Physical therapists have tons of different tools in our tool bag. If each of us practiced solely with the goal of using these tools to get people all the way well, the public would likely have a much better understanding of how a PT can improve their quality of life. What’s the problem then? Why don’t we treat people with highly researched and highly effective hands-on care? Well, if you’ve been reading here, you know that the clinic that your talented PT works in isn’t helping.
What are some of the techniques that physical therapists can use that you aren’t getting because of “PT Mill” models and insurance company-dictated care? As a patient, you may not even know that your therapist can do these treatments.
1. Trigger Point Dry Needling
This is a soft tissue manipulation technique that is used to treat people with muscle knots and pain. People who benefit the most from this technique are those with chronic headaches, migraine, neck, shoulder, arm pain, or leg “referred” pain that results from these knots. In our practice, it is used in conjunction with other manual techniques to knock out soft tissue problems.
The problem with getting this paid for by your insurance company is that it takes a lot of time, a lot of training, education, and practice. From the perspective of ‘quick and dirty’ care seen in most PT Mills, dry needling is difficult to justify when you’ve got two patients on the table and two more in the queue. From a continuing education point of view, learning all of the skills necessary to master dry needling takes a long time and lots of resources that most PT Mills don’t have and don’t want to set aside.
Firstly, these needles are solid. There is no hole where any liquid passes through. This makes them very small, and in the world of needles, the smaller the diameter, the less likely it is that the needle will be sensed at all. In fact, when working with patients, most don’t realize the treatment has begun because they don’t sense the ‘needle stick’ they’ve come to expect. If the technique is done correctly, the sensation that we would expect is a deep cramping or aching sensation very similar to the patients’ primary pain complaint, but only when the poor tissue is stimulated. This sensation means the needles (and the PT) are doing their job.
2. REAL Manual Treatment
This encompasses any treatment that involves a PT using their hands to manipulate the patient’s joints, muscles, nervous system, and soft tissues. This is commonly done in many practices, but in our experience, far too little time is spent on this hands-on approach, and more is spent on passive care ‘off in the corner’ or with some machine attached to you. Insurance companies do pay for manual treatment, but in many cases, they will pay more for different techniques, which are the techniques that get done. This is bottom-line-driven care, not outcome-driven care.
3. Highly Intense Supervised Therapeutic Exercise
The reality is that when a physical therapist is also in charge of your high-intensity exercise program, all of your care along the spectrum of pain and performance can be taken into account. PAIN CHANGES MOVEMENT. No one would argue this. When you move differently to negotiate around pain, this will lead to more compensation and then more pain! This is why a physical therapist’s eyes are beneficial.
Personal trainers are highly skilled at teaching exercises to pain-free movers. Unfortunately, regardless of the number of years of experience, a trainer can never break down movement in depth like a physical therapist.
Many of our clients already have a personal trainer or strength coach. In these cases, we work with their trainer to ensure that the client’s care is coordinated and progressive, which will only lead to the highest level of progress for the client’s pain and movement.
One day, the health care payment system will emphasize using early assessment, preventative visits, and treatment from physical therapists to avoid big catastrophic injuries. There might be a long wait for this, so the best bet, for now, will be to get connected with a physical therapist who is highly trained in strength and conditioning or personal fitness.
What to Do to Get Yourself All-the-Way Well
Research your pain and see all of the options for treatment. Once you’ve collected your info, ask your doctor or therapist about each treatment. If they don’t have time or aren’t excited to hear that you’ve done some of your research, it’s time to look for a new pro. This goes for all of your health care teammates!
Dr. Carlos J Berio, PT, DPT, MS, CSCS, CMTPT is a licensed Doctor of Physical Therapy, Certified Strength and Conditioning Specialist, and a Certified Myofascial Trigger Point Therapist. In addition, he holds a Master’s Degree in Clinical Exercise Physiology. He has treated high school, collegiate, recreational, and professional athletes of various sports, including baseball, softball, football, hockey, tennis, swimming, golf, and martial arts. His experience as a collegiate and semi-professional athlete, as well as a professional baseball coach, make him a sought-after resource among elite-level athletes on the field and in the training room. The concept of ‘all the way well’ in his work as a physical therapist and fitness professional is what continues to drive Dr. Berio to be the best movement specialist there is.
Dr. Berio is the founder of SPARK Physiotherapy in Alexandria, Virginia. A clinic and approach designed from the ground up to set the new standard for integrity and patient satisfaction in the PT industry. Carlos remains active in several sports and enjoys agility training, powerlifting, and adventure races. He is an advocate for his patients, clients, and his fellow PT colleagues. He can be reached at [email protected].