I am in my final week in Fresno where I have been working with Work Comp injuries for 6 weeks.  It has been a great experience and I have met a lot of great people at work, CrossFit Fresno, and my two awesome room mates.  I thoroughly enjoyed CrossFit Fresno.  Jon and Rosanna are excellent trainers and I have been impressed with the emphasis on technique, corrective movements/warm up and variety of WODs they prescribe.  I would feel safe sending a patient to them to progress a motivated persons wellness and fitness.      

Everyone strives for wellness.  The main components are simple.  Exercise, nutrition, and rest.  Exercise and rehab is broken down into 3 more pillars:  Reset, reinforce and reload.  Gray Cook and the folks at Functional Movement Systems have preached using this as a treatment for any functional deficit (injury or no injury).  

1)  Reset the system – Use techniques such as manual therapy, massage, self mobilizing devices or neuromuscular training to relearn the pattern that is dysfunctional.

2)  Reinforce the system – once the system has been reset, use tape, corrective exercise, or practice to keep the changes that have been made.  Using tape and corrective exercise will ensure the changes convert into daily activities or improve an exercise technique (ie – overhead squat, running gait.)

3)  Reload – Exercise in the new pattern that has been reinforced.  

Kinesio Tape, Rock Tape, Leukotape are all brands and philosophies that can be utilized in step two above (Reload).  I have be trained in Kinesio Tape and use it on about 75% of my patients.  Kinesio Tape can be used for:  

1)  facilitation of weak or dormant muscles

2)  inhibition of tight or overused muscles and

3)  mechanical correction of joint play

Using Kinesio or other brand can greatly enhance a Crossfiter’s program.  With the recent CrossFit games 2013 in LA last weekend, many in my classmates were exposed to Rock Tape.  On my last class this Thurs, I hope to educate some of them and demo proper use of tape for effective Reinforcement of a dysfucntion.  Every Crossfiter has a pattern or impairment that can be reinforced.

Thanks for a great time, Fresno.  I have learned a lot.  Now, on to Cape Cod…   

 

It is Thursday evening and you are playing softball. After fielding a ball you throw to first base and feel an intense pain on the front of your shoulder. This is not a new pain but it feels worse than usual. Despite your usual treatment regimen that night (Ibupfrofen and ice), you wake up with a sore, hot shoulder. It is time to get this thing fixed. Afterall you have a tournament next weekend. If you live in California there is no way you are getting started with Physical Therapy before next week. With all the state laws and insurance company hoops to jump through it becomes difficult to get started on your recovery. But in South Dakota and many other states, you can get started that day!

Direct Access: Free to use your own judgement to seek out the appropriate medical professional without being told by another one to do so.

Why is Direct Access to Physical Therapy so important?

1) When you get injured, you want to get started as soon as possible. Direct Access eliminates the wait time to get into the specialist doctor or a costly trip to urgent care.

2) Going directly to Physical Therapy may cut down on healthcare costs (unnecessary imaging, medications, extra copays). These hoops to jump through keep patients from seeking treatment or from getting better faster. Don’t worry. Physical Therapists are trained in medical screening. If you need an x-ray, medications or if Physical Therapy is not appropriate, we will refer you on. The last thing we want is to do is treat someone who has a red flag (non-musculoskeletal pathology not warranting PT).  That is why it is called a red flag. Stop!
Here are some examples of theses hoops patients must jump through in various states/insurance types:
1) You can be evaluated by a PT but can’t receive treatment utility you get a MD referral.
2) You can receive treatment by a PT for 21 days but after that you need a referral.  How often do you completely recover from an injury in 3 weeks?
3) Many states and insurance companies require a signed plan of care by an MD prior to proceeding with care.
*These examples only delay care and provide extra work from all parties. More hoops to jump through make people reluctant to use insurance at all.

Why Physical Therapy?

1) We don’t get you better. We help you get yourself better.

Sure, we are going to use modalities (fancy machines to help you feel less pain and more relaxed) and have you relax on the table for a bit (for massage, joint stretching and other passive techniques). But, this is just a jumpstart or a reset to the system. Once the system is reset we will help you re-enforce the changes. The rest of the work is done by you. We are going to educate you and train you to do what is best during your rehab and going forth.

2) We want to make sure it lasts.

Guess what? You didn’t throw your arm out JUST because your shoulder is weak. There are probably 5 other factors contributing to your recurrent shoulder pain. Ergonomics, posture, exercise habits, sleeping habits, diet, throwing technique…these are just a few things we can identify during your treatment for acute shoulder pain.  Then we can help you prevent another occurrence. We love our patients but, really, we don’t want to see you forever.

Part of “making sure it lasts” is taking you to the next level of fitness. Everyone has body image or fitness goals. We can get you started on working towards those goals during the rehab process.

3) We have an eclectic approach.

We do manual therapy. We do exercise. We use machines. We use tape and braces. We know if you don’t do your homework (home exercise program) and will make you do it in the clinic before we do the passive treatments. The benefit of being eclectic is that we do what is most important for you all the time, not just what you expect us to do.

So next time you are sidelined by a nagging reoccurring injury, get on the horn and call a PT. We will get you started on recovery immediately… IF YOUR STATE HAS DIRECT ACCESS.

*Many states have been labeled direct access but patients DO NOT have clear access (“hoops” described above).  See below in Direct Access spelled out state by state. There is lot of current advocacy related to clear direct Physical Therapy access in these states. Please help support this effort.

References and More Information

American Physical Therapy Association info on Direct Access

Direct Access Spelled out State by State

Clout for Direct Access to Physical Therapy

Sat Session Cycle and Circuit

This Sat March 23rd I will be organizing a 1 hour Sufferfest cycling session with amplified music and flat screen viewing.  Thirty minutes of dynamic stretching, corrective exercises, and core stabilization to follow…

8:00am – 9:30am at the Rec Center in Deadwood

3 spots still available.  FREE!  Email me to reserve a spot or have questions:  ptjess@me.com

A second session is in the works for Sat March 30th.

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