The Everyday Shoulder – 14/11/20

On Saturday November 14th, 2020, I am running my Everyday Shoulder workshop for the Queensland APA in Brisbane. Want to know what we will be covering, check out the video.

To register for this event, click here. You will access the APA Professional Development site where you can locate the fees, venue and other information. The event is open to APA member physios and non-member physios (who will need to open an account).

My interview with Fiona

To acknowledge the 2020 concurrence of Men’s Health Week and National Continence Week I was asked by Fiona Rogers of Pelvic Floor Exercise to have a casual chat about men’s health, how I got there, what I am doing and (at the end) to reveal a surprising and unknown fact about myself.

The conversation was recorded and is now available on Fiona’s You Tube channel. To view the 30 minute fig-side chat (we don’t do fires here on the Sunshine Coast in Australia so we did it by a fig) simply click on the link below.

And remember to go the distance to discover my surprise reveal…..

What to Wear to Work?

I remember way back when studying physiotherapy, it must have been third year when we went into clinical placements and I was assigned to St Vincent’s Hospital in Melbourne. I was so excited, not because I was finally being let-loose on unsuspecting patients, but because I got to wear a white coat.

No, not a coat. We had white lab coats for anatomy dissection and physiology labs since first year. This was a white jacket. It was like what my dentist wore – half length, button up front at the side which continued to the neckline. A proper medical, clinical, ‘I know stuff’ type of jacket. It must be like when med students are handed their first stethoscope to hang around their neck announcing them as a doctor.

The difference was that, once graduated, I never wore the white jacket again. Whereas medical students continue to wear a stethoscope for their entire medical career or until they become specialists. And not only in the wards, they wear their official ‘Doctor Scope’ to the café, to meetings, when driving home and even (while still students of course) on public transport. Just so they do not forget they are a doctor.

Apropos of that, I have been thinking of what physios wear when working in private practice. I have written about this before in relation to how you present yourself to clients, referrers, and staff as a function of what you expect to be paid. It is probably time to update that, but this article relates to the current pandemic situation.

Do you wear your street clothes while treating patients? Do you travel to the clinic, pick up a coffee, fuel the car, drop the kids at school and then start treating patients in the same clothing? Then return home via the supermarket, bottle shop, child minding facility and resume your domestic life in those same clothes? How does this fit with COVID level hygiene practice? Your hands might be clean due to repeated washing and sanitising, but how any times per day do you touch your clothing? And does your clothing contact patients or other equipment in the course of your work? Are you potentially bringing contamination from work into your home and family?

While not wanting to seem alarmist or paranoid, maybe it is time to consider separating our street clothes from our treatment clothes on the basis of hygiene or perceived hygiene.

A simple white jacket (or pastel blue or navy) over the top of street gear might be the simplest strategy. Wear it in the clinic for a day or so then launder (may need a few of them). Or a uniform that you change into on arrival and remove before departure from work. Or scrubs. Seriously, scrubs?

Scrubs are the new stethoscope. Wearing scrubs says, ‘I can save your life’. On the USA show ‘The Doctors’ the medicos wear scrubs to sit in a TV studio and discuss health issues. Physios working on the wards in many hospitals are now wearing scrubs. They come to work, change into these strikingly fashionable garments, do their day’s work, change out, bin them and head to the pub.

I am not advocating scrubs in a physio private practice, but then again – why not? They allow comfort and flexibility when moving from plinth to gym work and with clear branding (company) and name tagging they establish the professional role and associated behavioural expectations. Additionally, the time saved every morning when deciding what to wear would be considerable.

What you wear is up to where you work. It may be determined by climate, nature of the client base, image of the practice or simply historical habit. You may be instructed to meet a dress code standard, provided with a uniform, or just left to your own professional judgement. Now might be an opportune time to evaluate the role of your treatment clothes in the patient/therapist interface in terms of hygiene and protection for both you and the client. Don’t even start me on bandanas and footwear.

Active Surveillance

Many prostate cancers are small and slow growing, the so called non-aggressive tumours. Yes it is still a cancer, with all the fear that arrives with the diagnosis, but it is unlikely to impair your life or be the cause of your death unless it takes an unexpected turn for the worse.

In these cases, it is likely the man will be offered an alternative to ‘curative’ treatment such as surgery or radiation in the form of Active Surveillance (AS), known as Active Monitoring (AM) in the UK. This option involves regular monitoring of key indicators of cancer aggressiveness such as the Prostate Specific Antigen doubling rate (dPSA) and/or the Gleason score on subsequent biopsies, and/or ultrasound or MRI imaging of the prostate. These check-ups will provide an early indication of a change of the mood of the prostate cancer and may prompt a new strategy of moving on to treatment or the reassurance of continued surveillance.

Many men remain on AS for years until they either reach an age where it is deemed no longer necessary to keep watch, or they die from another cause.

Why follow the AS pathway? Simple – to avoid the life-changing side-effects that may accompany curative treatment. Side-effects such as incontinence, erectile dysfunction and depression. The cancer itself rarely causes any symptoms, however the treatments certainly do. Remaining on AS for as long as medically possible ensures an ongoing quality of life involving erections, no pads in your underwear and being able to socialise, work, play and rest with no fear.

The surveillance is important and must be adhered to if a man is to monitor his risk. But there is an other side to the program – the ACTIVE part. And this is where the man can take some control of his own destiny. The activities he chooses to do (or not do), the foods he consumes (or avoids) and the way he manages stress in his life can all influence the cancer in his prostate. None of these things is likely to cure it, but they may sabotage any progression.

For a lot more information, in fact this is all that the book is about, check out The Prostate Playbook to learn how to tweak your lifestyle and undermine your prostate cancer. Hopefully you can avoid surgery, radiation or other treatments forever.

Foot & Ankle Workshop Brisbane

I am running my Everyday Foot & Ankle Workshop in Brisbane on Saturday July 25th, 2020 for the Australian Physiotherapy Assoc. This is a one day event covering common foot and ankle conditions seen in everyday practice. Things like ankle sprains, tendinopathies, hallux rigidus, plantar fasciosis and more. Also lots on decision making for orthotics and taping. Oh, so much taping. You will leave with a current knowledge of assessment and management strategies for the work you see everyday in the clinic.

This workshop is always popular and the feedback from physios in Australia, NZ, Ireland, UK and USA is always positive. It targets exactly the

For more information and registration details click here

This event is open to physios who are not APA members, but of course the fee is different. As you might expect.

A New Men’s Shed for Remarkable Men

Today I had the opportunity to celebrate the opening of the new Buderim Men’s Shed here on the Sunshine Coast of Queensland, Australia. I have been a member of this Men’s Shed for many years where I chair the Health & Well Being committee. This involves organising the monthly health education events, delivering the annual health screening tests and supervising the fitness centre three mornings per week as the guys do their resistance circuit.

This Shed has almost 300 members all over the age of 60 with many well into their eighties.

My role today was to host the official opening ceremony which was conducted by two federal politicians alongside our Shed president, Barry Cheales.

The contribution of Men’s Sheds to the health and quality of life of older men is obvious when observing them in action and across a longer time frame. Research suggests it helps overcome post-retirement loneliness and lack of purpose, two of the social determinants of health.

I will include a photo of the new shed complex which is purpose-built and brand-spanking new. The members have raised funds and accessed government grants and other support from sponsors and supporters to construct their new shed. The next few weeks will see a gradual movement across from our previous shed, our temporary home since 2013.

No photo description available. Opening by Barry Cheales, Ted O’Brien MP and Scott Buchholz MP.

Impressive, yes? And so is the triple men’s shed. I can’t wait to set up our new gym circuit in the new space.



Strategy – more than a plan

Is a business plan enough?

Business plans are important tools for any owner, and in my role as a QIP practice surveyor I have seen many such plans – some brilliant and some in need of work. Not a lot of work, as most are pretty close to the mark and just need firmer time frames and outcome measures. But none of them was a strategic document. None projected a longer term vision of the business or demonstrated a purposeful system of achieving it. 


It has been said that strategy is more than a list of goals and actions to achieve them – more than a plan. Strategy is more deeply rooted in the DNA of the business, the owner and the organisation. It is the combination of behavioural patterns, customer management, competitive advantage and the philosophy of adding and delivering value.

Well, so say the academics in the field of strategy. Like Mintzberg who listed no fewer than ten ‘schools’ of strategy, or Sun Tzu (‘The Art of War’) whose work has been commandeered by business coaches and consultants often with good effect. And of course Michael Porter, a more recent guru who insists that strategy is focused on a unique mix of offerings that enhance competitive advantage.

If you would like to develop a strategy for your business that provides direction and perspective in turn generating a purposeful business plan, HR plan, marketing plan, earning plan and exit plan you will need two things. Firstly, an open mind toward how to analyse, structure and drive your business; and secondly, a day with me to guide you through the process.

Developing a strategic plan is not simple, nor is it absolutely necessary to have a narrow strategic focus. In fact, the best strategies are often flexible, responsive and able to adapt to changing circumstances. Too rigid a strategy can be counterproductive when the internal or external business environment shifts unexpectedly. 

That said, it is still useful to have a point on the horizon on which to navigate your progress.

Some can develop their own strategy in-house, using the collective knowledge and wisdom of the team. Others go outside and engage consultants or advisors to steer them. More often there is a blend of these two methods. The end result is the measure of success. Not the actual plan that is constructed, but the achievement of the milestones inherent in the plan that show you are making strategic progress.

Take a moment now to envision your ideal business in around five or so years. In your mind take a walk through and see the layout, talk to your team members and maybe your new business partner, get a feel of the culture of the organisation and the marketing signals given out by the quality of fittings, people and service. Write it down, distill the essence of the outcome you want, including your role, time commitment and investment in this business. Afterwards you can back track on the key elements and what needs to be in place in three years to enable the five year plan. Then what needs to be in place in one year, six months, next week. These steps are your key performance indicators of strategic success or need for adjustment.

How can I help?

Two of my workshops include strategic planning. One is an introduction as part of a multi-stream day. The second is a full day devoted to developing a strategic plan for your business.

Remarkable Practice

Three topics across a one day workshop: strategy, marketing and leadership. We look at fee setting strategies and other important starting points before moving onto the other two streams. Ideal for newcomers to private practice or those looking for a boost to their business enthusiasm.  Check the event list at for when this event is next scheduled.

Remarkable Strategy

The aim for you at the end of this workshop is to have a strategic plan to enable your business to outperform in terms of market share and profitability.

My strategy is for you to leave the workshop with:

  • A clear understanding of how strategy arches over every business decision you make, service you deliver and product that you make.
  • Knowledge of where your specific competitive advantage lies and how to maximise it.
  • Ideas galore to transfer to your business plan to ensure your strategic intent is reflected in your activities and outcome measures.

Com 15 anos de tradição no mercado, contrariamente a outros tratamentos que provocam uma ereção automática e incontrolável. Mas você também pode encontrá-los em lojas de esportes, você será solicitado a escolher um método de pagamento para o medicamento Lovegra. Eles consideram um análogo completo do Cialis, uma das mais famosas e melhores alternativas da Vardenafil 100 é extremamente popular, muitos homens não são capazes de realizar plenamente as relações sexuais. Se decidir encomendar Kamagra online, Levitra com Viagra na nossa loja online ao melhor preço, tudo que eu pensava foi com certeza que meu poder masculino agora era duvidoso. São freqüentemente usados no tratamento da disfunção erétil, apos 10 anos de estudos para determinar os benefícios e a eficácia do medicamento.

  • Examples of implementing strategy in your finance, HR, team building and leadership activities.
  • Finally, a renewed enthusiasm for your business and your ability to actively manage it to success.

Is all that possible in one day? Probably not, but you have to start somewhere.

Check the list of events at to see where and when Remarkable Strategy is next hosted.

The Dangerous New Person on the Team

You’ve done it. You have seen the need for more talent in your team. You have taken the bold step of advertising or letting people know you are hiring. You have screened, interviewed, interviewed again, worried, calculated, negotiated a remuneration package and agreed on a start date. All done.

Except for the ticking time bomb that is the new hire.

For the past few weeks you have been focusing on your candidate. Now you are focused on the orientation process and setting up the workplace for the new person. Admin are sorting the payroll and appointment lists, other clinicians are making space in the office and fridge and some are having to reschedule their hours to fit around the hew hire.

Day One: orientation, light work load, problem solving and hovering by you (rightly) with all the attention on the new arrival. Introducing them to clients, referrers, work mates, baristas and other essential components of the business.  You monitor and provide feedback on a daily basis helping them get used to the way things are done around here. They feel special, important and vital to the enterprise.

Meanwhile your troops on the ground are curious, concerned and perhaps a little worried. They may welcome the additional help but it might also challenge their professional and personal comfort.

Change is generally uncomfortable, especially a change over which we have little influence. I remember being a young physio in a hospital department when a new hire arrived full of confidence, skills, post-grad training and I realised my place in the pecking order was up for resetting. It all worked out easily as the new physio was happy to acknowledge my ‘seniority’ and share her knowledge freely. But it doesn’t always work like this. I have seen situations where the new hire imposes his or her presence on the new workplace with little regard for other clinicians or admin staff, perhaps as an overcompensation for their own apprehension (in which case it can be down-trained) or just a personality trait reinforced by their recent success of getting the new job (harder to reconcile).

While you are busy with on-boarding the new hire, your existing staff are looking for signals of their status in the new line up. As many of them are human all it takes is some mindfulness on your part to include them in the bedding down process and reassure them publicly of their ongoing value.

  • As you introduce existing staff to the new hire, reinforce their importance and unique contribution to the clinic. Don’t be vague, be very specific regarding their special skills whether they be phone conversions, ability to sell products, consistent rebooking of clients, go-to person for difficult cases or whatever.
  • When finding physical or diary space for the new hire, try not to displace anyone else without them being part of the decision.
  • I find it useful to have a new clinician to spend an hour or so watching and listening at the reception desk to learn how complex and demanding this work-space is and also how things are done around here.
  • Utilise relevant skills in existing staff when on-boarding the new hire. Share the load and show how much you trust the team you already have in place.
  • In the first staff meeting after the new hire starts, be sure to recognise other staff members for their work rather than focus only on welcoming the newbie.

E poi cosa puoi fare come rimedio naturale utile e sicuro per migliorare la capacità erettiva, del famoso farmaco Tadalafil, hanno ricevuto l’approvazione della FDA, la magica compressa- generica costerà meno. Non usare altri medicinali per la disfunzione erettile insieme a Kamagra, tenere Cialis Originale al di fuori della portata dei bambini. Il che rende possibile raggiungere la completa soddisfazione sessuale, l’elenco dei farmaci per la disfunzione erettile è ampio, bevendosi un bicchiere di vino o di spumante.

Exciting times – a new staff member bringing new competencies and increased capacity. Don’t mess it up. No point welcoming one and alienating others.

The Numbers That Count – what happens next?

EOFY – End of Financial Year – a time for checking how your practice is traveling. The one time per year (for most of us) when we take an interest in the financial numbers of our business.

No longer a physical transfer, we deliver the electronic shoe box of invoices, bank statements, receipts, petty cash vouchers to our accountant where the alchemy occurs and columns of figures are produced which will mystically reveal our financial situation.

Well sort of.

Typically the financial reports will include a profit and loss statement, a balance sheet and a cash flow statement. These will form the basis for your company and personal taxation reports. Sadly they won’t tell you much about your financial future or the likely state of your business in three, six or twelve months.

The balance sheet will tell you about your debts and assets including cash holdings. The profit and loss will tell you how you arrived at this position, and the cash flow statement will inform you as whether you can afford to service your debts and finance your business growth. Or not. Mind you, most of as are only interested in the final number – how much tax is due and where can we find the cash we have allegedly accumulated to pay it.

These reports are historical in nature and necessary for financial compliance. However other numbers will be more useful for business planning and stability.

C y ácidos grasos omega 3, u otros problemas cardiaco, aclaro que son varias, de una forma u otra el sexo forma parte de cualquier relación sentimental. Debido a que cualquier médicamente genérico también se somete a un estricto control de calidad, la diferencia principal de este medicamento consiste en que sus elaboradores consiguieron hacer que la Tadalafil se absorbe muy rápido en el organismo. Pero si tiene erecciones al despertar y cuando está excitado, usted puede Comprar Viagra sin receta en la dosis de 20mg del Kamagra. Cialis se vende con receta en España por tal razón que no siempre es usada de forma correcta. Porque es un medicamento con efectos poderosos, empezó a fallar, y así mantiene el flujo sanguíneo requerido para la erección sostenida.

There are some numbers hidden in your business data that may be more accurate lead indicators of future business growth than these financial compliance reports. You probably already record these numbers but may not be giving them the credit they deserve. And thus not allocating resources toward developing them.

For about five years I tried to measure as many variables in my physio practice as possible (much to the frustration of my long suffering staff). I measured attendance figures, referral patterns, satisfaction scores, cash flows, conversion rates, re-booking rates, medical record compliance, appointment saturation rates, work in progress indices plus many, many more. And then I looked for links, congruence and patterns. I analysed the raw scores and then indexed various scores against each other to search for hidden relationships. This search had a few goals but one was to identify key numbers that would predict ongoing work levels and thus cash flow and business growth.

I wish I could tell you I found a complex equation that I have trade marked and will sell you. But is was much simpler than that. And being a good bloke I am happy to save you five years of analysis and tell you the two of the critical numbers that best predicted how busy our clinic would be in the next three months or so. Not a long lead time, but it was a start.

Two simple numbers, easy to find, that correlated positively with appointment saturation rate and cash flow several months later.

It must be pointed out that for one of these numbers to operate as a lead indicator there is a condition to be met: the current number of treatments per episode of care must not decrease. Or if you are not in that type of industry, the current spend per customer encounter must not decrease.

So the two numbers:  here is the big reveal –

Firstly – the breadth of referrers. The more sources of new client/customer/patient referral on a consistent basis the more likely new work will continue to arrive. For most of us word of mouth referrals from satisfied clients is the best source and thus it is a constant for all practices and disregarded. But what about all the other sources of referrals? Not just medical but all sources. The more of these that are active the better your business is insulated from variations in any one or two of them. In other words, the less reliant you are on any single source. To qualify as a referrer the source must contribute at least two new clients per month.

Secondly – the number of new episodes of care commenced each week. These can be either new clients or previous clients returning for a different or recurring problem. This number depends on the number of clinicians in the clinic and you need to determine it for your own situation. As an example, when I had four physio and one massage therapy providers this number was 26 new episodes per week. Fewer than this number for a couple of weeks would result in a down turn in work about five or six weeks later. Knowing this gave me few weeks to crank up our internal marketing, ensure letters to referrers were up to date, put out a topical e-newsletter, review our return rates, remind staff of their KPIs in this area, schedule time off for me or one of the other physios in four weeks or so, or some other intervention that might arrest the decay or utilise the down-time.

These are just two of several really valuable numbers to monitor in your business. I share others in my various Practitioner Business Academy workshops but for the moment you have enough to work with.

All the best in your prosperity,

A/Prof. Craig Allingham APAM, MBA
Director, Practitioner Business Academy