69. The "Missing Piece" Foot-Back Connection

🎙 Episode 69 – The "Missing Piece" Foot-Back ConnectionIn this episode of The Practice Builders Podcast, Dr. Kyle Pankonin breaks down one of the most commonly overlooked pieces of chronic back, hip, and lower-extremity pain: the feet. When foot mechanics are compromised, the effects can travel up the kinetic chain and potentially contribute to problems at the knees, hips, pelvis, and spine.Dr. Kyle walks through a simple system for evaluating foot mechanics, identifying common signs of pronation, and using objective tools like weight-bearing digital scans to determine when custom orthotics may be an appropriate part of the treatment plan.Key topics include:Why the feet may be a missing piece in chronic back and hip painThe five red flags of pronation to look for during an initial examHow weight-bearing digital scans can add objective information to your evaluationResearch connecting flat feet and pronated foot mechanics with low back painHow custom orthotics may help address biomechanical imbalances and leg length inequalityWhen heel lifts or shoe modifications may be appropriate for larger leg length differencesHow to explain the foot-back connection to patients in a simple, understandable wayWhy orthotics can also become a simple, staff-driven additional service within the practiceThe big takeaway: if you’re treating chronic back, hip, or lower-extremity problems without evaluating the feet, you may be overlooking an important part of the biomechanical picture. Build foot evaluation into your exam process, identify problems objectively, and address the foundation when the clinical findings support it.🎧 Listen now on your favorite platform!

🎙 Episode 68 – How to Help Patients Choose Spinal Decompression before Injections or SurgeryIn this episode of The Practice Builders Podcast, Dr. Kyle Pankonin explains how to help patients make a more informed decision when they’re considering spinal injections, surgery, or non-surgical decompression care. The key is not to pressure patients toward a specific choice, but to listen first, understand what their pain is taking away from them, and then clearly educate them on their options.Dr. Kyle walks through how to use clinical findings, MRI imaging, research, and a world-class physical exam to build trust and help qualified patients understand where spinal decompression may fit before more invasive options are considered.Key topics include:Why the conversation should start with listening, not sellingHow to uncover what pain is taking away from the patient and what they fear mostHow to clearly explain the differences between injections, surgery, and spinal decompressionUsing MRI findings to educate rather than scareWhy a thorough physical exam should always be correlated with the imagingHow to set clear expectations around results, timelines, and the treatment planDiscussing the financial side of cash-based decompression without creating pressureWhy telling some patients they are not a decompression candidate actually builds trust and authorityThe big takeaway: patients make better decisions when they feel heard, educated, and confident in the doctor guiding them. Focus on understanding the patient first, present the options honestly, and recommend decompression only when the clinical findings support it.🎧 Listen now on your favorite platform!

In this episode of The Practice Builders Podcast, Dr. Vince Leone and Dr. Kyle Pankonin break down how to keep decompression patients committed when doubt, discouragement, flare-ups, financial concerns, or outside opinions start creeping in. They explain why patient retention begins long before problems arise, with clear expectations, strong communication, and a treatment plan the doctor confidently believes in.Rather than waiting until a patient is ready to quit, Dr. Vince and Dr. Kyle share practical ways to coach patients through the entire care process, monitor progress, address concerns early, and reinforce why completing the full recommended protocol gives the patient the best opportunity for a successful outcome.Key topics include:Why the best patient retention strategy starts with setting expectations before treatment beginsHow to prepare patients for flare-ups, slower progress, and the normal ups and downs of careWhat to do when a patient says, “I’m not getting better fast enough”How regular re-exams and doctor touchpoints help identify problems before patients become discouragedHandling friends, family members, and other healthcare providers who question the treatment planWhy completing and financially committing to the full recommended protocol can improve patient complianceBuilding a patient communication system with education, research, FAQs, emails, texts, and ongoing check-insThe big takeaway: keeping patients committed requires more than delivering treatment. It requires leadership, communication, and clinical confidence. Set expectations early, stay connected throughout care, monitor progress, and address doubts before they become reasons to quit.🎧 Listen now on your favorite platform!

🎙 Episode 66 – Practice From Abundance: Part 2In this episode of The Practice Builders Podcast, Dr. Vince Leone takes listeners back inside a private Specialized Practice micro-training for Practice From Abundance: Part 2, moving beyond mindset and into the tactical actions that create more patient opportunities.Instead of asking, “Where are the new patients?” Dr. Vince challenges doctors to ask, “What am I going to do today to create more opportunities?” He introduces the Abundant Five, a simple weekly system built around five intentional growth actions that keep your practice consistently creating awareness, relationships, referrals, and conversations.Key topics include:Why growth comes from creating opportunities, not waiting for the market to deliver themHow consistent marketing activity compounds over timeThe Abundant Five framework: five simple growth actions every weekUsing emails, reactivation calls, social media, referrals, and thank-you notes to create momentumWhy getting busy is a reason to expand capacity, not stop marketingLeveraging existing patients, former patients, leads, community relationships, and referral sourcesMaking the appropriate care recommendation without projecting your own financial assumptions onto the patientThe big takeaway: abundance becomes useful when it turns into action. Choose five intentional growth activities, put them on your calendar, execute them consistently, and focus on putting more value, education, conversations, and relationships into your community.🎧 Listen now on your favorite platform!

🎙 Episode 65 – Practice From AbundanceIn this episode of The Practice Builders Podcast, Dr. Vince Leone gives listeners a behind-the-scenes look at a private Specialized Practice micro-training called Practice From Abundance, focused on recognizing when scarcity thinking begins influencing the way you run your practice.He breaks down how seemingly practical thoughts like “Will patients pay for this?”, “Are there enough decompression patients in my market?”, or “Can I afford to grow?” can quietly affect pricing, marketing, hiring, care recommendations, and investment decisions.Key topics include:How to recognize scarcity thinking before it starts driving business decisionsWhy you shouldn’t project your own financial beliefs onto patientsMaking the best clinical recommendation and allowing the patient to decide what they valueWhy you probably need fewer new decompression patients than you think to meaningfully growHow stronger marketing, communication, systems, and leadership can expand your impactWhy abundance isn’t reckless optimism, but a belief that opportunity can be createdA simple exercise for identifying where scarcity may be showing up in your practice The big takeaway: scarcity protects, abundance creates. Before changing anything, start by noticing where fear or limitation may be influencing your decisions and ask: What might I do differently if I believed there was more opportunity available to me? 🎧 Listen now on your favorite platform!

🎙 Episode 64 – Clinical Pearls That Will Make You a Better Decompression DoctorIn this episode of The Practice Builders Podcast, Dr. Kyle Pankonin breaks down several clinical pearls that can help decompression doctors improve case selection, interpret MRI findings more accurately, and set better patient expectations.He covers why Modic Type 1 changes matter, how discogenic pain can exist even without obvious nerve compression, and why larger herniations like extrusions and sequestrations may actually have a better chance of reabsorption than smaller bulges.Key topics include:Why Modic Type 1 changes should change your treatment approachHow discogenic pain can exist without nerve compressionWhat rim enhancement may reveal about disc reabsorptionWhy larger herniations may respond better than expectedHow annular fissures can cause chemical radiculitis and may require inflammation control before decompressionThe big takeaway: don’t make clinical decisions based on one MRI finding alone. Understanding inflammation, herniation type, and the true pain generator helps you choose better cases and manage them more effectively.🎧 Listen now on your favorite platform!

🎙 Episode 63 – Why Every Decompression Doctor Needs to Know the ResearchIn this episode of The Practice Builders Podcast, Dr. Kyle Pankonin makes the case for why decompression doctors need to master the research behind their treatment, not just the marketing claims that surround it.Marketing lines like "decompression puts the disc back in" often outpace what the evidence actually shows, and today's patients are educated enough to ask for proof. Dr. Pankonin walks through three recent decompression studies, what each one actually demonstrates and where its limits are, and shows how to pair that evidence with your own clinic's outcomes data to build patient confidence and improve case acceptance.Key topics include:Why "does decompression work?" is the wrong question, and what to ask insteadCombining your clinic's own outcomes data (e.g., 85–93% improvement) with published research to build trustA 2025 USF chart review of 267 patients: 90.5% reported pain reduction, with gains in reflex, myotome, and dermatome testingA 2026 Korean RCT with blinded MRI evidence of reduced disc protrusion in the decompression groupA pre-registered case study showing complete resolution of a chronic C6-7 disc extrusion after a 6-month combined programFraming disc reabsorption as a possibility supported by emerging evidence, not a guaranteeSetting realistic expectations, including the 50%+ pain relief benchmarkUsing AI tools like ChatGPT to automate weekly research summariesThe big takeaway: doctors who master the research, not just the marketing, build real credibility with patients, colleagues, and referral sources.🎧 Listen now on your favorite platform!

🎙 Episode 62 – 10 Common Decompression MistakesIn this episode of The Practice Builders Podcast, Dr. Kyle Pankonin breaks down 10 common decompression mistakes that can hurt patient selection, clinical outcomes, and case acceptance.From relying too heavily on MRI findings to pulling with more force than necessary, many of these issues come down to the same thing: matching the recommendation to the actual patient in front of you. History, exam findings, imaging, neurological status, inflammation, and severity all need to work together.Dr. Pankonin walks through the clinical and communication adjustments that can help doctors select better candidates, set realistic expectations, and use decompression more effectively across a wider range of spine conditions.Key topics include:Why imaging alone should never determine whether someone is a decompression candidateHow realistic expectations, including the 50% improvement benchmark, can improve patient satisfactionWhen an MRI is truly necessary and when history, exam, and X-rays may provide enough informationWhy identifying the actual pain generator matters before recommending a decompression programWhy large disc herniations shouldn’t automatically intimidate youThe importance of addressing inflammation aggressively in stubborn casesWhy more pulling force doesn’t necessarily produce better resultsHow to match the number of visits to the severity of the patient’s condition instead of automatically recommending 24 visitsWhy decompression can apply beyond traditional disc cases, including facet problems, stenosis, and some spondylolisthesis presentationsHow better case selection and dosing can improve both the patient experience and clinical resultsThe big takeaway: decompression works best when the protocol fits the patient, not when every patient gets the same protocol. Take the history, exam, imaging, severity, and goals together, then make the recommendation the individual case actually calls for.🎧 Listen now on your favorite platform!

🎙 Episode 61 – Stop Selling Technology, Start Selling a FutureIn this episode of The Practice Builders Podcast, Dr. Kyle Pankonin breaks down why patients don’t really buy decompression, laser, shockwave, or any other technology. They buy the future those tools can help them get back to.Most doctors naturally want to explain the science, the equipment, and the procedure. But patients are usually thinking about something much more personal: getting back on the golf course, traveling with their spouse, playing with their grandkids, or simply living without pain controlling their day.Dr. Pankonin explains how to uncover the patient’s “why”, connect your technology to that outcome, and shift your communication from selling treatments to selling transformation.Key topics include:Why selling technology and procedures often misses the patient’s real motivationThe question that helps uncover what pain has taken away from the patientHow to connect decompression, laser, and shockwave to the patient’s desired futureWhy the strongest recommendation focuses on outcomes, not visits or machinesHow to package services into condition-specific programs instead of selling them a la carteWhy your staff, marketing, and testimonials should all focus on transformationHow to set both a clinical goal and a functional goal for every patientThe big takeaway: patients don’t want to buy a machine. They want their life back. Find out what matters most to them, then show them how your care becomes the bridge from where they are now to where they want to be.🎧 Listen now on your favorite platform!

🎙 Episode 60 – Creating a Remarkable First VisitIn this episode of The Practice Builders Podcast, Dr. Vince Leone shares a micro-training on how to create a first visit that builds trust before the patient ever meets the doctor.Patients are forming opinions from the moment they pull into the parking lot. The way your office looks, sounds, smells, and feels can either reinforce confidence or quietly work against you.Vince breaks down a simple Weekend First Impression Audit to help you identify the small details you and your team may have stopped noticing, from the front desk and waiting area to the bathroom, treatment rooms, paperwork, and patient greeting. The goal isn’t a major remodel. It’s making a few low-cost, high-leverage improvements that create a more professional and intentional patient experience.Key topics include:Why first impressions directly impact trust and close ratesHow to audit your practice through a new patient’s eyesSimple improvements to your front desk, waiting room, bathroom, and treatment areasWhy your team’s greeting and communication matter just as much as the physical spaceThe challenge to identify 3–5 small improvements you can make this weekThe big takeaway: clinical excellence matters, but patients experience your practice before they experience your clinical skill. Make sure those first few minutes tell them they came to the right place.🎧 Listen now on your favorite platform!