🎙 Episode 56 – Decompression Case Review

In this episode of The Practice Builders Podcast, Dr. Kyle Pankonin breaks down two real decompression cases that show why this therapy belongs at the center of a modern chiropractic practice — and how to frame it so patients choose it over pills, shots, and surgery.

Both cases are a lesson in patience and patient selection. First, a man with years of recurring low back pain that chiropractic used to fix — until a 2025 injury and a large L5-S1 extrusion changed everything. He was only 25% better at month three; by month four he hit 75%, and today he's on maintenance feeling his best in years. Second, a 57-year-old post-surgical patient no one could help who reached 98% improvement with the right protocol.

You'll learn:

• Why chronic patients whose pain has stopped responding to standard care are your most natural decompression candidates — they already trust you
• Why large disc extrusions often respond better than small bulges
• Why breakthroughs often come late — and how setting the full 24-visit expectation keeps patients from bailing early
• The post-surgical waiting periods that make a patient a safe candidate
• Why you always correlate MRI findings with a thorough exam — the pain generator doesn't always match the imaging
• How to frame decompression against surgery using the real numbers: 85–93% success versus surgery's ~72% first-time rate
• What the research actually says about muscle relaxers, opioids, gabapentin, injections, and ablations

A must-listen for any doc who wants to become the go-to authority on disc and spine care in their market — because when you can show patients the data on every alternative, decompression stops being a hard sell and becomes the clear choice.

🎧 Tune in and learn how to turn complex disc cases into some of the most rewarding wins in your practice — clinically and for the patients whose lives you change.

🎙 Episode 55 – I Need To Think About It

In this episode of The Practice Builders Podcast, Dr. Vince Leone and Dr. Kyle Pankonin tackle the four words every decompression doc dreads at the end of a strong ROF: "I need to think about it." It's rarely a real maybe — it's a soft no from a patient who hasn't reached enough certainty to commit.

This episode breaks down why patients hesitate, how to prevent the objection before it surfaces, and exactly what to say when it does.

You'll learn:

• Why "I need to think about it" is almost always a polite no — and why most of those patients never come back without proactive follow-up
• The five root reasons patients hesitate, from not understanding the condition to not yet trusting you
• How plain-English analogies — the dried-up sponge, the ice cream sandwich, the stepped-on garden hose — build the understanding that drives a yes
• Why tracking your own success rate gives you the confidence and hard data to lay a patient's fear of failure to rest
• The exact language to uncover the real objection — "while you're here, what specifically do you need to think about?" — and why going quiet after is the whole move
• How to close the loop with take-home materials and a scheduled next appointment instead of letting an undecided patient drift away

A must-listen for any doc playing in the deep end of high-value cash services — because the difference between 2 starts a month and 6 often isn't your treatment. It's what you do in the 10 minutes of objections that follow the plan.

🎧 Tune in and learn how to turn "let me think about it" into "let's get started" — because patients buy hope, certainty, and a clear path back to their lives.

🎙 Episode 54 – Red Flags That Tell You a Patient Is Not a Good Candidate for Spinal Decompression

In this episode of The Practice Builders Podcast, Dr. Pankonin breaks down six major red flags doctors should watch for when selecting spinal decompression patients.

Successful decompression starts with proper patient selection. An MRI may show disc degeneration, bulges, or stenosis, but that does not automatically mean the patient is a good candidate. The MRI must match the patient’s symptoms, history, and exam findings.

He also discuss why doctors need to set realistic expectations, screen for psychological and compliance barriers, and look at the bigger picture when patients have significant comorbidities like obesity, smoking, poor conditioning, or lifestyle factors that may limit results.

Key topics include:

• Why the MRI must clinically correlate with the patient’s symptoms
• When severe multi-level central stenosis may limit decompression outcomes
• How fear-avoidance, disability mindset, anxiety, or depression can affect results
• Why “miracle seekers” often become disappointed patients
• How poor compliance can sabotage a 24-visit decompression plan
• Why comorbidities and lifestyle factors must be addressed before or during care

The big takeaway: not every patient with a bad MRI is a decompression candidate. The goal is to identify the right patients, set clear expectations, and create the best possible chance for a successful outcome.

Doctors should define success around meaningful improvement, such as at least 50% pain reduction and better function, rather than promising to “fix” or “cure” the condition.

🎧 Listen now on your favorite platform!