Dr. Nathan Kadlecek, PT
Is a physical therapist committed to providing high quality health information, largely focused on lower back pain and the gross overuse of diagnostic imaging, medication, surgery, low quality treatment methods, and the over-diagnosis of pain conditions. He's also a powerlifter, pain nerd, macro-scale thinker, and wants to help you think differently about pain, healthcare, and life.
I’ve uttered this phrase. You probably have too.
Not getting 8 hours of sleep? You should start. In a recent podcast interview with Peter Attia, MD and Matthew Walker, PhD they discuss over a three part series just about everything when it comes to sleep. Matthew Walker is the author of “Why We Sleep: Unlocking the Power of Sleep and Dreams.”
You can also follow him on twitter where he has tons of tips and data to help you sleep better and deeper:
Want to greatly reduce your risk of cancer, Alzheimers, dementia, heart disease, high blood pressure, diabetes, low energy, and much more? Then you should REALLY consider getting 8 hours of sleep.
Sleep and mental illness are also very closely intertwined. For people struggling with depression, anxiety, and other mental illness, it’s likely that sleep has also been affected. As they discussed, this is likely in a bidirectional manner, too. Lack of sleep leads to higher anxiety, and higher anxiety typically leads to worse sleep.
From personal experience, when I get < 8 hours of sleep, or if it is broken up due to the neighbors dog barking, or loud people, or a multitude of other factors, I will 100% be more anxious during that day and of course, more tired.
This is why I think it is so important to make sure to keep our sleep as consistent as possible in terms of our evening winding down routine and to control what we can control. We can’t control the noisy neighbors or dogs or random alarms that go off at 2:33 am. What we CAN control are our habits prior to going to sleep.
Each of us likely has a different guilty pleasure before going to sleep which could be hindering our depth and length of sleep. Here are a couple:
Blue light + electronics before bed:
I tend to read on my phone or scroll on instagram before bed which not only keeps me awake longer from the blue light but also keeps me up later, sometimes as much as 30-45 minutes which significantly cuts down on my time asleep. This also applies to TV. I know a lot of people have a TV in their room and it’s how they wind down, however, if you are struggling with sleep, it may be time to switch up this habit. What’s more important, living longer and healthier, or catching one show?
If you are drinking that beloved afternoon caffeine this could be causing you to not sleep as deeply. Caffeine blocks the adenosine receptors which are required to help you fall asleep. Instead of adenosine binding to these receptos, caffeine does, which prevents us from feeling sleepy.
As much as I love having an ice cold beer or some wine an hour or so before bed, it ain’t great for sleep. While alcohol and THC will help individuals fall asleep faster (in some cases) you end up not reaching the same depth of sleep. The deep sleep component of sleep is where we experience more of our memory solidifying from the day prior.
Have you ever felt incredibly HOT after a large meal? I’m talking about physically sweating and feeling a bit uncomfortable -- usually after eating an entire pizza. I love a great meal, however try to...
As nice as it is to be in a cozy room, it’s not great for staying asleep as we’ll often wake up in a sweat. I am very temperature sensitive and I always love when winter comes around (in California) as my room will be a perfect temperature (mid 60’s) to help keep me asleep for longer.
Americans are only getting 6.25 hours of sleep on average which is a large reduction from what it used to be just two decades ago. In order to function at our highest possible level, 8 hours is recommended.
From an evolutionary standpoint, sleep seems to be very disadvantageous. If we were sleeping back before we had shelter, this made us very susceptible to predators (so sleep could get us eaten). For our species to survive mother nature must have a VERY GOOD reason for keeping sleep as a core portion of our life.
If you want to greatly greatly greatly reduce your risk of Alzheimers, mental illness, and a host of other diseases, START OPTIMIZING YOUR LIFE AROUND SLEEP, not the other way around.
BAD HABITS. We've all got em'. The worst of them all are the ones that cause us to lose an hour or more of sleep! What are some things you do to help you fall asleep faster and sleep deeper?
My poor sleep hygiene is typically tied to me reading my phone IN BED for 30-45 minutes (or scrolling through instagram). I've made a committment to putting my phone outside of my room OR putting it on the other side of the room to prevent me from looking at it while in bed. I've done this in the past and it has worked absolute wonders for me!
The benefit of not looking at your phone screen and reading right before bed is it limits blue light exposure, AND if you're like me and your brain is constantly going, it allows you to wind down vs. gather more information that inadvertently makes you think while trying to fall asleep.
If You Ask These Questions; You'll Find a Great PT
It’s too difficult to find a physical therapist who’s actually good at what they do. I hear this all the time, “i’ve gone to a few physical therapists offices before and it was just the same old stuff over and over again,” or “I was really tired of getting passed off to aides and only being seen by the therapist for 10 to 15 minutes.” This is an unfortunate reality at a lot of PT clinics in the country. Good news for you is that I am going to be going into exactly how to find a great physical therapist near you, and, if you’re not happy with your current provider, how to find a better one.
For those of you strapped for time...
Here is your TL;DR version:
Groups of physical therapists who are great at what they do:
A few qualifiers:
Do you trust the person you are working with or potentially working with? Like with any relationship, the relationship you develop with your physical therapist or rehab professional is incredibly important. If you don’t trust this person, how can you expect the rehab process to be effective? Developing trust is faster for some than others. I’ve worked with clients who come in and we instantly hit it off, immediate trust. For others, it takes a few sessions before that person feels confident in the plan we’ve set forth.
I’ve also worked with people who end up not having as much trust in me and we didn’t have a great outcome. I find that this is likely the single most important aspect of the rehab process, what we rehab professionals call the “therapeutic alliance.” Have we jointly created a therapeutic alliance, a team approach, that will help you reach your goals, and are we on the same page.
I’ve been in clinics where the only thing I hear therapists saying are negative. As a colleague of these individuals, I can tell you, it’s terrible. It’s even worse for the patient as they are then working with someone who is burnt out, apathetic, and not giving 100%. Thankfully i’ve worked at clinics and hospitals where the therapists are the most positive people i’ve ever met and you can see this manifest in the patients lives, too.
When you have an injury or are dealing with severe pain, it’s important that the person you are working with be incredibly positive. While working through pain is not necessarily something we desire to be doing on a daily basis, it becomes a lot easier when you have a positive and uplifting coach working with you to guide you each step of the way.
Keeping up with the research
Do they have a practice of keeping up with the research? This one is a little harder to gauge from a patient perspective because you’re likely not that familiar with physical therapy research. A few questions i’d ask the therapist would be “what are recent continuing education courses you’ve taken,” “what are your favorite research journals to read,” “any recent studies that you found interesting?” You could also ask who some of their favorite researchers are.
These are a few questions I would ask your therapist to see if they truly keep up with the literature. To really be certain, ask a few different therapists the same questions. If you do this, you’ll be able to get a better idea of different practices and commonalities between each PT.
Do they talk straight with you and say “I’m not sure, i’ll get back to you on that?” I’ve found that the absolute best physical therapists that i’ve worked with are comfortable with saying “i’m not sure,” to the patient. Many times, people want to know how long something is going to hurt for, how long it will take to get their shoulder range of motion back, how long before they can start running again, among many other questions. The reality is that we can’t predict a lot of things, especially timelines.
In my experience, the best response to these questions is something along the lines of “i’m not sure and I can’t predict exactly when things will change, however we know based on ‘X’ that most people see a return to ‘Y’ within this date range.” Ranges are much more accurate as each individual will recover at a different rate. And… to some questions, we just don’t know.
High Volume Clinic “PT Mills”
These clinics are called “Therapy Mills.” I can’t tell you how many people come to me and say, “I really didn’t have a good experience at my last physical therapy clinic. I was one of four people that the therapist was seeing and I had no idea what I was supposed to be doing. They just put me in a corner and I stretched while they worked with someone else.”
Personally, I don’t think this should be happening, UNLESS it’s a sports clinic with multiple athletes recouping at the same time who understand what they are supposed to be doing. The most important parts of rehab are the understanding of what you should be doing and then actually doing it. If there are 3 or 4 people being seen an hour by one therapist it’s almost impossible to completely understand why you’re doing what you’re doing, there just isn’t the time to explain to each person and then correct it.
It’s possible you will still get better by going to a clinic like this, however, it really waters down what the rehab process could be in terms of you completely understanding your pain/injury, what the plan is, and how to properly execute it.
Minimal Time with Therapist
Like I said above, if the therapist is seeing >3 patients per hour then it’s likely you’re only going to get 10-15 minutes with them. I usually spend 10 minutes just catching up with the patient to see how they’re doing! Lol.
I’ve worked in clinics like this in the past and it’s too hard to gauge patient progress if you only get a short amount of time with them. If the PT has a physical therapy assistant (PTA) on staff, that’s great. The PTA is also a licensed professional that works in a similar capacity to what a physician assistant (PA) does for a physician.
Each of these team members should be spending adequate time with you, at least 30 minutes so that you have ample time to ask questions and get the work in.
Which brings me to my next point… if you’re only being seen for 10 minutes there is no way that anyone can sufficiently answer your questions. I don’t care what any healthcare provider says, that’s simply not enough time, especially during the initial evaluation and first follow up to help you understand exactly what’s going on.
Largely Passive Treatment Sessions
Ice, heat, massage, dry needling, cupping, scraping, and other modalities can be helpful to reduce some short term symptoms, but if you are getting some rendition of these every single treatment session, particularly at the end, the clinic is probably just doing this to bill for it. That’s a waste of your time and a waste of insurance dollars on something that’s not really needed (in most cases).
Like I said, some of these modalities can be helpful in the short term, but what I see way too often is that people become dependent upon these and start to believe that these are the cure for their pain or injury. It’s not accurate and rehab sessions should be focused on helping you understand the rehab plan and ultimately building self-efficacy, or the ability to cope and learn long term solutions.
Are They Familiar With Treating Your Specific Concern?
This is not the end all be all, but ideally your therapist has at least some experience working with your specific concern. For general pain concerns in major joints such as the shoulder, hip, knee, neck, and mid/lower back, most PT’s have tons of experience with this. When it comes to specific foot injuries, hand injuries, jaw pain, women and men’s health issues, neurological conditions, among others, it is more important to find someone who is comfortable and confident with these. There is a bit more specialization and complexity with that list.
Find a therapist who you:
If you do most of these above you’re going to have a successful experience with your therapist!
What has been your biggest frustration when working with a physical therapist?