The Future Adjustment Podcast Episode 3: Jay Greenstein & Integrated Practice Strategy

Daniel: Welcome to “The Future Adjustment,” Chiropractic Economics podcast series on what’s new and notable in the world of chiropractic. I’m Daniel Sosnoski, the editor-in-chief of Chiropractic Economics, and our guest today is Jay Greenstein, DC, who’s board-certified in physiotherapy and the CEO of Sport and Spine Rehab, a multi-clinic, multidisciplinary practice located on the East Coast. He’s a member of the Chiropractic Summit and influential in setting new policy and steering the course of the chiropractic profession. And he’s here today to talk with us about integrating multiple therapies and specialists under one roof. And, Dr. Greenstein, you’re also a frequent contributor to Chiropractic Economics. It’s a pleasure to have you here.

Dr. Greenstein: Daniel, it’s a pleasure to be here. Thanks so much.

Daniel: Great. So, as I alluded to in the introduction, you have a large number of practitioners who work with you. What challenges have you faced putting together what’s obviously an extremely complex type of clinical environment?

Dr. Greenstein: Well, it’s interesting that you mentioned complexity, because as an organization and as a business grows, complexity grows. And, you know, our goal throughout the last several years really has been to be very clear about who we are as an organization, what we believe, and how we behave, and making sure that we align that with the people that we bring into the organization. For many years, you know, we were always looking at skillsets. You know, are they certified in instrument-assisted soft tissue technique? You know, do they do dry needling? Are they well-versed in rehab?

But learning about, you know, good fits and folks who maybe we’re not a good fit for and they’re not a good fit for us, and learning about that, what we’ve realized is that the most important element is really whether or not that individual has values that align with ours. And everybody has different values. That’s what makes people unique, but the most important thing for us as we’ve built this organization and brought people on is making sure, in every level of the organization, in every position, in every job role, that we’ve got people who align with our values.

Daniel: Yeah. When I’ve looked over the, you know, Meet Our Clinicians page on your website, and I’ve looked at the various backgrounds of the practitioners that you’ve brought on board, you really do look like a coherent group of people who are all sort of moving in the same direction.

Dr. Greenstein: Yeah, it’s very true. You know, we tend to all be interested in some of the same things. You know, we’re interested in functional improvement, not just symptom management. We are very interested in always growing our educational base and having more tools in our toolbox to be able to treat patients in the best way as possible and certainly based on the evidence. And in some ways, we’re all very interested in also researching our own patient population, and how we use those tools, and how that drives better and better outcomes. So, we do have quite strong alignment with the physicians in our organization.

Daniel: Yeah, and I wanted to ask you, when you are able to offer a variety of services under one roof in kind of the rehab space that you’re in, how do you avoid running into conflicts of interest? How do you stay on the right side of the Stark Law and so forth?

Dr. Greenstein: Well, I mean, for us, we’re not worried about any kind of intraoffice referrals, because all of our doctors in Maryland and Virginia are licensed to provide all the services that we provide. And if our physical therapist, our chief clinical officer, Dr. Barton Bishop, who’s one of the world’s probably best physical therapist, sports clinical specialist, if he’s seeing a patient, he’s gonna provide all the treatment that he is able to provide under his license. If one of our other doctors, Dr. Patrick Engracia, is seeing one of our patients, then he’s gonna be providing all the services that are available to the patient under his scope of practice, under his licensure.

So, for us, we don’t really have that self-referral issue, because each doctor manages the patient completely. We don’t send patients back and forth to each other, other than maybe a consult, but usually that’s done as a group consultation, not as a referral back and forth within the organization.

Daniel: Gotcha. That’s quite interesting. And you mentioned of course dry needling and IASTM which are both quite complimentary modalities for chiropractic, but I also know that you’ve recently added cryotherapy to your practice which is really taking off really big right now. I’m reading a lot about it. Can you tell us a little bit about your experiences with adding cryotherapy to your practice?

Dr. Greenstein: Well, we’ve actually had cryotherapy for a very long time, but it’s not the cryotherapy that you might be thinking of or the audience might be thinking of as it relates to kind of a new craze that’s going on related to these cryotherapy chambers. The cryotherapy that we’ve been utilizing and studying actually for many years is the topical cryotherapy.

So we’ve been involved in research studies around Biofreeze for well since 2011 and looked at its efficacy, and how it impacts patient outcomes, patient compliance. And, you know, what we’ve found through our randomized control clinical trials is that it’s one of the most effective ways right at the very beginning of care to reduce pain, improve patient compliance, and help patients complete their course of therapy because they trust the doctor’s ability to actually get them out of pain which, you know, is so important.

When a patient comes to a doctor and they’re in pain, most or some want functional improvement, but every single patient wants to see an immediate reduction in their symptoms. That’s how they know the doctor has, one, identified the pain point,  the actual anatomic tissue that’s causing the pain; two, that they understand the functional issues behind the area of pain; and three, they can actually treat it appropriately with evidence-based care. And so when we apply things like cryotherapy, Biofreeze, and we’re able to get an immediate reduction in pain…we do an adjustment, we get a reduction in pain. We do soft tissue or dry needling, we get a reduction in pain. It builds trust for the provider, the patient then follows through with their treatment, and ultimately they get a better long-term outcome.

Daniel: Yeah. Yes, exactly, cryotherapy in the sense that you’re describing it, that kind of relies on what they call the gate theory of pain management, right?

Dr. Greenstein: Well done, Daniel. Yes, it’s exactly right. What we’re actually doing is we’re stimulating what’s called the TRP receptors, the TRPM8 receptors, and those receptors actually help to reduce pain information from getting into the cord and up to the brain.

Daniel: Yeah. And you see it’s pretty much wired into the body’s involuntary nervous system. When you bang your leg or bang your head on something, the first thing you do is you rub it with your hand.

Dr. Greenstein: Exactly. Exactly. It really is. While it’s different receptors, those are mechanoreceptors, the TRPM8 receptors, we call them, those are cold receptors but nonetheless it’s the same exact clinical neurologic pathway where we’re gating the pain essentially, as you mentioned very astutely,  There you go.

Daniel: Yeah. So, it’s correct for me to say that your practice largely caters to athletes and persons with sports-related injuries, is that right?

Dr. Greenstein: Yeah. I mean we treat, moms that hurt themselves lifting their children, but we do see a lot of athletes, and we do some really advanced rehab in our practice. So, we do a lot of post-surgical work. You know, of course we’re treating patients with neck and back pain, rotator cuff tendinopathies, but, yeah, we do a tremendous amount of rehab.

Daniel: Yeah. Can you tell me something about what’s unique and particular about dealing with this type of patient base that might be different from dealing with, say, the general public?

Dr. Greenstein: No, I think the athletic population tends to be very, very engaged in their care. They want to get out of pain quickly. They want to get better, and better means not just symptomatically better but they wanna get functionally better, and then they wanna find ways where they can maximize their performance. And I think we are so fortunate in chiropractic, because we can do all that. We can eliminate their pain. We can improve their function. And based on some of the current evidence, it’s coming out of New Zealand by Heidi Haavik and some others, we can actually improve their performance as well. So, I think the athlete is the perfect patient for chiropractic practice.

Daniel: I would tend to agree, and one reason why Chiropractic Economics devotes a considerable amount of time to sports and athletics and the research around that is because, you know, this is a patient base that not only is highly motivated and doesn’t wanna waste time or resources on things that are not going to be effective but improvement is directly measurable within the metrics of the sport that they are engaged in.

Dr. Greenstein: No doubt.

Daniel: And so it’s always a constant validation of the value of chiropractic when you see that athletes turn to it just so favorably and in such large numbers.

Dr. Greenstein: You’re 100% correct, Daniel, and what’s so interesting is that now every single team in the NFL has a chiropractor that’s part of the healthcare team. And the Olympics, you think about guys that have been to the Olympics in years past, I mean the United States has had an Olympic team chiropractor I think since LeRoy Perry in the ’70s. We’ve had, you know, world-class doctors taking care of world-class athletes for a really long time, and I think you’re right. It speaks volumes about the impact that chiropractic has, you know, on the human body, because these people, their livelihoods, their identity revolves around their ability to actually, you know, be an athlete.

And what’s really cool is that…the audience may not know this, but there’s actually a program through the Federation of International Chiropractic Sport called the World Olympic Scholarship Program. And this is a program where Olympians actually can get scholarships to chiropractic colleges and become doctors of chiropractic. And there’s been several Olympians that have either finished their program or enrolled right now in chiropractic colleges across the country where they were Olympians before, they’ll always be Olympians, but now they’ll also be Olympians who are doctors of chiropractic. So it’s a really cool program, and I’m actually the chairman of this program now, and I’m super excited to see it grow even more.

Daniel: Oh, that’s brilliant. Later on, offline, you and I will have to talk about that some more.

Dr. Greenstein: Absolutely.

Daniel: Well, hey, lastly, we’ve just got a minute left or so, what about your plans for the future? Are there any new areas or modalities you’re exploring or contemplating adding to SSREHAB?

Dr. Greenstein: Yeah, I think there’s some really great work that’s being done around regenerative medicine and how chiropractic fits into that or how regenerative medicine fits into chiropractic. I think it’s certainly an area of interest for us. Always, technology is an area of interest for us and finding ways that we can expedite and shorten a patient’s treatment plan, helping them get better outcomes faster I think is always something that’s top of mind and figuring out, you know, what technology exists that’s out there that will allow us to do that, whether it’s using the Multi Radiance laser or whether it’s using the Woodway treadmill system. There’s ways that we can leverage technology to help patients get better faster, and we’re passionate about that. That’s why we get up and do every single day.

Daniel: Gotcha. Well, I know that you’re a member of the Chiropractic Summit as is Chiropractic Economics, and so later this year, I hope to see you in Orlando…

Dr. Greenstein: Yes, I will be there.

Daniel: We’ll see you at the FCA National . Well, hey, thank you for spending some time with us today, Dr. Greenstein. This has been extremely informative and you’ve given us a multifaceted look at “The Future Adjustment.” I’m Daniel Sosnoski. We’ll see you next time. Take care.

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