“One piece of advice that I got from an instructor in PT school is he said, you need to talk with your patients and tell them like, I need for you to believe that you can get better. We get nothing else from this session today. I need for you to know and believe. This will help and that you can get better.”

Welcome to the PT Rebels Podcast. This is the place to learn how you can become a PT rebel and take charge of your own health and wellness. We will help you find answers to your questions about pain, injury, and the path towards healing in the most efficient and effective way possible. I’m your host, Dr. Gina Fick.

Dr. Fick: On this episode of the podcast, I’d like to introduce you to my friend Joann Pung. She owns Manual Physical Therapy in Bradenton, Florida, and she has a tremendous growing practice and a special niche as she’s been able to identify and effectively become an expert in her community for patients with chronic pain. Joann, welcome and just tell us more about yourself and about your clinic.

Joann: Thank you. Yeah, so it’s located in Bradenton, Florida. We’re very niche. So we treat the most complex chronic pain sufferers. Those that have tried everything, they feel like they just have to live with pain for the rest of their life, and we are there to help them and make them realize that there is hope.

Dr. Fick: That is fantastic. There’s such a need for that. Tell us about your why. Tell us your history. Why did you choose to serve these types of clients? What’s your background?

Joann: Yeah, so the backstory of that is very close to my heart. It’s my daughter, right? So she’s 21 years old now, but when she was born three months early, so she was only two pounds, 15 ounces. Yeah. And so she had a grade three bleed. Because of that, she essentially had a stroke when she was born, so we knew that she would have some physical disability, and a birth injury means cerebral palsy, so it’s very easy for us to accept that whatever physical deficits she has. You can just blame it on the brain that because she has cerebral palsy, that is why she has those disabilities. But I’ll never forget what the doctor, when he broke this news to me, he said I have bad news and good news. The bad news is that she has a bleed, and so she’s gonna have some physical disability. But the good news is that this incident occurred now. So when she grows up, all you have to do is manage the consequence of that incident. And because I looked at it from that standpoint, I approached the problem differently. So when I did physical therapy on her, I was like a rebel. I wasn’t following what I learned as a physical therapist. I started to think outside the box, and in the process it changed me as a physical therapist. So then I started applying it to my patients. And of course, I wasn’t in peds, so that means there was no one with cerebral palsy. But I applied it to chronic pain and I realized that it was almost like an aha moment. There is something about this. I found that it was a lot more effective than what I knew previously. How to treat them.

Dr. Fick: So by applying these new methods, what types of results are you seeing in your clients versus maybe in clients who haven’t had that type of treatment?

Joann: Yeah, so when I discuss this with patients, it’s the best way to approach it is ’cause, you know how sometimes I’ve had physical therapy, it doesn’t work, right? So I always say, whatever therapy you had, just understand that you haven’t had this yet. That’s a good starting point to have a conversation. Right. So just like with my daughter, the incident occurred at birth and I was just dealing with a consequence. So when I approach chronic pain, it’s the understanding that whatever the problem is, the osteoarthritis or herniated disc, that happened and that triggered the pain. But how you behave because you’re living in pain, that’s the consequence. So when I talk to them, I just want to correct the compensations. And when you correct the compensations, you realize that the pain coming from the original trigger is actually not so bad, and it’s like bringing it to their level instead of doing therapy speak.

Dr. Fick: So you must do a lot of communication and working with that patient initially to really build trust. Is that right?

Joann: That is the one thing that we have to gain first, because these are people who are extremely skeptical, like especially fibromyalgia for example. They’re like, oh, there’s no cure. You’re never gonna be able to help me. And so when we first start treating them, we have the smallest package. It’s a 12 visits. So it’s 12, 18, and 25, and typically they need 25, but if somebody wants to buy 25, we don’t want them to buy it because we don’t wanna have to deal with buyers remorse. So what we do instead is say you need 25, but I want you to buy the smallest package yet the 12. And we call it our trial package. So it is because it’s one thing for me to say, I can help you, but it’s another to deliver. So that would be our way of showing them that, yes, this is gonna work for you, but it’s like saying. You are not gonna get better at 12, you will get better, but it’s not gonna take care of it. So we have to make that clear. The pre-framing is, so I prioritizing.

Dr. Fick: I think what you’re giving them is opportunity to start to see some hope. Yes. Get some buy-in. And they see, oh, this is working for me. Nothing’s ever worked for me before this way. Right. Yeah. And then. They’re very happy to carry on that plan of care just because they’ve seen results. They start to trust you, they start to buy in. And with chronic pain, a lot of them just haven’t experienced that hope before.

Joann: Yeah, exactly. Just to have someone to talk to that they can trust, they can communicate well with, they start to see some hope. I had a patient last week and she was pretty adamant when we first met that she was sure that this wasn’t gonna work for her. She wasn’t gonna get better. She, I probably wouldn’t be able to help her with her pain. One piece of advice that I got from an instructor in PT school is he said, you need to talk with your patients and tell them like, I need for you to believe that you can get better. We get nothing else from this session today. I need for you to know and believe that this will help and that you can get better. I think once patients start to reframe in their brain like, alright, maybe I can get better. But I think before they can believe that they have to see, number one, that we know we’re talking about, that we’re able to communicate with them in a way that maybe no one’s communicated with them before, but also that they start to see some glimmer of hope or results. And I think that’s why this model is, is so important because some of the traditional healthcare models, they just aren’t able to get what I just described. They aren’t able to get that.

And we do really go down to their level in explaining, right? So for example, if somebody has a hard time walking because it hurts. So we’re how as a physical therapist, we talk about asymmetry, but to them it’s who cares love. So to me, one of the ways that I found that they can understand better is to use a word, are you capable? So in other words, looking at this body that is lopsided, are you capable of what you’re asking it to do? So, and then I would sometimes mimic how they look like, and I say, okay, so looking like this. Can you see me walking? Now you understand what you’re hurting when you’re walking, or if you are really lopsided and you are expecting that you can sit, your body is not capable of it. So if we put it from that standpoint, I think they get it.

Dr. Fick: What are some key pieces of advice or information you give your patients with chronic pain right away about things like sleep, hygiene, nutrition, different tools or strategies that they can start working on early on to help manage their chronic pain.

Joann: Like I said before, I’m a bit of a rebel as far as the treatment approach, and to me, you always think of it as you are educating them, and it doesn’t mean that they’re going to convert. It might take time, but if they can have a better understanding, that is my goal.

Dr. Fick: Are there certain factors that you feel can make patients with chronic pain spiral in a downward path? What are some of those things that you would caution patients with chronic pain against?

Joann: The problem with dealing with the very complex chronic pain is there is such a huge emotional baggage. I have to be fully aware of that. And one of the ways that we have addressed that is to do a lot of preframing. So I think we have four pages of what the journey is like. We even describe when the setback is a setback based is when are you gonna see the magic happen? So they understand, we tell them there are two times that you’re gonna have a setback. But when you do, we know exactly how to respond to it. So then they feel better about it. And the other thing is, in order for them to think that we are experts at what we’re doing, we tell them this, when you are in a lot of pain, that is the best time to come and show up. Okay? Because then. We say we use their pain as our guide to find a problem. And so if they’re in a lot of pain, then we want them at that time. ’cause most patients will cancel when they’re in a lot of pain. But no, we literally, if they try to, we call them and we say, you need to show up today. This is the time to treat you. Now, we also pre-frame if they don’t have pain. We say, when you come and you have no, you have no pain. That is a physical therapist, best day to treat you. It’s our favorite day actually, because that means we, instead of responding to your symptoms, we just get to work on the root cause. So the pre-framing, I think is, is very important, especially in the demographics.

Dr. Fick: I agree. In terms of referrals, do you get more word of mouth referrals? Do you get referrals from physicians or in your community? Where do you see the most leads or referrals coming from?

Joann: I would say strategic partnership and word of mouth. Definitely the reward for referral is actually successful. Word of mouth.

Dr. Fick: Are your goals for the upcoming year this next year?

Joann: Yes. The first one that I’m working with, that’s my top priority is to become a local expert. Right. I actually started that middle of this year where I started to write articles for a magazine. I think November will be my sixth article and we can really see how it impacts people when we mention it. And then the one thing that is in the works right now, in fact I’ve done it already last week, is a TV interview. You’re able to reach more people. Yes. Get the message out and you can help more people. Yes. I think ultimately that’s the goal. That is the goal. We are seriously looking for those people that have lost hope. The more complex it is, the more excited we get because we know that we can help them.

Dr. Fick: Yeah, that’s amazing. Yeah, it’s amazing. In terms of business growth, how have you seen your business grow over the last year? What do you think you can attribute that most to?

Joann: The fact that I dropped Medicare, that’s a huge one, right? It really helps that we do holistic treatment. And the other thing is we raised our prices again in January. I thought I would never get to that point. I thought I’d maxed out on my pricing, but we raised it up. There is this gentleman who was in a lot of pain dealing with it for a long time over the phone. The guy says, if this is gonna work, I am willing to take the second mortgage for this. And so he did convert and his first day of treatment. He brought over $8,000 to pay for the whole package, and he thought that he was gonna get a discount because it was cash, but we didn’t give him a discount because we don’t give discount. I didn’t think anything of it. And then once he was done with the program, I happened to have a conversation with him just to see how he was doing, and he said, you, you remember Joann, that first day when I brought $8,000, when I realized that I was gonna get a discount? That was when I felt that I was in the right place because he said, if you are gonna give me a discount, you must be good and. It threw me off because I’m like, what a crazy way of looking at it. I didn’t even realize that people would think that way, but I’ll never forget that.

Dr. Fick: It’s such a powerful story. Yeah. The fact that he was willing to take out a second mortgage on his home. Yeah. That’s how desperate some of these clients are for help. Yeah. Wow. I got chills when you were telling me that story actually.

Joann: Yeah. I’ll never forget that guy for sure.

Dr. Fick: Yeah. I think our patients, our clients are our listeners to this podcast. I think the stories just really resonate with them. I think several of our listeners could just be sitting there right now, listening, going up. Yeah, that, that really resonates with me. That touches me. And so if there, if there’s a patient in the Bradenton Florida area that needs to get in touch with you, that wants to get in touch with you, what is the best way to contact you?

Joann: So we have a website, so it is manualconciergeht.com. And then they can also call us. And the number is 9-4-1-2-2-6-2-6-0-5.

Dr. Fick: Fantastic. Well, thank you so much for your time today.

Joann: You’re very welcome.

Dr. Fick: You are doing great things. You are really affecting lives in such a positive way. Thank you. And we are thankful for clinicians like yourself and just continue to do great work. I hope you achieve all your goals and more in this upcoming year. And again, just thank you for being part of our podcast.

Joann: Thank you. It is a privilege to have the ability to transform people’s lives and I’m sure you can relate to that.

Dr. Fick: Absolutely. That’s what it’s all about. Yeah, absolutely. Thank you, Joann.

Joann: You’re welcome. It’s my pleasure.