Author Archives: steadfastclinics

General Election Clinic Lessons – Decision, Change and The New Order

Nicola Sturgeon transforms the SNP

Nicola Sturgeon transforms the SNP

This morning the UK political landscape sees some significant change.

During the five years since the last election, individual voters have had very little power to point the country in a given direction.

And then we have a General Election and a vote.

A vote is a choice.  We choose and that simple act of making a choice can have far reaching implications for the future.

I am not here to comment on politics but a couple of lessons stand out for clinics:

1/ One minute you can be here and the next minute you can be gone (Liberal Democrats)
2/ One minute you are in the background, the next minute you have taken over a country (SNP)

I have been visiting clinics this past month.  A common theme has been the concern that more and more clinics are entering the market.

With a swathe of new graduates entering the market each year, most will find it difficult to get jobs in established clinics.  The new graduates will thus set up shop by themselves, rent a room somewhere and slowly build themselves up.

Some of these will have clearer purpose, ambition and charisma than others (SNP) and these are the clinics that pose the biggest threat to the old guard (Scottish Labour).

Fading Leadership

Of the others, whether new or old, those who dawdle along and don’t stand up for anything clear or just aren’t heard will find it difficult to be seen and will fade from view (Lib Dems).

I was not particularly interested in the political debate but what struck me was the frenetic activity of the last few months.

With an election coming up, suddenly I knew who the candidates were (lots of leaflets) and it seemed there was much greater clarity with some firm new promises to win voters.  Activity and decision lead to change.

Today is no different from yesterday but in 5 years time, we may look back at some significant changes in the UK political/ economic landscape because of the choices made last night.

Here are my General Election takeaways for clinics:

* Decide what sort of clinic you want to have in 5 years time and start work on it now.
* If you do have a vision of a clinic, stay visible and make it clear to your public what you are offering. 
* If what you offer is good, patients will give you their vote of confidence.

And remember if you aren’t building it, someone else is.

By Stephen Small
Director Steadfast Clinics & IDD Therapy Services Tel: 01279 602030 (Intl +44 1279 602030)
Steadfast Clinics supports a network of IDD Therapy Disc Clinics.  To find out more about becoming a centre of excellence in conservative spinal care, get more information at www.iddtherapy.co.uk

Clinic Marketing – No such thing as new patient tap, clinic water pump insight.

TapOne of our IDD Therapy Spine Centres called today to ask us to arrange for some new adverts in his local paper to promote the clinic.

The reason being there was a bit of lull in new patients starting treatment so he wanted to engage in some marketing activity.

This happens with all clinics and all businesses at some stage and is part of the ups and downs of being in private business!

But it illustrates an important point about marketing a clinic ,or any business for that matter.

The fact is there isn’t a tap you can simply turn on or off when you need new patients. There will always be a slight lag between activity implementation and the arrival of people needing your services.

The keyword to every successful clinic and business is consistency.

Water pumpUsing the water analogy and a metaphor from the legendary Zig Ziglar, keeping a flow of new patients is like pumping an old fashioned water pump.

You work hard and pump like crazy to bring the water up to the surface, then once the water starts to flow, you just need to keep pumping gently to ensure a steady flow.

BUT, if you stop pumping, the water drops back off and then you need to work really hard starting all over again to get it going.

So, however small the steps you take, taking the steps of implementing a strategy each day, week or month are key to ensuring a steady flow of new patients.

That starts with a goal, then a plan to get there and then the consistent implementation of the action steps to get there.

Now, one can argue that there are ways to get customers instantly.  e,g google adwords is an instant way to reach out to patients.  But, it is easy to blow your money on adwords so I would say that whilst it is a way to instantly get new patients, it does require some practice.

We could all be more consistent.

If you have a lot of patients, you may think that you don’t need to market your business for new patients.  That is particularly the case with established businesses who have enough business to be comfortable through word of mouth.

But how many times have you been so busy you were turning people away.  And if you are in that position, why not consider a satellite clinic so you can help even more people?

Consistency, consistency is the name of the game.

Expect to make mistakes along the way but that is part of the process.  Take anything which requires skill and know that the skills were only acquired by learning through mistakes.

If you need some new ideas for your clinic marketing, then get a free CD and some materials from leading international clinic coach Paul Wright to set you on the way, CLICK HERE

Author: Stephen Small
www.steadfastclinics.co.uk  

Acting as a human guinea pig to experience advanced spinal mobilisation capability of IDD Therapy

IDD Therapy is the fastest growing conservative spinal treatment.  Thoughts about the application of spinal mobilisation got me thinking about how we might make use of the parameters of treatment for different therapeutic objectives.  

In this video I act as a human guinea pig to set a treatment with an increased level of spinal mobilisation and extended duration of distraction.  That sounds more dramatic than it was since treatment is very safe, although I was slightly nervous!

IDD Therapy is a programme of treatment involving a series of one minute distraction and mobilisation cycles to decompress targeted spinal segments.

Part of the mobilisation is a patented oscillation capability at the point when the joint is distracted. Typically, this oscillation force is set at 10lbs and applied for one minute at a moderate frequency.

The computer software in IDD Therapy gives clinicians the unique ability to adjust the oscillation in line with principles of manual therapy, whether Maitland, Harmonics etc.

Oscillation Frequency & Amplitude

Differing frequency and amplitude of oscillation/mobilisation (60 seconds)                                                               Low Freq’cy      Moderate Freq’cy          High freq’cy               10lbs oscillation            20lbs oscillation

In this video, I explore what a higher oscillation force feels like by increasing the oscillation force from 10lbs to 20lbs (amplitude) at the point when the joint is distracted under tension.

Since the oscillation force has a bigger distance to travel between high tension and low tension, it is necessary to decrease the frequency, ie the number of cycles, to allow time for the distraction force to go up and down within the range of the oscillation.

This reduces the number of cycles of oscillation in a 60 second high distraction. Therefore the duration of the oscillation at the high distraction is increased from one minute to 90 seconds.

Thus the joint is opened for longer and at the same time, the joint and surrounding soft tissues are exposed to more significant distraction and mobilisation forces.

I have received many IDD Therapy treatments and observed that the combination of longer distraction at high tension and greater degree of oscillation results in a greater feeling of decompression.

The treatment feels more powerful and remains comfortable. The next day after treatment, I could feel greater range of movement, improved posture and less stiffness in the lower back.

Whilst IDD Therapy is typically given as a course of treatments for chronic disc-related conditions, IDD Therapy is used as a tool when clinicians need something more than hands alone to increase range of motion and soft tissue function in the lumbar spine.

Author: Stephen Small
Director Steadfast Clinics Ltd
www.steadfastclinics.co.uk  www.iddtherapy.co.uk

Short video demonstrates limitations of anterior-posterior spinal mobilisation for herniated discs.

The latest dynamic spine models allow us to see the effects of forces on intervertebral discs.

Manual therapy typically uses an anterior-posterior directional mobilisation to treat spinal segments.

IDD Therapy treatment comprises a targeted longitudinal distraction, with a longitudinal oscillation/ mobilisation at the point of maximum joint distraction.

IDD Therapy 25 minute treatment graph

This decompresses the discs and works soft tissues simultaneously in a way which is not possible with the hands alone.

Author: Stephen Small
Director, Steadfast Clinics Ltd
www.steadfastclinics.co.uk

Clinic Marketing Through Mud and Dust – Lessons from my time in Africa

When I worked in West Africa, I had a book about marketing in Africa “Marketing through mud and dust”. 

Marketing through mud and dustThe lesson in this book was that brands are built at street level.

With large extended families dependent on a small number of bread winners, when you engage a couple of people with your brand you engage with the whole family because of the network.

Big brands like Maggi (Nestlé) do the tv advertising and bill boards, but when you get down to street level they all have an army of foot soldiers talking to local people and businesses.

maggi-1Maggi event Maggi rep

Without that the fancy expensive stuff doesn’t work nearly as well – or you have to spend a fortune.

Some brands I worked with had more budget than others – Absolut vodka to Vita stock cubes (competitor of Maggi stock cubes!) , but the starting point is always at ground level.

That is like local clinic marketing.

Community MarketingEvery new patient is worth many referrals.  You might be or just think you are special because you get your business from word of mouth, but there are new patients in pain looking for a new clinic.

How do you think your competitors survive? If you get out there and in amongst it you will get visible.

Think of it as grass roots brand building.

Author: Stephen Small
Director Steadfast Clinics Ltd
www.steadfastclinics.co.uk

Clinics in the community – get visible to be seen and remembered.

For clinics without natural footfall or street visibility then you have to work harder.  As we come into the summer there are fares and local events where you (or your team) can be out and about promoting the clinic. 

Community Marketing

Get out and about to be seen by your community.

If you are engaging in building your brand through other media, local people will already have an imprint of your brand in their minds, so this is a moment for them to meet you.

My sisters live in Leicester and a couple of weeks ago sent me this when out and about at a local street festival. You don’t need to be there yourself.
You have team members who could get out there for you or you could even pay someone to talk to people and engage people to come in.

The best part is, they often only cost £30. If not events – often for free or a modest fee, local supermarkets will let you have a table with a banner.

Author: Stephen Small
Director, Steadfast Clinics Ltd
www.SteadfastClinics.co.uk

Spinex Disc Clinic – the new name for non-invasive disc treatment in London

All physiotherapists, osteopaths and chiropractors treat intervertebral disc problems.  And yet, pain consultants up and down the country have waiting rooms full of people with back pain and neck pain, caused by disc-related problems.

Spinex Disc Clinic

Spinex Disc Clinic – Edgware Road London

Spinex Disc Clinic, a specialist back pain clinic in London helps patients caught in the back pain no-man’s land where standard manual therapy and exercise haven’t worked, and where they need something more for their pain without resorting to injections and/or surgery,

Causes and consequences. 

When it comes to back pain, cause and consequence are quite similar.  The cause of your back pain might be a herniated or slipped disc.  However, the real cause of your herniated disc is one of a number of factors such as the compression of the disc from poor posture over a long period of time, combined with a lack of exercise and so on.

So the cause of the pain is actually the consequence of changes in the body which lead to the disc problem.

All clinicians treat the causes of pain, but first of all they treat the consequences of the causes of pain.

Where Spinex Disc Clinic and other IDD Therapy Spine Centres come in, is when the consequences of the causes of pain e.g severe compression and restricted mobility, are such that manual therapy alone is not able to address the problem.

The first things to do therefore is to take pressure off the disc and improve tissue function, then the focus can be on addressing the real causes which led to the problem.

In some ways it’s like obesity treatment.

The cause of obesity is a calorie surplus each day built up over time.  The consequence of that is excess weight/ fat.  First the person has to work hard to get rid of the excess fat and then they make lifestyle changes to ensure they stay at a healthy weight.

Now, the person will make the lifestyle changes as part of the process of losing weight but they have to work harder than normal because they need to burn more calories to cut the excess.

When it comes to disc treatment, for some patients lifestyle changes alone (improved strength, more activity, better posture etc) are not enough to undo the consequences / causes of the pain.

Spinex Disc Clinic is primarily focussed on those patients with disc problems who need something more than manual therapy.

Clinical Director Sally Lansdale is a highly experienced osteopath who finally resolved her long standing problem with a series of IDD Therapy treatments.

Since then she has had two clinics offering IDD Therapy and now Spinex Disc Clinic is the evolution of those clinics now located in North West London, just off Edgware Road.

For more details about Spinex Disc Clinic, visit www.SpinexDiscClinic.com 

Selling drinks in Africa and clinic marketing – valuable lessons for growing your clinic.

In the first ten years after leaving university I worked primarily in Africa, based out of the UK. 

A complete career U-turn led me into healthcare but now, as I look back, I can see how certain strategies used by multinationals can be applied to clinics of any size.

Whisky and the legionI had several jobs which included two working at large drinks companies.  I dug out this old photo out which sees me, bottom right, with members of the French Foreign Legion in a bar in Gabon, Central Africa.

So what does selling Grants whisky have to do with clinics??

It’s about the approach to marketing.

In the drinks industry the last three months of the year, and in particular Christmas, are when you generate most of the sales volume.

But, in order to get people to choose your brand, you have to have your brand in the purchasers mind when they are at the supermarket shelf, in a bar/restaurant or thinking about a gift for someone.

In that moment of decision a synopsis of all the brand messages they have ever been exposed to goes through the purchaser’s mind.  A lifetime of brand messages creates an attraction to a brand, but also the position of the bottle on the shop shelf/bar makes a big difference: “Eye-level is buy level” and then you have the influential promotions, special offers etc to sway the decision at the crucial moment.

Most clinicians will say with pride that “word of mouth” is their main source of new patients.

That is generally true, but I believe that this can partly be explained by the fact that very few clinicians have a consistent marketing strategy throughout the year to bring them patients from other sources.

If we relied on word of mouth in the drinks business, we would never grow the brand.  Likewise I visit clinics who invest a lot (time and/or money) in marketing and they are much busier than their competitors.

You see, like the person who buys one or two bottles of whisky a year, a potential patient may not be in pain right at the moment.  You have no idea when a person’s pain will be bad enough that they go looking for a clinic (brand).

Not all marketing works, but so often, clinicians expect an immediate response to a piece of marketing.  Then, when it doesn’t come (and they ‘lose money’), they retreat to thinking that “word of mouth is the only marketing that works”.  Perhaps the ad/message/activity wasn’t quite right anyway, but consistency also plays a big part.

It takes time to build trust in a brand, being there (visible) consistently with your brand plays a big part in building trust.

It is much harder to get people to switch a brand of whisky they have been drinking for ten years, than it is to introduce new consumers to your brand.

Whisky PromotionIn this photo you can see me centre (slightly worse for wear!) in a nightclub in Cameroun.

Drinks promotions in bars highlight your brand.  Any new consumer you engage, like any new patient is likely to stay loyal to you provided you look after them.

Plus, the non-whisky drinkers pick up a powerful brand message and one day they may have cause to choose a brand for themselves or someone else.

So, back to the person with a back ache:  most people live with their pain and take painkillers.  How many times do you hear people say “it was finally time to get my back looked at”.

Like the decision to purchase a bottle of Glenfidich whisky, the brand influences have been built up over time.  Drinks companies invest heavily in that.  As pain develops, so does awareness of pain remedy messages.  It’s been well documented that when you think of a new car you want, you suddenly see that make and model everywhere.  It’s the same thing.

For a clinic, even a few hundred pounds a month to get your BRAND visible to people in your community, gives you much more of a fighting chance to be selected over the competition- in that moment in the year when someone’s pain is sufficiently bad that they want to take action.

IMPORTANT – The other reason consistency is important is because it keeps your brand visible to your existing customers.  Of course, the relationship between a patient and their clinician is much more profound than the relationship between a consumer and a brand of whisky!

However, I am yet to meet a clinician who hasn’t told me that they acquire patients from their competition.  Now, when everyone says that, I’m afraid that means that some of those patients who left your clinic and never returned … didn’t all feel that they had a satisfactory experience with you or they aren’t that fussed where they go so are ready to respond to new messages from other clinics (like the eye level purchase decision at the supermarket shelf).

NOTE we Brits are very polite.  I once sat through a consultation with an osteopath, I answered the right questions but I didn’t get a connection with the guy so I never went back.  Now, he may have thought that he restores patients in one visit but that is not the case every time.

If you provide a good service, you have an opportunity to draw in disgruntled patients and those who don’t have particular loyalty – and there again is a reason to stay visible.

Remember 90% of clinics are passive and don’t market themselves consistently to grow their practice.  Therefore, you don’t need to invest too much to make yourself visible and stand out from the crowd.

I hope this helps.  It remains for me to say Sláinte (SLAHN-chə) which means “health” and is a Gaelic toast to use whenever you drink Scottish water.

For marketing strategy ideas for your clinic, you might like to visit our website to get a free report. CLICK HERE

Good luck.

Stephen Small
Director Steadfast Clinics Ltd
www.steadfastclinics.co.uk  www.iddtherapy.co.uk  www.thermedic.co.uk

Case Study Template For Back Pain Treatment – Comments Invited

As we expand availability of IDD Therapy treatment for discs and nerve pain, we encourage all IDD Therapy provider clinics to write up case studies.

Ultimately we want to refine the patient cohort so that we get better predictability of outcomes and use the strength of the network for multi-centre data analysis.

We use subjective and outcome measures and I wanted to share the outline and structure of a case study template so that if someone had some suggestions for improvement, they could contribute.

The template has some details specifically for IDD Therapy treatment, but they can be deleted for use with other conditions, if someone wanted to.  The IDD CASE STUDY TEMPLATE is a word document you can click to open.

IDD Case Study Template doc

There are many different treatments for back pain and as the somewhat cruel saying goes, there is more than one way to skin a cat.  IDD Therapy spinal decompression is a tool used by clinicians when they want to decompress, distract and mobilise a targeted spinal segment in a manner they can’t achieve with their hands, or traditional traction.

Author: Stephen Small
Director Steadfast Clinics Ltd  www.steadfastclinics.co.uk  www.iddtherapy.co.uk 
email: stephen.small (@)steadfastclinics.co.uk

Low Back Pain Treatment – Inflammation, IL-6 and the new FAR infrared treatment connection.

I recently posted an article regarding drug-based Rheumatoid Arthritis treatment targeting the IL-6 protein.

I was interested in the potential implications of a study by Wong et Al (1), showing that as well as pain relief, post knee surgery patients treated with FAR infrared exhibited reduced levels of the proinflammatory IL-6 protein.  I raised the question whether the new FAR infrared modalities be an effective treatment aid for Rheumatoid Arthritis.

FAR infrared and IL 6 protein

http://www.ncbi.nlm.nih.gov/pubmed/22339105

“This study demonstrated that the FIR can lower the NRS of pain and thus reduce the discomfort experienced by the patient. Findings indicated that effective application of FIR decreased the serum level of Interleukin-6 (IL-6) and Endothelin ET-1, which represent the subjective indicator of pain.”

Working so heavily with low back pain and IDD Therapy spinal decompression treatment, this got me thinking about inflammation, IL-6 and low back pain.  What are the potential applications of new infrared modalities as a cost-effective tool to ease inflammation and reduce low back pain … without the need for steroid injections and anti-inflammatory medication?

With regards to Low Back Pain, we observe on many occasions that patients using Thermedic infrared pads report pain relief beyond what might be expected from a standard conductive heating aid.  I have written at various times that the humble “heat pad” offers more profound benefits than we might think, see evidence.

Looking at some of the research into IL-6 and back pain, Heffner et al (2) show that higher levels of IL 6 are associated with chronic low back pain (CLBP) and sleep disturbance:

“Individuals with CLBP had more sleep disturbance than controls. Circulating IL-6 levels were similar for the 2 groups; however, in adults with CLBP, poorer sleep quality was associated with higher IL-6 levels, and both sleep and IL-6 related to pain reports.”

Burke et al show that there are high levels of proinflammatory IL-6 in the nucleus pulposus of painful intervertebral discs:

“We have compared the levels of production of interleukin-6 (IL-6), interleukin-8 (IL-8) and prostaglandin E2 (PGE2) in disc tissue from patients undergoing discectomy for sciatica (63) with that from patients undergoing fusion for discogenic low back pain (20) using an enzyme-linked immunoabsorbent assay. There was a statistically significant difference between levels of production of IL-6 and IL-8 in the sciatica and low back pain groups (p < 0.006 and p < 0.003, respectively). The high levels of proinflammatory mediator found in disc tissue from patients undergoing fusion suggest that production of proinflammatory mediators within the nucleus pulposus may be a major factor in the genesis of a painful lumbar disc.”

Kraychete et al (4) show that:

“…  patients with chronic low back pain due to disc herniation presented higher levels of TNF-alpha and IL-6, but not of IL-1 or sTNF-R.”

Thus whilst looking at the Wong et al study showing reduced levels of IL-6 for knee pain post surgery using infrared,  we can also see that elevated levels of IL-6 are associated with CLBP.

Could Wong et al help us to explain more fully the observed benefits of FAR infrared for relieving low back pain?

TherMedic is a new technology which uses a mains powered carbon-fabric element which emits FAR infrared.   It replaces lamps.  Worn against the body TherMedic provides a localised constant infrared heat/energy source.  Evidence shows both thermal and non-thermal effects from the resonant energy for pain reduction for a variety of conditions.

Most of the evidence comes from Asia where the technology is developed and being applied to many medical conditions.  We expect that European academic interest will develop as awareness of the new technology and its applications spreads.

PW140-Lower-Back-Thermography-heat-only   l220103-heat-pad_jpg   l220103-temp-control_jpg

Regular users of Thermedic for low back pain report “not being able to live without their TherMedic” infrared pad.  Patients with sciatica report that their pain has disappeared which is surprsing for something viewed as a simple heat pad and used on the lower back.

PW140-TherMedic-Lower-Back-PackShotRather than simple pain relief from heat and increased blood flow which “feels nice”, might Thermedic infrared have a deeper effect by helping to reduce levels of inflammation-causing IL-6 in LBP?

There is clearly a lot to explore, but as you look into the new FAR infrared fabric application for low back pain relief, you will see that there is a lot more than meets the eye.

Convention has it that heat should not be applied when there is inflammation.

Having heard from people suffering with inflammation but reporting relief when using TherMedic Infrared, could the new infrared turn some of that conventional thinking about heat and inflammation on its head?

Author: Stephen Small
Director www.steadfastclinics.co.uk  www.thermedic.co.uk  www.iddtherapy.co.uk

1) Wong CHLin LCLee HHLiu CF. The analgesic effect of thermal therapy after total knee arthroplasty.  J Altern Complement Med. 2012 Feb;18(2):175-9. doi: 10.1089/acm.2010.0815.  http://www.ncbi.nlm.nih.gov/pubmed/22339105

2) Heffner KLFrance CRTrost ZNg HMPigeon WR Chronic low back pain, sleep disturbance, and interleukin-6. Clin J Pain. 2011 Jan;27(1):35-41. http://www.ncbi.nlm.nih.gov/pubmed/21188850

3) Burke JGWatson RWMcCormack DDowling FEWalsh MGFitzpatrick JMIntervertebral discs which cause low back pain secrete high levels of proinflammatory mediators. J Bone Joint Surg Br. 2002 Mar;84(2):196-201. http://www.ncbi.nlm.nih.gov/pubmed/11924650
4)  Kraychete DCSakata RKIssy AMBacellar OSantos-Jesus RCarvalho EMSerum cytokine levels in patients with chronic low back pain due to herniated disc: analytical cross-sectional study. Sao Paulo Med J. 2010;128(5):259-   62. http://www.ncbi.nlm.nih.gov/pubmed/21181064