PT Treatments that Work but Your Insurance Won’t Let You Have

Physical therapists have tons of different tools in our tool bag. If each of us practiced solely with the goal of using these tools to get people all-the-way-well, the public would likely have a much better understanding about how a PT can improve their quality of life. What's the problem then? Why aren't we all treating people with highly researched and highly effective hands on care? Well, if you've been reading here, you know that the clinic that your talented PT works in isn't helping.

So what are some of the techniques that physical therapists can use that you aren't getting because of "PT Mill" models and insurance-company-dictated care? As patients, you may not even be aware that these treatments can be done by your therapist.

1. Trigger point dry needling:

This is a soft tissue manipulation technique that is used to treat people with muscle knots and pain. People who benefit the most from this technique are those with chronic headache, migraine, neck, shoulder, arm pain or leg "referred" pain that results from these knots. In our practice it is used in conjunction with other manual techniques to knock out soft tissue problems. 

The problem with getting this paid for by your insurance company is that takes a lot of time, a lot of training, education and practice.  From the perspective of 'quick and dirty' care seen in most PT Mills, dry needling is difficult to justify when you've got two patients on the table and two more in the queue. From a continuing education point of view, learning all of the skills necessary to master dry needling takes a long time and lots of resources that most PT Mills don't have and don't want to set aside.

FYI's on Dry Needling:
Some people, myself included, have an aversion to needles and the name of this technique would send some people running. That said, the type and size of the needles used in Trigger Point Dry Needling is probably far from what you have in your head.

Firstly, these needles are solid. There is no hole where any liquid passes through. This makes them very small and in the world of needles, the smaller the diameter, the less likely that the needle will be sensed at all. In fact, when working with patients, most don't realize the treatment has even begun because they don't sense the 'needle stick' they've come to expect. If the technique is done correctly, the sensation that we would expect is a deep cramping or aching sensation very similar to the patients' primary pain complaint but only when the poor tissue is stimulated. This sensation means that the needles (and the PT) are doing their job.

2. REAL Manual treatment:
This encompasses any treatment that involves a PT using their hands to manipulate the patient's joints, muscles, nervous system and soft tissues. This is commonly done in a lot of practices but in our experience FAR TOO little time is spent on this hands on approach and more is spent on passive care 'off in the corner' or with some machine attached to you. Insurance companies do pay for manual treatment, but in many cases they will pay more for different techniques and so those are the techniques that get done. This is bottom-line driven care, not outcome driven care.

3. Highly intense supervised therapeutic exercise:
The reality is that when a physical therapist is also in charge of your high intensity exercise program, ALL of your care along the spectrum of pain and performance can be taken into account. PAIN CHANGES MOVEMENT.  No one would really argue this. When you move differently to negotiate around pain, this will lead to more compensation and then more pain! This is why a physical therapist’s eyes are very useful.

Personal trainers are highly skilled at teaching exercise to pain free movers. Unfortunately, regardless of the number of years of experience, a trainer will never be able to break down movement in the depth that a physical therapist can. Many of our clients already have a personal trainer or strength coach. In these cases we work WITH their trainer to ensure that the client's care is coordinated and progressive and will only lead to the highest level of progress for the client's pain and movement.

Maybe one day, the health care payment system will place an emphasis on the use of early assessment, preventative visits and treatment from physical therapists to avoid big catastrophic injuries. There might be a long wait for this so the best bet for now will be to get connected with physical therapist who is highly trained in strength and conditioning or personal fitness.

What to do to get yourself all-the-way-well:
Research your pain and see all of the options for treatment. Once you've collected your info then ask your doctor or therapist about each treatment. If they don’t have time or aren't excited to hear that you've done some of your own research, it’s time to look for a new pro. This goes for all of your health care teammates!

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.