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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. 

Exercise Induced Muscle Cramps: Kind of a Big Dill

By Megan Peach, DPT, OCS, CSCS
megan@excelptmt.com

You know the feeling. You can see the finish line but you can’t get there because of a sudden onset of a muscle cramp in your calf that is demanding you stop. Dehydration and electrolyte imbalance were originally thought to be the cause of muscle cramping; the current theory is one of central regulation. In other words, muscle fatigue or stress create an imbalance in signals from the muscle to the central nervous system. As a result, the central nervous system alters motor neuron control and signals the muscle to continue to contract resulting in a cramp. Factors thought to be related to exercise induced muscle cramps include prolonged activity, muscle fatigue, increased exercise intensity, high levels of static stretching prior to exercise, and multiple high intensity workout days prior to competition. Muscle cramps often resolve as spontaneously as they occur, and usually within a few seconds to a couple of minutes. Suggested treatment of a muscle cramp includes rest, prolonged stretching with the muscle at full length, and pickle juice! You might think that pickle juice is related to electrolyte imbalance, but a new theory suggests that certain molecules in pickle juice (or other pungent foods) attach to receptors in the mouth and upper GI tract that are directly connected with the central nervous system. These receptors help the central nervous system to reduce the signal to the cramping muscle, therefore diminishing the cramp and your discomfort. So the next time the end is in sight but a muscle cramp is holding you back, grab your pickle juice. Because finishing a race is an accomplishment – it’s kind of a big dill.

Murray B. How curiosity killed the cramp: emerging science on the cause and prevention of exercise-associated muscle cramps. AMAA Journal 2016; Fall/Winter: 5-7.

 

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Megan Peach, DPT, OCS, CSCS specializes in manual treatment of spinal dysfunction, as well as knee and shoulder pain and is a member of the Excel Physical Therapy running specialist PT team. Megan’s philosophy for physical therapy treatment embraces educating patients about the tools they need for enhancement of proper body movements during work and play to promote a pain and injury free active lifestyle. 

Matt Heyliger, DPT's interview with Kelsey K. Sather: Tips for climbers on how to maintain stability and mobility on and off the rock.

By Tiffany Coletta
tiffany@excelptmt.com

 “Physical therapist Matt Heyliger merges his passions for outdoor athletics and body mechanics to deliver fine-tuned, effective treatment. His interview offers tips for climbers on how to maintain stability and mobility on and off the rock.”

–Kelsey K. Sather

 

 

 

 

 

Kelsey K. Sather is a local Bozeman writer whose fiction and essays aim to promote humans’ connection to nature. As an avid climber and health enthusiast, she also writes about fitness, food, and outdoor play. Kelsey is passionate about using storytelling to advocate for gender equality and ecossytem preservation. She creates articles for her online journal, These Words Like Rocksand curates The Work Behind the Bodyseries at her website kelseyksather.com.

As Part II in The Work Behind the Body series, the Worker’s Wo/Manual offers interviews with health and fitness professionals about bolstering athletic performance and overall wellness. Though most of the questions will relate to athletes of all genders, there will always be questions specific to the female body. The hope is to empower women and men through knowledge as they pursue their best selves in sport and life. 

Hip to be Cool: Preventing Running Injuries - Outside Bozeman Magazine

By Jason Lunden, DPT, SCS
jason@excelptmt.com

“Hip to be Cool – Preventing Running Injuries” article from Outside Bozeman Magazine

by Jason Lunden, DPT, SCS

Join Jason Lunden, DPT, SCS and Megan Peach, DPT, OCS, CSCS at our Running Experts Forum event on 3/29/2017, 6:30pm at the Bozeman Library for a lively discussion of ALL things running. Our Physical Therapists who specialize in Running Injury Treatment and Running Evaluations along with several Bozeman running expert special guests will discuss various running related topics and answer audience questions. Bring your questions or email them in advance to megan@excelptmt.com!

Advanced Training...We're at it again!

By Matt Heyliger, DPT
matt@excelptmt.com

Matt Heyliger, physical therapist with Excel Physical Therapy of Bozeman and Manhattan, recently completed a Level III Advanced Lower Quadrant Integration course with an emphasis on integrating biomechanical assessment of the lumbosacral region, hip, knee, foot and ankle. The course follows the respected North American Institute for Orthopedic Manual Therapy (NAIOMT) program for advanced certification training. Key concepts studied during this four-day intensive course, held in Seattle, included advanced clinical reasoning and assessment approaches and integrated manual therapy and join manipulation approaches for complex biomechanical presentations.

http://www.bozemandailychronicle.com/business/people/people-in-business-for-sunday-november/article_9037a164-59dd-58ac-9dd1-ca773d1927e6.html

Truing Your Frame - Fit Your Bike to Avoid Injury from "Outside Bozeman"

By Jason Lunden, DPT, SCS
jason@excelptmt.com

from Outside Bozeman Magazine

Spring 2014 Issue

Fit your bike to avoid injury

While cycling is relatively easy on your joints, because of the constrained position and

repetitive nature of the sport, it can be easy to develop overuse injuries.

These injuries are often attributed to ramping up training mileage too quickly or being improperly positioned on your bike. Training errors can be avoided by following a proper training schedule. Fitting your bike to your body—not the other way around—helps achieve proper positioning.

It’s best to see a professional bike-fitter at a physical therapy clinic or your local bike shop, but here are some tips to alleviate common pains associated with cycling.

Foot/Ankle

Achilles’ Pain
Cause: foot positioned too far back on pedal
Solution: move foot forward on the pedal by moving your cleat further back

Arch Pain
Cause: foot positioned too far forward on pedal
Solution: move foot back on the pedal by moving your cleat further forward

Knee

Anterior Knee Pain
Cause: saddle too low and/or too far forward
Solution: move saddle up so there’s a slight bend in the knee at the bottom of the stroke

Posterior Knee Pain
Cause: saddle too low and/or too far back
Solution: move saddle so there is a moderate to slight bend in the knee

Spine

Lower Back Pain
Cause: stem too short
Solution: get a longer stem

Neck

Neck Pain
Cause: bars too low
Solution: raise your bars by getting a more upright stem or moving headset spacers from the top of the stem to the bottom

Jason Lunden is a board-certified clinical specialist in sports physical therapy at Excel Physical Therapy in Bozeman and a clinical BikeFit Pro Fitter. For more information on bike fitting or injury prevention, visit excelptmt.com/bikefitting.

Rock Hard - Spring Climbing Exercises from "Outside Bozeman"

By Matt Heyliger, DPT
matt@excelptmt.com

Rock Hard – Spring exercises for climbing From Outside Bozeman Magazine

Outside Bozeman Spring 2015

by Matt Heyliger, DPT, Physical Therapist at Excel Physical Therapy in Bozeman, Montana

Click here to access this article on the Outside Bozeman website.

While some of us are still hoping to get in as much spring skiing as possible, the season is changing and the thought of warm days and dry rock is enticing. This is the time of year when climbers realize that winter has taken a toll, and it’s time to grow our forearms again. It’s also when we’re at an increased risk of injury due to de-conditioning. So how can you make this your strongest season yet, red-point last year’s projects, and move on to new objectives? To get started, let’s review some well-documented training concepts, like the “4-3-2-1 concept” developed by Erik Hörst in his book Conditioning for Climbers.

Four weeks of endurance training: rack up as much mileage below your highest on-sight grade as possible. Shoot for three to four days a week of rope climbing on a variety of rock types.

Three weeks of power training. Head to Spire and spend those rainy May days bouldering. Complement this with hang-board training, systems training, or campus training.

Two weeks of anaerobic training. This is maximum-intensity training over short periods of time with equivalent rest time. For example, climb four boulder problems (or roped pitches) consecutively without rest, then rest for the same duration of time. Repeat to fatigue. This will increase your ability to dig deep in situations where rest is not an option.

One week of rest at the end of this 10-week cycle is vital for proper tissue healing and an injury-free season.

Additionally, antagonist training provides muscular balance without adding mass where it’s not useful. We do a lot of pulling in climbing so go push on something—high repetitions of push-ups and shoulder presses are good. Strengthening forearms is important for the stabilization of the elbows and wrists. Try the following exercises:

Wrist Extension
Forearm flat on thigh, hold dumbbell with wrist flexed. Bend wrist up (extend) to feel muscle activation on top of forearm. Lower and repeat.                                            

Pronation
Forearm flat on thigh, secure band with foot tracking band to outside of hand, palm up. Rotate palm downward feeling muscles inside of forearm, slowly return to start. Repeat.

Supination
Forearm flat on thigh, lower slowly toward opposite knee, return to start position feeling burn in extensors in each direction. Repeat.

Radial Deviation
Forearm flat on thigh, lower slowly in casting motion, return to start position feeling burn in top of forearm. Repeat.

Ulnar Deviation
Arm straight at side, weight facing back, perform casting motion back, slowly raising weight to feel burn in back of forearm. Slowly lower and repeat.

Finger Extension
Theraband (or rubber band) around fingers with fingers bent. Straighten fingers and thumb and pull out and up. Hold for five seconds, return to bent finger position and repeat.

Shoulder Stabilization
Shoulder stabilization is also key. Extensive research confirms the benefits of scapular and rotator-cuff stabilization for overhead athletes. In climbing, we spend a lot of time with our hands overhead pulling on holds in awkward postures. Try the pictured exercizes to protect your shoulders and prevent overuse injuries this season.

Core Strengthening
All climbers benefit from core strengthening regardless of ability. Emphasize more static exercizes, like plank and side-plank, as these aare more specific to our sport than crunches.  

Do these exercises three times a week until you are climbing regularly, then cut back to once or twice a week for the remainder of the year to reduce the risk of elbow tendinopathies, wrist injuries, and finger injuries.

While just getting out and climbing is way more fun than training, being able to climb is also way more fun than being injured. “Roctober” is many months away, so tune your machine this spring and have an injury-free season.

Wrist Extensions (wrist flexed)Wrist Extensions (wrist extended)
 
Pronator (forearm flat)Pronator (forearm rotation)
 
Supinator (forearm flat)Supinator (forearm rotated) Radial Deviation (forearm flat)Radial Deviation (forearm rotated)
 
 
Ulnar Deviation (arm at side)Ulnar Deviation (raised)
 
Finger Extension (bent)Finger Extension (straight)
Shoulder Stabilization (start)Shoulder Stabilization (finish)
 

Matt Heyliger, DPT is a physical therapist at Excel Physical Therapy. Please call the Bozeman office with any questions at 406-556-0562.

The information in this article is intended for informational and educational purposes only and in no way should be taken to be the provision or practice of physical therapy, medical, or professional healthcare advice or services. The information should not be considered complete or exhaustive and should not be used for diagnostic or treatment purposes without first consulting with your physical therapist, occupational therapist, physician or other healthcare provider. The owners of this website accept no responsibility for the misuse of information contained within this website

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