- I have back pain (or neck pain). What kind of doctor should I see?
- I've been diagnosed with a herniated disc. Shouldn't I see the surgeon?
- What about my regular doctor and my other medical conditions?
- Do you prescribe pain medicine, i.e., 'manage pain'?
- Do I need a referral to see Dr. Doerr?
- Are you competing with other specialties?
- My problem is better now. What if I have problems in the future?
- Do I really need therapy?
- Am I a candidate for your treatment?
- Can I skip therapy and just get injections?
- I'm athletic. Why do I need therapy?
- How does your therapy differ from other clinics?
- How much personal attention will I get in therapy?
- Will therapy make me hurt worse?
- What if I might need surgery or injections?
- What about my chiropractor or personal trainer?
- What if I don't get better?
- Is this covered by insurance?
- Do I need a referral to have physical therapy/rehab?
- I was sent for physical therapy—will I get to see Dr. Doerr, too?
- Do you take care of other joints besides the spine?
- Can’t you just show me the exercises I need to do that will make my spine better?
- I don’t have time to do physical therapy…
- How long will physical therapy take?
- Can’t you teach my personal trainer to do my therapy?
- My doctor / my trainer gave me some exercises for my back. I’m doing them but getting worse. Why?
I have back pain (or neck pain). What kind of doctor should I see?
Back to Physical Medicine FAQs
In general, you should see a doctor who will examine you closely for the warning signs of a serious problem, who will order and study the films (MRI, X-rays) to confirm a diagnosis, and who will 'shepherd' you through your treatment to a satisfactory resolution of your problem.
A physician like Dr. Doerr, specializing in Physical Medicine (also known as PM&R, or physiatry) is a great starting point for patients with a spine problem. His job is to make a diagnosis, give it a name, and decide upon the best plan of action. He provides the patient a rationale as to whether his/her problem can improve with simpler treatments, or if injections and/or surgery may be needed.
Many family and primary doctors use Dr. Doerr as the point of entry into the 'system' for their patients with spine problems. He will stay involved with a case until the patient is successfully treated or referred.
I've been diagnosed with a herniated disc. Shouldn't I see a surgeon?
Back to Physical Medicine FAQs
Possibly, but the majority of herniated (ruptured) discs heal without surgery. The size and location of the disc on MRI coupled with particular findings on history and physical exam - such as changes in your bowel and bladder function, reflex changes, or new arm or leg weakness - help to determine if you need to see the surgeon immediately, or can try other treatments. Often, the surgical decision is contingent upon whether or not you have a good response to physical therapy and/or injections. It is important to us that you can understand and even 'see' your problem on your films, so that you are part of the decision-making.. And again, we will stay involved in your care until the problem is definitively treated.
What about my regular doctor and my other medical conditions?
Back to Physical Medicine FAQs
Management of other medical conditions (diabetes, heart disease, hypertension, etc.) is not a part of this program, but Dr. Doerr must be aware of them to properly manage your treatment here. In general, these conditions do not limit one's ability to engage in spine rehab. Also, it is our duty to keep your regular doctor in the loop with regard to our diagnostic impressions, treatment plan, and consultations. Because fragmented care is almost as bad as no care at all, we send letters and progress notes to document visits and rechecks to keep your doctors abreast of your status.
Do you prescribe pain medicine, i.e., 'manage pain'?
Back to Physical Medicine FAQs
We are not a 'pain clinic', but a physical rehabilitation center. However, Dr. Doerr does prescribe appropriate medications which may include pain medications when you are an active rehab patient. If we are prescribing, we require 24 hours notice to call/prepare your prescription. Lost, stolen or damaged prescriptions cannot be replaced. Once a patient has 'graduated' his or her rehabilitation program, further prescriptions become the responsibility of the patient's primary physician or specialist.
Do I need a referral to see Dr. Doerr? Back to Physical Medicine FAQs
Usually not. Unless your insurance company requires a referral from your family doctor, you may call our office to make an appointment with Dr. Doerr for a comprehensive exam. While most of our patients do come by recommendation from other doctors, a growing number of our patients are self-referrals.
Are you competing with other specialties? Back to Physical Medicine FAQs
We have no "turf battle" with other specialties. We aren't competing with neurologists or pain specialists or orthopedic surgeons or neurosurgeons. On the contrary, we enjoy good relations with all specialties and utilize them for the sake of our patients, as they do for theirs. Indeed, if you still need further evaluation or treatment that goes beyond our offerings, we will make your referral and appointment, and send any pertinent information and films to support your case - because it's the right thing to do.
My problem is better now. What if I have problems in the future?
Back to Physical Medicine FAQs
''We'll leave the light on for you". Even when you finish care and are discharged, we still consider you to be one of our own. So if you have a problem down the road, we want you to call us for advice and we'll be pleased to care for you. It can be a scary and lonely feeling when you are in pain. We want you to feel that you have a safety net, and can call us if you have a problem.
Do I really need therapy? Back to Physical Therapy FAQs
Yes, if you want to get over your current problem, as well as prevent or limit further issues with your spine in the future.
Although 85% of patients with acute back and neck pain can improve completely with time and conservative treatment, many have limited function and prolonged or recurrent pain before things settle down.. These issues result in less activity and altered spine mechanics. Certain muscles weaken (atrophy) and others become overused. This imbalance results in higher loads and more strain upon the already compromised back and neck, creating a vicious cycle that must be stopped in order to restore normal function.
Our therapy consists of purposeful remedial strengthening and 'reprogramming' of essential spinal and 'core' muscles. We use our hands to evaluate, monitor and treat muscle tone and alignment issues. We use specialized machines and gravity-based exercises to increase your control and endurance. But, just as importantly, we teach you the proper spine mechanics you must have when doing real-world activities, and we teach you the 'do's and don'ts' of exercise - whether in the gym or on your bedroom floor - to help prevent further problems.
Am I a candidate for your treatment? Back to Physical Therapy FAQs
- 33% of our patients have had previous spinal surgery.
- 80% have had previous physical therapy.
- Some patients are referred to us for treatment of conditions that have already been diagnosed.
- Others are sent for diagnosis as well as treatment.
In the end, any patient at any point in their process is a candidate for aggressive rehabilitiation.
Can I skip therapy and just get injections? Back to Physical Therapy FAQs
Injections can be very helpful, and a number of our physical therapy patients have had successful injection therapy as part of their care. We often think of injections as a 'reset button' where the 'fire' in an angry joint or surrounding an injured disc is 'cooled'. But we also strongly believe the duration of relief provided by injections is directly related to how well you 'behave' afterwards. If you don't have a strong-enough core to withstand spinal loading forces, and if you haven't learned proper spine mechanics and proper 'spine hygiene', the benefits of your injection may be short-lived. Physical therapy is essential for assuring you have all the strength and knowledge needed to better prolong the positive effects of injections.
I'm athletic. Why do I need therapy? Back to Physical Therapy FAQs
We observe that athletes and serious exercisers often are misinformed about what kind of exercises are safe for their spine. An inventory of their regimen is absolutely important because it often reveals motions or forms that are biomechanically unsafe for their particular condition. Learning these insights is key to getting (and staying) better.
So, while the 'physical' part of physical therapy can be reduced by motivated athletic patients who can precisely execute and complete their assigned exercises, it is the 'learning' part of therapy where athletes have thanked us for helping them discover certain activities that kept their problem from healing, and mastering strategies to reduce further problems even while continuing to exercise vigorously.
How does your therapy differ from other clinics? Back to Physical Therapy FAQs
Most physical therapy clinics focus upon relieving the acute (new-onset) symptoms of intense pain and spasm, to quickly return you to regular activities. However, because research has shown that most back pain is rooted in overuse and past injuries, you can expect another flare-up because the underlying condition has not been addressed. Our exercise-based rehab addresses these deeper problems with remedial strengthening and muscle reprogramming, and then we teach you home exercises and proper spine care to stay improved.
How much personal attention will I get in therapy? Back to Physical Therapy FAQs
Plenty! Almost all of our patients receive one-on-one treatment with a member of the physical therapy staff for the entirety of each therapy visit. This commitment to quality individual care is extremely uncommon in the physical therapy world. We recognize that spine patients need a lot of hands-on treatment and teaching, and that there are no shortcuts. So far, even in spite of the current climate of shrinking insurance reimbursement, we have been able to remain uncompromising, and thus provide superior care.
Will therapy make me hurt worse? Back to Physical Therapy FAQs
Apprehension is the greatest limiter of physical performance.' If you have been in pain for a long time, it is natural to be very concerned if your pain increases upon starting an exercise program. Activating muscles that haven't been used in a while will cause your body to protest a bit (especially in the first few weeks). Keep in mind that our techniques of therapy are carefully designed to avoid putting discs and joints at risk. Our goal is to strengthen and reprogram muscle and nerve function to "unload" vulnerable spinal structures. Also, rest assured that it is our duty to listen to you and analyze your pain patterns to assure that nothing of alarm is happening as you progress through therapy.
What if I might need surgery or injections? Back to Physical Therapy FAQs
We often receive referrals of patients who might require surgery or injections but the referring doctor wants to see if rehab might improve the patient's symptoms. Other times we are sent patients who are already scheduled to have spine surgery, but their surgeon wants to begin 'pre-hab' strengthening before the procedure.
Our experience working with these patients has demonstrated that even patients who need surgery can "get strong" and "reprogram". The important message here is that the severity of the problem does not separate who can achieve the milestones of therapy from those who cannot; instead, the severity of the problem determines who will improve and who will not - as they achieve the milestones.
If your response to physical therapy indicates that you might indeed benefit from surgery or injections we will clear the path for you to have a prompt consultation/re-consultation. We will assure that the consulting doctor receives our reasons for referral, as well as whatever data (X-rays, MRI, therapy notes) will help to make an informed decision.
What about my chiropractor or personal trainer? Back to Physical Therapy FAQs
The hardest task in caring for your spine problem is matching the right treatment to the condition. Chiropractic manipulations, acupuncture, massage therapy, surgery, injections, and physical therapy are reasonable treatments at particular times for certain conditions in different people. Because other activities or therapies may either negate or aggravate our treatment, we often try to control outside variables. While in therapy with us, we may ask you to refrain from certain other activities or treatments; then reintroduce them as your condition stabilizes.
What if I don't get better? Back to Physical Therapy FAQs
If your spine problem doesn't get better with therapy, you may be proving that your condition needs more investigation, or the services of a spine surgeon or pain specialist. We believe it is our responsibility to our patients to establish a diagnosis and refer appropriately if we are unable to help.
Is this covered by insurance? Back to Physical Therapy FAQs
Yes, if your insurance covers physical therapy. Some of the plans we participate in include Blue Cross/Blue Shield, Health Plan Select, United Health Care (including State Merit), Medicare, Medicaid CMO's, and Beech Street, and we are also a Worker's Compensation provider. You may check this list of providers or call us at the office to confirm your insurance. Please see Angie or Wendy for concerns regarding your insurance coverage or payments.
Do I need a referral to have physical therapy/rehab?
Back to Physical Therapy FAQs
If you have a physical therapy order from a doctor you may call and schedule to begin treatment immediately. Many doctors will prescribe physical therapy, but the choice is yours where you wish to have it. Please be aware that some insurances may require pre-authorization before beginning treatment - just call us if you have any questions.
I was sent for physical therapy—will I get to see Dr. Doerr, too?
Back to Physical Therapy FAQs
If you were sent here directly for physical therapy, and if your problem is still present upon meeting therapy milestones, your case will be evaluated by Dr. Doerr. Whether you come to us via physical therapy or the physical medicine route, we strive to put together a picture of your problem: we obtain surgical reports and pertinent progress notes, as well as we order and/or review all imaging studies - the reports and the actual films - to design the best individualized treatment plan.
Do you take care of other joints besides the spine? Back to Physical Therapy FAQs
Yes. In fact, because we are orthopedic physical therapists, our therapy staff is trained, equipped and very comfortable in treating all sorts of joint, muscle and bony problems, including joint replacements and surgical joint repairs. We take care of shoulders, hips, knees and feet (and almost everything in between).
A number of physicians directly refer their patients to our physical therapists, and trust us to give capable and complete care to even their most fragile patients. Also, because there is so much overlap between neck problems and shoulder issues, or low back problems with hip, pelvic, knee and foot pain, complicated patients are frequently referred to us because we will spend the time to analyze, sort out and thoughtfully treat their problems.
Can’t you just show me the exercises I need to do that will make my spine better? Back to Physical Therapy FAQs
Yes—but it takes a bit longer than you might think. We so sincerely want our patients to do well—we devote a significant amount of therapy time teaching you a home exercise “curriculum”—and we coach you to do these exercises correctly. Because some exercises look pretty “standard” to the untrained eye, it is extremely important to understand the slight variations that can get you into trouble, and what your body should feel when doing them correctly. There is no room for “almost” after a person has lost time, money or work from an injury (especially one that could be prevented).
I don’t have time to do physical therapy… Back to Physical Therapy FAQs
Taking care of health problems can be time consuming and inconvenient. Physical therapy is an investment to actually reduce your overall inconvenience by learning exercises, stretches and strategies to control, manage, and even heal your problem. Taking some time now can help you be more independent in the future. We are here to help you solve the current problem as well as prevent future problems.
How long will physical therapy take? Back to Physical Therapy FAQs
We begin planning your discharge on your first PT visit. On your first day of physical therapy, we actually write treatment goals to accomplish so that you will leave us as soon as possible—but leave safely, and with knowledge of the proper spine “care and feeding” to manage your specific problem. Keep in mind we are strengthening muscle (not just treating symptoms. Significant improvement comes as you gain enough strength to enter a 'therapeutic range', can maintain spine stability when using it, and can avoid the 'bad form' that will aggravate it again. We have seen many people waste untold amounts of money, worry and frustration because they were in a hurry and couldn’t understand that the goals of therapy are so much more than learning a “magic exercise” or “magic stretch”. We are dead serious about your problem—and there is a lot to accomplish in PT—but our success is in getting you better and gone, not in keeping you around forever.
Can’t you teach my personal trainer to do my therapy? Back to Physical Therapy FAQs
Personal trainers do a great job of supervising exercise programs to develop and maintain overall strength and conditioning. But, they are not trained or credentialed to treat injuries.
Physical Therapists are trained in biomechanics, kinesiology and the science of injury repair—their job is to analyze, treat and rehab you when something is not right. They will also teach you the do’s and don’ts for your specific problem, so that when you are better you will understand what to modify in your exercise program with your trainer so you can stay that way.
My doctor / my trainer gave me some exercises for my back. I’m doing them but getting worse. Why? Back to Physical Therapy FAQs
It’s personal. While some exercises are good for all back conditions, there are others that may be right for one problem but are a poor choice for another. We’re pretty finicky about distributing handouts or booklets of spine exercises unless we know the diagnosis (so we can select the correct exercises for your problem) and unless we can personally teach and review the exercises with you.
It’s a jungle out there. There are lots of booklets, pamphlets, sheets and magazine articles that show exercises for strengthening and taking care of your back. However, current research shows a number of back exercises that are still commonly accepted as being “good” for you (for example, “Supermans”) are just plain bad, and will rupture a disc in the vulnerable person.
No matter what anyone says, it’s NOT simple. Even if you have pictures or videos of the exercises, keeping perfect form while doing them is hard. You will need feedback and coaching to get it right. Even a simple squat can rupture a disc if you are not paying attention to keeping the correct curve in your spine while doing it.