…and why you don’t need a PT to do hands-on treatment!
I was talking to a classmate from college today who has been having ongoing knee pain for months now. She is an avid CrossFitter who also likes to bike and run, but her knee pain is so bad that it now hurts to sit at work and gets in the way of her daily activities.
When this first happened, she went to a sports orthopedist, who diagnosed her with tendonitis and PFPS, and referred her to physical therapy. She has been going to physical therapy for three months now, and really isn’t sure if she is making any progress.
She says that she usually is frustrated, and is now just feeling sad. She cannot do what she loves, doesn’t know what is wrong, or why she isn’t getting better. She is debating going to get an MRI, but knows that it might be expensive and doesn’t know what it would tell her.
We hear stories like this all of the time, and I wanted to take some time to answer these common questions to help others like her in their wellness journey.
Why you DON’T need and MRI to know what’s wrong.
Let’s use low back pain as an example. Most patients that feel that they need an MRI to know exactly what is going on, even after I’ve evaluated and treated them. An MRI, as a routine diagnostic tool for common low back pain, will not tell you why your back hurts, it will only show you things that are already there and which are common for most people. Furthermore, an MRI for low back pain typically leads to more procedures and surgery than necessary, when a quick visit to a physical therapist can give you the tools you need to begin to heal and recover from back pain right away. Physical Therapy for low back pain has better outcomes than surgery, is less expensive than an MRI and Surgery, and it is much, much, much less risk to your personal health and well-being. People can die in surgery or from the side effects, and Failed Low Back Pain Syndrome means that surgery did not work, which is about 50% of the time and this is a well documented condition (ie. problem) in the medical literature.
So, when do you need an MRI?
If you have neurological signs and symptoms including bowel and bladder dysfunction, your foot drops or drags, or possibly if you have a personal history of cancer. Your physical therapist can determine if you need further evaluation by a physician.
So what should you do instead of getting an MRI to know what’s wrong?
Go get a Total Body Diagnostic to find the CAUSE of the issue.
A total body diagnostic is where we take a look at your whole body and how it moves.
Because, where your body hurts may not be where the problem is. You can have shoulder pain, but it’s because your mid back doesn’t move well. Or, you might have hip pain, but just because your ankle’s not moving well. One story we hear too much is people go in and you say, “Hey, doctor, my hip hurts.” And they say, “Oh, that’s bursitis. Let’s do an injection.” And then it doesn’t work, so let’s do an MRI. Then, they see that you’ve got a torn labrum. They tell you to do some surgery to fix your labrum. This whole time, you’ve never been to PT or you’ve never been to multiple PTs. You’re going down the wrong path, but it’s not your fault. Because that’s the path that is the path of least resistance for the way the medical system is being incentivized right now.
What you need to do is stop and think, ”Am I scared about my test results? Okay. I need to speak to someone who has time to sit down with me, hear my story and explain what’s happening, and even possibly offer me an alternate understanding of what’s going on.” Because if you’ve been struggling for years because of a herniated disc, herniated discs heal. They heal just like a cut or a scab. So, if it has been weeks and you’re healed, and if you’re still thinking, I’ve got a herniated disc, I can’t do X, Y, and Z, then you need to be seeing someone else. Someone who can tell you WHY you still hurt, and empower you to move.
The way we do it here, is by taking all of our patients through a total body diagnostic exam. It’s 20 minutes of your time where we sit and chat with you about what’s going on. We discuss your goals, where the problem is, how long it’s been there.
We look through your whole body. We find out where you hurt. We replicate or improve your symptoms.
But what if you have already tried physical therapy?
We like to use the analogy that physical therapy is like a restaurant.
You wouldn’t ever say, “I went to restaurant and got food poisoning, so I am never going to restaurant again,” would you? No! Physical therapy is the same way. Just because you have tried it once, doesn’t mean that it won’t work for you. You might not have found the best fit for you and your case.
The therapist and the clinic aren’t the only thing that affect success, the patient also plays a HUGE role in their treatment. We typically give patients exercises to do at home to keep them progressing even when they aren’t in the clinic. If a client doesn’t do the exercises, or isn’t honest with their PT about how often they do their exercises, or if the exercises are helping or hurting, this can make the therapist’s job a lot more difficult.
Physical therapy isn’t a magic, quick fix, and PT’s don’t fix people. The PT and the patient make up a team, like a coach and athlete relationship. Both people have to put in the work, be honest, and communicate well to see the best results.
How do you know if PT is working?
Like we mentioned before, you and your PT need to be able to communicate well to see the best success. You should know how to measure your progress, whether that be pain levels, range of motion, strength, or functional improvements. Your PT should also set short and long term goals with you so that you feel like you are still making progress no matter how small. The healing process can be filled with ups and downs, so it is important for you to be able to know how you are progressing to keep you motivated during the “down” times of rehab. In our clinic, we find that folks typically see positive changes in three to five visits. You shouldn’t need to wait three months and wonder if you are making progress.
So, why does virtual PT work?
Usually, I can tell you what the problem is just by watching you move, because most people have a MOVEMENT problem, not a structural problem. Luckily, in my friend’s case, she lives in a big city so I know a few good PT’s who she can go see. Some folks do not have that option. Some are high risk and cannot risk exposure to COVID, and others live in rural areas and do not have access to quality PT. Others are just too busy, and prefer to be seen in their home and not commute to our clinic. These are the folks who we have been helping virtually over the past year.
They love virtual PT because they can replicate what we do in the office at home, and they feel more independent and are more active in their treatment plan, leading to great results!
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