Since You Put It That Way
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Since You Put It That Way
Physical Therapy: What You Should Know
In this episode, Dr. Louder talks with Megan Pass, PT, DPT about the fundamentals of physical therapy and what you as a patient should know about the efficacy of different approaches to physical therapy and how you can choose the best physical therapist for you. In their conversation, they mention not only recovery from injury, whether chronic or acute, and recovery from surgery, but also injury prevention so you never need to have surgery. Finally, they take a mind-body approach to the discussion, touching on the helpfulness of an understanding of the nervous system and how physical therapists can facilitate the best mental and emotional state for positive outcomes. Listen in for the details!
Intro for "Since you put it that way" podcast.
Outro for "Since you put it that way" podcast
Hello, thank you for joining us on Since You Put It That Way. Our guest today is Dr. Megan Pass. She is a physical therapist, a doctorate in Physical Therapy from Duke University; her undergraduate's from Michigan State University here in Michigan. And she practices here in West Michigan over here by me in Holland, Michigan, and she's going to be with us for a series, or I would dare say ongoing conversations. Today's conversation, however, I'm going to pull up my notes here, is about the introduction to what physical therapy is. What do physical therapists do? What should we know about physical therapy and how to choose a good physical therapist? So without any further ado, here's the conversation that Megan and Mary had regarding physical therapy. Thank you for joining us, and enjoy the conversation. Well, welcome Megan to Since You Put It That Way, our podcast that makes everyone stop and pause and think, "Well, since you put it that way, let's think about that." Welcome, welcome. As we get ready to go into conversation about physical therapy, you're a physical therapist. Why? How'd you get there?
Megan Pass:How would I get here? What a great question, Mary. And thank you, thank you for this opportunity to share my story and the story of, a unique story into physical therapy actually. My story into PT is just like almost every other physical therapist that was a chronically injured athlete, who was nicknamed Ford by my personal trainer, fix or repair daily, three sport varsity athlete. And I never let my injuries stop me. But that also then led to some great compensation patterns later on in life. And so my athletic trainer, at the time in high school, was blessed to have an athletic trainer dedicated to our high school, our local
Mary Louder:Right. hospital paid for the service for the area school districts. And he, I was like, Well, I want to be an athletic trainer. And he was like, No, you're too smart for that. And thank you, Chuck, Chuck Middleton, who is now a doctor of physical therapy as well in my hometown, and it just catalyzed me into this
Megan Pass:And then I ended up at Duke doing physical therapy. path. And so went to school Michigan State for my undergrad, even knowing I wanted to be a PT, but definitely explored some different avenues. My undergrad is in nutrition because I found that fascinating. Not the dietetics nutrition, but nutritional sciences. So the metabolism of the body. And so spent three years in--through their program and graduated as a doctor of physical therapy.
Mary Louder:Yes. Duke is not easy to get into. So you have to be a bit nerdy, aren't you?
Megan Pass:I'm a total nerd.
Mary Louder:You know, the nerds rule the world, really, at the end of the day.
Megan Pass:They do, they do. I'm a total smarty pants, and I have no idea how I retain information or facts, but it happens. So here we are.
Mary Louder:Well, I have a funny story about physical therapy, because I-I'm one of those athletic trainers. And so my undergraduate at the University of Montana was in athletic training. And I loved it, and I excelled in it, and got like four point in it. And so I thought of going into physical therapy because our programs were combined. So you, you applied to the professional program, and then you got into athletic training. And then my second year in athletic training, I thought, Well, I think I'll consider physical therapy it would be an add-on year, and then go from there. So I talked to the director of the physical therapy program and she set me straight. I simply was not physical therapy material, she said. And the funny thing is, my advisor when I first started at the University of Montana said, Oh, you need to go be an osteopath, to which I said, Oh, no, they're quacks. And there's a story about why they're quacks or I thought they were quacks in my book that's coming out later this year. So I'll hold those details but I certainly was of that mindset and undergraduate. So quacks on one side, not physical therapy material. So then I go to Michigan State for graduate school for athletic training. I get fascinated by spinal biomechanics. And then I find out an osteopathic school's at Michigan State. I applied to one osteopathic school of all the schools in the nation and what happens? I get in and I'm an osteopath.
Megan Pass:You know what? That story cracks me up because there's an interesting parallel there. So I was going to apply to athletic training school at Michigan State for undergrad, knowing it was one of the top ones in the nation and the ATC-PT combination would be gold, but I was in the marching band at Michigan State. And I didn't want to give that up. Total nerd here.
Mary Louder:A band nerd to boot!
Megan Pass:Band geek right here, righthere.
Mary Louder:Yeah. Oh, that's hilarious. And so then, I swung back around when I visited Missoula when I was in medical school, and I found that department chair and shared the delightful news that I was so glad that I wasn't physical therapy material after all, and I agreed with her, because I'm a doctor!
Megan Pass:Well, you know what I have, like such respect for physicians, because the only the reason I didn't go to med school because I was pre med undergrad, the only reason I didn't go med school is I just can't handle the, like, the pain and the suffering. And that like acute, acute, acute aspect of care. And so I can't tell you how many times I'd end up on the floor observing and all sorts of stuff. So that is like why I'm a PT, and have gone the route I have gotten. So I have so much respect for physicians in the way that they are able to hold that and be a part of that process. Because that is not for me.
Mary Louder:Which, what's interesting is the rehab part. I'd be like, seriously, can we just get there? So I'm like at the other end to that ready to diagnose, treat, do the surgery, put them back together. I'll sew'em fix 'em, bolt 'em, screw them up, all right, they're all yours. Now. Off you go. I see my work here is done. So Oh, my goodness. So it's really funny. And we found two we know without going into details how different, parallel, the same, our lives have been and our interests are and so that's one of the reasons that we're connecting now in collaborating with both physical therapy, osteopathy, healing, you know, transformative care for all aspects of any person who's interested. Mind, body, and spirit. So, yeah, so it's just so funny. So, alright, so then now, you know, when people talk about physical therapy, though, they literally think they're gonna go and just get an exercise program. They're on a, you know, a treatment table, they're left alone, and I hear that a lot still now. Well, alls I go and do, they give me exercises and they don't do anything. I don't even know if people are doing the exercises right.
Megan Pass:Yeah.
Mary Louder:Tell me about the different physical therapists, the different roles, acute care, chronic care, really give us a tutorial of, you know, an overview of physical therapy.
Megan Pass:Yeah, so physical therapy was actually founded in the second world war through convalescent nurses, and working with injured soldiers and helping them convalesce and rehab back to function, essentially. And so knowing that that's where physical therapy started, it's an easier way to look at our role, essentially. Whether our role is in the hospital of getting someone up out of bed, or getting them to learn how to reroll in bed, to sit, to stand, to walk, to transfer, whether that is range of motion and PNF, proprioceptive patterns, if they're in the ICU, whether that is facilitating neuromuscular reawakening after a stroke, that's more of the acute side. And then that also translates into, like, skilled nursing home care, through the transitional care that is available to people. So that's like an elderly person who has a fall and isn't safe to go home yet. So they would go there and work on rehabbing themselves--or not themselves, but work with a therapist to rehab through all the different therapies to be able to be independently functional at home and safe. So a lot of people think physical therapy is strength because the outpatient world is so heavily dictated by insurance. And I'm just going to call it as it is.
Mary Louder:Yeah, fair.
Megan Pass:Um, I feel like it has dumbed down our profession. And it has dumbed down to the care that people get, because it is, yes. So you go to outpatient clinic and you get a round of exercises and you do them and the therapist has seen four people in an hour. So they're seeing 18 people a day. How do you get that hands-on care? and that is being dictated by the ins--or allowed, by the insurance and dictated by money, plain and simple. And I have been grateful enough to always have worked one-on-one with patients. I did travel PT right out of PT school, which was ballsy. But I did it. And I always made sure that I worked in clinics, whether--and this was insurance-based clinics too--that, where I was one on one. Because in--think about any acute care or hospital setting, you're one on one because that patient may fall and then you're working on moving them out of compensation patterns. Well, the same thing happens in outpatient care, we create compensation patterns from injury. So it's not just about strengthening, it's about retraining the body to come back into homeostasis, its neural patterning, to then be able to function again, because the body has this innate ability to heal, this innate ability to remember. And yet it also has this really amazing skill to compensate so that it can't injure that one area again.
Mary Louder:Yes. So it's avoiding that area of injury by repatterning.
Megan Pass:Yes.
Mary Louder:Now, even before we get to that, I still think of three times 10, you're going to take your ankle--so if we do an ankle injury, or a chronic ankle injury, or maybe it's a grade two, so for our listeners, grade two means the ligaments are old, they're not strong, but they're not torn, but they're stretched. And when making use the word proprioception, that's the positioning of where your joint knows you are in space, without your eyes, because the eyes always seek the horizontal when you're--when the eyes are open. But if you close your eyes, that's where the balance comes in. And that's not driven by your, your balance system, or your eyes from your brain that's driven by receptors in your joints. And that's where the proprioceptors are. So you retraining from the bottom up versus the top down.
Megan Pass:Yeah, and it's also remembering that the Golgi tendons are also within the muscles. So that's another nervous system cell that helps with proprioception. So it's not necessarily just what's in the joint, but it's also within that surrounding muscle. And so it's about finding synergy, about finding the ability for them to work together to know where they're at in space, in order to be able to function in day-to-day life.
Mary Louder:Right. So now, a patient's not going to go in and say hey, hey, physical therapist, how's my Golgi tendon now?
Megan Pass:No, no. No.
Mary Louder:That's like, is your refrigerator running? Go catch it.
Megan Pass:And I think this is the question that everyone's asking then how do you know who's a good physical therapist?
Mary Louder:Right.
Megan Pass:Right? How do you know? And--interesting story, my dad broke his clavicle this summer, falling off a four wheeler.
Mary Louder:Collarbone for those--
Megan Pass:Yep, sorry, collarbone. Thank you. I got in my clinical mind. And he--like, he flipped himself off a four wheeler. And, like, go Dad.
Mary Louder:Yeah.
Megan Pass:And they wanted to refer him to physical therapy. And he called me and asked the question, How do I know where to go?
Mary Louder:Yeah.
Megan Pass:And I was like, Okay. Because being protective daughter, I'm like, Just come see me, but I live two hours away. So that's not possible.
Mary Louder:Right.
Megan Pass:It's the question of what do they most commonly treat?
Mary Louder:Okay.
Megan Pass:Because most PTS will say they're general--generalist, I treat everything. Well, mm, okay, maybe, but okay.
Mary Louder:Okay.
Megan Pass:How many years they've been practicing. Now, that's not always an indicator of how good they're going to be or not. But it is an indicator of--those first two years of PT school, you're--after PT school, you're just trying to figure it out. I'll be just plain honest with you. And I feel like that's every licensed, like, practitioner. Those first couple years--
Mary Louder:Right, that's why it's to practice medicine. They haven't gotten it done right yet.
Megan Pass:You're just trying to figure it out.
Mary Louder:Exactly. Move along here, nothing to see.
Megan Pass:Yep. And then ask like, what's the mentorship like? What is the, what is the clinic like? Are you guys talking case studies? Are you having conversation? Or if that's not an option, do you have a community that you do that with? And then number three, you kind of follow your gut. If you meet someone and you're like, This person doesn't know what they're doing, or I'm not sure, then go somewhere else is the same thing with a physician. And so truly, my best advice to people is like, yeah, there's all the like, the skill stuff, but really, truly, if you want someone on your care team, you have to click with them. You have to connect with them. And so if they do an eval and give you exercises and walk away, that's not I'm going to be who you want to be, and you say, Okay, I'm gonna go find someone else.
Mary Louder:Right. So their first question, I would add a caveat to that first question. They're gonna say, who's their insurance take? Right? Because most people will stay within that system. I'm not saying that that's correct. But that's what we do.
Megan Pass:Yeah.
Mary Louder:And there's so many conversations we can have around that, but that's not our topic today. I'm gonna rein us both in from that, from our inherent right to have health care. Moving right along here. Okay. But, so, find out in your local community, who has been liked, who your friends have liked and why, what their outcome has been, that might be a slightly different approach, but similar.
Megan Pass:So yes, if you have that community.
Mary Louder:Okay.
Megan Pass:So, and that's where relying in it on a community if you have that community, in my dad's case, he didn't have that community.
Mary Louder:Okay.
Megan Pass:And so then it's also reading reviews, quite
Mary Louder:Yeah. Oh, yeah, that's a good one. Yeah, reading frankly. Google reviews. And I think the replies to the Google reviews are important. Because, you know, like, it's honest that most people who get discharged are not happy, give the review. People are super happy, they're on their way, they tend not to review. But it's also the reason why a review was placed. You know, what were they going for? I even had one review of someone who hadn't seen me, it was just a spam. And so I was able to call that out and get that removed. So those types of things. And I think, too, people look, sometimes if it's in with a system, or not. Sometimes their, their surgeon might refer them or their primary care physician might refer them. I know, I developed really good, you know, back in the day, really good relationships with my physical therapists. Why? Because I was interested, because that's probably also my background in being an osteopath. I don't think it was because I was a control enthusiast, but probably--
Megan Pass:I don't know, we'll see Mary.
Mary Louder:I think it was part of it. All right, all right, all right. But that did push outcomes a certain way, I'll tell you what. But in--you know, building that team together for collaboration was good, because, and I welcomed the physical therapist calling me. So that's another thing, too, is how much does a physical therapist collaborate? Or how comfortable do they feel getting collaboration which you talked about, you know, amongst themselves? Or who is their team that they're reaching out with?
Megan Pass:Yeah, and it's also something to remember, too, that there's different practice acts within different states, too.
Mary Louder:Yeah, say something about that.
Megan Pass:Yeah, so um, I am a Michigan native. But this is the first time I've practiced in Michigan in the 12 years of my career. I moved here from Oregon, and Oregon was a complete direct access state, we were able to see people without even collaborating with their physician if they were not covered--if they were not covered by Medicare or Medicaid. And obviously, I always push to collaborate with the physician and at least give the notes, but if the patient didn't feel comfortable with it, or didn't want them to have it, then I didn't do it. And so it's also being really aware of then, as a practitioner, like you're part of the team, like we're never independent, even in that type of state. And so I always tell patients, I'm like, Well, who do I go see, can I go see this person or this person? And I'm like, if you feel like they're, you're benefiting from them, okay, you need an entire team around you. And if you feel like it's not benefiting you, or it's hurting you, and I will be the first one to say if it's not benefiting you, then it may not be a good idea. But that care team is so important and working together as healthcare providers, instead of saying, no, no, no, just see this person, just see me. That to me is always a little bit of a red flag.
Mary Louder:Yeah. So here's a question. Should physical therapy hurt?
Megan Pass:Ah, great question.
Mary Louder:Yeah.
Megan Pass:Sometimes yes. But here's the difference. It's learning the perception of what pain is. Is the pain feel injurious? Is that, does that feel like the pain of causing injury? Or is it that good pain? And we all know what that good pain is, the good soreness, the good stretch? The good ache, the--but if--even like sharp can sometimes feel good, but if it's that like injury, like acute injury, stabbing on--like, and it sets your nervous system onto alert and your physical therapist cannot explain why that's happening, to help you downregulate your nervous system, then physical therapy should not hurt.
Mary Louder:Okay. Because I think of something like a frozen shoulder, and you know, how we treat that is so different now than when I trained back in, you know, it was after the horse and buggy, but you know, so--where, you know, there we used to just really--we did, we really pushed quite hard in the range of motion. And then it moved to manipulation under anaesthetic. And then now we actually inject, we did inject, not nec--we did steroids, I moved away from steroids and did prolotherapy, which is a whole, you know, podcast in itself. And then I moved away from the joint to get to the joint that was frozen.
Megan Pass:Yeah, frozen shoulder is an interesting one, I actually have a lot of success treating frozen shoulder, which I know doesn't surprise you, Mary, and you'll hear more about this in upcoming podcast episodes. There is a difference between stretching into someone's ability to tolerate the pain versus stretching to their end range and they can't breathe.
Mary Louder:Okay.
Megan Pass:And this is where the nerve--see, my the last several years of my practice, the nervous system is like the indicator of all of this, whether we're putting someone into fight or flight or whether they're able to be in that healing capacity of pain, but they're not trying to run away. They're not trying to fight, they're not freezing, they're not trying to disassociate, or they're not trying to fawn like, oh, no, it's okay. It's okay. It's really becoming a co-facilitator of their healing instead of me as the therapist being in charge of their healing.
Mary Louder:Right. So that brings us right into the autonomic nervous system, which for folks, that's the vagus nerve, it's the big thing, one of the big things, but there's way more to it than the vagus and I'm waving my fingers because of the Golgis, of the, you know, reticular activating system because of the midbrain, because of the neural, autonomic and the immune system and the fascia and, and peace on earth, goodwill towards men. I mean, this is a completely complex issue. And we can't dumb it down. And we can't, it's--to make it--to simplify this is to take years of practice of something that's very complex and present it clearly.
Megan Pass:Yeah, I think we can simplify it in a language to patients for them to understand. But for a practitioner, to put it into practice, we can't really dumb it down. And that has been the difference between me and most other physical therapists, is I am very aware of what the autonomic nervous system is doing. And knowing that healing of our body, and that innate ability to heal takes place when we're closer to the parasympathetic nervous system than the sympathetic--which parasympathetic is rest and digest, sympathetic is fight or flight. And so that piece and so you want to find a good PT, versus an exceptional PT? That's what you're looking for. Are they addressing the nervous system? And your capacity to just handle your experience while you are with them? Which is why I say meet them. You don't feel safe and comfortable with them?
Mary Louder:Yeah.
Megan Pass:It's not--you may get results, but it may, they may be subpar from what you're looking for.
Mary Louder:Yeah. Now, let's go the other extreme, which I think is an equally fascinating. Person has a knee replacement. They have no physical therapy. Say something about that. And it might be sassy and that's okay.
Megan Pass:Are you dumb?
Mary Louder:That's okay. That's a good, fair question. And the patient, they may not know because what they're doing, and this is my experience in an observation as a physician, observing the patient seeing another physician is, Well the specialist said I did--this specialist said I didn't need it. You're just family practice. I'm like wt, f and h.
Megan Pass:So this is a trend that started about five, five or seven years ago, there was a study that came out regarding surgery, a rotator cuff surgeries, and it said that five years post surgery was no--or five years post surgery was no different whether they received physical therapy or whether they didn't receive physical therapy. And so what has happened is so--let me say that again.
Mary Louder:I'm rolling my eyes at the five year mark.
Megan Pass:Yeah. So that study again said that five years after, post a rotator cuff repair, so shoulder surgery, patient outcomes were no different with receiving physical therapy versus not receiving physical therapy.
Mary Louder:Okay.
Megan Pass:And so--
Mary Louder:The road up to the five years, what did they--what did they miss out on? What did they struggle with? What--
Megan Pass:What type of therapy did they get? Were they addressing the compensation patterns that happen after a rotator cuff surgery? My guess is no. And the reason I can say that, though--
Mary Louder:How about before that caused and if it wasn't an acute injury, if it was chronic?
Megan Pass:Well, if it was chronic, then we have built those--compensation patterns have been wired and ingrained into the nervous system because what fires together, wires together. And so if it was a chronic shoulder injury, okay, so you go to lift your arm, okay? Here, whenever we got a shoulder shrug compensation pattern. And then after surgery, if the therapist is not being super cognizant about getting range of motion while keeping that shoulder down. And then the patient isn't super diligent about retraining themselves, because I'll be really honest with you all here. This is a lot of work for the patient. Because behavior change requires conscious thought while you're moving.
Mary Louder:Awareness.
Megan Pass:And awareness. I mean, the graph of behavior change is you're unconsciously incompetent to consciously incompetent--knowing that you're not doing it right--to consciously competent, meaning you have to think about it to do it right. To then unconsciously competent, meaning Oh, now you can do it without thinking about it. But the bridge to get there is you have to think about it. And then you have to do it right over and over and over again.
Mary Louder:And you have to not be in the autonomic fight or flight sympathetic response, you have to be in the relaxation response for it.
Megan Pass:Bingo.
Mary Louder:Healing and forward ex--executive functioning occurs.
Megan Pass:And I'll be really honest with you all here, like as a new therapist, I was that person, post surgery, post knee, pushing them to end range no matter what their pain was, because that's what I was taught. But I quickly saw, quickly saw, and maybe this is like my empathy, like uber-heightened, that they were just wincing and didn't want to come in. And I was like, Huh, I wonder if I just take them to their end range, and then get them comfortable and feel safe with me. And then maybe we can nudge a little bit further. And while we didn't see a lot of progress within a session, session to session, we saw a ton of progress because patients were adhering, they were doing their home exercise program, because they're like, Oh, this isn't excruciating.
Mary Louder:Right. The other thing I wonder about that study of the five-year outcome is whose idea was five years was the gold standard to figure out that that's what we measure.
Megan Pass:Well--
Mary Louder:How did we arrive at that measurement?
Megan Pass:I don't know. And quite frankly, I read the study very quickly. And I was so pissed off about it, that I threw it away. And I wish I kept it, because I also want to know who did the study.
Mary Louder:Yeah, we'll have to dig that one out for further discussion. Because I've got thoughts on that one, too. Because that's, you know, that's the thing too, about, you know, the studies, we have to look at the quality of the studies. What are--not only who's doing them, how long they did it? There's so many things on that.
Megan Pass:Yeah, so many. So what's happening since then, Mary is this has been extrapolated to total hips, total knees, like all sorts of surgeries. And I just also have to think that it's also maybe coming from the insurance company a little bit, because--
Mary Louder:Oh, it has to be, because, you know, they're, they're--the patients are out of the hospital and, and knee, a total knee can be an outpatient procedure now, you know, and a hip can be maybe an overnight, maybe two, depending upon the comorbidities, but nearly almost an outpatient as well depending on if they do an anterior, posterior approach, and how young and healthy the person is or you know, what we would consider the comorbidities. So I think there is a lot that goes into that. I think of you know, when I think of the tissue around the joint because we--certainly going in the front of the hip is easier than going in the back because the incision's smaller is, you got to you know, avoid the big vessels of the iliac and the femoral artery, vein and nerve and the lymph. So there's a little more--you have to be cleaner, the back is a little--you can be a little sloppier back there, as it were. Sorry surgeons if I'm calling you sloppy, not mean to but I've trained a lot in orthopedics and was going to be an orthopedic surgeon and decided not to because I wanted to sleep instead of being up in the middle of--
Megan Pass:Well, and I have witnessed several anterior and posterior approaches, and I would agree with you, there's a lot more precision on an anterior approach than a posterior approach.
Mary Louder:For sure.
Megan Pass:Yeah.
Mary Louder:So there's a lot less tissue trauma in the anterior approach that's the whole key with a smaller window, but you're still disrupting the capsule, you're still disrupting the proprioception, you're still putting a metal implant of some type titanium, etcetera, etcetera, in and that's changing, literally, the, the, both the anatomy and the physiology of that joint. I don't even know how we could arrive at not retraining that joint and retraining the person.
Megan Pass:And I think this is the misperception of physical therapy. And I don't know where this happened, where physical therapists are just exercise people, because we're not. And well, you can just strengthen yourself on your own. And I don't know, at what point or when this perception came in. Because I went to Duke, I went to a really good school, that was never my experience in school. It was never my experience where someone comes to you for knee pain, and you don't look at the core and the hip and the ankle. Like you always look up the chain and down the chain. That's how I was trained. But then in working with other PTs, especially new PTs, and even older PTs, they never did that. So I don't know at what point our profession did this disservice to ourselves. Because truly, a total joint is trauma to the body. It's no different than a car accident. It's an elective trauma.
Mary Louder:Yeah. Which is controlled, controlled trauma, surgery is controlled trauma.
Megan Pass:And so you're changing, coming back to the autonomic nervous system, you are changing how your body is going to fire and function and move. Because there's pain after a surgery that will create compensation patterns to avoid that pain.
Mary Louder:And then there's even just fear.
Megan Pass:Mm hmm. Which is I think, I mean, thank you for bringing that up. Mary. I think fear is the strongest compensation pattern, and ingrain or to really ingrain these compensation patterns, because it's survival. Our brain wants us to survive.
Mary Louder:Yeah. I can't imagine what an artificial joint feels like because it's artificial. And I mean, and I take that--I say that from a body awareness position. As a But, but she had so much hip pain that really translated into physician, I'm an empath. I'm a medical intuitive, I'm there, I can feel things, I can feel things in other people. I certainly feel what I feel in my body, right? I can't imagine. And I think of myself skiing down a hill, or mountain rather, you know, I call it a hill and going, I wonder what it would feel like to not know what my joint is doing, you know, because it's just different. I can't you know, and so it's fascinating to me to think about stuff like that and what people actually feel. You know what they say what they report my mom had, we called we had a nickname for my mom, titanium Nene. Her nickname was Nene, for Henrietta and she had both hips done and so we called her titanium--she didn't mind. her sacrum, which is a whole nother, you know, episode, that when her hips were done, and she was out of pain, she was so mobile and just so free. And I said, Well, what your hips feel like? She does they don't feel I don't have pain. But she also said that statement, I don't feel. So that's interesting.
Megan Pass:Yeah, yeah. And it's also just a huge indicator of pain. And that fear of pain and how it will change your compen--it will change your movement patterns. And then the reliance on the Golgi tendons, not to bring that back again--
Mary Louder:Lovin' out to the Golgis. Not to be confused with goji berries.
Megan Pass:Yes. But then the proprioception required within the muscle, but you're still missing that proprioception within the joint.
Mary Louder:Yes.
Megan Pass:So building that capacity and that awareness--
Mary Louder:Yes. And so we build proprioception folks, by balance. We build it by standing on one leg, or standing on two legs with your eyes closed, or one leg with your eyes closed. Or on kind of a half a ball. I mean, there's graduated ways to try retrain your body. So what I'm hearing is, find a physical therapist, push for physical therapy, don't just accept the status quo, if you really want to return to full function, and I dare say ahead of five years. So you can be a non-qualifier for that study, because you've fully recovered much sooner and don't meet those standards in five years. But you know, and I don't know why I'm being so cheeky about this today, but I think it just, you know, makes me kind of chuckle about, I agree the dumbing down of this and it's such an important thing to rehab fully, and to, you know, check around, find good therapists, you know, if you don't feel comfortable and they're just saying, you know, drop and give me five or here's a dumbbell or here's a kettlebell or here's an ankle weight, you know, I know, you might be there with a lower, you know, extremity injury, and you can't run quickly away, but move quickly away from them.
Megan Pass:Yeah, yeah. And as you're speaking, Mary, just another quick tip for everybody. A really good therapist isn't going to give you sets and reps and make you adhere to them. Because they're going to have you be feeling what you're feeling in your body. And you're going to do reps to fatigue or reps that are only in good form or--so that's another indicator. Thank you for bringing that up and reminding me on that one.
Mary Louder:Yeah. Okay, good. All right. So, I think we've got more to discuss here, because we haven't even scratched the surface.
Megan Pass:No.
Mary Louder:And I think that this is really important, because it's going to really get into, we're going to go into the land of chronic pain, we're going to go into the land of how chronic pain is managed in our complex medical system, our medical industrial system, how it's handled in our pharmacological medical industrial system. How it's handled in our psychological, medical, industrial, we're going to go everywhere with this over time. So this is going to be you know, something that we're going to keep returning to, and then I think there'll be fun to do some specific injuries, specific rehabs, even talking about some stroke, coming back from that, what could be expected, you know, ankles, rotator cuff, I think it's super important.
Megan Pass:Sciatica.
Mary Louder:Sciatica.
Megan Pass:And the different types of sciatica because that's not always from your back.
Mary Louder:Right. Oh, fascinating. Okay. All right. And this is, you know, my bailiwick because I did all the stuff I came up through and being an osteopath, this is, we just sat around talked about this all the time. And this is why I didn't become, one of the reasons I didn't become a surgeon, because I spent so much time helping patients avoid surgery that I was a competing intention to my own self. So just went the other way.
Megan Pass:Yeah, I just also want to say out there, like, you know, total joint replacement, that surgery is cool. Like to be able to be in excruciating pain and not be able to walk or function and then have that and go through good rehab and have this whole capacity and new life back. So I do want to make that really clear that I'm not like--
Mary Louder:For sure. And my mom attested to that for sure, and she had a rotator cuff repair as well. So, you know, I'm, yes, I just have memories of her being under anaesthetic. We won't go there, out of respect. Because she's passed. So I will hold those stories.
Megan Pass:So there is a place for the Western industrial medical complex.
Mary Louder:Absolutely.
Megan Pass:And then there is a place to know where to advocate for yourself to get the best care that is available to you.
Mary Louder:Yes. All right. Well, we're going to--on that note, we're going to hold and have you come back and tell us more about many other things that we're going to talk about. So I want to thank our listeners for tuning in to Since You Put It That Way. This is episode 1.0 of physical therapy. Here we go. And our guest has been Dr. Megan Pass who is a physical therapist here in West Michigan, and go to our website, we've got her information, you can reach out to her to consider some physical therapy with her and consider working with her and getting more of your questions answered. And thank you very much listeners for tuning in today. And we'll see you in our next episode.
