Host Dr. Flowers, co-host Robin French, and VIP guest Clay Ardoin discuss how he empowers his clients with acute and chronic pain to find that long-term solution, enabling them to live a life where they are not afraid to move or do the things they love to do.
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You Are More Than Your Diagnosis: The Long-Term Solution With Clay Ardoin [Episode 37]
Physical Therapy
How are you, Robin?
I’m good. How are you?
Good. I’m great. I’m so excited to have our friend, Dr. Clay.
Yeah. I’m sure our female audience is excited, too.
I think everybody’s excited.
Welcome.
Yes. Thank you. It’s a pleasure to be here. Thanks for having me on the show.
Thanks for joining us. I thought I’d read a little bio to get us started and then we’ll have some good conversation here. Owner of Sculpt U Physical Therapy in Houston, Texas, Dr. Clay graduated with his Doctorate degree in Physical Therapy from Ithaca College in 2015. He has a strong passion for bridging the gap between rehab and return to sport, as he is also a Certified Strength and Conditioning Specialist, CSCS.
That’s what that stands for.
Clay Ardoin or Dr. Clay.
Most people go with Dr. Clay. My brother was the first doctor, so he goes by Dr. Ardoin, usually. I just decided just go by Dr. Clay most of the time.
Years ago, to be a physical therapist, you didn’t have to have the Doctorate, right?
That’s correct.
When you went on to school, what happened? I’m glad they did.
I’m glad they did, too. The curriculum is the exact same. I think it was more of a financial thing, probably for the schools. They have exponentially more amount of PT programs around the country now. It used to be very small niche. Now a lot of people are trying to get into rehab and physical therapy, so everybody that practice now has to have their Doctorate. Even for the older therapists, they have bridging programs for them to become doctors.
It’s not easy to get into physical therapy school.
No. It’s pretty competitive. It’s very difficult. Now, a lot of people are trying to get in and they’re making it very competitive.
What sparked your passion to get into this?
A lot of different things. I was always an athlete growing up. I played three sports in high school and had my fair share of injuries way back then. I had a great therapist. He sparked my interest for rehabbing and stuff. I knew fitness was always going to be part of my lifestyle, and I really wanted to learn how to create longevity and learn how to train. I’ve met so many different people in all different walks of life that say, “I wish I knew now what I knew back then. It made me want to go down that path. My business partner and my brother is also a doctor of physical therapy, and he started out first and set the pathway for me.
Did he encourage you to go to school and become a physical therapist?
He did, actually. He was a big role model for me in that regard. I’m glad that he did that. I said, we’re business partners now, so we were able to develop a good working relationship, and it’s been really great.
Chronic Pain
You guys work with virtually every one of our patients at J. Flowers Health Institute over at the Houstonian, and you see quite a bit of acute pain and quite a bit of chronic pain, which is my core clinical specialty. What’s your philosophy in physical therapy, working with an unrelenting chronic pain issue with someone?
Honestly, it’s very complex. It’s first understanding what is happening with the patient. There are so many different things that that patient can be experiencing that can be affecting their pain. It’s very hard to get them to understand, and the research shows us pain is 100% produced by the brain. It’s not by tissue damage. It doesn’t matter if it’s acute, it doesn’t matter if it’s chronic, how long it’s been there. There are a lot of different factors that play into chronic pain. One of them is the medical system. Medication’s okay. It’s okay to get on medication, but that needs to be tapered off and weaned.
Pain is 100% produced by the brain.
A lot of times, patients are on there way too long. There’s the patient’s mental and emotional response to that. How much stress do they have in their lives? What can you do to reduce that stress around that area? There’s their lifestyle and their habits, things like that, their diet. All those things can be improved on when you’re dealing with chronic pain that can really help to desensitize the nervous system, because at the end of the day, that’s what we’re trying to do is drive down your neural sensitivity to the situation.
There are some other factors, too. What was going on around the time that that patient had pain? Maybe something traumatic in their life happened? They didn’t really think about it, and they just attributed everything to that one thing that happened, but really, it’s a cumulative thing that’s happening around there. What we treat mostly is the active lifestyle because we do know that active lifestyles can help to desensitize pain, and that’s how we return people back to a full lifestyle.
Treating somebody with chronic pain, you have to take all of these things into account. If somebody comes into my clinic and is just like, “My shoulder hurts,” and I just focus on that shoulder, I miss this huge opportunity to address all of these things. That’s where a comprehensive assessment really comes into play. What you guys do at the Flowers Institute is to uncover those things. We can’t do it alone because there are so many complexities to pain. We teach people that there’s just a different lifestyle and a different way to address what’s going on.
One example we give, it’s like this cup here. This is their capacity to handle stress. You pour a little bit of water in, that’s their injury that they’re dealing with now. You pour a little bit of stress in their life and all these different stressors, how their fear of returning, playing with their grandkids again. There are two ways to address that. You can reduce the amount of fluid in the cup, reduce their stress, which you guys do a great job of, helping them understand what’s going on. You can increase the capacity of the cup. There are both ways that you can do it, and we try to do it on both ends, but you can’t do it without the collaboration of a team.
Attacking it from a multidisciplinary approach.
That’s why we love working with you guys at the Flower Health Institute because so many things like this get missed in the medical system because they get five minutes with their orthopedic surgeon, or their aunt told them that they had back pain one time twenty years ago, and they think that they’re going to have that exact same experience. The research shows us it’s just not like that. We’re so resilient, our bodies can handle so much, and once you teach somebody that they can do that, it’s really powerful and empowering.
I hadn’t thought about doing this on the show with you, but I’ll throw something at you real quick. We share a patient that’s a long-term patient that’s been here for about a year, a year and a half at this point. Without mentioning any names, you and I are working with her on a multidisciplinary program. I believe there was an initial trauma as well. Initial injury and a traumatic event and then this long-term pain issue, and where she was and where she is now. Talk a little bit about what your approach to someone like that is.
Yeah, for sure. The first thing that you have to do is you have to gain their trust. You can’t tell them that their pain is not real because that’s the first way you’re going to lose a patient. So many people in their lives have already told them, “This is not real. I’ve had shoulder pain. You shouldn’t have this type of pain.” That’s the first way that you can catastrophize that situation, to tell them that they don’t have that pain. It’s very delicate. As treatment plans go, you can drop the perfect treatment plan, hashing out all these things. Nutrition, lifestyle, coaching, activity, stress management, all these things. At the end of the day, the patient has to be the one to activate it.
You can’t tell patients their pain isn’t real. That’s the quickest way to lose their trust.
We can only do so much. We can show them the plan, but if they’re not willing to put in the work to do it, that’s going to be the first barrier. I know exactly who you’re talking about, and you could see that she wanted to be there. She wanted to do that, and she put the work in. We didn’t do that. We showed her the way. The most important aspect of it is you’ve got to create that trust between the clinician and the patient. That’s where it all starts because once they buy into it, then you can start moving forward. As you said, we’ve been working there for a year and a half. How many patients do you know that are willing to put that time in?
Not many. Not at all. Robin, this was a patient that flew here from the West Coast on a medevac jet and couldn’t even really feed herself when she came. Dr. Clay agreed to come over and he would visit with her every day in person, all throughout COVID.
Could she walk?
No. She could barely walk.
She wouldn’t walk. She wouldn’t wash herself. She would try to look around, but she could only use her eyes. She literally could not move her body.
Was it all up here?
That is the idea. Not to her, though. It’s everywhere to her. You have to start to unravel those things. If she just comes to me in that condition, there’s nothing I can really do. I need somebody like Flowers Institute to start to unravel some of those intertwined emotional connections that she has with pain, things that have been going on for years and decades and things that she never even knew. Something happened in her childhood that’s now causing her to have this catastrophic reaction.
The pain is real. It was a real legitimate injury, but the intensity of the long-term pain is so high based on the nervous system reaction and trauma. Here she is a year and a half later, along with his help, and the rest of the team’s help, but at a minimum, she walks 3 miles a day, sometimes 5 miles a day.
She’s working out every day.
Full range of motion.
It’s unbelievable. That’s why we do what we do. When you see patients’ stories like that, it’s really motivating. When you can see somebody change and it just starts to click for them, that’s why we do what we do, and we put the work in. It’s those types of people that we really like to help because they want help so badly, but they’ve just been led down so many wrong paths. Mismanaged and not listened to.
What I’ve found is if you take the time, if you have the time to listen to a patient, they’ll tell you what’s wrong. They will tell you what is wrong with them, but you just have to listen. The patients get so much stuff jammed down their throat from the medical system. They’re just so broken by the time that they get to you.
If you take the time to listen to a patient, they’ll tell you what’s wrong.
Including the quick fix pill that you like to talk about.
For sure. That goes along with our society and our culture, and we’re not going to be able to unravel all that stuff. They come in and they want to get fixed right now.
Immediate gratification.
You tell somebody that’s successful businessman or woman and they got all this lifestyle stuff going on. They got kids, they’re trying to work, they’re doing all this stuff, and you tell them that their pain is because of stress, they’re going to walk out of your room. They’re like, “I can’t do anything about that.”
“It’s my lifestyle.”
“I’m not going to change. What do you mean you want me to change?” If you want to be here, this is what it’s going to take and this is why you’re here.
We end up with all those folks that ended up taking those pills that can’t get off of them and started using them.
It’s a metaphorical pill, but it’s also real pills, too. When we say a quick pill fix, they want results like this.
Immediate gratification.
They’re like, “Fix me now.” They don’t want to put the work in to get to where they want to go. As I said, you can lead a horse to water, but they can’t force them to take action.
Typical Session Expectations
Take us through your average physical therapy session. What should people expect when they come to see you?
It really depends on, obviously what they’re coming in for. Let’s say we unravel all this stuff, and we lay it all out for them. They’re all bought in, and they’re ready to get going. As physical therapists, we’re very good at treating pain. Somebody comes in and they have pain around a certain area, say it’s their lower back. We’re going to work that lower back. We’re going to do some soft tissue work and some manual techniques. Maybe it’s spinal manipulation, maybe it’s dry needling, maybe it’s grassed and stuff to calm down that central nervous system around the area just to relax it so they can move and they feel like they can move.
After that, it’s really important. We call that a reset. We’re trying to reset their nervous system so they can tolerate movement. At the end of the day, movement is what’s going to get them better. It’s not me. I can’t do that. Passive things are very short-lived. You have to get somebody moving, and they have to be active. The next thing we do is we try to correct their movement patterns. If they have a faulty movement pattern or something, something where they’re not moving right, that’s creating some increased pressure or tension somewhere along the body that we can address. We’re going to do that with some corrective exercise.
At the end of the day, movement is what’s going to get patients better. That’s why resetting the nervous system to tolerate movement is important.
What we do at the end of that session is sometimes not in a full session. Sometimes, they need multiple sessions of soft tissue work to desensitize the nervous system and to feel safe to move. We’ll do that as long as we need to, but the ultimate goal is to connect their rehab program to functional moving patterns, whether it’s getting them back to squatting, deadlifting or running. It’s not about what I want them to do. It’s about what they want to do.
They come to me with a goal. “I want to get back into doing this.” Everything that we do is driven to getting them back to their goal. It’s our job to have them set realistic expectations. The quick pill fix, it’s not like that. We’re not going to do that. We’re going to draw out this treatment program, and at the end of it, you will be here if you buy into this program.
That’s what we do in a typical treatment program. We get them from passive treatments to active as quickly as we can. What we don’t want to create is a system where they’re reliant on us as providers. I don’t want them to come in here and feel like they’re broken, or I’m adjusting them and putting them back in place. That doesn’t happen. So many different professions make them feel like that. They go in for adjustments twice a week, or they’ll get a soft tissue massage and just lie there. They feel good for 30 minutes and they get out and then what happens? That’s not how you get better. You need to have an active program for active problems.
Impact Of Weight Training
Follow a plan just like everything else. You were talking about deadlifting. You say that weight training really changed your own life. Tell us about that. You don’t really look like you lift weights. How did weight training change your own life?
There’s just so many benefits to getting into the gym. Building some self-confidence, from a mental perspective, it’s unmatched. It’s those endorphins that you get from pushing yourself just to another level, understanding that you can do that, and you doing that, there’s just so much power in that. Personally, I didn’t really have that issue, although it was a great confidence builder for me throughout high school and college. I played college football and ran track, and so it was obviously, from that perspective, that it made me a better athlete and a better person. I made a lot of friends that way. It was great comradery with a lot of different people, and it led me to where I am now. Honestly, that’s what has gotten me to where I am now is just learning my own body and helping other people understand theirs.
There’s so much power in understanding your body and pushing your limits.
Mind-Body Connection
I think that your body has a lot to do with understanding the human condition. How do you think physical therapy, working out, and fitness, has changed your own human condition up here in your head?
The more that I do it, and the more that I continue to educate myself on what I know, the more I research and stuff, but I feel like the less that I know. I’m not afraid to tell people that I don’t know. That’s a big thing. When I first got out of school, I thought I could treat the world. I thought I was like I know what that is like, “Get over here. Let me stretch that out.”
Now it’s like when I meet you and I meet other providers and start to take a holistic approach, it’s like, I don’t know much. I’m going to do the best I can. I know the people. I have a great network of providers. If I can’t do it, I know where to send them immediately. I’m not going to keep them in a system where I can’t treat them. That’s important.
Understanding the human condition is understanding that everyone’s different. Everybody has different needs. You cannot put somebody in a cookie-cutter program and expect them to do the same thing that somebody else did. That’s how we treat and we understand that, and we appreciate people. People trust us with their health. I don’t take that lightly. They could go anywhere else. I’m just so appreciative of where I am now, for people trusting me with their health, and for you sending us patients.
You can’t put someone in a cookie-cutter program and expect the same results for everyone.
It’s great having you a part of our team. How is it working daily with your own brother? How’s that worked out? You guys seem to get along fantastic, by the way. No other reason to ask you that.
A lot of people will tell you don’t get into business with family. I would disagree. I couldn’t imagine talking to somebody else the amount that I have talked to my brother. We talk every day ad nauseam. Constantly. We enjoy it. We love doing. We come from a very small little farm town in upstate New York where nobody really gets out. It’s just been great to build the practice that we’ve built together. We trust each other 110%. I don’t have to look over my shoulder or anything like that. That in itself is a stress relief as running a business is very stressful. The last thing you want to do is worry about internal issues.
Unique Approach To Practice
You have a very unique approach to practice. You do your practice in a different way, just as we do our practice in a different way. You’re a concierge physical therapist. Do you want to talk a little bit about your practice and what clubs you’re in?
The clubs have been great to us. The Houstonian, as you mentioned before, we’re also at Fit River Oaks, Houston Racket Club and the Briar Club right now. We’re looking to expand. What makes us unique, it’s not only the quality of care that we provide, the one-on-one time that we have with our patients because if you know physical therapy, if you ever have been through it, if you get stuck in a system, like a bigger hospital system, let’s say, you’re going to be treated with 2 or 3 other patients in the same hour. It’s not the therapist’s fault because it’s the system, but you get fifteen minutes with your patient and then you pass them off to a PTA. I am talking to you about all of this complexity of pain. What are the chances I’m going to uncover that in fifteen minutes?
Minimal.
How many people go there and they say, “I’ve tried physical therapy.” That’s not rehab. That’s not physical therapy. Until they’ve tried that, what happens is they’ll go to their doctor. They doctor will say, if they’re lucky, they’ll say they’ll go to therapy. They’ll go to that place for four weeks, and they’ll come back and say, “It didn’t work. I tried.” It’s like, “No, you didn’t.”
It is so wild to hear that time after time.
Another unique thing about the model is that we get to catch patients before they get stuck in the system. They come into the clinic with questions. They say, “I just hurt my shoulder. What do I do?” We can educate them because that’s the biggest part. It’s just educating them on what they’re about to deal with so they can set their expectations properly. I’m not talking down doctors or anything like that, but because of their lack of time with the patient, they’re going to send them for imaging. They’re going to put them on medication. It’s going to be weeks before they can even get back to them. They’re going to come back still in pain because they told them to rest, ice and sit there and do nothing.
That exacerbates pain. Ten percent of people that actually go to the doctor may get referred to physical therapy. Ninety percent of patients that go to the doctor in pain will never even step foot in a physical therapy clinic. They go in with some type of lower back issue, let’s say it’s really common. The reason why they have lower back pain is because of something else that’s going on.
They’re trying to squat and their ankle’s really stiff. Now they’re bending forward or their shoulder mobility sucks. On and on. We could talk about that stuff, but with a proper movement diagnostic and the proper plan of care educating people, you can really get ahead of chronic issues. We have the network of providers that understand what we do. I refer patients out all the time. I’m not trying to keep people; I just want to keep them for myself. I want them to get them on the right path. I will send them to the right orthopedic surgeon. I’ll send them to the right place.
Do you have to be a member to go to the clubs that you’re in?
No. You don’t have to be a member. One of the clubs, you do, but we have multiple locations for that reason and you don’t have to be a member to come see us.
As far as issues that you see, what’s the most common?
By far, it’s lower back pain. People in all walks of life have lower back pain. Eighty percent of people will have low back pain at some time in their life. That is the most common. Two of our clubs are tennis clubs, so we see a lot of shoulder and elbow stuff and stuff like that.
You’re also very innovative in your practice, and you’re always looking at ways to evolve and expand the patient population that you see. I know now you’ve expanded your practice to include pelvic floor therapy as well as pre and post baby training for moms and dads. What’s going on with all of that? It’s so cool.
That’s really exciting. We’re just trying to find a way to reach more people and to have them expose the type of care that we can provide to them. Pelvic floor is not my expertise, but I know how to find the right people to do that. What I do know is how underserved that community is and how much they can benefit from just, just education, understanding and having somebody touch them in a comfortable climate where they don’t feel like they’re in a doctor’s office and they’re getting exposed. We teach them how to function properly and we teach them how to get back into weight training.
A lot of moms are just scared. You’re scared pre and post. They don’t feel like they can get back into doing what they once did. They feel like, “This is normal. This is my life now.” What we know is that’s not true. You can train into your third trimester. Obviously, that program changes as you go. You need to develop the fundamentals and understand how to move before that happens because when it does happen, things happen. That’s part of it.
Afterwards, it’s proper education and getting you back as quickly as it can working with the doctors. We don’t overstep our boundaries or tell them to do things they’re not cleared to do. We work with the doctors again to make sure that, that it’s okay for them to do that. We get them back as quickly as we possibly can. It’s a new program for us and we’re really excited to roll it out.
Bucket List
We’re almost out of time, but we wanted to ask you a couple of personal questions. What’s on your bucket list that you haven’t done yet?
I love to travel. It has been a little difficult to travel. Definitely getting back and just getting some relaxation time. I love the beach. I love to do active things outdoors. Luckily, I was able to get out skiing once this year, which was a blessing. It was really nice. That’s on that bucket list for sure. Business-wise, again, I would love to be able to provide care, not just here in Houston but throughout the country, using the model that we run. It’s effective and I know it can be done.
We have another former patient that we worked together that owned a huge physical therapy practice up Midwest. You can always call her and ask.
We still talk, actually.
She just called the office, checking in.
She’s a sweetheart.
Talk about a difficult woman. Doctor, heal thy self. She’s a physical therapist or no?
She used to be for a very brief time.
She became an entrepreneur and grew this huge physical therapy. I think she employed I don’t remember how many.
She’s got almost 1,000 clinicians.
What an amazing change that she had in her life.
We see that all the time. We get almost get numb to it, but you got to take a step back and just realize we’re really changing people’s lives.
Enjoy the wins because occasionally there’s one that we’re not going to win no matter how hard we try. We absolutely love working with you. Our patients love working with you. The other providers really like your feedback and, and I believe it’s invaluable to the services that we offer. You have to be part of our multidisciplinary team. Thanks for being here.
Okay, sure. Thanks for having me.
Anything we didn’t cover physical therapy-wise that you want to throw out there?
No, this was good. It’s a different take on physical therapy. It’s just people don’t really understand the challenge that we fight is that people just don’t know what physical therapy is. They think it’s like sitting in the corner pulling on bands and like handed a sheet of paper. That’s what they used to do. That’s old school. Unfortunately, there’s still a lot of practices that still do that. We’re trying to break that mold and help people understand that there’s a better way.
The challenge that we fight is that people don’t know what physical therapy is. They think it’s just pulling on bands.
If someone wants to reach you and they can actually watch you in some of your videos on your Instagram, but how do they find you?
You can find me on my personal Instagram. It’s @Dr.ClayFit. You can use our business Instagram, which is Sculpt U Official and then our Facebook is Sculpt U. Our website is SculptUPT.com.
If they want to reach you, Dr. Flowers, at the J Flowers Health Institute?
It’s a lot easier than mine.
Thank you again, Dr. Clay.
Yes. Thank you, guys.
Thank you so much for being here. It was fun.
That was a lot of fun.
Absolutely. Thanks, Robin.
See you next time.
Important Links
- Dr. Clay Ardoin
- @Dr.ClayFit – Instagram
- Sculpt U Official – Instagram
- Sculpt U – Facebook
