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Athletic development specialists dedicated to the art and science of excellence in movement

Notes from Physical Therapy Clinic Observation: Part II

It’s been a long time since Part I of this “series”!  Part II will be a summary of many days in the clinic rather than a single one.  Since posting Part I, I’ve been fortunate to actually be accepted into school, which I will begin within a few months. 

The main objective of this post is to hopefully look back in a few months/years and see what has changed.  I currently write through the lens of a coach but undoubtedly my perspectives may evolve with new life and educational experiences in a brand new role. 

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Why do many people bypass the medical field in favor of fitness, alternative medicine, or self-help?  The fitness world is (generally) friendlier than your typical front office medical staff.  Coaches and trainers generally have 30-60 minute 1-on-1 sessions available.  There’s camaraderie in fitness.  Not saying that customer service trumps results, but I think most clinics can do better. 

Yet some clinics have taken the clever step to schedule certain types of patients together.  Indeed, I learned there is evidence showing that outcomes improve when patients experiencing the same types of conditions can rehab simultaneously.  Camaraderie can run strong in the clinic…almost too strong as some patients don’t want to be discharged after building friendships! (more on what to do with them below...)

Good to see more clinics migrating toward a “gym” setup.  Rather than taking half the facility for examination rooms, some facilities have dedicated most of their square footage to an exercise area with tables on the perimeter. 

It is still unfortunate that most patients have been brainwashed into the gospel of the MRI.  In general, the PTs were good with explaining that MRIs don’t tell the whole story.  But gosh, media and surgeons sure have put the hex on patients.  It’s almost as though people need permission to feel pain or not feel pain based on the MRI (PT Question: “tell me you feel pain?” Patient Answer: (pointing to MRI) “Right there”).

Time management is critical.  The more efficient you are with documentation, the more time you can spend actually taking care of people. 

As a patient/coach/athlete/trainer it is completely and utterly ridiculous to bypass the superior toolkit the PT has to effect rapid changes.  For all our talk about mobility training, the ability of certain physical therapy techniques to make rapid mobility changes should not be ignored.  And I'm not even talking about painful cases, just mobility in general.

That said, too many fail to close the loop with movement.  Feeling like gumby when you get off the table is nice, but can you stabilize the newfound mobility?  Some clinics and clinicians were better than other at incorporating movement and learning into the process than others.   

…This is why it is so important to pass the patient back over to fitness side.  Maybe I’m biased, but the referral pipeline from PT into fitness is quite dry.      

But that’s what PTAs and PT techs are for, right?  Not to be too harsh, but quality control almost universally lagged. 

My biggest criticism of the exercise component (typically administered by the PTAs and PT techs): Trying to get too much done.  Running through an exercise list like checking off findings on a scavenger hunt.  Unfortunately, insurance likes to see that a lot has been accomplished.  How can you explain to an insurance drone that spending 30 minutes teaching squat mechanics (one exercise) can be a superior strategy over doing eight exercises in that time? 

In some clinics there is an institutional aversion to making people lift anything heavy.  Being a practiced lifter is certainly not a prerequisite.  But how is it that people aren’t allowed to lift any more than a pink band or be locked into a machine, yet when they are sent “into the wild” they’ll challenge the exact same movement pattern with FAR more weight? 

….Obviously there’s a time and place for everything and there are many people for whom the pink band is a sufficiently challenging load.  But a little common sense goes a long way toward building the necessary resilience to avoid coming back into the clinic (Now, I’m talking about outpatient clinics with emphasis on sports and orthopedics, not inpatient where the situation is different and you really wouldn’t make an ICU patient farmer’s carry an 80kb kettlebell!). 

Breathing quality is often ignored.  Some of this may be logistics (time). But again, this goes back to the interplay between fitness and rehab.

Warmups…total joke in many places.  Five minutes on the elliptical?  Most people work harder walking from the car into the clinic. That said, there’s a vast range in quality (some clinics are indeed quite contemporary in this area), so I should not be too harsh.  Likewise, space also can limit things.  But again, you can always do better. 

Back to customer service…I was fortunate that none of the clinics I visited still relied on ultrasound and e-stim to “reduce inflammation.”  But is it really such a bad thing for a patient to get ultrasound and “chill out” before going back to the stress of life?  Though it’s far from best use of resources for a PT clinic and some might even call it demeaning to the practice, it is at least defensible.  Having people walk out feeling good (even if from nonspecific effects) is not necessarily a bad thing if it can be accomplished with minimal investment.   

Conclusion

Despite some of the negative commentary here, I’ve been fortunate to see clinics incorporating best practices, constantly trying to improve.  Maybe the negative stuff stands out because the good stuff should be seen as routine.  I think I’ve been fortunate to see the performance and rehabilitation continuum first through the lens of a coach before joining the rehab field.   I’m sure perspectives will change over time, but it’s worthwhile to record the present for a retrospective look in the future.    

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