Hi! My name is Gary Johnson M.D. Why am I happy? Well, I'm living a doctor's dream. My patients do well.
What do doctors want? It varies, but most would say they want to make a positive difference in the lives of their patients. Simply put, we want to help people. That's what we all put into our medical school applications.
I'm new to this practice as an insider, but so far I am judging it to be a place where people do well; the outcome numbers prove it, and everyday I see it and feel it. I also see and feel professionalism. I see and feel optimism, and hope. These are important ingredients when it comes to healing and restoring human bodies. And, I'm judging that I'm working in a system designed to maximize the likelihood that we employees all have the resources around us each day to do excellent work for our patients.
When people get strong, deep down in the core of their bodies, they feel better, and can do more. Usually that also means they gain control over, or even freedom from, pain.
I've done back and neck care just about every working day of my 30 year medical career. I've seen a lot. For some individuals there are very significant barriers to gaining control over chronic back and neck pain. The pain begins to control them, and makes them someone they don't want to be. Some of those folks are at risk of losing relationships, homes, jobs, and financial security for their families. Fear, anxiety, sleeplessness, low esteem, hopelessness, and depression are often in the mix. These individuals need more help than just the aggressive, measurable strengthening protocols at the heart of our program. And, they certainly need more than is typically found in the average therapy clinic centered around the routine aches, pains and athletic injuries of everyday life. This place has a very deep pool of talent and experience, and the therapists have many resources to call upon to react to the bio-psycho-social needs of all their patients. Problems do get solved here, rather than kicked down the road. That's what people want.
I want my patients to do well, and to be happy. Here at PDR my patients have the resources available to them that maximizes the likelihood they will do well. That makes me a happy doctor.
Hello visitor! In our constant effort to provide better patient care, we’ve updated this article to make it easier to read and to provide additional details. This article was originally posted on March 8, 2013. This article was updated on January 17, 2016.
Todd Ginkel, D.C., CEO of PDR Clinics, explains that exercising and strengthening the spine musculature to resolve back and/or neck pain can be difficult because larger and stronger muscles in the back may activate before the cervical or lumbar muscles are isolated. MedX machines, however, like those used at PDR Clinics, addresses this obstacle by directly isolating a patient’s muscles, eliminating interference by other muscle groups that are not directly involved in the patient’s back or neck pain.
“MedX machines, which include the Lumbar Extension, Rotary Torso, Cervical Extension and the Cervical Rotation, isolate spinal muscles so effective rehabilitation may occur,” Dr. Ginkel explains. “Without proper isolation, compensatory muscles are activated with little to no effect on the muscles that need to be targeted, such as the multifidus in the lower spine.”
Software resides in the MedX equipment and allows clinicians to collect data throughout all phases of rehabilitation, Dr. Ginkel says. Initially, therapists conduct a physical test and compare the results to age-, gender- and weight-based norms. These scores and comparisons enable therapists to tailor a rehabilitation plan to each patient. Because the software gathers data throughout the exercise process, therapists compile empirical evidence quantifying how each patient responds to therapy, which enables them to determine if and when patients meet their rehabilitation goals.
“We don’t take our patients beyond their ability levels,” Dr. Ginkel says. “We bring them back to where they should be to perform the activities of daily living, and then their home maintenance program maintains that. It’s not like strenuously working out your biceps so they get huge, and then when you stop, those muscles return to normal. We try to return our patients to their normal ability levels.”
After completing an eight- to 12-week rehabilitation program using the MedX machines at PDR, patients maintain progress through the practice’s Maintenance Program, which allows patients to use the MedX machines once a month. Dr. Ginkel notes that an internal study of PDR patients showed that 97% of those who used the MedX maintenance program successfully maintained their strength gains or had gained additional strength at one-year follow-up.
Stabilization is the Key
To help a patient achieve proper lumbar isolation during exercise, the MedX lumbar extension machine, for instance, keeps the pelvis and legs fixed in place through a system of padded restraints. Therapists may adjust the machine to fit each patient, preventing disc herniation or further injury. Dr. Ginkel explains the motion of the exercise actually reduces disc bulging and helps direct blood flow to the injured area, loosening ligaments, muscles and connective tissue.
Jennifer Missling, M.S.P.T., Director of Rehabilitation at PDR, says limiting patients’ range of motion also helps allay fears of movement that may have been reinforced by constant pain.
“The MedX machine is a great tool because only therapists can get someone who is guarded in their range of motion in the machine, which only allows them to move in an isolated way,” Missling says. “Patients feel safe, work one on one with their therapists, and objectively see their range of motion improve every week, which gives them confidence and spinal strength to be more successful when we move them into more functional movements and activities.”
Reducing Downstream Costs
Thomas Kraemer, M.D., Medical Director of PDR, explains that back pain is complex because as the pain essentially shuts painful muscles down, other muscles activate to carry the burden. Therapists at PDR use the MedX machines to reactivate the muscles that have been dormant and inhibit those muscles that were never supposed to activate to begin with. Doing so renormalizes movement, prevents further exacerbation and, by encouraging blood flow to the weakened musculature, encourages the reduction of myofacial adheasions and restoration of muscle mass.
Ultimately, PDR teaches its patients the techniques and exercises that enable them to take control of their therapy.
“From their first consultations with physicians on day one of the program through the rest of therapy, we teach patients how to be their own therapists,” Dr. Kraemer says. “We want them to be independent, self-sufficient and maintain their health on their own. We’re trying to build independence so they don’t have to keep utilizing health care.”
Patient education does not stop at the proper training regimen, Missling says. Patients also learn self-management techniques for addressing painful muscle flare-ups and receive training in proper functional movement that prevents patients from suffering additional strain caused by improper lifting, standing or sitting.
Things Have Changed
Over the years, approaches to treating back pain have changed, Dr. Kraemer remarks. Whereas the old approach was marked by timidity, he says the new method is predicated upon aggressive treatment, depending on patient comfort. At PDR, the MedX machines play a significant role in providing effective and aggressive treatment, enabling therapists to more quickly move patients with chronic or recurrent back pain to standard exercises.
“If patients are weak in isolated areas, such as the back, then it will be difficult to be successful with normal exercises,” Missling says. “By using MedX equipment to bring them up to a normal level of strength and range of motion, those exercises become much more effective.”
Pre- and Postsurgical Utility
Dr. Kraemer notes that some patients respond well to standard exercise, and for these patients, therapists at PDR provide comprehensive therapeutic services to facilitate their recovery. For those who have not responded well to standard exercise or are recovering from surgery, a therapy that includes exercises using the MedX machine may present the best therapeutic option.
Dr. Ginkel emphasizes that patients considering surgical intervention for back pain may experience relief through therapy using the MedX machine, thus eliminating the need for surgery.
Lindsay Haugen, P.A.-C, one of our providers at Physicians Diagnostics & Rehabilitation Clinics (PDR), was recently interviewed on her experience in moving from a surgery-based practice to a rehabilitation practice that emphasizes intensive, non-surgical management of spinal disorders. She received her P.A. degree from the University of St. Francis. Lindsay Haugen joined PDR Clinics in February, 2012.
Question: What type of practice were you in prior to joining PDR?
Answer: Orthopedic Spine Surgical Specialty.
Question: Approximately how many surgical cases were you involved in per week?
Answer: I would assist in approximately 8 to 15 cases per week.
Question: Has your philosophy/scope of management of spinal conditions broadened since joining PDR? If so, how?
Answer: The patients that I see at PDR come in with similar spinal conditions that we would direct toward scheduling for surgery. After surgery these patients would then be potential candidates for non-MedX physical therapy. I would typically send patients for MedX therapy if they needed to return to work without restrictions. I often thought MedX therapy was too aggressive for my post-operative patients. After working with PDR and the MedX rehabilitation program with specialized protocols, I am finding patients can start therapy prior to surgical intervention and sometimes avoid surgery altogether. I am also finding patients can regain function, return to work and life activities whether they had a surgical procedure or not.
Question: Can you explain what MedX therapy is and how it is used in PDR’s rehabilitation program?
Answer: MedX therapy uses specific MedX equipment which is designed to isolate and strengthen the supporting spinal muscles and discourages the typical compensatory movement patterns. Using MedX exercise allows for improvement of mobility, stability, and strength of the spine and surrounding support structures. MedX therapy is the core of the PDR program in addition to a home exercise program to maximize a patient’s recovery potential.
Question: So, even if a patient had a surgical procedure, you are now finding they can still benefit from intensive spinal rehabilitation?
Answer: Yes. I’m finding that many patients can avoid surgery all together and if a procedure has been done, a patient can benefit from intensive rehabilitation by returning to previous home, work and leisure activities earlier and more successfully. In addition, I’m finding that even if a patient goes on to require surgery, prior spinal strengthening can help patients recover from surgery more quickly. These post-operative patients tolerate MedX therapy well. They demonstrate a greater reduction of post surgical pain symptoms compared to patients that do not attend therapy after the recovery phase as determined by their surgeon. I am finding patients can improve their quality of life.
Question: Based on your broad experience treating patients with neck and back pain, what do you see as the future of spine care?
Answer: The trend is toward multidisciplinary spine care, with the exhaustion of conservative care, including intensive spinal rehabilitation, before resorting to more invasive options. Good medical oversight and continuity of care will be an important aspect management of spinal conditions.
Lindsay Haugen, P.A.-C, currently treats patients at Physicians’ Diagnostics & Rehabilitation. If you’re interested in setting up an appointment with Lindsay, speak to our excellent front desk staff at +1 (952) 908-2700.