Episode 1776 - Clinical success: one choice required

Dr. Miller Armstrong // #ClinicalTuesday // www.ptonice.com

In today's episode of the PT on ICE Daily Show, Spine Division lead faculty Miller Armstrong makes his debut on the podcast discussing what separates the top 5% of physical therapist from the rest of the profession.

Take a listen or check out our full show notes on our blog at www.ptonice.com/blog.

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EPISODE TRANSCRIPTION

MILLER ARMSTRONGGood morning, everyone. My name is Dr. Miller Armstrong. I am a lead faculty for cervical and lumbar spine management, and I'm out of the Nashville, Tennessee area, and super excited to talk about today the topic of clinical success, one choice being required. So what I mean by this, and I'm gonna do a few parts here, so I'm gonna be on over the course of the next couple of months talking about this, but it starts here. What is that one choice? And at ICE, we are quite literally obsessed with thinking about what makes the top 5% of our population and of our profession, what makes them the top 5%. Like what is different about those people that are the best? What do the experts do differently than the rest of us that make them the experts? And so to frame this, I really have to tell you a little bit about my background so that you're able to better understand where I'm coming from. A side note, I couldn't resist hopping on the back porch. It's a rainy day here in Nashville, so it's a beautiful morning. So I couldn't resist jumping on the back porch today. But I was born in this area. I was born and raised in Nashville, Tennessee, actually just south, about 30 minutes, in a town, and now it's a city, called Murfreesboro, Tennessee. And in Murfreesboro, there's a university. And that's where, I mean, throughout my entire life, and throughout my entire childhood, I was in Murfreesboro. Elementary, middle school, and high school. I was down in Murfreesboro, and the college down there is called Middle Tennessee State University. So if you're not familiar with MTSU, they're a mid-major Division I when it comes to sports. So Conference USA, they play schools like Western Kentucky. Conference has switched around a ton since I've been there. When I was there, it was like Marshall, Western Kentucky, Florida Atlantic, Florida International, UAB, things of that nature, kind of in the southeast region of the country. And so I played football throughout my entire childhood and growing up, and then I eventually played football at MTSU. And team, after my second, or after my first year, heading into my second year, we had a coaching switch. And so my first year there, I was playing quarterback and I was on like scout team, practice team quarterback. But going into my second year, we had a defensive coordinator switch. And so the new defense coordinator, of course, brought alongside with him a lot of other staff. So we had a lot of new faces on the other side of the ball. And in that offseason, I got switched over to So I ended up playing linebacker the last few years that I was at MTSU. But you have to imagine that it was not only a new room, like in the college sports world, especially football, I knew a lot of those guys that I was playing linebacker with, but I didn't know them that great. So it was a little bit of a new feel as far as walking into a position room. What was even a newer feel was now we had new staff. And so it was not only a new position, it was a new linebackers coach that I had to get to know. And this guy's name was Siriki Diabate. And Sariki, he's one of my favorite people on the face of the planet. And he was a younger guy. So for the college coaching world, being in your late 20s, early 30s is really young to be a position coach. So Sariki was leading the linebacker room. And Sariki had such a fascinating story. Almost so much so that we couldn't really relate to this guy. So, Sariki was from the Ivory Coast, and he came over to America in his late teens. The dude was like 17 or 18 by the time he showed up in New York, and he experienced a lot of unrest. growing up. Growing up in the Ivory Coast, like, there was a lot of civil wars, there was a lot of unrest in the town that he lived in. So much so that there would be times where, like, militias would come into the town, and he would have to get out of there with his dad for days at a time, just in order to stay safe. So it was a really tumultuous time growing up for Seriki. And so his family saved up some money, and they sent Seriki overseas to America to have a better opportunity. And so Siriki showed up in America, didn't really know any English, didn't really know any direction, but he found American football. And through American football, he found that he had a really nice talent for it. And as he started playing a lot and getting a lot better, he ended up at a juco down in the Bahamas, where he eventually got recruited and ended up playing for Syracuse up in New York. And so as he's playing for Syracuse, Siriki was an undersized guy for the ACC. So the ACC is one of the major conferences across the country. So a lot of big schools, Florida State, Clemson, a lot of these teams. And so those humans are huge. These people are massive. Siriki was about 5'10", 5'11". And at the time he played at Syracuse, He was only about 215, 220 pounds, which is sounds big to the normal American, but for a division one power five conference middle linebacker, that's a small size. Most of those guys these days are walking around 6'1", 6'2 plus and well over 230, 235 pounds. We would watch Siriki's tape. So we would find his highlights basically as a linebackers group and we would watch him when he was playing at Syracuse. Sometimes the GA that was in our room would watch or would bring it up so that we could watch it all together. Because when you watch Sariki run around the field, there was something different about this guy. There was something different about what Sariki looked like on film. So just to give you a little bit of context, in the world of football, especially on the defensive side of the ball, players are graded, a lot of times, individually and as a group, and as a defensive group, they are graded according to how many people are in the frame on film when the play is over. So when the ball carrier is tackled, how many defensive players are in the frame. So if you only have like two guys in the frame that the camera captures, that's not very good. It doesn't show a lot of effort. It's a way to grade effort versus if you have like nine or 10 guys out of the 11 on the field that are in the frame at the end of the play. Coaches, defensive coaches love that. Defensive coaches love that. Individually, they will grade these guys based off of how many times or what percentage of times that an individual is in that frame. So if you're not in the frame at the end of a play, 40, 50% of the time throughout the game, the coach is saying, hey, you're not giving enough effort. Like you're not showing up around the ball when we're watching film. So knowing that, when we would watch Siriki's tape, when we would watch film on our coach, he was literally in the frame every single time. You couldn't find a play where this guy was not in the frame. It was so impressive. He was all over the field making plays in the backfield, making tackles, and if he wasn't making tackles, he was near it. He had the epitome of what good effort looked like. And so it was really interesting to watch, and it was really interesting to hear his mindset. And what he would talk about, team, he would walk into the room, and then he would watch our tape, or we'd be on the practice field, and he'd be all over us as far as trying to get us to make plays. And he would say things like, hey, run through that guy's chest. Like a pulling guard, and if you're not familiar with football, a guard is an offensive lineman. Those guys are usually 315, 320 pounds or more. A pulling guard coming around trying to put hands on you, Siriki would just simply say, run through him. The ball carrier is behind him. So run through that guy. And we would look at him and almost laugh. We were frustrated, but we would almost laugh. We'd be like, Siriki, what does that even mean? Like, what do you mean run through this guy? So much so that throughout that offseason, throughout the first few months that Siriki was there, even through the first few games, like game three, game four, we're watching film, he's still on us, like just decide, just get in there and make a play, run through that pulling guard, whatever it might be. We had such a hard time with this as a linebackers group that eventually we were like, coach, like shoot us straight. What do you actually mean by this? And team, what Sariki was saying next quite literally changed the way I view everything that I do in my career and in my life because of the mindset that he portrayed. What he said was he said, Miller, well, he said, team, crew, he said, guys, what we have to understand is that you really only get one decision. You get one decision. And that decision is whether or not you want to be successful. That decision is only decided by you, and it's really the only decision that you get to make, is whether or not you wanna be successful. Okay, what do you mean by that? And what Seriki said was, if you, and this is in the context of college football, but he said, if you want to be a good college football player, if you wanna be one of the best in the country, you watch film. you learn the playbook. You not only learn the playbook, you show up early. Maybe you get a good stretch in, maybe you get your body warm before the workout, and then you're the first one going as hard as you can in the workout. Even school, you can't get on the field if you have bad grades. So you show up to class, you do your work, you study, you take your tests, you perform well on your tests. But all of that is just what follows making the initial decision that you want to be successful. And that's what he was trying to get across to us. So making that play is just quite literally making the decision that you're going to do what's required. He said that this also comes down to doing everything that the coach says. He said, if you fail, but you're doing every single thing that I'm telling you to do, it's not on you. Your success is determined by your decision. that really started to broaden the way that I viewed a lot of different things because I started to think of, okay, now that I'm in the physical therapy profession, what does that mean? What does being successful look like in physical therapy? And that's what we obsess with here at ICE. In our cervical and lumbar spine management courses, we talk about that. Like, what makes the top 5% the top 5%? And at the end of the weekend, we share a slide. But we talk about a lot of different things throughout the weekend about what makes those experts the experts. Some of those things are like doing the basics really well. not making bad decisions because you don't have bad data. You're not sloppy in your physical exam or your straight leg raise or things like that. You're about it. You lead from the front. You have competency across multiple domains. All of these sorts of things is what attributes a great physical therapist. And so what we have to realize is that that That is preceded by making the decision to be successful, to be the top 5%. It's not like the top 5% or the experts have some magic pill that they take and then they become this great physical therapist. What they've done is they've decided on the front end that I'm gonna be successful. And what that looks like is eradicating all of their weaknesses, making sure they have four asterisk signs that they can chart and that they can track over time. making sure that they, in the first five minutes of every single session, making sure that they never forget to retest their asterisk signs, doing trial treatments, adhering to the test retest model, having a nice hypothesis list because they do their symptom behavior first, like all of these sorts of things that we talk about at ICE, it's all preceded by the experts making the decision on the front end. Because Siriki would argue that if we are not, say you're not rechecking asterisks after a trial treatment on day one, He would argue that that's not getting sloppy, that's deciding to not be successful. Once you make the decision to be successful or be the top 5%, every single thing else, everything else follows. Everything else follows. It's extreme ownership. This guy got to that mindset before the book came out, right? But I love that idea of, Okay, if I don't feel like I'm getting good outcomes, it's probably because I may have woken up that morning and not decided on the front end to do what it took. So whether or not, the fork in the road is whether or not I want to be successful. Once I make that decision, you just do whatever is required of you. And what is required of being a successful PT? All of the things that we preach here at ICE. So if you're not being about it, maybe then you actually didn't decide to be successful. All of those sorts of things. So team, chew on that for a little bit. So excited to be able to jump on here with you all. I love talking about those things. I love sharing a little bit about Sariki, and he had a lot of other sayings throughout three or four years rolling around with that guy, but yeah, it was a lot of fun, a lot of fun. We do have some courses coming up here soon. So, if you want to get into a lumbar or cervical spine management course, August is your month. We're coming in hot all of August. So, August 3rd and 4th, I'm going to be up in Aspen Mall, Pennsylvania, just outside of Pittsburgh, rolling with lumbar spine. The next weekend, August 10th and 11th, in Longmont, Colorado, Brian Melrose is going to be out there in Colorado. And then the following weekend, August 17th, 18th, I am going to be out in Grass Valley, California, over at Body Logic PT with that crew. If you're looking to get into cervical, August 3rd and 4th, if you're in the Cincinnati area, we might only have one spot left or so. It might even be sold out by the time I'm saying this, but cervical management was Zach Morgan. And then the last weekend of August, August 24th and 25th, over in Bend, Oregon with Brian Melrose as well for cervical spine management. So quite literally every single weekend of August, if you want to take a spine course, we're somewhere in the country doing it. Lumbar or spine or lumbar or cervical team. Thank you so much. I can't wait to see you next month talking about the next thing here and have a great day.

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