- [Narrator] The region's premier medical information program, "Call the Doctor."

- There's a good chance that you, or someone you know, will at some point, require physical therapy.

Whether that's because of an injury, illness, or surgery, proper physical therapy can help you recover better.

We wanna know what's new in the world of PT.

What to expect, and how to get the best experience out of your physical therapy.

What's new in the world of physical therapy, in this episode of "Call the Doctor."

We are so glad you're with us for this season of "Call the Doctor."

Welcome to this episode.

Let's get right to tonight's panelists.

I like to think it's a pretty diverse crew tonight too.

Go ahead.

We'll start with you.

Go ahead and introduce yourself.

- My name's Joe Gocek.

I'm a physical therapist for Lehigh Valley Health Network.

I graduated from St. Francis University with my Doctorate in physical therapy in 2015.

Since then, I have worked for LVHN, practicing primarily in outpatient orthopedics.

So people with issues of the joints, the hip, knee, ankle, lower back.

And since then I've gained my board certification in orthopedics, as well as becoming certified in the McKenzie Method.

- Great.

We'll talk about that in a little bit, 'cause I'm curious about that.

It's great to have you here.

What about you?

- I'm Jean Bohanan.

I graduated from Russell Sage College many years ago.

- [Julie] Just a few.

- Just a few.

And I live in Mountain Top.

I have worked for Allied Services for 34 years.

I've worked in their brain injury department, as well as their outpatient and I've been in their pediatric program manager for about 28 years now.

- Great.

Welcome.

- Thank you.

- And what about you?

- I'm Steve Kulikowski.

I graduated from Misericordia University with my Masters and Doctorate in physical therapy.

I've been with Allied Services for over 25 years.

I've worked in the inpatient rehab side, outpatient aquatics, and I'm currently in the home health area now.

- Alright, good.

We'll get to that in just a few minutes too.

I wanna start, and I know physical therapy is something that everybody knows what physical therapy is.

But I'm curious, clinically, what are some of the different reasons someone might need it?

Maybe there are reasons that I'm not even thinking of.

What are some of the main, most common reasons that someone might come to see you?

- So, in my setting, the two biggest diagnoses we see are neck pain and lower back pain.

They're chronic conditions typically that people deal with most of their lives.

They come to see me to help resolve that pain and try to get it at bay and get it to go away completely.

- I'll actually give that question to all of you 'cause I have a feeling that your patients are somewhat different.

- Yes, I was gonna say, so I think for me, I see children who may have gone through some trauma or injuries.

Children who are born with birth issues or prematurity.

We also have patients that have suffered brain injuries, people who have been in car accidents, neurologic injuries, strokes, even arthritis can be in children as well as adults.

So there's a lot of diversity to the services we can provide.

- All right.

And who might your typical patient be?

- Typically, we see usually some elderly individuals after an injury, a stroke, maybe a joint replacement, or a fall at home.

They'll typically be recovering from those injuries and coming home from a hospital or a rehab setting.

And then when we get them into the home, we try to get them back to being more mobile and safe in their home environment, figuring out what it is that they need to do to make themselves safe so they could get around and do their everyday tasks in their house.

- I'll actually, I'll jump right into that question because I'm interested in what physical therapy looks like in a setting, an actual hospital, or other clinical setting versus the home.

And you do a lot in the home.

What other things are you looking for in someone's home?

- Well, a lot of times, a patient will leave a hospital or rehab setting and they appear to be doing great.

They'll be walking with a walker, a cane.

And they'll be able to walk on the tile floor of the hospital and everything appears to be great.

When we get them into the house, we find out that everything changes.

Sometimes they have thick carpeting, they may have a lip of a doorway to get into a room that might be more difficult.

Their walker may not fit.

Walker or wheelchair may not fit into a narrow doorway into a bathroom or a bedroom.

They may have furniture that's obstructing their pathways.

So now they have to try to walk sideways and that wasn't what it was like in the hospital.

And now they're struggling to get around.

We find that sometimes stairs could be an issue.

And in a hospital setting, the stairs and the railings are perfectly sized up.

When you get into their house, they may have an older home.

They may have a 12-inch step and the handrail may not go all the way up to that final step.

So we try to find out what it is that their major limitations are and maybe make some minor modifications, minor adjustments to their home, to make it safe so they could stay in their home environment.

- So it's possible somebody can do really well in your setting, and then they can maybe backslide a little bit once they get to their own home.

- Yes.

And a lot of times, it could be just a simple of a $20 grab bar, can make all the difference in the world to keeping this person safe and in their home environment and preventing a very costly and painful fall.

- You mentioned brain injuries, neurological PT.

Which I imagine is a completely different ballgame from other types of PT.

I mean, silly question here, but how many different types are there?

Will most physical therapists know all of those types or other specialties?

- I think there's a combination.

All of us are trained in all areas when we go to school.

But as we expand our continuing education, we tend to go into specialized areas, whether it's orthopedics or pediatrics or neurologic.

So there are clinicians that are specially trained and certified in those different areas.

But basically most therapists have the skillset and the ability to meet those standard needs for most clinicians.

But you can find people who have neuro certifications or ortho certifications, and there are enough patients in this area that there are unfortunately a large bunch of neuro patients that need that specialized care.

So at Allied, we do have a specialized team that only sees neuro patients.

We have a specialized team that also sees patients such as have vestibular problems because it's such a defined area and there's such a special training for those things, we offer those services.

- So it's worth a little research if you're told that you need physical therapy to find out some of the different types there might be out there.

- Finding the best match.

There's therapists out there that have done, worked on special knees injuries and work with certain protocols.

So finding that therapist that matches your injury and what you need is really a great idea.

- Can physical therapy, this is a strange question, I guess I'll give it to you.

Can it, you're like, "Thanks a lot!"

Does it fix things or does it just help someone be able to better manage whatever it is that they are dealing with?

Do you see what I'm getting at there?

- Yeah, absolutely.

I think it's a combination of both.

There's definitely some things that we can fix, and get people 100% back to their condition beforehand.

However, there's some things that are gonna be more of a chronic issue that people deal with throughout the entirety of their life.

And we have skills that teach them to manage that appropriately and help guide them kind of through the rest of their life so they can live it in as good of a shape as they are able to.

- Is there a typical amount of time you might see a patient, or is that all over the map?

- It varies quite widely.

For some patients, I may only see them for one or two visits to develop a home program and get them set up where they're comfortable and can do it on their own.

Some people with some more traumatic injuries, I may see three, four months, or even longer, depending on the severity of their injury.

- In a situation like someone who's had a knee replacement or a hip replacement, how would you handle something like that?

Is that a different course?

- That's actually a very standard protocol.

That's probably one of the most common diagnoses that we see in the clinic.

Standard length of stay in the outpatient physical therapy clinic after a knee or hip replacement is somewhere one to two months, sometimes a little longer, but I'd generally say one to two months of physical therapy.

- What can't it do, Jean?

I mean, I understand that physical therapy can do a lot for you.

But is there a point that which you would be, with the patient thinking, "I think this person needs the next step."

What might that next step be?

- So there are some different things in children, as well as adults, where sometimes we reach a point where maybe for a neurologic injury they may have some spasticity where the joint has gotten contracted and there's range of motion limitations.

So we can stretch and we can exercise to a point, but sometimes we need other interventions, whether that may mean medication or surgical interventions to gain that mobility that I can't get through manual procedures and exercise.

So sometimes we need to pass those patients on to more of an orthopedic surgeon or a neurologist to address some of those things.

There's some medications out there, Botox injections, and other things that can really help with spasticity.

Same thing if someone has severe arthritis, we can help rehab that knee to a point, but if the pain continues and even with strengthening, they're not getting the relief and pain is limiting their ability to move, then they may need a joint replacement.

So, we try to do conservative measures first.

Strengthen and balance a musculature, as well as work on the range of motion.

But there may be that point where the damage is so great that they need to take that to the next step.

- And that would be something that a physical therapist, as part of that team could say, "I think this is necessary," whatever the case might be.

- [Jean] Mm hmm.

- I wanted to talk a little bit about aquatics.

I believe that was something that you have some experience in.

Why is the pool such a great place to be for physical therapy?

- Well, it's the warm water environment.

Typically the water is about 94 degrees, so it's nice and soothing on and relaxing on muscles.

The other big benefit is it takes a lot of the pressure off the joints.

When we get into water that's about chest level, it can take almost 75% of the weight off of our knees and back and hips.

So people will have greater freedom of movement.

They're able to move a lot easier and with movement and with the warm water, helps to loosen up the joints.

They're able to exercise, build up their strength, and then hopefully that'll translate to better outcomes and better mobility on the land surfaces as well.

- Anecdotally, what have you seen, or heard from patients who've done aquatic therapy?

- We've had people actually in tears when they actually get in the water, that they're actually in some pain relief for the first time in years.

And it's a natural pain relief.

It's not heavily doses of medications.

They're actually able to move, and they're actually sometimes brought to tears that they actually feel that good.

They really can't believe that they're finally having some pain relief.

And they can really start to gain some strength and mobility back again.

- Something that I would imagine they can do for a very long time, with swimming.

Very low impact.

- Yes.

Yeah, it's great, it's a nice low impact.

You can get a great aerobic workout in a pool environment without beating up your joints.

Especially for some of those folks that maybe aren't a candidate.

They have bad arthritis, but there are a lot of individuals that for other health reasons, aren't a candidate for surgery.

So we're trying to find something else that can at least make some improvement on their quality of life.

And the pool can definitely be that area.

- Is physical therapy changing, Jean?

Do you think in how either it's viewed in the medical world, or how physical therapists go about their job?

Has anything changed?

Or I should say what has changed since you first started?

- Yes, I think there's been a lot of change.

And I think technology has played a huge role in our profession, and is now coming into our profession more.

We are now having the opportunity to use robotic devices for gait training.

So we own the Trexo robotic gait training system for children, which actually has an iPad and six computers.

So I can program the child's gait into the system and drop the child in and they can work on overground mobility, whether it's with resistance or with assistance.

Years ago I would have to have two therapists helping hold the child up.

I would be behind them trying to advance their legs on the floor.

And I would think their gait looked a little bit better or maybe their steps looked a little bit better, but it was all my interpretation.

Now with the computer systems and the iPads and the technology, I can actually measure how much strength the child's gaining.

I can measure their stride length.

I can show to the parent and the child the gains that they're making and I can show the insurance companies the changes that we're getting.

And it gives the child the opportunity to have freedom and independence away from me.

So they're actually standing in a device and they can initiate movement on their own.

And for a child who's in a wheelchair most of their day, to be able to stand up on their own and not have someone holding them, is such a gift.

And the motivation to learn more, for the child, is just so present and amazing.

So it's been a huge changes, the robotics and the technology, that's come along in our profession.

- I can see how excited you are about that.

- [Jean] Yeah.

- But this job used to be a fairly difficult one that way.

I can imagine in hearing you describe what that must have been like, to have to have to walk someone around.

- And the child's progress was limited by my own physical abilities.

So my limitations of being able to sustain that activity was limiting how much I could progress the child.

So now, I can step back, and let the robotics system do what I couldn't do.

- You were gonna say something?

I thought I saw you - - No, no, no.

- I thought you were jumping in.

- No, the technology has definitely changed the way we do things.

And also just the way we get reimbursed for what we do.

It's harder and harder to get more therapy visits for all patients.

And anything that we can do to prove why we're doing what we're doing and why we're giving someone benefit is a great thing.

- Why is it getting harder?

- Just insurance limitations.

Unfortunately, everything is cut back.

There's just limitations with everything.

People used to be in a hospital for sometimes five to 10, 15 days after a joint replacement.

Very often they're going home the same day, or the next day, after a knee or hip replacement.

So, we are seeing people in a home setting and in outpatient settings much sooner than we ever did before.

- Is that a good thing for you?

- There's a lot more to consider.

There's potentially a lot more issues that could arise fresh out of surgery.

So there's still potentially feeling the effects of the anesthesia, adjustments to medications, adjustments to their pain medications, having a lot of pain and not knowing what to do.

When they're in the hospital setting they hit the buzzer and they're asking for the nurse.

And they have people right there.

When you're in the home environment, you maybe have a spouse or you may be home alone, and that could be a very scary thing when you don't even know if you're able to get up out of your own bed or off your own recliner to get your own, go to the bathroom, or get yourself a drink.

- Go ahead.

- I think the opportunity with some of the new systems that we have is the ability to capture data in a more accurate way.

Patients feel better, patients can tell us they're feeling better, but the insurance companies in that need to see more concrete documentation that we're actually making a change.

Not just, oh, it's fun to hang out with a therapist.

So it's good that we can have that documentation and also to share between clinicians.

So if someone else is picking up my patient, they can see the data and the way I've had things set up so we can be consistent in our care, which comes for better outcomes for our patients overall.

- Joe, I guess I'll ask you.

We'll kind of take it back a little bit to the beginning.

If you see a new patient or someone new who hasn't seen you yet, where do you start?

If people haven't needed physical therapy yet, what can they expect?

- Yeah, so the first step is the initial evaluation.

At least in the orthopedic setting.

And across most settings.

And that's where I'm really gonna get to know you.

It's our chance to talk and discuss your past, learn about your medical history, the condition that you're seeing me for.

And I'm gonna gather a lot of different data that's gonna steer me in the direction that's gonna help me to provide the best treatment for you.

- Could you gimme an example?

I mean, obviously not a specific one.

- Yeah, for sure.

So if someone comes to me with chronic back pain, I'm gonna start, I'm gonna learn how long have they actually been dealing with the back pain.

What was the nature of the injury?

Or did it come on without any specific incident?

Then I'm gonna try to learn more about the pain.

Is it constant?

Does it vary at times?

A more descriptive, learn about the description of the pain and kind of go really in-depth and learn a lot about their presentation, so then I can find what is actually the right way to treat this patient.

- How do you help a patient through, I imagine there's some sort of home portion of the work that you're giving them.

You can do this work with me, but here's what you can do at home to help yourself.

Can you talk a little bit about that and can you tell if someone is really invested?

- Oh, I can really tell if someone's invested in.

And that's something I preach to most of my patients, is I'm not gonna flick a magic light switch and make them better when they come into the clinic.

I'm gonna give them the tools and the knowledge that empowers them to treat themselves and get themselves better and give them that confidence that they can really help themselves and that the pain that they're dealing with isn't gonna be a burden for them for the rest of their lives.

- And what about you?

What might a patient see, or expect, if they are new to you?

- So some of it will depend on their age.

I do see a lot of infants coming in.

So it's mostly the parent's expectations when they come in to see me.

And they do receive a full evaluation.

Get medical history and what the priorities and the goals are.

So, every parent has concerns.

And it's focusing on what the primary issue is for them.

And we do, I call it their exercise prescription, or exercise dose.

So they're sent home with activities that they're to do and sometimes kids need charts to guide them.

We've been doing a lot more of YouTube videos.

And they will send me their Snapchats of their exercises.

So technology's been helpful from that standpoint to motivate the kids to do their part.

But it's figuring out, for children, they're not gonna do something 'cause they don't see the benefit of it.

Adults, you can explain why they're doing it, children, not so much.

So it has to be something fun and engaging.

So it's setting up activities that parents can play with the children on a daily basis to encourage those kind of habits and activities we want them to do.

- All the research I did talking about what's new and I did not think about my cell phone and TikTok as a way to get through.

But I suppose that's a large part of what you're doing if you have someone of that age.

- Yeah.

- And they respond to that?

- Yes.

And that's their, for me, I am a, it's a foreign language to me.

For them, it's their native language, it's what they're growing up with.

So I have to step in and join and they teach me a lot.

- And what about you?

If someone is coming to you, how does that work in your case?

- Well, I actually go to them.

So I'll be in their home.

- Okay.

- But yeah, we'll be in their house, and we'll do a walk through of their whole house.

Try to find out what is it that you need to do.

So we'll walk into their bedroom.

Up and down, off the bed, and into the bathroom, off the commode, maybe walking down the stairs, if they have stairs down to a basement where their laundry is done, or upstairs to possibly to their bedroom.

Maybe the front steps if they're, to get in and out of their home.

So we're just kind of saying, "What do you need to do here?"

And show me how you do things and let's see if there's anything that possibly I could show you a safer way to do it, or an easier way to do it.

So you can get around your house safely and you can stay in your own home.

So many people wanna stay in their own home.

They don't wanna have to go to a personal care setting or have a family member live with them.

So we can try to hopefully help them keep in their own home.

- And what you said a few minutes ago was actually really eye-opening about, say, someone who is an older person.

You wouldn't think, it's not a fall per se, but if you get even a stomach bug and you're in bed for a couple of days, I mean, I don't wanna put words in your mouth, but could describe a - - You know, I try to tell people, the stronger we are, the easier it is to recover from anything that's gonna come down the road for any one of us.

Whether it's the stomach virus, a cold, the flu, anything and everything.

A slip and a fall and a sprained ankle.

If we're in better shape, we have a better chance to get back to what our normal activity is.

If we let ourselves go at any age, it's harder to get back.

We all know ourselves.

If we don't go to the gym often, when we finally get back to the gym, it's a lot harder.

If you're not active, it's a lot harder to get back into that activity again.

If you can stay active, it can mean the world of difference and especially when we're talking about an elderly individual.

If they lose 20% of their strength, they may not be able to walk.

And if they're only able to walk 50 feet right now, if they lose 20% of their strength, they may not be able to simply get from one room to the other in their house.

- [Julie] Hmm.

- And that's where they may need to have a hired caregiver, or possibly go to an assisted living facility.

And that's life changing.

So we, hopefully, try to prevent those things from happening.

- I wanna talk a little bit about the McKenzie Method you mentioned earlier?

I can't even read my own scribbles here.

But talk a little bit about that and maybe some other methods that you have learned, a little bit more about what people can expect.

- Yeah, so with the McKenzie Method, that focuses primarily on the use of repeated motions to treat neck, back pain and a number of other joint issues.

And it's a really easy way to empower the patient to help them kind of treat themselves.

That's something the McKenzie Method treats or preaches, is that the therapist will help you find what's the right motion for you, what do you need to do, and then we help get you moving in that direction.

- What are some of the other, I don't wanna say methods, but what else might you deploy?

- Yeah, so depending on the patient, there's times we're gonna use manual therapy, where we actually use hands-on techniques to mobilize the joint, or loosen some tissue that may be really kind of tight or restricted.

There's a number of modalities we can use to help patients ease their pain.

As well as just education and teaching the patients why do they have the pain that they have, and what can help them in return.

- And Jean, I know there's been a lot going on in robotics.

You mentioned that one particular piece of equipment that you use with pediatrics, but what else do you have to work with?

- So Allied has made a significant investment into robotic gait training devices.

So we have the Trexo in the pediatrics and there is an exoskeleton that they use in adults.

And we also have an AlterG, which is a treadmill that has a pressure support system that can unweight the patient.

So a patient who's newly knee surgery that may be having trouble with strength, being able to have a gait, a difficult gait pattern or limping when they're walking, we can unload that limb enough to get a smoother gait pattern and have them walk in a better pattern to relearn so they're not learning how to walk with a walker limping, and then we take the walker away and now we have to unlearn the limp and relearn how to walk.

So we can go right into teaching them a proper healthy gait pattern right from the start.

And we can unload and reload the limb as we need to to compensate as their strength changes.

So we have a lot of tools available to us.

There's also a nice video and feedback system in the AlterG, so the patient can actually see their progress, see their stride lengths, see how they're putting more weight on one foot than the other.

So there's a nice biofeedback where they can learn how to walk again in a healthy pattern.

- So you can actually learn some bad habits in physical therapy if you're not careful.

And then - - [Jean] Yeah.

- Have to unlearn them before you relearn the next step.

- Yeah.

- [Julie] That seems pretty counterintuitive.

Yes.

- Yeah, yeah.

So you have knee surgery and it's painful so you hold your knee stiff.

And so then you learn to walk with a stiff knee or you're not allowed to put all your weight on that leg.

So you're kind of hopping on one side for a while until you can put the other one down.

The surgeon says it's okay.

So now you've kind of changed how you walk, and your body forgets.

So we need to kind of retrain and get back into that healthy gait pattern.

- And you develop back pain and then you need to see again.

- And then you have to go to Joe.

(all laugh) For neck and back pain, would you say that's the most common?

I mean, you said that's what you see most of.

Is that common for you as well?

- I would think almost everyone has experienced back pain at some point in their life.

And when you have back pain, it could affect everything, from reaching for the remote control to lifting up a pot of pasta, to walking up and down the stairs, to tying your shoes.

So back pain is something that can affect anybody and everybody and it could be extremely limiting of a lifestyle.

- And I think about someone with arthritis.

That's never gonna go away.

So do you see people for their entire lives?

Is there a point where physical therapy says, "Okay, we have taught you everything you need to know, or everything that you can do on your own?"

Do you see people for a lifetime?

- I wouldn't say for a lifetime, but we check in with them throughout their lifetime.

There's a lot of times when conditions flare up that we're gonna come check in and say, "Hey, we know you've been dealing with this back pain for a while, where are you at?

What can we do to help you at this point in your life?"

And then they may be good with their exercises for three months, three years, who knows how long?

But they may need to check back in with us when it flares up, 'cause some of these chronic conditions like that, have the unfortunate side of them where they will flare back up at times.

And we're there for those times when they're in need and need to figure out what's right for them at that time.

Because it may vary from when they were having back pain when they were young, to as they get older, and they have more arthritis and those kind of things.

- Have any of you been in physical therapy?

Have you needed physical therapy?

- I did when I was actually in high school.

I had a back injury, so I did receive physical therapy.

And that kind of made me start to think about this profession.

So yes.

- I wondered if it informed anything that you ended up doing.

- I think that's a pretty common thing with a lot of clinicians you see out there.

They had done therapy in the past, and they realize what a great field it is and it makes 'em wanna shift that way for their career.

- [Julie] Just curious, total curiosity.

- Yeah.

Yeah.

I think the other thing, going back to your question, I think we tend to do, what I call "episodic care."

So our care is over a lifespan, as you can see.

I'm working in pediatrics, middle-aged, elderly.

There are periods in our lives where there are changes that we require therapy intervention and it can be helpful.

So even some of my patients, I may see them, that had CP or had a traumatic brain injury when they're teenagers.

They may come back when they're in college because they're having pain because of having to walk longer distances, or I have not been around long enough that now I have patients that are coming back, that they're having their own children.

So after delivery, your body changes, and things are different.

- [Julie] Sure.

- So they may need therapy to kind of retool and address some of the issues that may develop with those different body changes that occur in our lifetime.

- All right.

Well, thank you, to all of you.

I told you it was gonna go fast and it did go fast.

That's all we have for this episode of "Call the Doctor."

Thanks for joining us, and we'll see you next time.

(gentle music)