Testimonials

Challenge: The client you treated 8 years ago seeks medical records to document a disability. You shredded their records last year. They are dismayed. What do you do?

You can offer to compose a report based on what you remember, if you remember, and provide it to the client. If the client was well-known to your office, you may know enough to write a simple narrative regarding their past therapy visits. You may have some files saved in your old computer records or billing program, with a diagnosis and billing codes, which you probably stored in some archive. You can simply inform them that you shred all old documents in accordance with HIPAA guidelines every 6 years, and you regret any inconvenience this may have caused.

You are working on a client with muscle pain and very tender trigger points (TPs). As you dig into the muscle with manual therapy or massage, the client is jumping and complaining about the pain. What do you do? Choices:

1. Keep digging, you think, no pain, no gain.

2. Stop digging and work on another area.

3. Apply ice to mitigate the sensitivity.

4. Start exercise since they cannot tolerate the manual therapy.

5. Tell them to take some medication before the next visit so it doesn’t hurt so much.

6. Press your thumb into the trigger point and hold it for awhile. They will be so happy when you release it they will feel better.

There is an alternative: positional release. If the pain is related to trigger points, simply pushing more may cause undue discomfort. Ischemic compression is often beneficial to reduce the painful sensitivity of those TPs; however, it is painful to press on them. Applying pressure may mitigate the pain afterwards by “gating” the pain. (Melzack and Wall’s theory) It may also stimulate A fibers to override the C fibers carrying pain messages. Is there a way to reduce the tenderness without causing more pain? Yes, if the pain is related to a reflex dysfunction. If the muscle spindle bias is elevated, they muscle is more sensitive to stretch, and the muscle may tense even when it is not in a stretch. using positional release (also known as Strain-Counterstrain) may reduce or even eliminate the tenderness and abnormal tension in the muscle by resetting the spindle threshold (the bias) to a more normal level of sensitivity. In most positional releases, the muscle attachments are approximated to remove all tension, and the position is held for about 90 seconds. Not too long to wait to make a difference! Educise offers courses in positional release and integrated neuromuscular re-education to address the abnormal tension and pain associated with TPs. There is ample evidence to prove it works, too!

Challenge: A prospective client contacts your office for care. You do not accept their particular insurance, they may be hesitant to make that appointment. What do you say to encourage them to come to you for care?

Before the phone sounds the usual “click”, be sure to catch their attention. Typically, after they hear you do not accept their insurance, the call is over. “No, we don’t take blah blah insurance, but we can probably help you.

What can you offer to encourage them to book your appointment?

Value: Do you know what your copay is?” If they do, you may be pleasantly surprised that it is a high value, such as $50 per visit. “We may be able to save you some time or money.” “Did your doctor tell you to go to PT 3 times per week?” If so, that adds up to $150 per week in expenses. “In our office, we see only one person at a time for fully attended care, not the typical group therapy. Since we see only you, we spend more time overall with hands-on therapy than you might receive in another office where they treat multiple clients at once. Becaues we spend the time, we do not need to see you 3 days/week. Most clients only attend 1-2days/wk. We charge only $75 per regular visit, so you are getting more value for the money.”

Specialty care: Do you offer any specialty therapies? Are you board-certified in a PT specialty such as orthopedics or geriatrics? Educate them about your area of expertise. Do you offer aqua therapy, or Pilates? TMJ or chronic pain interventions? Expert sports analysis? Ergonomic consultation? Golf analysis? Explain how you differ from the neighboring offices by your experience in areas of expertise.

References: Ask who referred them to your office. The more personal referrals you generate, the more likely people will book appointments. Even for patients who initially called, learned we did not take their insurance and went elsewhere, many called a few weeks later, asking to switch to our office.

Results: Do you keep statistics on your outcomes for common diagnoses you encounter? Share them. Keep a list of successful clients who gave you permission to offer their name as a reference for their excellent outcome. Better yet, ask some referring physicians for their recommendation or to use them as a reference. People like to go where they have heard others had great results.

Connections: Do you know other practitioners in the area who take their insurance? Do you have a relationship with them? Refer. Yes, refer. Ask the client to tell them who referred them. Referrals work both ways. When the offices we refer to receive clients from us, they usually return the favor. Perhaps someone who had chronic pain presents to them, and they do not want to spend the time necessary to address the issue, so they refer to us. It works both ways.

Challenge: What do you do when a patient presents with multiple issues in the same visit, and you do not have time to address all of their concerns?

Clinical problem solving requires the ability to prioritize.

1. Pain

If pain is the overriding issue, use the Numeric Pain Rating Scale to determine which region is most impaired by the pain. You can ask the patient to rate pain on the scale of 0-10, with 0 representing no pain and 10 as the worst pain imaginable. Offer to work on the area with the greatest pain first, then address the other regions in turn, based on severity. If there is Trigger Point pain with muscle spasm, Positional Release may be beneficial to reduce the abnormal muscle guarding and restore the normal threshold for excitation of the monosynaptic reflex. Ischemic compression may also help.

2. Disability

Another way to manage multiple areas of impairment is to decide which problem is restricting their activities the most. There are many disability indices available to quantify the level of disability for a particular body part or activity. Question the patient: What specific activities are you having difficulty with? Are there movements you are unable to perform due to this issue?

3. Motion restriction

Observe what movement patterns are most limited in flexibility. If the restriction is interfering with daily functional activities, select interventions to improve mobility to the most limited region first. If you are familiar with myofascial release work, you may use the General and Local Listening assessment to identify areas of facilitation, and begin treatment in those areas. After treatment, reassess using the Listening skills to measure how effective the intervention was. Listening skills are introduced in our Evidence-based Myofascial Release with Craniosacral Therapy course. Dr. Jean-Pierre Barral, DO taught the technique as part of the Visceral Manipulation series.