Medical “Red Flags”: When Symptoms Might Indicate Systemic Illness

One of the best things about the law in Kansas that allows patients to see a physical therapist without a physician referral is that it increases access and increases choice.  Consumers can now come see us “off the street” prior to seeing a medical doctor.  Sometimes though, a patient might present to physical therapy with symptoms that are not indicative of a “physical therapy problem,” meaning one with a musculoskeletal or neuromuscular diagnosis.  Physical therapists are readily equipped to recognize when something is “fishy” and when a referral to a medical doctor is appropriate.  The PT’s at SSOR have recognized these situations a number of times and have referred them on to appropriate providers, so rest assured, you can be confident that you will be evaluated appropriately and funneled to the providers that can help you best. So what are some of these symptoms?

“Red Flag” Symptoms

Unexplained weight loss
Persistent headaches
Pain of unknown origin and onset
Numbness or weakness of unexplained origin – an example of this might be an impending stroke.  Patients will often have facial numbness or have weakness on one side of the body.
Nausea, typically lasting greater than 2 weeks.  A one-day stomach ache isn’t necessarily a “red flag.”
Persistent Fever, Chills, General malaise
Unexplained night pain – pain in a joint is one thing, but if you have a deep, boring intense pain that is not relieved by any position or medication, this is something that should be addressed.
Anyone with neck and trunk pain that has a history of cancer.  Your physical therapist should be immediately suspicious of metastases of the cancer.
Throbbing, Aching or Pulsating pain – might be a vascular condition.
Back pain at the same level of abdominal pain
Pain associated with organ function, like eating or defecation.
Urinary or bowel dysfunction
Dizziness or fainting (“syncope”) spells
Radiating pain in right shoulder (typically), the scapula, or thoracic spine of unknown origin.  The reason for this is that splanchnic nerves, which innervate the visceral organs, share nerve “traffic” with the phrenic nerve, which innervates the diaphragm.   Therefore, any organ problem will be interpreted as having a muscular issue as well.  Think of it this way – the nerve is the interstate and the various nerves that go to muscles and organs are the exits along the way.  Any “accident” at an exit will cause issues throughout the interstate.  Not a great analogy, but hopefully, that makes more sense.
Really the bottom line with this is that the physical therapist should be able to provoke or relieve your pain through the physical therapy examination or you should describe a specific pattern of your pain.  It will be worse/better with certain positions or movements or even time of day.  Unremitting pain that is not made worse or better by anything is a major red flag.
If you have any of these symptoms, you should see a medical physician.  That said, be confident that if you come to SSOR for what you believe to be a back problem and we can’t find anything in our exam that indicates you truly have a musculoskeletal back problem, we’ll refer you on to people that can help.

Physical Therapy for Patellar Dislocations

A common condition we see at SSOR is a dislocated patella, more commonly known as the “kneecap.”  This can be a very painful and debilitating condition, making even otherwise benign activities like walking and bending the knee a struggle.  A recent article in Sports Medicine and Arthroscopy Review showed that management of this condition should be conservative initially, but surgery is indicated in only specific cases.

Relevant Anatomy

The patella sits in a groove on the femur known as the trochlea.  The quadriceps muscles attach to the superior aspect of the patella and attach at the tibial tuberosity via one common attachment, the patellar tendon.  The patella fits in the groove much like a lock and key.  The caveat with this injury is that if the groove is shallow, known as “trochlear dysplasia,” the patella can slip out rather easily compared to people that don’t have the condition.

What causes a patellar dislocation?

Typically, an awkward fall/slip is the mechanism that causes a patellar dislocation.  The quadriceps often contract violently as a protective mechanism which effectively pulls the patella out of the trochlea.

Should I get an X-ray?

After a patellar dislocation, it’s a good idea to see a physician and get an X-ray to see if there is a fracture or other damage that occurred as a result.  In some cases, an MRI is warranted but that will be determined by your physician.

Exercises for Patellar Dislocations

Rehabilitation after patellar dislocations is a complex undertaking.  First of all, we have to get any swelling you have eliminated as much as possible and get your pain under control.  Pain relievers and ice are two common ways to do so in addition to rest.  Bracing can help as well to help with not only pain, but also the fear and apprehension that accompanies this condition.  We often have patients use assistive devices too because it makes walking less painful and guarded.  Many patients, either on their own or from the erroneous instruction of their physicians, are told to get rid of the crutches.  Limping often ensues and further aggravates the knee. We highly recommend using an assistive device until gait is normal.
Once pain is under control and range of motion is improving steadily, we’ll begin strengthening of the quadriceps as well as the gluteals.  The gluteals are a vital part of knee function and ultimately control what happens at the knee because they control the femur.  Think of the gluteals as the “train station,” the femur as the “track,” and the patella as the “train.”  The track is controlled by the station.
The sports physical therapists at SSOR are hands-on – we spend a considerable amount of time doing soft tissue work on our patients.  After this injury, there are many tender muscles and soft tissues that need our attention.  Many times, people are pre-disposed to patellar dislocations because of tight structures on the lateral aspect of the knee.  Therefore, we work on loosening up those structures as well as performing soft tissue techniques on the quadriceps to maximize pain relief and muscle function.
Another area of emphasis is balance and neuromuscular training.  After establishing balance on stable surfaces, we’ll move to more unstable surfaces to help you learn to develop control with different perturbations so your muscles learn to respond quickly to movement that is out of the norm.
Depending on your desired activity level, we have a specific progression for return to running and impact activities.  Once specific tests are passed to indicate physical readiness to begin these activities, we’ll work to get you back to the activities you enjoy.
The staff at SSOR is your first choice for rehabilitation after patellar dislocations.  Our physical therapists are experts in the evaluation and treatment of this injury.  Our staff routinely sees this condition and we assure you that you will see results quickly.  Give us a call at (913) 904-1128, it would be a privilege to serve you.  Remember, you no longer need a physician referral to see a physical therapist in Kansas – don’t delay!

Rehabilitation for Hypermobility of Joints

It’s interesting in physical therapy when we don’t see something for a while, then get a “run” on the same diagnosis.  We’ve had a few people recently that failed therapy elsewhere likely from not being diagnosed properly.   We’ve had some folks come in with widespread hypermobility lately.  These people come in and say that their joints pop a lot or they ache fairly regularly.  For the most part, we tell them that if this “popping” they hear isn’t painful, its likely nothing to worry about. That being said, if we are suspicious of a person having global hypermobility, (which can be associated with popping in your joints) we screen them using the Beighton Scale.  Being hypermobile can be associated with painful joints and poor posture because the ligaments are not able to passively support your joints.  They ache because the muscles are working so hard to stabilize a “loose” joint.  On the flip side, hypermobility can be completely asymptomatic. Hypermobility is defined as the ability of a joint to move more than what is considered a normal range.  In laymen’s terms, being“ double-jointed” is synonymous with hypermobility. Sometimes being hypermobile can be beneficial (for sports that require a great deal of flexibility like gymnastics) but it can also be problematic and potentially can be the culprit (or at least a contributor) for many pathologies.  If you are identified as “hypermobile” it’s a good idea to be proactive and have a good understanding of your condition because being hypermobile puts you at a higher risk for dislocations, subluxations, degenerative joint disease, or nerve compression.

 What is the Beighton Scale?

The Beighton Scale is a screening tool that is used to identify people with widespread hypermobility. It looks at the mobility of 9 different areas in the body. It’s relatively quick and easy to perform and you don’t need any additional equipment.  Keep in mind, this test is not the only determining factor for hypermobility. A person could have hypermobility in different areas of the body such as the neck, hips, shoulders or ankles, which are not accounted for using this scale.

 The Beighton Scale

The Beighton assessment is a measured on 9 point scale. Each joint that is hypermobile of the ones listed below receives 1 point. A person that scores 5 or higher is considered to have widespread hypermobility.

1. Extension of the pinky finger (1 point for each limb)
2. Thumb to the forearm (1 point for each limb)
3. Hyperextension of the elbow (1 point for each limb)
4. Hyperextension of the knee (1 point for each limb)
5. Forward bend (1 point total)

 Physical Therapy and Exercises for Hypermobility

 Hypermobility can’t be treated, per say, but it can be maintained or controlled.  It’s not something that is surgically corrected, unless someone has repeated patellar dislocations for example.  Education about body mechanics and ergonomics can reduce incidence of pain.   Bracing/supportive wrapping or taping can also help provide some extra stability to an otherwise loose area.  It’s also a good idea to get a consult a physical therapist about sports, activities and professions that won’t exacerbate or increase risk of injury.
Again, while there are no treatments that will magically decrease the laxity of your joints, other interventions involving proprioception (which is the ability of your joints to determine how they are positioned and relay that message to the brain) should be incorporated. Additionally, strengthening exercises should be included into an exercise regime to help absorb shock so that your joints aren’t taking the blunt of impact forces.  In a normal joint, the surrounding structures including the ligaments and muscles help support and stabilize the joint. If the ligamentous structures are too lax, the joint can become less stable which can lead to degeneration of the joint surfaces. Thus, to help decrease the impact forces at the joint, strong muscles can help serve as shock absorbers.  For what it’s worth, many people stop exercising because of the pain or achiness in these cases – provided pain isn’t worsening or becoming more debilitating, this is something to try and work through.
Do this quick screen on yourself or a family member and if you find that you are hypermobile, give us a call and we’ll educate you on how to avoid current or future complications associated with hypermobility.  The sports medicine experts at SSOR will give you a comprehensive plan to address your condition.  Remember, you don’t need a physician referral to see a physical therapist in Kansas.
Special thanks to our physical therapy student Mallory Mahoney for writing this guest post!

Top Ten Questions Patients Ask Physical Therapists

We get a ton of questions from our patients about a myriad of things.  We love addressing these because we’re confident we have the best compliment of our clinical acumen coupled with our knowledge of the evidence in the literature.  The internet is a sea of misinformation and unfortunately, many patients’ physicians don’t spend time with them to address all of their questions and concerns.  Therefore, they’re often confused and anxious about why they’re in our office.  That’s why physical therapists are critical health care providers to help patients make informed decisions about their physical health.  In no particular order, here’s the top 10 questions we hear.

1.  Why do I hurt?  This is obviously a complex question because there are many reasons.  There are the physical reasons but there are also many psychosocial ones – stress being one of them.  We do what we can do educate patients about what “good” pain or pain that is not harmful is and what “bad” pain is.
2. Can you help me?  Clearly this is a concern because people don’t want us to waste their time or money.  “Help” is a broad term because help may just be education about posture, ergonomics, and how to minimize pain.  All that said, a competent physical therapist will be honest with you about the extent at which they can provide you what you are looking for.
3. Will I always have pain/always have to deal with this?  Patients want to know if this is something that is transient or if it’s truly something they have to live with.  For example, arthritis is going to happen to most of us as we age.  That said, there are things we can do to minimize the effects of it.
4. What can I do to help this/fix this?  Physical therapy is undeniably a process that the patient has to be involved in.  Most people understand that it is not all on the physical therapist to make them better.  It is definitely a situation where the physical therapist has to give the patient the tools they need to succeed, but ultimately, at 1-3 visits per week at about an hour each session, that is a lot of time outside of the clinic that people can take charge of their condition.
5. Could I have prevented this?   Many patients understand that life happens and there is only so much we can prevent.  However, many may not realize that they don’t have to be sitting in our office right now had they done some things leading up to the injury.  For example, every runner that steps in our doors should have done hip strengthening exercises either prior to starting a training program or do exercises as part of a maintenance program.
6. Is this going to get worse over time?  Many patients fear that once they start hurting, they’re destined to a life of pain and having to avoid doing the things they love.  While every case is unique, it’s rare that the outlook is hopeless.
7. Why didn’t anyone tell me this before?   Maybe it’s because we see so many people here that had often numerous unsuccessful attempts at physical therapy.  Maybe it’s because we have a deep understanding of musculoskeletal conditions and the real reason why you’re in our office.  Regardless, because we explain the “how’s and why’s” so thoroughly, our patients leave our office understanding why they’re here and what has to be done to fix it.
8. Does heat/cold/supplements/creams work?  Boy, there a ton of supplements, herbal remedies, fad treatments, medications, and alternative therapies that people might use to help themselves.  Ads can be deceiving, and as stated previously, the internet is a sea of misinformation.  Even “studies that show X” works are often poorly designed or done by the company selling the product.  We are a great resource to ask these questions.
9. When can I run/golf/go back to work/garden again?  People want to do what they enjoy doing.  They want to know how fast they’ll get back to it (and what they can do to prevent it).  The physical therapists at SSOR are very astute at giving you a prognosis for your return.
10. How much will all this cost me?  The insurance industry is so confusing.  Benefits very greatly and can change over time.  Often, bills come long after the services are provided.  Our approach is to be as up-front as possible about not only how many visits you’ll need but also how much it will roughly cost you.  We don’t want people misleading us, so we don’t do it to others.

Maybe you have many of these same questions.  Give us a call, it would be a privilege to serve you.  We’re proud of our approach and our outcomes.   Allow us to show you the difference at SSOR.

How to Maximize Benefit From Physical Therapy: What YOU Can Do

At SSOR, we’re committed to continual professional development and looking for ways to get better at every aspect of our care.  In our discharge surveys, we ask patients if there is anything we can do to make our service better. One patient suggested that we have a list of what to expect from physical therapy as well as a list of tips to make physical therapy more beneficial.  We’ll do a two-part blog on this.  Here’s a list, in no particular order, of how to make your physical therapy more beneficial.

• Be consistent.  Show for your scheduled appointments.  If your schedule is just too hectic to commit, wait till things settle a bit so you can be “all in.”
• Do your home program as directed by your PT.
• Take our advice with posture/ergonomics and other ways to help maximize pain reduction.
• Be careful with “internet shopping.”  It is a sea of misinformation and “fear mongering.”  Many times, that does more harm than good.
• Be objective.  You might not be 100% better, but recognize when things are trending in the right direction.
• Talk to us! Tell us if something is not working or if you need something.
• Get proper sleep.  Sleep is linked to both pain and recovery.
• Understand that pain doesn’t necessarily mean injury.
• Try not to be obsessed with what MRI’s show.  Many asymptomatic people have positive findings on MRI.  See the previous point.
• Understand progress takes time and it may not get better overnight.
• Have a positive attitude – be careful with negative language.
• Don’t compare yourself to others with similar conditions.  Everyone has different medical histories, different surgical procedures performed by different surgeons, etc.
• Don’t rush through the exercises.  Take your time and use proper technique as instructed by your PT.
• Don’t stop your exercises when formal PT is over.  Participate in a regular maintenance program.

We feel this is a comprehensive list of things you can do to make your physical therapy more beneficial.  We’re sure there are many more, but these are the main ones, without a doubt.  It would be a privilege to serve you – give us a call!

Exercises After Arthroscopic Shoulder Surgery

We see many people here at SSOR that have had or are going to have a shoulder arthroscopy or “scope” to clean out debris or get rid of bone spurs.  People that typically need one have pain with activity, especially overhead activity or when they exercise.  It can be painful and debilitating and reduce a person’s ability to work, play, and function.  After a shoulder scope, people usually do very well if they follow the physical therapist’s restrictions and modify activities until they are appropriate to resume them.  The shoulder rehab specialists at SSOR are here to help you after your surgery.

What do they do in surgery?

Basically, the surgeon uses a an arthroscope (“camera”) to visualize the joint with one hand and then uses various tools to clean up the debris or pain-generating structures in the shoulder.

What about pain?

Ice and pain medication will help you get through those first few days.  Talk to your doctor about pain management.  Studies have shown that ice can not only decrease shoulder temperature, but also be an effective adjunct to pain relief after shoulder surgery.

Rehab after Shoulder Surgery

Usually, physical therapy after a shoulder scope (where nothing was fixed that is, just “cleaned out”) is pretty straightforward.  At SSOR, we’ll measure your other shoulder to establish a standard that we want to get you back to (provided that shoulder isn’t a mess!!).  We’ll talk to you about pain management and activity modification to help facilitate your recovery as well.  As far as rehab exercises after shoulder surgery, here’s what will/should happen:

1.  Range of motion activities begin on your back.  Your physical therapist will assist you with range of motion (ROM) exercises (“passive range of motion”) to help get your motion back and prevent stiffness.  After your passive range is better, we’ll begin active-assisted range of motion exercises where your uninvolved arm will help your involved arm move.  Again, these should start on your back.  The only exception to this rule is an exercise called the “forward bow”, which has been shown to have <10% activity of the rotator cuff.
2. As active assisted ROM improves, begin active ROM on your back.  It is critical that you start AROM on your back because it is in a gravity-minimized position.  In sitting or standing, your shoulder muscles have to resist the forces of gravity pulling your arm downward.  Therefore, raising your arm in sitting or standing can be painful and cause some compensatory actions to occur, which in turn cause more pain and dysfunction.
3. Head to the “beach!”.  After you’re able to raise your arm on your back without pain, try the same activities in a recliner or in a “beach chair” position.  Continue to progress being more upright until you can raise your arm to 90 (parallel with the ground) without your shoulder “hiking.”
4. Once ROM is restored, begin strengthening.  Your physical therapist should guide you through exercises to strengthen your rotator cuff and scapular muscles.
5. Once strength is restored and your doctor has cleared you, begin gradual return to activity. Whether it’s golf, tennis, or just being able to play with your grandkids, your physical therapist should have a progression to safely and effectively get you back.

All of this typically takes place over the course of 4-8 weeks, depending on a number of factors.  It is imperative that you follow your doctor and physical therapist’s prescription because you can definitely make yourself worse.
Give us a call if you are having arthroscopic shoulder surgery and we’ll get you back on track.  Our shoulder rehab specialists are well-versed on the best exercises after shoulder surgery and use effective, hands-on techniques for your to restore range of motion and function to your shoulder.  It would be a privilege to serve you!

Patient Self-Referral/Direct Access

Why This Law is Great News for the Consumer

As of July 1, 2013, a new law was passed in Kansas given the citizens of Kansas the ability to see a physical therapist without a physician referral.  Prior to this, you needed to get authorization from a doctor first.  So, if you are playing basketball over the weekend and sprained your ankle or maybe you have some neck achiness at the end of the work day, you needed to see a doctor first who would then write you a script for physical therapy.  Now, you don’t have to do that.
This new law most importantly improves your access to healthcare and gives you more choices on who you can see.  Imagine if you had to go to the doctor first before you could say, see the dentist or eye doctor.  What if you’re hurting and the doctor can’t get you in for 2 weeks to see him/her and you want some relief of your pain?  With this new law, the consumer is able to choose who they want to see.
Another reason why this law is beneficial to the consumer is that it will likely reduce costs.  Seeing a physical therapist first may save you from unnecessary co-pays at a physician’s office.  Further, MRI’s, surgeries, and medications are expensive.  Many times and for many reasons, people get diagnostic tests or medications that they may not need and in some cases get surgeries that may not help them.  A recent report showed that patients are having more medications and more back surgeries, but the outcomes are worse.  The only consistent benefit for chronic low back pain is physical therapy.  Other recent studies have shown that surgery is no better for than physical therapy for meniscus tears and cervical radiculopathy.  Physical therapy is the more conservative approach.  Additionally, a recent article found that physicians who own MRI machines order these services more often.  This is not to say that surgery can’t help you or shouldn’t be the first choice for you or that all physicians are “crooked” – it just means that in many cases, physical therapy is the less invasive and less costly intervention.  The consumer should have the choice about who they want to see.
Third, the new law enables the consumer to see the musculoskeletal experts – physical therapists – without barriers to treatment. Most physical therapists spend anywhere from 45 minutes to 1 hour evaluating you and educating you about your condition, as well as providing exercises for you.  Physical therapists are graduating with Doctor of Physical Therapy degrees and have approximately 8 years of schooling to do so.  As a result, people leave physical therapy offices with a better understanding of their condition and a solid plan for improvement and reducing pain.
For the skeptics out there, there are built in protections for the consumer.  This new law requires that the physical therapist send the patient back to their physician if there isn’t documented improvement in 10 visits or 15 business days, whichever comes first.  Secondly, there are many states that have had similar versions of this law in place for several years.  If these laws were harming the consumer, laws would be repealed and malpractice insurance would be higher.  Overwhelmingly, this is not the case in the states that have had these laws for years.  Physical therapists are competent medical practitioners who can help people reduce pain and improve function.  Furthermore, physical therapists are trained to recognize when a patient presents with a condition that is not musculoskeletal in nature.  Our job is not to diagnose the condition but to send the patient on to the appropriate provider.
Health care is a collaborative effort between the patient, the physician, and the patient’s physical therapist – this law will not change that at all.  It will simply provide an opportunity for patients to get care from the provider of their choice.  Give the physical therapists at SSOR a call to help you with your needs so we can help you reduce pain and improve function at (913) 904-1128.

10 Things We Wish Doctors Knew About Physical Therapy/Therapists

We’re trying something a little different in this post.  It seems like we have conversations on a daily basis with patients about how some things that physicians say are puzzling about physical therapy, rehabilitation in general, or their condition.  Don’t get us wrong – we love our doctors and they are a critical part of the health care team, but there are some things we hope physicians take note of here, and things we hope informs the patient about physical therapy.

1.  It’s not just a sheet of exercises.  Many times patients tell us that their doctor “gave them some exercises” to do for their condition.  While that may work from time to time and people want “home solutions” nowadays, there is much more to physical therapy than exercises.  We do a thorough physical assessment and manual therapy and mobilizations to help things move smoother and easier. Time and time again, therapeutic exercise, education, manual therapy, and pain management is the tried and true method to get people better.  Physical therapists are experts at that and can significantly help patients lead healthier, happier lives following this treatment plan.
2. PT clinics ARE different – it’s not just who’s closest to work or home.  Like any business, there are different levels of quality.  Some clinics don’t have the “vibe” that people like.  Some clinics have people that have varying degrees of specialty.  Some clinics, well, don’t do such a great job.  Patients should be encouraged to look for a physical therapy clinic that suits their individual needs.  It would really help if physicians took the time to get to know the physical therapists in the area and help the patient make an informed decision, not leave it to front office staff.
3. Modalities don’t do a whole lot.  For some reason, there are many physicians that have grasped on to the idea that physical therapy is all about ultrasound, TENS units, hot/cold packs, and electrical stimulation.  While these things may help at times, the evidence supporting their use is scant at best.  Physical therapy is much more than passive treatments like these.  Sure, they can help someone in pain “take the edge off,” but ultimately they will need manual therapy, exercise, and education to maximize their outcome.  Physical therapy is an “active” process in the end.
4. Limping is not normal.  Many patients walk into our doors limping and say, “Doc said I could get rid of the crutches!”  Unfortunately, that is a really bad idea.  The abnormal walking pattern not only changes the mechanics of walking, but also can delay healing, increase pain, prolong swelling, and delay return of function.  You should use an assistive device of some kind until gait is normalized.
5. Patients need a few visits after any soft tissue or joint surgery.  We’re always surprised how many patients tell us that “doc said I didn’t need therapy after surgery.”  The problem with this is that many people unknowingly compensate after a surgery and this prolongs the healing process, much like in #4 above.  Mark our words – a majority of people end up needing physical therapy more later than if they would have come right away.  3-6 visits becomes 12-15.  That is obviously more time and cost on the patient.
6. Physical therapists are trained to pick up “non-musculoskeletal problems.”  Many patients come to physical therapy complaining of things that are systemic in origin, not musculoskeletal.  Physical therapists are trained to recognize when a patient presents with symptoms that are not compatible with physical therapy and properly send them on to their doctor.  Having a good relationship with a physical therapist helps facilitate this with patients.
7. Many problems patients have are in areas other than where the pain is.  For example, many patients complain of shoulder pain but the problem is really in the neck.  Another example is that many patients have low back pain and the patient gets MRI’s, injections, etc for the back but the problem lies in the hip.  If patients aren’t responding to treatment or if MRI’s are inconclusive, consider sending them on to a PT for a thorough biomechanical assessment to determine the source of the problem.
8. Physical therapy is a better option than injections or pain medications.  Several studies have shown that physical therapy is better for chronic back pain, and for tendinopathies, injections are no better than therapy after 3 months.  We’re obviously a little biased but why not try the cheaper PT before an expensive MRI or try PT before a more invasive injection.  Sure, injections are needed at times to help calm the pain down so the patient can do PT – we have no problem with that.  However, injections aren’t a panacea for everything.
9. We can offer many suggestions about protocols.  We look at protocols regularly and wonder what the heck is going on sometimes!  Either outdated exercises, lack of supporting evidence for exercises, or treatments that are prescribed that are contradictory cloud the treatment plan.  Most physical therapists would invite the opportunity to collaborate with physicians on protocols.  Many protocols are just guidelines to be followed and many physicians leave the door open for the physical therapist to work within restrictions, but there are many things that can be adjusted to protocols to make them more effective.
10. Patients should not take months to see results.  For most conditions, if physical therapy is prescribed right and done effectively, patients should see results quickly.  For more chronic conditions, a great outcome can take time, but there should be positive trends.  If not, #2 on this list may apply.

We hope this list is thought-provoking for patients and physicians alike.  The end goal is obviously a great outcome with as little cost and as least invasive as possible.  Call for an appointment to see how the physical therapists at SSOR can help you achieve your goals.