PTAG Blog

Thirty years ago, I was an athletic trainer and teacher in high school. An orthopedic surgeon named Steve Hunter was my team doc. I went to surgery and clinic with Dr. Hunter when I was not teaching class. He taught me the fine points of exam of sports injuries and to avoid the pitfalls of “you see what you look for and you find what you know”. Dr. Hunter introduced me to George McCluskey and Tab Blackburn, physical therapist who would become my mentors for life in the skills needed to succeed in the profession of physical therapy. George and Tab convinced me to attend physical therapy school at Georgia State University.

After graduation, I joined George and Tab in private practice. George McCluskey was a pioneer in the early days of private practice physical therapy. He was and continues to be an advocate of independent small business in the practice of physical therapy. I enjoyed 18 years in practice and learned so much about business and people, and what makes a successful healthcare business.

Fast forward to 2003. I opened my own outpatient physical therapy practice. At the time, many physicians were opening their own physical therapy practices. When I spoke to my orthopedic surgeon friends and referral sources, they told me that a good patient care was more important than the extra money that owning PT would bring them.

My team and I provide excellent care to patients in our area and enjoy a collegial relationship with the local physician community. We make their patients happy and consult often. We work hard to make sure our mutual patients have the best possible outcomes.

Fast forward again to 2013. Each morning I pass a three-story steel skeleton. It is the infrastructure of a new medical office building, which belongs to my friends, the orthopedic surgeon. It will house their new clinic and MRI and their new physical therapy office.

I have often been asked to join their new practice. I admit that I have thought about it a lot. These physicians are my friend and my colleagues. I knew them back when they were orthopedic fellows. We have learned together, played together, consulted and worked together side by side on an equal footing. I have asked them and myself: why I would want to be an employee instead of a fellow professional?

As a member of APTA for 30 years, I admit that I am fully indoctrinated in the governance of our profession. Our professional association debated for many years the effects physician self referral would have on our profession and is on record as opposing such business arrangements.

Physician ownership turns autonomous, decision-making professionals into technicians. If not in practice, in process. While reviewing PT documentation from a physician-owned practice, I have seen that the “supervising” physician co-signed the note, along with the physical therapist that provided the service. Doctors of physical therapy do not need to be “supervised” by physicians nor do we need to have our notes co-signed.

The Affordable Care Act is changing the health care system in ways we do not yet understand. Physical therapy is uniquely positioned to become the preferred provider for evaluation and treatment of neuromusculoskeletal conditions. PTs are graduating with the skills to do this.

When physical therapists are employed by physicians, they impede change in an already-broken healthcare system. If we become technicians, our profession and our future doctors of physical therapy will have no place to grow.

I am not the first to feel the impact of physician self-referral and I am sure I will not be the last. My physician friends tell me that they like the way my team and I treat our patients, but they are forced to refer for profit because of the changing healthcare economy.

Others have taken the hit and improvised, adapted to the change and overcome to prosper in this environment. Our profession will certainly do that as well.

Our patients will continue to seek out competent physical therapists. Unrestricted access to our services is essential to allow a level playing field for competition and best use of the dwindling health care dollar.

Let us choose to be leaders of healthcare change. And as doctors of physical therapy, let us choose not to be perceived as technicians in practice or process.

RM Barney Poole, PT, DPT, ATC
President

Thoughts or comments? Contact PTAG President Barney Poole at president@ptagonline.com

Mike Thomas knew he faced a long recovery.

In 2011, he was riding his motorcycle when an approaching car made a quick left turn – not noticing him traveling 60 mph in the oncoming lane. The head-on collision sent him flying 200 feet through the air and, combined with the impact, broke nearly every bone on the left side of his body.

Some say he is lucky.

Four surgeries and a series of metal rods and plates rebuilt his left side and completely reconstructed his shoulder. He spent the following three months in a hospital bed, and a month in a wheel chair before finally being able to walk on crutches.

And although he had begun walking again, Thomas still faced a number of complications. He couldn’t touch his left foot to the ground or use his left arm. His muscles were jelly. His joints were swollen and immobile. The ongoing pain and lack of mobility were drastically affecting his quality of life.

He decided it was time for a change and sought physical therapy treatment to regain function and regular movement.

Thomas was first introduced to Amanda Pilz – owner and practicing physical therapist at ProMotion Physical Therapy – in February 2012.

It only took one meeting for Pilz to recognize Thomas’s needs were extensive – and would require long-term treatment. He couldn’t tolerate bearing weight. The joint in his shoulder was locked, and lack of regular movement had severely weakened his muscles.

Over the next 10 months, Pilz – alongside physical therapist assistant Carrie Shamburger – started the long process of treatment, working with Thomas 2-3 times a week. She developed a specific exercise plan that fit his needs and worked within a realistic timeline to help him recover.

Pilz began by addressing basic wound care and release of adhesion restrictions, before progressing to small movements aimed at improving his joint ranges and muscle firing patterns. She then shifted to joint mobilizations and exercises to increase his strength and functional range of motion for his active lifestyle demands.

Now almost two years after the accident, Thomas is back on his feet and credits his recovery to Pilz and her team.

“They pushed me, made me sweat and stretched me to the limit every week,” Thomas says. “They built up my confidence and gave me encouragement during those weeks when I thought I was regressing and felt like giving up.”

Pilz mirrors Thomas’ sentiments and emphasizes that while treatment is the first stepping stone toward recovery, the best results come from patients who are fully committed to their program.

“When we meet with patients, it is important that we help them set specific goals that guide them toward recovery,” Pilz says.

Pilz says there was no shortage of motivation in Thomas’s case.

“There were a few times we had to pull in the reigns and remind him to take things more slowly,” Pilz says. “But it’s always refreshing to work with someone who understands that their investment in recovery will give them the highest dividends.”

And for Thomas, physical therapy not only helped him recover, but it showed him the bigger picture – that includes traveling, riding mountain bikes, playing volleyball and walking his daughter down the aisle at her wedding only six months after the accident.

Feats that seemed too difficult to overcome but made possible with the help of physical therapy.

I participated in a “boot camp” style exercise group on Thursday last week, and one thing is certain: I am out of shape. Four days later, I’m still sore. Wikipedia defines boot camp as: “ a type of group physical training program conducted by gyms, personal trainers, and former military personnel. These programs are designed to build strength and fitness through a variety of intense group intervals over a 1 hour period of time.”

I have participated in three different Atlanta outdoor fitness boot camps over the past five years, and can say with certainty that all boot camps are not created equal. Research has shown that working out in groups gets the same results as working out alone; however the social aspect increases compliance and motivation. Some of us love exercise, but others need that little extra social motivation to stay compliant.

Refugees from high-intensity group exercise make up a small but significant portion of my client base. These formerly sedentary individuals, lured by promises of fast results (or by the low prices offered on Groupon or Living Social) jump in with zeal and intensity. For those who have never participated in group exercise, this can lead to fatigue, burnout and, worst case, injury.

However, if you are smart about how you chose your group and take responsibility for your own health and safety, you can get good results from boot camp and other group fitness without injury.

Consider your goals. When a 58 year old female stay-at-home mom told me that she injured her shoulder performing a barbell snatch: Barbell Snatch Video

My first question was “What are you training for?” Her answer? “I just wanted to lose a little weight and get in shape.” For this woman, who had a history of shoulder problems including multiple shoulder surgeries, barbell snatches were never going to be a good idea, no matter how good her form. And what “functional” activity was she getting ready for? So ask yourself the same question when evaluating classes: “What do I want? What am I training for?” And the follow up to that question is: “Is it worth it?”

Be honest (with yourself) about your fitness level. This is exactly what I did NOT do last week. I tricked myself, thinking, “I’m in pretty good shape, I run and cycle and do core work. I’ll be fine!” Well, an hour of squats, lunges, sprinting and pushups are not the same. I should have been getting ready for a month, or attended a class that was designed for newcomers to fitness. Even if you are not new to exercise, even intense exercise, evaluate where you are TODAY, and be honest.

Ease in. See above. When starting a fitness program, it is not a good idea to work out the same body parts multiple days in a row. Nor is it useful to be so sore that you can barely move for four days. If you start a program and find you are unable to perform all of the exercises, stay for half the class, or ask the instructor for modifications based on your fitness level. Sign up for a per-class rate instead of a monthly membership, because you will be more likely to overtrain if you feel you have to get the most out of an unlimited pass.

Listen to your body. Many sedentary folk have a difficult time discerning the difference between the strain of effort and the pain of injury. You must learn to discern these, and when those “twinges” that indicate injury are felt, they must be respected and accommodated. Sharp pain and pain in joints are those to listen to. At the first sign of pain in your knee, for instance, evaluate your form with the exercise. If you are fatigued and your form is suffering, ask the instructor to give you an alternate. If he or she refuses, this is a red flag.

Do your homework. “Personal trainer” is not a protected term in Georgia, and pretty much anyone can call herself a trainer. When selecting a group, search the website for the type and amount of training they have had. Call and ask questions. A good training program includes days of training as well as practical exams. You aren’t working out on your computer, so their training should not have been 100% online. Read reviews on Yelp, Angie’s list and others, paying attention to the negative reviews. Do they have multiple complaints about injuries, lack of supervision or huge classes? Again, red flags.

Beware of any program, gym, class or instructor who tells you that their way is the only way. Many groups are dogmatic about their way, and will overwhelm you with “evidence” that you must squat below midline, work out every day, etc. to get fit. There is not one way to get fit or strong, and there is not one group or program that is for everyone.

A good boot camp, group fitness class or gym will have well-trained instructors who watch you and listen to you. They understand that improper technique will lead to injury and losing clients. A good instructor to student ratio is 1:10, though with some classes you need more or less, depending on how many “newbies” there are versus experienced members. You should feel free to ask questions, ask for an alternate or decline to do an exercise.

I will be back to boot camp this week, but this time, I’m staying for half the class and doing girly pushups, and my body will thank me!

Dr. Ingrid Anderson, PT, DPT, OCS

Ingrid is owner of Intown physical therapy located in old fourth ward, Atlanta. For additional information visit http://www.intownpt.com/