I said, so if I were you, I will hold off on the injection and I will hold off on any type of surgical procedure until we can see if conservative management would work. She got tears in her eyes and she said, you just made my day.

Welcome to the PT Rebels Podcast.

This is the place to learn how you can become a PT rebel and take charge of your own health and wellness. We will help you find answers to your questions about pain, injury, and the path towards healing in the most efficient and effective way possible.

I’m your host, Dr. Gina Fick.

On today’s episode, we discuss how you can be the best healthcare advocate for yourself, and we’ll discuss a few stories and highlight the importance of being your own advocate and what that looks like in the medical field. Being an advocate for yourself. It really just means not settling for something then the best, and if you feel like you’re in a physical therapy setting or a healthcare setting, that you are not being heard, that you’re not getting the answers that you want or need, or you feel like you’re getting the runaround. It’s okay to look elsewhere. It’s okay to fire that provider, and it’s not necessarily a failure of that profession. It may be a failure of that provider or that provider system. Most often, it’s a failure of the system. It’s an insurance-based system that’s typically the culprit. And although the provider may be top-notch or very good. That provider may be forced to see 20, 30, 40 patients a day, and they just don’t have the time. They don’t have the time to adequately listen. They don’t have the time to adequately diagnose, and they’re stuck in a model of care that is less than adequate, and thus you’re receiving care that is less than adequate as well. And so you may be, you know, caught in a situation where you’re not receiving the treatment and care that you need simply because you’re not able to get to the bottom of the cause of your symptoms or your pain. You know, through the years I’ve, you know, I’ve, first of all, I’ve been a physical therapist now for almost 25 years, so I’ve had a lot of experiences in the medical system and profession and experiences with patients, and just time to hear and listen to their stories, their stories of triumph, of success, and also stories where the med medical system has failed them. And so today I just wanted to highlight some of those stories of where I think. The care was either reckless or inadequate for that patient and how we were able to help those patients. One of the stories that comes to mind is actually a recent story of a middle-aged female who went to her orthopedic surgeon with hip pain, and she had been experiencing hip pain for. About the last eight months and she went into the orthopedic surgeon. She had, um, been experiencing pain with pickleball and wasn’t able to play pickleball anymore. She didn’t have one specific incident that she had injured her hip with trauma, with a traumatic event. However, she you. Started having gradual increases in hip pain, hip pain on the outside of her hip, some occasional low back discomfort or soreness, and some pain into her, uh, groin area as well. So when she went into the orthopedic doctor, he ordered an MR, I took some x-rays. And never really took her through any testing. No range of motion, no strength testing, no functional testing, and asked her to come back in a few weeks to review the MRI, which she did. When she went back to review the MRI, he told her that she had a torn hip labrum and that she would need surgery to repair that labrum, which would be extensive in terms of the surgery and the rehabilitation process. So. That doctor spent about five minutes or less with her. Again, didn’t assess her functionally, didn’t access, assess her range of motion, and she decided to do some research on her own. She decided to be our own advocate and started looking for answers. And I remember on uh, labor Day, I actually got a phone call and I forgot it was Labor Day ’cause I was kind of doing some work on my own and I took the call and it was her end. She said, I can’t believe you answered the phone on Labor Day. And I laughed. I said, I actually kind of forgot it was Labor Day, but I’m so glad that I was able to get ahold of you. And she said, yeah, I’m really just looking for answers. She said, I went on your website, saw a lot of athletes on the website. Wasn’t sure if this clinic would be a good fit for me or not, but you know, I’m looking for someone who can give me answers and I want, really wanna avoid any type of painful injection or surgery. And I said, well, you called the right place. And I said, I’d really love to meet with you and assess your hip and see what we can do to help you. So a few weeks later she scheduled, I saw her in the clinic. Her, uh, husband came in with her, and we sat and I just listened to our story. And it’s so important for us as providers to have time to listen and to take time to understand where the patient’s coming from. Again, this patient wanted to avoid any type of surgery, painful injection, and she was told by the orthopedic surgeon that this was really her only option and that if she didn’t go through with a surgical option, he wasn’t really sure what else he could do to help her, perhaps this perhaps an injection, but he was pretty certain that the torn labrum was the root cause of her pain and the pain generator and surgery was going to be the only thing that would fix that. And I said, well. Let’s assess your hip. Let’s assess, um, your back. Let’s assess your gait. Let’s assess your function. So after listening to her story, I also looked at her imaging reports and saw that she had a small torn labrum, but she also had some lumbar spine arthritis and degenerative changes. And she also had a injury too. Like the gluteus minimus and gluteus medias tendons, and she had tendinopathy of the gluteus medias. So when you have multiple potential pain generators, what we like to do is figure out where is that pain coming from? Is it all three structures? Is it one structure? Does that structure really need surgical repair? And so we started the assessment process. I watched her walk. It was obvious from the start that she had weakness in both hips, particularly the hip that was hurting. She had what we call Trendelenberg gait where her hip dropped on that side of opposite of the pain actually, and she also had just a lot of apprehension and fear with movement. When I looked at her lumbar spine, she had significant limits in lumbar rotation, she had significant limits with lumbar rotation and extension and pain reproduced in the low back and lateral hip with lumbar extension and rotation to that side. When I did further testing of her hip, passive, and active range of motion, she didn’t have a lot of groin pain with active range of motion flexion or internal rotation that you would normally see with a labral tear. When I took her hip into passive hip flexion and internal rotation, she had a significant limit, but not a lot of pain. However, she did have pain reproduction on her, the outside or lateral part of her hip when I did resistive testing to those muscles that had tendinopathy. So for instance, when I tested. Hip abduction and extra rotation of that hip. It produced her pain. She was also unable to lay on that side. So those symptoms that I was able to provoke through testing started telling me, uh, more of a story about really what was going on. And I, I just looked at her and I said, you know, I think that labral tear was maybe a, uh, just incidental finding. I said that I don’t feel like that is where I. Your primary source of pain and dysfunction is in your hip. And I said, so if I were you, I will hold off on the injection and I will hold off on any type of surgical procedure until we can see if conservative management would work. And she got tears in her eyes and she said, you just made my day. She was about to leave for Arizona for the winter and was really looking forward to and excited about just spending time down there and the thought of surgery just. Was something that she couldn’t really bear to think of and imagine as far as the limitations that that would bring for the rest of the year. So I think one of the take home messages in this is that, you know, because of the model of care that orthopedic surgeons have to function in, in this high volume type setting, you know those surgeons will see 40, 50 patients a day. They don’t have the time, unfortunately. I think a lot of ’em wanna have the time. I know orthopedic surgeons will run behind a couple hours because they just decide they’re gonna take the time to, to spend with the patient. But what happens is that they just end up running an hour or two behind all day long. But in this setting, orthopedic surgeons sometimes only have five minutes with their patients or less. Three to five minutes. And so they’re not taking these patients through testing. They’re just relying upon imaging saying, all right, we found a problem. Here’s a surgical fix for it. We can go ahead and schedule you for surgery. And unfortunately, I think a lot of people have unnecessary surgeries that could have been resolved with conservative physical therapy management. Now on the flip side, I think there are a lot of physical therapists in the same system who also aren’t taking adequate time to diagnose the root cause of patient’s pain, the pain generators, and aren’t adequately treating that because again, they’re in a broken system, a broken model of care with the insurance base system where they just aren’t spending adequate time listening to the patient and doing functional testing, or they don’t have the correct training to be able to identify those pain generators. So in this patient’s case, I told her, I said, I think we need 10 to 12 visits. If you trust me, put your trust in us. I think that we can help you and this is what we’re going to do. And I laid out the plan for her. And you know, we’ve been at this almost 12 visits and now she is able to sleep through the night without pain interruption. She’s has full range of motion in her hip without pain, significant increases in strength in her hip. She knows what she needs to be doing on her own and does that independently in order to continue to gain strength. Her hip is not swollen or painful as it once was, and she’s made fantastic progress and has been able to avoid surgery. I think that is a success story, and it’s also a story of the importance of being your own advocate and not just always trusting what one medical provider has to say. You may not know that the answers and the direction that you need to go, however, you know, start doing start, start going online, start talking to other providers. Call and reach out to providers just to try to get answers. And sometimes that takes some work. But if you’re able to avoid a surgery that could, you know, be a 6, 9, 12 month process of recovery, that is significant and that is worth the time investment of just doing your research before you just trust the provider who tells you that you need surgery to fix a certain, uh, structure That may or may not even be where your source of pain is. I think oftentimes patients come into our office who are confused and are worried and don’t really know what direction to head with the care. We have direct access here in Colorado, which means we can see patients without a physician referral, which is really good if you are a provider who knows how to screen and adequately evaluate patients. And as physical therapists, doctorate level trained physical therapists we’re. Trained extensively in medical screening and trained extensively in how to differentially diagnose certain conditions, musculoskeletal conditions in our patients. So when patients come in and they’re fearful and they have a lot of questions, we actually welcome all of those questions. We welcome communication because a big part of our role at that first visit is not only listening to the patient, but also helping them navigate the healthcare system that they’ve been in and the confusing terms or. Ideas or diagnoses that they’ve been given. And we help them navigate, yes, that’s correct, or No, I don’t really see that. Or, Hey, this is what I see and this is how I can help you. And so I think a commonality that we see in patients who come in who are, you know, confused and concerned about what may be really going on with them is that they just have a lot of questions and don’t feel like they’ve really adequately been heard by their healthcare provider. Whether that’s a physician in our past, you know, physical therapist or other healthcare medical professional. Who maybe didn’t have the time to adequately explain or didn’t take the time to adequately explain what was going on. And I feel like if you have the time and take the time to really listen to patients and also. Get an idea of their background and experiences with the medical profession and with physical therapy, then you can start to gain a therapeutic alliance with that patient so that they have a better understanding of not only what physical therapy is, but this model of care that we’re promoting in our practice. They can start to build more trust in that system and trust that you know, not only that you know how to help them, but that you want to help them. You care deeply about making sure that they have good results with your care. As a story of a lady who I saw at the end of COVID, and she had been in her house for about 18 months and had not left her house, she had become very depressed. Her husband reached out to me as a last resort, and I. Thankfully had a lot of time that day to spend, and I didn’t even really know the situation that I was about to walk in or step into. But I’m so glad that I did, and this lady, again, was really suffering, had a lot of pain, had a long history of pain and confusion, and as far as like what her actual pain in her diagnosis was, and so. The very first thing that I did, I, you know, I drove out to their home. This was when I was doing mobile visits during, at the end of COVID, and I walked into their home and the husband guided me back to his wife’s room. And when I walked into the room, I just knew that I was there at the right time and place for this patient. And she was in a bed. It was like, kind of like a hospital bed. She even had a. Table beside the bed that almost that looked like a hospital bedside table. She had her medications lined up on the table and water, and she had a bed that would elevate like a hospital bed, and that’s where she sat most of the day and very, and really didn’t leave the room very often. And her husband sat across the room and looked extremely concerned and the patient looked very frail and, and I said, you know, tell me your story. I wanna hear your story. She told me a story of chronic pain and she told me a story of failed medical system and failed care throughout the medical system, and a story of unnecessary surgeries, unsuccessful injections, pain management, where the doctor would just throw narcotic pain medications her way and she would take those because that’s the only thing that she knew that would really help her pain. This patient had a unilateral SI joint fusion. That was an effort to try to decrease her back pain. In reality, her back pain was coming from facet joint arthropathy and pain due to arthritis and her facet joints on that side, so she had an unnecessary ciliac joint fusion on the right side. Failed. It didn’t resolve her pain. It actually kind of made her pain worse. So she started seeing pain management and when I saw this patient, she was taking over 10 oxycodone a day. She had lost a significant amount of weight. She was very frail, very thin, could barely walk across her house, which was not a big house. And she was on a pain patch as well, very depressed. Her husband was, you know, he basically said, you know, Gina, you’re our last hope. I feel like. I don’t know what else to do. I don’t know who else to turn to, and if you can’t help us, I’m not sure what we’re going to do. And so I just thought, you know what? It was actually just the perfect day and perfect opportunity to spend. I think I was there for three and a half hours and I charged them, I think for an hour because I felt so compelled, wanna help this patient. And I think at one point we’re all in tears and I said. Thank you so much for trusting me enough to allow me into your home and to hear your story, and thank you for trusting me enough to just speak openly and clear and honest with you. And so I just began to educate her on what chronic pain is. I began to try to develop a trust in a relationship with her, and I saw her, we still see her, but I saw her consistently for over a year. We started out with very simple exercises in the bed, exercises at the edge of the bed. Tried to encourage some movement. I got her a little. Spike that she could do, you know, while she sat in her chair at home. And we started out, I think, riding that for one minute a day and we started just increasing from there. I started encouraging her independence and I said, you know, we have to get off these pain medications. I said, do you trust me enough to help guide you off these pain medications? And she said, yes. And so we worked together and she did all the hard work and, and we worked together. And now she’s not taking any narcotic pain medications. She’s off the pain patch. And fast forward to, gosh, now about two and a half years later, she’s walking. Around the lake, near her house, a mile, a mile a half. You know, several times a week she goes to the rec center in her community and does independent workouts, lifting weights, riding the bike, walking on the treadmill. And it’s a success story because I believe that she was determined enough and placed her trust in me when you really, at that point, I wouldn’t have blamed her if she would’ve given up. She placed her trust in me as a healthcare provider, and she thought, well, let’s, this is my last, you know, last ditch effort here. Let’s see what can happen. And because she was able to get off the pain medications and just start a gradual increase in her movement and strength, and now to the point where again, she’s able to walk independently around this lake by her house, I think that we were effectively able to affect a huge change in her life to the point where I’m not sure. What the, what the outcome would’ve been if I hadn’t have been able to help her and come to her house that day. And it’s not about me, it’s just about the fact that I was in the right place at the right time and I was given an opportunity and I thought, you know what, I, I have to reach out and I have to help this, this lady and this husband, and this family. And you know, it has long lasting implications. You know, she was able to return to a cabin that they had in the mountains for the first time in five years. She was able to start going to her grandson’s baseball games. She was able to spend more time with her husband. She was able to start driving again. So many things, and I’m just so thankful that I was placed there at the right time and place to be able to hear her story that they, that she hadn’t given up, that her husband was an advocate for her as well, and reached out to me and when the medical system was failing, both of them, you know, he reached out to me, found help. Thankfully found the right person that could help. And now it’s a success story and these are the type of stories that we hear all of the time. And I’m just so grateful that I can still, you know, be a physical therapist in this profession and I can affect change and help people, and help, uh, people change their lives and help people, you know, avoid unnecessarily and costly injections and surgeries and pain medications. Because so many times there is a better way. There’s a different road to go down, and if you’re stuck in a situation where you aren’t receiving the medical care that you need, if you aren’t receiving the physical therapy care that you need, fire that provider. It’s not necessarily a failure of the provider. Sometimes it’s a failure of the system, but seek care elsewhere, don’t give up. There are so many great providers and situations out there for you, and we would love to earn your trust and respect as that care provider that can help you navigate a better path forward and a better outcome long term, and help give you answers to your questions about pain so that you can be a advocate for yourself and a PT Rebel essentially, which is what this podcast is all, all about. So that you can live a better life and achieve the answers that you need and recover as quickly and safely as possible and have long-term lasting results.