We all have the patients that are obsessive over their diagnostic imaging findings. They are fearful for you to even evaluate them without reading their MRI reports. Some of the most distressing words we hear as clinicians can be, "have you seen my imaging reports?" Immediately, the patient is at risk for becoming a slow responder due to the presence of perceived threats from the reports. Recently, I had a patient who had an MRI that revealed some disc herniation in her lumbar spine. I tried to educate both the patient's family and another involved health care practitioner on how disc abnormalities can be normal in teenagers and twenty-year-olds as many are asymptomatic with those same problems. No matter what I said, there was a level of fear in that patient's family (likely heightened by the confirmation from the other practitioner) that could not be shaken. Recently, a study came out showing just how common disc bulges can be. Between 70-78% of asymptomatic individuals in their twenties have a disc bulge in their cervical spine. This further increases the evidence of how it is a normal aging process. The fear instilled by imaging can be difficult to treat. It is by far my weakest area as a physical therapist. I used to think it would apply to a small population, but it appears to become ever more important with the progression of pain science. I currently am reading Therapeutic Neuroscience Education and have read Explain Pain in order to develop my methods of educating patients on pain science. What other sorts of resources or methods do you use in this area?
James Heafner PT, DPT, OCS:
Owner and lead physical therapist at Heafner Health, cash-based physical therapy in Boulder, CO. Areas of expertise include orthopedic and manual therapy, functional movement, pain science, and movement science.
In May 2013, I earned my Doctorate in Physical Therapy from Saint Louis University. After graduating from the Harris Health Systems Orthopedic Residency in October 2014, I moved to Boulder, CO. Since living in Boulder, I have started my own cash-based PT practice, earned my OCS certification, and teach for the OPTIM Fellowship and COMT program in Houston TX and Scottsdale, AZ.
Chris Fox PT, DPT, OCS: Physical therapist at Foothills Sports Medicine & Physical Therapy in Scottsdale, AZ and regularly lectures at the Phoenix Campus for NAU's DPT program and for Optim Manual Therapy's COMT program. Completed multiple advanced manual therapy courses implementing aspects of biomechanical analysis. He received his DPT from Saint Louis University in 2013. Completed Scottsdale Healthcare's Orthopaedic Residency (now Honor Health) in July 2014. He became a Board Certified Orthopaedic Specialist in 2015. Level I Expert in FMS and SFMA , Kinetacore FDN Level 1 certification, and IASTM Technique course completion. He would like to pursue further education in McKenzie Technique, Dry Needling, Strength & Conditioning, Orthopaedic and Manual Therapy.
Brian Schwabe PT, DPT, SCS, CSCS:
- Board Certified Sports Physical Therapist (SCS) at Elite OrthoSport in Santa Monica, CA which specializes in treating collegiate/professional athletes and clientele from the Beverly Hills, Hollywood, and Santa Monica areas.
- USC Sports Residency Trained Physical Therapist (<1% of all PT's residency trained)
- DPT from Saint Louis University
- Future plans/interest include:
1. USAW, SFMA & Catapult Systems technology for NBA teams
2. Pursuing a position as a sports physical therapist &/or Strength coach for a Division 1 athletic medicine department or professional sport team.
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