We all need help: some more than others, some for a brief period, others a longer stint, for a wide variety of issues. Finding a competent caregiver to help you navigate the slippery slope of healthcare can be tricky. But it’s not impossible, and begins with a bit of self-examination. What are you looking for? What are your needs? What are your preferences and priorities? What are your resources, in terms of time, availability, and finances? For instance, if your highest priority is having someone who can be available for you on short notice then that may be a determining factor in the kind of help you seek. Or if your schedule will never let you make or keep appointments then you may do better with a walk-in kind of situation. If finances are the number one item for you then you will need to work with someone who accepts your insurance or meets your out-of-pocket budget. If locality is important then there is no point in looking at providers out of your area.
Defining your expectations can be very helpful too. If you are looking for alternatives to medications, tests, and surgery then it may not serve you (or the provider) well to consult someone who leans heavily on these interventions. Conversely, if you like these approaches and have a firm mindset that they are what you need, then there is no point in you seeing someone (like me) who is all about offering alternatives and options to these approaches. If you are of the opinion that all you need from physical therapy is a few exercises then you may want to choose a therapist who supports that perspective. You get the idea.
How can you know about a provider? Word of mouth can be very helpful. Ask around, learn what others have done and what they say. Google reviews may also provide insight, but may not be as readily utilized in healthcare as with a restaurant (not saying they shouldn’t be – we encourage them!). If the provider or practice has a website then explore that. While listings of credentials and diagnoses treated can be misleading, you can begin to get some idea of the person/practice. Admittedly it can be hard to know with absolute certainty what you are getting into. But with some research you can at least step into an encounter a bit more educated and prepared. After all, not all providers are created equal. While there will certainly be some similarity between professionals with identical credentials, there can also be drastic differences. Some of it may just come down to personality, and who clicks with you.
There are a dizzying array of approaches to treatment especially of muscles, fascia, and soft tissues: Rolfing, Graston, Instrument Assisted Soft Tissue Mobilization (IASTM), various forms of massage, cupping, foam rolling, acupressure with various balls, exercise, yoga, fascial counter-strain, strain/counter-strain, dry needling, acupuncture, and more. No one technique works for everyone all the time – patient/client or clinician. That’s why it’s good to have multiple tools in the toolbox, or, as I prefer to say, jewels in the jewel box. But most clinicians have an approach that is fundamental: they have found something that seems to work best, and they have focused energy and resources into learning it. I salute anyone clinician who commits and sacrifices to improve their skill set in an effort to provide better care and results. Find an individual who is passionate about what they do and never stops seeking and learning, and you will find a good provider.
For me the approach that is foundational is the Fascial Manipulation-Stecco® Method, or FM. Since graduating physical therapy school in 1984, I have always migrated towards soft tissue techniques. This lead me to learning more about myofascial trigger point treatment, which lead to learning dry needling, which lead to learning FM. There are several aspects to why I have come to utilize FM as the basis of my practice model:
- FM provides a reasonable explanation as to why people present with the problems they do. It has always bugged me why things happen. The body doesn’t just create a pain or a problem for no reason – it’s ALWAYS a response to something somewhere. We like to call things with no apparent cause insidious or idiopathic, as if giving it a sophisticated name suffices. My good friend and colleague, Dr. Adam Van Nortwick, defines idiopathic as, “The idiots haven’t figured out the pathology!” Amen, brother. Shoulder pain that manifests out of the blue for no apparent reason may really be a biomechanical compensation for soft tissue dysfunction surrounding an old wrist fracture. There’s always a reason for what the body does. Whether we want to accept the challenge of sleuthing it out is another issue. It is not easy.
- FM gives a method for approaching the body holistically and globally, incorporating all past and present problems – even if they are remote and seemingly unrelated to the primary complaint. In healthcare we are all taught to perform a medical screening, which is asking about/exploring all the medical problems someone may have. But I never learned why it all matters and how it may play into the primary complaint. I wasn’t taught that an ankle sprain from 20 years ago could be a factor in current knee pain, or even influencing urinary incontinence. FM gives me a method for bringing all the medical history into play for addressing not just active complaints, but past not-fully-resolved problems. Even internal dysfunction such as constipation may have a root in an old knee injury.
- FM works. No method is perfect, and some folks are just tougher to heal than others. But in my years of experience I have not found another approach that even comes close to rivaling this method.
One question I repeatedly encounter is, “Do you know anyone who does this type of treatment (typically we are talking about FM) in Michigan, Ohio, Arizona, etc.?” The motto of the Fascial Manipulation Association, “A Knowledgeable Hand is Potent,” is so true (Figure 12).
Knowledgeable hands do not necessarily go with lots of letters after one’s name, nor do knowledgeable hands always accompany a particular health care field or licensure. To my way of thinking, knowledgeable hands are developed by a person who:
- Uses their hands regularly and frequently for palpation in assessment and treatment
- Is open-minded and seeking, even when it means they need to revise their paradigm, which is very demanding
- Embraces a life-long path of learning
- Is willing to give all they can to each patient, and is also passionate about helping people recover and thrive. At the heart of this is formulating a plausible hypothesis as to why their body is doing what it is.
So I commend anyone who does all this, regardless of their professional silo or which approach(es) they utilize.
Lastly, I’d like to comment on how you might think about your choice of provider, be it a physical therapist (PT) or another professional. Many people reach out for help when they are in trouble – namely in pain. While that is essential and will never be fully alleviated, I am passionate about early intervention and prevention. I believe that many of the problems seen in health care could be prevented or contained if just identified and addressed earlier/differently. Rehabilitation of a total knee replacement is necessary, but I propose that we really should be preventing them. It’s often a matter of timely and appropriate intervention to address biomechanical faults that wear out a joint. These can often be identified through movement assessment and palpation by a skilled provider, who intervenes before the problem becomes painful. This takes us back to where we started with finding a good provider! My future plan is to write more on maintenance and prevention, as well as recognizing issues in children – the heart of early intervention/prevention. For now I’ll point you to my page on Find a Provider, and hope that it offers some assistance. You may notice that there are not a lot of FM providers – some states are completely absent on the listing. This is part of what motivates me to teach FM courses: we need more providers!
Health and Joy to you!