Do you have the feeling or expect that Physical Therapy should be covered by your insurance?
Physical therapy providers are starting to identify some very good reasons why involving your insurance may NOT be in your best interest!
Just like filing an auto insurance claim for damage that doesn’t meet your deductible – it is often best to forego involving your insurance and just pay out of pocket. There is no need to inform your car insurance that there was any damage and risk them increasing your premiums the next time your policy renews. It is the same with filing a health insurance claim. Filing a small claim for physical therapy can have negative complications and unintended consequences. Especially when you can get diagnosed in 2-4 visit at Nick Rinard Physical Therapy, and get good results soon after that, it is better to not have your insurance medaling in your physical therapy affairs by questioning whether you “deserve” physical therapy or not.
Health insurance companies are demanding more and more that patients meet certain criteria, through one-size-fits-none measurements to either deny you care, or begrudgingly agree to authorize just a limited number of visits. This is insulting to your legitimate pain, and disrespectful of your medical providers who should be the only ones deciding if you need care or not. Also, your insurance reserves the right to determine – even after the fact – that your care is/was not “medically necessary” and deny your claims leaving you with an unforeseeable bill. This really is unethical and undermines your relationship with your provider. Also, insurance companies are increasing your cost of care to save themselves money with patient portions closer and closer to the total bill. You, the patient, are better off just paying at time of service at our clinic and not bothering with the extra headache, expense, and disrespectful treatment associated with filing insurance claims – even though you are totally legitimate!
Nick Rinard Physical Therapy’ wants to save you money. Our pay at time of service rate eliminates billing uncertainties from insurance companies. We are making visits more affordable and getting better health outcomes for patients. Advantages to paying at time of service include that patients get uninterrupted service, higher quality care they can trust, hassle-free billing, and no surprise bills at the end. It really is a win – win for both providers and patients for those with high deductibles, who want care out-of-network, who are self-employed, self-insured, expired PIPs and for people who have health savings accounts.
Now is the time to stop insurance companies from unethically pretending to be medical providers and payment specialists that do not have the patients’ best interest at heart. We are your providers working for you! It is our oath to get you results, free of pain and back to living life… We know health insurance companies cannot promise the same.
The case study I would like to share with you today is only the second hip derangement of this type that I have seen. “Jim” was a 55 year old male who presented with right hip pain that started for no apparent reason 5-6 months prior to coming to physical therapy. He said the pain was provoked only when he was walking, but it occurred consistently at a distance of about 50 to 100 yards. Often it was so painful he could not continue walking. Jim figured out that changing his right foot position enabled him to walk a little further, albeit slowly, and then he could resume normal walking for another 50 yards or so. He would change the foot position by stepping partway onto a curb or raised ground such that the outer edge of his foot was tilted up (eversion, as we therapists call it), and then he would angle his right knee inwardly. That was the only way he had found to improve walking, but the hip just would not stay better.
In desperation, Jim said he had looked online and tried numerous “hip exercises” without any relief. He consulted his doctor, who recommended MDT, which we do here at Nick Rinard Physical Therapy.
Assessment
The mechanical assessment was positive for only two findings: limited and painful hip motion into flexion (folding the knee to chest), and weak and painful testing of hamstring resistance. The protocol for ruling out a joint derangement is to repeat motions to determine if the baselines change. The question is which motion to repeat. One can move either into the most painful direction, go the opposite direction, or check rotations. I chose to go into the most painful direction, in this case, flexion. But before testing I wanted to establish how far Jim could walk in the clinic before his pain started. By the time he walked one length of the hallway and back, he reported pain. I then instructed Jim to bend his knee to chest (compressing the groin) repeatedly and after 20 to 30 times. It produced his familiar pain initially, then the pain abolished and his motion increased. I tested walking after that and Jim said there was no pain even after walking 3 lengths up and back through the hallway! I gave Jim his exercises and scheduled him for 2 days later.
Progress
When Jim returned he reported that he could walk longer distances without the pain starting, however, he still got to the point where he had to modify his foot position in order to continue. I knew we were on the right track, and the next step in treating a joint derangement is to progress forces. I did this manually by applying over-pressure, and instructed Jim to do it in standing by folding his chest down to his knee with it supported on a bench or chair. By the next visit, Jim reported that this had worked very well and he had not experienced any pain at all! So, the derangement was reduced and I needed to wean him off the home exercises to see if it would return or not. I gave him the weaning program and asked to see him back in 2 weeks.
Pain Free
After 2 weeks, Jim came back reporting that he had been able to walk unlimited distances! He resumed walking his dog, going on walks for exercise, and walking wherever, and whenever he wanted. He reported his longest walk lasted 4.5 hours. He said there was no return of the original hip pain from which he had suffered for months. However, on his last two walks, he had started noticing a new hip pain, this time in the front, not on the sides. I re-checked his baselines and neither flexion motion nor resisted hamstrings were painful. That meant it could not be a re-derangement. Resisted hip flexion was painful, and that was new. I concluded that his sudden ability to walk pain-free resulted in his over-doing it. Jim had increased walking too fast and gotten a minor tendonitis. That was easy to treat, and by his next visit, Jim was pain-free again and able to progress walking, though this time more gradually, which was safer.
Successful Treatment
Jim’s hip treatment was obviously a success. It took only 4 visits. This hip derangement was unique because the direction that reduced it (flexion); I have only seen one other hip derangement require flexion to reduce it. The fact that Jim resumed normal activity too fast is typical of reduced derangements – the patient feels so good that they over do it. Luckily in Jim’s case, we found the new problem and fixed it just as fast as we found and fixed his chronic hip pain.
Did you know that you help make up 40% of the patients we see? Yes, YOU!
40% of the patients we treat are past patients returning for a different issue, or patients referred to Nick Rinard Physical Therapy by a past patient.
We want you to know that we appreciate you, and that despite all the changes that have happened to healthcare (and those to come) YOU are still still our first priority.
We are committed to your PT being as effective as possible, and are still working hard to get you better in an average of 6-8 visits!
Call 503-244-6232 for your Evaluation or Free 15 minute consultation.
This week I will tell you about the rapid recovery of an ipsilateral shift. An ipsilateral shift was described by Robin McKenzie of the McKenzie Method®, and the treatment of this patient of the week follows Mechanical Diagnosis and Therapy® principles exactly as I was taught them. The patient presents with a lateral shift deformity of the trunk shifted away from the side of dominant pain.
Gerry, (not his real name), arrived with his wife to clinic after suffering 10/10 pain in his back, buttock, and thigh, and had a severe ipsilateral shift. This had been present for 2 weeks, and Gerry stated it had recently worsened after a massage session. Gerry could not recall any incident that caused injury or otherwise caused the onset of pain. He stated he had tried standard chiropractic treatment with no effect.
While I was taking Gerry’s history, his wife reported that he had to crawl to get around their home for the first hour after getting out of bed. Even at his best, he could barely make it down the hall to my office. He was completely unable to dress himself, drive or go to work.
The shift made the mechanical diagnosis easy. It was most likely a mechanical derangement. Any attempt Garry made to bend forward or backward resulted in severe pain, and nearly no range of motion. Trying to correct the shift himself, even when leaning against the wall for support, also resulted in severe pain and no gain in range of motion.
Therefore, manual forces had to be applied by the MDT therapist – in this case – me! (I have achieved certification in Mechanical Diagnosis and Therapy® by the McKenzie® Institute, designated by “Cert. MDT”).
Manual shift correction is described in various published works by Robin Anthony McKenzie, the originator of the McKenzie® Method of Mechanical Diagnosis and Therapy®. It involves full body pressure against the hips and opposite side of the trunk provided by the therapist. It can be painful to experience, however, only pain that centralizes is permitted, according to McKenzie®. As I learned in my McKenzie® training from expert therapist Colin Davies, the duration of force application can last a long time – up to 45 minutes. Gerry’s shift was challenging. I applied force for 45 minutes, but still there was only minimal correction of his shift!
By day two, Gerry could walk better, but was still shifted. This time, manual force corrected the shift in 15 minutes. The next day Gerry could correct his own shift and he was not taking any pain medication anymore!
Now, one week later, he is no longer shifted at all. He can dress himself, including his socks and shoes, drive, and go to work. Regarding walking, he only needed to swing his Right arm normally again – he had been supporting his back with it and lost normal gait in the interim. He reported pain levels of 1-2/10.
Treating Gerry was very satisfying. His mechanical diagnosis was clear, treatment was difficult, but not confusing. I credit the McKenzie® Method of Mechanical Diagnosis and Therapy® with giving me the expertise to be so successful in treating this, and other painful spine and joint conditions. Thank you for your interest in the clinical case study of the week!
Nick Rinard Physical Therapy is back from the long Memorial Day weekend– getting patients results.
If you are in pain- let us help you get rid of what ails you before the first days of summer!
“Bi-lateral flank pain. This issue does not appear to be structural, but Nick helped treat mid-to-upper back pain which was also present. I feel I have the tools and techniques to self-treat this and prevent future flare-ups. Thanks!”
A mistake that people often make is waiting too long to start physical therapy treatment for their aches and pains. This commonly occurs because you may be thinking, “this will go away on its own,” or, “it’s just normal for me to feel like this at my age.” I want to clear up some confusion on mechanical pain versus normal muscle soreness that does not require skilled therapy or treatment.
Muscular Pain:
Experienced after a sudden increase in activity or exercise.
Running 6 miles when you typically only run 2 miles
You increased the intensity or length of time to your typical workout
Will be experienced 1-2 days after the increased activity has been performed and will typically begin to dissipate or be gone in 3-5 days after onset.
Is typically vague pain or experienced in a general area. The pain will not be sharp or pin-point to a specific area.
If you’re educated on what muscles perform which actions, the sore muscles will correlate with what activity you were performing.
Does not have increased or decreased pain associated with positions.
Mechanical Pain:
May have a sudden onset without explanation of occurrence (you woke up with pain for no apparent reason).
Will typically have a loss in range of motion. For example: it may be difficult to stand up straight in the morning or after prolonged sitting or driving.
Will have positions that will increase or decrease symptoms. For example: pain increases with sitting, pain is better while lying down.
If you’re experiencing mechanical pain the sooner you seek physical therapy treatment, the better! A good Physical Therapist can determine which exercises will reduce your symptoms and get you back to doing the activities that you love!
Waiting to start PT after an accident can actually INCREASE your healing time
Some people are told to “rest” for 4-6 weeks before starting therapy after an accident. The problem with this? There are many things a person can do immediately after a car accident to facilitate healing and prevent dysfunction.
All too often, we see people 6 months or more after a car accident or motor vehicle accident (MVA).
Without exercises at home, the picture is this: limited, painful movement of the spine or joints, global weakness, and poor posture that becomes painful when corrected.
The same is true for other types of trauma as well! Prolonged rest causes stiffness, and can lead to increased pain.
Nick Rinard Physical Therapy has a very effective treatment protocol that helps patients avoid loss in range in motion, and decrease pain!
Vertigo is different than just feeling dizzy from time to time.
It is an episode that can come on quickly, resolve just as quickly or last for hours and even days.
Vertigo can be caused by no apparent reason, antibiotics, jumping, sneezing, allergies, sleeping, falling to name a few. It can have serious effects on your safety while walking and driving.
Nick Rinard Physical Therapy has had many patients call his/her MD only to be told vertigo will go away on its own or scheduled an appointment to receive a generic hand out-that is not patient individualized. We have found this one size approach does not fit all. These self-help hand-out are most beneficial with the guidance of a physical therapist.
Please do not spend days or even weeks trying to heal yourself or wait for your symptoms to go away.
In as few as 2 visits our tailored approach can get you back on solid ground. Safely walking and driving around without fear of falls or a sudden onset of dizziness while driving.
