DPPS vs. Traditional PT: Why Insurance Isn’t Always Saving You Money

Case of the Day – Oct. 24 2015

Today’s case is a great example of why clients often choose our integrated therapy sessions in lieu of traditional physical therapy. While physical therapy is a fantastic resource, and a good PT can be invaluable in many scenarios, it is often prescribed by doctors for the wrong reasons. (Remember, most doctors are not pain specialists. If you go to a general practitioner, orthopedist, etc., and they cannot find a problem that falls within their specialty, then they have no choice but to turn to generic answers, typically medication and/or standard physical therapy.)

At DPPS, our specialty is pain resolution. Yesterday, we saw a new client who was referred to us by a work colleague when her doctor told her she needed physical therapy for acute neck pain and stiffness. During our phone call, she was initially hesitant when I explained that we do not accept insurance. Understandably, most people want to take advantage of their health insurance because of the perception that it will save them money. Ultimately, this individual chose to see us anyway based on the strong recommendation from her colleague and because she could still use her flexible spending account with us.

As we see with most clients, the location of her pain and the source of her pain were not identical. In her case, most of her neck and shoulder pain was coming from neurological dysfunction in her pelvic ligaments and internal organs. (Yes, your organs communicate with your brain, and yes, we can identify and correct miscommunication when it occurs.)

When she walked in our door, her neck pain was an 8.5 out of 10, and she had perhaps 10 degrees of rotation in her neck. An hour later, her pain was 2.5 out of 10 and she had at least 60 degrees of rotation. From there, she probably could have chosen to recover completely with some additional rest, but she was adamant about returning for at least one more visit because of how powerful the work was.

As we explain to many clients in similar situations, when calculating costs, you have to consider the number of visits. Even paying out-of-pocket for two visits, this client will spend less than half of what she would have spent for her “prescribed” number of PT visits and the associated co-pays. And because traditional physical therapists cannot usually assess and treat the vast array of neurological issues we can, there is no guarantee they would have ever focused on the real causes of her pain. 

For reference, here are some common locations of organ referral pain. If any of these patterns seem familiar to you, consider scheduling an Integrated Therapy session with us.

 

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Ligaments as a Source of Pain and Suppressed Performance

Case of the Day – July 28th, 2015

Denver Pain and Performance Solutions clients — as our name implies — are evenly split into two broad categories: those who are seeking to eliminate acute or chronic pain and those who are have noticed mysterious declines in athletic performance. (In reality, these two groups coexist the vast majority of the time.) In both cases, one of the first and most important things we do is assess the function of the pelvic ligaments.

All too often, even among well-educated healthcare professionals, ligaments are viewed as inert structures that passively hold the skeleton in place. Nothing could be further from the truth, and we prove it to clients on a daily basis. While ligaments certainly do play a critical role in maintaining skeletal alignment, they also function as a communication network of sorts that directly and actively affects muscle activity. The pelvic ligaments in particular are important to assess due to their “core” location and strong relationships with muscles from the ankle all the way to the neck. If the pelvic ligaments are dysfunctional, clients can present with symptoms ranging from a susceptibility to ankle sprains to thoracic outlet syndrome. Even if pain is not present, dysfunctional pelvic ligaments are a major player in performance losses due to their tendency to cause shut-down in muscles throughout the body.

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How prevalent is this issue? We find dysfunction of the pelvic ligaments directly linked to pain and performance loss in 100% of our clients.

Most recently, we saw a young female athlete who had been suffering from chronic low back pain for 8 months. Our initial assessment showed an inability to fire the spinal erectors, glutes, hip adductors, hip abductors, hip rotators, hamstrings, and abdominals. Think that’s enough to cause a painful lower back and loss of performance? The protocol helped us identify the pelvic ligaments as a major culprit, so our corrections began there. After identifying and correcting dysfunctions in the inguinal, pubic symphysis, sacrotuberous, sacroiliac, and sacrospinous ligaments, the client was able to fire all previously weak muscles with very little effort. Her gait improved dramatically, and she reported feeling stronger and more stable than she had since her pain began.

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If you have experienced pain or weakness in the same muscles for long periods of time, despite corrective work that seems to create temporary improvement, there is a strong possibility that the actual issue is poor communication between the pelvic ligaments and the brain, leading to motor control deficits. In other words, the muscle problems are just a symptom of a deeper problem, and no amount of treatment targeting only the muscles will solve the problem permanently.

 

 

Just Say No to Orthotics

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The role of an orthotic is essentially to change the nature of the contact your foot has with the ground. When your foot has lost the ability to properly adapt to the landscape, an orthotic changes the landscape to accommodate your foot. I do tell my clients there is a time and place for orthotics: namely, when they provide a dramatic decrease in pain that allows a person to return to normal daily activity, eliminate pain medications, etc. Sadly, the vast majority of orthotics do not fall into that category.

Rather, orthotics tend to be blindly implemented as a panacea for a variety of symptoms, before even attempting to improve the function of the foot. Again, orthotics can alleviate pain. And when you sprain your ankle, you alleviate the pain by walking on crutches. But you don’t walk on crutches for the rest of your life. If you did, you’d be trading ankle pain for shoulder and neck pain, and you’d be sacrificing a lot on the performance front.  Instead, you work hard to rehabilitate your ankle, restoring it to full function and strength. So, if orthotics seem to provide some benefit, shouldn’t you consider that as an indication that your foot isn’t functioning properly and would benefit from rehabilitation?

Often, proper foot rehabilitation can take a lot of time and effort. But it’s always worth it. Not a day goes by when I fail to make a direct connection between a client’s pain pattern and some type of foot dysfunction. But just as often, dramatic improvements in foot function can come rapidly. The above client’s primary complaint was pain under the ball of the big toe that was progressively getting worse. In both photos, the hip and ankle are held in neutral to ensure the visual changes are in fact stemming from changes in the foot. In the first photo, you can see the base of the big toe is significantly lower than the rest of the foot. When that foot strikes the ground, which joint do you think is taking the brunt of the impact? In the second photo, you see a much more even forefoot, with the big toe and little toe at the same level. The best part? The below photos were taken 30 minutes apart, after therapy combining PDTR®, ART®, and AiM™.

The client’s pain disappeared, and she reported feeling like her foot was working properly for the first time in years.

How Foot Dysfunction Affects Your Entire Body

The Transverse Metatarsal Ligament

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When was the last time someone assessed you for pain or a drop in performance and concluded that your primary issue was dysfunction of the transverse metatarsal ligament? If you answered, “never,” you’re probably in good company. Far too often when looking for root causes of pain and dysfunction, we are drawn only to symptomatic areas. If the knee hurts, we call it a knee problem; if the hip hurts, we call it a hip problem. And of course, most doctors and therapists will treat it as such. So what is missing?

In this case, what is often overlooked is the neurological connection between ligaments and muscles. Specifically, every fiber in a ligament corresponds neurologically to a fiber in a muscle. Thus, when a ligament has neurological dysfunction, it will always cause weakness in one or more muscles.

The transverse metatarsal ligament in the foot just so happens to correspond with a number of “anti-gravitational” muscles in the legs and hips. In a healthy functioning ligament, this serves an important purpose: when you bear weight into the foot, the ligament is stretched, and it tells the brain to fire the muscles of the leg necessary to keep you upright. However, when neurological dysfunction exists in the transverse metatarsal ligament, the opposite happens: you transfer weight into the foot and stretch the ligament, and key muscles in the leg and hip go weak.

Now imagine what happens when you run, jump, change directions, or lift weights in this scenario. Just when you need your most powerful hip and leg muscles, they are shutting down, leaving you prone to injury and pain.

I saw two cases last week that fit this description. In both cases, we made numerous corrections to the areas of pain and beyond, and the clients saw immediate improvement. But the problems came back within a few days. It wasn’t until we corrected the dysfunction in the transverse metatarsal ligament that the problems resolved for good.

Complete resolution of pain and dysfunction often requires a lot of detective work. As always, I encourage people not to give up hope if conventional methods of treatment have failed. The body often has the right answers when you know where to look.

Pain, Performance, Sexual Function, and Leakage

Pelvic Floor: Pain, Performance, Sexual Function, and Leakage!

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I’ve been seeing a great deal of pelvic floor dysfunction this week. One middle-aged woman had been dealing with urinary incontinence for years, on occasion leading to embarrassing accidents in public. We treated her pelvic floor dysfunction in 5 minutes, and she hasn’t had a single issue since.

One young adult male who competes in Olympic lifting came in for hip pain and tension. After two treatments, his symptoms improved only slightly. Finally, we treated his pelvic floor for 5 minutes, and it proved to be the key that unlocked his hips.

An adult male came in for low back pain. Sure enough, his pelvic floor had significant dysfunction. We corrected it in 5 minutes.

A recently married woman had lost interest in sex because of the pain it created. After 5 minutes of pelvic floor correction, she later reported, “My husband is now your biggest fan.”

Finally, a mother brought in her eight-year-old daughter who had been dealing with the embarrassment of “leaking” on a daily basis. We worked on her pelvic floor for 5 minutes, and she’s been “leak free” since. From her mother:

“I brought my 8 yr old gymnast daughter to Noah after realizing her pelvic floor needed some attention. (She) was leaking a bit when she urinated and it was becoming a real problem each time she exerted herself. I brought her to Noah and he was able to ‘fix’ her within minutes. His bedside manner with children is every mother’s dream. He relaxed her with essential oils and made her feel comfortable as he took us verbally step by step through the process. Noah produces healing results!”

Pelvic floor dysfunction comes in all shapes and sizes. It can lead to back pain, hip pain, loss of athletic performance, sexual dysfunction, and incontinence. These are all big issues that affect people’s daily lives. And, as you’ve figured out by now, it usually takes 5 minutes to fix. Some problems are complex. This isn’t one of them. Get evaluated by a P-DTR practitioner!