I became a physiotherapist because I wanted to make a difference to people. Straight out of university, in 1999, I worked in a combination of private practice and hospital work for a couple of years, combined with some sports trainer work with local sporting clubs.

The work was good; I learnt from great physiotherapists, people would come to see us because they were in pain, and we might have made them feel a bit better.

But ultimately, they weren’t fundamentally different and I wasn’t making a real long-term impact on their lives, and that wasn’t okay.

This was about the time the early stages of research into core stability training was coming out, mostly from Queensland and Dr Peter O’Sullivan in Western Australia, showing that we could begin to make a difference in preventing lower back injury after occurrence.

This was extremely exciting because it showed that  we could actually make a change to people in the long term, not just wait for them to hurt themselves, apply a few remedial techniques and hope they felt better.

At the time, I had heard that Craig Philips of DMA Physiotherapy had bought an ultrasound and was looking at core stability under the surface, so I gave him a call and he kindly showed me how the system worked.

Wow, this was great; we could look under the surface and really see muscle training in action.

Not long after this period, I started my first practice in Bulleen, out of a doctor’s surgery.

Like everyone else, I had an initial consultation when I did some assessment, and then follow-up consultations in which I would implement a plan and try to make people feel better.

But, I was also very diligent on keeping statistics, and found that about:

• 40 per cent of the clients would feel better in about 5.2 consultations


• 20 per cent of the clients would have to be referred (to a specialist   or back to their doctor)


• 40 per cent of the clients would just ‘disappear’ because they weren’t better or just didn’t get what they wanted within about 4.2 consultations.

This was not okay. This time it was my own business and I really wasn’t making a difference; something about the service had to change.

The business model, the 13-week program and the full-body assessment

When I stepped back and really looked at what wasn’t working, the answer was not the lack of physiotherapy skills or the lack of knowledge, it was the fundamental structure of how the service was being delivered.

A little while earlier, I had had a conversation with physiotherapist Steve Sandor, who said that what he would love to do was assess someone head to toe, really determine their strengths and weaknesses and make a real change to their biomechanics to get the best from their performance.

I asked myself: why can’t I do this? Because no one else was doing it? That was not a good reason. 

In the next few months, I pulled apart every aspect of clinical sports medicine, sports physiotherapy and the AIS screening protocols to develop the first version (in Word) of the Full Body Assessment System.

The other question I asked was: can I really make a difference to people’s strength and biomechanics in 5.2 consultations?

Of course not, it takes three months to really develop strength and most injuries take about six weeks for a good, solid scar to form and three months for good remodelling. So, the first 13-week program was born in about 2004.

For the first time in my working life as a physiotherapist, my goal, to make patients better in the long term, was aligned with the goal of the patients, to be better and get the most out of life.

Some of the clients who I started seeing in 2004 are still customers today and are living active and full lives, because we have been a part of their lives over the years.

Why and how it works?

It works by taking a long-term view of the patient’s outcome and using what we know about tissue healing and strength training and using it to our advantage to get real change.

We know that we are not really going to get strength changes with the patient in 5.2 consultations, so we outline from the start that the expectations are in three months.

This is so the patients stop trying to expect a ‘miracle’ cure every session and the physiotherapists stop trying to ‘fix’ every problem each session and focus on slow and steady change over time.

In addition, because we have looked at the patient head to toe, we have a good idea of all the major issues and can slowly and steadily address one area at a time until we achieve our goal of allowing the patient to get the most out of life.

In this way, all the major areas are addressed over time and not rushed.

Also, we are able to move the client from focusing on ‘the injury’ to focusing on their long-term goals and their performance, and their physical hopes and dreams, such as climbing to base camp of Everest, or a bike tour of the Alps or just playing with the grandkids on the weekend.

Challenges and considerations

At the start the biggest challenge was me: I had to change my way of thinking to focus on the long term, to really get a change in outcome for the patients and be comfortable about being different to everyone else.

The second challenge was the customers.

This was not like a typical physiotherapy practice, even though I had the same physiotherapy degree.

Would they accept this model, was it sustainable? Not everyone did, and that’s okay.

Enough patients did to make it sustainable and when they started to feel better and do more things in their lives, others started to notice and would tell others, so word of mouth grew and so did the business and the service.

The third challenge was whether physiotherapy staff would accept the model. Again, not everyone did.

During our interview process, we asked the potential candidate to have an observation day and see if it was really what they wanted to do. Many would turn around and say, ‘Thank you, but this is just not for me’. That’s okay.

Some staff members would turn around after a year or so working for us and say, ‘This  is good, but I just want to learn to fix people with my hands’.

That’s also okay. But, the right staff members would stay and be part of our system, feel part of the team and part of the local community and that’s great because that’s where they feel like they belong.

What success looks like

Success looks like a 97-year-old woman who comes in most Thursdays, does her program with us and has a chat to the staff and other patients.

They all know her name and ask her how she is, then she goes home and we see her the next week. She is independent and is able to live her fullest life, because we have been a part of it.

Success looks like a middle-aged lawyer who had been a patient for five years when she was diagnosed with breast cancer and underwent surgery and chemotherapy.

About a year ago, she turned around to me and said, ‘It’s now been five years since I’ve been in remission and I got through the whole thing because of your team’.

We have just written a book, 7 ways to a healthier lifestyle, which we plan to give all of our patients and to be our standard after our first session with a patient.

These people’s lives are different because we are part of their lives.

From a business perspective, because the patient relationships are long term, I don’t need as many new patients coming in the door to be sustainable and can just focus on getting the patients better in the long term.

Michael Dermansky, APAM, is the senior physiotherapist and managing director of MD Health, a physiotherapy and exercise physiology studio with a clinical exercise focus in two Melbourne locations. Michael has been working in physiotherapy since graduating from Melbourne University in 1998,  and is even more passionate about getting the best outcomes for clients than he was then.