good reviews and all that stuff. If we're like pushy with that kind of thing, it's really like, what does the person value and are we the right fit to help them achieve it? That's really how we look at things, you know? If we compare physical therapy as like a commodity, like in network versus out of network, people are going to be like, well, why am I going to pay you this when I can just use my insurance here? It's not a commodity, right? It's like, what's the, what's the difference? Like, there's got to be some kind of difference. Yes, totally. And when people ask us, right, they're like, well, why are, wow, that's like, wow, that's really expensive. We tell them, you know, straight up with what our pricing is. And our answer is always like,

yeah it is do you want to know why you know like i haven't we're not hiding anything right it's just like there's there's a reason that you reached out to us whether it's like a google review you saw or someone referred right i'd rather be able to have that conversation with a person than you know them just go on thinking like this person's crazy charging for physical therapy you know yes this is key and also a part of this conversation that's often not discussed is that the amount of money that somebody invests into whatever it is is that actually like giving them buy-in into that too. So they're going to put more energy and effort into their healing process in the context of PT. Whereas, you know, if they're paying, you know,

through insurance or like a smaller co-pay or they're not really making the financial investment, they're probably going to be a little bit less likely to actually put a lot of energy and time and commitment into that process. So it's actually a win-win in most cases if you're paying a bit more, but, you know, you're working with really good people who are very, very, attentive providers and they have a track record of success and then you're making that investment and now you're really incentivized to do the work to get you to the better place as well. Yeah, I mean, hands down, right? We actually, we submit out of network for people if they have it and you know, they just kind of have a co-insurance. But our process doesn't change. Like, I don't care how,

like, who pays for your services? Like, our process with every person is the exact same for that reason because we want people to be invested in their in their care right they need to be autonomous right in the in terms of like their ability to like make decisions and and understand that a lot of like the outcome is really kind of in their hand we're we're guiding the process yes but if they just think they're going to show up and like magically it's going to get better it's just not the not the case so we're very much consistent with how we how we do things regardless of if it's insurance out of network or you know someone's paying fully out of pocket and to your point right the outcomes are good because people are very invested in getting better.

And we do everything we can to help support that process for them. That's incredible. When did you make the shift into the cash PT? So when did you start your practice? Also, when did AMP be, when was AMP birth? And then when was the shift to like the cash base system? Yeah, we were cash from day one. So we, I started the pandemic, basically, February 2020.

and then February 2020, we basically also closed just because the world kind of shut down during that time. I would say we've been like in person since probably like January 2021, something like that. Yeah. Amazing. And I mean, you kind of mentioned this already, but you have you noticed that since like the inception of AMP, you've been able to better help people and get better outcomes with individuals working within this system? Yeah, hands down. There's no, like part of it is just bandwidth, right? Like we're able to spend more direct time with a person. It's not just like, oh, hey, just checking in. Okay, do your exercises with the aid now.

Right. We're able to like kind of real time assess, try things. If they work, great. We just keep doing those. If not, then we can like modify on the spot. So we see like those results very, very quickly. And then, you know, we're able to gradually kind of progress things over time so that like the person is very kind of autonomous in the process. But yeah, the results themselves are, I mean, night and day, different, you know. Yes, yes, I can imagine. And I think this is just a very important takeaway for people in general, whether it's PT or other medical services, you know, going the extra mile to find a provider that's a good fit despite what that cost might be. Like, if you really want something, there's a way to financially make it work, whether you have to sacrifice other things that

maybe aren't as essential. Like, there's really nothing better that you can invest in other than your health because you need your health to in order to do anything in life in order to engage in the things you love in order to spend time with friends and family like you need to have that bandwidth of wellness in order to you know it just goes without saying like you only have this one body you need to take care of it and do our best to do that but on that end so would you be able to talk about when AMP education started and like what that program looks like because I think it's very unique I've never seen another PT that also offers like like this more meta coaching scenario as well, which I think is super valuable.

Yeah, 100%. Yeah. So this kind of happened during the pandemic as well. So at the time, I was doing a lot of one-on-one like mentorship with other like trainers or other PTs or whoever, right? And a lot of people had very, very similar questions and very similar issues that they were they were kind of dealing with. So I kind of just took that and put it into. to a 12-week program. And it's really grown a lot. We're launching the 11th or 12th rendition of it right now. And it's been cool.

We've had over 200 people now. Wow. Yeah, it's been great. Yeah, so we basically, over 12 weeks, we have a combination of recorded modules. And then we do small group mentorship sessions over like Zoom, like we're doing right now, where we take people, we kind of like coach people through things or if we're doing like assessments,

like walk them through the assessments and like all that kind of stuff. And the real goal is that people have like a foundation to kind of filter information through, but also to make decisions off of because that's one thing that, you know, it's like objectivity versus emotion, right? Like you want to be as objective as possible when you're when you're doing anything that requires a decision, I think at least, you know, because that way you can at least be consistent and like you can minimize the effect of any kind of like biases, all that kind of stuff. So we kind of just teach our our process with that, you know. So it's like people have some, some clarity on, you know, how to, how to, how to approach clinical care because it's, it's tough, right? Like, we don't know

when we give a person an exercise or we do some kind of manual therapy with a person. We don't know how the person is going to respond. It could be favorable. It could be no change. Could have a negative response, right? So it's like really being able to, then real time decision, you know, problem solve and make decisions is kind of what we, you know, the end goal of the the whole thing. But yeah, that's how we kind of put it together. And we've kind of tweaked it a little bit as we get more feedback, you know, every time we do it. But yeah, it keeps growing and yeah, it's been a lot of fun. That's great. And I mean, you can just expand your reach and your ability to help people so much more when you're working as like a meta practitioner

and coaching the coaches and like in training the DPTs and other providers to do what you're doing. And it's just at scale. It can be, you know, incredible, the reach that you can have. So that's awesome. Do you strictly work with DPTs in that program or are there other credentials in there as well? Yeah, yeah, other credentials. Yeah. So we don't, we don't actually, I don't speak to pain. Let me think obviously conversations about pain come up, but I don't talk about treating pain or anything like that.

We approach everything is very much from like a movement system perspective, right? So with that, you know, being said, we have, it's usually like 60% clinicians, I would say, so we got a lot of PTs and Tyros. And then the rest is some type of fitness professional, whether it's strength coach, personal trainer. I saw someone signed up the other day. They're like a yoga instructor. So we get a lot of different, we Pilates instructors, a lot of different practitioners kind of in one place. And where it's like super beneficial is, you know, like as like, not just like for me as like a person who's like teaching, but also for like the other people in the group is

I think hearing the questions that people ask from different professions is very, very useful because it's just another perspective. And I know for myself, it's like, oh, wow, interesting. Like a person has never really asked me that question before or like I see where you're coming from. That's like an interesting way to think about it. So for me like that learning environment is just is very conducive for for a lot of different like learning styles, mine included because it's very visual and interactive, but you also get like people at different levels and different professions kind of working together. So it's been a, it's been a cool experience and that was just like an unintended benefit

that just kind of, you know, I've noticed from it. That's awesome. What size are the cohorts typically each 12 week session? Yeah, they range a little bit. So we do two bigger launches a year. One of them is now, so during like the Black Friday, like holiday time. So that we usually cap at 25 people. We have three instructors, you know, in the program, two in addition to myself.

So it still has that like very personal, like small group kind of one-on-one feel to it. And then the on the lower end is usually about 15 people is what we kind of cap it in the other two. Amazing. And do they, is there any sort of like assessment process during the course? like during the course or the trainings or what does that look like? Yeah, so actually we're, you mean for the people going through it, right? Yeah. Yeah, yeah.

So we're actually adding something now because we're getting it, you know, credentialed for CEUs. And I just, it's just a process. I'm like, I just don't want to deal with this. Yeah, I've heard it's a pain. Yeah, but I think it's worthwhile. Like, you know, it's worthwhile. It helps some people out, you know.

So we're going through that process and part of that requires that we have, you know, formal assessment process. Yeah. Yeah, informally, what we kind of, what we not kind of do, what we do is we have, so there's, once we get through like the first like four weeks or whatever it is, five weeks, it's all kind of geared to like foundational information and like assessment. So there's, there's like an informal kind of assessment process there. And then at the end, it's really like about putting together a plan of care or a treatment

session or a training session or a training block for a person. So there is like, you know, there is like kind of like a capstone little little parts. to it, but it's not formal by any stretch. That's awesome. That's a great resource, though. And yeah, I mean, it's definitely helpful despite all the, like, the bureaucracy of it. The CEOs can be helpful for people to build their and grow their businesses. And so I think that's great that you're doing that. You also have a podcast, right?

We do. Yeah, it's a little infrequent these days. But yes, we do. I'm drawing a blink on the name right now. Amp radio. It's that infrequent. Yeah, I knew we had amp in it. Amp Radio always make progress. That's what it's called.

That's what Amp stands for actually. Oh, I didn't know that. I love that. Yeah. Yeah. So it's me and my buddy Encore, who we know. Yes, I do. And we really, it's geared towards, you know,

clinicians and fitness professionals. And I try to bring on people who, it's very geared towards, like, professional and personal development, like within this space. So we don't really get into too much nitty-gritty, like, you know, X's and O's of biomechanics or anything along those lines. We kind of kind of try to keep it very,

relatable stories that people have kind of gone through, especially we're seeing with a lot of younger practitioners who are coming up in like the social media world. Understandably, there is definitely a lot of, what's the word? Like, a lot of confidence issues, I would say, like with, oh, I see so-and-so on Instagram and like, you know, they do everything and have it all figured out, you know, so trying to kind of create like a more realistic picture of what it. clinical practices in life and or what clinical practices like. So we try to have people on like with those who can share those kind of stories about, you know, their development and those types of things. Yeah, I think that's super important. Like there's a lot of posturing and like illusion

on social media where it's, it can be really hard, especially if you're like a new, you know, practitioner in whatever space in the health fields and you're trying to figure out how to do well and make it and like find people who have good quality information that you can, you know, know, emulate and learn from. It can be really hard to kind of do the vetting process to find those resources and, and figure out, you know, where you should be focusing your time and money and all these things. You're just like this excess of information that we have available, that is available to us these days. And it can be super hard to just sort of sift through all that and figure out what's, what's true, what's not so good, what's like a partial truth. There's a lot of that on Instagram. So

Yeah, that's great that you're kind of focusing on that within the podcast and in general, just like delivering high quality information with nuance and with the ultimate goal of just helping people. Yeah, yeah, 100%. I mean, Instagram is a wild, wild place. Like, one post is like, you can just literally be scrolling and like you'll have two completely opposite ideas like right next to each other. So it's very, it's very confusing for people.

And, you know, part of the mentorship program for us is really, like I said, is that that framework to just filter information through, right? Like you need a lens to kind of understand and appreciate what we do through. Like that lens should probably keep growing and changing as you learn more. But if it's just like, is this good, is this bad? It's like, like, you need a way to like objectively look at those things, you know. So we try to, we try to help people out with that as well. Yeah, that's a huge red flag in general whenever you're foraging for information.

And somebody says like X is good or X is bad, like you can automatically know that they're wrong because it's completely stripped of context and without the context you can't know whether something is good or bad and it's often way more complicated than that and so that's just like a very like immature way of thinking about concepts in general and you mentioned also like the polarity of ideas on instagram and that's also something that's really common within uh science and medicine too like you can depending on what you're looking up you could look up two completely opposing ideas and find scientific literature to back up both of them and so that's where it's like there's like there's like there's like there's a this paradox that really, you know, kind of comes to the forefront. You have to be able to look at the ideas and tease apart the context within which one of them could be true and the other one could also be true and figure out what, you know, most appropriately applies to your perspective or your situation or if you're working with somebody

their situation. So it's nothing is black and white and that does make it more challenging, but it also gives you a lot of potential for, you know, learning new things and being able to growth nuance and your capacity to, you know, interpret information and ultimately, like, serve others as well. Yeah, 100%. Yeah, I love that. Are there any things that you would like to share before we wrap up about any, like, interesting case studies or anything that you would like to share with regards to, like, the PT environment, maybe what people shouldn't accept within like a standard PT approach? Like, how would you be able to determine whether or not you're receiving good care, for example, what would be some things you would look for?

Yeah. I would say that the biggest thing is that the practitioner appreciates your goal and respects your goal and understands your goal and that the treatments are getting closer to achieving that goal. Because a lot of times, like we see this with our patients all the time, it's just like I said earlier, right? It's like all the things you shouldn't do, right? And there's no way of knowing that you're getting better. So you go through, you do your like quote unquote like rehab exercises.

thinking you're doing the right thing, but you don't really know if you're getting better. So there needs to be something objective, and then it needs to be moving you, you know, closer and closer to that kind of endpoint. That would be like the biggest thing that I would look for. Amazing. That's super helpful. So, I mean, on that note,

do you want to share where people can find you? I know you're on Instagram. Do you have a website as well? Yeah, for sure. So on Instagram, it's probably the easiest way to get me. It's at, what is it, at doctor. Sean. Dot Astorga.

And then you'll find all our information there. We have all the information about the mentorship program, about the podcast, all that kind of stuff is kind of in that little link and bio thing that you see there. I'm pretty open to DMs, all that kind of stuff. So yeah, any questions or anything I can help with? Just, yeah, I'd be happy to do so. Okay, great. And is your mentorship program currently enrolling right now?

Yes, we are currently enrolling. We have Black Friday's deals going on until December 1st. I'm not sure when this is going to get out there. And then we have a couple of other events in December that are going on. So we're going to be doing a three day. So I'm big on context and like the nuance. So we're going to be doing like a three day kind of series that is going to be case study oriented where we're kind of go into like some more depth on like the principles that we kind of use in our care. where, you know, this is very much like a person with pain who's gone has like a performance

related goal. So it's applicable to even like the trainer. Going into like in depth on the case, the principles, the thought, the thought process, the assessment process and then ultimately like the outcome. So we're going to be doing that. I forget the dates offhand, but sometime mid-December. And then our mentorship program is actually starting January 2nd. Great. And the information about enrollment is also in your Lincoln bio. Yeah, it's in the Lincoln, Lincoln bio. And you're going to hear. If you follow me right now, you're going to be hearing about it for pretty much four more weeks. Perfect.

With our normal content, you'll still get that stuff too. Amazing. And if people want to be a patient in your practice, is that information also in the Lincoln buyer? Should they DM you? You can DM me. I don't know off the top of my head what our AMP Instagram is. I can tell you right now. I believe it's at AMP Performance Rehab.

Yeah, it's at AMP underscore Performance underscore Rehab underscore. Yeah, that or you can DM me and I can kind of guide you to the right place there. Great. And I'll include all of your Instagram handles and like website link and everything in the show notes so people can find you. But on that note, thank you so much, Sean, for coming on. It's always a great time chatting with you. And I think we've shared a lot of great points and you've shared, you know, just a wealth of knowledge on what good PT actually looks like. And I think it's so sorely needed in today's environment. so just thank you so much for coming on and sharing. Oh, thank you for having me.