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.