Joe & Angie McGilvrey’s physical therapy office Apex Physical Therapy in Fort Myers, Florida has quickly become one of the top performing offices for positive outcomes. They way they use the Neubie from early stage rehabilitation to elite athletic performance is a shining example of their creativity, passion, and holistic approach to wellness.
I’m joined today by Angie and Jason Wyns, who runs the sports performance side of the facility. Listen in as they describe how they set themselves apart from the competition by not only utilizing cutting edge technology but also “walking the walk” themselves.
Garrett salpeter] 0:57
I’m joined today by Angie, and Jason Angie and her husband, [Joe] [Joe], not pictured here. They are the founders and owners of APEX physical therapy in Fort Myers, Florida. And Jason is the director of performance. So thank you, Angie. And Jason, thank you both so much for being here.
[Angie McGilvrey] 1:16
You. Thanks for having us, Garrett.
[Garrett salpeter] 1:18
Yes, yes, it’s my pleasure. So Angie, first question for you. Can you tell us please a little bit about the history of APEX, how you and [Joe] got into owning your own facility and just a little bit of the origin story?
[Angie McGilvrey] 1:34
Yeah, so I’m gonna go as quick as I can through this. Because we will be actually celebrating our 15 year anniversary of APEX in October. So congratulations, are you there. But basically, in 2005, it started with us packing up a U haul, with everything that we possibly owned in the state of Illinois, out of Chicago, and moving to Fort Myers, Florida with the dream of establishing our own physical therapy practice.
[Angie McGilvrey] 2:03
So yeah, we were just two kids on a mission to do it. And we did. So we’ll fast forward a little bit more pertinent to what we’re talking about today. 2017. Being in southwest Florida, we were hit in late 17. With hurricane Irma. And that was a was a huge reset button for our practice, you know, our practice had been just general outpatient orthopaedic based centre, and we dealt with a variety of variety of patients, and we’re largely referral base from physicians. At after Hurricane Irma, it just really opened our eyes up to putting more of the things we can control in controlling more of our controllables I guess, and really changed our vision of apex. One of those things being direct to consumer marketing.
[Angie McGilvrey] 3:05
And the other big thing being taking our practice in the direction of an avatar patient, which was the athlete and more specifically, the Cross Fit and or Spartan Race, sort of sort of athlete. Jelena I’ve had the pleasure of competing and doing a tonne of Spartan Races together. So that’s that was a little bit of where our passion lied, as well as working closely with coaches and people in the Cross Fit community. Us participating in Cross Fit as well. So it just the passion just aligned so well there.
[Angie McGilvrey] 3:43
And so that was our direction, full speed ahead since 2017. And then I had the great pleasure in 2018, to be introduced to Garrett and new fit technology. And the the blend of having this, this technology, this kind of market differentiator, so to say this catalyst to push us in the direction of these higher performing, athletic, lead driven kind of high performance individuals, and it just seemed to just go so well together. So after I went to Austin, I got to actually train with Garrett and meet his family.
[Angie McGilvrey] 4:25
I mean, I knew it was just, it was it was a perfect match. So now here we are 2020 I didn’t even have back then an athletic performance director. We didn’t even have an athletic performance programme and now I do and I’m so happy to have Jason with me who’s also been trained with the with the new fit and basically, we’ve been able to just open up our scope to go all the way from rehabilitation side, addressing the patient and then moving them all the way up through into kind of the client, return to sport elite performance, taking them all the way through that spectrum, and utilising the new fit technology throughout that whole continuum as well.
[Garrett salpeter] 5:14
That’s awesome. Thank you so much for that. And I love how, how clear you are and how you mentioned, you became a really avatar focused, really tightly focused business, focusing on people who have similar passions to you, and [Joe] , so you can really relate to your, to your avatar to your ideal customer, ideal patient, and you can you can speak their language, they speak your language, so you’re really able to, you know, to work with them in a very powerful and meaningful way. Because you because of that reliability. I love that. And I also, I guess, I guess I have to ask, are you doing this episode instead of [Joe] , because you won the last Spartan Race is that you beat him in the last race is that you earned the right? Just kidding, of course, but
[Angie McGilvrey] 5:59
I might have a few more medals, but we won’t.
[Garrett salpeter] 6:05
I love you to do that together. You know, we see your posts on social media and different things. And YouTube definitely walked the walk. I mean, you you put in the work and continue to push yourselves. And it’s awesome to see. So I commend you for that for not only helping others do it, but leading by example, and really doing it yourselves. And I think that’s another reason why you’re so able to effectively serve that specific avatar. And, Jason, I want to ask you real quick, because you have this kind of more strength and conditioning fitness oriented background, I want to ask you a couple of things, you know about what it was like to come and work in a physical therapy practice? And also what it’s like incorporating the newbie into that strength and conditioning paradigm. So I’m throwing a couple of things at you at once here. Sure.
Yeah, I think the easy answer for both of those is it’s made me better in the strength and conditioning realm. tenfold, I would say, just understanding the continuum of care, from a physical therapy aspect, back to sport, just to be able to see that progression is, I’d say, invaluable to, to my success as now a strength and conditioning specialist coach, performance coach.
And then the new fit just adds another layer on top of that it gives me gives opened up so many more like avenues for us to be creative and expedite the process that we’re trying to accomplish for sure. So in terms of expediting the strength gains, or dysfunctions and imbalances. It’s been an incredible experience so far. Yeah.
[Garrett salpeter] 7:50
And are you seeing people who start as physical therapy patients and transition exclusively? Or do some people come in just for finished training? Also, what’s the blend on that front?
Yeah, it’s a little bit of both, we’d say it’s a natural fit for them to transition to me through physical therapy, because we are seeing a lot of those athletes now. So having that interaction with them, even though the therapy has been beneficial.
You know, I’ll jump in and just kind of introduce myself, everyone kind of knows what I do here. And then they see that as the end result, to be transitioned to that. It’s like a graduation. And then like in terms of the continuum of care, it’s like, it’s all similar. And I think this is important, because it’s, not only is this important part of the practice, I think it’s very necessary in physical therapy today. To have it because I think physiological, it’s like, the same benefits in terms of what we’re trying to accomplish.
[Garrett salpeter] 8:51
Oh, yeah, I think we could do a whole podcast episode, and maybe we will, the overlap between truly effective therapy and truly effective training and how it’s really, it’s a, in my belief, a very artificial distinction to call something trimming. There’s some differences.
[Garrett salpeter] 9:10
But so many of the goals are the same. You’re trying to whether you’re trying to recover and heal damaged tissue and an injury or you’re trying to stimulate the body to repair and rebuild muscle and connective tissue after workout. I mean, it’s the same rebuilding repair processes you’re tapping into. You’re trying always trying to improve movement, motor control, coordination, flexibility, your range of motion.
And it’s not and it’s not so obvious that even mobility and strengthening is, is I think, is interchangeable as well.
[Garrett salpeter] 9:39
Yeah. So what is that transition? Yeah, I’m thinking if, if, if I’m a physical therapist, and I’m just listening to this for the first time, and I have a more traditional practice, and I’m asking you, how receptive are your opinion if your patients are coming to you for physical therapy?
[Garrett salpeter] 9:56
My patients are coming to me for physical therapy. What how receptive are they going to be to transition into training normally they see me and then they might come back for to nap when it’s allowed, but when they’re healed, or when their insurance benefits are up, or whatever, they’re usually gone, how receptive are patients to, to actually staying on and doing more services within the practice?
[Angie McGilvrey] 10:21
So I can, I can speak to that first, I think it all goes back to the value that we’re able to provide to them from day one. So we’re know both Jason and I share the same vision on just always giving as much as we can, and providing our clients with the best value we possibly can. And I think as long as we are going down that same lane, it’s much more of a natural transition.
[Angie McGilvrey] 10:52
You said at the beginning that they, we both walk the walk, and Jason is a cross fit coach, as well. Jason participates in a lot of athletic events. And so they see us as you know, hey, if Angie and Jason say this is going to be beneficial, then, you know, I think this is really going to be beneficial. So, you know, there is a certain sense of, you know, growing that rapport, and they have to know love and trust us. And that just comes with doing your very, very best and giving them as much value as you possibly can on on on each occasion.
[Garrett salpeter] 11:30
That’s awesome. I think that walking, the walk is so important, leading by example, showing people what’s possible, if they, if they put in these this work and follow these steps, they can get to this point. And they know they’re more confident they can get there because you’ve done it, you’re showing them as possible.
[Garrett salpeter] 11:47
So that’s awesome. One other one other unique element about your practice that I just want to ask about a little bit. I know that that Angie, your husband, [Joe] , co-founder, co-owner, recently became certified in ultrasound diagnostics, and then he’s able to do some very sophisticated diagnostics of muscles, tissues, nerves. Can you talk a little bit more about that unique diagnostic capacity that that you have there now?
[Angie McGilvrey] 12:19
Yeah, yeah, thank you, Garrett. Quite, it’s quite an accomplishment for him, he finished a two year residency programme and sat for a board certificate in which he just recently got pat his passing results in June. So he is now certified electro diagnostician, which basically gives him the ability to perform EMG and NCS so that nerve tests, nerve conduction studies and electromyography in the same manner, and with the same skill set that a physiatrist and or neurologist would perform these tests. So that is, that is really cool.
[Angie McGilvrey] 13:02
And he’s also currently going through his residency programme to become to become a fellow of musculoskeletal ultrasound. So meaning that, you know, he’ll have his independent ability to do his own read reports and everything doing diagnostic ultrasound, as well.
[Angie McGilvrey] 13:19
With the ultrasound, we’re able to look at pretty much most all tissues. I know, we’re talking a lot on the nerves standpoint, but we’re able to really see nerve like, well, we can talk about like the median nerve at the wrist, we’re able to actually look in and trace and draw out how the diameter of that nerve to determine what normal values are, and or if there’s some dysfunction happening there.
[Angie McGilvrey] 13:45
And we can do that throughout, you know, many nerves throughout the body, around the joints, most specifically. And then, of course, the EMG test that has been just paramount in a patient comes in with any type of neurological signs and symptoms, we want to make sure, you know, to what extent the nerve damage is. Because that is a different treatment approach, depending on on what we have going on with that nerve and where quite possibly they could come in, and we think it’s musculoskeletal, but in it, but it’s not, it’s actually a neurological dysfunction. So it also can really help us with differential diagnosis, too.
[Garrett salpeter] 14:27
That’s awesome. That’s awesome. So I do want to ask, specifically how the newbie has impacted your practice how, you know, pretty much in 2017 You made the change in your kind of marketing and strategy and messaging 28 teams, Sarah, serendipitously timed, we got to connect and you incorporate the newbie definitely would like to know for you what has changed there and that can be in terms of outcomes.
[Garrett salpeter] 14:57
And then you know, also I’d like to drill down a little deeper Er, from the general and talk specifically about how it’s impacted some of those some of those particular cases where you’ve had, you know, peripheral nerve damage or different things. But starting to start with the general, how would you say that that incorporating the Nubie has impacted apex?
[Angie McGilvrey] 15:17
From a general standpoint, I think I will go back to using that market differentiator. It really has set us apart from other practices, other outpatient physical therapy, personal training, you know, chiropractic, any of those entities and has set us apart. You know, in that field, I think that that’s, that’s one of the biggest things.
[Angie McGilvrey] 15:45
Also giving us a, a reason to kind of direct market to our public and our community as, as an entity on Hey, come in and try we have this technology. If you’ve had been unsuccessful with this unsuccessful with that, we have this we have something different, you haven’t tried this, before, we have this elite technology, this used to only be professionals. Now we were number two, you know, to have this as a physical therapy practice. And being able to give that messaging has just from the business side of things has just been a huge impact and allowing us to grow and serve more people.
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[Garrett salpeter] 16:58
Awesome. And then from a patient experience perspective, how is it you know, once you get them in the door, how has it impacted, you know, come from before, you know, pre 2018, to post, how has it impacted, treatments, outcomes, you know, generally from a clinical side,
[Angie McGilvrey] 17:22
I can speak on the from the clinical side of it from the from the PT side. So what we know to be true in our profession is right around the third visit is where a patient will drop off. So if you don’t, if you haven’t really gotten them to see the value in your, in the work that you’re providing them in those first three visits, most highly, that’s when you’re going to see a drop off rate, and you’re going to lose the potential to help that person.
[Angie McGilvrey] 17:52
So what the new fit has done tremendously in our practice is we’ve been able to show them huge gains and huge immense amounts of value on day one. Immediately, you know, people who walk in and they’re limping and not and all of a sudden, they’re walking out after one treatment with no limb, or you know, we bring a pain score from an eight down to a three in a matter of 20 minutes. And when you’re able to show them that type of data, especially in those first few sessions, from the from the patient side of things, now we’ve been able to convince them that we’re going to be able to help them and we have the opportunity to continue to do that, and get them to their greatest potential. And obviously, from the business standpoint, then we have even more opportunity to continue to serve them as well. So that’s how I’ve seen it from the PT standpoint. I’m sure Jason can kind of chime in too.
Yeah, I would say that the success in terms of using the new fit is also directly correlated to referrals and how much new businesses coming in to the facility as well. Just you know, one person, you know, leaves here after strengthen auditioning with me for, you know, a couple of months and people are asking them, you know, how do you see these gains? What? What’s changed in your programme? And you know, and so that’s how we get some referrals that way as well. It ties in full spectrum in the business for sure.
[Angie McGilvrey] 19:32
Can you talk about your pull ups? Oh, sure. Info really quick, Gary. I’m so I’m so proud of him in this one,
Please. Um, we have one client in particular that we would consider very active. You know, it does a lot of boot camp and even personal training outside of here prior to working with me. She started with some hip pain in physical therapy transition with me, we got rid of that and she’s running fine. But then she had a goal of a lifetime goal of wanting to be able to do a pull up. But even being so strong and active in, in normal life, she had never been able to do so. We started about eight sessions into like a pull up kind of protocol with a new fit. And she got her. Within a month and a half. She got her first pull up so nice. Yeah, I mean, that’s, that’s one of many kinds of stories like that. But it’s a lot of fun to see it come to fruition.
[Garrett salpeter] 20:34
Yeah, that’s awesome. Yes.
[Garrett salpeter] 20:37
And she probably I would imagine, correct me if I’m, if I’m wrong, but probably was able to do it without necessarily having to, you know, pack more muscle mass on her lats because it’s, it’s, you know, there’s both the amount of muscle that we have, then there’s also oftentimes, more importantly, that neurological skill of being able to activate more of the muscle at the correct time to express the strength that’s there. And if you’re doing if you’re making those changes in eight sessions, that sounds like it’s probably too short to build a tonne of new muscle. You know, it’s probably more like learning that learning the skill of muscle recruitment and coordination and activation, right?
Yes, absolutely. And obviously, it’s not like, we didn’t throw the pads just on the lats every time she came in. Yeah. So we, you know, we’re moving them around. We’re doing just as much pressing as pulling and just trying to reprogram those muscles to be firing properly.
[Garrett salpeter] 21:30
Awesome. So it wasn’t even it mean, you it was more of a general programme. It’s not like it was eight sessions of purely pull up focused work anyway.
Right. No, it wasn’t. We’re just coming into it doing pull ups. Yeah, there’s a lot of different things involved.
[Garrett salpeter] 21:45
Yeah. Wow. Very cool. So in terms of specific instances like this, that’s a great one. Thank you for sharing that. Angie, I think you mentioned that you had you had one that was share worthy on the rehab side, as well in terms of how the newbie was able to impact nerve injuries. And it also in the context of having this sophisticated way to diagnose and measure peripheral nerve damage and different in different capacities that you have there. Can you talk a little more about that? I think it was one particular instance. Right?
[Angie McGilvrey] 22:21
Yeah, thank you, Garrett. We’re Jason and I are both very proud of this gentleman because he’s, he’s kind of been what our vision is as far as he has come in from the rehabilitative side and now he’s actually currently working with Jason from the performance side on just continuing to get stronger and function better in life. But he came to us back in 2019. In January with acute pain, it basically long story he had an episode of Oh, my goodness. The it’s the herpes virus, shingles. I’m sorry, I’m sorry. He had an episode of shingles, which ended up resulting in severe nerve damage in his one in his right lower extremity. Okay. Wow.
[Angie McGilvrey] 23:19
So he came in on a walker, his wife basically holding him up, just couldn’t even almost walk across our flight from our entrance to the table, severely debilitated. And I mean, went from and this was almost an overnight change was a you know, normally functioning, walking, lifting, voting, you know, gentleman. Back at the end of January, we did an EMG study to actually determine what was happening and from his lumbar second to fourth level, it was determined that he had severe so from mild moderate to severe is how it’s determined severe damage of the axon of the nerve. And that it was acute This is resultant of what just happened, you know, with this episode.
[Angie McGilvrey] 24:09
Most specifically, it told us also that there was a decrease recruitment, basically, none of the motor units if anything, maybe one little itty bitty one left firing, mostly affecting his VMO his ad doctors and his rectus femme so we’re like, alright, what are we going to do here? New fit. That’s exactly what we’re gonna do here. So, we will we will kind of fast forward we did some creative things with him. We did some of the traditional mapping and some of that work. But then what we also did is begin to utilise his pad placement along this specific presentation, meaning we had him hooked up to VMO at Dr. Rectus, Pham, and utilised him beginning at the 500, but then going into the 55 current, specifically targeting what we knew neurologically needed to be primed, right.
[Angie McGilvrey] 25:14
So let’s fast forward we used we use the Navy on him probably two to three times a week, going through re facilitative. We retested him about 10 months later, via EMG. He now had what was determined as moderate axonal damage. So we actually had improved some of that damage that was happening, as well as now where he only had those itty bitty one motor units firing, he was showing normal recruitment patterns at all of those muscle groups. Wow, which, so that’s like the sciency behind it functionally, by this time in October, no Walker, he was walking independently. And we were, you know, beginning to build him up into higher level functional movement patterns. And then fast forward to the present.
[Angie McGilvrey] 26:09
He’s currently with Jay who Jake, Jason can kind of comment on what they’re currently working on. Because he’s gotten to the point with me that from a rehabilitative standpoint, he’s doing fantastic. He’s doing, he’s doing amazing. So we retested him just a couple of weeks ago to look at where he was at. And it came back with a normal study on where to EMG if somebody had no idea what this gentleman’s history was, and just walked into an office and said, Hey, can you EMG test me, they would have shown a normal study, the only thing that that stuck out was
[Angie McGilvrey] 26:51
The way that the amplitude will show up on the on the metre, or on the on the report that that they see. But what that indicates is that there was actually collateral sprouting of those nerve fibres. So you know, when we break that axon in half, we all know that it doesn’t grow together all beautifully and pretty in the same exact way that it was before. But what can happen through the correct, you know, feedback is that we began sprouting, you know, that neural tissue began sprouting and finding a way and moving all of these little like roots along to get that connection back again, to begin utilising those muscles. So I mean, he is just, he is amazing in what he does, functionally, and then what the science behind it has shown, then Jason gets the pleasure of working with him now.
I’m super proud of him for sure. He’s pretty much now three times a week, athletic performance only. And he’s pushing 80. Right. But he he’s doing 80 years old. Yeah. He’s, he’s doing a programme that, you know, I would expect for someone, you know, half his age, even to have a tough time going through, he’s continually making new bounds and leaps that like, if you walked in and saw him a year ago, you would just say, like, he’s never going to be doing these things. There’s no chance. But it continues to show up. And it’s, it’s awesome to see. That’s that Oh, Angie, go ahead.
[Angie McGilvrey] 28:23
I’m sorry, Garrett, I just have to add on that. Being able to take him from where we took him from to when I said to him, you know, from a rehab standpoint, you know, you’re ready to transition to Jason a, I don’t think that would be possible without utilising the new fit technology.
[Angie McGilvrey] 28:42
And be without having the new fit technology, I don’t know that we would have the ability. And for him to see the value of us continuing to impact him in the way that we’ve been able to, like I said, he comes in and shows up three days a week, to get on a machine with Jason because he’s seen what it could do from a rehab standpoint. And now, you know, as as an eight year old gentleman, he just wants to live life better. Yeah, yeah. He just wants to be the best he possibly can. And I mean, I look over and I see him back squatting with the bar on his back. And like, I mean, it’s just, it’s, it’s amazing.
Yeah, just recently, last session, he has, like, you wanted me to take measurements of his arms and legs and stuff. And he’s like, I want to see how much more strength again next three months. So it’s, oh
[Garrett salpeter] 29:28
My gosh, what a wonderful story. Thank you so much for sharing that I love how it highlights the full arc from early stage very early stage rehabilitation, through later stage rehab, early stage fitness all the way through this, this entire continuum that you’re able to offer there. And, you know, people you know, like you said, it’s, you know, it’s super rare to see that kind of new collateral growth and sprouting and axon tissue and You know, it’s already rare, let alone at 80 years old, when most people probably think that, you know, it wouldn’t happen at all, or it’s at least extremely unlikely. And yet you’ve shown that it can.
[Garrett salpeter] 30:13
And that highlights, you know, for me some of the some of the early research that that I did in this kind of breadcrumb trail that I’ve been following for the last 15 years to developing this technology and different things and highlights how that difference between direct current alternating current, and how at least in animal models, you know, and we also certainly believe in humans, direct current has been shown to have some benefits on regrowth and regeneration of bone, muscle, connective tissue and nervous tissue. And it seems like, seems like it’s the, it’s not just the theory, like we’re actually seeing it in real life, which is awesome. So thank you so much for sharing that. And that’s, that’s, that’s really powerful. So, so if people are listening to this, and they want to look up apex, and they want to follow along with your Spartan Races and your rehab patients and the clients that Jason’s training, what’s the best way to check out apex and to follow along with your adventures?
[Angie McGilvrey] 31:16
Thank you, Garrett. We have adventures for sure. Social media, probably Instagram is probably the easiest, the best on Instagram, where Apex physical therapy, SW, FL, on Facebook, where Apex physical therapy and concepts and rehab is is our Facebook. You know, always feel free to message JRI on either one of those channels. And we’d be sure to answer any questions or help out if anybody needs any help along the way, or just wants to chat about anything. You know, more than happy to do so.
[Garrett salpeter] 31:57
Awesome. Thank you. Thank you so much. And I have to admit, you know, you’re talking about talking about avatar and identifying your ideal customer, I have to say we have found our ideal customers in you and Apex because we love we love you know, physical therapists and trainers, you know, practices that are our Share, share our passion for this mission of really being able to help people and being able to leverage technology to do it in a more powerful way.
[Garrett salpeter] 32:23
But not technology, not in a way that replaces where they become reliant on the technology but in a way that’s really humanising rather than dehumanising in a way that allows us to access that that potential that we have inside of us, and I just hear that passion coming through. So I want to thank both of you. Send, Send my regards and gratitude to [Joe] as well, please. And yeah, so give them a follow apex. Thank you. Thank you so much. Apex physical therapy, SW FL on Instagram. And thank you so much.
[Garrett salpeter] 32:55
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