Dear Physio, I Can Take it From Here…

So, when does physical therapy end?

This is just a short piece, a reflective piece, about a value that makes up the very core of what I believe in and what I strive to achieve as a Physiotherapist – empowering my patients with the knowledge and the skills they need to make themselves independent.

These past few weeks have reminded me of a very special part of treating patients – discharging them. For months now I have worked intensely to help the small patient population with whom I have contact. After investing so much time in their development and progress, it is a magical moment when they come to me and say “I am not 100% better but I know what the problem is and I know how to make it better. What I need now is time to follow through on my goals and I can take it from here.”

What a pleasure it is to hear that. I know no one will ever be 100% when it comes to discharge and I am fine with that. First, I don’t set “being 100% pain free” as a goal and secondly, I think we all suffer from pain at some point in time. What I feel is more important is for patients to function normally and in the most ideal way for their lives.

Something patients frequently ask is “How long do I need to keep coming to Physical Therapy?”  Or, “Will I always need to do these exercises?”

The answer to the first – how long does it take you to no longer need Physical Therapy?

The answer to the second – No, you will need them when you need them.

What do I mean by this? Let’s take a look at the ideal stages of recovery involved between initial assessment and discharge.

STEP 1 – LET ME HELP STEER YOU IN THE RIGHT DIRECTION

It all starts at the beginning, when life is altered by pain or injury and when patients seek care because they don’t function in their normal way anymore. Sometimes it can be tough to get the ball rolling, to retrain movement patterns and daily habits, to get pain levels under control, and to motivate patients to begin to drive their own recovery. The first step as Physical Therapist is to understand the problem, the contributing factors, to identify milestones that help patients identify with their own recovery process, and then begin guiding them through rehab until they reach step 2.

STEP 2 – START TO TAKE THE WHEELS

Once pain is no longer driving a willingness to come to therapy, what is?

As I often say to my patients – I will sit beside you on this journey to recovery, but I will not drive you there. So, Step 2 is all about helping patients recognise what other barriers need to be overcome or goals need to be achieved before they can function unrestricted.

STEP 3 –  NOW IT’S YOUR TURN TO DRIVE

Once you are functioning well, do you know how to stay that way?

At this point in time I hope that my patients are developing a sound knowledge about how their bodies present/move/behave when they are both feeling good and feeling not so good. Developing this self awareness is a key step towards understanding their bodies better and identifying how their rehab should progress for them to be 100%.

STEP 4 – I AM NO LONGER A PASSENGER

If you’re staying symptom free and doing what you love – do you still need my help?

It is definitely sad to say goodbye but we have to set our patients free. This past week has been sprinkled with discharge assessments–patients who come in smiling because they only have good news to report. They are playing the sports they love, can use exercises to manage any niggles that may come up, are no longer thinking about their injury or their body part, and can see the end goal in sight. And this is when I ask – do you still need my help to get to the end? And with a smile, they reply, “I can take it from here”.

If you are reading this as a patient I want to to ask yourself:

Are you self-discharging too soon? There is a lot of work that lies between reducing pain and discharge.

Are you holding on too long?

Are you taking the steps along the entire journey to make sure your knowledge is developing and growing to accommodate for the changes in your body at that given time?

At TherapydiaSF we strive to form strong relationships with our patients. Communication is the key to break down what problems exist and create individualised treatments for those problems. We all have our niche areas or injuries we love treating, but at the end of the day, you are the person that will direct the treatment path and we are here to help and facilitate you to reach those goals.

Sian Smale, PT, MPhysio has been part of the TherapydiaSF team since 2016. Originally from Australia, Sian is trained in Musculoskeletal Physiotherapy and Clinical Pilates. When not working as a physiotherapist, you can find Sian cycling the hills of Marin, swimming in the elusive outdoor pools of the Bay Area, and chasing down the best avocado toast.

Health Insurance 101: Understanding Your Benefits

It’s a new year and, for many people, this means a new insurance policy. While insurance can be confusing, it is important to understand your health insurance benefits as you consider your options for treatment. We’ve put together a handy primer to explain the basic components of an insurance plan, in hopes that it will make life simpler for you!

In-Network vs. Out-of-Network: Providers who are in-network with your insurance company have agreed to accept a lower rate for their services, as determined by the insurance company, in exchange for being affiliated with and promoted as a “preferred provider”. Out-of-network providers determine the value of their services and are not under contract with the insurance company. Most plans have some level of 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. In fact, insurance companies may even tell you you have to work with an in-network provider, even if you have out-of-network coverage. This is wrong and misleading. We elaborate more on the difference between in- and out-of-network coverage in this past blog.

Explanation of Benefits (EOB): This is sent by mail or available online after each medical service you receive. Your EOB will include lots of information, but look for the billed amount, allowed amount, any payments made by your insurance company, and the amount you owe, or patient responsibility.

Billed Amount: The amount that your healthcare provider bills to your insurance company.

Allowed Amount: The amount your insurance company deems a service provided to you is worth. This may be equal to the billed amount, though is more often less than the billed amount.

Deductible: This is the amount of money you are required to pay before your insurance benefits kick in. This amount resets annually, typically at the beginning of the year. Occasionally, there are some services where the deductible is waived, but in general you are required to pay the amount of your deductible before insurance pays for anything. Generally, there are separate deductibles for in- and out-of-network providers, though occasionally they are combined.

Coinsurance: Generally, this is the percentage of what you are required to pay per service. This is most often calculated using the allowed amount. For example, 30% coinsurance means that you are required to pay 30% of what your insurance allows for a particular service, while they pay 70%. This shared payment responsibility starts only after you meet your deductible.

Copay: This is a flat-rate amount that you pay each time you visit a provider, regardless of the billed or allowed amounts. This won’t start until you have met your deductible.

Out-of-pocket max: This is the maximum amount of money you will have to pay per year for covered healthcare. Once you reach your out-of-pocket max, insurance should cover 100% of your medical expenses.

Visit limit: This is the maximum number of visits your insurance company will pay. However, this is not a guarantee. Often, an insurance company will state a high number, or even unlimited visits, but will deny payment after review of medical notes if they don’t consider treatment to be justified.

At TherapydiaSF, we are happy to call your insurance on your behalf to determine your specific in- or out-of-network benefits. We also offer discounted cash rates as an alternative, if you are faced with a high-deductible plan, high co-insurance or limited visits. Please let us know how we can help you get started on your path to a healthy 2017!

 

 

Physical Therapy: What to Expect

physical_therapy_san_francisco

Marathon training has picked up and your Achilles tendon has been bothering you on your long runs. Or maybe you played golf this weekend and your back has been sore ever since. Perhaps work has gotten busy and your neck has been sore for a week. Whether it’s a friend or your doctor, chances are, if you ask around, someone will suggest you see a physical therapist.

So what should you expect?

During your first visit your PT will work to understand your injury and develop a treatment plan. We will ask you questions about your pain or discomfort—when did it start, what makes it better, what makes it worse? We will ask you about your work and the things that you do for fun. Sure, we want to get to know you, but, more importantly, that info also helps us understand how to best help you and keep you as active as possible while you’re recovering.

We will watch you do certain movements and collect some information by taking measurements and conducting particular tests. Often we will even look at different areas of your body that may not seem to be related to your injury.

Once we feel like we have enough information to create your treatment plan, we will likely get started that first day by teaching you an exercise or two to work on until your next appointment.

You should expect to work with the same PT at each session. Occasionally, two PT’s will work together as a team during your course of treatment, but our goal is to maintain consistency from visit to visit, and we find this harder to accomplish when more than two PT’s are involved.

When you return for your first follow up visit, expect to get to work! Your PT will have developed a plan that may include a variety of manual therapy techniques (‘hands-on’ work) and will definitely include exercise. We might ask you to do some things that seem silly—feel free to ask us why. It is not uncommon to see our patients blowing up balloons during their appointments, or crawling across the gym mat. It’s actually fun and we laugh a lot! At each session we will check and recheck some of the same tests we performed on day one, to understand the effect of the treatments we have been providing.

When you leave our studio, you will be expected to do your homework. We will provide resources to help you remember your exercises and yes, we will know if you’re doing them. Patients who are active participants outside of the PT clinic almost always heal faster than those who aren’t. A physical therapist can’t make you better alone. Physical therapy is a team approach and we need your help!

How often you come to PT is part of the treatment plan that you and your therapist develop together. Among our patients, there is a wide range of plans that change over time (i.e. once per week, once every other week, twice per week, etc). There are several factors we consider when planning your PT schedule. From the rate of healing and the body’s adaptation to new activities, to being swamped at work or due to financial constraints, treatment schedules will be specifically recommended to fit your needs. However, you should expect to attend at least 3-5 sessions in order to get the full benefit of working with your PT.

Once you are back to your marathon training, out on the golf course, or are able to sit at your computer without neck pain, it’s probably time to graduate from physical therapy! Some of our patients choose to continue to work with their PT for exercise as part of one of our wellness programs while others reach out the next time they need us.

Let us know how we can help you stay as active as possible!

The Top Five Reasons Why You Should Get To Know Your PT

A few years ago I hosted a get together with a bunch of friends. At some point in the evening, after everyone had figured out how we were connected, someone remarked, “It’s a good thing you’re a PT. You wouldn’t have any friends otherwise.” As I looked around the room at my guests, two were physical therapy colleagues, while the rest were former patients turned friends. While I understand that some PT’s prefer not to develop personal relationships with current patients, I truly believe in the importance of developing a long-term professional relationship with one.

If it’s not a good fit, find one you trust and with whom you can connect. If they turn into a good friend, even better!

Here are The Top Five Reasons Why You Should Get To Know Your PT:

We’ll be spending quality time together.
During the course of your treatment, you’ll be seeing us regularly. I am fortunate to spend 45 minutes with patients, often once, maybe twice a week. Compare that to the amount of time you spend with your doctor during a scheduled appointment, or even how often you see your best friend in any given week. Several years ago, I attended the wedding of a patient-turned-friend after knowing her only a few weeks because, as she told me, “The only person I spend more time with during the week is my fiancé.”

You can confide in us.
Because we will be spending time together working on improving your health, there may be certain things that come up during our time together. Human are complex creatures. There are many factors that can contribute to health, some of which may not be that easy to bring up. As healthcare providers, we are bound by law and ethics to maintain your privacy, and need to know about factors that may be affecting your healing. During any given week I talk to people about such potentially uncomfortable topics as depression, intimacy, problems in relationships, and other sensitive things. We talk about frustrations with treatment and health concerns seemingly unrelated to their physical therapy treatments. Often, the things we discuss are vital to my success as a PT though occasionally I need to refer out to someone better equipped to handle the issue. You need to feel comfortable enough with your PT to be able to discuss the uncomfortable.

We can help ease your fears.
Perhaps you’ve just received a new diagnosis that is troubling, even scary. Sometimes the medical jargon associated with an MRI report or after a doctor visit can be overwhelming. Chances are, we’ve worked with other patients with similar problems and can help explain things in ways you’ll understand. It is not a normal week if I don’t have a friend or family member reach out with questions about a particular diagnosis. The discussion this weekend was about Jason Day at The US Open, his struggles with vertigo, and how PT can help…did you know that?

We can let you know when it’s time to get serious about your health.
There is a reason your back hurts. Ignoring it isn’t the answer and it is likely a symptom of a larger problem. The good news is, you’re willing to invest a little time and energy, and maybe a few little changes to your daily routine, we can make a huge impact. Sometimes a friend or PT who knows you well is the best person to impress upon you the importance of taking your health seriously. You only get one body in this life, treat it well.

We can help you navigate the confusing world of medicine AND fitness.
There is so much misinformation and conflicting advice floating around out there. Who can help you differentiate fact from fiction? A PT with a good clinical experience who has continued to grow professionally and is able to critically evaluate research is good person to have on your team. Well-meaning but incorrect advice is commonly dispensed from people who don’t have the same training and expertise as PT’s who work in musculoskeletal medicine every single day.

We really do care.
My colleagues and I talk about this all of the time. It is not uncommon for us to say to a patient, “I was thinking about you on my walk to work.” I often develop new treatment plans in the most unlikely of places. This is why my showers are sometimes a little longer than necessary. We PT’s are generally so invested in our patients that we take it to heart when someone doesn’t seem to value or appreciate our care. This is also the reason we are exhausted at the end of the week. Don’t expect your PT/friend to want to get together for Happy Hour on a Friday evening!

Lessons Learned

This post has been a long time coming, and I’m not particularly sure why.  Perhaps I was worried I might ruffle some feathers, but when I read the recent editorial by Jas Randhawa, DC and DPT student Kyle Balzer, I was ready to write.  If you haven’t yet read the post, you should:

http://www.jrsportperformance.com/uncategorized/pts-vs-chiros/

PT’s in California are facing a fight in Sacramento that threatens to take away our ability to perform techniques that we have been practicing for years.  SB 381 would prohibit physical therapists in California from performing joint manipulation, reserving the right to this technique to licensed chiropractors, physician/surgeons or osteopathic physician/surgeons.  I don’t know about you, but I don’t know many physicians trained to do joint manipulation.  However, HVLAT techniques are a part of physical therapy school curriculum.  See this editorial for more on the history and training of the two professions:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2565606/

But…I digress.  The intent of this post isn’t to discuss SB 381, it is to share a lesson I’ve learned over the past couple of years.

The interaction between chiropractors and physical therapists has often been contentious, but over the past several years, I’ve asked myself if it really needs to be that way.  PT’s and Chiropractors (we may as well throw Athletic Trainers into the mix) get so hung up on territory and competition and scope of practice, but the way I see it, it’s not only a waste of time and energy but leads to many missed opportunities for learning.

Some of my closest friends in the rehab world are not PT’s.  Some of the people I respect most as clinicians in the rehab world are not PT’s.  Some of my mentors are not PT’s.  The one thing we have in common is that we’re not afraid to learn from practitioners outside of our discipline.  As a result, I’ve been exposed to continuing education courses, have learned techniques that fall outside of the world of traditional PT courses and have become a better clinician because of it.  I’ve been fortunate to have conversations with other rehab specialists, been able to discuss complicated cases approached from different perspectives and am a better clinician because of that.

Rather than staking claim to certain techniques or being worried that someone will take business away, we should spend our time and energy learning from one another to improve the health and optimize the function of our patients. Let’s face it, there will always be plenty of people who need our help.