What Sets Your Practice Apart?

I finally made it to PT “graduation”.  Not from school (hah, I wish…), but from my post-op hip rehab.  On the whole, my PTs did quite an epic job.  I literally have not had pain in that hip since the day they wheeled me out of the OR back in May.

But…I felt that there was still quite a lot “wrong” with me.  I’d been having “burning” in my right quad and glutes during cardio (which I percieved as weakness), occasional joint pain in the right hip, and, most bothersome to me, radicular right-sided back pain that often goes into my calf. Running was painful, and to be honest I was having so much pain in my back during my daily life that I was too scared to run.

I decided to hit the strength training HARD. Using my new Certified Strength and Conditioning Specialist skillz, I wrote a program for myself.The goal was to get the right leg strong, keep the left leg strong, and hopefully help resolve some of my back pain in order to GET BACK TO CONSISTENT RUNNING AND TRAINING FOR RACES.  

I tried this on my own for three weeks, and while I felt stronger, the back pain was still there.  And running was still painful. So….I went out on a limb and got a second physical therapy opinion.  And WOW, was it an EXPERIENCE.

I won’t name of the clinic or the PT just yet, as I’ve only been once and am still processing my experience.  But several things jumped out at me that I felt were important to share for runners and especially for future clinicians who hope to work with runners.

1 This practice was a cash-based clinic specializing in treating runners.  You don’t come here for golfer’s elbow or general low back pain.  You come here because your RUNNING is being affected in some way.  It’s very niche, but I am of the opinion that specialized care is better care. This PT spent a full hour with just me, working on what was most important to me.

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2  The environment was clean and stylish.  I can’t tell you how much this matters.  I’ve been in clinics that are crowded, cramped, full of other people rehabbing or training, places with no privacy on the tables.  This clinic was the opposite.  There was a gym area with weights and RedCord cables, which lead into a bigger gym area with a treadmill, mirrors, and more equipment…which then lead into a private treatment room.  Everything was clean, neat, and had all the equipment you could ever want but it FELT sparse and spacious rather than cluttered.  There was no one else in the gym when I was there.  I can’t quite put my finger on it but the Feng Shui (or whatever) was ON POINT.  If you’re opening your own clinic, you really need to consider the environment you’re creating for your patients! Organize your clinic in such a way as to make guests feel 1) welcome 2) important and cared for, 3) calm and 4) like they’re in the right place!

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3  The PT asked me what my goals were.  And when I said, “get back to running”, she didn’t stop there.  She said, “okay so do you want to race? Or just run for fun?” and THEN she asked, “in your perfect scenario, how many days a week would you want to run and what mileage?” THIS IS WHAT EVERY RUNNER WANTS TO HEAR!! We want clinicians that care about our training, and about what we want out of the sport, because that differs for every runner! Don’t just ask your patients what their goals are – get SPECIFIC.

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4  Despite me having pain in daily life that’s preventing me from trying to run….this PT watched me run.  I ran outside, up a hill and down a hill, and then on a treadmill.  She took video, put it in slo-mo, and showed me the issues she found.  She then gave me simple cues, one at a time, to focus on, took another video, and compared the two.

I’m going to say this in all caps.  IF YOUR PATIENT IS HAVING PAIN OR DIFFICULTY WITH RUNNING, AND YOU DO NOT WATCH THEM RUN AT SOME POINT DURING THE EPISODE OF CARE, YOU ARE MISSING THE BOAT.

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5 She asked about the strength training I’d been doing and the previous PT I’d had.  the SPECIFIC exercises. She had me show her the exercises.  She then went through and told me which ones were actually contributing to my poor form and my pain, which ones were good, and which ones we needed to modify. Turns out, some of the stuff I’d been doing in desperate attempts to help my case were actually holding me back and contributing to my pain amd persistent weakness!

6 She went through my weekly workout schedule with me and helped me come up with a plan to get myself back on track.

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7 She did manual therapy that was evidence based and in which she was highly trained.  We did a lot of dry needling with intramuscular stim to my glute med, glute min, and TFL to get them to calm down.  This 1) was actually much less painful than traditional TPDN, which in the past I haven’t tolerated well and 2) it worked? we improved my ER/IR in prone by like a good ten inches in either direction……and now those hip abductors can actually do work! Bonus: I’m not too sore to walk, like I often am after traditional TPDB

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8 above all, she WATCHED ME MOVE, took video, and SHOWED me where the problems were and gave me a theory about why I am having the pain I’m having. I thought my right leg was hurting because it was weak – turns out, it’s hurting because it’s doing all the work.  My abductors on the left are so weak that I have a massive hip drop when I run, my core’s not as strong as I thought it was, and a lot of the things I’m doing are forcing me into a lot of spinal extension – hence the back pain.  Guys, it’s SO IMPORTANT to watch your patients in motion, doing the things they typically do be it a sit-to-stand or running. If you can 1) make a connection between their movement and their pain and then 2) change their movement and make a change in their pain, THAT IS PHYSICAL THERAPY GOLD.

and lastly, this PT made sure that my expectations were both realistic and optimistic.  Somewhere during the session, she literally said to me “you’re not a lost cause! you can get back there”.  She spoke as if getting back to my normal training volume and my normal race distances (primarily 13.1) were a given, and only a matter of time, not an impossibility.  But, she also made sure I understood that my pain was not likely to change in one day, or even in a week (not really difficult when your patient is a PT student, but this is KEY for a lot of people, especially when you do a lot of manual therapy!)

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Overall, this was an eye opening PT experience unlike any other I had.  .  From the standpoint of a future DPT –  this is how I hope to practice someday! Regardless of whether I’m in a cash-based setting, or what type of athlete I treat, there were some HUGE takeaways for how to go about an evaluation, and the type of environment you want to provide (both with your own manner and the physical layout of your clinic).  As a patient, I was similarly impressed with the depth and specificity of the examination as well as the tools I was given.

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