Tips Report

at mPower Physical Therapy

10 Tips report on Everything You need to know about Physical Therapy to help you regain or maintain your mobility for LIFE without Pain Pills, Medications or Injections.

We get it, it is so confusing with your friends, family and a variety of healthcare providers tell you what worked for them. How to help with your pain to get you back to being active without fear of losing your independence of doing the things you love. Not to mention Dr. Google.. LOL
Medications and rest are sometimes the first option with some doctors, You end up going to specialist and they spend 5 min with you and take imaging and based a lot of their decisions off the imaging. Maybe you get sent to physical therapy and you go to one of ‘those” places.. If you ever have had physical therapy you will notice you are in there with 2-3 other patients per therapist or you might get pushed off to tech. They don’t have the time for you and you end up going for lots of visits without results. You then try other healthcare providers. You end up feeling like you are on a merry go round of treatments and not feeling in control of your pain or the process. Sound familiar? Or maybe you are in the process of figuring out where you want to and you do not want to go down that path I mentioned above. Either way you are in the right place.

Here are my 10 Tips report on Everything You need to know about Physical Therapy to help you regain or maintain your mobility for LIFE without Pain Pills, Medications or Injections.

Tip #1: MRI – Imaging and MRI often leads to overtreatments such as expensive surgeries.

So often patients want to get imaging or have had imaging and get news from their doctor that they have scary terms such as “degeneration” or “arthritis” or they have a RTC tear or meniscal Tear. It leads you to think that there is nothing I can do or I have to have surgery.. Not always true.

The research on imaging is not great. If you take 100 people with no pain or problems (they are able to do everything) and image them, 60-80% of people will show arthritis, degeneration, RTC tears, meniscal tears, etc. It is a part of the aging process and the percentage goes up as we age. Much like getting wrinkles on our face.. It just happens. But now you have pain and you get imaging. Is what was imaged there before your injury? You don’t know…

It is why you need to get a thorough evaluation by a specialist to truly understand what is going on.. Let me tell you a story.. I had a patient I tried to see with shoulder pain. She was not getting better with physical therapy (she went to one of those places with multiple patients per therapist and doing cookie cutter exercises without a thorough evaluation). She tried acupuncture, injections, got imaging and it showed a RTC tear. I told her not to have surgery. Let me see you first.. She decided to have the surgery. Here we are 5 months after surgery and she was worse than she was before the surgery. She could not raise her arms to wash her hair. She finally decided to come in to see us.. You see her pain was in her shoulder, but her problem was in her neck!! Yes, we treated her neck within a few weeks she was feeling better for the first time in 2 years.. Please do not wait this long to come in and have us check you out..
Imaging showed RTC tear, but that was not the problem. It was a neck problem.

Tip #2 How we feel pain and why drugs and injections don’t work…

We feel pain in 3 different ways, Chemical, Mechanical, and Thermal. Thermal we will take off the table.. It is burns, sun burns, etc. No typically what is hurting us with an injury.
Chemical pain can be treated chemically (aka drugs). What is chemical pain? It is when you have an injury and you have swelling (aka chemicals). It is constant pain and feels like a throbbing. It DOES NOT come and go or happen one day and not the next. Which leads me to mechanical pain.
Mechanical pain is when you have something mechanical wrong (fix able issues with joints, imbalances, over use issues with muscles, tendons and joints, etc). It can also be something that truly needs to get fixed by surgery mechanically. So you need to find a good mechanic (aka physical therapist who understands the body) to help you address your mechanics. Mechanical pain can come and go, be constant, happen with movement and CAN NOT be addressed with drugs (chemicals). It is why you take drugs and they do not work. Most of the time, my patients have not clue how they injured themselves. It is not from a fall or accident. Which is good news and bad news. The good news is, you usually do not need surgery. The bad news is you need to figure out what you are doing and where the source of the problem is located.

Here are a few questions you can ask yourself to determine if you need to medication or just come in and see a movement specialist in physical therapy.

  • Does your pain come and go? – Not chemical
  • Can you move and increase or decrease your pain? – Not chemical
If you answered yes to one or both of these questions, find a specialist to help you address the problem and not treat your symptoms.

Tip #3 Where you pain is located is not often where the source of the pain is located

I do not know how many times people come to me and they had knee pain and they went to other healthcare providers and all they did was go to the site of the pain and treat that. The patients sort of get better but not fully. They come into see us and we found out that they had a hip or back issue or a combo of that and the knee.

There is a process. Phase 1: you have to figure out where the sources of the problem are and figure out what you are doing in your daily activities that can be contributing to the problem. This can be multiple issues going on as most of the time you have been compensating for years that eventually breaks the bottom down. You can not go to strengthening without figuring out the source.

Phase 2: Now once we get to the source, you now need to work on the muscle and tightness imbalances. By the time patients get to physical therapist it has been a few months to years. So with injuries that have been around for a while, there will be compensation which causes weakness in areas and tightness in other areas. This needs to be address next.

Phase 3: Getting you back to your activities you love safely. This can be breaking down your technique with whatever activity you want to get back to and progressing your training safely. No many physical therapy offices can do this part. They usually will just let you go when the pain is taken care of.. Then you get back too fast to activities and the pain returns due to tissue tolerance (tissue not tolerating the load or activity by doing too much too soon).

Tip# 4 80% of injuries do NOT need surgery.

Say what??!? Yes, that is right. Let me tell you why. As I said before, most of the people who come in have not clue what they did to injure themselves. Which means it is something that has happened over time with compensation or prolonged postures and positions that our body does not like. Did you know they have research showing that meniscal surgery in most cases the patient is not any better off than by not having surgery? That people in line for a total knee replacement getting an evaluation by a specialist, that 40% of them no longer needed surgery because they felt better. That we do 200% more back surgeries in this country than any other country.
Now if you fall and fracture something and your bones are displaced you need to have surgery. If you have something sinister going on like an infection or spinal cord compression or drop foot due to nerve compression, you need to have surgery. The sinister conditions happen less than 1% of the time. As a specialist, since we see you more often, we tend to catch these sinister cases that doctors miss. It does happen, but it is like 1 or 2 patients a year.
Our bodies have an amazing ability to heal, if we give it the right environment. If you don’t get to the source of the problem, physical therapy won’t work. If you push too hard for what the tissue can tolerated, it won’t work, if you do not have the confidence to let the patient know I have seen this, you will get better, it won’t work. You need a specialist who understands the whole body.

We do more surgeries in this country because you guessed it.. We do MRI and imaging without thoroughly evaluating a patient due to lack of time healthcare providers can spend with the doctors. It is easy to do a test and give you a pill or say lets do surgery, because it takes less time. Now I am not say thing happens all the time, but it happens more often than not. Doctors do not know what physical therapist can do, because not all physical therapist are the same. You go to a physical therapist that can not spend time with you and does cookie cutter exercises and it does not work. Which comes to my next tip…

Tip #5 How do you know a Physical Therapist or facility is going to be the right for me.

Not all Physical Therapy facilities are alike. Just start asking around. If you start looking at the websites, you will not find many places that specialize in AVOIDING surgeries, injections and medications. Most places you will see 2-3 patients per therapist per hour. You might get pushed off to a tech. That means you may see the therapist for 10 min. Or they do not spend any time with you because they are doing notes. It happens all the time. And the Hospitals, well if you like spending $400 a visit and get a physical therapist who may or may not be there in the next year and your relationship is lost.
Here are a few questions you can ask as you interview places…
  1. Do I get to see the physical therapist one on one for every treatment?
  2. Can I sit down with the physical therapist to see if they can help me without spending money?
  3. Do you have any education materials I can read about my condition written by someone in your facility (not from google)?
  4. Can you give me any ideas or examples of patients you have seen in the past with my condition? Can you give me an example?
These are great questions to start with.. You want the service to be able to provide you more time. The more time you can get with your provider one on one, the better your outcome.

Tip #6 How is physical therapy different than chiropractors, massage therapist and personal trainers.

First off all, lets talk about massage therapist and personal trainers. While there are amazing personal trainers and massage therapist out there, they do not get the education to do a full evaluation on figuring out where the source of the problem is located. Massage therapist treat or maintain your soft tissue, but why is that tissue tightening up in the first place? Is the tightness just a symptoms of something else that is going on. I literally can release a trigger point at times without even doing soft tissue. If you get to the source of the pain, the tightness just melts away. But if you just treat the symptom of the tightness, that is why you have to keep on going back and you feel good for a few hours or days, but it comes back again.
Personal trainers know how to train you for performance, but do not know how to do evaluations to understand where your pain is coming from. If they claim that they do, you might want to find someone else as they might be hurting you. While some will try a few things to see if they can help, but when they realize they cannot, they usually are the first to tell you or refer you to someone who can help like a physical therapist. So often these providers go to the side of the pain and do not address the other parts of the body that could be causing the problem.
Finally, Chiropractors. Yes, there are some amazing chiropractors out there.. However sometimes giving education on what you are doing throughout the day that is creating the problem is not there. They also typically do not get to phase 3 of getting you back to your activities safely with strengthening and flexibility issues. As well as progressing your safely back to playing tennis, or running, or playing with your kids, or working out.. You can not go from zero to 100%. It is like training for a marathon. You do not go from running 2 miles to running 20 miles in 1 week. You would injure yourself. You need a training schedule but for an injury and we do this really well. Not all physical therapist are able to do this piece of things.

Tip # 7 Common Questions: Does physical therapy hurt?

We often hear people are afraid of physical therapy because they hear it hurts.. Well, when you come to the right healthcare provider, one who listens to you, this will minimize the pain you get. This is one of the reasons on the first visit we do not give you very much to see how your body responds because it takes 24 hours sometimes before the body responds to what we did on the first treatment. I explain it like working out for the first time, soreness sets in 24 hours later. Something happens with physical therapy. So we have to adjust the treatments based on how your body responds which is why we are tailoring what we give you based on the baselines and your response to treatment.
I also like to tell patients there are two kinds of hurt. One is a hurt so good. That hurts and feels good at the same time. But there is also a hurt, hurt. It does not feel good. I explain this to patients so they can give me feedback on what we are doing along with the baselines we take in the evaluation. You are always in control and we are always asking questions to get feeback that will help us guide you in the process of getting you back to doing what you love.

Tip #8 Common Questions: What do I wear?

You just need to wear lose fitting clothes. If it is your shoulder, then wearing clothes that we can get to your shoulder. Or if it is your knee doing the same thing. The first visit we will be talking and asking questions to get a better understanding of what is going on and where we need to start. So, if you do not wear the right clothes on the first visit, you will be okay.

Tip #9 Common Questions? How do I know this Physical Therapy is Right for me?

There are a lots of physical therapy places out there. Most are good at taking care of you after surgery and following the protocol, however not all are good at preventing surgery, avoiding medications or injections. If you get to a place that sees 2-3 patients per therapist and you are not progressing or you are given cookie cutter exercises and they do no listen to you when hurting, you might want to find another location. We have had patients that complain their knee hurts with the bike and leg press, but they keep the patient doing these activities and tell them it will get better. This patient did not need to be doing those activities yet. We needed to step back and get to the source of the problem before getting to the strengthening and recover of function stage.

Tip #10 Common Questions: When will I see results?

People can see results between the first and third visit. Sometimes it takes time to rule out conditions as we see how the body responds. Remember a knee pain could be coming from the back or hip. There is a process to the evaluation, so we do not miss any piece. After that we continue to provide updated treatments with each visit which is why patients do not need to come in 2-3x a week. You have access to the therapist during the week for any questions or concerns that come up.