Welcome to the TPSF Team-Michelle Cotter, PT, DPT

Dear Friends,

I’d like to take a moment introduce myself as I am so grateful to be the newest member of the TherapydiaSF family. My name is Michelle Cotter and I’m a physical therapist. While I specialize in pediatrics, I love treating adults as well. 

My passion for helping people heal began as a youngster when I volunteered in the athletic training room at my high school while rehabilitating my own injuries.  It was further strengthened when I spent the summer of my junior year in high school helping my mom recover from heart surgery. I received my Doctorate in Physical Therapy from Samuel Merritt University in Oakland, California and completed my final internship at Lucile Packard Children’s Hospital, where I learned the intricacies of proving excellent patient care to children and their families. My experience working on the UC Davis Athletic Training team, as well as over 5 years of clinical experience, has helped me develop expertise in identifying movement dysfunction and choosing the best treatment methods for a variety of injuries for all ages. 

Over the past 3 years, I have also been treating infants and children, assisting in their gross motor development, so that they are able to play and participate in age-appropriate activities with their peers. I have had particular success in developing effective rehabilitation programs for children with developmental delay, positional plagiocephaly and a variety of sports-related injuries.

My goal as a physical therapist is to provide an individualized framework for healing based on current research and patient education.  I aim to facilitate the recovery and prevention of injuries for each patient, no matter what age, so that they may achieve their mobility goals.

I love educating patients about how their body moves and teaching them strategies to change dysfunctional movement patterns. I emphasize educating patients and families on their specific condition and how they will take an active role in the recovery process for optimal health and function. This approach to an interactive plan motivates me to be the best physical therapist I can be. I get great satisfaction in building collaborative partnerships focused on the achievement of life-long health and wellness with my patients

I am very excited for the opportunity to work in such a collaborative and interactive environment that promotes long-term health and wellness and I look forward to meeting each of you! Please feel free to contact me if you would like more information.

Sincerely,

Michelle Cotter, PT, DPT
Doctor of Physical Therapy

Top 5 reasons we are out-of-network with your insurance…and what that means for you

physical_therapy_san_francisco

I sat down earlier this week to write a piece with the title above, but very quickly realized there really aren’t that many reasons. The only reason we are out-of-network with most insurance plans comes down to one simple fact:

We want to offer physical therapy treatment on our own terms, the way physical therapy was intended to be provided.

Most plans have out-of-network reimbursement. Many people think that if a practice is not in-network with their insurance, they can’t seek services at that clinic. The truth is, in most cases, you can work with a PT who is out-of-network. All it means to be in-network is that a physical therapy provider has signed a contract with a health insurance company that allows the insurance company to decide on the value of the physical therapy provided. Sadly, the current climate of physical therapy insurance reimbursement often has providers being paid less than the cost of a personal training or Pilates session, haircut, or full tank of gas.

A few things you need to understand about physical therapy:

  • We have extensive education, training, and are licensed by the state in which we practice (see The Educated Therapist).
  • All physical therapy is not created equal. PT’s do not receive a handbook on graduation day that tells us how to treat a specific diagnosis. Treatment should be customized, taking into consideration an individual’s activities, lifestyle, home and work demands, and even emotions related to the injury or pain.
  • All physical therapists are not created equal. Some PT’s further their education by taking classes and additional training beyond what is required by our governing board. Some PT’s look for every opportunity to expand their knowledge and stay current with studies and treatments. Good PT’s know that there is not one treatment to help everyone and, while we may not be able to cure all, we have a network of additional resources who might.
  • All components of physical therapy, from hands-on treatment to exercise, should be delivered by physical therapists.

We have chosen to stay true to our ideas of how physical therapy should be delivered. We find that our 45-minute treatment sessions, spent entirely with a physical therapist, help us form relationships with our patients, allow us to address multiple components of pain and injury, and often expedite treatment.

While out-of-network benefits vary, we have discovered that out-of-network reimbursement is often comparable to in-network coverage.


 

What does this mean for you?

We will:

  • provide excellent customer service from the first call.
  • check your benefits and discuss these with you before your first visit so that you have an understanding of the payment and reimbursement process.
  • help you find the best PT fit.
  • follow up with your insurance company on outstanding reimbursements.
  • reimburse you as soon as we receive payment from your insurance company.

What’s different?

  • Your PT may structure a different plan of care than used in traditional PT.  Do you really need 2 times per week for 8 weeks? Maybe not. Your PT will work with you to develop a plan that will help you recover effectively, while keeping in mind schedule and financial concerns.
  • We expect you to be actively involved in your own recovery.  We can’t make you better by ourselves.
  • You will have homework. We may ask you to modify some of your activities (Thought you knew how to sit?? Think again). We make these recommendations not to put a wrench in your lifestyle, but because we know they will help expedite the healing process.
  • We will be available to encourage and support you along the way.
  • You can access your PT via email in between appointments if you have questions or concerns.

Please let us know if we can help you learn more about your physical therapy benefits.  We will gladly call your insurance to verify your coverage and provide you with the information we receive.  We look forward to helping you on your path to recovery!

 

The Educated Therapist

Let’s face it. Most physical therapists aren’t winning any sales and marketing awards. Most of us have don’t have a business background and typically enter this profession based on a love of health, exercise and helping others. In school, we don’t really have time to cover anything beyond examination and treatment of our soon-to-be patients. We graduate, enter the world of health and wellness as practitioners of physical therapy, and soon realize the competition is fierce. In San Francisco, a city with something for everyone, there are individuals providing health and wellness services that seem in direct competition with everything we offer. There are personal trainers, massage therapists, Muscle Activation Therapists, Sports Therapists, Neurokinetic Therapists, Core Activation Therapists, and more. Have you ever stopped to consider who is best trained to help you heal? While these practitioners may indeed be skilled at the services they offer, based on our level of education and training, physical therapists are in a league of our own.

The other day, I had a pleasant conversation with a gentleman who was interested in learning more about the field of physical therapy. A seemingly intelligent man, he’d also had personal experience as a recent physical therapy patient. At some point in our conversation, he stopped me and asked, “Do you have to have some sort of certificate to be a physical therapist?” My jaw dropped.  It was then and there I realized how physical therapists have done such a terrible job of informing the public of what we do, what we can offer, and why we should be considered the practitioners of choice for musculoskeletal health.

So here’s what you should know: physical therapists go to school for 7-8 years. This includes 4 years of undergraduate education, heavily based in science (physics, chemistry, microbiology, exercise physiology, etc.), and 3-4 years of graduate-level education. Students graduating from physical therapy programs in the United States today earn a Doctor of Physical Therapy. The first Doctorate program in Physical Therapy was started in 1993 at Creighton University in Nebraska and, as of 2015, all accredited and developing physical therapist programs are DPT programs. Often part of a medical school, PT programs teach physical therapy examination and treatment, as well as courses in Anatomy, Neuroanatomy, Pathology, Pharmacology, Radiology and Differential Diagnosis (how I determine if a symptom may be something more serious—and outside of my scope of practice—than run-of-the-mill back pain). In fact, when I attended UCSF in the early 2000’s, the physical therapy students were the only students who performed full cadaveric dissections. Other programs used the cadavers we spent our first foggy summer in San Francisco dissecting. It was also the start of our collaboration with the first year medical students, where we 2nd year PT students helped teach the medical students musculoskeletal anatomy. Most recently, residencies and fellowships after graduation have grown in popularity to provide advanced training for physical therapy school graduates.

Beyond our formal education, physical therapists are licensed by the state in which we practice and are held to a high level of professional conduct that includes requirements for continuing education every year. Most courses are held on the weekends and many physical therapists travel great distances to take courses of interest. This year alone, PT’s from TherapydiaSF will take courses in San Francisco, San Diego, Montana, and Las Vegas. Some physical therapists also opt to enhance their degree and training by completing board certification in different areas of practice, including Orthopaedics, Pediatrics, Women’s Health, Neurology and 4 other areas of specialty practice.

The next time someone suggests physical therapy, please consider our extensive training and education and know that we have the education, expertise and dedication to help you work, play and move without pain.

 

 

Navigating Nutrition Part One: Processed Food

“Avoid processed foods” is common nutrition advice given out these days. It is a well-intentioned, sound suggestion that seems easy enough to follow…assuming you know what the term “processed foods” means. As it turns out, there is no easy definition of “processed foods”. Most foods we eat are processed in some form or another unless you’re eating it straight out of the ground.

The degree of processing is what most people are talking about when they use this term, and even then, there is no set list of things to avoid, and some processed items are better than others. Generally speaking, this refers to anything that comes in a package, but doesn’t usually apply to things such as milk or whole beans in a can. Confused yet? Who can blame you?

So why is this advice out there? One reason is that it can be very easy to overeat packaged goods. A box of cookies can disappear in an instant, and no time was taken to prepare them. Another reason for this advice is the number of unfamiliar ingredients used in our “food” these days. For example, maltodextrin, soy lecithin, and artificial flavors are all common ingredients found on nutrition labels. Do you have any idea what they are? This isn’t some big exposé, I’m just pointing out that you might not know what you are putting in your body. Lastly, processed foods tend to have a lot of sodium or sugar added in, which isn’t good for us.

It might not feasible to go “package-free”, so here are some rules of thumb to simplify things:

  • Only choose foods with 5 ingredients or less.
  • Make sure you know what each ingredient is, and how it’s made (knowing that something is made “from corn” or “from soy” doesn’t tell you how it’s made).
  • Check the nutrition label for the amount of sodium (look for items with 150mg or less per serving).
  • Choose items with no added sugar. That means NONE of the following ingredients: sugar, corn syrup, fructose, high-fructose corn syrup, agave nectar, honey, brown rice syrup, dextrose, maltose, sucrose, molasses.

Do your best to buy whole foods and do the processing yourself, but when you need to buy things in a package, be sure to check the labels!

The Holidays: A Time of Love, Laughter and Overeating

You know the scene, you swear you’re going to have just one drink at a holiday party, and the next thing you know you’ve lost count and have a killer headache the next morning. Or maybe you show up to the party thinking there will be dinner only to find out they are only serving apps, so you start taking down every bacon-wrapped scallop in sight. Or perhaps your Aunt Margaret swears you’ve lost too much weight and starts handing you a snack every time you walk by. Or hey, maybe it’s just the holidays and you only get this food once a year, so you cram as much as you can onto that plate…and then make a second trip. The holiday season is packed full of healthy eating obstacles (some more fun than others!). If you want to stay healthy through the holidays without adding “lose holiday weight gain” to your New Year’s resolution list, it takes a bit of planning and mindfulness, and we’ll tackle some of the big ones here.

Booze

Without a doubt, the biggest contributor to holiday weight gain is all the extra alcohol consumed throughout the season. We see friends and family we haven’t seen in a while, and every occasion seems like a real good reason to celebrate. Not to mention in addition to the beer, wine, and regular cocktails, eggnog, hot toddy’s, and mulled wine make their way onto the menu this time of year, and hey, it’s been a while since you’ve had one! Here are some tips to keep holding the reins on your alcohol intake:

  • Give yourself a weekly allotment for alcohol and plan it out. If you have several events in one week, decide ahead of time where you would like to spend your “booze dollars”. If you find yourself having trouble sticking to it, you might need to make some events alcohol-free.
  • Keep track – a serving of wine is 5 ounces, which is less than half of most wine glasses. If you fill it up to the top, that’s two drinks. If someone comes around and tops off your glass, count it as another drink. We frequently have the equivalent of 6 drinks in one night, thinking we only had two.
  • Watch the higher calorie drinks – eggnog, cider, and most mixed drinks have a lot of extra calories in addition to the alcohol. If you need to have one for the season, keep it to just one.

Hors d’oeuvres

These tasty little morsels seem so innocent, but do a lot of damage. Typically crowd-pleasing fare, these items tend to be mini-calorie bombs, and if you show up hungry one after another will slide right down, adding up to more than a meal’s worth of calories…before you even get to dinner. So what can you do?

  • If you know the party will be appetizers only, make sure you eat a small healthy meal before you go. This will take the edge off any alcohol you have, and prevent you from stalking the waiters circulating the apps.
  • Only try 1-3 appetizers, and only if they look worth it – the point is for you to get a small taste of an amazing dish, not to substitute for a meal.
  • If it’s a dinner party, try having a small snack with protein beforehand so you can hold out until dinnertime.

Buffets

Buffets are a popular, convenient way to serve dinner, and are generally a healthy-eating nightmare, especially if it’s a potluck. It’s as though someone thought of every food you were trying to avoid and put it all on one table. You’re sure to see at least a few of these this holiday season.

  • Take a tour of the buffet before you get in line. See what’s available and decide ahead of time what you want to put on your plate.
  • Only fill up one dinner plate, and only go through the line once. No, you cannot start stacking the food vertically to get more to fit.
  • Try only small portions of the heavier items and fill most of your plate with the healthier options.

Family

This section could take up its own blog post, or even its own book, and could probably be co-authored by a psychotherapist, but we don’t have room for that here, so we’ll only cover the basics!

  • Stress – is there a lot of tension at your holiday gatherings? Meditation and therapy are more productive solutions, but in the interest of time, try this quick fix: instead of eating to drown your sorrows or avoid talking to someone, bring a large plate of pre-cut veggies to share as hors devours. When you’re feeling frustrated, grab a small plateful of veggies – the crunch will help get your aggravation out and keep your mouth full so you don’t have to talk!
  • The pushers – the ones pushing high-calorie although made-with-love food. Quick fix: small portions, big fanfare. “This is so delicious! You’re such a fantastic cook! No, I can’t fit anymore, I’m so full. It’s so good, but I also want to save room for XYZ too, I wouldn’t want to miss that!”
  • Look for healthier recipes of old favorite foods. If your family resists, stick to a serving the size of a ping-pong ball. The first 3 bites are where you get all the taste and flavor, after that your taste buds become accustomed to the food and you spend the rest of the time trying to “chase the taste”.
  • Bring your own healthy dish so you know there is something there you can fill your plate with.

The holidays should be a jubilant time of year, where you enjoy the company of friends and loved ones. Although everyone has different ways of celebrating during the holiday season, we hit on some common pitfalls here that frequently trip people up. There are certainly challenges we didn’t cover here. If you need a little help figuring out how to enjoy the holidays without damaging your waistline, head on down to see your friendly neighborhood Registered Dietitian. You can get your own customized plan that still allows you to have fun! Happy Holidays!  Bethany is seeing clients at TherapydiaSF, located on Maiden Lane in downtown San Francisco.

On the Run with TPSF: How to Avoid Running Injuries

This issue of On the Run is written by Lindsay Haas, PT, DPT, OCS.  Lindsay is a physical therapist at TherapydiaSF and enjoys working with runners, dancers, and all athletes for rehabilitation from injury and improved sport performance.

The good news is that you signed up for a race.  It may be your first or your twenty-fifth, but you are ready.  Of course you want to stay healthy.  Especially when you are gearing up and looking forward to completing your upcoming race!  The bad news is that rates of injuries in runners is high, and its even higher when training for an event.

The #1 risk factor for injury in running was a history of injury, usually within the past 12 months (1).  Most injuries in running are caused from overuse, which is defined as repetitive microtrauma to the musculoskeletal system.  Increased training loads (such as running more when training for an event) can exacerbate an old injury.  Also, you may have changed your running pattern to compensate for your previous injury and as a result overloaded another part of your body and created a new injury.

The second highest risk factor was the weekly distance.  Runners who complete more than 40 miles per week were found to be more likely to sustain an injury (2). When you run more, you can overload the musculoskeletal system to the point where it can’t recover, thus creating an injury.

So how do you stay healthy throughout your training?

1.  Change it up.  Since most running injuries are caused by overuse and repetitive strain, its important to introduce variety to your training.  You should already be active in strength training (shown to decrease the risk of injury and improve performance!) but you should also be changing up your runs.  Try running on trails, or try altering your pace.  Even if you’re not participating in a training program that incorporates tempo runs and speedwork, there should be some variety in your runs.

2.  Watch your form. It is important to have good running form.  Your cadence is the number of steps taken per minute, and should be more than 170 steps per minute on both feet.  If its too slow, you may be putting too much stress on your body.  Increasing your cadence will help with over-striding.  Focus on taking short quick steps and keeping your feet under your hips.

3.  Treat injuries before they start.  Don’t wait until something hurts.  Using ice and self-myofascial release (such as the foam roller) are good tools for when you are sore, but there are ways to be proactive as well.  Listen to your body, if you need to adjust your workout or take a day off its okay.  When you are running keep track of your heart rate and level of fatigue to know if you need to slow the pace or even stop for the day.  If you are feeling sharp or stabbing pain, you need to stop. Avoid the ‘three too’s’: too much, too soon, too fast.  Pushing yourself too hard can compromise your ability to recover.

Still worried about getting injured while training?  Schedule a Fitness Screen with one of TherapydiaSF’s physical therapists.  We will identify any potential risk factors to injury or decreased performance and create a customized exercise program to help you meet your training goals.

(1)http://sprunig.net/wp-content/uploads/What-are-the-Main-Risk-Factors-for-Running-Related-Injuries_2014.pdf

(2) Walter SD, Hart LE, McIntosh JM, et al. The Ontario cohort study of running-related injuries. Arch Intern Med. 1989;149:2561–4.

 

Fit as a…fiddle?

run-rehab-featured

 

Body image has been a hot topic over the past several years. Recently, many companies have run advertising campaigns to promote healthy body types in reaction to the extremely thin models who have been so prevalent in the media.

The recent video of dancer Misty Copeland has had a huge impact on the dance world and has made us think about the concept of an ideal dancer’s body.  I remember not too long ago, when “athletic body type” was considered a euphemism for “thick” or “heavyset.”  I hope you agree that while Misty is certainly athletic, she is neither thick nor heavyset.

Beyond the notion of an ideal body type, I’ve recently been thinking about the concept of fitness. I blame this partly on recently reading The Sports Gene by David Epstein, and also having just returned from a continuing education class filled with practitioners who each work with a different clientele, including college athletes, golfers, yoga practitioners, and the general population, some more active than others.   As I thought about the baseball pitchers, cyclists, runners, and CrossFit participants with whom we each work, I could easily identify ways they are fit, but I also thought of areas where they may be deficient.  I began to wonder about fitness.

When someone is decribed as “fit”, what does that really mean?  Does it mean the same thing to everyone?  There are different dictionary definitions of fitness, some of which brought a smile to my face:

1. The condition of being physically fit and healthy (I’m going to need a little more here…).

2.  Good health or physical condition, especially as the result of exercise and proper nutrition (ok, we may be getting somewhere…).

3.  The capacity of an organism to survive and transmit its genotype to reproductive offspring as compared to competing organisms (well….I bet you know plenty of people who have the capacity to transmit their genotype to reproductive offspring who you would not call fit).

So, we’re back to the drawing board with defining fitness.

Is a body builder with bulging biceps and massive quads more fit than a marathon runner?

Is Tiger Woods more fit than Serena Williams or Michael Phelps?

What does it mean to be fit?  Ah…what I would do to take a camera out onto the streets of San Francisco and ask people this question (stay tuned…).

As we think about each of the athletes and their respective sports, it quickly becomes clear that fitness is hard to define and describe.  While the bodybuilder might have larger muscles that allow him to lift heavy weights, the marathon runner would certainly show greater cardiovascular endurance across those 26.2 miles.  Tiger Woods and Serena Williams both demonstrate amazing muscular development and precise hand-eye coordination, but if he had to run around the golf course like she does the tennis court, could Tiger keep up with Serena?  Michael loves the game of golf and, like Tiger, has an amazingly strong core, yet I wouldn’t want either one of them representing the other’s sport in competition.

This is an important topic to me both personally and in my work with athletes of all ages, skill levels, shapes and sizes.  To me, there is no one definition of fitness.  I believe that fitness is a balanced combination of strength, stability, balance, flexibility, and endurance…and maybe even mindfulness.  What the general population thinks of as an ideal of fitness may actually be a person who excels in the sport in which they train, but has severe and potentially harmful imbalances in some of the categories mentioned above.  The fittest people with whom I work are those who enjoy a variety of exercise and sporting activities.  These are the folks who are rarely in our studio for treatment, except for the occasional tune up after having changed their routine. Often, the people who appear most physically fit are those who are plagued with injuries related to imbalances in overall fitness.

I’ve learned that there is no one ideal body type just as there may be different ideas of fitness.  I encourage my clients to be successful in their rehab and develop and improve their fitness by recommending a three key steps:

1. Move well and move often.

2. Find something you enjoy doing.

3. Mix up your routine—your body will thank you for it.

So, what does fitness mean to you?

And, in case you were wondering where “Fit as a fiddle” came from…

When should I see a physical therapist?

Many of the patients I treat are extremely active, though few make their living playing sports professionally. They are passionate about their lifestyle and sport of choice, and take their health very seriously.  With many sports and hobbies, aches and pains are likely to occur.  Athletes quickly get used to sore muscles and minor injuries, often considephysical-therapy-san-francisco1ring these a normal part of an active lifestyle.

But should these be treated more seriously?

Many of the patients with whom I work initially ignored what seemed to them to be minor injuries, yet have since become more frequent or more intense.

At what point should you visit a physical therapist?

Read more for quick tips to decide if what you’re feeling needs a closer look.

1. Immediately after a specific injury.

A number of recent studies have shown support for early physical therapy for lower back pain.  The studies show that physical therapy within 2-4 weeks of a lower back injury leads to a decreased risk of surgery and injections, fewer doctor visits, faster recovery, and fewer incidents of chronic pain.

Clinically, I have seen even earlier physical therapy provide excellent results. I am a strong advocate of patients developing a relationship with a physical therapist as a practitioner on their medical team (see post).  I also believe that patients should have email access to their physical therapists in order to communicate updates and ask general questions.  Often, a patient will email or call our office within the first few days of an injury and we will schedule them that day.  Earlier this year, I worked with a triathlete who developed intense back pain after a weekend race.  We saw her the next day and within a week she reported an 80% decrease in her symptoms. The following week she reported a 95% improvement and was able to race again exactly one month later. The sooner we can see a patient post-injury, the faster their recovery from the painful, acute stage.  This allows us to move to more advanced stages of physical therapy earlier, in order to address the root cause of their injury.

2. If an old injury has reappeared or never disappeared!

As I was getting ready to graduate one of my runners from physical therapy the other day, she asked, “but…how will I know if I need to come back?”  It was a great question, yet one without a definitive answer.  Runners, especially, are subject to occasional minor aches and pains.  At what point should they take these more seriously and seek help?

In general, you should reconnect with your physical therapist when:

You feel pain during an activity that gets worse as you continue the activity.  This is a sign that something is not right.

Your pain changes the way you perform the activity.  If you are running down the street with foot pain and you have to limp so it doesn’t hurt as much, go home and call your PT.  Remember, the faster the painful symptoms are addressed, the more likely the root cause will be identified and other related injuries are less likely to occur.

You feel pain during three consecutive workouts or activities Often pain will be present at the start of an activity, but will disappear within a few minutes.  Does that mean it should be ignored?  No.  If you are consistently feeling the same or similar symptoms, even if they go away during the activity, schedule an appointment.  Pain is a sign of tissue fatigue or too much stress on a particular part of the body, likely related to an underlying movement dysfunction.  In English?  You’re likely not moving as well as you could, an area of your body is doing more than its fair share of the work, and it needs some help.

3. For an annual check up.

Physical therapists can be, and should be, the medical practitioners of choice for a musculoskeletal wellness/fitness screen, an assessment with a physical therapist to identify risk factors for developing a particular injury.  Much like we visit the dentist on a regular basis, we believe that everyone should schedule an annual preventative visit to their physical therapist to identify and address areas of dysfunction (that tight neck you’ve been complaining about, poor posture, or the shoulder that occasionally hurts in your bootcamp class).  Left undetected, these will likely get worse over time.  We would much rather see you once a year to revise your exercise program and keep you healthy, than have you wind up in our office as our newest patient!

Remember, you shouldn’t try to tough it out or wait until an injury becomes more severe before visiting your physical therapist.  You will wind up suffering needlessly and make our jobs even harder!

If you’re still not sure you should come in for an assessment, feel free to email us:  hello@therapydiasf.com.

In your email, please provide the following:

-where is the location of pain?

-how did the injury occur?

-how long have you had the pain?

-what makes it hurt?

-what makes it feel better?

We will review the information and advise you on the best option for your injury.  This may include advice for self-management, the need to schedule a physical therapy assessment, or a physician contact, if necessary.

When should I see a physical therapist?

Many of the patients I treat are extremely active, though few make their living playing sports professionally. They are passionate about their lifestyle and sport of choice, and take their health very seriously.  With many sports and hobbies, aches and pains are likely to occur.  Athletes quickly get used to sore muscles and minor injuries, often considephysical-therapy-san-francisco1ring these a normal part of an active lifestyle.

But should these be treated more seriously?

Many of the patients with whom I work initially ignored what seemed to them to be minor injuries, yet have since become more frequent or more intense.

At what point should you visit a physical therapist?

Read more for quick tips to decide if what you’re feeling needs a closer look.

1. Immediately after a specific injury.

A number of recent studies have shown support for early physical therapy for lower back pain.  The studies show that physical therapy within 2-4 weeks of a lower back injury leads to a decreased risk of surgery and injections, fewer doctor visits, faster recovery, and fewer incidents of chronic pain.

Clinically, I have seen even earlier physical therapy provide excellent results. I am a strong advocate of patients developing a relationship with a physical therapist as a practitioner on their medical team (see post).  I also believe that patients should have email access to their physical therapists in order to communicate updates and ask general questions.  Often, a patient will email or call our office within the first few days of an injury and we will schedule them that day.  Earlier this year, I worked with a triathlete who developed intense back pain after a weekend race.  We saw her the next day and within a week she reported an 80% decrease in her symptoms. The following week she reported a 95% improvement and was able to race again exactly one month later. The sooner we can see a patient post-injury, the faster their recovery from the painful, acute stage.  This allows us to move to more advanced stages of physical therapy earlier, in order to address the root cause of their injury.

2. If an old injury has reappeared or never disappeared!

As I was getting ready to graduate one of my runners from physical therapy the other day, she asked, “but…how will I know if I need to come back?”  It was a great question, yet one without a definitive answer.  Runners, especially, are subject to occasional minor aches and pains.  At what point should they take these more seriously and seek help?

In general, you should reconnect with your physical therapist when:

You feel pain during an activity that gets worse as you continue the activity.  This is a sign that something is not right.

Your pain changes the way you perform the activity.  If you are running down the street with foot pain and you have to limp to avoid it, go home and call your PT.  Remember, the faster the painful symptoms are addressed, the more likely the root cause will be identified and other related injuries are less likely to occur.

You feel pain during three consecutive workouts or activities Often pain will be present at the start of an activity, but will disappear within a few minutes.  Does that mean it should be ignored?  No.  If you are consistently feeling the same or similar symptoms, even if they go away during the activity, schedule an appointment.  Pain is a sign of tissue fatigue or too much stress on a particular part of the body, likely related to an underlying movement dysfunction.  In English?  You’re likely not moving as well as you could, an area of your body is doing more than its fair share of the work, and it needs some help.

3. For an annual check up.

Physical therapists can be, and should be, the medical practitioners of choice for a musculoskeletal wellness/fitness screen, an assessment with a physical therapist to identify risk factors for developing a particular injury.  Much like we visit the dentist on a regular basis, we believe that everyone should schedule an annual preventative visit to their physical therapist to identify and address areas of dysfunction (that tight neck you’ve been complaining about, poor posture, or the shoulder that occasionally hurts in your bootcamp class).  Left undetected, these will likely get worse over time.  We would much rather see you once a year to revise your exercise program and keep you healthy, than have you wind up in our office as our newest patient!

Remember, you shouldn’t try to tough it out or wait until an injury becomes more severe before visiting your physical therapist.  You will wind up suffering needlessly and make our jobs even harder!

If you’re still not sure you should come in for an assessment, feel free to email us:  hello@therapydiasf.com.

In your email, please provide the following:

-where is the location of pain?

-how did the injury occur?

-how long has have you had the pain?

-what makes it hurt?

-what makes it feel better?

We will review the information and advise you on the best option for your injury.  This may include advice for self-management, the need to schedule a physical therapy assessment, or a physician contact, if necessary.

Lindsay Haas, PT, DPT, OCS

Blink-CorteMadera-color-2014-05-23-00-22-52-370-130420-small

We are excited to welcome Lindsay Haas to the TherapydiaSF team!  Sydney and Lindsay worked together several years ago when Lindsay was in her last year of physical therapy school at UCSF/SFSU.  Since earning her DPT, Lindsay has practiced physical therapy in San Francisco, gaining quite the following of loyal clients!  We are happy that she will now be working with us at TherapydiaSF.  Lindsay joins the team this Monday, June 2 and will be treating patients daily, from 9:30-6:30.

 A little more about Lindsay in her own words:

“The foundation of my practice as a physical therapist comes from my certification as an Orthopedic Clinical Specialist, and my ten years combined experience working as a PT in San Francisco and as a trainer for Division I college athletes at UCLA.  My background in sports medicine and therapeutic exercise helps ensure my clients return to activity as soon as possible, and my knowledge in and passion for biomechanics – for which I use manual therapy techniques and neuromuscular re-education – helps them avoid future injuries.

By the end of physical therapy, I believe my clients should be experts on their own conditions and body.  Through working together, my goal is that they learn the root causes of their ailments, as well as gain the tools they need to play a proactive role in their own long-term wellness.  Being attentive and open-minded, I aim to listen to my clients’ words and bodies to create a rehabilitation and wellness plan that is catered to their goals.  I love building long-term friendships with my clients, engaging personally with them in support of both their injury recovery and their long-term wellness.

My desire to continue learning and improve my practice motivates me to seek out and absorb the latest research and continuing education opportunities.  My passion includes stopping injuries before they start, and I would like to see physical therapy grow to be not just about rehabilitation but also about injury prevention.  As our profession evolves, I get excited about using all the great tools available combined with ongoing education to ensure my clients remain active in the pursuits they love.”