Graham Sessions 2019

By Fred Gilbert, PT, DPT

Since 2015, one company has improved the health and wellness of over 44 thousand individuals within their walls.

The market reach for this company alone has increased 1,267 percent in three years. Their innovative model has already reached 21 different locations in 18 states in under four years. They are changing the way that care is delivered across the United States and changing the way people move within each location. So, how are they doing it?

This company has prioritized a fun, energetic work space that delivers the results that they promise:

  • Improved sport performance
  • Improved range of motion and flexibility
  • Reduced muscle and joint pain
  • Improved posture
  • Improved relaxation and decreased stress

These promises have been met with each of the 44 thousand plus individuals that have come through the door since 2015.

This company is doing so much right. Not only are they delivering care that is transcending expectations and the limits we thought held us back but also, as they state on their website, they “launch you back into your life, propelling you forward with the newfound energy that comes from your body moving, working, and feeling exactly the way you want it.”

They are built upon delivering an experience that is focused on: “reclaiming your freedom. The freedom to move as you want, to be active and engaged in the life you see yourself having, with no pain and no risk of injury.”

What better way to realize the vision of the APTA to “transform society by optimizing movement to improve the human experience” than this company?

This vision is being realized within an accessible model of care built upon a personalized, energetic, and inspiring experience. The company is changing the game. How are you keeping up in your practice? What can you learn from this company?

This company is StretchLab.

StretchLab is a boutique fitness experience that is sweeping across the country. It is a stretch service provided by Flexologist with “Flexologists” who have exactly one week of training in anatomy, proprioceptive neuromuscular facilitation (yes, PNF), and customer service. StretchLab has grown to over 21 locations, with 650 units sold as of 2017 (a 557 percent increase in just two years) and delivers a simple brand promise: If you are feeling tight and you come here, you will feel better. If you are feeling tight and you come here, you will feel better. What could be more simple, digestible, and attractive to a consumer than that promise? No work, no confusing fees or delayed appointment slots. A simple membership inside a friendly, fun, energetic environment with guaranteed results.

No home program to follow, medical record to track down, or insurance claims to hassle with. Clean, simple results at the hands of an “experienced and knowledgeable flexologist.” They are providing transparent, simple care at a convenient location for a low price. The market has demanded a solution to their problem and StretchLab is answering the call. Everywhere you look there is a simple, passive, accessible, inexpensive option for an equivalent service that we provide in physical therapy. Tight muscles? StretchLab is there for you.

Joint pain? Here’s Biofreeze.

Back pain? Head over to The Joint for a two- to three-minute chiropractic visit to get you going.

Poor posture? Slap on some K tape and a posture bra and you’re good to go.

Personalized movement training with built-in modifications for your injury? Let me introduce you to Mirror, a personalized fitness experience in your home. There is a passive, accessible, and simple solution for everything we do. And it is only getting worse.

Companies like StretchLab are the reason that I believe that physical therapy will die. The emergence of StretchLab feels harmless on the surface. Another boutique fitness experience that will fade with the rest of the studios. But think for a second about the implications of StretchLab.

In the consumer’s eyes they are providing a service not too dissimilar from physical therapy.

In fact, to most consumers they are providing exactly the service that physical therapists provide. How many of you have received phone calls from friends, family, and former clients saying, “Hey man! I’ve got this back pain that has been bothering me—what stretches should I do for it?”

We are a profession branded as providing stretches and exercises—whether you like it or not—and StretchLab is stealing the market. No more phone call or appointment necessary. Feeling pain and think you need some stretches to cure it? Head on down to StretchLab.

Consumers are demanding a solution to the inconvenient, costly, impersonal, ineffective treatment they need on a daily basis. Companies like StretchLab are creating a marketplace for consumers to find a solution they desire—and they are doing it with unskilled, unlicensed workers.

They are able to provide this service without having to enter the complex medical system, and they are doing it with employees who need no certifications, no licenses, no oversight. So what are we doing as a profession to listen to this market?

What are we doing to excite the masses about the potential they have to not only resolve their aches, pains, and limitations but blow past them to move their best tomorrow, and the next day, and the next?

The gut reaction that most have when I bring up this topic is that the cream will rise to the top. Consumers will know quality, and our practitioners—with years and years of study and a DPT—will rise to the top.

But intellect alone isn’t enough to continue to grow our profession to own the movement space. We need practitioners with a grand vision of the future. We need practitioners with a passion to change the way the world moves that wakes them up in the morning and puts them to sleep at night. We need practitioners with a powerful motivation to push through every obstacle they find in their way today to lead society to their best movement tomorrow.

Relentless, resilient, ambitious, hungry individuals who are prepared to shoulder the yoke in the name of a healthier tomorrow.

In short, we need practitioners with Grit.

But let’s visit for a second how we are nurturing those clinicians within the walls of our clinics. Let’s take a closer look at how we are empowering our clinicians to be gritty. Empowering them to provide a differential experience for clients that will combat the move on the market from companies like StretchLab.

Author of Grit, Angela Duckworth defines four psychological assets that a gritty individual possesses:

1. Interest: intrinsically enjoying what you are doing

2. Capacity to practice: trying to do things better than we did yesterday

3. Purpose: the conviction that your work matters

4. Hope: a rising-to-the-occasion kind of perseverance

Do our walls stack up as pillars to these four assets? Or are our walls barriers to grit that cap our potential?

In my opinion, the walls of our clinic are the antithesis to interest. We recruit employees with a vision for the future, a vision that reaches the furthest corners of our communities, our society, and our world. We recruit them for their interest and then we lock them away. We listen to their passion, and their goals, and their dreams. We nod our heads, we shake their hands, and we tell them that we will absolutely support them—so long as that is done on your own time or you make up the patient care hours. It’s hard to be interested when that interest is contingent on the bottom line. Survive the day, survive your schedule, survive the emotional load of our profession, then you can go outside to change the world.

But, one might say, if we are going to be confined to the walls of our clinic at least we will have plenty of time to practice our craft, to learn within the walls to maximize every moment. But in the world we have created there is no time to practice. If you take the time to practice, you lose a unit; if you lose a unit, you hurt the clinic. And if we do find ourselves in the fortunate situation of being surrounded by great mentors who lift up and support our interest and practice… well, we have to take a reduced salary for that.

For those individuals who are motivated to practice and elevate their skill set, they have to do it at the expense of engaging community partners, expanding and diversifying their interests in business and marketing, and participating in association and advocacy leadership—the things that push our profession forward rather than maintaining the status quo.

And if we must grind through, if we must overcome the obstacles of the system, at least we have our purpose. Each of us started with a purpose. Somewhere along the way—and my guess is the second year of PT school—we lose that purpose. We focus on surviving. That mentality is reinforced inside every wall that our profession builds: Survive this caseload. Survive these notes. Survive this week. Survive this debt.

Purpose? Our profession’s purpose has narrowed down to survival. We argue about autonomy and marketing, movement system and treatment paradigms. But what are those things without a purpose?

If interest, practice, and purpose are the walls of our clinic, hope is the foundation. Hope, Duckworth says, defines every stage of grit. A hope that what we are doing matters, that it matters to the health of the person sitting in front of us, to their family and to the friends, to their homes and communities, and ultimately to society.

The most common form of “hope” you will see in a clinic is the hope that a client cancels so you have an open spot to complete notes. Grit should be the fire that flames our interest, our practice, our purpose, and hope should be the spark that ignites that passion, not the water the quenches the flames.

Hope is the foundation for a better future, which elicits our desire to go out and transform the world through movement. But when we focus on survival we lose hope. When we lose hope we lose our spark, and without our spark we burn out.

We have created a culture that kills motivation and neglects those with grit. We need a group of motivated, inspired, and gritty practitioners to stay relevant in the health care marketplace. We need a group driven by purpose with an edge to combat the snake oil and move our society toward their best life. Instead we have a burnt out group of clinicians trying to survive. Instead, we have clinic walls that hold us down rather than lift us up, that suffocate rather than inspire.

While we search for breath to make it through another day, consumers are moving on to more accessible, more inspired, more motivational options.

The walls of our clinics are the ultimate personification of a passive, docile, yielding, meek profession. Their very existence elicits the mindset that we will wait for the world to come to us, rather than rising up to drive change forward.

Forget championing the movement system. Forget solving the opioid crisis. Forget Medicare for all, fair payment systems, or direct access to care. If we can’t empower our providers with interest, and practice, and purpose, and hope—if we can’t give them these basic necessities to be gritty, we can forget the rest. We will continue to manage care, rather than prevent and improve and transform care, and other companies and competitors and professions will pass us by.

Each day that we live inside our walls is another day that physical therapy is forgotten and I believe that physical therapy will die within the walls of a clinic.

The walls of a clinic are a metaphorical concept. I am not saying that brick and mortar clinics are going to kill our profession.

The walls of a clinic are a mindset. It is a culture, an expectation, and a notion of how we should exist in the world. Our profession will die within the metaphorical walls of the culture and mindset we enable and encourage.

We need to create a mindset and a culture that encourages our practitioners to own the day. To own the way that they practice. To own the care that each individual is given. To own an idea that they have, to nurture that idea to life, and to champion that idea every day. We need a culture that sees a company like StretchLab and bristles, digs in their heels, and pushes back.

We need a mindset shift in our profession. We need to reshape the infrastructure so that we raise up our clinicians and instill a culture of grit from the very beginning.

And we don’t need to create an entire new persona for our profession. We don’t need to start it all from scratch to ultimately succeed. We don’t need to do market research or focus groups, surveys or task forces. We simply need to look at our past to understand our future.

Mary McMillan was the embodiment of grit. Try to show me a more determined, resilient, driven, ambitious, take-no-shit person than Mary McMillan and I will call you a liar. We were founded by a group of bad-ass women driven by grit. Driven by a purpose that saw every obstacle as the way forward, not a reason to turn around.

Mary McMillan came to the United States after being rejected for medical school. She came here during World War I in a convoy under complete blackout conditions. Obstacles? Rejection and the World War. Solution? Move to a new country in the middle of a war and start a new profession. That is Grit.

McMillan was so well respected in her time that she was asked to travel to Oregon to train 200 potential reconstruction aides. In true government tradition, the Army was dragging its feet on approving her departure. Her response? Mary threatened to resign and was approved within 24 hours to go to Oregon. She was a woman serving in the Army during World War I and commanded that kind of respect. Obstacle? Bureaucracy. Solution? A take-no-shit attitude and resilient determination. That is Grit.

McMillan was the very embodiment of care beyond the clinic walls. She was never confined to one physical location waiting on the world to come to her. Mary moved to Peking, China, to expand the reach of the profession she held so dear. During her stay, Mary was evacuated to Manila. While there, the island fell to the Japanese. As she realized she was going to become a POW, Mary and 3 women stole a truck, drove to the hospital to recover drugs, instruments, beds, and bedding to furnish the internment camp hospital. All the while Mary slept on a filing cabinet. Obstacle? Being a prisoner of war. Solution? Stealing a truck and sleeping on a cabinet to rise up and prepare to provide health care. That is Grit.

We don’t need a hero. We don’t need a revolutionary. What we need is a mindset shift. A shift to build a world where our practitioners can be gritty. A world where our practitioners are moved by purpose, not by survival.

We need every clinic owner, professor, mentor, and practitioner to look back to our founding. Look back to the days when our leaders slept on cabinets to make the world around them a better place. Set the expectation every day that you and your team and your clinics and your schools will embody the relentless, resilient, ambitious hunger to inspire that will change the world.

Every system you build, every schedule you create, every lecture you give should be focused on one central tenet: How am I inspiring grit today? How am I giving my employees, my students, my bosses, and myself the opportunity to be gritty today?

Are we empowering our profession to be gritty like Mary McMillan or simply to survive the day?

I believe our profession needs the Mary McMillan mindset.

I believe we can empower every person in our profession to rise up and take ownership of the movement system.

I believe we can reach every corner of the globe with grit and determination and compassion.

I believe that physical therapy can realize a world healed by movement.

I believe that physical therapy will die within the walls of a clinic, but if we change our mindset there is a chance we will thrive.

Copyright © 2018, Private Practice Section of the American Physical Therapy Association. All Rights Reserved.

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