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. 

How to Build Muscle Faster: Blood Flow Restriction Therapy

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

Blood flow restriction training (BFR) is a relatively new technique being used in physical therapy and gyms to increase muscle strength.  We have been using BFR therapy at Excel Physical Therapy with promising results.   BFR therapy utilizes compressive forces from a specialized blood pressure cuff to restrict venous blood flow from a muscle group while allowing for continued arterial blood flow to the muscle.   The result of the restricted venous blood flow is a state of ischemia to the exercising muscle.  Exercising in a state of ischemia seems to cause a physiological cascade that results in increased signaling that promotes muscle growth, even at lower loads on the muscle. 

Utilizing BFR under careful supervision of a physical therapist, allows one to prevent muscle atrophy and increase muscular growth and strength while recovering from injury or surgery.   BFR is not a panacea and therefore is just one component of a proper rehabilitation program.  The ability of BFR to stimulate muscle growth at lower loads of resistance make it a perfect modality to consider for the earlier stages of rehabilitation.   To learn more about BFR therapy and to see if it would be appropriate for you, be sure to ask your physical therapist here at Excel Physical Therapy

 

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Jason Lunden, DPT, SCS specializes in the rehabilitation and prevention of sports-related injuries, with a particular interest in the biomechanics of sporting activities – running, cycling, skiing, snowboarding and overhead athletics. Jason serves as a physical therapist for the US Snowboarding and US Freeskiing teams, along with the US Paralympic Nordic Ski Team, and is a local and national presenter on sports rehabilitation and injury prevention topics. Jason is a Certified Clinical BikeFit Pro Fitter.

Your Chronic Low Back Pain Could Be Instability of the Spine Lurking in the Shadows

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

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While 80% of all US citizens will experience some level of low back pain during their lives, 10.2% (2006 US Survey) of all adults in this country have suffered from chronic low back pain that limits activity for an extended period of time.  As a physical therapist that specializes in treating the spine, I often have chronic low back pain patients that struggle to understand why their condition exists.  Many clients arrive for an evaluation after years with severe bouts of low back pain that comes and goes with minimal cause or explanation.  Trips to the doctor for medication, days missed from work, and visits to various types of practitioners are common with this diagnosis. My experience has found that some of these chronic low back pain patients have spinal instability as the source of their condition. 

Spinal instability or excessive vertebral segmental motion is a possible cause of chronic low back pain.  General wear and tear, previous injuries, and congenital abnormality of the vertebrae can be factors that lead towards instability.  Looking at the spine with the muscles removed, there is a beautiful structure that is present which allows for movement, but also provides stability from one spinal segment in relation to its neighbor (above or below).  The discs, ligaments, and vertebrae themselves provide this passive stability.  Compromise to these structures can lead to instability or an excessive amount of movement.  The muscles of core and deep spine provide protection and smooth movement between the vertebrae and the low back in general, which is termed dynamic stability. When passive stability is lacking, dynamic stability is in greater need.  However, dynamic muscular stability of this level is often lacking in spinal instability patients.  With these individuals, acute low back pain bouts arise when an activity, such as shoveling snow or even bending over to pick up a pencil from the ground, overloads the available passive and dynamic stability.

Perhaps the most common form of low back instability is an anterior spondylolisthesis or a slippage forward of a lumbar vertebra in relation to the vertebra below it.  This diagnosis can be picked up through a detailed and specific physical therapy evaluation and then confirmed with a specialized x-ray of the lumbar spine.  A spondylolisthesis has various grades, depending on the degree of slippage measured on the image. A mild or even moderate spondylolisthesis is best treated with specific core stabilization exercises and teaching the patient how to safely lift, given this diagnosis.  Higher grades of spondylolisthesis may require surgical spinal fusion to stabilize the segments. Many patients go years or decades without understanding the true source of their chronic low back pain.  In some cases, instability or spondylolisthesis is the culprit lurking in the shadows.

 

As the founding owner of Excel Physical Therapy, David Coletta, MPT, CMPT strives for our clinics to deliver unprecedented excellence with patient care in the Gallatin Valley. David established Excel PT in 2001 on the principles of specialization, advanced education and customer service. David specializes in the treatment of back and neck pain, spinal issues, whiplash, headaches, TMJ/jaw pain, and postural dysfunctions. 

A considerable amount of David’s advanced training occurred through the North American Institute of Orthopedic Manual Therapy (NAIOMT). He has completed advanced certification in manual therapy (CMPT) with NAIOMT, and he has received advanced training in dry needling techniques for the spine and extremities. David is a Certified Clinical BikeFit Pro Fitter.

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. 

“Understanding Climbing Injuries" Talk @ MSU Climbing Gym 1/29/2019

By Matt Heyliger, DPT
matt@excelptmt.com

Community Education Series | Free

 “Understanding Climbing Injuries: The Biomechanics Behind Acute and Overuse Injuries in Climbing”

presented by Matt Heyliger, DPT

Tuesday, January 29, 2019 | 12pm-1:30pm

Montana State University Climbing Gym in the Hosaeus Fitness Center

  • Learn about the most common contributing factors to both acute and overuse injuries in rock climbing.
  • Deepen your understanding of upper extremity anatomy and biomechanics.
  • Learn self-care techniques that are critical to injury prevention and treatment.
  • Learn how to safely re-introduce climbing after injury/rehabilitation.
  • Discuss approaches to training for climbing including safe use of a hang board and campus board. 
  • Have questions? Q&A with Matt Heyliger, DPT after the talk.

Matt Heyliger, DPT is an avid climber and mountain sports enthusiast.  His passion for climbing has taken him around the US, Canada and Mexico. Matt has a specific interest focus in biomechanics and how impairments at one level or joint affect other body structures. Matt has specialized in working with and treating rock climbers for more than 5 years. In the past year he has been able to broaden his approach to treating climbers through integrating video analysis and specialized biomechanical assessments in the Climbing Lab at Excel Physical Therapy. 

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. 

Making Sense of Back Pain Seminar @ Bozeman Library

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

Community Education Series | Free & Open to the Public

“MAKING SENSE OF BACK PAIN: what you’re doing wrong for back pain

presented by Bobby Bemis, DPT, COMT, Dip. MT, FAAOMPT

Thursday, October 11, 2018 | 6:30-7:30pm

Bozeman Public Library Community Room

  • What we are doing wrong with back pain as a society, as a healthcare system, and as individuals.
  • Why not all back pain is the same and why that is so important to understand.
  • Learn how to take the correct steps to control and manage your back pain in a healthy way.
  • Why MRI’s and x-rays may be sometimes misleading.
  • Learn practical exercises, movements, and modifications to help your pain and dysfunction.
  • Low back pain from all age populations will be discussed.
  • Q&A with Bobby after the talk.

Back pain is the most common complaint U.S. healthcare professionals receive daily. Come hear Bobby Bemis, a fellowship-trained orthopedic physical therapist through the American Academy of Manual Physical Therapy, discuss back pain and how you can find the pain relief you seek.

Bobby Bemis, DPT, COMT, Dip. MT, FAAOMPT 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 from the University of Colorado, Bobby earned a Doctorate in Physical Therapy from Regis University in Denver, Colorado. Post-graduation, Bobby 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 through the Institute of Manipulative Physiotherapy and Clinical Training (IMPACT). Bobby was designated as a “Fellow” with the American Academy of Manual Physical Therapy (AAOMPT) after passing a rigorous oral and practical exam. 

""Megan was efficient with my time and money. She was honest about expected recovery time and didn't cut any corner. No nonsense PT!" -- Bozeman Client" -- R.

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