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Do you need an MRI?

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I recently had a new patient start working with me who had low back pain. When he first arrived, he was very frustrated that his doctor had not ordered an MRI.

“How can you know what’s really going on if you don’t have an MRI report to look at?” he asked me.

“My doctor told me that I didn’t need an MRI because it would just show that I had degeneration and he already knows that,” he told me.

Clearly this man was frustrated and you may be too. So, let’s clear up these two question by discussing why doctors are ordering fewer MRI’s for low back pain and what this means for your low back pain.

MRI’s became common in the 1980’s in America. The MRI machine became a tool to be able to “see inside” the patient and find out what was truly going on. This greatly aided diagnosis and treatment because the MRI is able to look at soft tissue structures including muscles, ligaments, tendons, and organs.

Previously, the medical community had only had X-ray which shows any bony issues but does not show soft tissue abnormalities.

The MRI machine became extremely popular because of its ability to accurately show what was going on in INSIDE the person’s body, thus making diagnosis of the issue and treatment much more predictable. What a huge bonus to the medical community and to the patients!

Low back pain has long been a “mystery” to the medical community. It affects 80% of people at some time in their life but it affects people differently. Some people report sharp pain while others have dull pain. Some people have pain with sitting while others have pain with activity.

So, what is really going on inside that low back?

This new tool, the MRI, was put into action to find out the answers. And, it did it’s job. MRI’s found herniated disks, degenerative join disease, arthritis in the spine, torn ligaments, and so many other things. Which all sounded very scary and led many people to have surgery to correct these things.

So, in the 2000’s researchers started wondering “What does a normal, pain free spine look like on MRI?”. They started doing MRI’s on people who had never reported low back pain in their lives.

And, what did they find?

They found herniated disks, degenerative joint disease, arthritis in the spine, torn ligaments, and so many other things.

To be clear, the researchers found the same issues in spines that were pain free as they had in spines that had extreme pain.

What does this mean? It means that if you have an MRI on your spine today you are likely to show some degeneration, possibly a herniated disk, and something might be torn. This is whether or not you currently have pain in your low back.

This is the reason that doctors are hesitant to perform MRI for low back pain. What they find may or may not be what is causing the pain!

MD’s are realizing that it is the “clinical presentation” they need to look at to determine what is causing the pain. So, they send patients to a Physical Therapist to evaluate the patients’ pain reports and correlate them with the clinical signs that the patient presents with.

Physical Therapists listen to what the patient SAYS and tests how the patient MOVES to determine the true root cause of the patients low back pain. Therefore, we do not need an MRI report to show us what is going on inside because the body will tell us during the evaluation.

That’s how I know what is going on without having an MRI report to read. Now, if you have had an MRI, feel free to bring the report along. I am happy to discuss it with you.
However, if you do not have an MRI report and your doctor is not willing to order an MRI – have no fear. We can figure out what is going on and treat you appropriately for the issue you have without the report.

If you have questions regarding your specific low back pain and would like to schedule a free Discovery Visit to learn more about how we can help you, please contact us here.

Snow Shoveling 101

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Snowpocalypse hit the Pacific Northwest and left behind snow, sleet, hail, slush, and ice.  Last I heard, the groundhog was awaiting extradition from the Bahamas for his poor forecast this year.  As we move forward to finally getting out of the house, here are some key tips to remember while you are shoveling all that snow.

#1 – Use the shovel to push the snow – Walk with the shovel in front of you to push the snow out of your way.  Kind of like your very own snow plow.  This puts the snow in a nice pile ready to be lifted.

#2 – Bend your knees – do a squat to pick up the snow with the shovel.  Bend your knees and keep your back straight.  This is critical when the snow is heavy as it is now.  Make sure you have two hands on the shovel to distribute the weight.

#3 – Pivot your feet – when you are getting ready to throw the snow make sure you pivot your feet.  This allows your back to stay in a neutral position.  Twisting of the spine with a weighted load (like snow!) is the most common cause of injury to the low back.

#4 – Make sure to breathe – keep your breathing regular.  Holding your breath while you are lifting increases the pressure on your back.  Breathing also helps to improve your endurance.

#5 – Take a break – we’ve gotten a lot of snow this year and clearing it away will take some time.  Make sure you take regular breaks to head inside, warm up, and drink some water.

Snow shoveling is a great workout when you can’t get to the gym, yoga studio, or Crossfit box.  If you need more of a workout, offer to clear your neighbor’s driveway too!  Be careful with your body if you are not used to performing heavy lifting or endurance type activities.  Give yourself lots of breaks and keep an even pace.

If you have any questions regarding proper snow shoveling technique or if you hurt yourself in the snow, please reach out to us at PT4EB.

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Why more people are choosing to pay cash to eliminate their pain

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We are all familiar with the usual course of treatment when we are dealing with an injury or chronic
pain. First, we go see our Primary Care Physician (PCP) who recommends pain medication and muscle
relaxers. We take those for 4-6 weeks and go back to the PCP when the pain is not any better. The PCP
then orders an X-ray which doesn’t show anything and we are referred to a specialist. It takes a couple
of weeks to get in to see the specialist. Meanwhile, the pain medication is not eliminating the pain and
is upsetting our stomachs. The specialist recommends either surgery or avoiding the activities that
cause pain. This is the assembly line of the modern medical system that leaves many people feeling
frustrated or hopeless.

Did you know that you could bypass this system?

In Washington State, you can see a Physical Therapist directly to deal with your pain issues. You do not
need a prescription. You may even be able to go in for a free consultation to get all your questions
answered and see if PT is right for you.

Don’t I need an MRI?

What if you could avoid the cost, hassle, and exposure of having an MRI? Research has proven that
what shows up on MRI’s is often not correlated to what is causing your pain. Often the pain is caused by
a movement dysfunction that an MRI cannot see. Physical therapists are experts on movement
dysfunctions. They are able to “see” areas that are not moving correctly and help to get them moving
pain free.

How do I know if Physical Therapy will even work?

Often the art and science of Physical Therapy does work, it is the mode of delivery that doesn’t work.
Traditional PT’s in an insurance based model are forced to see more patients in less time. They are
compensated for using things like ultrasound, E-stim, and ice/heat. In this system, the insurance
companies decide how much treatment you get instead of you and your therapist deciding on the best
plan for you. Insurance companies often dictate the schedule you are seen on which may not be the
optimum for your body or for your lifestyle. Having 2-3 PT treatments per week can be a strain on your
already busy schedule.

All of this restraint has caused Physical Therapy to get a bad reputation.

What other options are available to you if you don’t want to take medication, you don’t want surgery, or
you have had a bad experience with Physical Therapy before? You can take matter into your own hands
and pay out of pocket for an experience that is custom tailored to your unique needs.

You want me to pay for Physical Therapy?

Yep.

Here’s why – people will see a chiropractor, massage therapist, and personal trainer in an effort to
manage their pain and move forward with their lives. Physical Therapists are specialist in movement
disorders and have training to move stuck joints, release tight muscles, and teach you specific exercises
to help your body heal. We will also offer you loads of education on how to keep yourself healthy and
pain free in the future.

Here’s how – at PT4EB we spend more time with you. Most sessions are one hour. You are given our
complete attention for that one hour. We usually only see people once per week for 6 sessions and
then we spread sessions out. Often people require a total of 10-12 sessions. During and after your
treatment, we can check in over E-mail if you have any questions. Traditional PT clinics blow through
your 12 visits in 4-6 weeks. This is long enough to get you feeling better but not long enough to make
real changes in your body. The real changes you need for long term results. This costs you more in the
long run as the problem comes back.

Since the insurance companies do not decide on your course of treatment, we are able to spread your
visits out. We are able to give you undivided attention. You have time to get all your questions
answered. You have complete access to us both during and after your treatment for any questions that
come up.

Many times sessions can be paid for by submitting your claims to your insurance company. Please let us
know and we will provide you with a superbill – the paperwork needed to submit your claims. We also
accept Flexible Spending Accounts (FSA) and Health Savings Accounts (HSA)

People often come to our clinic as a “last resort” after exhausting their other options. They refuse to
have surgery which is the only medical option provided to them. People are tired of taking medication
because they realize that it only masks the symptoms. They are frustrated, disheartened, and
sometimes depressed over their lack of activity. The biggest question I hear is – how come I didn’t find
you earlier?

Are you curious if this model is right for you?

If you are local to the Maple Valley area, please feel free to give us a call. We are happy to answer all
your questions or have you come in for a free Discovery Visit to see if we are a good fit for your needs.
Please click here to fill out a brief contact form (link to contact form).
If you are not local please feel free to give us a call. We have a network of other providers throughout
the US that we can connect you with who hold these same values.

Your health is at least worth a conversation, right?

Traveling to Kenya

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I recently returned from a two week teaching trip in Kenya. I volunteer with a program that teaches Physiotherapists in Kenya hands on skills and clinical problem solving.

So, what was I doing there? This trip I was able to go into the clinic with the Physiotherapists and treat patients. This is a great opportunity for the wheels to hit the pavement with everything the students have learned in class. And, it gives us a chance to really check out their skills in a clinical environment.

Many people have asked me why I travel so far away to help a group of people that I had no direct connection with before I started traveling there. I have boiled it down to two reasons.

Reason #1 I travel to Kenya to teach – I WAS ASKED!

About 5 years ago, this program had a teacher drop out at the last minute. They threw the net wide trying to find someone who could go to Kenya for two weeks at the last minute. I happened to be transitioning to a new job and could take the time off work. So I volunteered.

How many times in our lives are we stuck, frustrated, overwhelmed, in pain, unsure of how to move forward in a situation? And, how many times do we ask for help? Our society prides itself on being independent and not needing help from anyone else. But, a beautiful thing happens when we open ourselves up to help from others. Not only are we blessed with their assistance, they are blessed to assist us.

I encourage you to think about any situations where you feel stuck and may need to ask for help. It may be in preparing for the holidays, it may be in getting through the holidays, or it may be a need you have had for a while. Find the person that can unstick you!

Reason #2 – I AM UNIQUELY QUALIFIED TO SERVE

The program I teach with requires an OCS or FAAOMPT. I have both. I also have my PhD which is kind of like an advanced teaching certificate. There are very few people who have all three of these qualifications so I fit their unique profile of instructors.

I enjoy traveling – especially when I get to meet new people. I lived in Germany for 3 years with the US Air Force and I realized that I LOVE to travel. But, I prefer it when I get to meet the local people and spend time with them. The trip becomes way more meaningful when you are able to break bread and have true discussion.

I love being a Physical Therapist and want to see the quality of PT improved worldwide. I believe that Physical Therapists offer a unique perspective as movement specialists. We understand how things are supposed to move and what can happen to the body when things aren’t moving correctly. PT’s are qualified to work on joints, muscles, ligaments, fascia -the entire body.

I am uniquely suited with these aspects of my personality and education to serve the Physiotherapists of Kenya. You are uniquely suited with aspects of your personality and education to serve a certain group of people. It may be your neighbors, it may be at the school your child attends, it may be at the home where your parent is living because they are no longer safe alone. Your people are out there and they need you.

I encourage you to take some time to think about all the people you serve in your life. And, think if there is anyone else you might be uniquely gifted to serve.

 

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