I really enjoy treating kids, especially elementary aged and teenagers because they tend to respond so well to osteopathic manipulation. Recently I wrote about a 5-year-old with left leg pain that was keeping her awake at night and really limiting her with playing and being active. She had somatic dysfunction present that was changing how her pelvic girdle was functioning and was creating her pain. A couple visits and she is back to normal. I had another experience with a young lady recently, aged 9 that was very similar. She is a dancer, active, very talkative and an all-around enjoyable great kid! Her mom got ahold of me based on a recommendation from another teens mom that I helped back into sports. This young lady’s mother called me back in September and seemed very exasperated due to the fact she had a child with leg and hip pain that was really affecting her being a kid. It all started back in mid-May when her left leg began to give way with walking for some unknown reason. It kept getting worse and by the end of May she was unable to sit in the criss cross position on the floor due to pain and lack of motion in her left hip. At the beginning of June, she went to Nationwide Children’s and saw an orthopedic physician. X-rays were performed that came back normal and she got the diagnosis of bursitis and was prescribed anti-inflammatories. I see this all too often. One of the problems is a horrible exam is performed or not really performed at all. If a good clinical exam was performed, it would be known the pain was not coming from hip bursitis…very frustrating! Of course, the anti-inflammatories did not work, and her symptoms became worse and at this point she was having a hard time walking, was crying in pain and could not rotate her hip into external rotation, which is the position where the toes turn out. She had an MRI done in mid-June that also came back as normal so the ortho doctor performed a hip joint injection for pain control and diagnostic purposes. She did not get any relief from the injection and at the end of June she started traditional physical therapy. It was thought maybe she had a labral tear, but this was ruled out at this point in time. Her pain kept getting worse and the ortho department at Children’s Hospital sent her to the Sports Medicine Department in July. She was prescribed gabapentin, which is a powerful nerve pain reducer and anticonvulsant medication, along with another round of anti-inflammatory medicine. Her pain did not change, and she was using crutches at this time and due to the lack of progress Children’s Sports Medicine department sent her to Cleveland Clinic’s rheumatology department to make sure she did not have an autoimmune disorder. After that trip, the young girl and her family were left deflated and feeling hopeless because Cleveland Clinic was unable to help. Time continued to pass, and nothing really changed, and it was mid-August when another hip injection was tried without help. Around this same time, the exhausted little girl was sent to Children’s Cincinnati for a second opinion and to further rule out a labral tear. She underwent another injection under sedation with a specialized MRI that can better visualize the hip labrum. That test also came back normal. Throughout all this time, her whole summer was lost, she missed out on dance, which she loves, and the beginning of school was being affected. The whole family was feeling hopeless I was told. It was the end of September when I received a phone call from the young girl’s mother. It was explained to me what was going on and what the symptoms were and a general history of all the treatments that were tried. From the phone conversation I remember saying I am pretty sure I can help in a couple of visits. It sounded like the typical history of a lumbosacral dysfunction that was shutting down the glutes and causing pain to go into the hip and into the leg. These dysfunctions are not easily diagnosed unless a good clinical exam is performed, and one knows what to look for. These are the kinds of patients I fix all the time and the history tends to be similar so that is why I was confident I could help this young lady. The first treatment was in the beginning of October and I knew what was going on from the evaluation I performed. She had left hip and leg pain, had a moderate limp with gait, had very little hip external rotation present, very weak glute max and medius muscles, and core weakness. Her left hamstring was increased in tone/tightness due to her glutes being shut down and inhibited, which happens quite often. The hamstrings will tighten to help create stability of the pelvic girdle when the glutes are not doing their job. I treat using Muscle Energy Technique, which is an Osteopathic Manipulation, along with myofascial release, stretching, and exercises that complement the manual medicine. After the first visit she did not feel significantly better, but when I assessed her on her second visit, I knew I would win the battle. Her spine moved better, her glutes were firing easier, and her hamstrings were not as toned/tight. She still had some of the same dysfunction present due to the fact her spine had not been properly mechanically working for months. By the third visit she was significantly better. She looked pretty much back to normal. I did see her for a fourth visit just to make sure we had it beat. She was able to return to dance and get back to be the normal, rambunctious little girl she had been before May when this all started. This is why I am so passionate about manual medicine and the manual medicine program at Michigan States Osteopathic Medical School. These professors and teachers have changed my way of thinking bout the body, how to assess and treat pain. The more I learn, the more I realize I am only scratching the surface of healing from manual medicine. The bad part is people don’t know manual medicine exists and they are so used to just taking medicine, doing traditional therapy, or listening to the physician that says nothing is wrong. Well there are other treatments that are very successful and powerful out there, but the hard part is getting people with pain to learn about them. I’m trying one patient and word of mouth at a time!
Tag Archives: muscle energy technique
Treating a 5 Year Old and Being Surprised
I had an interesting experience recently. I received a call from a mother with a little girl, age 5, with pain in her left leg. It really bothered her at night and was waking her. Nothing really seemed to help. From my memory, chiropractic care and massage were tried without much lasting help and the family was looking for another option that might help their little girl that was on the natural side. They did not want to deal with medication or injection and diagnostically nothing seemed to be wrong. They showed up at my office and the little girl was cute as a button. She was wild and rambunctious like I was expecting but at the same time she had this left leg complaint that sounded very familiar. No known injury or causative factor, but the leg hurt, and it would not go away. I hear those complaints a lot, but not typically from a 5-year old. I did what I normally would do and performed a mechanical evaluation of her lumbar spine and pelvis. I was surprised to find the same abnormal mechanics I usually find in the teens and adults I treat. She had a sacral torsion and a dysfunction at her L5 vertebra that was creating her leg pain. I treated what I found, and her spine and pelvis corrected very easily. After 2 visits I never saw her again. The last I checked in with the family, the little girl had not complained about it in weeks! I was actually sort of shocked at this case because I had never had a client so young, but what I found was exactly what I would expect to find based on her pain complaints. This goes to show performing manual medicine can help people of all ages and to treat what is found and not limit clients based on age. That is exactly what I did, and it took only 2 visits to get rid of the pain. Manual therapy using muscle energy technique (MET) is amazing.
Why Go to My Cash Based Physical Therapy Practice?
At the end of 2016 I opened a cash based physical therapy practice, which is a different business model than people are used to seeing with physical therapy. Most physical therapy practices take insurance which, in my opinion, causes headache and restrictions on abilities to treat. When not having to deal with insurance, I can focus on quality of patient care and not quantity which is very attractive to my style of treatment. I can provide 60 minutes of one on one treatment focusing mainly on all hands on manual medicine using specialized techniques that take years to develop. I give exercises as a complement to my treatments to work on at home. Typically, clients only come 1x per week for 3-4 visits (except for those who like to come for maintenance) as opposed to 2-3x per week for 4-6 weeks.
Getting better with minimal number of visits should be a big consideration when deciding on physical therapy these days with sky high deductibles that can range from $3000-$5000 easily. With a high deductible plan, an hour visit at a typical insurance based physical therapy clinic can cost anywhere from $150-300 depending on how much is charged for each 15 minutes (charges are usually based on every 15 minutes). With a high deductible insurance plan, the patient must pay all the costs of the visits out of pocket until the deductible is met. This can add up to a fortune.
At a typical physical therapy clinic, visits are usually scheduled every 15-30 minutes, with the goal of keeping patients for 45-60 minutes, therefore a lot of overlap occurs. A clinician cannot be with 2 people at once doing hands on treatment with the overlap, so this means there is a lot of time doing repetitive exercises and using machines without too much guidance that could be done at home.
Let’s look at the cost effectiveness of my cash based clinic versus insurance based clinic:
| Cash PT | Insurance PT | ||
| Cost per visit | $75 | Copay | $30-60* |
| Number of visits | 4 | Number of visits | 12 |
| Total costs | $300 | Total costs | $360-720 |
| Time with PT | 240 minutes | Time with PT(15 min for a 30 min visit) | 180 minutes |
| Cost per minute | $1.25 | Cost per minute | $2-4 |
*Copay is not usually the only cost per visit. Often, with high deductible plans, $60 is the copay collected up front with the rest being billed later, which can significantly add to the total bill. Or, a copay has to be paid, plus being responsible for 20% of the total bill with a typical 80/20 insurance plan.
As you can see, coming to my cash based clinic is much more cost effective if you break down the actual cost per minute of seeing a PT. The table does not include all the variables that effect the total costs but it gives a general idea of the breakdown. Such as if someone has a high deductible insurance plan, they may get stuck with the cost of the entire bill, which can be thousands of dollars. Also, perceived value is very important because many of my clients appreciate that they only see me, as opposed to many other clinicians. This means they are only explaining their symptoms one time as opposed to every time they see someone new. Also, my visits are a full hour of hands on treatment and not just doing exercises or using machines that could be done at home or a gym. This means a much higher quality of care which leads to getting better much quicker.
Owning a non-insurance based physical therapy practice, my priority is to give the best care possible and provide the highest quality of treatment I know how. This makes practicing physical therapy very rewarding again and should for years to come as my practice grows.
What is Muscle Energy Technique (MET)
Over the weekend I had a continuing education course for physical therapy to continue my license. The course dealt with using manual therapy, specifically muscle energy technique (MET), to correct problems of the pelvic girdle, sacrum, and lumbar spine. I have taken many courses over the years to learn my specialty of MET and I am very partial to the courses and education provided by Michigan State’s Osteopathic medical school and their manual medicine series. Michigan state has given me the knowledge and skill to treat my physical therapy clients outside of insurance, because of the great outcomes I get. The course I took was not a Michigan State course but it did provide a great review of the knowledge I already have along with reminding me how powerful MET is. Using physical therapy and MET is how I get such great outcomes far and above the norms and is why I can be an independent practitioner and not have to deal with insurance.
What exactly is MET? Muscle Energy Technique (MET) is defined as a form of soft-tissue treatment in which the patient’s muscles are actively used, on request, from a precisely controlled position, in a specific direction, and against a distinctly executed therapist-applied counterforce. The key defining element of MET is the use of an isometric contraction before subsequent stretching or movement of restricted tissues. What this means is if you have a sacrum/tailbone that is stuck in an abnormal position for example, I can put your body in a specific position and use your own muscle contraction to put the sacrum back in place. I can do this with your pelvis and the vertebra up and down the spine.
Using MET not only puts the bones back in the appropriate positions it also resets the normal length of the muscles that are involved in locking the bones into the abnormal position. When bones and joints are in abnormal positions this can cause muscles to shut down and significant pain that can become chronic unless the dysfunction is fixed appropriately.
Using manual therapy and MET takes time when done appropriately. I spend at least an hour evaluating leg length, the pelvic girdle, SI joints, lumbar spine, pubic symphysis, muscle strength and tightness. I then give physical therapy exercises that are very specific to help hold my adjustments in place that are a complement to the manual therapy. Treating by this method, in my opinion, can only be done appropriately on a cash based manner because of the time and attention involved. Insurance gets in the way of the best care I know I can give. In the long run, I am much cheaper than other treatment methods because my clients usually respond very quick and my goal is to have the pain mostly gone within 4 visits.
I am very passionate about what I do and using MET has allowed me to help many people and achieve great outcomes. I am greatly appreciative to all the instructors I have had over the years that have furthered my career and given me the knowledge to help people in pain.