In the physical therapy profession, imaging in the form of X-ray and MRI are regular assessments that we request and include within our patient model. Imaging is done, generally, to rule in or rule out certain conditions and to help make a medical diagnosis. Many patients believe that their physical therapist needs to see their X-ray or MRI in order to get appropriate treatment. This is often not the case! Imaging is simply another assessment in which the details therein are considered right alongside other in-clinic details, such as your squat/lunge or night-time pain, that physical therapists use to understand your biomechanics.
Physical therapists are trained to evaluate and treat people without diagnostic test results, full-stop. We do not need radiographs or MRIs to accurately assess and treat your conditions! The medical diagnoses and imaging findings are respected by the therapist, but therapists do not evaluate, prescribe exercises, or otherwise treat based on your imaging. Just as a picture of someone will not tell you a person’s story, a picture of a body part will tell a physical therapist very little about the entirety of the biomechanics of that region!
Additionally, all kinds of “incidental findings” in asymptomatic people can be found in all areas of the body with medical imaging. These findings include disc herniations, spinal stenosis, nerve compression, arthritis, hip and shoulder labrum tears, rotator cuff tendon tears, meniscus tears, signs of inflammation and tendonitis, and others, in asymptomatic people. These types of findings are in all populations – young, old, athletic (recreational to elite level), military, musicians, dominant and non-dominant sides, etc. Below is a summary of a literature review’s findings on spinal MRIs in asymptomatic populations1. As you can see, the prevalence of these findings on MRI does increase with age, but again, these are people without symptoms. Many people are walking around with “abnormal findings” with zero pain.
Pain and injuries are complex and experienced differently by everyone. A physical therapist relies primarily on a physical assessment and detailed history to determine the most appropriate treatment for someone. Each patient, even ones with the same image findings and medical diagnosis, will have a different physical presentation, location, quality, and intensity of symptoms, aggravating movements, physical activity history, stage in the healing process, personality, goals, etc. None of this can be gained from an X-ray or MRI, but all of it is important when treating someone.
So, when is imaging necessary? The most consistent time I send out for imaging is when the expected progression of recovery has stalled or regressed. As a doctor of physical therapy, I am very well trained in expected healing times of tissues. If timing is off for healing and has been so for some time, I request for imaging to add another assessment to the list in order to better fully understand what we are dealing with.
Thanks for reading,
Dr. Marcus PT DPT
“Since 2008, average family premiums have increased 55 percent, twice as fast as workers’
earnings (26%) and three times as fast as inflation (17%).”
“Premiums for employer-sponsored family health coverage rise 5% to average $19,616; single
premiums rise 3% to $6,896.”
“Deductibles for covered workers has tripled since 2008, growing 8 times faster than wages.”
Not trying to be a Negative Nancy, but that’s no bueno. Unfortunately, this is where our current
healthcare system stands.
This data was released by the Kaiser Family Foundation in a recent survey.
The annual survey was conducted between January and July of 2018 and included 4,070
randomly selected, non-federal public and private firms with three or more employees (including
2,160 that responded to the full survey and 1,910 others that responded to a single question about
Over the past decade, insurance premiums and deductibles have significantly increased relative
to workers’ earnings and inflation.
We continue to pay more for insurance, but get less in return.
We want a healthier country, but we continue to create barriers to access “healthcare.”
So how do we change this?
Use the system less and, more importantly, NEED IT LESS.
What I’m getting at is taking control of our own health. We have plenty of data to show that
chronic disease is impacting this country.
Improving and maintaining our health and wellness through movement, nutrition, sleep, stress
management, and social relationships is crucial. With technology, we have this information at
our fingertips. While it can be tough to decipher through the guruism and instamodels these days,
it’s important to do your research and find professionals that you trust with your health.
Here are some general recommendations we give:
1. Move everyday. Strength train at least 2-3x per week. Test your heart and lungs.
2. Eat real food, not too much, mostly plants (but also.. protein is life).
3. Get at least 7 hours of quality sleep each night.
4. Stress management is often overlooked and this can be managed through self-reflection,
meditation, counseling, exercise, etc. Find what works best for you.
5. Social connection and relationships is an area I believe is very important for all of us. We
all have our people and it’s important to prioritize those relationships for our own health
If you want to dive further into the details of this survey, you can find the original article here:
Insurance and healthcare is expensive. Employers and employees are starting to take notice of
this tread. They’re being incentivized to take a proactive approach as well as minimize the use of
At the end of the day, let’s get people moving better and eating less shit, and more importantly,
realize that we have the power to take control of our health and avoid being imprisoned by this
expensive healthcare system.
Dr. Ravi, DPT
Pain is NOT fun. When it interferes with daily life, playing with kids, taking the dog for walks or fitness, it becomes very inconvenient. Chronic pain is an interesting phenomenon because we often don’t know the true cause. Also, the intensity does not necessarily indicate the severity of the injury. Pain does not equal damage!
With chronic pain, imaging should have limited bearing on the decision for course of action. Although the images may show changes- tears, arthritis, etc.- what’s to say that is the pain generator? Studies have been performed that demonstrate the 60%+ of people WITHOUT low back pain have imaging that shows bulges or degenerative changes. So just because you have changes on images and pain, there is not definite proof of correlation for chronic pain. We suggest to skip the routine imaging until you have tried other options to decrease the pain.
Can you get rid of pain even without “fixing” the tissue with surgery? Yes! The body is incredibly resilient and resourceful. The body has the ability to heal; this coupled with strategic strengthening in supporting musculature can knock pain out completely. There are exceptions to every rule, but at our clinic I have seen more “injuries” successfully treated with mobility and strengthening than with surgery. Honestly, some that chose surgery realized the recovery was more tedious and painful than managing the pain while we worked through a rehab program.
Don’t get me wrong, surgery is absolutely necessary sometimes. If there is major instability around a joint or a traumatic event, we are so thankful for surgery! But it definitely something to avoid if you don’t absolutely need it.
Do I need surgery?
Have you tried physical therapy?
How much of your function is compromised?
Did you get a second opinion?
What are your goals?
How is your overall health?
Don’t settle for a “quick fix” and think that going under the knife is the first and only option. Work with a physical therapist to decrease the pain, improve the function and teach you how to keep your body healthy! We would love to help you get back to a pain-free and high functioning life.
Thanks for reading,
-The AP Team
We hear this too often:
“I’ll wait until I’m injured to go to physical therapy.”
“My shoulder hurts but I’m just going to wait a few weeks and see if it goes away.”
“When my knee started hurting I went straight to the ortho surgeon for recommendations.”
“I’ve had back pain for 15 years. It is just a part of being old; there is nothing they can do!”
Many people still picture physical therapy as the place your grandma goes when she has a hip replacement or after a shoulder injury where you perform simple band exercises for 6 weeks. Unfortunately, this leads people to think that physical therapy isn’t for them.
If folks don’t go to a physical therapist first, they go to their primary care doc or other medical docs. Many times they end up seeing an orthopedic surgeon who suggests expensive imaging that often elevates fear but also may lead to unnecessary procedures. Ok, so surgery is the extreme. Many times, people will wait a few weeks (or months!) to get it checked out. For most injuries or pains, physical therapy sooner rather than later will decrease the time it takes to get you back in the game and decrease your cost.
But what about those of us who have had pain for 6 months or 6 years?! You will see the best results from a movement specialist (that’s us!) watching you move—carry objects, bend and lift, run, lift weights, etc—and correcting any dysfunction. Hopefully the surgeon suggests physical therapy first! Then you know where to call. ☺
Physical therapy at Athletes’ Potential is different from your usual PT clinic:
- One on one with a Doctor of Physical Therapy
- One hour per visit
- Skilled hands-on techniques
- Personalized homework- not just therabands and hamstring stretches!
- No referral needed
Case Example: A middle aged, male patient with chronic shoulder pain for over 15 years! Imaging showed a massive rotator cuff tear and labral tear. Orthopedic surgeon was ready for surgery ASAP; just to be clear, this is a pretty severe injury so surgery is often first thing on the table. However, this patient wanted to try anything BUT surgery. After 12 weeks of commitment to rehab homework, coming in weekly for hands-on work and slow return to golfing, he was pain-free and beginning to have full range in his swing. Now a year later, he has no shoulder pain and a pretty solid golf swing. We focused on decreasing pain and improving function rather than harping on “fixing” the tear. It takes patience, dedication and active involvement from the patient—but it is possible!
All of this to say, if you have pain with sitting at your desk, picking up the kids or during your fitness routine, DON’T WAIT until it take you out of the game. The earlier we can address it, the sooner it will feel better. Less time and money than the other options!
Why is physical therapy at Athletes’ Potential different? As Danny always says, if you have a body you’re an athlete. Your “rehab” should prepare you to play with your kids on the ground and carry 15 grocery bags at one time! Pelvic tilts and therabands won’t get you there.
Give us a call and let us know how we can help YOU!
Thanks for reading,
This is a common question that we are asked at Athletes’ Potential. When delving into this seemingly deep conversation with patients, it becomes quickly evident that many people do not actually understand their benefits or insurance plans. It also becomes quickly evident to the patient that the current healthcare system is not an efficient one.
The short answer to that question is… there isn’t one. In fact, when folks ask if we “take” insurance, what they are usually meaning is, "Can I pay my copay to see you?” Sure, we “take” insurance in the sense that once the deductible is reached, the visit will be covered by a varying percentage. But copays are for in-network providers. What people don’t often realize is that there is still a deductible to be met, out of pocket.
The ideal insurance plan for young, healthy individuals is one that includes an HSA or FSA. Deductibles will be higher but assuming you have low healthcare costs, you will be banking money each year.
An HSA is a health savings account. It is a savings account for money that can only be used for healthcare. Many times, a business will match the amount of money you add to your HSA each month or some percentage of it. The benefit? This money can grow throughout your career into a large sum that is not taxed. So sure, use it as a store of money for healthcare but it is likely there will be some residual.
An FSA is a flexible savings account. Similar to an HSA in that it is a pot of money for healthcare. The biggest difference is that your company will put a lump of money in it at the beginning of the year and whatever is not used in that year goes away.
Other plans- HMO, PPO, etc are also common. It is usual with these that there is a network of providers that have a special rate and are often lower costs per visit—as long as the healthcare provider that you seek out is in the network.
A deductible is the amount of money that must be paid out of pocket before insurance will cover a percentage. Some insurance plans have one deductible and some have separate in-network and out-of-network deductibles.
Example: Sally’s plan has a $2000 in-network deductible and a $4500 out-of-network deductible. She pulls her hamstring and needs PT. If she chooses an in-network provider she will pay out of pocket until she reaches $2000 then her costs are covered 100%. If she chooses an out-of-network provider she is responsible for $4500 before her costs are covered 80%.
For a mild hamstring strain, the national average for visits is 10. At the usual PT clinic, they likely want you to come in 2-3x/week for 5 weeks. This cost per session could be anywhere from $50-300 depending on what the PT does with you and how long you are there. On top of that, your PT may be treating between 2 and 5 people at a time!
Technically this company “takes your insurance” but the payment still comes from your pocket. Until you reach $2000—which likely will not be met with the treatment for the hamstring.
Transparency: At Athletes’ Potential, transparency is important to us. Unfortunately, the healthcare system makes that muddy because of the complexity of plans that leads people to think all healthcare visits are a $20 copay.
The reality is, insurance is meant to be used as a failsafe for emergencies. Just like with the car—bad accident, the insurance helps. But if you need an oil change, that’s on you! Deductibles are so high and benefits are less because healthcare is being over-used. So rather than going to the cheapest place for the cheapest oil (that you will have to change more frequently), why not use the quality shop with the quality oil?
Why should you choose us over your in-network providers?
Our visit average per plan of care is half of the national average. In the long run, you will save money.
One-on-one sessions with a Doctor of Physical Therapy who understands your lifestyle and goals. We have experience with weightlifting, running, CrossFit, sports, yoga, gymnastics, etc.
Better outcomes than your usual PT clinic.
Care from a provider who thinks outside of the box, encourages input from the patient and helps establish long term performance goals.
Complete transparency with costs and plan of care.
Dr. Danny, PT, DPT, OCS, CSCS
I hate to say it but I resent our convoluted healthcare system.
We live in the greatest country in the world and yet we have such a confusing and broken health care model. I’m not here to write about my idea for a solution. I’m here to tell you how we are avoiding many of the pitfalls of our current medical model.
First, let me add some context by telling you about a recent experience my family had with a physician group.
My wife had been feeling tired for almost two years. We thought it was just the fact that we have two kids under the age of 5 and we own a business. Both of those things can be rather stressful.
We did blood work and were able to get her feeling better but it was always a short lived response.
Finally, we decided to see an internal medicine doctor and they narrowed it down to either celiac disease or small intestine bacterial overgrowth (SIBO). This was the prognosis because she had been put on antibiotics for a sinus infection around the same time she started feeling excessively tired almost two years ago.
We go to the office visit, the doctor is behind schedule and spends hardly any time with us. He gives us a couple options for testing and we decide to do a blood test to rule out celiac disease. We ask him and the front desk staff what the office visit will cost and what the blood test will cost.
They tell us they do not know.
Fast forward to 1 month later, we get a bill from the physician for $360 for the office visit. That’s $360 for a 15 minute conversation with the physician. The next day we get a bill for the blood test. Grand total for the blood test, $940. One blood test costs $940? What the hell kind of X-Men next level blood test was this?
The results of the test showed there was no celiac disease so the solution was another round of antibiotics to fix the SIBO. Great, let’s fix this thing. So we ask the doctors office how much will the antibiotics cost? They tell us they don’t know. We call the insurance company and ask what the antibiotics will cost, they tell us they don’t know.
Alright, you’ve got us by the balls, let’s just get the antibiotics and wait for another bill in the mail. The good news is, the antibiotics worked great. My wife has been feeling better than she had in years. The bad news is, the bill we got for the antibiotics was $1650.
Let’s add this all up.
One office visit = $360
One blood test= $940
One bottle of antibiotics= $1650
Grand total= $2950 plus hours of office visits and testing and phone calls with the insurance company
Here’s my general feeling throughout the entire process: Are you kidding me?
As much as the cost of everything was, that’s not the part we were mad about. It’s the complete lack of transparency in the entire process. Tell me I’m going to have to get a $1650 bottle of pills that will cause my wife to feel better and I’ll gladly pay that. Send me a bill for the same amount a month later and now you’ve got an angry consumer.
Transparency is the key. Communication is vital. This is a relationship between a patient and their medical provider. It’s no different than any other relationship.
When I opened Athletes’ Potential 3 years ago, this was a core value for us. Transparency in medical care. Why is this so rare?
If you ask me what we charge, I’ll tell you. We charge $190 for an hour long visit and it’s an absolute steal compared to the crappy healthcare you’ll get pretty much everywhere else.
-We’re always on time because we respect the value of your time.
-We’ll never send you a bill a month later for some amount of money.
-You’ll always have email access to your provider to answer any question you have because we want you to feel comfortable through the entire process.
-We treat people the way we would want our own family to be treated.
I see more and more medical providers moving this direction. It’s better for the patients, it’s better for the provider and it sets the precedence for an honest, long-term relationship.
Sadly, many of you have probably gone through the same process my wife did. This isn’t an isolated incident that we can chalk up to bad luck or chance. This is a daily occurrence in our medical system. I hope it continues to move toward a better model but in the meantime we’ll do our part with our patients.
We strive for honest, selfless service of our patients everyday. That will never change.
-Dr. Danny, PT, DPT, OCS, CSCS
Here’s a scenario I see all too often in my clinic:
You’re a middle-aged, ex-athlete but you still like to workout and are a weekend warrior. You bang your knee up a little doing a CrossFit workout or a long trail run so you go to see a physical therapist. You have a good job and you have health insurance through your company. You pick a clinic that you find that takes your insurance that’s near your home or office and go in for your first visit.
You get your diagnosis, they do some work on you and then you leave with some homework and a plan going forward. This plan is typically to come back 2-3x/week for 4 weeks. As you head to the front desk to check out, they present you with a bill. The bill is for $250 and is due today for the cost of your treatment session.
You’re completely caught off guard. You are almost positive that you had read you have a $40 co-pay for physical therapy. The front desk staff explains to you that is correct but it’s only a $40 co-pay after you’ve met your deductible. Your deductible is $2,000. She explains that once you’ve met that out of pocket expense which should be after the 8th visit, then you will have a $40 co-pay.
You pay the bill and leave aggravated. You wonder why the hell you’re paying $400 a month for insurance. Why didn’t anyone tell you before that you had to meet the deductible first before your insurance started kicking in?
My opinion on insurance is that you only win if you lose. What I mean by this is that you really only get a return on what you’ve been paying for if you get hurt badly or get very sick. We all need insurance for these catastrophic events but most people can expect their insurance to pay for very little if they are healthy.
It used to be that deductibles were as low as $200 and maybe $1,000 on the high side. I know individuals that have a $3,000 deductible on a single person policy. I’ve seen family deductibles in the $10,000 range. They are trending higher and the emphasis on the consumer (you) to pay more out of pocket is expected.
First, let’s clear up some confusion. In the scenario I laid out above, the $250 is an estimate. If the physical therapy practice that you go to is in network with your insurance, that means they have a contract and will charge set amounts. If you want that money to go toward your deductible, that clinic has to charge you the same amount they would bill your insurance company.
Let’s do a little bit of math here and show the true cost to you assuming you want to use your insurance and apply your physical therapy towards your deductible.
$250 a visit x 8 visits to meet the deductible= $2,000
4 more visits to meet the 12 visits recommended by the physical therapist at the co-pay amount of $40= $160.
Total cost for physical therapy= $2,160
Last thing is to factor in the the cost of your time. You have now gone to the clinic 12 visits, each for 1 hour. Let’s assume that round trip you drive 30 minutes to each visit, that would come out to 6 hours of driving back and forth from the physical therapist. Add in 1 hour for each of the 12 visits you spend there and that equals 18 total hours.
Total cost $2,160 and 18 hours of your time.
Let’s compare this to an out-of-network model like the one we use at Athletes’ Potential.
Because we have no contracts with insurance companies, we can charge whatever we want. Our office visit is $175 for an hour visit. This exclusion of being in network with an insurance company allows us to make decisions based on patient needs, instead of when you may or may not meet your deductible.
Our clinic average is currently between 3 and 4 visits. Let’s say we see this patient once a week for 4 weeks for a total of 4 visits.
$175 a visit x 4 visits= $700
We also need to factor in the time cost. Let’s say we have the same 30 minute round trip commute to our clinic. This patient makes a trip 4 times for a total of 2 hours driving. Total time commitment 4 hours of physical therapy plus 2 hours of driving= 6 hours.
Total cost $700 and 6 hours of your time.
So if it’s less expensive and costs less time to not use your insurance, why would you want to use it? That’s a tough question to answer. I think most people don’t actually know what their health plan covers or doesn’t cover. It’s also very confusing to look at your benefits sheet and try to figure out what it all means. You have a deductible, a copay, co-insurance, family vs individual and max out of pocket expenses. No wonder people show up at a clinic thinking they have a $40 copay and get slapped with a $250 bill.
So should you just dump your insurance? Well, no, you legally need it and hopefully you never have a catastrophic event but if you do, that insurance will come in handy. I also think there are a few scenarios where you should use your insurance.
The main physical therapy scenario in which you should use your insurance is if you need surgery. Surgery in most cases will be expensive enough to meet your deductible. Once that deductible is satisfied you owe that $40 co-pay for your insurance. Early on in the post surgery physical therapy plan it’s important that you get consistent treatment. It’s also not rocket science. They know why you’re there and for the first 6 weeks in many cases they are following a standard post surgery protocol laid out by the doctor.
We actually turn people away almost every week that just had surgery. Not because we don’t think we can help them but because it will be more cost-effective for them to go to an in-network clinic since they’ve met their deductible. Once they get out of the early stages of rehab and can get more into return to sport/activities, they will switch over to us for home-based programming and advanced movement retraining.
Here’s the litmus test I usually give people to see if it’s worth it to use their insurance or seek out a provider outside of their insurance contract.
Have you met your deductible?
Do you value your time?
I hope this helps navigate some of the difficult to understand territory that is our current health system. Before you decide to go see someone for physical therapy, ask yourself the questions I posed in this article.
If you’re in the Atlanta area and you want some help dealing with an injury or getting back to an activity you’ve been avoiding, give us a call. We can set up a 10 minute phone consultation with one of our Doctors of Physical Therapy to see if you’re a good fit for what we do.
Dr. Danny, PT, DPT, OCS, CSCS
“Everybody needs a coach. Every famous athlete, every famous performer has somebody who is coach — somebody who can say, ‘Is that what you really meant?’ and give them perspective. The one thing people are not really good at is seeing themselves as others see them. A coach really, really helps.” - Eric Schmidt, CEO of Google
I love this quote. In this quote, Eric Schmidt is talking about an executive or business coach. He’s a pretty successful man and he still relies on the help of an outside coach. The job of coach can take many different roles. You can be a sport specific coach like baseball, strength coach like CrossFit, or business coach like Eric references. I think there is a new breed of coaches that is very much necessary and underutilized: Physical Therapists.
Not surprising; right? The person writing this post is a Physical Therapist and he’s telling me we should view Physical Therapists as a coach. I’m a skeptical person by nature so my goal is to prove to you that I’m not an asshole out for self-promotion by the end of this.
There are a few reasons I feel the Physical Therapists fits perfectly in the role of a coach, but we have to distinguish one thing first: I am talking about Physical Therapists that have solid movement evaluation skills. I’ve pissed off some of my colleagues in the past with some bold statements so I will try to not piss anyone off here. There are many different ways to specialize as a Physical Therapist. You can work with kids, the geriatric population, neurologic disorders, sports, and a host of other areas. Not all Physical Therapists have continued their education after school to really learn about assessing and improving athletic movement. This doesn’t mean they are bad at their job. It means they have decided to continue their education in other areas.
To help you pick the right Physical Therapists/Coach, look for one that has training with at least one of two groups. The first is Gray Cook and Functional Movement Systems. This is the group that developed the Functional Movement Screen and also teaches a practitioner course called the Selective Functional Movement Assessment. I’ve been through three of these courses and I think they are great. The other group is MobilityWOD. Yes, I’m absolutely being biased here considering I teach for this group. Honestly though, if you are a CrossFit athlete in particular, the information MobilityWOD teaches is right up your alley. Look for a PT that has been exposed to both groups and they should have a strong understanding of movement assessment/correction.
Once you’ve found a competent Physical Therapist for the role of coach, you need to use them. I’m not just talking about when you’re hurt. This is a mindset I would love to see people change. You don’t wait until your engine locks up before you change your oil. Why wait until your body shuts down before you get some help? The first way to get help is to get your movement assessed. At Athletes’ Potential we use a mixture of the screens Functional Movement Systems teaches in the courses I’ve been to and movement minimum tests we teach with MobilityWOD. This tends to give us a very broad view of movement quality and quantity. Not only that, but it also allows us to see if there are any glaring side to side differences (asymmetries). Fixing these movement impairments leads to less injury and better performance. That’s two very good things.
Once you’ve been assessed, now it’s time for your Physical Therapist to either do some hands on work (dry needling, manual therapy, joint mobilizations) to address the problems and/or give you some homework. There should always be open communication between you and your Physical Therapist. They are now your movement/body maintenance coach. I typically recommend following up once very two to three months for a “check-up." No, this isn’t a turn your head to the side and cough check-up. This is looking at your movement again, seeing change, doing hands-on work if needed, and progressing what you are doing at the gym.
Look, you only have one body. Most of us take ours for granted until it breaks down on us. I’ve been there as well. I’ve had multiple injuries during my time in the Army and I didn’t start taking care of my body until I stumbled across MobilityWOD a few years ago. A Physical Therapist has a unique skill set of medical knowledge, movement assessment and hands on manual skills. One should be an integral part of your training in particular if you’re a CrossFit athlete. Our motto is "Movement is Medicine" and we really do believe that. Get your movement checked out, get a plan, and let that Physical Therapist be a coach for you.
-Dr. Danny, PT, DPT
“Price is what you pay, value is what you get.” Warren Buffett
I’ve written on this topic a bit recently. If you haven’t read part one check it out here. (Link is currently inactive; our apologizes. We're working to fix this.)
I feel the perception of cash based physical therapy is a bit skewed. The overwhelming sentiment from people I meet is that cash based PT is only for the super rich. That actually couldn’t be further from the truth. In fact, I see more teachers and students then CEOs, lawyers and doctors. Why is it that students and teachers think going the cash based route is better? They base their decision off value, not price.
Let’s do another cost/value comparison like we did in part 1.
I recently had a client come to Atlanta clinic that had a subacute neck injury. She aggravated it doing power cleans and had already seen two different physical therapists. The injury occurred 7 weeks ago and she had been to a total of 6 PT visits. Her copay is $70 per visit. This is on the high side of copays for physical therapy as most are between $20-70 per visit. She’s already paid $420 for physical therapy and states about 20% decrease in symptoms when I saw her.
So far I have only seen her once and we will only need a second visit to look at her power clean technique(because this is how she hurt herself to begin with). On evaluation she demonstrated what’s called a facet joint sprain. Basically she sprained a joint in her neck and it can be very painful/restricting. We used a variation of what’s called a mobilization with movement. In 10 minutes we were able to get full range of motion back with 75% reduction in pain. The rest of the visit we worked on improving the movement of the joints in the neck and then went over her homework which was a variation of this video post.
Let’s do the actual math. She paid $420 for 6 PT visits and got a 20% reduction in symptoms over a course of 6 weeks. We will see her 2 visits for a total of $350. She got a 75% reduction in symptoms and full range of motion back. Not only that she has the knowledge to maintain and continue to improve her neck.
Is cash based physical therapy really more expensive? In this case no. Also, I don’t want to give off the impression that all physical therapy clinics that take insurance suck. That’s not the case at all. Here’s my main point. If a physical therapist with the same skill set, knowledge and training get’s 2-3 times more hands on time with a patient they will get better faster. That’s the beauty of the cash based model. It’s just one on one with a physical therapist. If you want to get better as fast a possible, cash based is the way to go.
-Dr. Danny, PT, DPT
I’ve recently had a ton of new patients come my way. I'm not saying this to brag, I say this because they all seem to be coming my way through the same pattern. First, they get injured and wait a few weeks hoping the injury will go away. This is kinda like when my son hides behind behind my nightstand when he doesn’t want to take a bath. Bath time isn’t going away anytime soon and neither is your injury.
Next, after a few weeks of dealing with pain, most people go and see their physician. They usually are given some medicine and are sent to a specialist, like an Orthopedic Surgeon. Once at the specialist, they are re-evaluated and diagnosed. This also typically includes unnecessary advanced imaging such as MRIs. Usually at this point you will be given a referral to a physical therapy clinic. The problem with this, is that now it’s been a few weeks at best and you’ve gotten some very expensive and most likely unnecessary images of the injured body part. To make it worse, no one has even addressed any mobility, stability or movement dysfunctions that most likely caused the injury to begin with.
Our current medical model is often enraging to think about. I like to think that most medical providers are very ethical people. We get into medical careers to help people and it makes us feel great when we get someone better. The majority of the problem is based off of two factors: 1) Providers are having to see more and more patients with declining insurance reimbursement and 2) Decisions are often times dictated by money.
I spent the last 4 years practicing as a Physical Therapist in the Army. Conditions are not ideal, by any means. Our budgets are too small, we have too many patients and our patient base is constantly doing extremely physically demanding activities (i.e jumping out of airplanes with 60 lb. of gear on). We also have a much different model of treatment.
If you hurt yourself in the Army you typically go straight to the physical therapy clinic. From there, if you do not get better you are sent to see your family practice physician or a specialist. Images, like MRI, are only ordered when absolutely necessary. Surgeries are only performed after physical therapy has been performed for at least 2-6 months unsuccessfully.
So, why is the model so much different in the civilian world versus the military? It’s simple: money. Surgeons and physical therapists do not get paid based on how many surgeries they perform or visits they see a person. Surgeons are busy enough in the military. They prefer for patients to go straight to the physical therapy clinic. This way they only see the patients that are truly surgical candidates if they do not get better with physical therapy. It's more efficient and cost effective.
Don’t get me wrong, I like money as much as anyone. I want to make as much as I can to support my family. I will, however, never let money dictate how I will treat a patient. I currently average just under 3 visits with clients before symptom resolution and discharge. I’ve even had business mentors tell me to stop getting people better so quickly. They want me to hold back and try to draw out my average number of visits to 5-7. I tell them I can’t do that, it’s unethical in my mind and I wouldn’t want someone doing that to my family members.
Here’s my point with this blog post. Go see someone that will actually put their hands on you, spend time with you and address the physical limitations that are causing your injury. Surgery is a last resort and there’s no guarantee you will be any better after a surgery. I’m obviously biased because I’m a Physical Therapist. If you’re injured you should get to a competent Physical Therapist as quickly as possible. This is how we keep the military fit to fight and it’s even being adopted by private companies. Intel used early physical therapy access and saved $2 million dollars in a year! Also, Aetna and Starbucks used early access to physical therapy and cut the cost of back injuries in half!
It you're having difficulty figuring out what to look for in a physical therapist, take a quick look at this blog post. It should help steer you in the right direction.
Good luck and thanks for reading.
-Dr. Danny, PT, DPT
Dr. Danny and staff's views on performance improvement, injury prevention, and sometimes other random thoughts.