Everyone experiences aches and pains from time to time. Steps like applying ice, resting, or using over-the-counter anti-inflammatories will sometimes take care of the problem. But when these approaches don’t help, it may be time to consider a physical therapy evaluation. Indiana’s “Direct Access” law allows you to go directly to a physical therapist for evaluation and treatment without the added step of a doctor’s referral.
Listen in as Ryan McNeely, PT, Senior Physical Therapist, with Hendricks Regional Health Physical Therapy, explains that with direct access to PT, everyone can now get the physical therapy help they need without a referral.
Selected Podcast
Direct Access to Physical Therapy Benefits Consumers
Featured Speaker:
Ryan McNeely, PT
Ryan McNeely, PT, is a Senior Physical Therapist, Physical/Occupational Therapy with Hendricks Regional Health Physical Therapy. Transcription:
Direct Access to Physical Therapy Benefits Consumers
Melanie Cole (Host): Everyone experiences aches and pains from time to time, and steps like applying ice, resting or using over-the-counter anti-inflammatories will sometimes take care of the problem. When these approaches don’t help, it might be time to consider a physical therapy evaluation. Indiana’s direct access law allow you to go directly to a physical therapist for evaluation and treatment without the added step of a doctor’s referral. My guest today is Ryan McNeely. He’s a senior physical therapist in physical and occupational therapy with Hendricks Regional Health Physical Therapy. Welcome to the show, Ryan. So, tell us when are some red flags? People have aches and pains as we described--when is it time to maybe see a physical therapist for an evaluation?
Ryan McNeely (Guest): Sure. Thank you, Melanie, for having me on today. I really appreciate it. It’s a great question that we get asked very often is when is it time for me to go in and see somebody. I typically have a couple of policies. If it’s been there for a couple days and it’s not getting any better, we all are going to do something in our life that makes us sore. And, as you mentioned, you apply rest, ice and if it goes away that’s great. But if it’s still there after a few days and it’s not getting better, it’s not changing, and those remedies aren’t doing anything, getting things treated quickly can make a big difference. It’s a whole lot easier to treat most injuries from a musculoskeletal standpoint if we get in quickly and get them assessed. That’s where the direct access law with physical therapy comes in great because you can get quickly in with your physical therapist, somebody you’ve probably built a relationship within the past, and we can take a look at things and we can make it better a whole lot quicker when you catch it before it really becomes chronic.
Melanie: So, how does this direct access benefit patients as opposed to seeing maybe they go to an orthopod or a neurologist or somebody first? What is the defense between that direct access?
Ryan: It’s a great question and we’re all working in the same partnership. We work very closely and directly with orthopedists, sports medicine doctors and with family practitioners as well and in no way does direct access take the place of any of those. Honestly, if we identify issues that are beyond our purview and things that we can't handle, we’re going to be utilizing those same people and make same referrals to those specialists as well. A lot of times, if something is not dealing with an acute fracture or dealing with something that’s acutely traumatic, it’s just your muscles, bones and joints and injuries, then going directly to a physical therapist helps because it gives us access to care faster. Instead of getting right in and just working with pain medications, we’re actually treating the problem as fast as possible. And that’s where I typically tell people it’s great to have a relationship with a physical therapist already who knows your history, who knows what’s going on with you for from a musculoskeletal standpoint, so that when you do get in with them, they’re going to know what’s going on and can work with you quicker, without delaying care. If they need to bring somebody else in, we work very closely with all those other medical professionals, and we’ll get them involved if need be as well, and get that care and access and moving along as fast as possible.
Melanie: So, what’s involved in an evaluation with a physical therapist? What can people expect?
Ryan: Sure. We typically spend a full hour with our patients the first time they come in. This is not a quick process. We’re going to spend the first half hour at least most likely, going through a detailed subjective exam history of what’s going on with the patient, what’s really bothering them. Going through a detailed physical exam, looking not just at the joint or the area that’s involved but everywhere above and below it, trying to see how your movement patterns are really affecting what’s going on. I see it very often. I treat a lot of running injuries. I can see somebody who has a deviation in their form led by their foot, I can see it in their pelvis, I can sometimes see it even in their shoulders in how they have to adjust. So, we’re going to take the time to look through all those different aspects and see really what is, not just why is it hurting, why somebody is having tendonitis or somebody’s having stress to a certain joint but is it because something else is going on somewhere above or below the chain, that’s really driving that extra stress through there, and not just fixing what’s hurting that day but trying to fix those movement patterns, trying to fix what’s going on so it doesn’t come back. That’s what’s really, I think, sets us apart in that extra time we spend and allows us to work on not just the issue involved but the whole dysfunction that may be going on above and below throughout the entire body that’s putting extra force to one spot.
Melanie: So, if Indiana’s direct access law allows you to go directly to a physical therapist, then, Ryan, what is the insurance situation for that if referrals are not needed?
Ryan: And, it really hasn’t changed a whole lot from an insurance standpoint. Insurance companies see it just as they did before even direct access laws came into place. Outside of our Medicaid laws in the state of Indiana, all commercial insurance, for the most part, will allow direct access to and pay for those physical therapy referrals. Sometimes it requires a little bit extra paperwork on our part but that’s not a big deal--that’s for us to take care of. But, we’re happy to work with any person and their insurance, and we’ll check all that before they even come in so there aren’t any hidden aspects to it and we can check that beforehand and make sure everything is covered beforehand.
Melanie: It’s really great. It’s a great ability for people. Now, tell us about physical therapy itself and what you can do to help people with some of those aches and pains? Does it look like a workout room? Explain about what you do and what some of the equipment is?
Ryan: Yes, your traditional physical therapy clinic, in most settings, is going to be little bit varied. You’re going to have private rooms where we’ll spend time with patients one-on-one if we need to, providing some privacy. Most every physical clinic also, though, usually has a large gym with bikes and treadmills, with weight equipment, with free weights, with various mats, various tables for going up and down, and we’ll have lots of large Swiss balls hanging around a lot of times as well. My kids, whenever they come to visit me in the office, love running around and seeing all the equipment they can climb on and play with. And, we use all of that to put a patient through a program that is designed specifically for them. We’ll use our high low tables that we have in the room for us to get really good movements, so if we need to work on a joint to mobilize that joint and get it moving the way it properly should. We’re going to use some of the gym equipment to work on strengthening different muscles that we identified are in knots; maybe are they out of balance and they’re not working properly. Somebody’s using one muscle more than the other, we need to balance that out with something else, and we’ll go through some strength program with them that day in the office, teaching them how to do it, then, on their own as well, so that they can continue doing it ongoing. The key to physical therapy is always going to be first, like we talked about, identifying what the true problem is--what is the true aspect that’s leading to their musculoskeletal breakdown, and not just where it’s hurting but the entire chain. But then, too, it’s going to be designing a program that the patient is a partner with, and is something they can do on their own going forward, because physical therapy for a patient is going to usually last much longer than their last day in actual therapy itself. We’re going to teach them the tools to fix their problem themselves and to keep them at bay, and to correct their movement patterns which may require little bit of work on them, but we’ll teach them how to do it; we’ll take them through it with the clinic; and we’ll show them how to do it at home as well so that they can correct their movement patterns so that they can move forward, move freely, and have better range of motion, have better strength, and have it in a way that’s going to prevent muscle breakdown in the future as well.
Melanie: And, obviously, it depends on the patient and what condition that they’ve got, but how long typically can a person work with a physical therapy. You mentioned working on their own, and people can't think of it or don’t think of it as personal training session. It’s a very different thing. So, how long and how many times, generally, can they see a physical therapist?
Ryan: The short answer is, however long they need to fix the problem. Obviously, we work with insurance companies, and sometimes there are limitations with visits from an insurance company but, for the most part, we work with most patients a few weeks at a time, maybe a few months. Somebody with more larger issues, somebody just had an ACL reconstruction, I might work with those patients up to six months or so. But, the answer really comes down to as long as is needed for the patient to fix their problems, to fix their movement patterns, and then to show and demonstrate that they can do it on their own to make sure it doesn’t come back. Some people, that may take only one to two visits and be done really quickly, that’s where I get back to your first question, is when to come in. If we can catch things quickly so they don’t get out of hand, so the pain doesn’t get really set in and the tissue doesn’t break down, then it’s a whole lot easier to treat and maybe it’s just one or two visits. If it’s something that’s been there for many years, and problems that have been there for a long time, back pain that’s been persistent since they were in high school, well, that might take a little bit longer, we’re going to have to try to fix something that’s been there a lot longer, and those might take four, six, eight weeks or so. But, really we come down to we’ll spend with you as long as you need it, but we’ll give you then the tools to continue to do it afterwards as well.
Melanie: So, in just the last few minutes, best advice about physical therapy direct access, and tell us about your team at Hendricks Regional Health and Wellness Physical Therapy.
Ryan: Sure. We have a great team here of physical therapists both in Brownsburg, Avon, Plainfield, and then our main hospital out in Danville as well. We got physical therapists, occupational therapists as well as speech therapists on staff. We work in conjunction with each other to provide the best care in Central Indiana. We’ve been recognized by Health Grades over the years for some of our aspects of customer service and our outcomes. We have been leading the charge from a direct access standpoint from the very beginning and have been utilizing this law to help our patients here on the West Side of Indianapolis for a long time now. We work in conjunction, then, not just with the physical, occupational and speech therapists here but we have a conjunction of orthopedic surgeons and sports medical physicians as well as lot of primary care doctors in our network. We spend and take a collaborative aspect of how we approach our patient care. Utilizing those different resources, even our wellness department for some of our long-term care for people that really need help with some changes in their lifestyles as well. We want to take an approach in how we look at somebody who’s not just somebody who has knee pain, but we want to look at that person as a whole person, and how we can fix them, how we can fix, not just their pain and not just their movement, but how can we provide them the tools and the sources to provide care that’s going to give them an ongoing ability to continue coming back or even just effect some lifestyle changes they need to that will help them prevent some of the other problems that could persist as well. We have a great group of people at all four of our clinics that are here to help anybody.
Melanie: Thank you so much, Ryan, for being with us today. What great information. You’re listening to
Health Talks with HRH. That’s Hendricks Regional Health. And for more information, you can go to www.hendricks.org. That’s www.hendricks.org. This is Melanie Cole. Thanks so much for listening.
Direct Access to Physical Therapy Benefits Consumers
Melanie Cole (Host): Everyone experiences aches and pains from time to time, and steps like applying ice, resting or using over-the-counter anti-inflammatories will sometimes take care of the problem. When these approaches don’t help, it might be time to consider a physical therapy evaluation. Indiana’s direct access law allow you to go directly to a physical therapist for evaluation and treatment without the added step of a doctor’s referral. My guest today is Ryan McNeely. He’s a senior physical therapist in physical and occupational therapy with Hendricks Regional Health Physical Therapy. Welcome to the show, Ryan. So, tell us when are some red flags? People have aches and pains as we described--when is it time to maybe see a physical therapist for an evaluation?
Ryan McNeely (Guest): Sure. Thank you, Melanie, for having me on today. I really appreciate it. It’s a great question that we get asked very often is when is it time for me to go in and see somebody. I typically have a couple of policies. If it’s been there for a couple days and it’s not getting any better, we all are going to do something in our life that makes us sore. And, as you mentioned, you apply rest, ice and if it goes away that’s great. But if it’s still there after a few days and it’s not getting better, it’s not changing, and those remedies aren’t doing anything, getting things treated quickly can make a big difference. It’s a whole lot easier to treat most injuries from a musculoskeletal standpoint if we get in quickly and get them assessed. That’s where the direct access law with physical therapy comes in great because you can get quickly in with your physical therapist, somebody you’ve probably built a relationship within the past, and we can take a look at things and we can make it better a whole lot quicker when you catch it before it really becomes chronic.
Melanie: So, how does this direct access benefit patients as opposed to seeing maybe they go to an orthopod or a neurologist or somebody first? What is the defense between that direct access?
Ryan: It’s a great question and we’re all working in the same partnership. We work very closely and directly with orthopedists, sports medicine doctors and with family practitioners as well and in no way does direct access take the place of any of those. Honestly, if we identify issues that are beyond our purview and things that we can't handle, we’re going to be utilizing those same people and make same referrals to those specialists as well. A lot of times, if something is not dealing with an acute fracture or dealing with something that’s acutely traumatic, it’s just your muscles, bones and joints and injuries, then going directly to a physical therapist helps because it gives us access to care faster. Instead of getting right in and just working with pain medications, we’re actually treating the problem as fast as possible. And that’s where I typically tell people it’s great to have a relationship with a physical therapist already who knows your history, who knows what’s going on with you for from a musculoskeletal standpoint, so that when you do get in with them, they’re going to know what’s going on and can work with you quicker, without delaying care. If they need to bring somebody else in, we work very closely with all those other medical professionals, and we’ll get them involved if need be as well, and get that care and access and moving along as fast as possible.
Melanie: So, what’s involved in an evaluation with a physical therapist? What can people expect?
Ryan: Sure. We typically spend a full hour with our patients the first time they come in. This is not a quick process. We’re going to spend the first half hour at least most likely, going through a detailed subjective exam history of what’s going on with the patient, what’s really bothering them. Going through a detailed physical exam, looking not just at the joint or the area that’s involved but everywhere above and below it, trying to see how your movement patterns are really affecting what’s going on. I see it very often. I treat a lot of running injuries. I can see somebody who has a deviation in their form led by their foot, I can see it in their pelvis, I can sometimes see it even in their shoulders in how they have to adjust. So, we’re going to take the time to look through all those different aspects and see really what is, not just why is it hurting, why somebody is having tendonitis or somebody’s having stress to a certain joint but is it because something else is going on somewhere above or below the chain, that’s really driving that extra stress through there, and not just fixing what’s hurting that day but trying to fix those movement patterns, trying to fix what’s going on so it doesn’t come back. That’s what’s really, I think, sets us apart in that extra time we spend and allows us to work on not just the issue involved but the whole dysfunction that may be going on above and below throughout the entire body that’s putting extra force to one spot.
Melanie: So, if Indiana’s direct access law allows you to go directly to a physical therapist, then, Ryan, what is the insurance situation for that if referrals are not needed?
Ryan: And, it really hasn’t changed a whole lot from an insurance standpoint. Insurance companies see it just as they did before even direct access laws came into place. Outside of our Medicaid laws in the state of Indiana, all commercial insurance, for the most part, will allow direct access to and pay for those physical therapy referrals. Sometimes it requires a little bit extra paperwork on our part but that’s not a big deal--that’s for us to take care of. But, we’re happy to work with any person and their insurance, and we’ll check all that before they even come in so there aren’t any hidden aspects to it and we can check that beforehand and make sure everything is covered beforehand.
Melanie: It’s really great. It’s a great ability for people. Now, tell us about physical therapy itself and what you can do to help people with some of those aches and pains? Does it look like a workout room? Explain about what you do and what some of the equipment is?
Ryan: Yes, your traditional physical therapy clinic, in most settings, is going to be little bit varied. You’re going to have private rooms where we’ll spend time with patients one-on-one if we need to, providing some privacy. Most every physical clinic also, though, usually has a large gym with bikes and treadmills, with weight equipment, with free weights, with various mats, various tables for going up and down, and we’ll have lots of large Swiss balls hanging around a lot of times as well. My kids, whenever they come to visit me in the office, love running around and seeing all the equipment they can climb on and play with. And, we use all of that to put a patient through a program that is designed specifically for them. We’ll use our high low tables that we have in the room for us to get really good movements, so if we need to work on a joint to mobilize that joint and get it moving the way it properly should. We’re going to use some of the gym equipment to work on strengthening different muscles that we identified are in knots; maybe are they out of balance and they’re not working properly. Somebody’s using one muscle more than the other, we need to balance that out with something else, and we’ll go through some strength program with them that day in the office, teaching them how to do it, then, on their own as well, so that they can continue doing it ongoing. The key to physical therapy is always going to be first, like we talked about, identifying what the true problem is--what is the true aspect that’s leading to their musculoskeletal breakdown, and not just where it’s hurting but the entire chain. But then, too, it’s going to be designing a program that the patient is a partner with, and is something they can do on their own going forward, because physical therapy for a patient is going to usually last much longer than their last day in actual therapy itself. We’re going to teach them the tools to fix their problem themselves and to keep them at bay, and to correct their movement patterns which may require little bit of work on them, but we’ll teach them how to do it; we’ll take them through it with the clinic; and we’ll show them how to do it at home as well so that they can correct their movement patterns so that they can move forward, move freely, and have better range of motion, have better strength, and have it in a way that’s going to prevent muscle breakdown in the future as well.
Melanie: And, obviously, it depends on the patient and what condition that they’ve got, but how long typically can a person work with a physical therapy. You mentioned working on their own, and people can't think of it or don’t think of it as personal training session. It’s a very different thing. So, how long and how many times, generally, can they see a physical therapist?
Ryan: The short answer is, however long they need to fix the problem. Obviously, we work with insurance companies, and sometimes there are limitations with visits from an insurance company but, for the most part, we work with most patients a few weeks at a time, maybe a few months. Somebody with more larger issues, somebody just had an ACL reconstruction, I might work with those patients up to six months or so. But, the answer really comes down to as long as is needed for the patient to fix their problems, to fix their movement patterns, and then to show and demonstrate that they can do it on their own to make sure it doesn’t come back. Some people, that may take only one to two visits and be done really quickly, that’s where I get back to your first question, is when to come in. If we can catch things quickly so they don’t get out of hand, so the pain doesn’t get really set in and the tissue doesn’t break down, then it’s a whole lot easier to treat and maybe it’s just one or two visits. If it’s something that’s been there for many years, and problems that have been there for a long time, back pain that’s been persistent since they were in high school, well, that might take a little bit longer, we’re going to have to try to fix something that’s been there a lot longer, and those might take four, six, eight weeks or so. But, really we come down to we’ll spend with you as long as you need it, but we’ll give you then the tools to continue to do it afterwards as well.
Melanie: So, in just the last few minutes, best advice about physical therapy direct access, and tell us about your team at Hendricks Regional Health and Wellness Physical Therapy.
Ryan: Sure. We have a great team here of physical therapists both in Brownsburg, Avon, Plainfield, and then our main hospital out in Danville as well. We got physical therapists, occupational therapists as well as speech therapists on staff. We work in conjunction with each other to provide the best care in Central Indiana. We’ve been recognized by Health Grades over the years for some of our aspects of customer service and our outcomes. We have been leading the charge from a direct access standpoint from the very beginning and have been utilizing this law to help our patients here on the West Side of Indianapolis for a long time now. We work in conjunction, then, not just with the physical, occupational and speech therapists here but we have a conjunction of orthopedic surgeons and sports medical physicians as well as lot of primary care doctors in our network. We spend and take a collaborative aspect of how we approach our patient care. Utilizing those different resources, even our wellness department for some of our long-term care for people that really need help with some changes in their lifestyles as well. We want to take an approach in how we look at somebody who’s not just somebody who has knee pain, but we want to look at that person as a whole person, and how we can fix them, how we can fix, not just their pain and not just their movement, but how can we provide them the tools and the sources to provide care that’s going to give them an ongoing ability to continue coming back or even just effect some lifestyle changes they need to that will help them prevent some of the other problems that could persist as well. We have a great group of people at all four of our clinics that are here to help anybody.
Melanie: Thank you so much, Ryan, for being with us today. What great information. You’re listening to
Health Talks with HRH. That’s Hendricks Regional Health. And for more information, you can go to www.hendricks.org. That’s www.hendricks.org. This is Melanie Cole. Thanks so much for listening.