The Logic of Rehab

We're not experts, but we can play one on the internet.

About The Authors

DEREK MILES

DM

I am a Physical Therapist at UF Health in Gainesville, Florida. I have a B.S. from Clemson University in Biochemistry and worked for a year in a genetics lab before returning to for a Doctorate in Physical Therapy. I hated bench work but loved the scientific method and that has carried over to where now Pubmed is still the primary source of information but now instead of an actual lab, a gym serves the purpose. Upon graduation from UF DPT in 2008 I completed a one year orthopedic residency/fellowship (I still don’t think they have decided what they were calling it at the time). Since, I have practiced at UF with a good mix of the spine and athletic population. I enjoy hanging around people smarter than myself and luckily Gainesville has afforded me a surplus of that population. I’ve been fortunate to have conversations with some of the best pain researchers in the country as well as some minds in philosophy that make any topic an interesting discussion.

My overall treatment philosophy: the crux would have to be we don’t know nearly as much as we claim and I am comfortable saying that to patients. My treatment involves getting really good at ruling out the problems that are out of my scope of practice then offering the best, science based treatment I can. Pain is a subjective experience for each patient so if I can change their subjective, I have changed their pain. It’s knowing how to address fear avoidance beliefs and change them to hedge towards a positive outcome. I need to make confronters remove the stimulus causing them pain and avoiders realize they are capable of more than what they think they are. At the same time it is not getting hung up on the actual diagnosis if it does not change the treatment as all that does is perpetuate anxiety in the patient.

I believe noncontact injuries are training injuries and a thorough review of the training history is an integral part of the solution. Our primary job is to educate patients and help them better define and achieve their goals.

From a movement dysfunction perspective we have to first define normal which often is a huge range. I try and refrain from constructing too much of a narrative on the problem as I see it to a patient but realize that, with time, they can become better at whatever sport they participate in. With that said, my biochemistry background has afforded me the ability to tear in to the literature on tissue healing and realize that time is an integral variable in the development of a treatment plan. We have not found any method to make collagen produce faster but we do know how to stress tissue to allow itself to heal while creating the most optimum environment.

I tell my patients early on that I am extremely boring therapist because they need to get good at the basics before we are going to go on to anything crazy. We will do drills and lift heavy weights until the drills are natural and the weights are still heavy but there’s a lot more on the bar. Never have I heard someone claim that an athlete is just too good at the basics.

 

MICHAEL RAY

svpc_

I am the founder of Shenandoah Valley Performance Clinic in Harrisonburg, VA.  I obtained my M.S. in Exercise Science from the University of South Carolina in 2010.  The primary areas of focus during my studies at USC were on motor learning, neuroimaging, and children with Developmental Coordination Disorder.  After graduating from USC, I briefly worked in cardiology and as a research associate before returning to school to obtain my DC from Sherman College of Chiropractic.  Since completing school I have also co-founded CrossFit Callisto.  I enjoy working with athletes and aiding them in injury risk management, rehabilitation, and sports performance.

My treatment philosophy:  increasing functional longevity – meaning to decrease the number of years patients live with pain, disease, and dysfunction thus increasing the number of years they are able to be active and do what they love.  The biggest epiphany since being in practice – we don’t know nearly as much as we think we do about the fields of pain, physical medicine, and rehabilitation.

My initial focus of care is ruling out red flags requiring a referral and then delivering the most science focused intervention currently solidified in valid research.  I operate under the premise that atraumatic musculoskeletal injuries are training based injuries most likely due to factors such as volume and intensity.  In my opinion, movements are not inherently “good” or “bad.”  It is simply a motor pattern to the body.  The body receives the information (environment and object you are attempting to interact with), processes it, and executes what’s the best way to complete the task based on previous knowledge of similar tasks or that exact task.  A movement that causes an injury is typically one that was not previously adapted to appropriately. My second realization in practice is our primary areas of focus should be patient education and behavior modification.

We currently have not found a valid way to expedite healing of an injury but do know through exercise we can remodel tissue and mitigate pain – which is why exercise is my choice for a primary intervention.  Interventions and their efficacy have been my crusade since graduation.  I seek to provide my patients with as little BS as possible.  Being a Chiropractor has provided an interesting perspective on the world of rehab and has further empowered me to focus on interventions that have gone through the rigors of scientific testing.