An Interview with Barefoot Matt (Dahmen)

I am excited to share with you an interview with Matt Dahmen, a local farmer in the Colorado Springs area. Matt was years ahead of me in listening to his body and eschewing faulty belief-systems that are unfortunately still common today. I remember having many discussions with him as I started my transition to barefoot and minimalist footwear years ago. I had chronic foot and hip problems that did not resolve with years of conventional treatment. I wasn't looking for a cure-all but I felt that going more natural with my movement made sense. Matt became an excellent resource and was supportive of my journey. Some of the most powerful and influential stories that helped me were not from the medical field, they were from people without medical degrees taking control of their own health. So without further adieu, I hope you enjoy this interview!

Matt Dahmen

What was the impetus to start your barefoot journey?

Growing up I never really liked wearing shoes, as soon as I would get home from school and basically the majority of summer and weekends I was sans shoes. I made the decision to forego shoes and live barefoot in 2010. I had learned about the Paleo Diet and ancestral health movement and it just made sense to me, so I began implementing a lot of the practices into my life. During this time I started researching a lot about minimalist footwear, as I have never been a fan of shoes and I was also interested to see if going minimal or barefoot would help with some of the problems I had been experiencing with my feet. It dawned on me I am already barefoot a lot of time, so the transition wouldn’t be that difficult.

How did you get started?  

I was already wearing shoes infrequently leading up to when I chose to forego them entirely so I had unknowingly already started the transition into the barefoot and minimalist lifestyle. However to fully transition into being barefoot I had to do some work on building up the pads of my feet. I found that hiking a few hours several times per week on trails with varying surface textures such as sand, gravel, dirt, and solid rock helped thicken the callus pretty quickly. It also helped me develop a better ability to adapt to different terrains and exposed me to a large degree of different sensations I was missing in shoes. It also helped to greatly strengthen my feet.

A few years after I started I learned about CrossFit and was lucky enough to find a gym that didn’t have any qualms and was supportive of me training barefoot. Training in the gym has exposed my feet to a lot of movements I wasn’t experiencing prior. It has helped me with learning how to adjust the distribution of weight on my foot depending on the movement, how to balance better, how to store and release energy more efficiently, and also how to react very quickly to falling heavy objects. With all of the variety of movements I was doing in the gym in addition to on the trails my feet began to strength even more.

What did you notice change over time?

The most significant changes I experienced over time were the development of arches and the overall strengthening of my feet. Growing up I had “flat” feet or collapsed arches. Basically if my feet were wet the prints I would leave behind were of the entire bottom of my feet. I had “weak” ankles and would often roll or sprain, especially when wearing shoes. I also remember even having lower back pain in elementary school, which I now contribute along with my ankle problems to my lack of arches.

My feet have physically changed over time since going completely barefoot. I have noticed that in the development of arches my feet have actually shortened some. I used to wear a size 13 with little room to spare, but now on the occasion that I have to wear shoes I can comfortably wear a size 13 and even 12 in some brands.

Another noticeable change was the widening of my forefoot. I always had wide feet, I remember growing up I could never wear Nikes because they were too narrow, but now they are much wider. I now have space between all of my toes and my entire forefoot widens when pressure is applied.

In foregoing shoes my feet and ankles have become significantly stronger. Where before even walking relatively short distances would lead to foot pain I can now go miles and hours on end without any discomfort. I’ve always been clumsy and my balance was always off, but now I my ability to balance has increased immensely and though I am still really clumsy, my clumsiness no longer results in frequent injury.

Matt's feet at 7-yrs old.

Matt's feet at 22-yrs old.  Still flat as a pancake.

What did other people in your life think about your lack of shoe wearing?

I'm pretty weird in general and already wore shoes as infrequently as I could so when I told people I was no longer going to wear shoes at all (except when absolutely required) the people around me responded by either rolling their eyes or basically saying “that sounds about right”. For the most part my friends and family just added it my list of quirks. A few family members voiced concern that I would “mess up my feet not wearing shoes” or injure myself.

What's the hardest thing about going barefoot?

By far the biggest challenges I experienced going barefoot were how to protect my feet in winter and figuring out where and when I cannot be barefoot.

Matt cut his toe while hiking and fashions a quick bandaid. 

What do you do in the winter to protect your feet?

I have found over time my feet continue to become more adaptable to varying temperatures, both hot and cold. For the most part here in the Colorado Springs region we have relatively mild winter with occasional periods of subfreezing weather or snow, which usually melts in a day or two. So for the most part I remain barefoot all winter, but on the occasion that I am going to be in snow for a prolonged amount of time or exposed to bitterly cold temperatures I have found a pair of neoprene socks work great for protecting my feet. Basically it is a wetsuit for your feet, they protect against the cold and feel very minimalist. I have found them pretty inexpensively on Amazon.com for around $15. They hold up well when used in snow or on smoother surfaces such as concrete, but if you try to take them on a trail they wear through really fast.

How do you navigate public places (such as restaurants and stores) where you cannot be barefoot?

The good news is anywhere outside you can be barefoot. For places like restaurants and stores I usually keep a pair of easy to slip on footwear like sandals in my car. The only time this doesn't work is when I take the footwear out of my car and forget to put them back, then when I get to the store I have to drive home to get them. I've come to terms with the fact having to wear shoes for a short period of time isn't going to undo all of the benefits I have experienced.

I have found one can be barefoot the entire time one is in an airport. However, the last time I flew through Denver International a TSA officer told me they haven't cleaned the floors in the security area since 1974, which was before they even built the airport.

For work or any time I have to wear shoes for more than a few hours I have found a good pair of minimalist shoes with a wide toe box are best.

Are there any other times you will still wear shoes?

I recently took over my family’s farm and have found wearing rubber boots to clean stalls and chicken coops is better than having to wash, re wash, re re wash my feet to get the smell out. Outside of that, I still go barefoot when doing chores.

What has being barefoot taught you?

I think the biggest thing being barefoot has taught me is being more aware of my surroundings. I have learned to adapt my walking or running to a multitude of different terrains and surfaces. It has opened up a world of senses and sensations I was lacking prior to leaving shoes. There is a huge disconnect people have from what they are standing on. Any time I wear shoes now I feel like I'm blindfolded.

Another major thing being barefoot has taught me is not  to blindly listen to conventional wisdom or what other people or even medical professionals are telling me. I was told my “flat” feet were something I would have to deal with the rest of my life and could manage it by wearing orthotic inserts and more supportive shoes. I have found it is best to listen to my gut, do my own research and observations, and go with what I think is best. If I make a mistake or decide something I am doing is not great for my health and wellbeing I will change it and look for a new answer. Going barefoot is by far one of the best decisions I have ever made.

Feeling the world in a way most people do not.

Have you saved money going barefoot?

I have saved some money not having to purchase shoes or socks. The few pairs of shoes I own have lasted for years because they rarely get worn. I own a pair of Vivobarefoot minimalist shoes, which are great and mainly used for work or times when I am required to wear shoes, but I do have to say they are the most expensive pair of shoes I’ve ever purchased.  

What are the most interesting comments or questions you've gotten about being barefoot?

Well the most common questions are: Doesn’t that hurt?, which for the most part the answer is no. I mean if I’m running and loose gravel rolls into my arch or I cut my toe on a sharp rock, then yes it does still hurt, but my feet have adapted and I do not experience any discomfort ambulating barefoot; Don’t your feet get cold? Which again the answer really depends, if only the pad of my foot is exposed to snow and/or ice, then no my feet don’t really get cold, but if I am walking through ankle deep or higher snow then yes my feet do get cold after awhile; another question I get a lot is Why don’t you wear shoes? Which I will usually answer by saying “because I don’t like shoes” and sometimes if the person asking seems more intrigued I will go into detail about the benefits I have experienced.

By far the most interesting comment I get, which it is mainly interesting because how often it has happened,  is when I am hiking and I cross paths with an elderly couple and the man usually has some comment about how he used to do the same thing when he was younger.

Some other comments I’ve gotten are “you’re brave” or “I could never do that”, which both I find funny because it does take some commitment and time to transition to living barefoot, but for the most part anyone can do it and it's truly not as difficult as people seem to believe. For thousands of years no one wore shoes and still today there are many places in the world where barefeet or minimal footwear are the norm.

What do you think are the most common myths about being barefoot?

I think a common myth about being barefoot is that it is bad for your feet. I was told because of my “flat” feet I should basically always be in shoes. I have the strongest and healthiest feet of anyone I know.

Another common myth is it is unhygienic to be barefoot. Yes, my feet might literally be dirtier in the sense that they have dirt on them, but simple washing will resolve this. However wearing shoes is basically having your feet in a petri dish. The warm, moist, airless environment of a shoe is the perfect breeding ground for anaerobic bacteria and fungi. My feet are constantly exposed to the air and I have never had any fungal issues and they don't stink. Being barefoot can expose you to more chemical and biologic contaminants on the ground than wearing shoes, but having a thick, hard to penetrate pad on the bottom of your foot functions the same way and avoiding areas known to have contaminants and having good hygiene negates any negative effects of being barefoot in the modern world.

Matt no longer has foot pain or "flat feet" as evidenced by this snow print.

What do you wish everyone would know about going barefoot?

The biggest thing I wish everyone would know about going barefoot is it is not as difficult as you may think and the benefits greatly outweigh any possible negatives. Also if you are not ready to completely forego shoes or your current employment does not allow or accommodate a barefoot lifestyle going minimalist and spending a much time as you can out of shoes is a great step in the right direction (pun intended).

What Quality Versus Quantity Means and Learning Oppurtunities

Quality versus quantity is something we hear all the time.  

We think it makes sense but do we really understand or practice quality over quantity?  Most things in life are numbers based and that automatically sets a quantity to whatever it is you are doing; whether it is lifting, running, hiking, swimming, etc.  We are overwhelmed with 25, 30, or 15-minute workouts or calorie counting.  Both are quantity but not necessarily quality.  With the emphasis on quantity, we get tunnel vision and "do it at any cost".  Why not, it is only 10 reps or 25 minutes.  What is the harm?  The harm is that we introduce unnatural movement and ignore the quality work it takes to be able to achieve our best.  I am not saying that we need to make it easier but we do need to make it right.

The first concept of quality is good movement and control to do the activity. 

Movement is just simply having the adequate range of motion and control is being able to stabilize through that range.  There is usually some stiffness or lack of control.  What do we usually do with that?  Maybe some quick stretch or see a Masseuse?  Maybe we foam roll or use some bands?  Do we even know what to do?  Stretching, massage, foam rolling, and band works can be great tools but they also are just symptom relievers.  They do not always get at the cause and the cause could be having poor movement and/or control.  We then push through that lack of movement and control to accomplish great feats.  This will only last so long.  In Olympic lifting, shoulder mobility and control as well as hip mobility and control are the keys to success.  Slight deviations may not be an issue.  However, as we up the volume and weight the lack of these elements can rear its ugly head.

The next concept is effective minimal dose.  

Effective minimal dose is the amount of exercise  or work that will bring about positive gains or changes without causing injury or over training.  This is tough because we are all different and the effective minimal dose is different.  That is why "cookie cutter" programs work for some but not all.  These programs show you before and after results and show people working hard. They emphasize "pushing it."  They talk about how to modify, but this is not emphasized or there is no explanation of when you should modify.   Worse, you do not want to modify the workout despite recommendations.  Modification ensures you get the benefit without "red lining."  It's like driving your vehicle aggressively all the time and then wondering why it breaks down.  There is a range of driving that will keep your car running well and you can deviate from time to time.  Your body is the same way.  Therefore, there is the effective dose of activity that will help you improve and minimize injury too.

So now you know the concepts, so what do you do now? 

The most important thing is to listen to your body.  Unusual stiffness or pain is a warning sign that something needs to change.   Incorporating preventative maintenance and recovery into to what you do is the next important thing. The workout is not the only thing that matters.  The workup to the workout and the recovery from the workout are just as important.  Knowing when to back off is the next important thing.  Most of us do not have a de-load week or active recovery week.  This is a week to work on mobility and control with light to no load and in a different form than your typical workout/activity.   This really makes senses if you think about it.  Have you been making good progress and working hard for weeks and then all of a sudden performance falls, sleep is difficult, and/or you feel fatigued?  It seems confusing because everything is going well but the change is your body (mostly your brain) telling you that it is time to back to down and work on recovery.  Most elite athletes have an off-season and a cycling of intensity throughout the season.  The rest of us have to program this into what we do.

To help you with this, we are going to have classes on recovery and preventative maintenance.  

The classes will be an hour long and will cover topics like foam rolling and mobility band use, the power of plyometrics, weight training form for all, and many more.  Please check out our website for classes that my interest you.

If you would like a question answered, remember that we answer a question a week on face book.  Submit your question and the answer may be published online. 

Crash Course in Muscle Fiber Types & Recruitment

Today I would like to spend just a bit of time clarifying a few things for endurance athletes regarding the training of muscle strength, endurance, and/power and I would like to make a case for strength training and plyometrics in your routine.  The nature of this article is not exhaustive but it will make a few points critical to your performance and your injury risk.

First let's look at muscle fiber types.  Some of you may be familiar with the idea that every skeletal muscle in our bodies have a mix of muscle fiber types.  Some fibers are more aerobic in nature and demonstrate better endurance (type I) while others are more anaerobic or glycolytic and help us with maximum power and strength movements (type II).

Simplistic summary of the main muscle-fiber types.

Now it's important to realize how our nervous system actually recruits our muscle fibers when we move.  The brain will always recruit it's type I or "slow twitch" fibers first because they exhibit the greatest endurance.  If the contraction needs to be stronger, the brain will then recruit more and more type II or "fast twitch" fibers until it can no longer recruit more fibers.  Interestingly it is believed that our brains cannot recruit every muscle fiber in a muscle all at once and it's true in the laboratory we always see only a percentage of muscle being recruited during a maximum effort.  This is partially modifiable as one adaptation to training is teaching the nervous system to recruit more of what we already have.  This is like taking the speed governor on a school bus from 55-mph to 75-mph.

The extreme example of full muscle recruitment would be a person showing superhuman strength in a crisis situation (such as lifting a car).  One theory is that the brain might decide in a life or death situation that it is willing to risk personal injury (muscle/tendon ruptures or even broken bones) in order to survive the situation at hand.  In other words, the brain removes the governor completely and the school bus is now traveling at maximum speed!  This hearkens back to the 1994 action-thriller SPEED with Keanu Reeves.

"Tell me again Harry, why did I take this job?"

Back to reality, we spend most of our time performing sub-maximal muscle contractions, and if you're an endurance athlete, you deal with muscle fatigue the most.  In that case, your brain gets a lot of practice cycling through your muscle fibers to maintain the correct amount of force over a sustained or repetitive effort.  In other words, as fatigue increases, your brain will recruit more type-II, fast-twitch muscle fibers.  Of course much of this is still very theoretical.  We can observe certain patterns in various athletes and note that certain styles of training tend to produce certain results.  However having a framework, despite its over-simplification, can still be of value when determining what a holistic and sustainable training plan might look like.

The primary issue that I see with endurance athletes is a heavy focus on training the nervous system to activate predominantly slow twitch fibers.  On one hand, this is a necessary part of endurance training.  We are all aware how effective base miles at an aerobic effort is to our long-term training goals each year.  Don't skip your base.  The issue arises when we actually need to recruit beyond the slow twitch fibers but we haven't practiced.  Running situations in which you would need to recruit beyond the slow-twitch include speed-work, running uphill or on difficult terrain, running in a state of fatigue, and racing.  Here we find ourselves once again staring the use it or lose it principle in the face.  It's important to note however that it is impossble to maximize your recruitment potential by running alone.  Yes it is good to vary your running workouts but our human bodies are better equiped to run when we challenge our muscles in novel ways.  This was less of an issue before the running boom in the 1970's and when most people had more physically demanding lives.

We are kind of meant to use our bodies all our lives and drop dead suddenly.

"Tell me again which color thera-band you wanted me to use?"

Unless you're doing something specific to target your other muscle fibers (or one could argue, to train the nervous system to properly recruit all types of fibers efficiently), you're clearly not taking advantage of your full potential and you will be at a higher risk for injury.  We need our nervous systems and muscles to be well-trained because it is not a question of if things will go bad but merely a question of when.  You will eventually run fatigued or need a bit more speed and power in a situation and it's better you have an excellent buffer of strength and power before that time comes.

Many roads lead to Rome but I have found that in general, most people benefit from 3-4 days a week of resistance training in their non-racing season where the goal is to build strength, speed, and power and 2-days a week to maintain when their running workouts become more intense and/or they're racing.  The easiest and safest way to strength train is to chose movements which you are more familiar with and which you have excellent body control performing.  A person can start with lower weight and higher repetition training and progress to higher weights as their form and technique allow.  The primary goal in building strength is to safely recruit as many of your muscle fibers as possible.  To build strength I personally do moderate-weight/moderate-repetitions most of the time and I move very slowly until I hit a fatigue point in which I cannot maintain excellent form.  By moving slowly I practice complete control of my exercises and minimize my injury risk.  That said, cycling the types of strength training is known to be highly effective as well.  Find a good strength coach if you need one (Colorado Springs is home to the National Strength and Conditioning Association) and be sure that any discomfort you feel in exercise is muscle burn, not joint pain.  Discomfort should not linger if you're doing things correctly.

Sorry Peter but don't be Peter...

Plyometrics, agility, and running drills that include skipping or hopping are also excellent ways to train your nervous system to better recruit its muscle fibers.  Here we are talking about more than overall strength (i.e. the total number of fibers you can recruit).  Plyometric drills target the speed at which we can recruit our muscles.  By increasing either the number of fibers recruited and/or the speed of recruitment, you increase your muscle power.  Power is the secret neuromuscular ingredient which helps us run faster with less effort.  For endurance athletes, power also helps us maintain our speed and good form when fatigue is a factor (and when is fatigue not a factor?).  These recruitment drills are a common missing ingredient in many runner's recipes for success but improving muscle recruitment is really the gift that keeps on giving.  Plyometric, agility, and running drills are ideally performed throughout the year in a smart and safe manner to help maintain all of the aforementioned benefits.  If you have no experience with this type of training, it may be smart to get professional assistance in the beginning in order to learn the basics.  Because plyometrics are inherently higher-force than most people are used to, the likelihood of sustaining an injury temporarily increases.

Olympic lifting (left-side) versus Power lifting (right-side).
Olympic lifts actually require a lot of power, not just strength because the speed of movement is very important in a successful lift.  Power lifting requires power but essentially one needs to be VERY strong as these are maximum lifts and the speed of movement is relatively slower.

While this crash course in muscle fiber types and recruitment won't make you an expert today, perhaps your brain is beginning to ponder how you might improve the effectiveness of your own training methods.  If you are attempting to be a competitive runner or if you would like to make yourself more resistant to injury, intelligent strength training and plyometric programs are a must.  The key is to start where you're at...we want to slowly re-train your governor, not have the bus speeding off on a draw-bridge.

Oops, should have thought this through...

Ask a Therapist - Top Five Reasons Your Injury Isn't Healing

In a somewhat divided nation, at least we can all agree that injuries suck.

There are many important things to keep in mind when you've sustained an injury, the greatest of which is, don't stop all exercise.  You may need to modify what you're doing or focus on aspects of your fitness or health that are not doing well, but you should never stop moving entirely.  Here are some of the top reasons why people struggle with injury recovery.

#1- You don't take time to recover or rejuvenate.  Without going into so much detail this point becomes a biochemistry and physiology class, there is a certain amount of healing that needs to take place on a daily basis.  Your body takes all kinds of stress (to include your workouts) in your daily life.  The good news is that the right amount of stress can make us stronger but only if we recover.  A perfect workout means nothing without the recovery piece.  There are many ways to recover from a workout but I like to think about the big picture.  Everything we do to our bodies will affect our recovery, not just what we do post-workout.  Personally I like to foam roll, practice yoga, and vary my training in cycles.  I like to ensure I get enough sleep and will skip workouts if it means catching up on important sleep time.

#2 - Your nutrition is...well, not optimal.  Eat things that were recently alive and are minimally-processed.  Get enough protein and make fewer trips to the liquor store.  And for the sake of all humanity, avoid trans-fats, vegetable oil, and eat as little sugar in your diet as possible.  Studies are clear that your nutrition status affects your immune system and you ability to recover and adapt to new stresses.

#3- You don't sleep enough.  How much is enough?  For most people this means at least 7 hours a night but if you're like me...you thrive on 8-9 hours a night, especially in heavy training.  Our brains and all of our cells benefit from the hormonal changes that occur when we sleep.  Growth hormone spikes while we are asleep to initiate this healing process.  Go without sleep and you destabilize the cyclic patterns of a multitude of important hormones.

#4- You're going at it alone.  It's smart to get professional assistance when you have a problem that's worsening or failing to improve with your strategies.  Many times it is a team effort to get the best results.  For example, I brush and floss my teeth daily but I still rely on professional cleanings periodically to maximize the health of my teeth.  There are always important things you should be doing to recover from an injury, however sometimes getting a helping hand is what you need to kickstart the process.  If you're like me, you usually avoid asking for help and are generally independent and self-sufficient.  It's a trait that can be good in some situations but get us into trouble if we are too dogmatic.  In the case of an injury, sometimes we end up suffering more than we need.

"If you want to go fast, go alone.  If you want to go far, go together."

#5- You have a poor attitude.  You need to want to get better and be willing to make any changes necessary to do so.  Your attitude about your body and what you're doing can make all the difference.  I can personally attest after having had my share of injuries that your mental state can affect whether or not you have the motivation to do the things you must do in order to heal.  Don't see a doctor, PT, chiropractor, etc with the expectation that they will fix you.  It's a failed model of medicine.  Instead it is better to work with a professional, get their support, use their knowledge, and use your can-do attitude to get better.  I watch people do this every day and the results can be quite amazing.

Always remember if you have an injury that your body is trying to remedy the situation.  Often times we don't pay much attention to our bodies until we are sick or injured when the truth is the healing process is occurring all day, every day.  With the exception of trauma, it's when we lose balance in the body that the illness or injury begin.  Those who are injured should look at this basic list for areas they may not be addressing.  To everyone else, practice healthy habits now and see how long you can keep injuries at bay.  And finally, remember that if you're injured it's not a free pass to lay on the couch, eat whatever you want, and binge watch the tube.  In my opinion, you are still in training.

Ask A Therapist - Can My Therapist Help Me Prevent Injury?

When Joe and I contrived starting a cash-based physical therapy practice several years ago we knew that one of our main objectives would be to offer more education to the public.  Many traditional physical therapy clinics are still positioned to treat injury after-the-fact.  In that setting, we have our hands tied by insurance and patients often go for their full 12 or 20 visits...or whatever is offered by insurance, regardless of what the patient needs.  In that setting, insurance is not particularly interested in paying out so that healthy people can get more education that might keep them healthy in the long run.  That's where cash-practices step in...

Sustainable Running helps runners assess their own movement quality and provides interventions.

Natural Performance Rehab, LLC. and other similar models of practice are the future of physical therapy.  No longer do we need to sit idle and wait for the injured ("The Walking Dead") to enter the clinic.  We are out among you to offer education, support, and a way to move forward towards a better quality of life.  We know that it is imperative that people take responsibility for their own health and happiness.  All this is true.  But I also believe that having good information and support from a tribe of people who get it, is also important.  By good information I mean information that is useful and actionable.  It's information that allows you to do your own experiment, to test for yourself if the research studies mean anything for you.  By a tribe I mean you friends, family, gym, workout group, therapist, chiropractor, massage therapist, etc.  Have a tribe!  Finally, challenge the medical establishment.  Challenge your therapist and your coach.  Ask questions always so that you can learn why someone is saying what they're saying, then decide if you agree.  Always ask.

Since both Joe and I run quite a bit and a high percentage of runners get injured every year, we have started first with running courses which are mostly taught at Crossfit SoCo.  We are actually in the modification process so that we can take our longer 4-hr courses, which are very comprehensive, and condense them to 1-hr courses on various topics (so you can chose the topic/class more specifically).  We expect to post a schedule in the coming weeks for our shorter running courses.  In addition, in a few months time we are working to add preventative courses for cross-fitters and weight-lifters as well.

We will always use THIS PAGE to post about upcoming classes.

Imagine your future self could come back and give you a few tips on how to navigate your workouts, your diet, etc. for maximum results and minimal effort.  Your future self could tell you exactly where your personal habits are leading and how you might benefit from reconsidering your current routine.  Fortunately, all of us can choose to do an assessment if we wish.  Many of us do this in other areas of our lives, performance evaluations at work, health and dental screenings, and perhaps we belong to some other group of like-minded individuals who also help us stay on a good course.  I rely on friends, family, professional mentors, and even some experts in their fields to bring perspective to my daily decisions.  Our mindset, our habits (unconscious decisions) and our conscious decisions will all marry to give us a path in life.  The great news is we can affect all of those areas and we can create a tribe or team around us so that we are not doing it alone or with just our willpower.

Some of the services we offer, such as classes and movement assessments, are designed to do just that.  Much like a general health screening or a visit to the dentist, we assess your movement health and give you feedback (and homework).  Sometimes we have movement inefficiencies that have not caused us any injuries, but they could become worse over time if they are not known.  It's like having tarter buildup and weak enamel.  All may seem fine until one day you wake up with tooth pain and the dentist says you have a cavity.  Our goal is to help make you aware of your movement so that you're now in the driver's seat.  We measure where you are, together we determine where you want to go, and then we create a plan to help you get there.  This is how medicine and health should work...

I realize this week's post is quite general about what we do as cash-based therapists so I thought I would introduce you at the end to Dr. Irene Davis of Spaulding National Running Center. Dr. Davis is both a physical therapist and a PhD.  She is one of the foremost authors of running mechanics literature in the country and she also runs a local-clinic that treats runners.  This is truly the ideal combination if you want some of the best evidence and information (i.e. she knows the research and she tests it in the real world).  You can find many great interviews via youtube but this interview is perhaps my new favorite.  It's a great listen as you commute.

Dr. Irene Davis
Her website.

Ask A Therapist - Why Are Health Care Professionals Not Taking Insurance

This week’s question is about health insurance.  The question is why are health care professionals not taking insurance? 

To answer this question, we need to talk about how insurance works.   Medical insurance helps you “afford” expensive medical procedures for you and your family.   Just like car insurance, you typically reach a deductible before the insurance company will pay (unless you do not have a deductible, which is rare).  Insurance does not make medical care “free” just as your car insurance does not make owning and operating a car “free.”   To complicate matters, medical insurance in its current form is a business in which its primary purpose is to make a profit.  This means that the care you are afforded is dictated first by profit, then by actual medical importance (and evidence-based practice).

Let's start by discussing co-pays.  Co-pays are the amount you owe for covered health care services after you have reached your deductible. According to the American Physical Therapy Association, co-pays are as high a $60 per visit, although I have seen as high as $70.  Recent legislation in Colorado limits specialty visit co-pays to $40 per visit but is not yet in effect.  What this means is you could pay up to $70 per visit to your physical therapist once you have reached your deductible (or $40 per visit once the legislation kicks in).  Additionally, most insurance plans separate medical (doctor’s visits) and rehabilitative services.  This means you have a specific deductible for rehabilitative services which is typically $2,000.  And remember that your co-pays and deductible are in addition to your monthly premiums.  So let's do the math, you pay the first $2,000 for the year and then $40/visit after that for someone your insurance company wants you to see?  How is that a deal?

Your insurance company has certain providers whom they have negotiated contracts (in network).  Surprisingly, provider selection is not based on how great the outcomes of their patients are.  It is based on how cost effective the provider is and how “fast” they can see you.  Insurance companies do not recognize certain treatments that are effective such as dry needling.  Insurance companies do not pay for injury prevention, education, or performance enhancement.  The insurance company is not concerned with your passion for Cross Fit, running, or other recreational activities.  They are concerned with your “minimum” function at work and home.

So how does this contract work?  Insurance companies negotiate a reimbursement rate with your provider.  If the visit cost $120 dollars, you pay the entire $120 if you have not met the deductible or $40 if you have met the deductible.  The insurance company pays a percentage of the left over portion (usually $20 of the remaining $80).  This is the agreement providers sign when they accept insurance.  For the physical therapy clinic this means that the provider must see more patients to make up for the loss of money.  Quantity of care trumps quality of care. 

Insurance is a “wager” that you will not encounter major medical issues.  The company covers you but the intention is to bring in more money than the company pays out.  This is why insurance companies will refuse to cover prevention or other helpful services.  Prevention requires regular check ups that are accessible to everyone.  This means the insurance company would have to pay out on everyone versus a percentage of the people who end up sick or hurt.  It seems counter intuitive that insurance companies do not pay for prevention or education.  Prevention and education could reduce the risk of medical issues.  Aetna, Anthem, Cigna, Humana, and United Health Care (the top five insurers in the United States) all have outperformed the S&P 500 for the last 5 years according to a CNN report.  Despite rising profits insurance companies have deferred more of the costs for routine visits and prevention onto the consumer.

Because of the current state of health insurance and its for-profit architecture, many providers are cutting out the middle man.  High deductibles mean that patients may save money dealing directly with the provider for the true cost of services.  Providers are also cutting out the expense of negotiating with insurance companies and having to hire coding experts in order to get the money they are entitled too.  Providers are emphasizing more prevention and individualized services that insurance based medicine will not cover.  Finally, the non-insurance provider is not “hedging” any bets on your health.  Your visit is about your health and well-being entirely...it's not a negotiation.