Insurance coverage can be a tricky thing to navigate. Do you know what your individual deductible is? If so, do you know about your family deductible and coinsurance for a specialist visit? For most of us, myself included, the insurance specifications have become seriously complex. Many times I’ve intervened on behalf of patients that have met their wits-end while attempting to understand their chiropractic or physical therapy benefit coverage. In an attempt to simplify some of the frequently used insurance terminology, I put together this little cheat sheet to help in minimizing the frustration factor.
A coinsurance occurs when there is cost-sharing between the insurance company and the covered member/family. The insurance company may tell you that your responsibility is a 20% co-insurance and that they will cover the rest of the charges (remaining 80%). Quite often a coinsurance comes in to play after an individual or family deductible has been reached.
Example: Your opthamologist visit is $400 and Optima informs you that you have a 20% coinsurance after meeting your $200 deductible. Currently, you have met $0 of your deductible. Your responsibility would be: $200 of the deductible and then 20% of the remaining $200 specialist visit charge = $40.00. The total you can expect to pay for the visit is around $240.
A copay is a set fee that you are responsible for each time you visit a doctor. There are usually tiers or copays where a primary care doctor is typically less than the copay you may have for a specialist. Some plans have a copay due in addition to a co-insurance.
The set amount an individual or family must reach before transfering over to coinsurance coverage for medical services. Some plans have relatively low individual and family deductibles of $200 – $500 while other plans have larger $5000 – $9500 deductibles. Once you have met your deductible you may only be responsible for a fraction of the percentage of your medical care, referred to as a co-insurance.
Out of pocket maximum or stop loss
This is the absolute maximum a covered member or family will pay out of pocket for medical care including copays, deductibles and co-insurance for a defined period of coverage (usually a calendar or a contract year)
The balance system is one of the most important systems the body uses. Throughout the day it helps us to drive a car without getting dizzy; slip on a slick surface without tearing ligaments; go up and down stairs without looking at every step; and walk down the sidewalk without tripping on uneven cracks. Balance is a complex masterpiece that can be honed to help every person function at their highest level. Have you ever wondered how gymnasts balance on the balance beam, or hockey players skate on ice while handling the puck, or how skiers tear manage to slalom downhill without falling? It all has to do with practice and creating a balance set to fit their unique sporting needs. There are three different balance systems that work together to create a wholly balanced world.
This is the feeling that we have in our feet, and is sometimes intertwined with proprioception. Somatosensation and proprioception are defined as how the sensors within the skin on our feet, joints, muscles and tendons sense where we are in space. These sensors constantly give feedback to different parts of the brain and brain-stem to correct movement, and ensure that the proper muscles are contracting to stabilize and move our body. This system can be disrupted by nerve damage (often called peripheral neuropathy), which often occurs with diabetes and some artery diseases. It can also be disrupted by pain, which is why anyone who has had an ankle sprain will tell you that they sprain the ankle over and over after the first injury. This is because the system is disrupted in the presence of pain so the ability of the ankle muscles to contract and prevent further sprains is impaired. When this system is disrupted due to lack of sensation or pain, the body relies on the other two systems below.
Simply put, vision gives us our picture of the world and integrates with the other systems to adjust muscle activity and movement to match what we see. We rely most of our vision during balance.
The vestibular system is an integral part to the balance system. It activates postural muscles throughout the day and also helps us move our eyes independent of head movement. This allows us to focus on one thing while there may be a lot of other things going on around us – think about reading a street sign while driving on the highway, for example. If both of your vestibular systems were non-functioning (you have two, one in each ear), the horizon would bounce up and down instead of being still when walking. Mismatches in information within this system is usually what causes motion sickness. The reason people get nauseous with motion sickness is that the brain has trouble with deciding which input to use – vestibular, somatosensory, or vision. Nausea is your brain’s way of saying: we need to sit down and take a break so I can figure this out. When this system is not functioning correctly, patients generally experience dizziness – defined as feeling off, light-headed, or spacey – and vertigo, which gives the sensation that the world is spinning around you. This system is most important for balance at night when vision can be eliminated.
Balance may not be as straightforward as it seems. It requires a lot of input and processing within our nervous system to work well. The good news is that our balance system can adapt to use one part of the system more than the other through training and practice. The bad news is that as we age, we generally lose sensation in our feet and vision leading to increased risks for falls.
We can help you find your balance before issues develop. Give us a call for your balance screening today!
Bryan Esherick, DPT
Treatments come in a variety of options. Opioids (oxycodone, hydrocodone, etc.) are often prescribed as treatment for an episode of pain patients are experiencing. If you haven’t been the recipient of these directly, there’s a good chance you know someone who has. They’ve been widely prescribed as they had always been considered both safe and effective. However, in the wake of an opioid epidemic, we want to remind our patients that there are safe and effective treatments that let you avoid the drugs – and without the side effects, That said, there are instances where these types of drugs are appropriate – post surgery or serious injury – and with proper management may be used safely. However, we want to use this platform to highlight our approach to more conservative treatments that can effectively alleviate pain.
As physical therapists, chiropractors, and massage therapists, we look to provide that first-line treatment for acute and chronic injuries alike – including: manual therapy; joint mobilizations; massage and soft tissue release; targeted therapeutic exercise; and health education. Let’s take a closer look at these distinct areas.
Joint Manipulation and Mobilization
Manipulation and mobilization are used throughout musculoskeletal health by chiropractors, physical therapists, and some osteopathic doctors. Despite popular belief, the aim of these treatments is not to put a bone back in place. Treatments like this work with the nervous system to affect pain (through release of endorphins), muscle tension (through reduction in pain and thus reduction in spasm), and proprioception (your brain’s sense of your joint position). In my opinion, 95% of cases require exercise to reinforce the effects of the manipulation. In other words, mobilization and manipulation gives your body a window to exercise with less pain so that you can correct the issue at fault and increase muscle tone. However, it does not correct the underlying cause of the pain independently. These are powerful pain relieving tools that can be employed to aid in your recovery from pain, especially in the spine.
Generally massage is thought of as a relaxation and stress reducing technique, but it can also be used as a powerful pain relieving and recovery tool. Therapeutic and sports massage are given in order to improve recovery through reduction in muscle tone and improvement in blood flow. Relaxation in muscle tone allows the muscle to receive the adequate nutrition is desperately needs to heal. Think of a muscle as a sponge; when it is squeezed out (overactive) it is not able to receive the water (blood) it needs to function. We see this happen often in cases of back pain associated with sustained postures, and receiving occasional massages would help alleviate this chronic paid in a more effective and cost-effective treatment. Massage also releases endorphins through a healing touch and targeted techniques, which helps to ease pain and creates a relaxing therapeutic environment for the body to heal. Your chiropractor or physical therapist may also use targeted soft tissue techniques to promote healing and pain reduction.
Therapeutic exercise is used widely by physical therapists and chiropractors as well. Movement encourages the body to release endorphins, reduce tissue tension through increased blood flow, promote healing through cellular processes, and prevent chronic pain from fear of movement. Exercise can be used as a means for tissue to adapt and heal to specific stresses it will encounter through daily activities. We use therapeutic exercise not only as a pain relieving mechanism, but also as a way to introduce stress to healing tissues in a controlled manner. If the tissue is not properly loaded over time, it can be substantially weaker than it was prior to the injury causing recurrent injuries. The best example of this phenomenon is chronic ankle sprains. Without proper rehabilitation, ankle sprains are likely to keep occurring as the body is unable to fully heal the tissue prior to sustaining a second, third, or fourth injury. Another common misconception is with arthritis. Many people stop moving because the arthritis is causing too much pain. On the contrary, our joints need to be loaded in order to provide nourishment to the joint surfaces. Without movement, joints can continue to degrade and become more painful. Remember, movement is your friend and is ultimately what will keep you feeling happy and healthy for years to come.
Education about a particular condition should not be taken for granted. It is the responsibility of your healthcare provider to educate you on your conditions, the treatment options, and expected recovery prognosis. Please don’t hesitate to ask your provider questions – fully understanding your condition is a key element to complete recovery. Education about pain can also be invaluable for the patient, which is why our office strives to provide pain education to help contextualize thoughts and beliefs about pain. Sometimes education is the stepping stone to preventing a patient from progressing to a chronic state of pain. For this reason, our office doesn’t just treat your condition, we help you understand it.
As you can see, there are many alternative treatment options for pain relief – and with far fewer side effects – than prescription drugs. It is important when seeking care for pain, that you explore all options landing on an course of treatment. Second opinions can often be helpful when you are unsure if a certain treatment is right for you. Trying a more conservative option first may save you time and dangerous side-effects from other riskier alternatives.
Our office uses all of the above techniques, and when necessary, uses other techniques including modalities and dry needling. Our goal is to provide our patients with the most comprehensive, evidence-based treatments to ensure the fastest and most complete recovery path from injury. We ensure that each patient is treated individually, as every patient has different needs from the healthcare system. Still have questions? Give us a call to learn more. We’d love to help you become the strongest version of your best self!
Bryan Esherick PT, DPT
Concussions. They can have lasting effects later in adulthood, so prompt treatment is essential to mitigate long-term effects. While the end of summer draws near, and fall sports get underway at the start of a new school year, it’s important for parents, trainers, and coaches to remain vigilant in watching for signs and symptoms of concussion in young athletes.
Here some tips to help you recognize concussions:
- Your child isn’t acting quite like themselves: Look for changes in your child’s usual mood, cognition, ability to pay attention, and energy level. When your child isn’t acting like he/she normally does following a game, it’s a safe bet they may have suffered a concussion.
- They sustained a jarring hit: Any hit, whether it is to the head or body, has the possibility of causing a concussion. Hits to the head are obviously related to concussions, but hits to the body can also cause concussions through whiplash-like mechanisms.
- Nausea or sensitivity to light or sound: These are some very common signs seen following a concussion.
- Dizziness while using their phone or watching TV: This can be caused by a sensory issue within the vestibular system. Also watch out for dizziness or imbalance while driving and walking in busy areas.
- IF YOU SUSPECT A CONCUSSION SEEK MEDICAL ADVICE: Waiting to seek medical advice can have an impact on the overall time it takes for your child to recover. Seeking medical advise as soon as you suspect your child may have a concussion is key.
One of the best things that you can do for your athlete as a parent or coach is to be sure that they have baseline testing consisting of physical, cognitive, and equilibrium tests prior to participation in practice and games. Should an injury occur, baseline testing allows the coach and trainer to know when it is safe to allow the athlete to return to sport after an injury has occurred. Also be sure that the testing for your athlete is comprehensive, and not performed only using the IMPACT computer-based test that doesn’t take into account the other functions of the body that may be impacted through concussion.
When seeking medical advice, remember that advice can come from a variety of medical practitioners including medical doctors, physical therapists, athletic trainers, etc. Medical examination usually consists of some tests and measures to determine the severity of the injury. Examination is necessary to rule out other serious pathologies, including a brain hemorrhage. Usual care for a concussion is a brief period of rest (1-3 days), followed by a graded return to sport and school, and then rest. Rest is essential for the brain to heal itself in the early stages, although activity should be resumed as quickly as possible while maintaining little to no symptoms. Physical therapists can help by determining a safe level of activity for the athlete and developing a sport specific training plan. Before your child returns to sport, ensure all testing compares to baseline, that physical activity has been progressed, and that your child is symptom-free with sport specific training.
By following these key steps after sustaining a concussion, your athlete can return to sport as quickly and safely as possible.
Note: This blog is not considered medical advice that should be used if you suspect a concussion in your child. If you believe your child may have suffered a concussion or would like to receive baseline testing, contact our clinic at 434-293-3800.
Charlottesville is where my heart, and home, is… now. But it wasn’t always the case. As a native of Pittsburgh, I enjoyed opportunity to gain my education on the east coast – earning my bachelor of science in biology with a minor in nutrition from the Indiana University of Pennsylvania, before ultimately graduating from Lynchburg College with a clinical doctorate in Physical Therapy.
Lynchburg boasted far greater weather than Indiana, PA, and I found myself taking up more outdoor activities – hiking, biking, exploring Virginia and all that it has to offer. I knew then, Virginia was for me. As I wrapped up my time in Lynchburg, I took an internship at UVA’s hospital for the summer. My fiance, then girlfriend, was living in Charlottesville at the time and as we took in the sights of Charlottesville – hitting up the shops, restaurants, and events around town – I quickly realized this was where I wanted to make my home.
A few years later, and we find ourselves residents of one of the most charming towns I’ve ever been in.
From the events constantly going on; the character of the people around us; the nature trails; outdoor sports; wineries; and breweries – I couldn’t imagine living anywhere else.
– Bryan Esherick PT, DPT
What is Parkinson’s Disease?
To better understand Parkinson’s, it is first beneficial to know about the populations it affects, what part of the brain it affects, and some hallmark signs and symptoms. Parkinson’s disease is categorized as a disorder of the basal ganglia (a cluster of neurons in the brain). More than 1,000,000 people in the United States are affected by this disease and it can affect people as early as adolescence, but has an average age of onset of about 60 years old. The cause of the disease is currently unknown, but researchers think environmental toxins, genetics, and a history of depression may be factors. The disease has been found to be caused by a loss of Dopamine (a neurotransmitter) in the basal ganglia. Parkinson’s is progressive in nature and there has been no cure found to date. Characteristics of Parkinson’s include small movements, quiet speech, postural Parkinson’s affects everyone in a different way and progression usually varies from person to person.
What is a Basal Ganglia and a Dopamine?
The basal ganglia are a collection of clustered cell nuclei that control movement. They are divided into two different pathways, each with different functions. The one pathway receives input from the muscles of the body about how a movement is being performed. This information is then interpreted to determine if the movement that is being performed matches what was intended by the brain. In other words, this pathway determines if the movement is of the right amplitude (big enough or small enough) for the intended task. If the movement does not match the picture the brain wanted, the first pathway sends this information to the second pathway. In the second pathway, the nuclei interpret the information received, and send signals to the brain to adjust the movement. Areas that can be adjusted from this information include consciousness, muscle tone, and appropriate “gain” of movement (bigger or smaller movements). To make it simple this corrective information can either ramp up (increase) the intended movements or it can ramp down (decrease) unintended movements.
The two systems use a complex loop to provide a system of checks and balances. The messenger that relays information between the two systems is called dopamine. This substance is classified as a neurotransmitter and provides a way for cells to communicate. Since Parkinson’s is characterized by a loss of dopamine in the two pathways, they essentially lose their messenger and are unable to communicate properly with each other. This can lead to faulty movement patterns or small movements and quiet speech, which are often a characteristic of Parkinson’s.
Current treatments for Parkinson’s vary from pharmacological treatments to increase the amount of dopamine in the brain to exercise therapy. Stay tuned later this month for a blog post about the LSVT BIG program and how it can help decrease the rate of progression of the disease and improve overall function in the population affected by Parkinson’s.
Bryan Esherick PT, DPT
Opioid prescriptions have skyrocketed over the last 25 years. Originally they were intended for post surgical patients and those in the end stages of cancer. In 1991 there were around 76 million prescriptions but by 2013 that number had risen to almost 207 million prescriptions.
There are strong ties in rises of opioid use and heroin use.
As prescriptions have risen, so have abuses. According to the CDC more than 1000 people a day are treated in emergency rooms for inappropriate opioid use. As many as 1 in 4 people using opioids long term struggle with addiction. In 2015 there were nearly 60,000 drug overdose deaths, nearly half of those were from opioid drugs and opioid prescriptions frequently lead to other narcotic abuse. The economic costs of opioid abuse is estimated to be$75 billion a year. On top of all of that, there is no research to suggest that the amount of opioids has had any impact on people suffering from chronic pain. Patients who take opioids for even 1 day have a 6% chance of using them a year later, a 13% chance if they are used more than 8 days and a 30% chance if they are used for a month.
This year the American College of Physicians updated its guidelines for the treatment of acute and chronic back pain to recommend first using non-invasive, non-drug treatments before resorting to drug therapies.
The Joint Commission (the organization that accredits hospitals) has also added chiropractic treatment to its pain management recommendations. The guidelines were published in the Annals of Internal Medicine and based on reviews of randomized controlled trials and observational studies, and recommend spinal manipulation, massage and therapeutic exercise as first treatments for low back pain. Multiple studies support manual therapies and exercise to both resolve acute and chronic pain, but also for conditions you might not expect to see a chiropractor or physical therapist for: Parkinson’s, balance disorders, arthritis, and many others.
Chiropractors and physical therapists have excellent patient satisfaction scores.
A typical treatment plan for a chiropractor or a physical therapist costs less than an MRI. Chiropractors and physical therapists are neuromusculoskeletal experts, and do far more than just pain relief, they create treatment plans that correct problems. You’ll be stronger, have better range of motion, and in general be more functional and be better able to do the things you love and your chance of recurrence will be lower. Do you have pain? Give us a call and see how we can help!
Summer is here again, and with it comes the feeling of needing to get into shape. We want to look our best, so naturally our activity levels increase drastically. This isn’t necessarily a bad thing – as exercise is one way to ensure a long and healthy life. Unfortunately, for a lot of us, a large increase in activity level without a sufficient ramp-up period can spell injury trouble. The good news is there are warning signs your body sends prior to actually sustaining an injury.
Our body does a great job of helping us know whether something is harming us. There are many checks and balances within the body that allow this to happen. For one, the level of pain does not necessarily equal the level of tissue damage. A little ache in the knees could be osteoarthritis or a torn meniscus. Sharp pain may represent only a minor ligament sprain or inflammation. So, how do you know if you’re over-doing it?
Here are the warning signs to watch out for:
- Pain during your warm-up: Warm-ups should not be painful! They get the body primed to work. If it is painful while priming, there is likely something underlying that needs to be take care of. Think of a car “warming up” for a trip on the highway; if it is shuddering, stalling, and a lot of warning lights come on before you make it to the highway, you’re in trouble before you even start the trip.
- Soreness that lasts more than 2 days: Soreness following a run or session at the gym – even into the next 24-48 hours – is OK. But, when it lasts for more than three days, something’s wrong. Take a step back and see what can be done differently. Did you push too hard or forget to include a proper warm-up? Our tissue needs to be exposed to demands that it can handle before loading too much. A proper ramp-up period will allow the tissues to adapt and respond to the demands placed on them.
- Inability to do as much work as the previous session: We’re always on the go, but our bodies do need REST. If you notice that your performance on workouts is declining, it might be a good time to give your body a rest. When we exercise, our muscles experience small micro tears. Healing these tears allows our muscles to build up and adapt to increased weight, distance, or other demands on your body. Your body needs time to heal before exposure to the same demands that lead to the damage. This doesn’t mean exercise needs to be stopped, but it may be a good idea to target a different part of your body or different muscular subsystem. For example – if you’re a runner, take a day off from running and add strength training on off days. If you’re lifting weights, try alternating days between upper and lower body exercises. Our bodies need variety to adapt. Without it, a decline in performance is likely follow.
- When in doubt, listen to your body: This one is relatively straight forward. If you refuse to listen to your body, and continue experiencing pain, it’s likely you’ll suffer an injury. The ‘no-pain, no-gain’ cliche is out. There is a difference between pain stemming from muscular fatigue, buildup of lactic acid and depletion of energy supplies and pain experienced when tissue damage is occurring. Know the difference and respond appropriately to the signals your brain is sending.
Getting back into shape for the summer can be extremely rewarding to just about everyone. But, a phase-in period to safely ease into your programs will help to ensure your body has enough time to adapt. Remember – listen to your body, learn from your mistakes, and build on the progress that you have already made. Stay healthy my friends!
Bryan Esherick PT, DPT
With the increase in technological devices of late, posture has been a recurring theme in physical health news more and more. You may have even heard the term “text neck”. If you’ve ever been to a physical therapist or a chiropractor you may have even heard more sophisticated terms like “Upper Cross Syndrome” and “Lower Cross Syndrome.” If you’ve been to Pilates, yoga or barre classes you’ve also probably heard about pelvic tilts and “tucking.”
We know that a good posture is healthy for us. But, you may be asking yourself – what exactly is good posture, and how can I maintain it?
Good posture looks like this.
Your ears should be in the middle of your shoulders – and your shoulders directly over your hips – and all of that in-line directly over your ankles. Be sure and keep your shoulders down and back, too – not rounded forward. When you’re in a good posture position, you should notice:
- Your spine should make a gentle ‘S’ curve.
- Your pelvis should be level and your weight should be evenly distributed through your feet.
- You experience no pinching in your lower back.
- You feel no discomfort or excess weight in your heels or the balls of your feet.
The affects of not maintaining correct posture can be significant. Bad posture can lead to pain, injury and even degeneration of the spine. So, take heed and be mindful of your posture in during everyday activities – including how you are holding your head and neck while texting.
Stay tuned for more in our series on posture – the positive, and negative, affects it can have on your health.
Sleep is important. Yet, despite our awareness of sleep benefits, we often don’t make getting enough of it a priority. Sleep loss costs the U.S. $4.2 billion dollars a year – an equivalent of 1.2 million work days a year. But there is more to sleep than getting enough. How you sleep can be just as important to your health.
Many people sleep on their stomachs. And while stomach sleeping can help with snoring, it can also exacerbate and prolong neck and shoulder pain from a recent or recurring injury.
Side sleeping – with your arms below chest level – is better. But, also brings risk of waking with numbness and tingling in your arms from having them in the wrong spot. I recommend sleeping on your side with your arms down, and your legs almost straight, with a pillow between your knees. Many people have a tendency to bring their chin toward their chest in this position. Try to keep your neck straight, and be sure your pillow is thick enough to keep your spine straight. Side sleeping requires a thicker pillow than sleeping on your back.
So, what’s the best sleep position to cover by best?
As a chiropractor, I like back sleeping with your arms down best. It keeps your spine straight and level. This is the ideal position for back health and injury recovery. Tucking a pillow below underneath your knees can be a good extra measure as well. However, if you snore or have sleep apnea, this may not be the best position for you.