I’ve got Matt Booth, a physical therapist out of Boise, Idaho on the show. I don’t typically talk a lot about treatment protocols and programs on the show. I've had Tom Dalonzo-Baker and Michele Kehrer. They are experts in what they do but we didn’t really focus on the treatment they provided and that’s the same thing with Matt. He is doing a specific treatment in Idaho and he teaches it across the world called the Fascial Distortion Model, FDM. The interesting thing about his story and how he uses FDM is from a relationship that he has created with his local physicians. The mentality that he uses now as he markets physicians or has marketed with them for the past few years and that is on the peer-to-peer relationship. I typically find for myself as a young owner and many therapists who I talk with that their approach to physician interactions is this is what we do. This is what sets us apart. This is how we treat your patients. We care more. We provide more hands-on therapy. While all of us have been known to share that same message without really standing alone and standing apart.
What Matt brings to the table is a different mentality in what are some of your problem patients or who are some of your most frequent patients and how can we help you treat them? Over time, Matt has become not only a therapist who can collaborate with these physicians but also a teacher of some of the methods that he uses. He has become more popular and gained a lot of notoriety and he became very busy in the Boise area. It’s that mentality that I like in our discussion. We also talked about how he has become free to treat as much or as little as he wants and allows him to instruct in this methodology. Let’s get into the episode. I think you will learn a lot simply from the mentality that he uses in his marketing and how he duplicates himself in the clinic to set himself free.
On this episode, I have Matt Booth, out of Southeast Boise. He’s the Clinic Director at Therapeutic Associates Physical Therapy and also the Cofounder of the Fascial Distortion Model Academy, the FDM Academy. He's been an instructor across the world. He's doing some great things within his clinic, both treatment-wise and for the physical therapy profession. First of all, thanks for coming on, Matt. I appreciate it.
Thank you, Nathan.
Let's get into your story. You've got some interesting stuff. When you first reached out to me, you said you were doing some intriguing things in the physical therapy space. I'm intrigued by not only the treatments that you're providing but more so how that's correlated to the success of your practice and the growth of your practice. Do you mind sharing your story about how you got into things and where you're at?
A number of years ago, a physician, an osteopath talked to me about this new treatment and got me into this course. Little did I know, he was pulling strings. I was the third PT in the US to be taking this class called the Fascial Distortion Model. I took the class and I loved it. I saw greater results fast and things took off from there.
This was many years ago. Was this a local doctor that you were working with?
He was local to Boise. He got me into it. I started doing it more. The patients were raving about it and it helped boost the clinics. We outgrew our previous space and we had to move the clinic for the second time.
That’s simply based on not only your relationship with this physician but the therapy that you're providing. Go ahead and get into that a little bit.
The treatment, Fascial Distortion Model, it's actually assessment and treatment. One of the main differences with it is the physician that came up with it recognizes patients. They tell the story of their symptoms with their hands or their gestures. If they draw a line, it's different than if they point the finger. It's different if they point with multiple fingers or a thumb into a soft tissue spot. It’s different than if they're moving across the joint line. It’s different if they are moving their hand around that can't quite put their finger on it. He identified six different sets of gestures. Those correlated with treatments he had done in the past or new treatments that can be made up on the spot that was likely to get quick results. He developed this model. It was among the osteopathic physicians and then started to get spread more. I got into it like, “This is great in a physical therapist's hands.” We do hands-on work. We can do something fast. The patient loves it because if they'd had any previous treatment, they usually notice, “This is a lot faster than this stuff I had before.” They're getting results quicker and they're out telling their friends about it.
It's all based on the hand motions and their description of their pain and how they're reacting or telling their story.
Telling their story in words, but mostly with their hands. When we teach this, we tell people, “You need to get out of your laptop. You need to be looking at your patient because they're telling me something with their hands. That can tell you which treatment you want to use.” It overlaps well with orthopedics. You might think of it as a soft tissue mobilization, a trans prescription to joint mobilization and joint manipulation. Any variety of different techniques with ASTYM, Gua Sha, Graston and ART. A lot of these things fit into this puzzle, but which techniques are we going to use? There are a lot of different things out there.When we talk to physicians we ask, 'Who are your most difficult (musculoskeletal) patients?' This allows us to talk with them about how we can help and what they can do in the meantime. Click To Tweet
You said it's both an assessment and a treatment model. It sounds like you can assess using this model but treat with any number of different things.
You could call it anything. One of the things I remember doing very early was like, “This is one of the things I learned as an intern.” Many years ago, this was a treatment we were thinking that we were releasing the muscle and there's a different theory for it with the Fascial Distortion Model. The treatment was exactly the same, but the reason I went to do that treatment was that the patient had shown me with their fingertips. They're digging into their upper trap and we're suspecting that there's a certain issue there and there's a set of treatments that we can use for it.
In the DO world, is this fairly common? Do most DOs know about it?
There are more and more DOs that are learning about it. It's been around for many years, so it's relatively new. It's one of those funny things where it's been around, but it hasn't been mainstream enough to be everywhere. It's being taught at more DO schools. I've been helping to teach it at some new medical school here in the Boise area. I went up in Washington, but it's going to more and more of them.
I don't typically have therapists who come on and discuss treatments they're providing and whatnot because we're focused more on business-related topics. The intrigue that I had with you as we talked on the phone prior to this is you've taken that and you've used this model in your relationship with local physicians, especially those who don't know the FDM. I think that's important to highlight and share that even if you're not using the FDM of treatment per se. What you've done is become someone who's talking on a peer-to-peer level with the local physicians. Tell me how do you promote this? How do you talk about this with the local physicians that you might not have done prior to?
It was helping a lot of the family practice physicians. We'd tell them, “There's a class coming to town.” I can't go and say, “There's this physical therapy class.” They're not going to want to go to that. If I say, “There's this class taught by osteopathic physicians, mainly taught to osteopathic physicians,” that spoke to them. I’d say, “It can help you assess and treat your patients faster. Even if you don't do the treatments, at least your differential diagnosis may go faster. Maybe you're not going to need to use as much image in your labs. Maybe those challenging patients that you're not sure like, ‘Is this personable anger? Are they symptom magnifier?’ You may be able to figure that out a lot faster.” I was going to them as a problem solver like, “This could help you with your tough patients. This could help you get through things faster.” Those that are concerned about the cost of care like, “This could reduce some of those costs.” You can use this first line that doesn't work, then you can back up to the medical model. A lot of the musculoskeletal conditions stuff fits into this. You learn this, use it first and then if you want to do some hands-on, great. If not, refer to us and we'd be happy to do it.
Do you recognize that this translates better or that the DOs gravitate to this more than MDs or some of the mid-level practitioners?
It depends. It's a personality. It's like they're Rorschach Test. Some DOs love it and some DOs lost their hands-on skills and they don't care to do that. They might still be interested in the assessment part of it. I have some MD friends that love it and they do it as well, even better than some of the DOs do. Nurse practitioners are doing it. PAs are doing it. It's open to chiropractors and athletic trainers.
As you're inviting them to these courses, did you have a tough time going to the courses initially or did you have an open door because the DO invited you?
I had an open door because a DO invited me. It was almost like the door opened for me and then closed behind me. For a lot of reasons, they had to have more DOs doing it, partly for their certification to get the continuing medical education credits for it. It took a few years before it was opened to other physical therapists. I had to keep beating on the door saying, “This would be great to let PTs in for a number of reasons,” and eventually that happened.
Have you had experience with PTs going to physician-focused courses in the past or what's your experience with that?
I've never heard of PTs and physicians going to the same courses before. There's a little bit in the North American Institute of Orthopedic Manual Therapy. I saw a couple of physicians go to classes there. They’re very cool doctors that they were doing some of this learning about manual therapy, but it’s extremely rare to see that.
Tell me a little bit about your relationship or how do you approach doctors with this technique or maybe even do have a relationship with them. Could someone who's maybe not FDM trained or certified go with the particular techniques that they follow or trust? Maybe learn from you on how to approach physicians regarding that technique. How do they weed out those patients that would do well with the treatment that they focus on and provide?
Do you mean without the FDM?
Yeah, maybe the way you approach it translates well to other techniques that they might be using.
I would say from the assessment part of it, it makes it easier with the FDM of like it's something that can learn. What's nice is having this relationship of being able to talk about, “We can assess and treat things at a higher level.” Maybe it has even given me more confidence of going and talking to the physicians about what we can do as PTs regardless of FDM like, “We're experts in musculoskeletal care. This is our wheelhouse. Tell me about your problem patients. What do you have? Who are your difficult patients to treat in your clinic?” We start talking about, “Those are plantar fasciitis people. Those are sacroiliac joint dysfunction people.” I can talk to you like, “Here are the things that I would look for. Here are the types of things that I like to do. I like those problem patients.” It's still going into them and being a problem solver of like, “Let's figure out what difficulties are in your practice and how can I help.” Instead of going in and asking for, “Can you send me some more patients? I need to see more patients.” Turn it around of like, “What are your problems? Can I help you solve them? I'll make your life easier because I love to treat these types of people.”
I love that message more than the, “We care more,” or “We have a hands-on approach.” All of us have used that in the past, but the issue is we all say the same thing because we all care more than the other guy down the street. We all use our hands more than the other guy down the street. That leads to the commoditization of our services. I love how you go and talk to them, specifically about their patients. Are there certain practices that gravitate more towards this, whether it's a family practitioner versus podiatrists versus a chiropractor versus an orthopedic physician or a neurosurgeon?
I've had referrals from all of those people that like the level of interest or their time attention span. You get up to the orthopedic surgeons and the neurosurgeons, they don't have the time to concentrate on you as a PT so much. I have one ortho-surgeon and he knows that we do something different. I told him about Fascial Distortion Model and he will write on the prescription pad, “Do that thing that you do,” like until we had it on the prescription pad, they don’t even remember what it was. “If it was something different, do that thing that you do.”
Among those other practitioners, the family practice doctors, anyone in family practice, urgent care places, they tend to like this. We can say, “For your work comp patients, if you've got somebody with a sprain or strain, this stuff works best. If you want them back on the job quickly like this week, let's use this.” I had a patient sent from Urgent Care with Achilles tendon issues and he was like, “I'm not sure if I'll be able to get back to this baseball game. It's two days from now.” We saw him for the second time and he's definitely playing. The Urgent Care loves those ankle sprains and knee sprains. The thing they don't like is that often we're so fast that the crutches and boots that they might issue to them, it’s not likely they’ll need them for very long. They're getting out of it often at the first visit.
I would assume that you'd have a lot of success with nurse practitioners and physician assistants. Simply knowing the lack of depth of their schooling, that something like this would be beneficial for them.
My number one referral source is a nurse practitioner and she will bring a lot of force with her hands-on techniques. She does a ton of it. If it works, then she sends the patients over to us. If it doesn't work, then she tells them, “You need more expertise,” and then she still sends them over to us. She doesn't have the time to do the follow-ups, but she loves to use it as part of that assessment.
Do you also teach that to local physical therapists in town?
Since it opened to PTs about a few years ago, it’s slowly catching on. Business-wise for myself, I'm interested in teaching other referral sources about it. I've been out to the physician community, PAs and nurse practitioners. We've had in the past maybe eight classes in the Boise area. There are 60 to 80 practitioners in the area that are doing this. That's for referrals. On top of that, we also work with the family medicine residency program. Every two weeks, we go over to their clinic and we treat their patients at their clinic with one of the residents and a faculty member who's been FDM trained. We're teaching the residents quickly like, “Let's get this going.” The patients are screened. This is a musculoskeletal case that’s likely to succeed with FDM, but then they're learning, “We can do things fast. Maybe we don't need to do injections. Maybe we don't need to do medication. Beyond that, we can also teach them about the other things in physical therapy we do outside of FDM.
The value I want to bring to the audience is finding something, whatever it might be, whatever your techniques are to bring that information to the physician's office and not keeping it to yourself. Training them and teaching them exactly on what you're doing so that they can recognize who is going to be a great candidate for physical therapy and who might not be. Maybe even help them do some treatments on their own. That ends up being maybe beneficial to them in cutting down their episode of care. It can also strengthen that relationship with physicians. You’re many years into FDM, but initially, as you got started, was it hard to get in with those doctors and have those talks about what you're providing and what you're doing or was it pretty smooth getting into it?Your leadership comes from how you're able to provide a platform for other people to provide solutions. Click To Tweet
It depends on the relationship and some of their interest level. Some physicians are wide open and ready to learn new things and others are set of how PTs are. Some of them were easy to talk to and they loved it. Others, it was a learning process. For me, I still need to go in as a problem solver to that conversation of what is it they want to figure out. Even though I'm excited and I think it would help them, that isn't necessarily where they're at that moment. I have to figure out how do I help them figure out that this would be beneficial for them. I have to find their problem first and then show them how they could solve it. If the FDM is helpful for them, that's great. Probably only 5% or 10% of the people I've talked to about it goes to a class, but they know there's something different about that.
I like your mindset because anyone can take the mindset that you talked about, “How can I help them?” Not everyone's going to be open to it. Maybe for another guy out in Kentucky who's looking to grow his practice, not every physician out there is going to be looking for the next physical therapy to send his patients to. What makes you different is you can go to that physician and say, “How can I help you? What kind of patients are you seeing? This is what I would do with them and this is how I can help you.” Coming from that mindset and from that perspective instead of, “How am I going to soak in more patients out of this guy,” it puts you in a different position and helps you show that you care and that you are a peer. You can show that you have some knowledge. I think doctors would appreciate that.
That has carried over and helped us in some of our other programs like men's health and women's health. They don't know what some of the things we can do. They never knew there was an option besides the medication or surgery for incontinence, pain problems in the pelvic area. It carries over for sure.
What do you see in the future? What are you going to be working on in the next few years?
Things are going a few different ways. We're starting to teach into physical therapy schools. We’ve gone down to Rocky Mountain University in Provo, Utah. We get a lot of interns from there. We’re looking at getting into more PT schools. We’re definitely working with more medical schools and those classes where we have combined. Sometimes we've had seven or eight different types of professionals in a class like MD, DO, PT, PTA, chiropractor or athletic trainer. It's cool seeing like, “We're all going to work with this one model, but we all have a different way of looking at the patient.” The class has become a networking opportunity so that people there are like, “I need to get your number. I didn't know where you're at. We might be even 100 to 500 miles away. I didn't know where you are, so I can send patients.”
You're the Cofounder of the FDM Academy. For someone who might have a treatment idea or interested in getting into continuing education as a presenter or speaker, maybe they’ve got some good treatments that they're providing and they want to spread the knowledge. What would you recommend to them to break into that field and get known?
This fell into my lap so easily. I don't know if I'm the best person to answer that one.
Did you have some hurdles along the way? Even at the very beginning to spread the message, whether it's the doctors or physical therapists that you could say, “If I were to do it again, I might recommend someone to do it this way.”
I'd love it if we had more research. That would be great, but it is interesting how long it takes to get research going. There is some research out about FDM. We took it to the Cleveland Clinic and PT there, they're big on it. After the first day, he's like, “This is great.” He had ideas for seven different studies. It's been a couple of years and he hasn't finished the first one yet. It takes on to get these going and then publish. A time machine could go back 40 years, dropped us off of somebody and then catch up with them now.
We’ll be ahead of the curve at that point. You find that if you can get published, then that's a huge boom to whatever you're proposing.
Getting research out there, that's wonderful. It's not my cup of tea. I'm not great at it. Being an instructor for this, I have a conflict of interest. It’s not my baby. If I was on the title for a research thing, I have a conflict of interest. That's going to taint the article. I'll throw up my hands and say, “I'm not the guy, but there are smart researchers out there that are starting to work on this.”
You're the Cofounder of FDM Academy, you're the Clinic Director at your own clinic and then you're traveling across the world presenting and doing these seminars. Are you treating full-time? I'm wondering about your schedule and how you manage your time.
I'm wondering about my schedule too. I wonder how I manage my time. My wife says that when retirement comes, I won't know what to do with myself and not reinventing something else. I like to stay busy. On top of all that, I'm usually training for a Half-Ironman Triathlon or a Full-Ironman Triathlon like every six months, Half-Ironman, a few years ago it was a Full-Ironman. I like to stay busy.
How often are you treating? How much time are you treating per week?
I would see probably 50 patients in a week. I'm there the whole week. That's returning visits, 30 minutes and clinical evaluation, 60 minutes.
You're a super busy guy. My recommendation is always that PTs, especially owners or directors of their clinics have two days a week where they were focusing on admin stuff. It's impressive that you're able to keep that schedule and that patient load.
I have a good team around me at my clinic. They help out and people have stepped up and do other leadership roles. Part of my lead as being the director has been helping others to lead. As among the aides, staff PTs and my front office, they all get their own thing to do and they get incentivized in different ways. That makes my life easier and then allows me to go on these teaching trips.
There you go because it seems like you've obtained that capability of having the freedom that you want in your practice. It's simply because of that. I want to highlight that to the audiences is that you've developed a leadership team to do the things that you need them to do to keep the clinic running and successful. You have admin, systems and procedures in place because Therapeutic Associates has been around for decades. You've got a lot of policies and procedures already out there that provides you with the freedom then to treat as much as you want. I'm sure you could treat less than 50 patients a week if you wanted to, but also train for Ironman and cofound an academy. That's impressive.
It is fulfilling to be able to do all this. It keeps you from getting bored and doing one thing too much. This balance keeps the juices flowing. When I go out and teach, it's a lot of stress to go out and do those things. Sometimes I'm presenting mostly to physicians or one time it was to the only physician. I was at the A.T. Still University, the first osteopathic medical school in the world. The stage fright there was like, “I'm at the Mecca of where osteopathic medicine developed and I'm lecturing them as a PT.” I have to think this is osteopathic techniques. It's an assessment and I have tons of quotes from A.T. Still in my lecture. It's okay. It's good.
That’s impressive because it's important as we get older into the physical therapy profession that if you were treating simply full-time all day every day, that could be difficult. It's important to grow, whether that's in terms of leadership and doing other things to keep the energy level up.
I have to credit my team. There are multiple people in my clinic that have helped me get to where I am. Even in the growth phase of when we started doing more FDM and we're getting busier, it was my clinic staff that came to me and said, “Here's all the data on why we can no longer stay in this clinic and we need to expand. We need to move.” They told that to me. The more I learned about leadership, the simplified way I tell them at the staff meeting is, “If I get out of the way, you guys do a great job.”
Out of entry, are there certain leadership books that you read, follow, techniques or whatnot?
Therapeutic Associates has a leadership training program called Hot House. We do a ton of stuff with that. We do a Myers-Briggs type of personality thing. You take that information and then that is put into this training program. The leaders of our program are improv actors. I've got us out of our comfort zone of doing some improv type of acting in some of our work with different tools. Trying to get us out of our comfort zone but let us help the other people in our team lead. The leadership was so much about us leading in a more top-down approach. It was a bottom-up of like, everyone's in this and we listen to them. Our aides have wonderful ideas. We have to give them an outlet for it and make them feel that they're heard, it's worth it and we need that.
That's impressive because no matter where you're at across the country, but if you're the owner and director, your leadership comes from what you're able to provide a platform and outlet for other people to provide solutions and help them understand that you're not the answer man for everything. They can provide solutions and create an environment that they want to work in. That's impressive that you'd done that. You've also seemed to probably duplicate yourself because you've trained these people in FDM and what you expect out of your treatments and protocols and how things should be done. You've been able to essentially duplicate Matt Booth a few times over within the clinic.There are plenty of people that can do a lot of things better than you can. Click To Tweet
We take as much as it's helpful the duplication process. We don't want complete duplicates of me, but that's what's great about when people are coming to me. The clinic has been around for seventeen years. I have a lot of people asking for me, but I can say, “Go to my other PT. They'd been trained in this and they can do these other things too.” I can offload in my schedule. I don't need to be there for everybody, but I can train to be there for everybody.
That's where you've probably started gaining your freedom is you've been able to, I say duplicate yourself, but where you're not carbon copies. Duplicate what you do in the treatments that you provide so that you have not only faith in the practitioners, but you can then express that faith to the patients who are asking for you and move them along to the practitioners. Also, seeing that things get done the way you want them to get done with your admin staff, your techs, support staff and whatnot. That's where you've found a lot of freedom is what I can tell.
Patients that come to me that think that I can do everything, it's great than to say sometimes like they want me to schedule them or do something else. I'm like, “No, we have policies and procedures here and one of those is we make it director-proof. If I can't do it, it's director-proof. That means I can't screw it up. Someone else is going to do that task for you because they can do it much better than I can.”
An important lesson to learn is that there are plenty of people that can do a lot of things better than you can and give them the ability to do so. Is there anything else you want to share with us, Matt?
You ask where FDM is going, one of the things that we're doing, we’re doing some global outreach. They took FDM down to Belize and we taught six Belizean doctors how to do FDM. We had a great experience there. They're considered third-world country bordering on into the second-world country, but there are not a lot of resources there. I heard of this before I’ve gone to Africa for a teaching trip as well. In that situation, it is so cool to see something that has no cost to it. There are no real tools involved. You use your eyes, your brains and your hands and you can help people quickly. To see it put in action, we did a couple of clinic days. We had about 100 patients that we treated in two days after we did the training, and 95 out of 100 were better.
The doctors were blown away like, “If we had known how to do this before, we would have given them NSAIDs. We would have told them to go to the hospital and maybe surgery. We couldn't have worked on all these people and gotten them better so quickly. We're going to go back there year after year and do more training with the doctors. It was even cool for our American friends going down to help with the training. They were getting so much experience on these people that need your help. Think of first-world problems like some of my patients back home are like, “This was pretty minor for you.” This person in Belize, this is the difference between their food getting on the table or not. The pressure is on when we go out and treat. It’s like you need to get this person better right now. All the people were going and said it helped enhance their hands-on skills. They have the thinking cap on of, “I have to do my best to get this person as good as possible now before they leave.” That was a great experience.
Do you have other service projects plan like that in the future?
We have another one to Belize in February. We're probably going to go there for a few years. One of the physicians looks like she is interested in becoming an instructor. She needs to be able to help out with Central America and then they go on to other countries that are needy. Everyone I've talked to loves this thing because it's cheap. It doesn't cost anything. You just learn it and then you go do it.
Thank you for your work. That's a great story. It's impressive. If people wanted to reach out to you or find out more about FDM or Therapeutic Associates, how would they get in touch with you?
Email works well for me. Email at email@example.com, that stands for Therapeutic Associates Incorporated PT. Email is the best.
Thanks again for your time. I appreciate it.
Thank you, Nathan.
Dr. Matt Booth is a graduate of the University of Southern California, earning both a Bachelor’s in Exercise Science and his Doctor of Physical Therapy degree. He has been the director of Therapeutic Associates Physical Therapy – Southeast Boise since 2002.
In 2010 he was introduced to Fascial Distortion Model (FDM), finding better results for his patients, and an opportunity for the entire physical therapy profession to provide better care. Since that time he has immersed himself in FDM, as well as paving the way for physical therapists to also be trained in FDM.
In addition to being an Instructor of FDM through the American FDM Association, he also teaches FDM to physician Residents in the Family Medicine Residency of Idaho. Dr. Booth has taught and presented on FDM nationally and internationally, including classes at the Cleveland Clinic, the Mayo Clinic, in Burkina Faso, Africa, Canada, a global service trip to Belize, and at the FDM World Congress in Cologne, Germany.
He is Clinical Faculty for the University of Washington Medical School – Family Medicine, and the Idaho College of Osteopathic Medicine. When not in the clinic or teaching, he can be found with his family training for his next Ironman Triathlon.