TPSF Holiday Coat Drive: November 13-December 22

Do you have coats in your closet that you no longer wear?

TherapydiaSF is hosting a coat drive for the holidays! Stop by either TherapydiaSF location now through December 22 and donate your gently worn coats to a great cause!

Health experts report that even a 2-degree drop in body temperature results in reduced heart rate, loss of coordination, and confusion. Adults cannot work effectively and children find it difficult to learn. For most, a warm coat solves the problem. But, for the nearly 15% of Americans living in poverty, a warm winter coat is a budget “extra.”

Join the team at TPSF this holiday season to give back to those in need! For every coat you donate, you will receive a raffle ticket for a drawing to be held on December 27th. Three tickets will be drawn for your choice of a physical therapy evaluation, a Pilates session or a RunRx running assessment.

TherapydiaSF-Embarcadero Center: 1 Embarcadero Center, Lobby Level

TherapydiaSF-Market Street: 580 Market Street, Suite 100 (mezzanine level)

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!

 

 

Movement Matters

sf_run_assessment

You’ve heard it before, “exercise is good for you.” It probably started with your PE teacher in grade school and now it’s your doctor reminding you at your annual physical exam. It seems that a new study touting the benefits of exercise is reported on the nightly news almost every week. We all know that exercise is good for losing weight and getting stronger, but what you might not realize is that beyond the physical changes you see, by committing to a regular exercise routine, you’ll have a positive impact on your mind, body and soul. So why is it that according to the Centers for Disease Control and Prevention, 25 percent of the U.S. population doesn’t participate in any physical activity?

Mind:
When faced with a busy schedule and too many meetings on your calendar, exercise often takes a backseat. If you’re not sleeping well and wake up exhausted, the last thing you want to do is lace up your running shoes and head out for a sweat session. However, the next time you’re fading midday, consider skipping your visit to the local coffee truck and hit the gym instead.

According to a 2011 study of more that 3000 people, those who get at least 150 minutes of exercise a week sleep significantly better and feel more alert during the day than those who do not.1

In that same year, a study of older adults revealed that regular aerobic exercise increases the volume of the hippocampus, the area of the brain related to memory, and can help improve memory function. While its effect on the mind is continually being studied, findings strongly suggest that exercise promotes improved brain function.2

Body:
You’ve probably known that aerobic exercise is essential for heart health as long as you can remember. Starting an exercise program is often the first piece of advice given to individuals at risk of developing cardiac disease. People who exercise regularly tend to develop less heart disease their sedentary colleagues. If they do develop a form of heart disease, it happens later in life and is generally not as severe.3

Exercise also promotes bone health, an important consideration as we age. While studies are ongoing, one released earlier this year showed moderate intensity aerobic exercise may have a protective effect on bone and cartilage by regulating elements in the body involved in increasing our bone mass density.4

A strong heart and strong bones are important, but exercise can help the body in other ways. Emerging research suggests that moderate amounts of exercise may have a positive effect on chronic pain by changing an individual’s perception of and response to their pain.5 Movement continues to be the most conservative, most inexpensive, and likely the most effective treatment for lower back pain, a condition that affects 80% of us during our lives.

Soul:
Have you ever started a workout in a bad mood and ended it feeling even worse? Not likely. Do you alleviate stress with a tough session? You might be on to something. There is a strong link between between exercise and mood. In general, active people are less depressed than sedentary people. A 2007 study concluded that exercise was generally comparable to antidepressants for patients with major depressive disorder.6 A hot topic of research in the mental health field, scientists are extremely interested in learning how to prescribe exercise as treatment for a variety of conditions including stress, anxiety, and depression.

The more digitally connected we are, the less real contact we tend to have with friends and family. There’s an app for everything, but not one that promotes in-person interaction with our true social circles. Exercise has a positive effect on our relationships and can even lead to developing new friendships. Finding a common exercise interest increases motivation, fosters healthy competition and can create strong social bonds with friends and family.

The benefits of exercise are vast and the scientific support of movement continues to grow. Who wouldn’t want to look better, feel better and be better? If you’re a regular exerciser, keep it up! The changes you’re making are huge. If exercise hasn’t been your thing, find something you enjoy, commit to your health and get moving. Your mind, body and soul will thank you.

  1. Loprinzi, Paul and Bradley Cardinal. “Association between objectively-measured physical activity and sleep, NHANES 2005–2006.” Mental Health and Physical Activity2, (2011) 65–69.
  2. Ericksona, KI, et al. “Exercise training increases size of hippocampus and improves memory.” PNAS 108.7, (2011) 3017-3022.
  3. Myers, J. “Exercise and Cardiovascular Health.” Circulation.107(2003) e2-e5
  4. Alghadir, JH, et al. “Correlation between bone mineral density and serum trace elements in response to supervised aerobic training in older adults.” Clin Interv Aging.11 (2016) 265-73.
  5. Jones, MD, et al. “Aerobic training increases pain tolerance in healthy individuals.” Med Sci Sports Exerc8(2014) 1640-7.
  6. Blumenthal, JA, et al. “Exercise and pharmacotherapy in the treatment of major depressive disorder.” Psychosom Med. 7 (2007) 587-96.

 

trx2

 

 

 

 

 

 

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!

How to stay motivated to exercise during the foggy days of a San Francisco summer

Come December, almost every fitness magazine or blog features an article about how to stay motivated to workout during the winter months. The Internet is full of fitness tips for winter, while retailers push the latest in coldweather gear.

San Francisco is a city with little variability in our temperatures, making these articles virtually irrelevant to our fitness buffs. Yet, we do have one weather phenomenon that can be a buzz kill for outdoor recreationalists. While the rest of the country enjoys warm summer days, we often host an unwelcome guest named Karl the Fog. Karl is active on social media, with his very own Twitter, Facebook and Instagram accounts. Don’t get me wrong, some people welcome Karl and appreciate the cooling blanket he provides. It is easy enough to escape his presence with a quick trip inland. Plus, it’s pretty amazing to see his fingers of fog creep across the skyline, hiding the sun and its warmth in a matter of minutes. Others, myself included, are easily affected and develop feelings of fatigue and sluggishness. We may need a little push to get outside for exercise. On my first day of graduate school at UCSF almost 15 years ago, a professor told us to be sure to escape the city on weekends to avoid developing SAD—Seasonal Affective Disorder, a type of depression that often occurs during winter conditions…or, in our beloved city, during the summer when the sun doesn’t shine. I still get a burst of energy when I wake up to a clear, sunny morning. On those perfect days, I can’t wait to get outside and don’t want to waste a rare, beautiful day. Those kinds of San Francisco days make even the foggiest worth it.

So how can you stay motivated to exercise during the foggy days of a San Francisco summer?

      • Appreciate the cool- While the fog may be lingering in your neighborhood, just a few miles in any given direction the temps may be soaring, making a morning workout intolerable. Last weekend I was visiting my hometown and got out for a fairly early run…in 85 degree heat (and loved every minute of it). Yet, friends in hotter climates complain of having to workout at 5:00 am to avoid the heat, or worse, they have to stay in an air-conditioned gym for their daily dose of exercise.
      • Wait it out- Depending on the day, it may actually burn off. But, as soon as you see a glimpse of clear sky, head on out. You never know when Karl will return. It may be a matter of a couple of hours, or might stay clear the rest of the day.
      • Or don’t…There’s a strong chance that he’s here to stay for the day. Embrace the cool climate and know that you’ll have a sunny day soon enough. According to a 2011 study of 229 students conducted at sunny Santa Clara University (1), exercising outdoors was more enjoyable and resulted in less tension and stress, compared to indoor exercise.
      • Try a different neighborhood- In a city known for its microclimates, you can almost always find a sunny spot in San Francisco. Venture to a different neighborhood for some exploration and, fingers crossed, maybe a little sun. Some of the sunniest neighborhood in San Francisco include the Mission, Noe Valley, DogPatch and Potrero Hill.
      • Appreciate your surroundings- The outdoors take on an entirely different look and feel under the cover of fog. Views you have seen a million times, suddenly become new, taking on a different type of beauty. Have you ever seen The Presidio under cover of fog? Or heard the foghorn sounding under the Golden Gate Bridge? The trails in Glen Canyon become beautifully mysterious when shrouded in fog.
      • Take it indoors- There are a ton of great indoor fitness options, if you just can’t drag yourself outside to face the fog. Some of my favorites are TRX, yoga, Pilates, and circuit training workouts in the gym or at home.
      • Grab a friend or play some music- Can’t get out the door? Grab your iPod or call a friend. Both have been linked to increased motivation for exercise. In fact, a 2013 article in Scientific American (2) reports, “Music distracts people from pain and fatigue, elevates mood, increases endurance, reduces perceived effort and may even promote metabolic efficiency. When listening to music, people run farther, bike longer and swim faster than usual—often without realizing it.”

Tips for exercising on foggy days:

      • Don’t overdress- While wet, foggy weather isn’t always cold weather. You’ll learn your lesson if you head out with too many clothes into the often warm, humid air. Your best bet is to dress just like you do for any SF day—layer, layer, layer (preferably in a sweat wicking fabric).
      • Don’t forget the sun protection- Sunscreen and sunglasses are a must on even the foggiest of days. According to dermatologists, 87% of the sun’s rays penetrate through clouds, fog and mist. While these can block sunlight, they don’t effectively block harmful UV rays.
      • Warm up appropriately- Depending on the temps, you may need more of a warm up on a foggy day. I recommend a dynamic warmup and light start to your workout.

Ahh…the sun just came out—time to hit the trails! See you soon, Karl.

 

References:
1. Plante, TG, et al. Exercising with an iPod, Friend, or Neither: Which is Better for Psychological Benefits? Am J Health Behav.™ 2011;35(2):199-208.
2. Jabr, Ferris. “Let’s Get Physical: The Psychology of Effective Workout Music”. March 20, 2013. http://www.scientificamerican.com/article/psychology-workout-music/.

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!

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.