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: sciatica
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.
Treating low back pain
WHAT DO I LOOK FOR WHEN TREATING LOW BACK PAIN? 4/10/16
Low back pain is very common in today’s society. Most people have dealt with low back pain themselves or at least know multiple people with low back pain. It can be very debilitating and life changing, especially if the pain does not go away. Treatment for low back pain in physical therapy is usually mediocre at best due to the difficulty in being able to properly diagnose where the pain is being generated. Pain can come from the discs, nerve roots, facet joints, and abnormal muscle use. Having a good understanding of how the spine moves and functions, and how abnormal spinal movement affects the body is key to successful treatment in physical therapy.
What do I look at when evaluating a low back? I look for specific weakness in the glute max and med muscles. They are very important in lumbar spine and pelvic stability. The hip flexors are often times very tight, therefore specific manual therapy releases have to be performed along with stretching. Transversus abdominal and deep low back muscle called the multifidus also need to be retrained appropriately. I also look at very specific movement of the individual lumbar spine vertebrae, thoracic vertebrae, and sacrum. If the vertebral segments are not moving the way they should, osteopathic manipulation is performed to help correct the movement. I use a lot of osteopathic manipulation (OMT) called muscle energy techniques (MET). Uncorrected vertebrae will cause muscles to shut down and not do their job. This is where the skill of a movement expert and manual therapist comes into play to be able to find and correct the abnormal spine movement or lack of movement. The abnormal spine movement is called a somatic dysfunction which will be discussed in another blog. Using those basic guidelines is how I have been able to be very successful in fixing low back pain be it chronic or acute. Acute low back pain is much easier to fix with usually only needing 1-2 treatments over a 2-4 week period. Chronic low back pain is more difficult to fix but can usually be done over a 6 week period and a total of 4-6 visits. Come give physical therapy at Wright Physiotherapy a try and you will be amazed at your new pain-free way of life! Go to the contact page and send me an email to schedule an appointment or give me a call.
Physical therapy using manual therapy for treatment of pain.
Hands on manual therapy using osteopathic manipulation techniques is the most effective way to treat orthopedic pain! The philosophy of osteopathy is to treat the body using manipulation to get the body to function as efficiently as possible, and then work on appropriate strengthening exercises to prevent the pain from returning. For example, with low back pain the movement of the individual vertebra in the low back need to be improved for normal function and then appropriate core strengthening and stretching needs to be done to allow the body to heal efficiently.