“A rut is a grave with the ends knocked out.” -Dr. Laurence Peter

My first 6 months as a manual therapist were some of the most interesting and challenging times in my life.  I learned more in my first 6 months of practice than I did in 8 years of college.  That is not to discount my college professors or the material, but I learned a ton in my first 6 months in the trenches.  The reason why the learning curve accelerated was because I was/am 100% present.  I’m not satisfied with confusion I substituted experience with “over the top” service and research and was an absolute rabid sponge for information from mentors in person and online.

After 6 months I saw more regular clinical presentations and patterns that were easy to recognize.  These were stratified with a couple “Dr. House” (the WTF cases that you have no idea what’s going on) cases a day that were still confusing.  As time went by I would be lucky to see a complex “Dr. House” case every month or two.  This wasn’t by accident because everything that didn’t make intuitive sense went in my “research notebook.”  Since my productive time of day is in the morning and not late at night I dug into these topics the following morning because I always got to the office an hour before first patient to make sure I was fresh and caffeinated for researching complex topics.  The more confusing cases I dug into the less they confused me in the future.  I still see little things that confuse me or intrigue me every day in my practice and I still research daily. Now I have to look harder for confusing or intriguing things to research.  Usually now those intriguing things are patterns or connections on my functional exam or orthopedic exam among categories of patients or of patients with similar diagnoses.  An example would be breaking down biomechanically and neurologically why most of the sciatica cases and hamstring injuries are left sided or why most groin injuries are right sided.

There are no shortcuts, no tricks, no magic classes, no practice management companies, no diagnostic imaging, no supplements/potions/oils/fairy dust and no fancy modalities that will make my doctor brain more effective at fixing patients.  It takes this deliberate practice to speed up the learning curve and go from self-doubting white belt to black belt as quickly as possible.

There are times that I find myself going through the motions out of boredom due to lack of “Dr. House” cases.  Usually at this precise time a patient will come in with a rolling suitcase full of medical records.  For those fans of the Simpsons my brain is doing the devious “egggggsssssellent” by Mr. Burns at that moment.  Being the last option for a patient should be invigorating not offensive for those outside the normal western medicine (primary care, orthopedists, neurologist) tumble dryer.  I thrive on the pressure of a tough case being dropped in my lap and it’s up to me to do research on the fringes of my specialty to find the next hand hold on the climbing wall.  I may not be the quick fix for these patients but I can at least be their advocate to come up with some new leads and actions steps, give them hope (when it is realistic), and help them navigate the medical system when they feel like they have fallen through the cracks.

If I am in a rut and the “Dr. House” case doesn’t appear to fan the flames of excitement then I buy a new book related to my field or sign up for a continuing education course I have been wanting to attend.  My wife makes fun of me because my Christmas/tax return wish list is continuing education courses, medical models and books.  If I attend a course I don’t change my method of practice but I look for the 1-3% of the course that is usable in my practice and it gives me a fresh perspective and a new lens in which to look at patients.  Those that attend a course and totally jump ship on their method of practicing show that they aren’t confident in what they do or they don’t understand why they are doing it.  Buckle down and learn the fundamentals because otherwise you’ll be looking for the next fancy trend in a few months.

A couple months ago I started Brazilian Jiu Jitsu.  I have wanted to learn a martial art for a while, but I didn’t want to take a martial art that would leave me constantly injured or put my head at risk of traumatic brain injuries.  BJJ seemed like the most sensible and most compatible with my type A personality (which took out Thai Chi) due to the ability to tap if someone was choking you out or had you in submission.  I also had a 6 year friendship with Jerry Musquiz who is now my coach.

This is my white belt mentality list to follow whenever learning a new skill:

  1. Check the ego.
  2. Show up.
  3. Be a sponge.
  4. Two ears. One mouth.
  5. Celebrate small victories but not too long.
  6. Constantly learn to avoid the rut.
  7. Stay humble.
  8. Teach and mentor others.

Check the ego- I know the human body, move relatively well and have a decent baseline level of fitness.  I could have went in with an ego onto the mats and gotten hurt or humbled very quickly.

Show up- You can’t study abroad from your living room sofa while learning a new skill.  You need to show up even when you don’t have to.  Go to open gym/open mat but make sure to recover adequately because new movements work new muscles.

Be a sponge- Soak up information like a sponge.  While learning a new skill I listen like there will be a test at the end of the session and try to absorb everything as fully as possible.

Two ears. One mouth- You have two ears and one mouth for a reason.  If you aren’t the coach or an experienced member (color belt) in the class anything you have to say that isn’t a question probably won’t contribute to the value of the class for others.  Listen, ask questions but other than that just zip it and learn.

Celebrate small victories but not too long- You have to celebrate the fruits of your hard work like earning a stripe, winning a medal or hitting a personal best but get back to the grind right away because your competition is training hard to beat you when you’re out at the club celebrating.

Constantly learn to avoid the rut- New information yields a fresh perspective.  This bumps you out of the rut and keeps you motivated. The less experience you have the less likely you are to fall into a rut because everything is new and exciting.

Stay humble- When you are no longer the newest person and you start to feel confident, stay humble.  There is a purple or brown belt willing to do this for you if you can’t stay disciplined and humble without getting your ass handed to you on a platter.

Teach and mentor others- As soon as your coach has trust in you and you have gained some experience help others if you see them confused and in the same spot you were in as a brand new white belt.  I am starting to enter this phase as a doctor but will be in the numbers 1-4 stage in BJJ for at least 18 months or longer.

Learning new skills makes life exciting and we shouldn’t stay in our comfort zone because we are a purple, brown or black belt at being a stock broker, CrossFitter, runner or fantasy football team manager.  Branch out, get out of your rut, learn something new but follow the 8 rules of being a white belt.  You can’t buy your way up to a blue belt or use your brown belt in distance running to skip steps in any new skill.  Start at the first rung on the ladder, get up when you stumble and trust your coaches and mentors.  Work hard.  Stay Humble.


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