FAQs
- Do I really need treatment?
- Am I a candidate?
- How do we do it?
- How does our therapy differ from that at another clinic?
- How long does it take?
- How painful is it?
- What if that pain means something's wrong?
- What if I might need surgery?
- What about my chiropractor or personal trainer?
- What happens if I see the nurse practitioner and not the doctor?
- What if I don’t get better?
- What about my regular doctor and my other medical conditions?
- Do you prescribe pain medicine, i.e., 'manage pain'?
- Is this covered by insurance?
- Do I have to have a referral to come to your clinic?
- I was sent for physical therapy—will I see the doctor, too?
- Do you take care of other joints besides the spine?
- Are you competing with other specialties?
Do I really need treatment? back to FAQs
Although 85% of acute back and neck pain patients improve completely with time and conservative treatment, the remaining 15% enter a chronic phase with ongoing pain. The ongoing pain causes a reduction in muscle use which in turn results in atrophy of the musculature. The atrophy also then causes the patient to be less active; all resulting in higher loads on the already compromised back and neck, etc., creating a vicious cycle that must be broken in order to restore function.
While 'pain' is the reason for entering our rehab program, 'functional restoration' is the goal, which, in turn, reduces this pain.
The body has many ways to 'get the job done'. If something hurts or is not strong enough (both usually are linked), the body will unconsciously find another way to accomplish a task with less pain or effort, thus 'shutting down' the muscles that cause the movement that causes the pain. While this is a good strategy in the short term, over the long haul, it can be maladaptive because once we have changed the mechanics of doing something; the 'balance' of the muscles behind the mechanics will change as well.
So while the body is saying 'if it hurts, don't use it', we are saying 'if you don't use it, you will lose it'. Important spinal muscles atrophy and, therefore, require remedial spine strengthening.
Am I a candidate? back to FAQs
The facts:
- 50% of our patients have had 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.
How do we do it? back to FAQs
Strengthening of atrophied musculature is elemental to improved range of motion, decreased spasm and increased endurance. We use proprietary machinery and techniques to isolate the musculature in question for purposes of
- objectively quantifying strength and range of motion limitations;
- progressively exercising the isolated muscles;
- objectively measuring improvement.
We are able to target specific muscles, both isometrically and dynamically, with our exercises and machinery. Range of motion must be carefully controlled and there is a progressive introduction of exercises. Any 'flare-up' is cooled down with whatever modalities (heat, cold, etc.) may be indicated. Sore muscles frequently occur early on, as would be expected in any exercise program.
How does our therapy differ from that at another clinic?back to FAQs
Most physical therapy for a spine problem is focused upon relieving the acute (new-onset) symptoms of intense pain and spasm, so you can return to your regular activities. Because research has shown that most back pain is rooted in overuse and past injuries, “putting out the fire” with ultrasound or stretches may relieve today’s symptoms, but you can expect another flare-up because the underlying condition has not been addressed. Exercise-based rehab addresses these deeper problems with remedial strengthening and muscle reprogramming.
How long does it take? back to FAQs
A program of rehabilitation typically lasts at least twelve weeks. While our rehab program may last longer than the usual course of physical therapy, we are strengthening muscle (not just treating symptoms) which takes 3 to 6 months instead. Significant improvement is not immediate and only comes after the patient gains enough strength to enter that 'therapeutic range'.
How painful is it? back to FAQs
This is important. Since our program is exercised-based, patients should expect soreness and stiffness, just like when someone jumps right into any exercise after long inactivity.
What if that pain means something's wrong? back to 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.
Though the usual patient reaction is 'pain is telling me that I shouldn't do this exercise', that pain is telling us that the patient needs the exercise. Our techniques do not load disks or spinal joints: muscles and neuro-muscular re-education are our targets in rehab.
What if I might need surgery? back to FAQs
We often receive referrals of patients who might require surgery 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. The important message here is that the severity of the problem does not separate who can get strong from those who cannot; instead, the severity of the problem determines who will improve and who will not - once they get strong.
What about my chiropractor or personal trainer? back to FAQs
The hardest task in caring for your spine problem is matching the right treatment to the condition. Chiropractic, 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. We may ask you to refrain from certain other activities or treatments while in therapy with us.
What happens if I see the nurse practitioner and not the doctor? back to FAQs
Not a problem. Dr. Doerr and Alice Woodruff, APRN sit down daily to review each new patient’s chart, and they personally review every X-ray, MRI and lab test together. This time-intensive commitment is the only way we have found to assure that all aspects of our patients’ cases are given the full consideration they expected (and paid for).
What if I don’t get better? back to 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 neurosurgeon 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.
What about my regular doctor and my other medical conditions? back to 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 these conditions and the patient's baseline exercise conditioning as they pertain to the management of his or her presenting physical problem. 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 doctor abreast of your status.
Do you prescribe pain medicine, i.e., 'manage pain'?back to 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. Once a patient has 'graduated' his or her rehabilitation program, further prescriptions become the responsibility of the patient's primary physician or specialist. If we are prescribing your medications, please give us 24 hours to call/prepare your prescription. Lost, stolen or damaged prescriptions cannot be replaced.
Is this covered by insurance? back to FAQs
Yes, if your insurance covers physical therapy. Some of the plans we participate in include Blue Cross/Blue Shield (except HMO), Health Plan Select, United Health Care (including State Merit), Georgia 1st, Medicare, Medicaid, 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 Dona or Wendy for concerns regarding your insurance coverage or payments.
Do I need a referral? back to FAQs
If you have a physical therapy order from a doctor you may call and schedule to begin treatment immediately.
If you feel you need physical therapy but don’t have an order, or more basically, if you have a problem that needs to be evaluated and diagnosed, you do not need a referral to call and make an appointment with Dr. Doerr and his nurse practitioner for a comprehensive exam. If appropriate for your condition, he or she will order physical therapy and follow your progress.
I was sent for physical therapy—will I see the doctor, too?back to FAQs
Your prescription for physical therapy will also result in a physical medicine evaluation by us if you haven’t enjoyed resolution of your problem upon meeting therapy milestones. 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 op 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 FAQs
We do hips, shoulders, and knees, too. Because there is so much overlap between neck problems and shoulder issues, or low back problems with hip, pelvic and knee pain, we are well-versed in the evaluation, sorting-out and physical therapy of these areas as well. Patients are frequently referred to us with apparent non-spine issues because we will spend the time to analyze and diagnose, treat and/or refer.
Are you competing with other specialties? back to 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.