A lot of people don't realize that this skill set is part of the PT scope of practice (provided you attended a school or had some other form of training in the skill). There are differences between professions in how and why "cracking" joints is performed along with different terminology, but the main point to get out there is share how the techniques can enhance a rehab session in very powerful ways beyond just the "crack."
In physical therapy, the term we use is manipulation. With physical therapy sharing a lineage with osteopathy, manipulation of the spine or any other joint system is grounded in one of the core tenets of osteopathic medicine, which is the body has the innate ability to heal itself. Our role as practitioners is for the body to reach a homeostasis that enables this self healing ability. We're not putting joints "back in line" or fixing things "out of place." We're simply using a technique with the body that can make some change to create a more optimal environment for healing.
If a physio manipulates your spine, for instance, you clearly feel a change to your body in the immediate aftermath. That's simply signaling that some change has occurred in the short term which creates conditions for the body to more effectively deal with any problems internally.
So once we perform the manipulation, that's actually when we're getting started. We're squandering ripe opportunities for improvement if we stop there. Yes, we can still benefit if that's all the session entails, but the "magic" in the manipulation is how it allows us to move better to do the physical work and even psychological work during that SAME SESSION that will have the greatest long term change for the body.
I always say there are some things you just can't exercise your way out of, or at the very least that exercise alone without other techniques will make for a longer road toward healing. Adding manipulative therapy into a session literally allows us to supercharge EVERYTHING that we do. What it also does is make our results more durable, meaning because we achieve such a potent effect with the combo of manipulation (and other manual techniques) plus exercise, you don't need to come in several times per week to see results. It's like taking your car to the mechanic and having them fix the problem, versus having to come in multiple times per week to keep topping off fluids leaking from the engine.
It also avoids the common scenario where you might get some wonderful treatment on the table and feel amazing, but then get in your car and drive around for a while or return to work at a desk for the body to revert closer to where it was before treatment. Then you go exercise in a separate session and you've lost some of the immediate benefit of the therapeutic technique.
Bottom line: physios are trained to perform manipulative techniques (joint "cracking" in crude lexicon) and doing so allows the amazing results achieved within comprehensive treatment session to have the longest lasting effect.
Wonderful summary here from Dr. Jenna Siracuse at On Pointe Wellness in Virginia. Every single one of these apply to how we care for patients at Ventana Physiotherapy.
1. More one-on-one time with your therapist.
This is 100%, without a doubt, the most important piece to me (and most of my patients as well)! When you are not worried about billing insurance companies and being reimbursed for your time, you suddenly have much more of it to give to your patients. There are typically no aides or trainers involved in your session, it is all time spent with your therapist. Most PT's went into this business because they love working with and helping people. This therapy approach really allows us to get back to the reason we became PT's in the first place- and you reap the benefits!
2. More personalized attention.
When you are working one-on-one with your therapist, I can assure you the care you are getting is far more personalized then it would be otherwise. Your therapist won't be running back and forth between patients, the focus is 100% on you. This allows us to really assess each of your movements and make adjustments based on what is happening during each exercise. The end result is a completely individualized treatment plan to correct your specific muscle imbalances and help you get better faster!
3. Builds a strong patient-provider relationship.
Now, I know this one may sound a bit redundant but it sure is important. When you are being treated in a cash based PT setting you build a really strong relationship with your therapist. You are probably going to be spending a lot of quality time together and end up feeling more like friends in the end. Trusting your therapist has a huge impact on your healing, and having the opportunity to get to know each other one-on-one really allows for a deeper sense of trust to develop. All of my patients have my cell phone number and know I am always "on call" and they reach out whenever they need me. Most cash based PT's I know do exactly the same for their patients.
4. Yes, It may actually save you money in the long run.
Quality over quantity is an important concept here. More one-on-one time with your therapist means we don't need to see you as often. On average, I only see my patients 1x/wk but it is for a full hour. Sometimes we need 4 visits, sometimes its more. Either way, it gives you plenty of time between sessions to work on your program and start to see some results. More importantly, it empowers you to put in the work which = getting better, FASTER. With a less frequent PT schedule, this often works out to be much less than actually using your insurance.
Take this scenario for instance: a patient with a high copay of $60 per visit who needs to go to PT 2-3x/wk for 8 weeks will spend close to $1000 over the course of their care. During their visits, they are likely only spending ~20 minutes of actual one-on-one time with their PT. That's a lot of money and time for little reward. If that patient instead chooses a cash based PT practice that charges $150/visit and needs only 6 visits, you are looking at $900. The math is a no-brainer!!
5. More freedom to address multiple issues at the same time.
While it is extremely unfair, insurance companies strongly dictate if you get better or not based on what they will approve. Did you know that under insurance PT's can only bill for treating one body part at a time? That means that you would need 2 separate evals and visits each week to be able to bill your insurance for your knee and your shoulder problem. In some cases, your PT may be able to justify it. They just better be prepared for a lot of extra paperwork, which really means less time for personalized patient care. Crazy right!? In the case of cash based PT-- not an issue! We can treat whatever issues you are having without you needing to worry about it being denied by your insurance. Again, the outcome is you getting better faster because you are actually getting the care your PT knows you need.
6. More freedom to explore the root cause of the problem.
With longer one-on-one appointments and not worrying about insurance approvals, your PT can perform a thorough assessment of strengths, weaknesses, imbalances and how you move. This means we have a full picture of what is going on. It may be your hip that is pinching, but WHY!? Maybe you don't have a strong core or your upper back mobility is limited. So we work on all of these areas and make sure to address the reason it happened in the first place. This results in you living pain free and preventing issues from returning in the future. No trying to explain this to an insurance company just to get denied.
7. Many insurance companies reimburse for out-of-network PT.
Depending on your out-of-network benefits, your insurance company may actually reimburse you for your visits! Just make sure you get a superbill from your PT that you can submit to your insurance company. At [Ventana], I always provide my patients with a superbill on request.
8. More flexible scheduling means getting more of your time back.
It is no secret that time is our most precious commodity, and we cant get it back. Only needing to see your PT once a week gives you more time back to do whatever you love! At [Ventana] Wellness I try to give you back even more of your time by giving you the option of home-based visits. You won't see your insurance company offering you this option very often!!
The last 2 are my favorite...
9. Empowering you to help heal yourself.
A good Physical Therapist will not "heal you" they will teach you to help heal yourself. Physical Therapists do not want you to use us as a crutch, we want you to take your health and wellness into your own hands. You have the power to help heal yourself, we just give you the guidance you need to get there. By choosing cash based PT, you have already taken a huge step towards empowering yourself, because you have made the commitment to invest in your health. The truth is, patients who pay out of pocket are far more committed to their treatment plan because they have paid their hard earned money for it.
10. Your health is worth any amount and is the BEST investment you could ever make.
It is simple, you only get one body and one chance-- take care of it!!
All of this really comes back to one main point. Cash based Physical Therapy has the ability to provide you with the highest quality of care. Aren't we all looking for a better experience with health care these days? I can promise you that high quality, affordable care still exists and your insurance company does not have to be the barrier.
I could not be happier with the choice that I made to leave traditional clinic life behind. As with most PT's who switch to a cash based model, my intentions have always been to put my patients first and give them the care they deserve. I can now say with certainty that I am able to provide them with a better patient experience than they would get anywhere else.
If you are considering cash based Physical Therapy for yourself, start with a simple Google search for PT's who may provide this in your area. I highly suggest taking advantage of a phone or in-person consultation so you can get a better feel for if this is the right way to go. In the end, its all about fulfilling your individual needs. Stay informed, do your homework and know that there are still so many health care providers out there who truly care about helping you live your best life!
RESET - make. an immediate change to the body, often through some form of manual therapy. Think of hitting the "delete" button or even doing a complete system restart of a device. Many degrees of resetting exist, which can be something as gentle as light stretching, to something more potent such as a spinal manipulation. Regardless of what technique we choose, we're trying to make a change to the body.
REINFORCE - but we can't stop there, although that is where many people do stop, being sent away from the clinic and just hoping that that therapy "sticks," or if not, making plans to keep coming back again and again to keep addressing the same problem over and over (think of those times you've been told you need to sign up for a plan of 2-3x per week for weeks on end...). Reinforcing stage is where we teach the body to move differently. If you typically round your back when you hinge forward, this is where we might teach you different mechanics to spare your spine. But remember, change is unlikely to happen unless we actually DO something, which is what the reinforcement stage is all about.
RELOAD - This is where we take our reinforcement strategies and hit the "SAVE" button. Ever have that feeling of getting great therapy but then within a day or so you feel like nothing much has changed? We can avoid this phenomenon by applying loading strategies to the body to remind it to make a change. Remember the example of changing how we bend forward? To transition from REINFORCE to RELOAD, we'd take that same pattern but make it more demanding such as by picking up a weight. This is how we avoid the problem of feeling great off the table and doing some light movement but then feeling like we take a few steps back when increasing the demand or intensity of the movement. This doesn't mean we challenge ourselves at a high intensity without proper progression; it simply means we need to provide something (such as a weight) that speaks to the body and reminds it to make some type of permanent change.
Allan Phillips, PT, DPT is owner of Ventana Physiotherapy