Terry Rehabilitation & Testing | Physical Rehabilitation and Functional Testing

Stiff/Frozen Shoulder

OVERVIEW

Chronic or acute inflammation of the shoulder can result in stiffness of the shoulder capsule, severe pain, and occasionally severely limited motion. While treatment of a stiff/frozen shoulder can be very painful, it is generally not terribly complicated and improves in a reliable fashion. Physical therapy can also serve prepare the patient for consultation with an orthopedic surgeon, by restoring optimal shoulder flexibility, strength and function. Because normalized passive motion is a prerequisite to successful RTC repair, even patients with a diagnosed RTC will benefit from skilled physical therapy intervention. Read more

It Must Be More Complicated Than THAT

This is something that goes unsaid in my office, but I can read it on the faces of patients. Today’s patient had suffered 6 months of nagging headaches and neck pain. After a few visits to the doctor for NSAIDs and muscle relaxants, he was referred to a neurosurgeon and pain management physician, an MRI was ordered, and his neurosurgeon referred him to see me.

3 visits into his therapy he has no pain. In fact, he had only minimal pain after the second visit and seemed a little paranoid that it was all just too quick and easy. After today’s visit, it makes sense to him, but he still seemed to want a more complex explanation. A few exercises and that was it. How could this be?

The master mechanics turn the same wrenches on the same bolts the same way. All the automated diagnostic help in the world (for cars or people) still can’t beat a mechanic’s fundamental knowledge of how something works, when it comes to getting something fixed quickly and easily.

I have no explanation for why neck pain and mechanical headache required waiting for neurosurgical and pain management referrals and an MRI. That’s a complex answer I don’t have. On the other hand, his pain was localized, symmetrical, and mechanical. That’s easy for most therapists.

I should have made something up about scoliosis, his “hip bones being out,” trigger points, or “compensation” for something like his wallet, and he might have found that more satisfying, lol.

Chasing “The Latest Thing”

I recently received a voicemail message from a former patient (whose son I had also treated) asking if I practice a specific proprietary, trademarked, and well-publicized technique. I responded via email, and then realized that this response could have been written a dozen or so times over my previous 17 years as a therapist, so I ought to just make a generic letter regarding all such techniques:

Dear _______,

I hope you and your family are doing well. ____ is a proprietary treatment approach that incorporates very good marketing resources, with very expensive tools and educational materials, and is a treatment technique very similar to many other techniques that have been used for tens, if not hundreds of years.


Despite the hype, _____ has yet to demonstrate it’s effectiveness as a technique above and beyond other techniques. I just checked their website (figuring that I would find the most favorable literature there) and found a list of published case studies, most of which were single case studies. That means that as a “new” treatment, it was published in a peer-reviewed journal or magazine, with the data from only one patient that was treated using the technique.

Although they tout a presentation they put on at a_________ meeting, that research has yet to be published in a peer-reviewed journal. I’m not sure it ever will. There is no date regarding what year the presentation was made.

They have an effectiveness chart for ______ that looks very impressive, but again, it does not compare the effectiveness of their technique to any other treatment, and in the fine print states that their outcomes include treatment that is comprised of other techniques with _______ being only a portion of the total treatment.

Other research on their site is included if it mentions _______ in passing, as a “new” or “alternative” technique for a particular problem.

Without any randomized control studies, nor any other comparative data to demonstrate effectiveness, I will not be taking their courses or touting their trademarked name or logo, unless someone offers it to me free of charge. The same treatment techniques have been taught to physical therapists (including me) for decades, but without the same expert marketing panache.

The generic term for this kind of treatment is _________ and does has proven effectiveness in very limited circumstances. I practice __________ on selected patients, based on evidence of effectiveness. I select a technique if can I get a better result with it, or can I get the same result as other techniques, but with fewer visits or expense for the patient.

Hope this clears some things up. Some physicians – especially sports medicine physicians – are perennially sold on the latest and greatest technique, only to move on to the next new thing a few years later. I wish that more would read the scientific literature, or simply find a therapist whose judgement they trust, rather than chasing after the latest fad. Unfortunately, many therapists have simply given in, and pay exorbitant fees for these classes, so that they can claim they provide a proprietary technique, even if they know it to be ineffective. It’s simply a marketing decision.

So….call me to ask if I can treat a particular problem, and ask me my opinions of the technique. Allow me to use my best judgement and the most current information, and I can give you the best outcomes possible. If things are not working out as planned, I have several “alternative” tricks up my sleeve as well that may be helpful, and I can route you to the person who can ultimately solve your problem if I cannot.

Scope of Practice – Therapy Services

Therapy Services Provided: “Orthopedic Spine and Sports for All Ages”

We specialize in outpatient orthopedic rehabilitation of all types, and for all joints.

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Treatment Effectiveness – Trick or Treat?

Read This First

This is a very interesting article, and I think that any patient that is planning to undergo physical therapy should read through it.  After you’ve read it, I have a few (ok, more than a few) comments:

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We Have a Facebook Username!

What is a Username?

A Username on facebook is a shortened URL that allows others to easily find a facebook page.

facebook_badge260

While individuals were able to obtain usernames over the summer (maybe before that) business pages initially had to jump through some hoops.

 

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Treatment Expectations

I have recently started doing “Utilization Peer Review” work in my spare time.  I wanted to ensure that I was acquainted with all aspects of the workers compensation system, and to be honest, I was a little curious to see what other clinics were doing.  UPR means that I spend some of my time each week working on a contract basis for insurance companies, reviewing the work of other therapists, and making recommendations regarding the appropriateness of proposed future care.

Well, it’s been extremely revealing, and leads me to today’s post about treatment expectations.

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Therapy Referrals – FAQs

Write a Winning Therapy Prescription!

Write “Evaluate and Treat,” and include any other pertinent information, like precautions, limitations, or suggested/recommended treatments, and FAX it to us. That way we can contact the patient and start effective, evidence-based treatments immediately.

Therapy Prescriptions are Required in Texas

Because physical therapists are much more involved in caring for their patients than political activism, the State of Texas is one of only a few areas of the industrialized world where a prescription is required to initiate physical therapy treatment.

Legal Parameters

After relocating to Texas, I contacted the Executive Council of Physical and Occupational Therapy Examiners to find out what the legal parameters were surrounding a therapy prescription. I had just received a therapy prescription that said “Patellofemoral pain. Hamstring stretches, straight leg raises, home exercise program.”

In this case, ECPTOTE informed me that my entire treatment program, unless modified/replaced by another order, would be restricted to only those two exercises. No other intervention is legally allowed. Application of an ice pack (or the recommendation of ice) would violate Texas law.

In most cases, a very restrictive prescription like this was not the intention of the prescribing physician, but was an omission of “Evaluate and Treat” before making specific treatment recommendations. Regardless of the reason, we must amend the order to provide appropriate care outside of those treatments explicitly allowed.

Why Should I refer patients to physical therapy?

  • For timely conservative care of orthopedic injuries
  • To get your patients back to work, athletics, and life as soon as possible
  • To empower your patients to take care of themselves

When should I refer patients to a physical therapist?

  • Musculoskeletal complaints of duration > 6 weeks
  • Any loss of passive range of motion
  • Tendonitis prior to becoming tendonopathy
  • Injuries that interfere with work or athletics

What should I write on the prescription?

  • “Evaluate and Treat” allos the therapist to use his/her professional discretion
  • Note any limitations/restrictions that should be observed
  • Frequency, duration, and modalities do not generally need to be noted, unless you have specific preferences

Why should I fax the patient’s prescription?

  • To maintain continuity of care – you will receive timely communication to let you know if there is a problem or delay in initiating treatment
  • To avoid procrastination/compliance problems – we will contact each patient to be started as soon as possible
  • To avoid confusion – we can verify benefits, give specific directions, and refer to another in-network therapist, if needed

What kind of feedback do I get?

  • Initial Evaluation and Treatment Plan (sign the back page and return if required)
  • Routine Progress Notes (sign the back page and return if required)
  • Discharge Note to inform you of the patient’s final disposition

Where is Terry Rehabilitation & Testing?

  • Click Here for addresses and directions
  • Call (972) 939-6501 for specific directions

What if I have questions or concerns?

  • Contact us at (972) 939-6501
  • Fax us at (866) 451-0585

Therapy Referral Advisor

If you haven’t read the introduction/explanation, please click here and do so first.

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Therapy Referral Advisor – Introduction/Explanation

How Do You Know When to Refer?

Well, this is an attempt to help you arrive at a decision with your patient’s best interest at heart, relying on evidence (peer-reviewed studies, quality assurance studies), experience, and situational considerations.

If you have previously read this introduction, click here to get to the full guidelines or click here to see our Referral FAQs.

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Insurance Network Questions

Do You Accept ____ Insurance?

As a general rule we accept all forms of health and auto insurance. However, there are certain networks to which we cannot gain membership.  We encourage providers to refer patients based on the high quality of care they receive in our clinics, regardless of insurance status. Read more

Personal Attention

What Personal Attention Mean?

When we say that we provide “personal attention” it means that our full attention will be focused on you during your appointment. That means that we don’t split your time with another one, two or even three patients, as is common in some other physical therapy clinics. Read more

Terry Rehabilitation & Testing | Physical Rehabilitation and Functional Testing