Ask Mike Reinold Show

Can Physical Therapy be Used for Maintenance and Not Just Injuries?

On this episode of the #AskMikeReinold show we talk about our concept of “performance therapy” rather than traditional “physical therapy” to help with maintenance and prehab, instead of just tradition injury rehabilitation. To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.

#AskMikeReinold Episode 218: Can Physical Therapy be Used for Maintenance and Not Just Injuries?

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Mike Reinold: On this episode of the Ask Mike Reinold Show, we talk about the concept of performance therapy for maintenance, and not just using physical therapy for big injuries and surgeries.

Mike Reinold: Let’s get at it, because some people actually dislike that portion, so I hope you fast-forwarded. So, let’s see. We have a question from Greg from Connecticut. Greg says, or asks, “Do you recommend athletes continue some type of maintenance physical therapy once their treatment is complete? If so, how are you able to make this happen in an in-network provider when insurance doesn’t usually cover these types of services?” So Greg, I love this question because this may be the most important question we’ve ever answered for the future of sports, or out-patient, or orthopedic physical therapy.

Mike Reinold: I mean, and we’ve kind of addressed this all the time, but at Champion we have intentionally … We call ourself performance therapy, more than we call ourselves physical therapy. Because we think performance therapy is a better phrase for what we provide. We help people perform, we help people … If you go through our CPSS model or other systems, it’s talking about restoring, optimizing, and enhancing their performance. This is performance therapy. Nowhere in there is it like hey, you had surgery and you need physical therapy. That type of thing. So, I do think there’s a need for our profession to progress, and to get beyond the fact that physical therapy is just for these big traumatic things.

Mike Reinold: So, let’s talk to the crowd and get some of your guys’ thoughts on this, but should we be using physical therapy for maintenance? What are some examples at Champion for people that we do use this on? And I think we could all briefly just touch … We got to keep it 15 minutes, but no pressure. Briefly touch about maybe all of our specialties. Now, we’re sports, so I’m going to give you that for an example, and maybe Dave, you can touch upon gymnastics and … I hate to say crossfit, especially nowadays, but just the fitness athletes. And just somebody that trains, you know what I mean? Somebody that trains. So Dave, why don’t you start? What’s the point of physical therapy? What can you provide somebody like a gymnast, and a fitness athlete that’s not just injuries?

Dave Tilley: Yeah. And this is definitely something that I’ve learned a lot from you too, especially, because I … I was at an in-network job and I was doing a lot more kind of what you would consider regular PT. And I felt two things. One is that people always felt they wanted sometimes a little bit more. Not in terms of coming three times a week or stuff like that, but they just wanted someone to be in contact with in case hey, this feels weird or is this a normal part of my training? So, I thought that that was lacking sometimes, was just that open communication. And then two is, I feel like, we’re really lucky at Champion where we’re working with people all year round, for performance issues, and then also for physical therapy or rehab issues.

Dave Tilley: And so, we see a lot more of the multifaceted nature of sports, and I think you guys worked in pro baseball, and I think that if you don’t have that perspective seeing someone through a full season, and seeing someone maybe through an off-season, pre-season, and their end goals, I think sometimes you don’t really understand what they’re going through. And so, for us, you guys did it with baseball and for me in gymnastics, we just know competitive sports create unique adaptations that are sometimes great, but if they’re gone too far they sometimes are negative. And the one example I’ll use with gymnasts for example, and this is common in baseball players, common in crossfit, is if you do a lot of lat-based [inaudible 00:04:37], major and peck-based activities, you’re going to continue to get some stiffness in those muscle groups because they get extremely overworked, right?

Dave Tilley: You guys have shown in studies, the eccentric trauma of throwing on a shoulder loses some range of motion overhead, and that is now maybe a risk factor for elbow injuries. And in gymnastics, we don’t have that data yet, but I think we’re seeing a very similar pattern, whereas if you do a lot of bars and your lats get stiff, or you do a lot of crossfit and Olympic lifting and your lats get stiff, and you lose overhead motion, well your back might start to become a problem, or something of that nature. So, it’s not for us about trying to sell somebody into a your life program, we need your time and your money. It’s more about you have goals, you want to get there, and we know that over the course of a season if we let this go unchecked, we see some athletes kind of have problems.

Dave Tilley: So, our services are every other week maybe, in an in-season, for a quick half hour session of soft tissue, some manual strengthening, consulting on their program, and just giving advice that’s really I think what we find it as. It’s not a always need to be here for the rest of time and we’re just here for whatever they need.

Mike Reinold: All right. So, you brought up a really good point that I liked that you brought up, I liked … Dave talked two times during that about being almost like a concierge to the people where is this a big deal? Like hey, check this out real quick. Is this something I should be worried about? And a lot of times, we just pat them on the back, and say, “Nope. Get back out there, man. You’re good.” You know what I mean? That type of thing, right? So, being a concierge, being there for somebody I think that’s super helpful. That doesn’t mean you need to be going every week.

Mike Reinold: But the other big thing I think Dave brought up, that I think is really good, is look, if you’re going to participate in this activity that uses your body to the max, you’re going to have repercussions from that. You’re going to have tightness, weakness, fatigue, maybe some soreness. So, this is funny. When we do an evaluation for somebody that comes in for an injury, it’s almost like we have two components to the exam. But what do we look at? We look at what’s the pain, structural stuff, like the diagnosis. But the whole other thing we do, it’s like what’s tight? What’s weak? What’s this? So, let’s just say it, let’s break it down. It will cause tightness, weakness, and pain. Why is it that people only come to physical therapy when they have pain?

Mike Reinold: Come to physical therapy when you have tightness and weakness, because you’re going to come in for pain and we’re going to work on these two things. So, maybe we should work on those things before you have pain. So, that’s a whole paradigm shift almost, where we have to change the narrative …

Lenny Macrina: Hot topic.

Mike Reinold: Somebody make that a clip for social media. But we got to change the narrative here a little bit here to people that … It’s like the performance aspect of it. So, I love that. So Dave, good stuff. Mike, for golfers, what do you do with … What’s the thought process for your golfers?

Mike Scaduto: Yeah, I think Dave kind of nailed it from a general perspective, that things kind of change over the course of a season. And golf is maybe, for most people, for most amateur golfers, it’s a little bit less structured than gymnastics in that people may play one weekend, and then they take two weeks off, and then they’re playing four rounds next weekend. And they just, they tend to get sore and they tend to get stiff. So, we have to do something consistently to counteract the stress that golf puts on their body.

Mike Scaduto: Also, the stress or lack of stress that they’re getting throughout the week, working in their jobs. We’ll say if they have a sedentary job. So, then these people try and go out, they try and play golf, which is a very extremely repetitive, asymmetrical rotational movement that puts a lot of stress on all areas of the body, and then they end up getting sore. So, our goal is to kind of address that before it becomes an issue for them. But at the same time we have to, over the course of a year, we have to change their program. And so, I think if we’re trying to, in an off-season let’s say, trying to gain a lot of mobility and gain some strength, then when it shifts to them playing a lot of golf our philosophy kind of changes to let’s maintain what we have. Let’s not lose any mobility, let’s not lose any strength.

Mike Scaduto: So, I think yes, they need to definitely come in for maintenance care, and the deep goals kind of shift over time, exactly how Dave said.

Mike Reinold: I thought that was really good, because Dave spoke really well on that we can be here for maintenance and management, I’m going to say management too, because Dave’s like us in baseball. Working with the player year round, you have to manage that. What I think Mike brings to the table with the golfers, Mike actually works with the most sedentary of all of our populations, right? It’s the golfer that works all freaking week-

Mike Scaduto: I’m somewhat offended by that.

Mike Reinold: You know what I mean? Think about it, you’re an attorney by day, and then you try to golf on the weekend. So, Mike brings up a great point where we, as physical therapists in performance therapy, it’s almost also pre-hab. Right? So, it’s preparing them for the task they want to do, and not combating the stress of golf, necessarily, but combating the stress of their life to get them prepared to do the activity they want. That is a cool differentiation.

Mike Scaduto: Yeah, exactly. And I think one of the really big things with golf is we do see injuries that are acute and happen from the stress of the golf swing, but oftentimes it’s nagging aches and pains that then … That come about in everyday life, that then become an issue when they start to play golf. So, it’s kind of maybe a little bit different than gymnastics where they’re literally tearing muscles off of bone in practice.

Mike Reinold: That’s a known fact. Fact. That’s the easiest thing they do. Lisa, you’re probably the best that of all of us, right? I mean, that’s probably a fact.

Lisa Russell: That’s generous.

Mike Reinold: But I mean, from your perspective as an athlete, how has that changed how you now perform performance therapy for your rowers? I mean, you’re an athlete, you know what I mean? So, what did that experience teach you about how to perform performance therapy on them? Terrible question, I’m sorry. But you can answer that better than I just asked.

Lisa Russell: I mean, when I was full-blown training, that’s legitimately when I found Lenny, because I knew I needed someone to help me manage. I was digging myself into a hole all the time. And once I figured out okay, I need some maintenance soft tissue work along the way, my training got much more consistent, and I was in general pain way less frequently because I was managing everything we’re talking about.

Mike Reinold: All right. Keep going on that, I like this. So, as an athlete, you proactively sought out a little bit of this. So, at the time you were also a physical therapist.

Lisa Russell: Right, right, right. Yeah.

Mike Reinold: So, that was super helpful that you appreciated that. So, you had the number one thing that the general public’s missing, awareness. You knew this existed and this would be something for you. Again, if you’re listening APTA, I know you’re not, but if you were, awareness that we do more than just these big injury things. All right. So, keep going on that, tell us how your performance, how rowing improved from that.

Lisa Russell: I mean, I actually felt like I was able to use my body more appropriately. I was not crumbling into a tight ball of whatever. So, I mean, and that’s where taking that experience and trying to teach the rowers that I train with now, and work with, and just rowing friends of mine, the benefits that I had in doing that for myself, and like hi, I’m also here for you and I can help you with this. I try and teach the rowers that I interact with, I’m here for you as a resource. You don’t have to just text me or call me when you’re hurt. You can text me or call me, and say, “Hey, I want to come in and see you”, when things just feel tight, or you had a really heavy training load for the week and you …

Lisa Russell: Wherever I fit into your toolbox, essentially, that’s kind of how I tell people. I’m here as a tool to help you continue to train and continue to perform, and not just for the oh, my ribs are starting to bug me, what do I do about that? And the friends of mine who have actually listened to that, definitely have had more consistent training over the past few years than they previously did. So, it’s pretty powerful-

Mike Reinold: That’s huge.

Lisa Russell: … one you figure out the balance.

Mike Reinold: Right. And I mean, you can share that. So, we have experience with athletes, so we can say, “Yeah, no, we know this helps.” But you can share, you can say, “Look, I’ve been there. I’ve done this. This helped me.” So, that’s pretty powerful to get that message across. So, why don’t we wrap up with a little bit from Len a little bit. So, I don’t think we really need to cover baseball. I think we’ve kind of covered everything. But Len-

Lenny Macrina: I agree.

Mike Reinold: … let’s talk about the business side of this. What is your advice to somebody that is in network, that is an insurance-based thing. How do you deal with this sort of thing? What do you recommend they do?

Lenny Macrina: Yeah, we hear this all the time, we’re speaking at meetings that you guys are cash-based, it’s easier for you guys. But that’s-

Mike Reinold: Why is it easier for us? That makes no sense, by the way.

Lenny Macrina: I don’t know.

Mike Reinold: It’s probably way harder, but anyway.

Lenny Macrina: Yeah. I agree. I think people who, you got to show value, obviously, for the people that come to see you. So, whether or not they had an injury with you, and they use their insurance, and they appreciated your services, well, they need to know that you offer a potentially cash-based option to continue some of those services for a nominal fee. So, maybe you offer a 30 minute session after they get through their eight PT Blue Cross, Blue Shield visits, or you know what I mean? They have an ACL and they have 12 sessions, well, they need more visits. So, you have a 30 minute, or a 60 minute option, or some kind of option where they have some kind of program that they can come and continue to see you.

Lenny Macrina: And obviously if they see value in what you have provided them with their insurance visits, they will probably continue with you. It’s you. They want to work with you. Somehow. They want to feel better, they want to be able to perform better, and it’s you that they want to work with. And they will find a way, especially for their kids, right? Parents will do anything for their children, to get them to be feeling good and to be able to perform at their highest level. So, you got to introduce a program to them, and you obviously have to give them good services, great services. Because they’re using their own cash now, because they perceive cash is king, so if they’re going to use their cash they better be receiving the top services that they perceive.

Lenny Macrina: So, give them that option and I guarantee they will use that option and want to stay with you, and it’s an extra revenue source for your facility.

Mike Reinold: Yeah. I think that makes sense. It’s a lot easier to transition somebody that rehabbed with you to this performance maintenance thing. A couple tips I think I’d give you, based on that would be it’s very clear that nobody wants to buy physical therapy, so keep that in mind. We’re kind of saying that that’s part of the problem right here. So, you just have to change the name, you have to brand this and make it a product. So, say it’s baseball, just sell them a velocity program. Call it a velocity program. Well, what is it? It’s manual therapy, manual strength, you know what I mean? It’s like, it’s the things we would normally do in a treatment.

Mike Reinold: Or maybe it’s like a return to sport ACL program. See what I mean. What you don’t want to say is, “Hey, you’re out of insurance. Do you want to just pay cash for physical therapy?” You’d be like, “No.” You say, “Hey, you’re out of insurance. Now it’s time to transition to our super happy fun, ACL, return to sport program.” You have to come up with a cool name, and sell that to them. And I think they will have a much better appreciation that this is like a different type thing. I think that’s the other thing. And keep this in mind, massages are 100 bucks, personal trainers are 100 bucks for one-on-one. You go get a lesson with a golf coach, or a baseball pitching coach, it’s 100 bucks.

Mike Reinold: Don’t be afraid to charge for the service you’re about to provide, and you’re probably going to way over-deliver it because that’s what we do in our fields, so don’t be afraid to charge, don’t be afraid to come up with that. But come up with it, make it a marketing thing, a rebranding thing where you’re not just saying, “Okay, you’re out of insurance, now just give me cash for the same physical therapy.” No, it has to be like a return to sport program, a velocity program, a performance enhancement, a maintenance program. Come up with a cool name. In baseball, we call it our arm care program. People dig that name, that concept, they get that. So, you have to find what your people are aware of, and we kind of talked about that with Lisa, being aware of it, and then deliver that to them. And I think you’ll be much more successful in that model. Make sense?

Mike Reinold: So, awesome. Great episode, thank you Greg for the question. We appreciate it. If you have more questions like that, again, just head to the website, MikeReinold.com. Click on the podcast link and fill out the form, and be sure to head to iTunes, Spotify, rate and review, and we will see you on … the next episode.