In this episode, Jacqui Broering, PT shares her journey from working in the corporate PT world to owning her own clinic, and discusses how using the Neubie has changed the dynamic of her entire practice. With a rural clinic, she also sees a very wide range of interesting cases, and she shares some compelling experiences working with everyone from patients who have phantom limb pain after losing a limb in a farming accident to professional athletes who have sought out her clinic. She has also become a leader in the treatment of acute flaccid myelitis (AFM) and shares some very interesting perspective on treating that. Check out Jacqui’s clinic at www.performanceptw.com and view the case study about the amputee she worked with at https://neu.fit/wp-content/uploads/2022/02/Broering-Amputation-Hypersensitivity-Case-Study.pdf
Garrett: Welcome to the undercurrent podcast. I am joined today by Jackie Broering, physical therapist and owner of performance physical therapy and wellness in Cold Water, Ohio, a rural part of Ohio. And she’s had her practice there, it’s been operating since 2014. And one of the really interesting things about that practice is that being in a rural area like that, she sees a tremendously wide range, incredible breadth of patients dealing with a wide variety of injuries and challenges and circumstances. And I am really excited to dive into that with you here Jacqui. Thank you so much for joining us today.
Jacqui: And Garrett, thank you for having me.
Garrett: Well, let’s dive in here. Can we start with just setting the historical context for people? Can you let everyone know what performance PT and wellness was like, what your practice was like those first several years between 2014 when you opened, just pre neubie or before you and I connected?
Jacqui: I guess I could even go back even a little bit further in why I even started the practice to begin with.
Garrett: Even better. Yes, please.
Jacqui: I started out as a PTA and then became a PT and then became a clinical director for a company that was held by a private practice owner. And then they sold to a corporation. And after being part of the corporate world and patients became numbers, it became more and more evident that we had to see more and more patients in a shorter period of time. And you only just felt that pressure. And growing up, I grew up with a family of entrepreneurs, I guess you would say, they’re all farmers. And so I knew how to work hard, and I knew that there was a value in the quality of that care that you gave a patient.
And I also knew that from my clinicals and just from working, is that therapy’s not a commodity and I wanted to write my own story and be in charge of my own headaches, I guess, so to speak. And you gotta be a little crazy and you gotta be a little committed and be willing to take risks because I knew that even if I failed the worst thing that could happen, I could end up exactly right where I was. And that was in therapy. So it seemed like it was just a win-win situation. So then I started the clinic and in doing so I thought that the best way to provide a lot of care was that one on one care and do a lot of manual and do a lot of continuing education.
However, when you do a lot of continuing education for yourself and you develop your own manual skills, then you end up creating a bottleneck and you’re just working and working and working, you’re physically tired, you’re mentally tired. And then you create a situation which you develop a clientele, but they only want to see somebody who has more the manual skill set, or you’re doing a lot of, you think you’re going to do a lot of great things and you add new technologies, so to speak, cupping or dry needling, or we started with BFR, blood flow restriction therapy, and we thought, oh, that’s great, until you turn around and everybody else is doing this same exact thing.
And so it was okay, but it didn’t quench my thirst for something even more dynamic. And when you saw that surgery was becoming a lot more technical. There was a lot of advancements in a lot of other areas of healthcare, except for physical therapy. People would develop their skill, their manual skill. They were doing continuing education, but there still was in me like what else is out there? And eventually I thought being a good therapist, I could run a good business. And the skillset for being a business owner and a good therapist is totally different. So after being physically and mentally exhausted I decided how can I run my business better and grow it so that there are more clinicians that work with me?
And so I hired Brian Gallagher through Meg business management, and then he introduced me to Jason Waz, who is the owner of New PT Tech in Tampa, who was also the very first PT I do believe that used the neubie. And that was the spark of that aligned with my mission statement. When you get all this business coaching, you decide, I do need a mission statement. I need a vision, where am I going? And I wanted to give superior care, but in a way that was innovative and wasn’t so physically exhausting.
Garrett: That’s great. I think there are a lot of other therapists who resonate, the ones who are still maybe thinking about going off on their own to be able to have that, what eventually becomes a success story here and that kind of framework that you used of look, best case scenario, performance PT thrives, like it has been. Worst case scenario I go back I’m a clinical director and I’m kind of back where I started. I think that framework can help a lot of people who might be on the fence. And then when you started having success, other people who have already done that can probably relate to that perspective of being a bottleneck in your business, where everyone comes in and wants you and wants your hands on them and those wonderful manual therapy hands almost feel at times like a pair of handcuffs, because if you’re not there doing it the business can’t be making an impact, can’t be serving people, can’t be doing its thing unless you’re totally there.
So it’s more dependent on you. And I also really like, you mentioned that and we’ve kind of perceived that too, that there’s evolution in many other areas of medicine and at times physical therapy has felt like there hasn’t been much. And obviously we’re hoping to change that, but really get some really good points there.
Jacqui: Yeah. Physical therapists. They’re pretty much, they’re conservative by nature. I mean, you can almost go to a conference or a big hotel and pick out the PTs. I mean, you can just pick them out and when you start a business, if you have, your navigational beacon is not, you’re going to go out and make a lot of money. My motivation was like, I have a purpose over a paycheck [07:52 inaudible] and I knew that if I could instill value and improve the quality of life of the people that I worked with, not just patients, but my staff, you are only as good as your team. And when you build up a good strong team and you fill your team’s cup up, they have so much more energy to give to their patients. And it just becomes a great circle.
Garrett: That’s awesome. Thank you so much for sharing that. And you mentioned that you had a visit with Jason Waz, so his clinic, his competitive edge in physical therapy in Tampa. And we did an episode, he was on episode number 8 on this podcast. I did one with him and I’ve of course worked closely with him and we’ve all been able to collaborate together. So that’s great. I’m glad you brought him up. So tell a little bit about your story and what motivated you to start in the first place and then kind of how things are going. So can you then tell us about that next stage once you met Brian Gallagher, once you incorporated the neubie, how would you describe it now looking back, big picture, a couple of years later, what changed in your practice from adding the neubie?
Jacqui: What didn’t change? Truly, truly, it has been. It’s not just the newbie. It’s a totally different way of thinking. It has been the catalyst that has exponentially turned our clinic into something far greater than I ever could imagine. We live in a county of 42,000 people. And when you go through business training, you’re like, you’ve got to market. So you capture so many percentage of the population and I don’t have that luxury of specializing. I get the responsibility and the challenge of seeing everything that walks in the door and some things they come to you and you’re not for sure exactly, what am I going to do with this patient? Or the things that you do, the gains are so very slow. And the pressure as a business owner and the pressure, even as just being a clinician. And you talk and you network with other private practice or even any physical therapist, it’s like deductibles are going up.
Patients out of pocket costs are going up, they’re being managed. You only have 12 visits or six visits, or so many visits. And so there’s so much added pressure to get that patient better in the least number of visits that you possibly can. And if you don’t have a big knowledge base or sometimes they just plateau and then they’re done with their care, that’s all they’re going to get. So you just give them a home program and that’s very frustrating because you feel like you let them down because you want to give them the best quality of life you possibly can.
Garrett: Especially, even more so in a small community, where everyone kind of knows you and you have that even more so probably than in a big city or something.
Jacqui: I would say, yes, because in this area you’re related or you know 60, 70% of the population truly. I mean everybody knows everybody. And so it’s not just in the clinic and you can walk away. I’m going to see that person at church. I’m going to see them at the grocery store. I’m going to see them at a school function. You’re going to see them at family reunion. It’s an investment into the community. It’s not like you can just walk away. So you want to make sure that your reputation either can make you a break you and so I’m going to lay it on the line and give it everything that I got.
Garrett: That doesn’t mean you’re off the hook if you’re in a larger urban area. It’s just an interesting dynamic to shine a light on there.
Jacqui: Yeah, you’re right. Since we’ve had the neubie, now we, for one, as a business owner, we haven’t marketed. We haven’t had the need to market in over a year because our patients are so overly happy with their care that they market for us. We’re seeing things that we never could successfully treat before, like Phantom limb pain. We are treating. We have traumatic farming accidents or car accidents. And how do you strength train a residual limb that needs to be able to be strong enough to manage a prosthesis when there’s not an extremity there. Like one of our farming accidents, he had transhumeral amputation and rotator cuff tear. And we used the neubie and within two weeks he decreased his Gabapentin and neuron by half in just two weeks. His orthopedic surgeon, his trauma surgeons said oh my gosh, I’ve never seen this before.
And then we were able to use some of the technologies and the education from both the level one and the level two of the neufit training to treat a two year old with a transhumeral amputation. And he did amazingly well. And so now we have these two amputees that come in and they’re actually helping each other rehab here in our clinic, which we would’ve never had that prior to the neubie.
Garrett: Oh, wow. So I saw the case study on the older gentleman who had his arm amputated and that there, that’s profound help with the strength function, Phantom limb pain, all that. I didn’t realize you had a young child who also had an amputation there.
Jacqui: Yeah, exactly. One month to the day. The older gentleman, he had his arm taken off in a self-propelled chopper accident. And then just a month later this little boy, he was two years old, got his arm caught in a grain auger.
Garrett: So these are fascinating. I want to dive into more of these specific cases as well, just to kind of carry through this thread on how the practice evolved. So those first years when it was more reliant on you and you felt like the bottleneck, were you the only therapist and at what point did you hire staff before adding the neubie and after? How has your staff evolved and your team evolved?
Jacqui: In 2014 it was just myself and a few PTAs and then eventually four years later, we kind of outgrew our 1500 square foot old bank. And actually we expanded to two locations. So we have now one in Port Recovery, Ohio about 5,000 square feet. And then our new Cold Water clinic is about 4,000 square feet of clinic space. And then about, not quite 2000 square feet of clinical or office space and a little upstairs, somewhat loft apartment, which has worked out amazingly well because the school is a block away. So when my kids are sick, like today or even our staff, they have a sick kid, they bring them upstairs, they watch TV, they’re alright. So it’s a great staff employee benefit.
And then what has been amazing that it’s worked out, a few years, actually it’ll be three years ago in August, one of our local kids, he was diagnosed, later on we found out was AFM or Acute Poliomyelitis. And at the time that he was diagnosed, he came down with a virus, was eventually at Dayton Children’s Hospital. And after a week or two that he was in the hospital, he was released and the parents are like, what do we do? Like what do we do with this kid who is in a wheelchair, has no head support, can’t move his arms or his legs? So I took his 70 pound body out of a wheelchair, laid him on a mat table. So I’m working with them and actually he was kind of like the whole spark of the need of getting the neubie.
You were treating this kid with an unknown diagnosis. They thought maybe virus, maybe not for sure at the time. And he’s in my son’s class. So he’s like my son and they played soccer together. I’ve known this kid since he was four years old. And so was that, like I’ve got to do something else, what else can be done? And eventually when we hired Brian and then I met Jason, I developed a mission statement that was kind of like,what are the things that I want to say yes to? And what are the things I want to say no to because there’s a lot of, try this gadget or try this or try that? And if you know what is your north star it’s like, does this align with my mission? Does this align with my values? And you could say, I love technology. I’m a technology junkie and I always want to push it as much as we possibly can to, what can we do to help our patients?
And knowing already what DC current did because we used those guns for Bell’s palsy, years and years ago, but it hurt. So I knew that the research out there, that DC current worked, but I had never known that DC current could work without hurting. And so that was kind of like the spark. And then I learned more about the neubie through Jason and then went to PPS and he actually treated my back in the hotel lobby because my back hurt really bad. And instead of taking an Advil and laying down in the hotel room, within 20 minutes I was pain free. I was like, that is crazy stuff. And I was sold because at first, you get to sticker [18:51 inaudible], oh my gosh, how expensive, like I can’t afford this. This is way too expensive. But yet at the same time I’m like, there’s something to it. Theres definitely something to it.
And then I flipped it. Like it’s an investment, it’s not a cost. If you look at the neubie, just like your employees. If you look at your employees as an investment and you look at this as an investment, it will not be linear in its pay back to you. It’s going to be exponential, it’ll be hockey stick growth. And that’s what it’s done for our practice.
Garrett: And since you’re at the top or at least near the top of the leaderboard, how many neubies do you have now between your two locations?
Garrett: Are they split four and four?
Jacqui: No three and five. But I’ll tell you what. We have it set up now there’s a neubie for every two tables and we use it so much. I think we use it for at least 80, 85% of our patients. And we now have physicians and patients who drive two hours, two and a half hours one way for the neubie. We’ve had two professional baseball players, one from the Cincinnati Reds, Art Warren, and then Craig Staman who is a pitcher for the Padres. And actually you probably know a little bit more about the backstory with Craig, on how he came to know us as well.
Garrett: That was so funny. I was talking to the staff and he was like, Hey, do you happen to know anyone near Dayton, Ohio and I’m like, well actually there’s someone and then you already knew his family that was like such a fun small world story.
Jacqui: Yeah. I’ve known Craig and his family my entire life. And here he was expecting, yeah, maybe I’ll go to Columbus or maybe I need to go to India or Chicago and here it is, Cold Water. Yeah, Jacqui I’ve known her my whole life. So who would’ve ever thought and it’s that neubie, knowing that it works so well for professional athletes, they wanted to find out, during the off season, last year or the year before when the Reds weren’t playing. And so Art came to the clinic, he goes, I’ll drive wherever I need to because John Bald or JB, he was working with Art during spring training and he healed his growing strain or leg strain.
What normally would take six weeks. He got better in a week. And he goes, Hey, as a rookie baseball player, I have to prove myself. I cannot be hurt. So he was willing to drive however far. And here we are in the middle of nowhere, but yet still the closest. So he came and then Craig, he came during the off season and now we’re treating his dad who has MS. And so it’s been a great opportunity to see patients that we never would’ve seen before. So when we had Lucas, he came in and we treated him with the neubie, that was kind of like the start of, we did a Facebook post on our Facebook page about Lucas’s success and people with AFM they’re desperate. There’s not a lot of treatment options that really help these kids regain their motor function back.
And with Lucas, when he first came in, he was 70 pounds and in a wheelchair. And now here he is 17 years old, driving a car, he’s running cross country. He still has a little bit of difficulty with head control, but amazingly exceeding my expectations in the amount of time that we’ve seen him.
Garrett: How long did you start with him? He’s 17 now, you started with him when he was, what 13?
Jacqui: We started with him. It’ll be three, let’s see, 2009, I guess three and a half years ago. I think 2018, 19. I’ll have to look. But yeah, his gains have been where we picked him up out of a wheelchair and he had no head control to now full range of motion. And in both arms, he’s running, he’s hitting his PR in cross country. So it’s so much more, like to me, when you have patients or actually when you have parents say that for the first time that I get to be a parent again and not a caregiver, that’s the stuff that aligns with your heart. You know you’re doing the right thing.
Garrett: Yeah. That’s so awesome. So a lot of people listening, may not be familiar with AFM because it is such a rare diagnosis. How unusual is that recovery to regain function like that for an MSP? What was his likely prognosis? How unusual is that or typical is that type of recovery?
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Jacqui: What’s really sad is that AFM has only been a disease recognized by the CD. I think only since 2016. So it is so new and it’s hard to do a lot of research on because the year that Lucas was diagnosed, there were only 8 cases in the state of Ohio that actually got the diagnosis. So what is their prognosis? I have done telehealth with kids as young as 18 months to I know of adults that even though it’s very rare, I have seen adults and it’s a virus that attacks the spinal cord and the onset is relative. I mean, it’s pretty fast. And they go from normal activities to, within a day or two, sometimes three days. And then it’s just a significant rapid decline. And when Lucas was brought to the hospital, they didn’t even know exactly what it was until a specialist came in.
And he was from another country and he is like, oh, I’ve seen this before, this is AFM. And so what is the prognosis? It has been all over the board. And I think some of that prognosis I’ve been fortunate enough to work with Lucas. I mean he was in therapy every day for a little while and we still work with him three days a week. And I think that’s the key to his success, is that he got to have that hands on because the neubie is not just, here, just slap some electrodes on somebody and then turn it on and magic is going to happen. It’s a learning process and we’ve had our neubies now for two years and we’re still learning different ways to apply it and different ways to use it all the time. I would’ve never. Some of the things that we’re doing for acute herniated discs, I’m like, that is crazy, crazy good.
They avoid surgery because you get their pain better and then you get your motor function better. I’ve never been able to specifically, do this mapping that we do with the newbie and using it for improving their range of motion. And then the way we set up electrodes, very specifically, we see the atrophy come back like significant atrophy come back, which I’ve never seen that before.
Garrett: That’s awesome. Thank you so much for sharing that. I think that hearing these examples will inspire patients and therapists alike to know what is possible when you tap into the power of the nervous system and really provide an opportunity to make those changes with these technologies and methods. And those are some really wonderful examples. I mean, talking about everything from AFM and all these other injuries and conditions, where you’ve been able to really get these transformative outcomes. I think it’ll be very inspiring both to patients and therapists alike. And another question I have for you in talking about this integration. I’ve been able to so successfully integrate the neubie into your practice. How has it been received by your therapists, on your staff? People who have been there with you and new students who are coming for their rotations? How has it been getting them to start using it? What’s that process been like for you?
Jacqui: Actually what ended up happening is that we used COVID as a perfect opportunity. We shut down voluntarily for two weeks and we didn’t go home. It was okay. Everybody reports to the office, we’re going to do continuing education. And Jason had just previous come up to our clinic from Florida. We flew him in and said, Hey, we’ve got five PTs in four PTAs that want to be trained. And instead of just two of us were supposed to go to Austin to do the training. Jason trained us. And then during COVID we had the entire staff be trained at the same time. And they were excited, hesitant because it can be overwhelming, but we had the opportunity to have one or two neubies first for about a month or so. So they were very familiar with it or at least knew more about it.
And then once we did the training and they saw the results and saw results with things that we didn’t see results with before, as profound. And it’s actually kept on going here what’s been two years. And instead of our therapist being burned out, they actually are ignited. It’s like, wow. I can’t believe we’re seeing this kind of improvement. And when the patient sees that improvement, the therapist sees that improvement and we’re seeing what you would see in a few weeks, we’re seeing it in one day, one visit. No, I’m not saying that’s typical for every single patient, but there are patients who definitely see an appreciable change in just one visit. And that is the spark that just keeps going.
And now it’s actually a magnet for students. We have students that are looking for advancements in technology, when we fill out these forms. What are some of the things that you have? And a lot of students that we have from all over, they’re like neubie, like I’ve never even heard about this. And my nephew who is from New Jersey, he’s in PT school. He goes, I had never heard of that. And now he tells his friends, I’m like, I want to have a clinical in Ohio. It’s been a magnet for students. So I think that it’s a great differentiator.
Garrett: That’s awesome. Very cool. So I feel like we’ve, we’ve kind of run the whole continuum of care here, talking about neurodegenerative diseases, Phantom limb pain from amputations, sports injuries and athletes. Can you just also touch on then that kind of aftercare piece, to really complete the continuum. What types of things you’re doing with people in more of that fitness or wellness or performance model after a plan of care is complete?
Jacqui: Well, and that’s exactly where we want to continue to evolve as a business. So we’ve done rehab, and now we’re doing prehab before surgery and we’re using it as a platform in developing our athletic performance. So if they’ve had an injury, then after they’ve been discharged from care that they continue on with the use of the neubie and some of the nuefit principles with enhancing there, not just range of motion and not just basic strength, it’s, power, agility endurance, those kinds of things. And then as our test model, our football team, our local football team, some of them were injured. Some of them were recovering from an injury and were done with rehab. And before the football games on Friday nights, we had a group of five, six, sometimes boys come in for half an hour or 45 minutes before they needed to report to the locker room.
And they do a complete warmup to their lower back, their hips, their shoulders. And we were able to go all the way to state and become state title runner up. And my son was in one of them. But it’s a great platform that we’re using for to prevent injuries, to help him really feel like they’re turned on and strength, and then use it as a recovery as well after they’ve been on the field all night, on a Friday night. The next morning you hook them up to the master reset and they get to chill out and dial back and help recover. And so it’s a good start to what we want to develop as far as our the athletic side, the performance part of our business.
Garrett: Awesome. That’s fabulous all around. Thank you so much for sharing that. And let’s see, is there anything else before we close, anything else that you feel like we have to share? Anything else that stands out from your experience?
Jacqui: As a physical therapy owner, I think other therapists then may want to know, bottom line, how does this maybe affect their business on a day-to-day basis? And I think when you are limited with the number of visits or say, it’s Medicare and there is certain number of dollar amount, we’ve been able, instead of like, we used to have 60, 65% of our patients seen three times a week. Now we only see 25% of them three times a week. We extended their plan of care out, instead of three times a week, now we see them twice a week. So we get to extend out their care. Their benefits are greater and they last so it’s better for the patient. And you’re able to see, because you have more availability you’re actually seeing and treating and helping more of your community.
So that’s been great. We’ve treated physicians who they’ve heard about this neubie magic machine and they come and once they’ve experienced it, they just automatically go to performance. They know what to do. So it’s been, I shouldn’t say a magic miracle machine, but in some respects I’ve never seen something work so profound and be so versatile, whether it be orthopedic or neuro, I think there’s just such a change in how you treat. It’s not just a tool, it’s a whole different way of thinking, that really results in better, full body care and not just a knee or a shoulder or a back or a stroke, you treat the person and not just a diagnosis.
Garrett: That’s awesome. Well, I think you said that beautifully and I appreciate that very much. And I just want to acknowledge you for being a real leader, a pioneer, being growth minded, learning new things, and encouraging that, continuing education with your staff. And like you said, putting purpose first and really living that. So I think you and your practice and what you’re doing is a wonderful example for how to both be productive and effective and impactful and profitable. And you can have both in business and you are a bright shining light example of that. So thank you very much for all the work that you’re doing. If people want to look you up, what’s the best way to, if they wanted to, learn about your practice, are you on social media or just look at your website, what’s the best way to find you?
Jacqui: Performanceptw.com, or we have a Facebook page at also Performance PTW or Performance Physical Therapy in Cold Water, Ohio. If you just Google it you’ll find it. So, yeah, we have a growing Instagram slow and then Facebook and website. We have a lot of testimonials on our Facebook page. Just to see the different types of patients that we’ve seen, especially it highlights like how Lucas, the kid with AFM, how much he has progressed and a lot of other neat things that we’ve seen. It’s been great.
Garrett: Awesome. And we have that written case study of the older gentleman who had his arm amputated, so we can link to that in notes for this show as well, for anyone here who is curious to see some of your work in action.
Jacqui: Well, I appreciate the opportunity, Garrett. And honestly, I think what’s even better about this neubie. It’s not just a tool, but the network and the community of people from the podcast to our mastermind calls, you feel like you’re constantly being connected with other like-minded forward thinking people. So it’s not just go to a continuing education course, and then you’re done. I continue to stay in contact with people that I went to my level one with and on mastermind calls. I feel like I actually, I know these people. So it’s a great support system. So you feel like you’re continually learning new things.
Garrett: That is, I think the best possible note on which to say goodbye. You said it beautifully, eloquently. Very nice there. Thank you so much for coming on the show, Jacqui, and thanks everyone for tuning in and listening, and we’ll see you on the next episode of the Undercurrent Podcast.
Jacqui: Thank you, Garrett.
Garrett: Thank you so much. Goodbye.
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