This is IMPORTANT
Look at this picture. I’ve been discussing this a lot with clients and also doing quite a bit of reading on this subject.
Just because you don’t have pain, doesn’t mean that your body is in perfect working condition and just because you are in pain, doesn’t mean you need to immediately have surgery or be overly concerned.
*Now, insert disclaimer* Please always see a medical professional for any and all injuries and medical advice. 🏻
This picture shows what imaging on Asymptomatic people found. Pretty impressive I must say. A vast majority of the population had slight tears in their knees, shoulders, hips and many have degenerative disks in their low back and don't even know it.
So...why bring this up? If you have pain and get an MRI, is the MRI showing you what's actually wrong, or...what used to be wrong?
Pain is not always related to what's in your MRI.
Benefits of In-Home Mobile Outpatient Therapy for Orthopedic Surgery Clients Medicare Part B;
No Home Bound Requirements
1. Improved Surgical Outcomes:
a. We can see the client at home prior leading up to surgery to prepare for surgery and complete a home safety evaluation to ensure the environment is set up optimally for the client.
b. We can see the client the day they return home from surgery or the day after to ensure safety in the home and initiate the physician’s protocol right away.
c. There are fewer missed visits when the therapist goes to the home, which improves outcomes with consistent therapy input.
d. Therapy in the home allows the therapist to determine how the client is functioning day to day in their own home and can offer education and training that will have a significant positive impact on recovery.
e. One on one attention. Often in an outpatient setting therapists are working with multiple clients at one time. The one-on-one attention provides better therapy outcomes leading to improved surgical outcomes.
f. Therapy in the home allows us to work on functional tasks in their natural environment at each setting vs. having to simulate functional tasks like getting in and out of bed, going up and down their own stairs, getting in and out of their shower.
a. Since we provide therapy in the home, clients do not have to find a ride to an outpatient clinic. Client’s often cannot drive to outpatient appointments following orthopedic surgery depending on type of surgery and medications.
b. Therapy in the home saves the client time. They do not have waiting room delays and do not have the drive time.
c. We see the clients when it fits best in their schedule, vs. when it fits best into an outpatient clinic schedule.
d. Care coordination is improved. Many clients have difficulty finding a caregiver to take them into a clinic. We also work with several community organizations to get clients the equipment and additional services they need.
a. Reduced risk of injury and falls trying to leave the home and getting to an outpatient clinic.
b. Removes the burden of transportation to and from the clinic.
c. Decreases the amount of people clients are around, minimizing risk of clients being exposed to different illnesses such as COVID.
a. Saves client’s money.
i. They do not need to spend money on gas.
ii. They do not need to hire someone to drive them.
Links to Articles
Weight loss is a hot topic in our society and many struggle with weight control. This is why weight loss is one of the top New Year’s resolutions every year. There are a number of factors that go into a successful weight loss plan, and exercise is one of them. Surprisingly, the exercises provided by mobile physical therapy can play a major role in accomplishing your weight loss goals.
Physical Therapy and Weight Loss
When you see a physical therapist, it is usually to recover from an injury or help alleviate a painful condition. Very often, the pain you are experiencing can be at least partially linked to weight gain.
Carrying too much weight can have several adverse effects on our bodies. These include:
Your physical therapist will perform a full assessment of your body and health, target areas of concern, and customize an exercise program designed to reduce and eliminate your pain and make you healthier. Your therapist will teach you the correct form for each exercise, so you can perform them with minimal pain and strain; and if one of your concerns is carrying around too much weight, you will be given exercises that will help get rid of the excess pounds.
Physical therapy works well largely because it is in keeping with Newton’s First Law of Physics “an object in motion stays in motion…” Or in the case of human beings, “a body in motion stays in motion.” In other words, if you exercise consistently, one success will stack on top of the other, and before you know it, your injury is healed and you are experiencing weight loss.
There is one key ingredient that makes all this happen; momentum. The power of momentum to make a permanent behavioral change and/or develop a new habit in your life cannot be understated. When it comes to physical therapy, this means keeping your appointments with the therapist and doing your prescribed exercises consistently.
Mobile Physical Therapy and Momentum
One major challenge for those recovering from an injury and/or trying to lose weight is that it is rarely a seamless process. There are good days and bad days. Days you feel good or great, and other days when you are experiencing pain. On those painful days, you may not even feel like getting out of bed, let alone going to the hospital or clinic for therapy. And unfortunately, missing appointments can be a big momentum killer.
Mobile physical therapy provides a solution to this common issue. With mobile therapy, the therapist performs the sessions in the comfort of your own home or office. This eliminates the need to drive or get a ride to your therapy appointment, which can really be a lifesaver on days when the pain is especially severe. By coming to you, it is much easier to keep your therapy appointments, allowing you to capitalize on the power of momentum and more quickly accomplish your health and weight loss goals.
Texas Physical Therapy Practice
Fitness and weight loss is now in the scope of the Physical Therapy Practice in Texas, if you have been told by your medical doctor to lose weight, it could be considered medically necessary qualifying for some insurance and HSA plans to save money and get you feeling better.
If you have never had Dry Needling therapy before you may want to read through the frequently asked questions below to familiarize yourself with what to expect after treatment:
What should I do after dry needling?
Generally you will not need to do anything after treatment except rest. Simply drink plenty of water and get a solid night of sleep. It is best not to workout after dry needling, but walking or any gentle movement is helpful to promote blood circulation. If muscle soreness is excessive then applying heat or alternating ice & heat can be helpful.
In the traditional approach to Dry Needling (from Janet Travell, MD), dry needling was followed by heat and gentle stretching to the effected area. While this may improve the effectiveness of a dry needling treatment, it is not entirely necessary. after a treatment as this could stir up more inflammation and prolong the healing time.
How long does it take to see results with Dry Needling treatments?
It usually takes 2-3 visits for lasting changes to hold. Usually the muscles will relax at first then fall back into old patterns of pain and dysfunction. Therefore, there is a cumulative effect over multiple treatments where the neuro-muscular patterns are retrained. After a certain number of treatments the pain cycle is broken and proper muscle and nerve function is restored.
What are the other possible side-effects of treatment?
The majority of patients report having sore muscles after dry needling. The targeted muscles may feel like they are a bit bruised but also more relaxed at the same time. It is common for the soreness to last between a few hours and a few days. Drinking plenty of water will speed up recovery. Soaking in a hot bath for 20 minutes (with 2 cups of Epsom salts) should also help.
Local bruising from the treatment is possible, but not a cause for concern. Any bruising will disappear quickly and should be restricted to large muscle groups such as the shoulders.
It is common to feel tired, emotional, “out of it” after treatment. This is a normal response that can last up to 1-2 hours after treatment. Most likely this feeling will pass quickly and you will sleep better than usual following treatment.
It should be noted that there are times when treatment may actually increase pain symptoms. This is normal and part of the body’s healing cycle. The normal healing cycle is pro-inflammatory at first then anti-inflammatory later. If worsening of symptoms continue over 2 days after treatment, keep note of it, as this can help your acupuncturist adjust your treatment approach.
Schedule an appointment for dry needling today:
That statement might sound a little extreme, so let me clarify it a bit. First, our clinic deals with pain and injuries. So this post is about diagnoses for musculoskeletal conditions. Hopefully, it’s obvious that if you’re dealing with pain caused by something like cancer, your diagnosis is VERY important and you need to get the appropriate treatment based on that specific diagnosis. Secondly, there may be a time when your diagnosis is even important for musculoskeletal injuries. But those scenarios are rare. Most of the time, when a patient walks into our office with a specific diagnosis, I keep it in the back of my mind but it usually doesn’t play a role in treatment. I’m sure this is a little confusing so let me start with an example.
Why A Diagnosis May Not Matter Let’s use shoulder impingement as an example. We have seen dozens and dozens of patients that have been diagnosed with shoulder impingement via x-ray or MRI. Shoulder impingement is believed to cause pain when a part of the shoulder blade rubs against the tendons of your upper arm and/or shoulder muscles. So one would think that this diagnosis would be key for treatment. Unfortunately, pain is a lot more complex than what is seen on an x-ray. With all the shoulder impingement causes we have seen, many have improved with muscle therapy techniques such as Active Release, Graston Therapy or Functional Dry Needling.
A large number have also improved with repeated movements (McKenzie Method) , where the patient moves their arm in a specific direction over and over again several times a day. Another group improves with treatment to the neck, as shoulder pain is often referred from a problematic neck. Sometimes, our treatment isn’t helpful for a patient so we send them out for an anti-inflammatory medication or injection. In the vast majority of all of these patients, they end up being completely functional after treatment and usually 80-100% pain free after 2-8 visits. But, if we were to do a repeat x-ray, I would bet money that the x-ray would look exactly the same as before. So, if the pain was caused by their diagnosis of shoulder impingement, none of these patients should have improved with our treatment or the medication/injections.
Why A Diagnosis May Lead To Unnecessary Treatment. So what gives? The problem with musculoskeletal diagnoses is that it is very rare to have no abnormal findings, even if you are completely pain free. MRI studies have repeatedly shown that 40-75% of PAIN-FREE individuals have disc bulges or disc herniations. Fifty percent of PAIN-FREE males over the age of 50 have a rotator cuff tear in their shoulder. Almost seventy percent of PAIN-FREE individuals have a hip labrum tear. If we relied on diagnoses, this would mean unnecessary therapy, injections or surgery for all of these patients, despite being pain free.
So if diagnosis isn’t the main part of examination, what is? Classification. Categorizing a patient’s symptoms into a pain syndrome class is where modern medicine is heading in regards to musculoskeletal injuries. Is your problem due to a joint issue (a derangement classification)? Then you may need repeated movements or adjustments. Is it due to a problem with a muscle (dysfunction)? You would respond well to muscle therapy and exercises. Is the it constant, does not change with movement and worsening? It may be chemical irritation, which would need rest, an injection or anti-inflammatory medications.
Our goal isn’t to change x-ray or MRI findings, our goal is to get patients to have a functional and pain free life. If you have pain, don’t worry about your diagnosis. Let somebody classify your condition.
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When to apply ice:
Generally speaking, the best time to apply ice is within 24 to 48 hours immediately following an injury. Application of ice during this stage has been shown to reduce the formation of edema and “secondary injury.” After that, it really becomes a personal choice. If you’re in pain, and ice makes you feel better, go for it! Some research has claimed that icing an injury after 48 hours is “bad” for you. But if you really dig into the research, it’s inconclusive on this topic. What I tell my clients is that if something feels irritated or inflamed – go for ice. It’s a much better and more natural alternative to pain pills!
When to apply heat: Once you’re into the chronic stages of injury or pain, I’m generally a fan of heat. But the term “heat” is relative – and doesn’t necessarily refer to the application of a heating pad only. In fact, research has shown that heating pads are not able to penetrate deeply enough to actually have an effect on the injured muscle or soft tissue. But it does feel good… which can be beneficial in and of itself because when you “feel” better – your nervous system relaxes. If the superficial heat can relax the nervous system enough so that you can actually tolerate the movements or exercises that WILL actually heal you – then I can see a benefit.
The BEST way to provide “heat” as a way to promote healing to an injury is through movement – but you need the right prescription. The mistakes I often see, especially around 2-4 weeks post injury, is that people aren’t moving enough (if at all), or they are overloading the tissue and moving too much.
Movement truly is medicine, and it’s one of the best and most natural ways to properly heal from an injury – but you MUST get the prescription right.So there you have it. You can’t really go wrong with either modality. The general rule is that if it’s an acute injury – ice up to 48 hours. For anything else, we typically recommend heat.
If you’re presently healing from an injury and not satisfied with your progress – perhaps you’re just missing the correct prescription. If you’re wondering what that magical movement is, or you’re wondering if the current movement you’re doing is safe, get in touch!
Speaking of movement as a way to heal…
Book a discovery visit to see how we can help you move better through targeted training.
We will design a program to help those who are dealing with lingering back problems, learn to move, and heal the RIGHT way – from the inside out with proper training. It’s also ideal for those that had recent back surgery and you’ve already been through your initial stages of general physical therapy.
Tags: back health, back pain, bruise, chronic pain, heat, heating pad, ice, ice pack, inflammation, injury, knee pain, movement, movement as medicine, pain, physical therapy, crossfit, pt, swelling
When anyone suffers an injury or is in pain, it is completely natural to wonder what went wrong and how we can avoid it from happening again. In most cases, it boils down to a simple equation of load versus capacity. Every tissue in the body has a certain capacity. If we apply a load that's much greater than the tissue's capacity, there is a higher risk of pain or injury. But if we apply that load slowly over time and actually give time for the tissues to make adaptations to that load, we should be fine because the capacity of those tissues will slowly increase. For example, muscles will get stronger, bone density will increase, tendons become more resilient. However, if we apply that load quicker than the tissues can adapt, we are more likely to get injured. For example, if you drop a brick on your foot, the load is much greater than the capacity, and it is applied abruptly so there is no time for adaptation.
While that example may be amusing, the more common scenario we see is someone who starts a new activity quickly. Again the load is greater than the capacity, and although it isn't as abrupt as trauma, it is still quicker than the body's ability to adapt, so the tissues start getting damaged and the capacity actually goes down. In both these situations, the load is applied faster than the tissue can adapt. On the other hand, sometimes we're smart and we keep a workout routine or running load constant. All is well until stress, illness, poor nutrition, not enough sleep, or many other factors reduce the capacity by hindering our ability to recover from each workout, and the capacity goes down. This lowered capacity also leaves us more vulnerable to injury. And in addition, pain can also be influenced by our beliefs, expectations, past experiences, and other things that are happening in our lives. So most injuries can be attributed to this load-capacity relationship.
Unfortunately, many people are told that their pain is due to biomechanical abnormalities, such as asymmetries in their anatomy or that they just move wrong. Examples of this can include a short leg, flat feet, their glutes not activating, their sacrum is out of place, or other things. These factors have been researched, and the conclusions are that many simply don't even exist. Of those that do exist, they may very well lead to higher stresses on certain tissues, but even then they play a small, if any, role in pain or injury. The fact remains if you give the body enough time to adapt, injury and pain are unlikely, even when we're not built perfectly or we don't move perfectly.
If you've ever watched the Paralympics, you quickly realize that humans are capable of performing at extremely high levels while possessing massive asymmetries and compensations, as long as you give the body time to adapt to the loads. We need to keep this in mind when thinking of the real cause of most injuries. Try not to get down on yourself in thinking that you're defective in some way, and don't be over analytical about how you move. Just think back about where you changed something too rapidly in your sport, your running, or your daily life. We also need to remember this if we somehow do get pain or injury. Once injured, it may become necessary to temporarily reduce the load with some rest.
But remember that if time of protection becomes prolonged, the tissue capacity will also reduce, and consequently less load is required to get injured again. This makes it necessary to make a slow return to previous levels of activity. The important thing to remember is that in the long run keeping some mechanical stress applied to the body is a good thing, as long as we respect the time it takes for the body to adapt. Be sedentary, and your body will adapt by reducing its capacity. Gradually and slowly increase in activity, and your body will adapt by increasing its capacity. Do it too quickly, and you may get injured. But if you remember the concepts of load versus capacity and tissue adaptation, you're on your way to understanding the root cause of most pain and injuries.
Healthcare is a disaster, and coaches and fitness professionals are the best possible solution. In this video, I'm going to explain to you why healthcare is a disaster, how it got that way and why coaches are the perfect fit to solve the problem.
It all starts with the way that doctors are paid. And we're talking about doctors who are managing musculoskeletal pain, so issues with joints, ligaments, tendons, muscles. The reason why, the way that those doctors are paid is a big part of the problem, is because the reason that people enroll in the schools that allow them to have the licensure to treat patients; chiropractic schools, physical therapy schools, medical schools, massage school, those schools all attract students with the promise of a reasonable certainty of financial return upon graduation. What that means is that people don't just become doctors because they want to help people. Certainly that is a part of the reason. The other part of the reason is because they believe that it's likely if they become a doctor, they're going to be able to make a good living doing it.
What happens next is we look at how doctors are paid. Doctors are paid by insurance companies based on their ability to help their patients reach what are called A-D-Ls. ADL stands for activities of daily living. Examples of ADLs are your ability to go to work, your ability to sleep through the night, cook food, drive your car. The way that ADLs are measured is your deficiency from what is considered normal and your ability to do them.
So maybe you should be able to sleep through the night without waking up at all, for an example. The doctor would write into the notes that you are currently only able to sleep for 30 minutes at a time due to the pain that you're having. That sets the baseline for how the insurance company decides how many visits they expect you to need before you no longer need care because they have evaluated millions upon millions of cases, just like the patient in question. And they have algorithms that let them know based on how the incident occurred, how long a person's been dealing with the problem, what the severity of the problem is, what interventions they've had in the past, they know about how many visits they think it should take to resolve the problem.
What happens now is the insurance company will allot your chiropractor or your physical therapist X number of visits based on their algorithmic math. What the doctor now has to do is treat the patient within those visits or ask the insurance company for more visits, which by the way, makes it appear is if the doctor is less efficient to treating patients than their peers. So what actually ends up happening is doctors ask for less visits because they don't want to get slapped on the wrist by the insurance company and told that they can't have patients come to them for payment without extensive documentation of what's going on because the insurance company wants to understand why they're so inefficient.
What happens next is doctors are accountable to helping their patients achieve ADLs, like we described before. So once the patient has achieved their ADLs, the doctor will no longer be paid. And if it takes the doctor too long to help the patient achieve their ADLs, the doctor will be inundated with paperwork and eventually cut off anyway. So it's in the doctor's best interest to see the patient as few times as possible to get into good standing with the insurance company who's cutting them the checks.
The problem is many of the patients who walk into the doctor's office, aren't actually there for ADLs at all. They're there for what we call ADIs, activities of daily interest. Schools who educate the students, who come through them to become the licensed professionals, are counting on those students becoming licensed professionals who will get paid by the insurance companies. What that means is instead of teaching those students how to treat for ADIs, activities of daily interest, they are teaching their students how to treat for ADLs, because that will be predictably paid for by the insurance companies in the professional world on the backside of their education. After all, nobody is going to take out 150 to $300,000 in student loans if there isn't a reasonable expectation that they're going to make that money back after they get the education done.
So what ends up happening? What ends up happening is there is nobody whose job it is to help you get back to the things that you're interested in. Once you can go back to work, sleep through the night, change the channel, drive your car, insurance companies stop paying. So schools only educate their students largely to get their patients to be able to do those things. Sure, there are elective classes and there are some schools that go above and beyond, but we're talking about the rule here, not the exceptions.
So schools are teaching their students how to get their patients back to their ADLs; driving their car, going to the bathroom, sleeping through the night, doing their job. Doctors are taught to stop treating the patient after they've achieved their ADLs. But your interests lie, your client's interests lie in being able to lift heavy weights and being able to run five miles at a time and being able to play pickup sports on the weekend and being able to play with their kids and chase them around the yard and being able to go fishing. No one's teaching doctors how to help patients with that problem. The unfortunate opposite side of this is that coaches aren't really taught how to help people with that either. So whose problem is it really?
We believe at Active Life that while medical professionals could be retrained on how to do this for their patients, that is the wrong place for us to be focusing. Medical professionals, doctors are the people who should be there to restore one's ability to regain access to activities of daily interest. It's the coach's job to be able to take the client, who just finished being a patient all the way across the finish line. No insurance company is going to reimburse a doctor who says that their patient feels fine, except when they're dead lifting over 200 pounds. No insurance company is going to reimburse a doctor who says that their patient is fine, except when they run five miles or more. No insurance company is going to reimburse the doctor when their patient says, "They're fine," unless they're throwing the ball as hard as they can.
These are things that do not classify as activities of daily living. They classify as activities of daily interest. Therefore, they will never fall into the purview of the medical professionals. The best people in the world to grab this slack and do something of meaning with it are coaches. The problem that coaches are facing today is that the amount of education that a coach has is so variable. It could be a textbook and a test. It could be a weekend seminar. It could be an extensive course load. No matter what it is, there is a wide array of inconsistency that is there. And most coaches who are getting the certification are doing it either by the textbook variety or by the weekend certification.
Most coaches don't know the difference between the function of the gluteus maximus and the gluteus medius. But these are things that they need to know if they're going to be able to help their clients bridge the gap between ADLs and ADIs. Most coaches aren't even educated on the various planes of motion; frontal, transverse, sagittal. So they don't know how to address problems that only exist in one, but not the other two.
At Active Life it's our ambition to humanize the doctor, professionalize the coach by providing them this education, and empower the individual by affording them the opportunity to go to a doctor who has been humanized, who understands that their role is to help with ADLs and then refer to the coach whose job it is to help with ADIs, so that the individual can get the outcomes that they want. I believe that we can fix healthcare if we start looking at it for what it is, incentivizing people who need education to be able to fill in what it is not, and that's our mission.