Value in Physical Therapy

“I rarely refer to physical therapy because with the co-pays and everything…” Says a friend of mine who is an MD. He regularly refers for MRIs and performs epidural injections which cost (quite literally) hundreds if not thousands of dollars per test and treatment.

“Physical therapy is too much for most of our clients” says a nearby foot surgeon who is a stones throw from my physical therapy office. I do not know the cost of plantar fascia releases. And toe resections. And ankle fusions. And tendon reconstructions. And amputations. And…Yaaahhhhh!hd-aspect-1454081235-dean-scream-header

Yes, physical therapy costs more than a monthly gym membership or lunch at your favorite deli. But it’s a lot less expensive than MRIs, surgeries, and injections. I still haven’t arrived at the point of this rant.

This is not a simple question of “Which treatment is cheaper?” The issue is VALUE.

Let’s say that you have a stubborn pain across the inside of your knee that has not diminished in a few weeks.

You could consult an MD to poke at (palpate) the knee and prescribe some anti inflammatory pain medications. You could hire an orthopedist to poke at the knee and give you a cortisone injection and tell you to quit doing the things that you enjoy. A typical chiropractor may check for imbalances in posture, alignment, nutrition, or some kind of chi electromagnetic field. He or she may lay you on a table, and perform specific manipulations on your joints.

You could do all of those things, and that would be okay, possibly even helpful. But none of these are likely to address the cause of the problem.

Your knee problem is very likely a movement related issue, and very rarely do medical disciplines outside of physical therapy have you, you know, ACTUALLYMOVE!

All of them demand little time or effort on the patient’s behalf. They are all chasing pain and stop shy of educating and empowering you to understand and address the cause of the pain if at all possible. I won’t go ahead and compare the cost of 6 or 8 visits of physical therapy versus diagnostic tests, surgery, and associated post-op medical care. But the data is definitely out there and easy to locate. You can see the results of some studies here , here, and there.

**Pain is not the bad guy, to be ignored or completely annihilated in the typical American way. Pain is a “tell,”  a guide that marks the way for an intelligent approach to treating the problem.

If you come to most physical therapists with a sore knee, they will-

-Take a look at your posture and alignment of the feet through the hips.

-Have you MOVE! What is the femur doing at the knee and hip in its accessible planes? Is the femur attempting to move in planes where it doesn’t have access, particularly at the knee? What is the foot and ankle doing in relation to the knee? Does the foot move too much or not enough? How are the core and opposite shoulder moving in respect to these accessible planes of movement? What general movement strategies does the person use? Do they access their hips when going up and down stairs, squatting or going to and from a chair?

From this, we can come up with a plan to address your specific impairments without relying on medications, injections, or invasive surgeries**.

Most folks with knee pain benefit from a handful of modalities to calm down the irritated and/or inflammed tissue.

Most have some pattern of weakness or tightness of the pelvis and hips.

Some with knee issues have ankles and feet that are too tight or tool flexible. Some have high or low arches that warrant work on their feet or even orthotic intervention.

I’m not saying that physical therapists can or should guarantee everyone a pain-free existence, or that medications, injections, and surgery do not have their place. They certainly do. But let’s not pretend that a thorough movement assessment and treatment has less value to the patient and the system.

It’s nice to believe in what you do for a living!

And if you want to go even one step better, find an exercise program, a personal trainer or -certain- guy who knows what he’s doing, so that you can train and maintain your body without doing harm in your exercise program. I mean, wouldn’t it be great if you could learn the details that address and prevent pains and problems before they become debilitating.great idea

I mean, geeze…you could even include this work as a part of a regular exercise routine that you should be doing anyway!

Imagine if you could schedule a detailed one – on – one assessment to go over your body, your barriers and personal goals, then carry that out with a little instruction and light assistance.




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