Welcome to another edition of the Doctor’s Note where we talk about what’s on our minds when it comes to your health.
Recently I met a couple of what I would call “common sense” physical therapists who decided in their late twenties to open up a cash only PT practice called Tri-Star Strength and Rehab. Meet Josh Davis PT, DPT, CSCS and Zach Jackson PT, DPT, CSCS, two guys who are both physical therapists AND certified strength coaches with a deep passion for helping people stay strong and healthy as they age.
I liked the concept of their practice so much, I decided to not only have them on the COMMON SENSE MD podcast, but also have them create a personal strength program that would help me work through an injured back. Thus, the title of this Note: Injury Rehabilitation Through Exercise.
Training is Rehab
During the CS podcast, Josh said, “Rehab is training and training is rehab”. I completely agree! Rehab and training are interchangeable, or at least they should be. I talk a lot about the importance of being active, especially if your aim is to age well. With that said, it’s really difficult to be active and not get hurt as you get older.
I went through this for years with my shoulder. I was probably lifting too heavy or with poor form and ended up injuring my shoulder. Even a simple push up was painful. What did I do? I stopped doing push ups! That’s what I am talking about today. When you get hurt, the tendency is to STOP exercising. But that’s not always what you should do. What I’ve learned is that by using strength training to work through an injury you are actually helping the injury get better.
Full Range of Motion Strength Training
Recently I’ve been fascinated with the Knees Over Toes Guy. I love his videos on YouTube (Ben Patrick: The Kneesovertoesguy). What he teaches is counterintuitive to what I have always been taught, which is that you should never put your knees over your toes when you squat. But that isn’t accurate, according to the Knees Over Toes Guy. You should be able to do a squat with your knees over your toes, because it encourages full range of motion of the knee joint.
When I talked about this with Zach and Josh they gave me some great insight around how they go about helping people get full range of motion. They said that full range of motion isn’t always the main thing that you’re trying to target. The end goal should be full range of motion within your tissue tolerance. I love this.
Note: Try standing up with your shin vertical. It isn’t going to work.
Squats and Deadlifts
In my opinion the bench, squat, and deadlift are really important exercises as you age. You get those down and then go from there. The problem is that when you get older you get scared to do any of those exercises. I’m probably like a lot of you. I just want to have less pain and be more mobile. I’m not going after size when it comes to lifting weights.
The truth is we should be doing squats and deadlifts for as long as we can! Think about all the things you want to be able to do as you get older. You want to be able to pick up your grandkids and be able to play with them. You want to be able to pick up groceries and put them up. The point is the squat and deadlift are very functional movements. They don’t need to be demonized.
Think of squats and deadlifts as full range of motion strength training. Zach and Josh say you want to break the movements down into motion. With a deadlift, you first want the hip hinge (where your hips go back first and your knees slightly bend). You can work through a deadlift in sequences. You can start lifting a bar off of a box, and then slowly work your way to lifting weight all the way from the ground. You can progress to full range of motion.
Note: It’s simple positioning, cueing, and knowing what the movement looks like.
I asked them about what they think is the most important exercise. They said both the deadlift and the squat. You’re going to be doing these movements for the rest of your life, hopefully.
These are the two most important, and yet they are the two most demonized within the medical community.
Cash Only Physical Therapists
Going cash only made me a better doctor. My patients are motivated because they made the choice to invest in my knowledge and care. Zach and Josh left the traditional PT setting and went cash only out of frustration similar to mine, the insurance game.
What happens in an insurance setting is that you have to do things in a way that satisfies the requirements to get reimbursed by a “third party” payer (insurance). Often the things you have to do have NOTHING to do with what will actually help the patient. This is the problem. It takes away from the care that patients deserve.
In a cash only setting you’re working for the patient instead of the insurance company. When you have to use a diagnosis code, you end up revolving the treatment around that diagnosis code. The cash only approach is individualized. The aim is to figure out why the injury happened and focus on how to prevent it in the future. The goal is to make you better than you were before the injury. It’s about finding the root cause of the problem and spending time with the patient.
In my opinion, going to a cash only medical practice or physical therapy practice is a step towards taking control of your own healthcare. You have more time with the provider, and their only focus is YOU, not a code. I’m really on the same page as Zach and Josh. They have to be better than they average PT and have to be more forward thinking. I’m proud of these guys.
Out of the five mantras of my anti aging practice: NUTRITION; EXERCISE; STRESS MANAGEMENT; and HORMONES, EXERCISE is by far the most important one as you age. It’s not even close. You have to exercise to stay healthy.
If you don’t move, you’re going to deteriorate. Walking is NOT enough, you have to BUILD MUSCLE. Watch my YouTube video with Josh and Zach and you will see how they personalize a strength/rehab program that works, even through injury!