Pursuit Physical Therapy on the Radio! Tune into am 740 The Game

Tune into am 740 The Game from 9am-12 throughout the week, starting labor day weekend, to hear the new Pursuit Physical Therapy radio commercials!  Also, on Fridays, we will have a call in live-talk and ask a question to our very own Dr. Ron Miller about sport injuries, rehab, and prognosis of injuries.  Visit www.thebeatofsports.com or 740 The Game for more information.  For more information about Pursuit Physical Therapy, our specialty programs, and what we can treat, visit us at PursuitTherapy.com

Bad Medicine!.......... for low back pain

Maybe Bon Jovi was right with Bad Medicine!  Does your clinician follow the established guidelines to treat low back pain (LBP) or are you receiving "bad medicine"?  A recent study from the Journal of American Medial Association - Internal Medicine, stated that " Despite numerous published clinical guidelines, management of back pain has relied increasingly on guideline discordant care."  The results of this 2013 showed:

No change in physical therapy referrals

Increase in narcotic usage

Decrease in NSAIDS and tylenol usage

Increase in diagnostic imaging (such as CT scans and MRI)

Increase in physician referrals

Physical therapy and the usage of NSAIDS were considered as GOOD coordination with the LBP guidelines and evidenced based.  Physician referrals, diagnostic imaging, and narcotic usage were considered BAD coordination with the guidelines.  This looks like the health care system is doing everything along the BAD track doesn't it?   So,is your clinician following the guidelines, that have been set by proven and established research, and may lead to better outcome for our patients with LBP or are they following Bad Medicine!   Here is another link to physician guidelines in the clinic regarding the treatment of LBP from the American College of Physician.  At Pursuit Physical Therapy, you never have to question your quality of care.  Your treatment is always what is best for you!  If you have LBP, call Pursuit Physical Therapy at 407-494-8835 or visit our website at www.PursuitTherapy.com for more information about how we can help your LBP.  

Fit Body Boot Camp Orlando and Injury Prevention

Are you a member of Fit Body Boot Camp Orlando?  Fit Body Boot Camp is a new fitness and weight loss training method that is sweeping the nation.  I had the opportunity to attend a training session at the Orlando location, and I love the training style!  This is the perfect workout: high intensity, total body involvement, functional movements, cardiovascular, and overall a short duration (30-45 minutes).  This is the perfect workout to help you lose weight, decrease body fat, and maintain muscle, and you don't have to plan anything!  Just show up and the trainers will take care of the workout.  I thoroughly enjoyed the workout even though my legs were sore for days!  Great job to Kerry and Andrea for opening a great gym, for their community involvement, and for spreading health and fitness throughout Orlando.

Proper biomechanics and flexibility is going to be essential to help prevent injuries from occurring with this type of training.  Just for example when squatting or even with a deep squat, you must have the proper flexibility and strength to complete the task with proper form.  When form and biomechanics become poor, this may increase the risk for injury.






Below is an example of a functional deep squat that you should be able to perform without any compensation.  How many of you can perform this?

This training may also predispose people to getting many overuse injuries such as knee pain, foot pain, and other tendinitis injuries.  Proper stretching, warm-up, and again flexibility will all be essential to help also decrease injury rates.

So what can you do to help prevent injury when training hard to reach your personal goals?  Here are 5 strategies you can do to decrease your chance of injury:

1)  Warm-up prior to high intensity workouts.  A simple 5-10 minute light warm-up should be fine.

2)  Stretch involved muscles.  Such as calves, hamstring, and quad muscle.  Stretching should be done for a 30-90 second hold!  If you do not like to stretch foam rolling is also a great way to reduce trigger points in muscle, increase flexibility, and decrease pain.

3)  Avoid Over Training.  Especially, if you have just started working out.  Slowly progress yourself to 3x a week and continue until you can perform training 4-5x a week.  Weight loss from decreased body fat does not occur over 1-2 sessions.  If it does, it is probably just water weight.  It takes a long time(> weeks) and your are changing your lifestyle so there is no rush to over train.

4)  Be aware of joint pain vs muscle pain.  Muscle pain is OK and this is just something that comes with exercise and training.  FUN FACT:  The muscle soreness the day after the workout is not lactic acid build up.  Lactic acid is removed within hours after your exercise.  The soreness the day after is called DOMS (delayed muscle soreness) and it is caused from muscle damage from exercise with is necessary for your to get stronger.  If you experience joint pain consult your local medical professional, example Pursuit Physical Therapy!, sooner rather than later.  The sooner the better and the more chronic the pain is the longer it takes to get back pain free!

5)  Follow a healthy diet with plenty of sleep.  It is amazing to see how the body feels and heals as you continue to train hard, when you eat healthy vs bad.  Has anyone ever done the same workout multiple times but when you happen to drink alcohol and eat bad after, how much worse and sore you feel the next day?  There is a difference.  Eat as a function of attaining your goals!

I hope these can help you decrease your injury risk and allows you to keep training at Orlando Fit Body Boot Camp!  For more information about Fit Body Boot Camp Orlando visit their website at http://www.fitbodybootcamp.com/fl/orlando-fitness-boot-camp/ and check out their client appreciation night on August 2nd here.  Pursuit Physical Therapy and Dr. Ron Miller will be there to answer any questions regarding proper training techniques, current pain and symptoms, and to perform free functional assessments.

Top 10 Reasons People Should go to Pursuit Physical Therapy: 4. Unmatched Credentials

4.  Unmatched Credentials

Due to the credentials of our specialists, Pursuit Physical Therapy proposes a higher quality of treatment, to each and every patient. Treatment is always received by Doctors of Physical Therapy, and a board certified specialist. Within the practice we accommodate numerous athletic and rehabilitative needs, for instance, our very own Ron Miller, DPT, OCS has advantageously completed a post-doctoral residency in orthopedic physical therapy; moreover, he is Titleist Performance Institute Certified to treat golf-related injuries as well as to provide a full golf-swing analysis. Emphasizing on swing mechanics, posture, proper alignments of the body, as well as follow-through; all ultimately tailored to the individual player to optimize performance and minimize injury.  Call today to get seen by our Board Certified Specialists 407-494-8835 or visit www.PursuitTherapy.com for more information.

Top 10 Reasons People Should Go To Pursuit Physical Therapy: 3) The Patient is Placed First

3)  The patient’s interest and what is truly best for the patient is placed first.

At Pursuit Physical Therapy, the patient never has to question whether their care is being prolonged, or sessions being added simply for profit. Fundamentally, this practice was formed with the intent to place patients first; to give patients the best outcomes as possible, as quick as possible! No one patient is alike, nor will they be treated as so! Bottom line, what is best for the patient’s recovery dictates how many treatment sessions are needed. The “typical recommendation” for physical therapy can be for three sessions per week for four weeks, with no incentive to get you better, faster—Not at Pursuit! Because you are constantly being reassessed throughout each session by your Board Certified specialist, if four sessions is all you need—four sessions is all you will pay for!  Call Pursuit Physical Therapy at 407-494-8835 of visit us at www.PursuitTherapy.com to get more information and get out of pain now!

Do You Suffer from Headaches? Can Physical Therapy Help?

Do you suffer from headaches?  The International Headache Society states there are over 14 different kinds of headaches and there are many causes of headaches.  One type of headache that can be treated by physical therapy is a cervicogenic headache.  A cervicogenic headache is one of the most common types of headaches and account for 15-20% of chronic headaches.    A cervicogenic headache is considered to be a headache with referred pain from a source in the neck that is perceived in one or more areas of the head and face.  This is an example below:

In this is an example of the "X" are active trigger points in a neck muscle (sternocleidomastoid muscle or SCM for short) in the neck and the red is the referred pain patterns that may be associated with this case to the head and facial areas.  It is also very common to see dysfunction is the upper cervical spine that is associated with a cervicogenic headache.  Usually the headache is on one side of the head (unilateral), is increased with neck motions, and can be reproduced with palpation of certain neck muscles.  The referred pain may follow this pathway, which some call it "like a ram horn":

The colors in the above photo show the most common referral areas for a cervicogenic headache.  Research shows that manual therapy in combination with exercise shows the best outcome for a cervicogenic headache and reducing your symptoms.  So this is something that CAN be treated with physical therapy.  Do you have a headache like this?  Are your symptoms similar?  Consult with your physical therapist and see if your have a cervicogenic headache and what interventions are best for you.  Please visit www.pursuittherapy.com or call us at 407-494-8835 for more information.

Can You Tell Me Where Your Low Back Pain is Coming From?

Where is your low back pain (LBP) coming from?  This is an MRI of a 56 year old male with LBP.   Many patients come to me with spine pain and the first this that they tell me is ..... "well I have degenerative disc disease", " I have a herniated disc", "I have a bulging disc", etc.  Usually I come back and say " Well, I have a bulging disc at L5-S1 too and I don't have low back pain."  Their facial expression is usually disturbed and surprised!  This is what my lumbar spine looks like and what a normal spine should look like (as compared to the first picture).

For those that do not know what we are looking at this is an MRI image of a lumbar spine.  The last disc before the sacrum starts is L5-S1 and this is the most common area of LBP.  To the left is the front of the body and the right is the back.  You can see that my L5-S1 does not look the same as the other discs above it and it is not as bright.  So some degeneration is going on there, but it doesn't mean that you have to experience pain.  This may be normal degenertion that occurs from stress to the spine, weightllifting, and from playing sports.  I usually tell my patients that you can take 10 people with LBP, put them in an MRI machine, and their MRI will have positive findings, such as a herniated disc, degenerative disc disease, modic signs, osteoarthritis, etc.  You can then take 10 people WITHOUT LBP, put them in an MRI machine, and their MRI will have the same positive findings!  Research has shown ( from a highly respectable journal and from a high quality study) that these abnormalities seen in MRIs do not strongly correlate the underlying pathology and cause of your LBP.  This means that there are false positives with MRI and with most LBP, you may not need an MRI right away.  This is when you can get started with physical therapy and treatment right away!  Why do you need to see a physician with complaints of LBP and get diagnosed with LBP, and then get referred to a specialist?  Research has shown the cost effectiveness, improved outcomes, and more efficient treatment with the early treatment of LBP with physical therapy services.

In Florida, you have direct access to physical therapy so you can begin you treatment early and there is no need to wait for weeks to begin treatment.  If you do not respond to physical therapy or if you present with red flags, then you can be referred to a spine specialist for more diagnostic testing and possibly warranting an MRI.  Contact Pursuit Physical Therapy today for your LBP and start treatment now!  407-494-8835 or www.pursuittherapy.com.  We also have a Patient Perspective page for information for patients regarding LBP and physical therapy.  Feel free to consult with us regarding your LBP and what is the best treatment for you!  Remember just because you have a herniated disc or a positive MRI finding doesn't mean you have to have LBP.  Even this person was asymptomatic and did not have LBP!  Look how far the spine has slipped forward in the picture below!

Physical Therapy for Acute Low Back Pain? Can This Work?

Lets review this example of low back pain (LBP), that I happened to go through over the past 4 days.  So, for some reason, I decided to go to the gym on Tuesday and perform deadlifts as a part of my workout, which I haven't done since last year.

So later that day, after working at a skilled nursing facility and driving to my other job, I noticed an increase in LBP with strong muscle spasms.  Pain is a good thing (yes, it is very important!) and it tells you that something is wrong.  I always tell patients to "listen to your body", and if you are doing a certain task or position and you have increased pain try to avoid this, stop that activity, or attempt to complete it in a different position.  It is accepted in the research that acute LBP will spontaneously resolve in 4-6 weeks, but who wants to wait that long?   I know what caused my pain and that starting treatment with physical therapy with acute LBP as soon as possible will show better outcomes, decrease unnecessary testing, decrease the cost of healthcare, and I can start my treatment now!    So I was flexion sensitive, meaning I probably injured my low back during the deadlift during a flexion activity, driving also increased my pain (a flexion position again), and I know that prolonged sitting, bending forward, and any lifting would all increased my pain.

 I attempted to avoid these position as best I can, but as I was seeing patients, my work required me to be in some of these positions.  So I began treatment by myself throughout the day ... by doing prone press ups!

Since I was flexion sensitive, I would treat my LBP with repeated extension.  Many people with acute LBP fall into a directional preference and you can treat this with repeated motion with good research to support this.  I would perform at least 1 x 10 of prone press ups every hour to help me get through my day.  When I got home I usually sit in my chair, send some emails, and watch TV with my wife, but I knew that sitting would increase my pain, so I decided to do this.

I watched TV and checked my emails in this position, and by the time I was done I had no LBP!  This remained throughout the night and the next morning, and I was able to do a run/walk the next morning with only some muscle tightness.  I continued throughout my workday to perform at least 1 x 10 prone press ups every hour and was able to get through my day without exacerbating any symptoms.  On the 3rd day, I was able to return to the gym and perform basic strengthening during a light workout.  I could say that on the 3rd day I was pain free with no muscle spasm with no increased pain with flexion activities or prolonged sitting.  I know that this case will not work for every case of LBP, but this is a perfect example with acute LBP how early access and treatment with physical therapy can greatly help your pain and show a great outcome faster than the standard.  Physiopedia is a great online resource regarding physical therapy and LBP.  Pursuit Physical Therapy also has posted free information regarding LBP on their patient perspective page that reviews how LBP with effect their treatment and care.  Don't wait 4-6 months until your acute LBP to resolve, call Pursuit Physical Therapy at 407-494-8835 or visit us at www.pursuittherapy.com and start your treatment today!

Press Release: Grand Opening

Physical Therapy Clinic

Offering Direct Access and Evidenced-Based Care

Opens In Maitland

ORLANDO, FL.--April 16, 2013 Pursuit Physical Therapy is proud to announce the grand opening of their physical therapy clinic at 1000 North Maitland Ave, Maitland, FL.

Pursuit Physical Therapy Clinic wishes to set the new gold standard in physical therapy.  “We will pursue better outcomes, faster results, and a better quality of life for our patients by offering direct access to high quality evidenced-based care from board certified specialists,” explains owner Dr. Ron Miller, DPT, OCS.   The clinic is a cash-based practice and no physician’s script is required to make an appointment.  “By eliminating health insurance limitations and guidelines, patients can receive one-on-one patient care, with no restrictions with your treatment, receiving a better outcome in fewer visits.”

Starting May 6^th, the clinic will be open Monday thru Friday and will offer early morning and evening appointments.  Weekend appointments are also available if needed.   The clinic will specialize in the treatment of neck and low back pain, spinal disorders, sport injuries, manual therapy and golf related injuries.   To make an appointment please call 407-494-8835 and for more information visit www.pursuittherapy.com.

Dr. Miller is credentialed by the American Physical Therapy Association (APTA) as a Board Certified Physical Therapist and certified through the Titleist Performance Institute for golf swing analysis and the treatment of golf related injuries.  Dr. Miller is also an active member of the APTA, Florida Physical Therapy Association (FPTA), American Academy of Orthopaedic Manual Physical Therapist (AAOMPT), and is currently elected to the position of Vice Chair, for the East Central District of the FPTA.

How Much is it Costing You Out of Pocket For Your Physical Therapy?

So we have reviewed why Pursuit Physical Therapy is cash-based, what evidenced based practice is and why it is important for you as a patient, and what is wrong with healthcare.  This post will show you the difference between a cash based practice vs and insurance based practice and how much it will cost you out of pocket.  Below is a table that shows the difference between a standard physical therapy practice and what it entails vs what Pursuit Physical Therapy offers.

Normal Standard Practice	Pursuit Physical Therapy Evidenced-Based Practice
3x  week for 4 weeks 12 sessions	2x a week for 2 weeks 4-6 sessions
No manual therapy	Manual Therapy
10+ exercises	4-6 exercises
60+ minute session	30-60 minutes session
Guided by health insurance	Guided by what the patient needs
Average out of pocket cost $500-1000	Average out of pocket cost $400-500
No incentive to get you better quicker	Incentive based

Many patients feel that they have insurance to cover their physical therapy and they do not want to pay out of pocket for physical therapy services.  So now we will review the difference in cost and an example of how much you pay out of pocket for each physical therapy service.  You think that since you have insurance that it will not cost you much out of pocket, but lets look at an example.   Now, every insurance policy is different, but we will use an example from what the average is that I have seen.  So we will factor in deductible, co-pay, and the miscellaneous bill that is sent to you house 3 months after you have received treatment.  Yes for some reason, with the standard insurance, sometimes they do not cover 100% of physical therapy services and I find more and more patients calling in 3 months after treatment saying that they received a bill from the hospital saying that they owe another couple hundred dollars for their treatment?? I know!

Normal Standard Practice Cost	Pursuit Physical Therapy Cost
3x a week for 4 weeks	4-6 treatment sessions
Average Deductable = $1000-5000	No deductible needed to be met
Co-pay = $20	No co-pay
Miscellaneous bill = $300	Each session =$75-100
12 visits x $20 = $240	6 visits x $100
+ 300
+ deductible ($500)
TOTAL = $1040	TOTAL = $600

So a cash based model turns out to be a cheaper out of pocket expense for the patient after all!  You also receive a much better quality of one-on-one care with a faster outcome.  Is it worth it to pay that much out of pocket at a standard insurance clinic, getting double booked with other patients and need to be seen for 3x a week for 4 weeks???  To me, I would rather pay less and get better faster.   What do you think about a cash based physical therapy service and how much you have to pay out of pocket?

Should I Get Neck Surgery?

A new study shows no different outcomes at 2 years with physical therapy vs neck fusion surgery + physical therapy in patients with a cervical radiculopathy (neck pain with pain that radiates into your arm)!  This means you may not need surgery, and you should consult with your physical therapist prior to contemplating surgery.  Surgery should be your last option and conservative treatments should be exhausted before surgery.  If you have neck pain or pain that radiates into your arm, contact Pursuit Physical Therapy and lets get treatment started to get you out of pain!