That kind of thinking let me dive into a couple different areas of study. One that that really stuck with me was Dynamic Neuro Muscular Stabilization that's at the Prague school of rehabilitation hospital in the Czech Republic and I started to get into their work initially and see that some of the founders of that school of rehabilitation professor like Karel Lewit and Vladimir Janda and currently Professor Patel Kolar.
They and their work has been referenced and cited in a lot of the other books I was going through as well. That body of work was a really big factor in my development.
Noah: As you started to develop that skill set and foundation, what was the next stage in your evolution, where did you go from there?
Dr. Fergus: What I've been trying to put together with GRIP started when I started hosting classes in my area of other well-established programs like dynamic neuromuscular stabilization. I've hosted a Janda approach course that was taught by a friend and colleague physical therapist Robert Lardner. I started to piece together these methods as well neuro dynamics and Mo's Mosley and butler’s pain science and looking at things. I was looking at where each pathway said the same thing in their own unique language and those areas of convergence between what we have in the chiropractic, what we have in pain science and in rehab. Where they all converge and are trying to accomplish the same goal or say the same thing. If we have Janda upper cross syndrome and we have this presentation in the connective tissue and we have thoracic outlet syndrome or t4 syndrome or more of a chiropractic perspective how do they relate. How can we look at all these avenues of diagnosis and assessment and refine those processes to get a better idea of what is happening with the patient? Do we go down the traditional chiropractic route of joint mobilization, do we go through a postural program or a soft tissue program.
The framework around this clinical presentation is to clearly and effectively assess the patient and then take the available literature that we all have access to see where things are converging and saying the same thing in their own language. We build a framework around that to guide clinical practice.
Noah: It sounds like you synthesized all of these seemingly divergent systems with the pain science, with chiropractic, and then brought those together and started to bring that into your clinical practice. What does your clinical practice look like? How do you leverage the research that you're coming across and bring it into a clinical setting?
Dr. Fergus: My clinical practice is unique in comparison to a lot of chiropractic offices. Our main focus is chronic and complex cases. That means that somebody who is presenting in our office has typically been to a few different medical doctors and potentially chiropractors and physical therapists. They've tried a lot of different therapies and for whatever reason it wasn't effective for them.
They still have the presentation that they started with or some level of it and they're looking for resolution and that's where we fit in. We provide our local community a detailed second opinion that is outside of the norms of what they've seen up to that point. Then we say, “Here’s what the literature says today, this is new, this is where trends are moving.” I present that directly to the patient. I say “I know you've had lack of success with treatment methods in the past, but since that time we've learned a lot more about the way the body works and we'll use that for your treatment.” Patients are enthused by having a potential new option for resolution. Integrating the literature into practice happens on a one-to-one basis first. Then it happens on the back end when our team of doctors discusses a case. We look at the presentation, the traditional ways of treating, what didn't work, and where we can access new information in order to provide improvement for this person.
Noah: I know many patients who feel like they've exhausted all of their options and you have creating something where they can actually get the relief they're looking for or at least explore a different venue they haven't tried before. I’d like to work with chronic and complex cases but at this point my knowledge base does not seem big enough. I don't even know where to look in terms of the research to have the resources to figure out what kind of clinical applications I would utilize. If you had to start at square one knowing what you know now how would you begin?
Dr. Fergus: I'll repeat my journey into chronic and complex presentations and what I utilized. First of all, what every chiropractor in your position in school and preparing for clinics should keep in mind is establishing a really secure working environment with the patient by providing what's right for the patient. So being in tune with the needs of your patient and what's worked for them in the past. What they have a fear about and what they're really happy and comfortable with that's the number one thing for these complex patients. They're often seeing you on one of the worst days of their life and it’s hard to meet somebody where they're at. A really good source for me has been working with the counselors that treat patients with PTSD and chronic pain and other psychosomatic type conditions and learning from them how they deal with the issues at home, with their job, with their family and how they manage their diagnosed conditions and pain? I learned how the physical component of treatment is effective for the patients seeking psychotherapy. I’ve built a relationship with the local mental health professionals. After this, then make Pubmed your friend. Get on Pubmed and use the keyword searches. Identify different categories of pain and different categories of muscle or nerve dysfunction. Use this information to determine what the patient presents with and what are the different categories of dysfunction in the patient walking in my door? Then divide out those presentations into something. To summarize develop a good working relationship with them, get in touch with some mental health professionals and learn about the psychological component of not being able to walk and sleep due to pain, and thirdly access the literature on Pubmed.
Noah: Thank you for going through the steps. I don't know how every other school is but I know at my school the research seems much underutilized.
Dr. Fergus: In most schools there's reference to the literature but it's not really important to students until they get into active practice and see what is not responding. Then you take interest in what they are doing in Japan, in Denmark and in South Africa to figure out how people across the world are managing these issues. We can pool resources and find some solutions.
Noah: That is students and chiropractors want is to find solutions for the people.. Where does GRIP Approach fit into this and what makes it unique?
Dr. Fergus: I think anything that's developed in healthcare is going to have some similarities with other methods so I'll highlight where we're unique. We've drawn heavily from what's currently available in the literature and other methods to create GRIP. Which is a movement assessment that looks at the body in joint regions in a single plane of motion at a time. When performing an evaluation on an individual, I want to ask does the brain, peripheral nervous system, muscles joints etc. work together in a unit for specific movement in a single plane of motion. Any joint can be evaluated. We break down the body into very clearly definable regions and very clearly definable actions to take the assessment portion further. The assessment is palpating the brain's ability to control the body.
As chiropractors, we're accustomed to palpate a joint in three planes of motion and assess its function. Does it have adequate movement in three planes of motion? Is it excessive? We're essentially asking the central nervous system, “Can you move this joint complex into three planes of motion?” If you're stuck in one plane, how does your body compensate for that? Where do you steal movement, or steal muscle activity, or endurance etc? We establish a couple neutral zones in order to determine if we have control over the movement we generate from those neutral zones.
GRIP starts as an assessment and when we go through a patient assessment, we have a clear way of saying, “this person's nervous system is having a hard time generating these five movements, these three are the most important clinically and then that test becomes actionable. It leads to strategies for correcting that loss of motion that are reliable in terms of clinically empirical studies as well as the current literature available. So, there's a treatment arm and an assessment arm.
Noah: We have talked a lot about what you do clinically. We've talked about this training that you've developed. Can you talk about your business? You're the director of Cornerstone health. What responsibilities do you have as a director outside of your clinical responsibilities?
Dr. Fergus: There are a lot of clinics that focus on acute and sub-acute presentations and do really well from a professional standpoint. That is not our focus. We refer simple cases out to others in the area. Assuming that somebody wants to get into treating complex and chronic cases first you must be effective at diagnosis. So when somebody comes in, we don't make promises of effectiveness or of one treatment method working. Essentially our promise to our patients is that nobody's going to look deeper than us. We spend a lot of time studying diagnostic methods and working with other diagnostic physicians in our area to really hone down the diagnostic procedures and give a good answer to a lot of patient’s that have been searching for the answer not getting it.
So, it starts with that simple promise we're going to look deeper. We're going to do a better evaluation. We’re going to give you as much information as we can gain from it and then that leads into the types of treatments that are available.
So far as the setup of the practice when I started it was solo, it was me in a clinic with two rooms a rehab room and a front desk. I was answering my phones, scheduling my patients, doing the exams, and the paperwork. The whole works from start to finish. That gave me a good opportunity to spend the time to create really good rapport with my patients. Which I found to a very effective part of treating complex and chronic conditions.
Ss we grew and our practice picked up. Patients that called in would say I've got condition in my shoulder, I've got a neurological condition in my spine. I've got this skin condition or this hair condition and I've heard you can help. I was glad for the referral, but I was much more effective in treating the spine and shot he shoulder than the skin and hair. We have tried to define a few areas we are really good at and provide effective treatment for those individuals. We clearly say, you're going to be seeing Dr. Ryan. He leads this type of care. He'll be consulting with other physicians to find the right diagnosis for you. It’s grown from a solo practice to three doctors that work in the system right now. We also started to integrate some strength training and some group training as a literature really supports that as an effective therapy currently.
Noah: I like that you have one person leading care but then you have all of these other resources that you can utilize within the clinic so that everybody gets the best care.
Dr. Fergus: You hit on a good point for students that are getting ready to graduate. Whether you work in a group practice or a solo practice or as a very busy associate is that one of the most important factors for success is having a really good network of people to discuss tricky cases with. We do most of that In-house, but when I was working as a solo practitioner, I would pick up the phone and talk to the best professionals in my network. It’s important to establish a really good group of people that you can conference with on cases.
Noah: It’s like school, when we have this mentor Doc who’s walking us through things and so I know most students in my position want to go into associate position to learn. It’s good to know that it's not necessary to associate, you can find those mentors outside of an associate position. So, what's the best place to find you?
So, most of my educational programs can be found on our education website which is https://www.gripapproach.com/. Or at https://cornerstoneclinics.com/
Writing with originality, generosity, compassion and purpose, Dr. Noah Volz imparts valuable lessons in an entertaining, engaging and snappy way―backed by a wealth of experience. As an author, chiropractor, and entrepreneur, he has started and run multiple companies and has been the host of the DC2Be Revolution YouTube channel and podcast.