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.
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?
Get out there and MOVE.
If you look up all the national and international guidelines for management of osteoarthritis, the first thing is EXERCISE.
That is all. Have a great day!
Many Many Many people have a meniscal tear and don’t even know about it.
Similarly, many people who have knee pain, who receive an MRI often find out they have a meniscal tear.
In the USA we perform TONS of unnecessary meniscectomies (removal of portions of the meniscus) and I’ve seen way too many botched meniscetomies to ever recommend this, UNLESS there is mechanical locking of the knee which is not spending to non operative management.
There have been a few great research studies now documenting how surgery vs. sham surgery (fake surgery) have the same outcomes when it comes to menisectomies.
I’d highly recommend the clinicalathlete podcast, particularly he episode which talks about meniscal tears and surgery outcomes.
What are your thoughts? Ever had a meniscectomy?
There is a lot of fear which surrounds back pain.
Much of this is likely due to societal norms and the acceptance of false narratives pertaining to lower back pain.
If we know that 95%+ of lower back pain is not dangerous, then why do we have such a large swath of the population suffering with chronic lower back pain issues?
This is not to say that there are not some genetic predispositions for developing lower back pain, however how much CONTRIBUTION is biological vs. environmental?
Some of you reading this might be dealing with chronic issues and what I am not saying is that it’s all in your head, or, that you should just suck it up and get better.
Chronic pain is incredibly challenging to deal with and the best thing we know to do with this is to focus on meaningful activities, improve sleep patterns, manage stress, improve exercise habits, and potentially pharmacological management in more challenging cases.
What are your thoughts on this, anything to add?
If you’ve been following me for a while you’ll know what my position is on back pain and surgery.
It’s not that surgery is never an option, in fact, it can be very helpful for some individuals with specific symptoms that are not getting better with conservative management.
My problem with our current system is that people are still rushed into getting an X-ray or MRI when it is not indicated.
Patients, you also have a role to play in this as I’ve met MANY who demand they absolutely need an MRI to “find out the root cause.”
It’s not that simple and often may lead to worse outcomes if you get the imaging early due to various beliefs that may come out of receiving this imaging.
What questions do you have for me? Anything I missed?
These are a bit more advanced and if you're having a lot of shoulder pain, these probably aren't the place to start.
These are great as a warm up or finisher type movement.
Have you ever done these? Do you have another type of plyo that you like to do?
Leave a comment and let me know!
There is tons of misinformation out there about back pain. It seems that no matter how much good information that is put out, we need an order of magnitude much greater to fight the BS. Our lumbar spine is actually quite durable. Lower back pain is very common and something that can be treated conservatively and non-operatively in most cases. These infographics synthesize the information written in "Should You Fear Lumbar Flexion," by Dr. Sam Spinelli, PT and posted on the site strongerbyscience.com and "Revisiting The Spinal Flexion Debate: Prepare For Doubt" by Greg Lehman, BKIN, MSC, DC, MSCPT.
Another relevant article by Greg Lehman is "Reconciling Spinal Flexion And Pain: We Are All Doomed For Failure But Perhaps It Doesn't Matter."
Rotator cuff tear?
What do you all of these things have in common? They can typically be treated non-operatively. In another blog post physical-therapy-its-much-more-than-exercise-and-massage-santa-cruz-ca.html, I wrote about what physical therapy is, and, I added a portion which talked about how rotator cuff tears can respond really well to non-operative management. Like, really well!!