Do I need a prescription for physical therapy?


For the longest time, to come to physical therapy you had to get a prescription. First you had to make an appointment with your PCP and take time out of your day. They would take a look at you and say I think you should go see a physical therapist. They would write you a prescription and send you on your way. Nowadays, there is something called direct access for physical therapy. Patients can come right off the street without seeing a physician and get physical therapy treatment. So does this mean that you no longer have to see a physician to be able to come to physical therapy? Well it kind of depends.  

The short answer to if you need a prescription is no. Direct access is meant for just that, to not have to worry about seeing a physician to get permission to come to physical therapy. Now, what will decide that is your insurance. Some insurance companies still require you to get a prescription, Medicare being one of them. My best advice to people that are wondering if their insurance accepts direct access is to call the number on the back of their card and ask. If patients do call in we can check for them, but it is much easier for them to call on their own.

How does direct access help the patient? For one, it takes an extra visit to the PCP away. This means they can just come straight to the PT and not worry about seeing an extra health care provider. Another way direct access helps is that it cuts costs for the insurance companies. Unnecessary visits are avoided and this in turn makes them happy. Direct access also saves patients time. Again taking away another visit can be the difference in an entire afternoon or evening for some patients. Busy schedules require efficiency and direct access does just that. And finally, it eliminates barriers to entry. If a patient wants PT, there should not be anything that stands in their way of getting it. This, in turn, opens of and enables people to seek this service without having restriction.

So the next time you get injured call your physical therapist so that they can properly evaluate you and get you on the right path to better health!

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When can I get rid of my knee brace after surgery?


There are a number of different braces given out after surgery for your knee. Most of the time it’s for support of the joint due to weakness. Braces can be cumbersome and bulky and very hard to deal with. The first question I usually get from patients with a brace is when can I get rid of this thing? I understand, your already in pain due to surgery and now you have to lug this thing around with you everywhere you go.

Each surgery to your knee is different and depending what was done will determine when you get out of the brace. A few different surgeries that I see commonly are ACL repair and patellar fracture. Other injuries that require a brace are quadriceps tendon rupture and femoral fractures. All of these surgeries end up with a common problem…atrophy. Atrophy is the wasting away of a muscle and in turn it becomes weaker and does not work as efficient as it once did. Your quadriceps muscles are what help support your knee from collapsing when walking, and when they are not working properly is when the brace is needed. The brace is usually locked at first to take up the slack of any weakness.

So what causes atrophy to happen? When you have surgery on your knee it becomes inflamed. That inflammation works it’s way into the quad and causes it to shut down. When the muscle stops working it starts to atrophy. Have you ever heard the saying “ if you don’t use it you lose it”? Well this statement holds true, especially after surgery. Another reason atrophy occurs is after surgery the last thing you want to do is move your knee or even put weight into it. When you are not working the muscle like it is used to, you start to atrophy. It’s the same move it or lose it atmosphere.

What do we do in the clinic to determine when you can stop wearing the brace? We want to make sure that you have proper strength in your quad muscle to support your knee when you walk. One way we determine this is to have you perform a quad set. You are instructed to keep your leg straight and push the back of your knee down into the table or the bed. We look at if your quad muscle is firing properly and moving your knee cap as it’s activated. We then ask you to perform a SLR. This is done by laying on your back and doing a quad set. Then while keeping your leg straight, lift it up off of the table. If you can keep the leg straight without the knee bending in the air you are ready to be out of the brace.

So the next time you are wondering when that pesky brace can be thrown out ask your physical therapist. The more you do your home exercises the faster you will be able to get rid of it.

Should I have an MRI first?

When most people have an injury, especially if it involves the neck or low back, they feel they need an MRI right away. Also, if a person is ordered to come to physical therapy after their injury without getting an MRI or some sort of advanced diagnostic testing they question why. These patients are usually fearful and hesitant to start physical therapy for fear that something is being missed about their condition and they might get worse or injure themselves more.

Many studies have have been done to show if there is any value of ordering an MRI or advanced diagnostic test following an injury. Unless it is a very serious injury there is very little correlation between positive findings and the relationship to level of pain.

Physical therapy is always the best conservative approach to any type of musculoskeletal injury. Early intervention is key to the overall healing process. Starting treatment early reduces the risk of the injury turning chronic. This can also help save you and your insurance company time and money. Unnecessary testing can get very expensive and this is what we are trying to avoid.

As physical therapists we are trained in detailed evaluations. I can guarantee that my evaluation will be more detailed than just about any health care professional that you will see. Education is a big part of what we do during our evaluation. We are able to find “red flags” and if something doesn’t add up we refer you out to another health care professional. There are clinical tests that we perform to determine what tissues are effected and if those are positive then we take the next step into treating them.

Advanced diagnostic testing is not necessary to have before starting physical therapy treatment. Sometimes, waiting to get a test before starting can delay the healing process of your injury. Physical therapists evaluate and treat a wide variety of injuries and can help with pain reduction and prevention of future injuries.

Is physical therapy going to be painful?

Before I leave the room after all of my evaluations I always ask my patients if they have any questions. I also ask, if what I just explained to them makes sense? At least 50% of the time, if not more, I get “ is this going to hurt? It is a very good question considering the majority of people have no idea what to expect from physical therapy. When people are already in pain to start the last thing they want is to have more pain. Also, at this point, people can be fearful of movement. Therefore, it can become challenging trying to explain what to expect. Let’s talk about this question of pain and if it’s really something to expect when you go to PT.

I absolutely hate when people say that I love putting them in pain! I also get very upset when patients and PT’s alike will state PT stands for pain and torture. Or a PT is a physical terrorist. Really? Is that what most people think we are and do to people? Let’s get one thing straight. My job is to promote movement, function and mobility using your own body to heal itself. I am not here to try and put you in the most pain possible. I have no desire to try and increase your pain nor do I get excited when I do. This is a misconception that a lot of people have and it needs to stop.

Yes, there are times that you may have some discomfort from certain movements, activities and treatments. Take the shoulder for example. A patient that has RTC surgery is going to have pain during PT because you have to move the joint in order for you to gain motion. The shoulder is healing from surgery and that is another reason that it is going to be painful. Any time you have limited motion you are going to experience some sort of pain/discomfort because the joint is not moving properly. It’s not a sign for me to see how much pain I can put you in. It’s just a guarantee that you will be in some sort of discomfort because of the limited motion the joint has.

Will you experience some sort of pain during PT? Depending on what you are coming for the answer is yes. Other times PT can and should be very relaxing and calming. General soreness from activity and exercise is not what I consider pain. It’s just your bodies way of telling you to move your ass more often and you wont feel this way. If you are seeing someone that calls themselves a pain and torture expert or refers to themselves as s physical terrorist I suggest you find a different place to go.

When things get tough will you quit?


As most of you know that read my posts my son plays travel baseball and I’m a coach on the team. Lately it has taken over my life, and I’m okay with that because I enjoy it so much! But I keep finding different reasons to talk about it because these kids show me something different each week. As with all 9 year olds there is an up and down attitude about them each day, week and month. One day they look like super stars out there and nothing can stop them. The next day they look like they are back in T-ball again. This past weekend was one of those weekends where you wondered how they would respond after the events that took place.

We played in a tournament called the Battle of the Boarder in Youngstown Ohio. Leading up to the weekend we knew that competition was going to be very good. 2 teams in particular were going to be there. Beaver Valley Red and West Hills. The last time we played West hills they beat up on us pretty badly. By about 13 runs to be exact! It wasn’t pretty, but our kids had bounced back in the next tournament they played in to take 2nd place. We were in a different bracket then either team and were set to face 2 teams we had never played. The day before the tournament started one dropped out and our schedule changed. Now we were scheduled to play Beaver Valley. I was excited to see how our kids matched up against them since we had never played them before. Once the kids heard that was who they were playing that’s all they talked about. They obsessed about it actually! And it was not in a good way. The game started and we walked the first batter, not a good start! Nerves were probably going crazy for most, but we managed to get 2 outs and the score was only 1-0. Then all hell broke loose! We committed 6 errors giving up 12 runs in the first inning! After the first inning it was 12-0! How does this happen? Little things like catching the ball before trying to throw it. Balls going through their legs, and coming in on fly balls instead of stepping back first. All things our kids do very well most of the time. Their nerves got the best of them. Needless to say the game ended in 4 innings after losing 18-1. We lost the second game 12-6 against another team we had never played mostly due to mistakes and kids just not being in the game. It was tough to watch and hard to talk to the boys afterwards. Sunday would tell us what type of team we have and how they respond.

The next morning the kids warmed up and you could tell they were more lively and upbeat. They started out strong and lead most of the game until the bottom of the 5th giving up 2 runs to be down 5-4. The kids battled that last inning but couldn’t find a way to get another run. We lost that game, but showed great resilience and determination to come back after getting the crap beat out of us the day before. It was great to see how our boys responded.

I wanted to share this with you all because there are always going to be times in life and in physical therapy that you are going to want to quit. Things are just going to get too hard for you and giving up seems to be the easiest thing to do. I know because I have felt like quitting before. My first 2 weeks of PT school I almost quit! I felt that it was going to be too hard and too much for me to handle. I was sick of school at that point and now I was going to have to go for an additional 3 years! I went home that weekend and thought about it a lot. I kept telling myself I could go and get a job for a little while and figure it out. Then I realized that I committed to doing this and this was what I felt passionate about. I’m so glad that I decided to continue my journey. Just know that it’s normal to want to just give up when things are tough and not going your way. It’s the way you respond and show resilience that makes all the difference.

Ask questions and educate yourself before you get cut


Educating yourself as well as being educated about your body and some of the injuries that we have is very important. Google is a very powerful tool that we use for different things throughout the day. You hear people all the time saying, “Just google it!” It’s so easy isn’t it? It’s also very easy to ask questions about what is going on. When patients are seen by a physical therapist, a PCP, a surgeon or dentist questions should be asked by both the patient and practitioner. Communication is key to the success of the treatment set forth. As a practitioner you need to know details about what the patient is going through. You need to know what type of symptoms they are experiencing so your course of action will follow that. As a patient you need to know what is going on and what is going to be done about it. Do you think this is important?

I was just evaluating a patient after he had had shoulder surgery the other day. The script said eval and treat, status post right shoulder surgery. I had started talking to him about when his surgery was and asked him a few questions about what was done. I knew he did not have a rotator cuff repair, but I was unsure as to what was actually done because the script was so vague. I said what exactly did you have done to your shoulder? The patient looked at me with a straight face and said “ I have no idea what the doctor did he just told me I needed surgery.” WHAT????? Are you kidding me? I didn’t say that to the patient, but I was for sure thinking it. What kind of person would just take the doctors word for it and let them cut into their body part without even knowing what they were doing? It makes absolutely no sense to me. Now, I want to give the benefit of the doubt to the surgeon because I’m sure he explained something to him. Or did they?

This isn’t the first patient I’ve had like this and it wont be the last. Are they putting too much trust in their surgeon? I would say yes they are. I would never recommend to do a treatment on a patient without first explaining to them exactly what was going on and what we are trying to do to help it. Educating yourself about your condition through self searches and questions is highly recommended and a big key to help yourself get well. I’m not suggesting to self diagnose yourself. I am simply suggesting that you research your problem so you can have some sort of knowledge about your condition, then ask questions. Knowing exactly what is going on helps understand why things are being done. Don’t just let a medical professional treat you without knowing exactly what they are treating you for. We all have to be proactive in our care and take action to be more informed about what is being treated and why. This, in my opinion, will help clinician and patient relationships as well as trust. Educate yourself and stay informed, only good can come of it.

How much does weight really impact my joint health?


If you have the occasional twinge of pain in your knees, hips or even your back, it is your body’s way of warning you of a potential problem. Pain is your body’s way to tell you that something is wrong and you need to do something about it. Similar to an engine light coming on in your car, pain is indicating a possible problem. Now, what is the cause? There are multiple reasons why your body sends off pain signals. First, if you injure tissue your brain tells you that you are in pain. If you have bad posture, eventually you will feel pain. Our joints are designed to take a lot of pressure during different activities. But when that pressure is increased just the slightest it can cause an enormous chain reaction and your function can be lost. So how does increased body weight really impact our joints health?

Studies have shown that for every pound of excess weight exerts 4 pounds of pressure on your joints, your knees in particular. Let’s just think about that for a minute…if you are 10 pounds overweight you have 40 pounds of extra pressure on your knees. If you are 100 pounds overweight now you have 400 pounds of pressure on your knees!!! That’s a crazy statistic! Now, walking on a level surface puts a force equivalent to 1 ½ times your body weight normally with everyone. So if you weigh 200 pounds you are putting 300 pounds of pressure on your knees. If you add an incline, the pressure goes up. Going up and down a step increases this pressure 2 to 3 times. And squatting, a very functional activity that we all do on a day to day basis, can add up to 5 times your body weight of pressure. This is why it is so important to know what we are doing to our bodies and the affect a few extra pounds can have.  

What does this mean? Well, with increased pressure on joints this can lead to joint break down, in turn causing osteoarthritis. Obesity and being overweight is one of the leading risk factors of osteoarthritis. Osteoarthritis is caused from wear and tear of joints. Once the cartilage is worn away this causes a bone on bone atmosphere which causes inflammation in the joint. Increased weight causes this breakdown to occur quicker than normal. And, pain levels can be even worse with those that already have osteoarthritis. Now you have an inflamed joint that is bearing 3-5 times the amount of pressure that it should.  

What can be done to avoid this? The simple answer is to lose some weight. Most people can afford to lose a few extra pounds. It’s easier said than done, I know. It all comes down to 2 questions. Is it important to you? And what are my goals? You really have to decide what is important to you. If not having pain is important to you, then this should be a priority. If being able to do any activity you want without pain, then this should be a priority. What are your goals? I would suggest setting small goals at first so that they can be easily reached. Seek out another partner to hold you accountable during your journey. In the long run it’s a life style change and it needs to be done in steps. Nobody ever said that getting to a healthy lifestyle is easy, but once you get there it is very easy to maintain that environment.  
So to sum it up, weight has a huge impact on your joint health. Your joints already have a great deal of pressure put on them when doing a specific activity. Adding any additional weight, just increases that pressure even more. This, in turn, can cause other issues such as osteoarthritis. Having a healthier lifestyle can and will prevent such things from happening and should be a priority.  

Which running shoe is best for me?


With so many shoe choices out there, in can be tough to find the right one. You ask yourself questions like: “What color will go with most of my clothes?”, “Do I want a high top or low cut?”, “What brand do I want?”, “Which shoe is the best value?” While all of these questions are valued points, they are not the questions you should be asking yourself. Even the most advanced runner needs help from time to time in the decision making process of choosing a running shoe. Here are a few tips and questions to ask yourself. These will help steer you in the right direction of picking that perfect shoe leather express footwear!

What type of arch do I have?

Normal arch: A normal arch has a half of an arch in a foot print

Low or flat arch: A low arch shows a print of the whole foot

High arch: A high arch only shows a print of the heel and ball of foot. Sometimes it shows a very thin line on the outside.

Once you determine what type of arch that you have then you can search for shoes in that criteria.

How much running do I plan on doing?

This will vary tremendously so I always tend to round up a bit for this question. If you intend on running 10-15 miles per week I would round that up to 15-20. Certain shoes wear more rapidly than others. Similar to tires on a car. If you plan on doing a lot more running you will go through shoes a lot faster and in turn will cost a lot more money in the long run. Cost as well as distance play a big part so choose wisely.

Once I find a shoe is this the only type I should ever run in again?

Some people think that since this shoe works now it will be the only one they can use forever. Many factors go into what works for certain people. Speed of running, stride length, body weight, arch type etc…these same things change over time with everybody. Finding the right shoe for you is a challenge. Sometimes you need to just experiment to see what is best for you. As your fitness levels and ways that you run change, so should your shoes. Bottom line is as you change, your shoes should also follow suit.

Should I only wear my running shoes for running?  

The quick answer is yes! All shoes wear at different rates, but if you use them for everything chances are they will wear out a lot faster. Wearing shoes specifically for running will help with the way the tread wears and will also help with injury prevention. Activities that involve side to side movement like basketball will start to wear the shoe in directions that it should not. Running shoes are meant to wear while running. They have a balance for forward motion. And the cost of a good shoe is not cheap so why wear them out quicker than you have to.

Should I wear in new shoes before I go for my run?

Most shoes now a days have nice movement in the material and do not need to be broken in. Some people will disagree and that is okay. I suggest that if you feel the need to break them in with a few short runs before your long ones than go for it.

When is it time to retire my running shoes?

About 300-500 miles is the suggested time to replace your running shoes. This varies because of different style runners. Some people have a very long stride length so the miles will be higher due to less strides per mile. Shorter people have a shorter length so they will have more strides per mile. This is just a general rule of thumb. In my opinion, if your shoes feel like they need replaced before the recommended mileage then replace them.

Choosing the right running shoe takes time. Sometimes it’s more trial and error. My suggestion is to find a Physical Therapist or a Podiatrist that can evaluate your feet and help you make the right decision.

My running shoe:

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http://amzn.to/2memu3x 
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Having trouble staying motivated? Try these tips to stay on track!


It can be very hard to stay motivated about things, whether you are in the middle of a fitness program, trying to lose weight or even trying to keep up with your exercise program at Physical Therapy. It’s hard to stay at a consistent pace because things tend to get harder each day and week. We all start off the same with anything new. We are very excited to see the results of hard work. Then we hit a wall and we plateau. We lose interest very easily and start to go off course. Then the excuses come: “I just got so busy and I couldn’t find time.” “After 3-4 weeks it just wasn’t working for me.” “My body is just meant to be in the position that it is I; it runs in my family.” Do any of these sound familiar? They do to me and I have found myself saying one of these a time or two. Being a Physical Therapist I deal with excuses like this all of the time from patients. I wanted to put a little list together of ways to stay motivated. I myself use some of these to stay on task.

Write down weekly and monthly goals:

Writing down your goals makes it that more real. It makes you accountable for what you say you want to do. If you hang them somewhere you will see them each day. It will make you more aware and want to accomplish them.

Surround yourself with like minded people:

Surrounding yourself with people that have the same vision as you can be the difference between a win or a lose. When you surround yourself with these kind of people your mindset shifts. This also holds you accountable to what you have set forth. If you are always around “Debbie Downers”, then you are going to be more apt to act like them.

Be patient:

You have to be patient. Things take time, especially if it’s something new. Everyone that starts a new exercise program or tries to lose weight wants results yesterday. Nothing in life works that way. You have to stay focused and keep your eye on the prize. Remember steady and slow wins the race.

Reach out to others for support:

This also goes back to surrounding yourself with like minded individuals. It helps to have support of others that are going through what you are. I always encourage my patients to talk to each other about what they are coming to PT for. Tell them your story, and what you have done to try and convince yourself you are getting better. Having others to bounce things off of can help keep you focused and motivated to continue.

Read and listen to personal development:

This is a big one, especially for me!! I have never read more personal development books than I have in the last 6-8 months. It helps me stay grounded. It shifts your mindset from “it can’t be done” to “let’s do this!” Personal development in my opinion should be something that everyone should work on. It gives you a sense of direction, greater resilience, improved focus and of course motivation to want to succeed.

Give yourself breaks:

There are going to be times when you want to give up and you feel overwhelmed. Burn out can happen, so you have to give yourself breaks. Take a day or two to refocus on what you originally started for. Rethink your goals and what you eventually want to do. Go out with your spouse, significant other or friend. We all need breaks from time to time.

Make sure to reward yourself:

You have to reward yourself every now and then. If you are trying to live a healthier lifestyle you need to be able to splurge on a meal you normally wouldn’t eat. If you are working towards a particular fitness goal you should reward yourself with something that makes you feel good. When my patients accomplish something or are doing well I always tell them reward yourself today you did great! When you reward yourself it helps remind you why you are doing this in the first place.

Sustaining motivation can be tough under the best circumstances. It’s not magic and it is not something you can just drink out of a bottle, but it is something that you can tap into when you feel like giving up. The next time you feel like you are losing motivation try these simple steps to keep yourself on track.
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Stress got you crazy? Try these tips to help

We all have stress in our lives and we would be lying to ourselves if we said we didn’t. With all that goes on during your daily routine it’s hard to stay away from stress. Our jobs, responsibilities, parents, kids and families can all throw us through a whirlwind and then the stress begins. You start asking yourself questions like: How am I going to get this project done by the deadline? How am I going to get the kids dinner, their homework done and get them to both of their games at separate fields? How am I going to check on mom, get to my meeting and try to spend time with my family? All of these questions would cause stress. I deal with things like this all the time. I stress about getting out of work on time just so I can get a workout in and get home in time for the kids to get off the bus. I stress about how I am going to fit patients in when I only have limited space at my clinic. I stress about when I get slow at work and what I can do to get better. I decided to put together a small list of things that you can do to try and decrease your stress levels. I do some of them on a regular basis to try and keep myself grounded.

Exercise: Exercise is a great way to relieve stress. As we exercise we release endorphines, which are the bodies natural pain medication hormones. When they are released it makes us feel better, improves our mood and increases our pleasure. This, in turn is what causes us to feel so good after a workout.

Socialize: When we are stressed sometimes we just want to be alone, but socializing with people can help as well. Talking to someone and venting is sometimes all we need. It’s also good to talk about other things to try and get your mind off of your current situation.

Read: Reading is one of the best ways to relax and even six minutes can be enough to reduce the stress levels by more than two thirds. Research has found that this is one of the best ways on top of walking, listening to music or having a cup of tea.

Meditate: Sometimes you just need to go to that other place that makes you happy. Meditation is a skill, but when done properly can take you into a whole new world of being happy.

Breathe deeply: Deep breathing exercises are always good to try and relax yourself. Have you ever seen the movie the Karate Kid? Mr. Miyagi had Daniel doing this to stay focused and not lose his cool. This actually does work and if you do it often enough it will become a habit. If combined with meditation it is very powerful.

Listen to music: Listening to your favorite music always takes your mind off of things. There is something about that beat! Or when your favorite jam comes on you just want to rock out! Don’t lie, you were just rocking out in your car the other day and got caught singing at a red light. I did! Seriously, I was at a red light just belting out some Kenny Chesney and I looked over and the lady was just laughing. It was cool because I probably made her day!

Mow the lawn: This is one of my favorite things to do when I am stressed! I love to mow the lawn! Anyone that knows me will tell you the same thing. I put my headphones on and drive. I like to make perfect stripes in different directions each week. It’s kind of like a picture that I am making. It makes me feel good when I’m done and look at how nice it looks.

Drink a beer or two: Now I’m not saying go get smashed, but drinking a beer or two can take your mind off things as well as help you relax. It also brings in the social aspect and helps you let loose from time to time. This is not recommended to do a lot, but every now and then you just need to enjoy yourself.

So, the next time you are feeling that stress start to build up try a few of these tips. I guarantee one will work for you. Enjoy, and as always don’t hesitate to reach out to me with any questions or concerns.