Direct Access to Physical Therapy

5 Things I'd Like You to Know Before Your First Visit

By Bobby Bemis, DPT, COMT, DIP. MT, FAAOMPT
bobby@excelptmt.com

What is physical therapy? How can it help me? What should I know? What role do I play in it? What if I don’t like going to the gym? Will it hurt? How do I know if I need it? What if I don’t like being touched? What if I don’t like exercising? Is it a quick fix? Maybe I should just get surgery? What if I can’t be helped? Maybe I just need to be tougher? Do I need therapy if my medication helps the pain?

I am guessing that if you are reading this article that you have asked yourself one or more of these questions before. Most of my patients have and it can be incredibly overwhelming. I am here to help you navigate the physical therapy world and maybe even a little of the healthcare world in general.  

Full disclosure. I am biased. I love physical therapy. I love that a generally non-invasive form of healthcare can benefit so many. I love that like so many things in life you often get out what you put in. I love that physical therapists, in general, are empathetic, positive, altruistic people that want nothing more than to see people walk out of the clinic in a better place than when they came in. This blog is for those of you who aren’t quite sure what to expect regarding physical therapy and how you can take advantage of what it has to offer.  

Physical therapy has undergone a major evolution over the past decades. Long gone are the years of using treatment time to primarily administer modalities (e.g. ice, heat, ultrasound, tape, etc.). No longer do we regard injuries as a purely physical experience and ignore all the other components of a person that can impact their pain and dysfunction. Physical therapists and hopefully other healthcare professionals now view patients in what is called a biopsychosocial framework. That means your pain is not only impacted by biological factors (e.g. arthritis) but psychological factors (e.g. anxiety) and social factors (e.g. a fight with your spouse). This framework continues to be supported by more and more high-level research from all over the healthcare world.  

Physical therapists are musculoskeletal experts and gateway healthcare practitioners. What does that mean? When it comes to musculoskeletal issues you will be hard pressed to find another healthcare professional that is better at diagnosis and treatment of these conditions. As gateway healthcare practitioners physical therapists have the ability to see patients without a referral and we are educated on how to screen for other medical conditions that may not be appropriate for physical therapy. In these cases, we can refer to specialists that have expertise in the appropriate area of care.  

Physical therapy can help you organize the complex and confusing world of today’s healthcare resources and options. Do you need to see a surgeon? Do you need to see a non-surgical orthopedic physician? Would you benefit from massage therapy? Would you benefit from consultation regarding a steroid injection? Could you benefit from some mental health counseling? Would a registered dietician be helpful? Or are you just where you need to be…in physical therapy?! 

Here’s 5 suggestions/recommendations regarding your first visit for physical therapy: 

  1. Come prepared. If you feel like you might be anxious, overwhelmed or nervous take the time to write out any questions you may have before your visit. That way you can refer to your notes when your mind goes blank.  
  2. Come with an open mind. Try to put aside any prior experiences you have had with the healthcare system.  
  3. Don’t get too fixated on imaging. Imaging is good at ruling things out but not great at ruling in things that are causing your pain. There is not a good correlation between tissue degeneration and pain…so be careful.  
  4. Remember that all pain is perceived in your brain…so your pain can change depending on the state of your mind. There are techniques and strategies to address neurological pathways that may have developed over time that negatively impact your pain.  
  5. Physical therapy is an active endeavor. It is very rare that a physical therapist can magically fix your pain or dysfunction in one visit. My goal is to get you back out there ASAP…but it will not happen overnight and will not be done passively.  

One of the biggest complaints I hear from patients regarding health care professionals, in general, is that most don’t listen and they lack empathy. Keep in mind that as a physical therapist at Excel Physical Therapy, I have 45 minutes to do the best I can to figure out what is going on and how to best provide you with the tools to improve and get better. To steal a line from the psychologist and author Malcolm Gladwell we must use “thin-slicing” to help us figure out the best path for our patients. That means that a good therapist or healthcare practitioner will skillfully direct the conversation to get the information that will allow them to best figure out a plan of care that can best impact the patient for the better. We want to hear your entire story and we will…over time.

One of the beauties of physical therapy is that we spend more one on one time with patients than almost any other healthcare profession. If you are honest with yourself and take into account your biological, psychological and social factors that may bias your opinion toward your healthcare practitioner and you still feel like you are being treated without empathy or by an outdated biological model, simply find a healthcare practitioner that works better for you. 

How can we help you? We are a specialized physical therapy practice that collaboratively provides the most effective manual, orthopedic and sports therapy treatments, allowing us to efficiently return patients to their highest level of comfort and functionality. 

We deliver one-on-one, direct patient treatment by our licensed, specialty-certified physical therapists to ensure preeminent physical therapy services and patient care. We have served the Gallatin Valley since 2001 and are locally owned and operated by physical therapists.

At Excel Physical Therapy, our entire team–physical therapy team, massage therapy team, front office care coordinators and patient services assistants–ALL work very hard each day to welcome, listen and help you to feel better as a result of our evidence-based treatment plans and services. Your excellent outcome is our sole mission: Superior care from expert clinicians, supported by passionate staff, impacting the Gallatin Valley and beyond.

Thanks for taking that time to read my article. I hope you find this information helpful. See you at Excel PT! 

 

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Bobby Bemis, DPT, COMT, DIP.MT, FAAOMPT is a fellowship-trained physical therapist at Excel Physical Therapy.  Bobby specializes in orthopedic manual physical therapy of the cervical, thoracic and lumbar spine. Although the spine is his specialty, Bobby has a high level of training in all regions of the body. After receiving his undergraduate degree, Bobby earned a Doctorate in Physical Therapy, became a Certified Orthopedic Manual Therapist (COMT), Diplomat of Manual Therapy (Dip. MT), as well as becoming certified in trigger point dry needling. Bobby then went on to become Fellowship trained and was then designated as a “Fellow” with the American Academy of Manual Physical Therapy (AAOMPT) after passing a rigorous oral and practical exam. Only a very small percentage of physical therapists achieve this elite status. The “Fellow” is a physical therapist who has demonstrated advanced clinical, analytical, and hands-on skills in the treatment of musculoskeletal orthopedic disorders and is internationally recognized for their competence and expertise in the practice of manual physical therapy. 

WHAT IS DIRECT ACCESS AND WHY YOU SHOULD CARE?

By Jackie Oliver, DPT
jackie@excelptmt.com

Direct Access. It sounds like an exclusive VIP backstage pass but, in reality, it’s an all access pass for individuals to see their physical therapist without a doctor’s referral. That’s right, you don’t have to spend time and money to go see a doctor before seeking physical therapy treatment. 

A study done by GALLUP, asked individuals which profession was the safest and most effective for treating neck pain. Overwhelmingly people answered physical therapy.  Though surprisingly when asked what profession they sought treatment from first, only 6% said physical therapy.  Most went to their medical doctor first. 

A lot of people are not aware that physical therapy is a direct access profession. Direct access benefits you in many ways. It streamlines your care, by eliminating the time between a physician’s appointment and getting in to see your physical therapist. By seeing your physical therapist first, you can start to improve your function, decrease pain and restore quality of life without delay. Furthermore, you could save hundreds of dollars on care. Medical doctors may do x-rays or prescribe medications that can end up costing a lot of money but don’t really solve your problems. Physical therapy is a great alternative to dangerous opioids and is often more effective than opioids, and in some cases surgery. If you think that your injury or pain is musculoskeletal in nature, a physical therapist should be your first stop. This will promote optimal outcomes and recovery. 

Not sure if we can help? Physical therapists are highly-trained professionals that are well equipped to be able to recognize if a problem isn’t musculoskeletal in nature and, if necessary, able to refer you on to the proper health care professional to address your issue. Physical therapists are not meant to take the place the of physicians, in fact, we work very closely with them to optimize your care. Keep physical therapy in mind the next time you have an ache or a pain that just won’t go away. We can help get you back to doing what you love. 

Call us today to schedule a thorough physical therapy evaluation in our Bozeman or Manhattan office.

Expanded Appointment Hours & Days in our Manhattan Location!

By Tiffany Coletta
tiffany@excelptmt.com

Excel Physical Therapy has expanded our treating hours in our Manhattan location! Our physical therapist team is treating patients Mondays through Thursdays. We see patients on Mondays, Tuesdays and Thursdays from 7:30am-6pm, and Wednesdays from 8:15am-5:15pm. Please call us at 406-284-4262 to schedule a physical therapy appointment that is convenient for you or to see how physical therapy can help you.

Visit us at excelptmt.com to learn more about our practice and for a clinic location map. We are located next to the Manhattan Athletic Club in Manhattan, Montana and have been proudly serving the Manhattan, Amsterdam, Belgrade and Three Forks communities since 2002.

Excel Physical Therapists of Bozeman & Manhattan are CareCredit Providers

By Tiffany Coletta
tiffany@excelptmt.com

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Excel Physical Therapy of Bozeman and Manhattan, Montana are CareCredit providers. CareCredit is a personal healthcare credit card which acts like a revolving line of credit for out-of-pocket healthcare expenses. Our office offers the option of no interest for 6 months. Our patients and their families can use their CareCredit account to pay for deductible, and or co-payments over a $200 minimum balance. 

Apply for a CareCredit account online at www.carecredit.com or via 800-677-0718. Patient Responsibility charges from our office are paid at the end of each visit until our office team can verify active CareCredit account status.

Please inquire with our front office team if you have additional questions at 406-556-0562 for Bozeman or 406-284-4262 for Manhattan or via info (at) excelptmt (dot com).  Thank you for choosing Excel Physical Therapy for your physical therapy needs. We truly appreciate our patients and hope you will consider us in the future and refer us to your friends and family.

Knee Repair? Study finds PT as good as surgery for torn cartilage, arthritis

By Tiffany Coletta
tiffany@excelptmt.com

Knee repair? Study finds physical therapy as good as surgery for torn cartilage, arthritis. 

  • Article by: MARLYNN MARCHIONE , Associated Press
  • Updated: March 19, 2013 – 11:52 AM
  • Published in the Minneapolis Star Tribune
  • Photo: Jennifer Simonson, Star Tribune

You might not want to rush into knee surgery. Physical therapy can be just as good for a common injury and at far less cost and risk, the most rigorous study to compare these treatments concludes.

Therapy didn’t always help and some people wound up having surgery for the problem, called a torn meniscus. But those who stuck with therapy had improved as much six months and one year later as those who were given arthroscopic surgery right away, researchers found.

“Both are very good choices. It would be quite reasonable to try physical therapy first because the chances are quite good that you’ll do quite well,” said one study leader, Dr. Jeffrey Katz, a joint specialist at Brigham and Women’s Hospital and Harvard Medical School.

He was to discuss the study Tuesday at an American Academy of Orthopaedic Surgeons conference in Chicago. Results were published online by the New England Journal of Medicine.

A meniscus is one of the crescent-shaped cartilage discs that cushion the knee. About one-third of people over 50 have a tear in one, and arthritis makes this more likely. Usually the tear doesn’t cause symptoms but it can be painful.

When that happens, it’s tough to tell if the pain is from the tear or the arthritis — or whether surgery is needed or will help. Nearly half a million knee surgeries for a torn meniscus are done each year in the U.S.

The new federally funded study compared surgery with a less drastic option. Researchers at seven major universities and orthopedic surgery centers around the U.S. assigned 351 people with arthritis and meniscus tears to get either surgery or physical therapy. The therapy was nine sessions on average plus exercises to do at home, which experts say is key to success.

After six months, both groups had similar rates of functional improvement. Pain scores also were similar.

Thirty percent of patients assigned to physical therapy wound up having surgery before the six months was up, often because they felt therapy wasn’t helping them. Yet they ended up the same as those who got surgery right away, as well as the rest of the physical therapy group who stuck with it and avoided having an operation.

“There are patients who would like to get better in a `fix me’ approach” and surgery may be best for them, said Elena Losina, another study leader from Brigham and Women’s Hospital.

However, an Australian preventive medicine expert contends that the study’s results should change practice. Therapy “is a reasonable first strategy, with surgery reserved for the minority who don’t have improvement,” Rachelle Buchbinder of Monash University in Melbourne wrote in a commentary in the medical journal.

As it is now, “millions of people are being exposed to potential risks associated with a treatment that may or may not offer specific benefit, and the costs are substantial,” she wrote.

Surgery costs about $5,000, compared with $1,000 to $2,000 for a typical course of physical therapy, Katz said.

One study participant — Bob O’Keefe, 68, of suburban Boston — was glad to avoid surgery for his meniscus injury three years ago.

“I felt better within two weeks” on physical therapy, he said. “My knee is virtually normal today” and he still does the recommended exercises several times a week.

Robert Dvorkin had both treatments for injuries on each knee several years apart. Dvorkin, 56, director of operations at the Coalition for the Homeless in New York City, had surgery followed by physical therapy for a tear in his right knee and said it was months before he felt no pain.

Then several years ago he hurt his left knee while exercising. “I had been doing some stretching and doing some push-ups and I just felt it go `pop.'” he recalls. “I was limping, it was extremely painful.”

An imaging test showed a less severe tear and a different surgeon recommended physical therapy. Dvorkin said it worked like a charm — he avoided surgery and recovered faster than from his first injury. The treatment involved two to three hour-long sessions a week, including strengthening exercises, balancing and massage. He said the sessions weren’t that painful and his knee felt better after each one.

“Within a month I was healed,” Dvorkin said. “I was completely back to normal.”

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AP Medical Writer Lindsey Tanner in Chicago contributed to this report.

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Marilynn Marchione can be followed on Twitter at http://twitter.com/MMarchioneAP

Lindsey Tanner can be followed on Twitter at http://www.twitter.com/LindseyTanner

Be Part of a Headache Research Study

By David Coletta, MPT, CMPT
david@excelptmt.com

Excel Physical Therapy Participates in a Research Study on Cervicogenic Headaches

 

Seeking Research Study Participants

Headaches can cause lost time from work, visits to multiple physicians, and a general loss in quality of life.  The major categories include migraine headaches, tension headaches, TMD headaches, and cervicogenic headaches.  While cervicogenic headaches are not the most common type of headache, the prevalence in the general population is estimated at 15%.

Cervicogenic headaches are defined as one sided, or one side dominant, head pain, which is caused by a neck problem.  Other symptoms include stiffness in the neck, decreased range of motion in the neck, increased headaches with neck movements or poor cervical postures, and a possible history of trauma.  Although physical therapy can be effective in treating tension headaches and TMD related headaches, cervicogenic headaches have shown, in multiple studies, excellent response to manual therapy.  Mechanical joint and muscle restrictions in the neck lead to a referral of pain into the head (cervicogenic headache).  Manual therapy based physical therapy utilizes hands-on techniques to restore muscle and joint mobility, eliminating the head pain. 

Interestingly, research indicates that manual therapy success in treating cervicogenic headaches does not depend on chronicity. Cervicogenic headache patients can benefit from manual therapy treatments whether the symptoms have been present for 20 days or 20 years!  As a manual physical therapist for 15 years, my success rate with treating cervicogenic headaches has been very high. Our research from this study hopes to clinically show which manual therapy techniques are the most effective for treating cervicogenic headaches.

Excel Physical Therapy is enrolled as a clinical site in a national research study to determine the best manual therapy techniques to treat cervicogenic headaches.  There are several other clinical sites throughout the United States also collecting data on real patients being treated in a physical therapy environment.  Mobilization or manipulation of the neck and upper back are the two manual therapy variables in this study.  Mobilization is a joint “popping” technique and mobilization is a joint “stretching” technique. 

The Treating PT at our clinical site is skilled and trained in performing both spinal mobilization and manipulation.  One treatment group will receive only manipulation and the other treatment group will receive only mobilization and exercise.  We anticipate that both groups will benefit from the manual therapy treatments, but the magnitude of improvement is part of our research question.  Both groups will have 6 physical therapy visits over 2 to 4 weeks.

We are looking for patients to be part of this study – To be included:

  • patients must have one side dominant head pain, pain in the neck or the base of the skull that is felt to project into the head, and at least one headache per week for at least 3 months. 

  • Patients cannot be included in the study if they have a history of stroke, high blood pressure, high cholesterol, diabetes, heart disease, peripheral vascular disease, smoking, or whiplash injury to the neck in the last 6 weeks. 

  • Patients are not being offered free treatments in this study.  As with all of our patients, cost for physical therapy services will follow our normal fee schedule and we are happy to bill your insurance or provide you with a payment plan.  In most cases, a doctor’s prescription is not required to receive physical therapy services in Montana.  Excel Physical Therapy is a preferred provider for many insurance companies as well.

 

Please contact me if you meet the criteria for this study or if you have any questions.

David Coletta, MPT, CMPT -Treating Physical Therapist

david at excelptmt.com (insert the @ sign in your email message)

406-556-0562

What Does Direct Access to Physical Therapy Mean?

By Tiffany Coletta
tiffany@excelptmt.com

Unlike some states where patients require a referral from a physician to be treated by a physical therapist, here in Montana you are entitled to “direct access” which means you are able visit your physical therapist directly whenever you are in pain, no prescription required.  The vast majority of major insurance companies will cover physical therapy the same way, whether or not you have seen a doctor first.  The rest of the country is beginning to follow our lead and the transition to direct access is occurring state by state as both insurance companies and health care providers realize the improved quality of care and reduced costs afforded by its implementation.   

The greatest direct access benefit for patients is the ability to get better faster.  Numerous back pain research articles consistently point to one variable as being the most important in the overall success of a patient’s physical therapy treatment:  How soon the physical therapist was able to begin initiating treatment after the injury.  If the therapist was able to start working with the patient within two weeks of the injury, results were significantly better than those patients who allowed more time to elapse before treatment.   

In an increasingly complex health care system, it is great to know that, here in Montana since 1987, we as physical therapists are able to maximize treatment results for our patients by addressing the problem immediately.

However, we as providers are still at the mercy of an insurance companies own rules despite our Montana state law. Therefore, please always check with your insurance company and their specific physical therapy outpatient benefit rules to ensure maximum reimbursement and coverage for your treatment. Our Patient Service Coordinators are happy to help you through this insurance coordination. Just call either of our offices in Bozeman or Manhattan.

"I come in for minor injuries or setbacks and Jason always gets me back to running! I love Excel PT and always recommend the PT's." -- K.B., Bozeman client

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