Physio-Fixit

New toy for the clinic. People like it🤷🏽‍♂️

If you’ve followed some of the previous letters, here is an update and response. If you’re a staff PT or a private practice owner this stuff is super important. These large corporations have driven reimbursements down to nothing. If we don’t come together as a profession and push back, things will only get worse.....
“Ms. Boudreaux and Fellow PT's,
I received a nice letter from your team this week stating that you are, "unable to offer an elevated reimbursement rate at this time." Since you are not able to offer an elevated rate, is there another way we can go about this? Would it be possible for us to add a surcharge to a patients visit stating that we have to charge this amount to account for the cost of living increases? Something like $10 dollars per visit. I know the answer is probably no, and I understand it is not just that easy to make a change. However, I do know a change needs to happen.

Would it be possible to set up an online meeting with 10-20 out patient owners along with Mr Duncan and his team to start to work on a solution? We could share some of our pain points as well as some of our success stories on how we have saved BX mounds of money by avoiding unnecessary surgeries. How our Net Promotor Score is greater than 8/10 with a sample size of 678.”

Another update on the fight to improve reimbursement for the physical therapy private practice! This affects us all, whether you’re in California or New York. Or a staff therapist vs owner.

Aetna + Preferred: All snow balls start with a snow flake - https://mailchi.mp/cb83257025d1/aetna-preferred-all-snow-balls-start-with-a-snow-flake

Anthem Shows Hand in Plan to Cut Physical Therapy

Presidents weekend vibes. Refresher B course

with
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Had a great time discussing pitching with the guys of What a great class. So excited to bring this back to If you are a this is a must. Let us help elevate your performance.

“Fellow PT,

I fell behind a little this week trying to keep up with everything at work. Sadly, we lost an employee that had been with us for over 3 years. She left to bar tend.... they could pay her more.... never stops.....

I'll make this short. Aetna reached out to me after my second email and agreed to have a meeting at my office to discuss our pain points and frustration with payment policy. If anyone could send me an EOB from one of your patients that went to a larger organization for therapy, that would be very helpful. I do have one from Blue Cross showing they are getting $300+ for the eval... imagine what we could do if we were paid $300+ for the same service.

Don't forget to black out any PHI.

Lastly, if you have any topics that you want me to bring up with her, please post them on the linkedin group below.

One I have:
1. Why don't you pay us for a new eval if the patient comes in with a different injury?

https://www.linkedin.com/groups/13662967/

Thank you,

Todd Jones MPT, ATC
Co-founder of Silver Creek Fitness and Physical Therapy”

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What is your favorite treatment for ? Some of your ideas might help a fellow PT! 🏋️‍♂️Follow Physio-Fixit
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What’s your favorite treatment for adhesive capsulitis? 🏋️‍♂️Follow Physio-Fixit
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“I CAN'T TAKE IT ANYMORE....

To all my colleagues in private practice. I have reached my limit..... A few weeks back I picked up a pizza for my family and I noticed an additional service fee from Pizza Hut. See image below.... This fee was charged to partially offset the increased cost of operations in the state of California. It seems a number of industries are struggling with increased costs and some are able to offset by adding service fees or just increasing the price of their goods or services. WE CAN DO NEITHER....

I do not have an interest in fighting with insurances that have not made any adjustments in reimbursement for nearly a decade. I only wish to educate them on our pain points and costs to provide a visit of outpatient physical therapy. I would like to take the stance that they are not aware of what is going on in our world and therefore have not made any adjustments. With this in mind, I plan to send out a letter each week to the CEO of Anthem Blue Cross and Aetna until I get a meeting set up to discuss what is going on in our world.

Moving forward I will keep you abreast of my weekly letters and how everything is progressing. I will also provide you with the name of the CEO and the addresses that I am sending my requests to in my next email.

Maybe you are in the same boat as we are in San Jose, or maybe you have your own issues that are making it hard for you to continue providing the type of care that subscribers of these insurances demand. If that is the case you might consider telling your story as well. I want to believe deep in my heart that insurance companies are not the bad guys and that we just need to provide them with good information so that they can make informed decisions.

Thank you,

Todd Jones MPT, ATC
Co-founder of Silver Creek Fitness and Physical Therapy”

BFR training on point 💪🏼 with
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💥Elbow Pain💥 this is treatment for ME! My own Physical Therapy session for elbow/bicep pain I have been having!!! I used Blood Flow Restriction (BFR) cuffs for help! 265 mmhg for 3 x 30 reps using 5 lbs weights! Problem: overuse injury on my biceps. I can’t do pull ups (functional effective exercise) or even 20 lbs curls (not a very good exercise but... STILL!). I also do eccentric curls to help decrease my arm pain! Isometrics make it feel worse!! That’s why I went with BFR! Felt awesome!! Really good burn with out pain. Biceps/elbows feel good for right now! Updates to coming... thanks for high quality equipment!

AKA The McKenzie Method. Cert MDT 🙋🏽‍♂️. .

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🔬𝐋𝐨𝐰 𝐁𝐚𝐜𝐤 𝐏𝐚𝐢𝐧: 𝐃𝐢𝐫𝐞𝐜𝐭𝐢𝐨𝐧𝐚𝐥 𝐏𝐫𝐞𝐟𝐞𝐫𝐞𝐧𝐜𝐞📚
Collaboration with .
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Directional Preference is a system of analysis & treatment with the goal of identifying exercises to change pain, resolution of antalgia & improve ROM.
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Joints are repetitively loaded/held sustained at end range for time in variety of positions:
• Standing Extension
• Standing Flexion
• Standing Side Glide
• Knee to Chest
• Press-up (also with lateral shift)
• Supine Flexion + Rotation
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EVALUATION STEPS:
• Anticipate loading strategies.
• Correct any fixed/antalgic posture. .
• In patients without a fixed antalgia, explore a single repetition of gross ROM in a variety of directions to establish a baseline of movement, screen for any catches or deviations, and check for centralization or peripheralization of symptoms.
• Observe repetitive end-range loading in each of the tested positions.
• Evaluate standing and prone extension from a lateral shift position.
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Once Directional preference is established, this can be used as the basis for treatment.
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𝐓𝐫𝐞𝐚𝐭𝐦𝐞𝐧𝐭:
Clinical trials have found that most patients responding to directional preference loading will have an extension bias.
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Prone press-ups should include a side glide component in the following situations:
• Presenting with fixed lateral shift.
• If beneficial during repeated testing where extension alone fails.
• Trial for patients with extension bias and leg pain (pelvis positioned away from leg pain).
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Perform 5-15 repetitions every 1-2 hours. As symptoms resolve, reduce to 1-2 times/day.
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Sometimes after a disc derangement has been treated, the patient is left with adaptive shortening (“dysfunction").
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Example, a patient who avoids forward flexion and doing extension exercises may have lost some ability to flex forward due to shortening of tissue or contraction of a scar.
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Often addressed with appropriate stretching exercises. important to finish flexion exercises with some repeated extension.
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𝐒𝐨𝐮𝐫𝐜𝐞:
CSPE Committee 2

Always great ther ex and return to sport ideas from .dpt .dpt with
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ACL rehab - single leg jumping and landing
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Learning to jump and land effectively after ACL surgery is a challenging task. The injury and surgery will effect proprioceptive awareness which decreases neuromuscular control. This is something I address frequently after surgery when they are ready for it.
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During single leg landing takes, I want to see good control of the body, hips and knees. I don’t want to see excessive trunk leaning whether forward or to the side. I also don’t want to see the hip rotate or the knees going into valgus on these tasks. While valgus is a normal part of sports, the athlete should be able to demonstrate good control with these types of exercises. I make sure they keep their eyes up so they don’t rely on their vision for balance. I enjoy cracking old man jokes and say “is there money on the floor?” so they know to keep their eyes up.
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Here are mid level single leg jumping and landing progressions I like to use with hurdles.
1️⃣ Single leg hurdle jumps with holds
2️⃣ Single leg hurdle jumped with extra hop - this works on quickly transitioning off the landing into a jump which is challenging. I start with a small hop to build confidence.
3️⃣ Consecutive single leg hurdle jumps - more challenging version than the last as they have to transition into a full jump to clear to hurdle.
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🙌🏼 Tag someone who would like these exercises!
👍 Like and save if you found it helpful!
🤷🏼‍♂️ Post questions or comments below!👇

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I like it with
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🌟There are some certain scenarios where discomfort is part of the process, but I don't agree with instilling dogmatism that pain is an inherent part of the process.
🏃What is most definitely true though is that MOVEMENT is an integral part of the rehab process.
🏋️‍♂️Without movement, how is our body supposed to get back to doing what we ultimately want to do which is MOVE PAIN-FREE!
🤔Don't settle for just the massage, or just the cupping, or just the dry needling, or just the adjustment, etc... We need to follow these things up with what really matters, which is moving our bodies.

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Attention ! For a possible quick fix of while running, increase your cadence. with
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🚨Increase Your Step Rate to Decrease Knee and Hip Joint Loading🚨
[knee pain solution]
🙋‍♂️Got a cranky knee that bugs you when you run? Try increasing your step rate (how fast your move your feet) to take pressure off that knee!
🙅‍♀️While not a solution for faulty mechanics, weakness, or muscle length issues, changing your step rate on your runs is an effective and fast way to decrease the load on your knees and hips, potentially even reducing your pain. A study in 2011 by Heiderscheit et al found that by increasing your step rate by 10% (at a consistent speed), it significantly lowered the amount of mechanical energy absorbed at the knee (a 34% decrease!!) and hip! Even a 5% increase in step rate decreased load at the knee by 20%!
This happens because as STEP RATE INCREASE, the STEP LENGTH DECREASES. Think about it, if you are moving your feet faster, but staying at the same speed, then the amount of distance you cover per step (step length) has to decrease. Because the step length decreases, it means that your heel is closer to your center of mass and the amount of force (braking impulse) the joints must absorb from the ground is reduced.
Common Questions:
❓Does increasing my step rate 10% mean I will have to work harder/breathe harder❓
NO. Greater oxygen consumption is required when step rate is increased by more than 10% of preferred, while increases less than or equal to 10% of preferred reveal minimal change in metabolic cost.
❓If I run at a faster rate than normal with an increased step rate, will I still have less loading on my joints❓
NO. The decrease in energy absorption is due to the decrease in step length, not necessarily the rate.
Citation: Heiderscheit 2011 Med Sci Sports Exerc.