BASIC REHAB RECOMMENDATIONS

So you have injured yourself - what to do next?


Always assess the situation: does it appear to be a life threatening injury? If so, call 911, and immediately consult health care professionals.

If your injury is not  life threatening, then consulting a Physical Therapist may be your best option. Most people think that in order to see a physical therapist, you need a referral or prescription from your doctor. However, this is no longer the case for most people in most states. Physical Therapist are educated at the Doctoral level, and have Direct Access within their scope of practice, which means that state laws no longer require a referral from a physician in order to consult a physical therapist.

Certain insurances may still require a doctor's referral, so be sure to check with your insurance before your visit so you don't get any surprise bills. This is very easy to do: take your insurance card, call the number on the back of the card and ask them if you need a referral from a physician to see a physical therapist (if you have Medicare, then you DO need a referral from your physician).

If your injury is orthopedic in nature (it likely will be if you hurt yourself while playing Pickleball), then a Doctor of Physical Therapy is your best initial option to expedite your recovery. Physical Therapists are Musculoskeletal experts, trained to evaluate your injury and design an individual plan of care to best fit your needs. Their knowledge of anatomy, healing time, biomechanics, and problems related to the musculoskeletal system is much greater than a primary care physician, and will save you time and money if you go to a physical therapist first.

What services do Physical Therapist offer these days? 

Physical Therapy has evolved a lot in the past 20 years. The scope of practice has been expanded, and the skills and knowledge taught in Physical Therapy school is very different than it used to be. Physical Therapists are licensed practitioners who are required to perform a minimum amount of continuing education yearly in order to maintain their license. They can provide these services:

- Spinal Manipulations

- Dry Needling (Western Medicine Acupuncture) - This is state dependent. There are still states (13 of them) where Dry Needling is not legal for Physical Therapist to perform, but as States catch up with current evidence, it will likely change over time.

- Individual Exercise Program Development

- Cupping

- Instrument Assisted Soft Tissue Mobilizations

- Joint mobilizations

- Soft tissue mobilizations (deep tissue release, muscle release)
- Taping techniques

How to find a good physical therapist: 

  1. You can always ask me for an opinion if you are looking for someone. I have contacts in a lot of places around the United States, and can try to find someone reputable.

  2. Do your research about the practice and therapist you are considering:

    1. How much time does the Physical Therapist spend 1 on 1 with the patient? If it's anything less than 40 minutes, I would avoid that practice.  

    2. Does the Physical Therapist have experience in Sports Rehabilitation? This is a tricky question: almost every orthopedic therapist will answer yes to this question. However, there is a BIG difference between an Orthopedic Physical Therapist, and a Sports Physical Therapist. While it is possible to be both, treating Sports Injuries and guiding athletes back to performing their sport is something that requires skill and experience, and cannot be treated like any orthopedic injury. Understanding the needs and demands of the sport is vital in designing a rehabilitation plan, and having a Physical Therapist that understands this and knows how to incorporate the requirements of the athlete into their plan of care is what differentiates Orthopedic and Sports Physical Therapists.

    3. Does the Physical Therapist use Ultrasound Therapy? If so, run away! Ultrasound therapy was very popular in the 90s, and is an outdated concept that has no significant evidence to support it's use for athletic injuries.

    4. Education, specialty training, continuing education: it is always good to see a Physical Therapist who graduated from a reputable Institution. However, that is only the start. Physical Therapists are required to perform continuing education, so inquiring about further certifications and specialties can be important when looking for a Physical Therapist. If the Physical Therapist has interests in sports and has taken courses to further their knowledge about sports rehabilitation, then they may be a good option!

What about chiropractors, massage therapists, acupuncturists, etc?

Here is my opinion on health care providers overall: there are good ones and bad ones - it doesn't matter what profession you look at, there will always be good, mediocre, and bad practitioners. They are people like everyone else, and don't always do the right thing. The biggest difference between Physical Therapy and other professions is the philosophy of care and reasoning behind every intervention. Physical Therapists focus only on 3 organ system: Muscular (muslces), Skeletal (Bones), Neurological (nerves). Every intervention is aimed at making a change within these 3 systems, as that is their area of expertise and what they are trained to do.

  • Chiropractors: as mentioned above, I believe there are good chiropractors, and bad chiropractors. The difference between traditional Chiropractors and Physical Therapist is the philosophy of care and reasoning behind the treatment. Traditional Chiropractors have long based their services on the Vertebral Subluxation Complex Theory, which is based on the notion that every organ system in our body can be affected and altered by changes made to the spine. They have claimed that there are segments of our spines that are out of place, or "Subluxed", which may cause injury or abnormal functioning of the nerves coming out of the spine and feed various body parts. These Chiropractors often claim that they are able to treat 10 organ systems in our body, such as helping with fertility problems, asthma, and even autism. I am not in support of the Vertebral Subluxation Complex theory, as I have not seen any peer reviewed medical evidence supporting that "Subluxations" causing impairments away from the spine actually occur. However, I have met some excellent chiropractors, who have great skills and provide manipulations to their patients and have great results, These chiropractors base their treatment and skills on neuro-anatomical findings, and do not claim they can treat your diabetes or autism by manipulations of the spine. They focus on restoring proper joint mobility, and normalizing the connections between the nervous system and soft tissue structures in our bodies. Chiropractors spend their time in school learning about the spine and how to manipulate it. Unless a Physical Therapist has taken advanced training to improve their Manipulation skills, Chiropractors often have better hands on skills than Physical Therapists related to spinal manipulations. 

  • Massage therapy: massage therapy can be helpful at times in order to control pain and make people feel better, but there is no significant medical evidence demonstrating a long term benefit associated with massage therapy. Basically, if you feel a massage would be helpful, then by all means go for it. Most times, a massage will not make your injury worse, although I have seen it happen.

  • Acupuncture: traditional Chinese acupuncture is based on the concept of energy flow (Qi, "Chi") within our bodies along certain pathways called Meridians. It is believed that obstruction of energy in certain areas can lead to pain and dysfunction, which is corrected by inserting needles at various points on our bodies to restore proper energy flow.  This differs from Dry Needling (Western Medicine Acupuncture) used in Physical Therapy, as Dry Needling is based on a Neuro-Anatomical basis. For example, if you have back pain, an Acupuncturist may insert needles over your entire body (ears, feet, arm, etc) in order to restore the energy flow, while a Physical Therapist practicing Dry Needling would place the needles in or near the area in pain in order to make a change in the tissues, local pH levels, muscle activation and modulate the pain. There is mixed evidence regarding the effectiveness of Chinese acupuncture. I have seen patients benefit from it, while others did not respond to it, but I have very rarely seen it make an injury worse.

 

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