Getting in the Driver's Seat of Your Own Health: Who Should Ride Shotgun and Who You Should Kick to the Curb

YOU need to be looking out for number one. Integrity in the sales and education of the public in health, preventative medicine and pain is becoming completely extinct. There are a few brave souls out there still trying to fight the good fight. The few of us will never have as loud a voice as the people pushing the "magic pill" but if you look hard enough you will find us. When you do find that skilled clinician and advocate for real improvement, help them grow their roots stronger so that we can weather the storm of fitness myth, fat loss legend and cure-all super pills.

It has become our mission to help our clients weather the 'nonsense storm' of misinformation shielded by our years of experience and formal training. If we are not riding shotgun with you, navigation will be tough.

The first lesson in getting all the way well is in finding the people you will put in your corner to look after your health. Every prize fighter has a corner. Every race car driver has their pit crew. These teams are specifically skilled to assess problems before they can interfere with the function of the overall system and to fix problems when they arise. Why should this level of proactive care only happen at these elite levels? We are all entitled to be treated in this way and if you follow these steps, you can be.

As a general rule, a good first question to ask a potential provider is, "How much time will I be spending with you during each visit?" Another great question to ask is "How do I reach you if/when there is a problem that needs to be addressed?" Your team members should be ACCESSIBLE! After all, what is the use of a great team if when you need to see one of them you have to wait 3-4 weeks? Once you've got this info, you should be able to use the following to complete your team.

You need:
1. General Practitioner (GP)/Family Physician:
This has to be someone you really trust. Some GPs spend a lot of time explaining and educating. These are the people you must look for. 
Your GP is your go-to for all things medical 'illness' and to keep your vital medical info handy so that a problem can be picked up early. Physicians are the experts of your organs. A great resource to have, of course. You will see this physician once or twice per year at least. Bad stomach bug? Bad sore throat? Energy level takes a dip? Rapid and unexpected weight loss? Fever? Pain that doesn't resolve after a few days or with a change of body position? These are some reasons to reach out to this member of your team ASAP!

2. Specialist Physician(s):
You may find that there is an issue that needs more regular attention or a deeper knowledge of a single body system (read: kidneys, heart, joints, etc). These pros exist because of the level of depth with which they can assess and treat medical issues. In addition, these are the physicians who can perform surgery if it becomes necessary. The  best orthopedic physicians will all tell you that if an injury or pain can be treated conservatively (without surgery) then you should do that. This is how surgeons and physical therapists have formed such an amazing relationship over history.

Unfortunately, my experience has led me to believe that most physicians don’t understand the difference between PT clinics and PTs. Their understanding is similar to what the general public thinks: that all PT is kind of the same whether you go to SPARK or you go to any other physical therapy “mill”.

3. Physical Therapist (PT):
Your PT is your musculoskeletal (muscle, bone, joint, nerve, MOVEMENT) expert. Movement and pain are in OUR wheelhouse. Basically, if it hurts when you move, your PT is the person to see. The bonus about having a PT in your corner is that in most states anyone can see a PT right away and without a referral. This is called 'direct access'. SPARK Physiotherapy is a direct access certified clinic. We use this to our clients' advantage because the majority of injuries are treated most effectively when we can see folks IMMEDIATELY after the injury happens.

The other bonus is that a PT's training spans many different orthopedic body systems. Lots of times, we'll see a client for an evaluation and that client has done a lot of research on their own or consulted their GP. Many times, while the diagnosis we see from a GP may be close, the true mechanical issue requires more thorough examination. Sometimes a problem that looks and feels like a herniated disc, for example, may actually be an issue of muscular or nerve tissue tension. This is where the manual physiotherapist shines! We are able to look at the entire movement picture and truly hone our care toward the problem area and not just the symptoms. This give our clients the most relief and the best chance that this issue does not crop up again. Just as you would see your GP regularly to make sure that everything is in working order, you should see your PT regularly for what we call a 'tune-up'. We'd much rather see our clients when they are pain free and work to keep them that way instead of only seeing them when they've had an injury that could have been avoided if we would have pointed out areas of weakness and addressed them.

Clients nowadays are so well educated and come with very good questions. Always feel free to question your physician or PT. Those of us who truly value the patient education experience enjoy explaining our methods to clients who express an interest.

In addition to the high level skills, like trigger point dry needling (pictured here) and cutting edge manual techniques we use, we work hard to provide the highest level of patient education. Our patients truly understand what it is we are looking at. Our patients become very intimate in the knowledge of their pain and their issues. Not only do we see them acutely and help them relieve pain now, we also teach them markers for when they should be seeing other practitioners. Often times, because pain can be dealt with in our office, patients start to realize, “ok well if this happening I should go to Dr. Berio immediately.”

Another thing we do differently is stay in close contact with our patients so if they have and questions they can shoot us an email or give us a phone call and we respond quickly. That’s not something that is a common occurrence, unfortunately, in PT or in medicine across the board. 

This is a key to being a good advocate for yourself –doing the research, finding out what makes the physical therapist that your going to see different. Just like if you were looking for a new dentist or a new GP or if you were about to undergo surgery, you would look for the best surgeon. Once you've found your PT, make sure that your  GP, specialist physician and other pros know who they should be partnering with to ensure that all of their patients are treated the best way possible.

Our clients become better advocates for themselves because they are armed with knowledge to treat themselves or to consult with a member of their team ASAP if an issue arises.

4. Dentist:
This one is a no brainer! There is no medical professional other than a dentist that can take care of your teeth like these folks. Have tooth pain or just want to stay ahead of the curve to keep those pearly whites gleaming? Make sure to have a good dentist in your corner.
However, from what we have learned via the most recent literature, some issues that were thought to be in the dentists' wheelhouse are proving to be better taken care of by our PT colleagues.

For example, temporomandibular joint pain/disease, mostly known by it's acronym 'TMJ', is an issue that may not be related to your teeth or jaw at all! Dentists are trained in teeth and not muscle, therefore they may miss out on properly treating some of their patients with this diagnosis. According to the most recent literature, about 47% of TMJ sufferers would be better suited seeking treatment directed at the soft tissues and muscles associated with the face, jaw and neck that REFER pain to the jaw and teeth! This is the job of a good manual PT! Neat, huh?

5. Alternative/Complimentary Disciplines:
Lots of people will reserve space in their corner for acupuncturists, nutritionists, massage therapists, chiropractors or personal fitness trainers. This is also a good idea. Some people feel that having an expert in these disciplines helps to fill gaps between other professionals' knowledge.

A good team has good communication. So as long as the ring leader (YOU!) is keeping track of everything and there isn't too much confusion about what the other pros are doing, you are doing exactly what you need to.

6. Coaches??
More people are working as hard as they can to excel at sports or other activities. What an awesome situation to be in! A team of pros dedicated to making sure that you function at the highest level and then seeing it all come together in the performance of a high level task. This is where we wish all of our clients wanted to be. The thing to be sure of here is that your 'skills' expert is aware of any movement or function issues that may be preventing you from performing a drill or exercise with perfect technique.

A good example of this is one that we see a lot. We working lots with agility and power athletes. Specifically rotary sports athletes like baseball and softball players, golfers, and throwers of all kinds. The higher level athletes we see almost always have a skills coach, sometimes more than one. The common line is, "My coach wants me to be able to do this drill but no matter how many times we work on it, I can't seem to improve". This is a dead give away that this persons body is simply not allowing them to perform the task. It has nothing to do with whether this young man or woman WANTS to do it correctly. If the task is asking you to move your hips in a way that you simply cannot, for whatever reason, the coach can yell until they're blue in the face, that specific movement WILL NOT HAPPEN. At least not in the exact way that the coach would like and then this leads to a lot of compensation movement which leads to injury.

So, who do you think is the best equipped professional listed here for assessing the movement quality of all the body systems?? Of course, the PT. The only true MOVEMENT SPECIALIST. We can take into account all of the systems that combine to produce powerful, coordinated and pain free motion.

Personally, I have a GP, a dentist, a 'knee doc', a 'shoulder doc' and a 'foot/ankle doc', and a golf pro. As we all  move and excel, we transition from amateur to advanced level movements. Sometimes during this journey, we can get dinged up trying to improve. Aligning the correct professionals and maintaining an active dialogue between each of them will keep you moving at a high level.

Who should NOT be calling the shots when it comes to your care?
People speak about their health insurance the same way they speak about a friend that no one else likes. You don’t see what’s happening behind the scenes! If you had great insurance you would have an accessible doctor who doesn’t make you wait and has plenty of time to spend with you. Another thing folks need to realize is that no matter how much you pay for health insurance premiums, the professionals delivering your services are still restricted in the amount of time and scope of service they can offer you because the insurance company is ultimately going to make the call on what will be paid for. Quite the conundrum for the pro who just wants to help you!

If your insurance is so good, why are your doctors' visits still getting shorter?
The answer:

Your well-meaning physician reports to your insurance that they saw you on a given day and the reason for the visit. Your insurance company almost ALWAYS counters with a denial. This is the first line defense to having to pay for anything. Truthfully, this is enough to dissuade some pros from seeking reimbursement for that service. The problem is that after enough denials, the pro will simply stop offering that service for fear of the long and tedious process to recover their due reimbursement, regardless of how effective or important that service is for your care. Each day we see third-party reimbursement decreasing while premiums are continuing to increase. 

YOUR INSURANCE COMPANY IS LOOKING AFTER PROFITS, 

NOT PATIENTS!! 

As long as this continues to happen, we are going to see lower quality care and higher volumes of patients.

As we continue to practice, the list of practitioners that we work with and refer our own clients to grows. At SPARK, through our experience, we have developed a network of folks in surgery and in medicine who are very gifted. When you are looking around for the best people and doing your research you may not know what questions to ask. Come to us and ask, “What should I ask my knee surgeon?” Even if we cannot help you, we're more than happy to point you in the best direction so that you can get all-the-way-well.

Dr. Carlos J Berio, PT, DPT, MS, CSCS, CMTPT is a licensed Doctor of Physical Therapy, Certified Strength and Conditioning Specialist and a Certified Myofascial Trigger Point Therapist. In addition he holds a Master's Degree in Clinical Exercise Physiology. He has treated high school, collegiate, recreational, and professional athletes of various sports including baseball, softball, football, hockey, tennis, swimming, golf and the martial arts. His experience as a collegiate and semi-professional athlete as well as a professional baseball coach make him a sought after resource among elite level athletes on the field and in the training room. The concept of 'all the way well' in his work as a physical therapist and fitness professional is what continues to drive Dr. Berio to be the best movement specialist there is. 

Dr. Berio is the founder of SPARK Physiotherapy in Alexandria, Virginia. A clinic and approach designed from the ground up to set the new standard for integrity and patient satisfaction in the PT industry. Carlos remains active in several sports and enjoys agility training, power lifting and adventure races.  He is an advocate for his patients, clients and his fellow PT colleagues. He can be reached at cjberio@sparkphysio.com.