Hello, my name is Jason Kart, and this is my blog, Jason the PT. I'm a Doctor of Physical Therapy, with CMPT and CMTPT certification. I really want to get back into blogging to help patients and those dealing with orthopedic conditions sort out the facts from fiction—the marketable fluff that leads to drawn out care plans that go in circles. I want to remove the traditional biases that we hold onto that keep us from reaching our physical therapy goals.
Truthfully, I feel that my profession often misses the larger picture, gravitating towards what sells to get patients in the clinic instead of asking the important questions that get to the crux of the matter. This leads to longer and more expensive plans of care, as well as a devaluing of what we do as physical therapists. Furthermore, in a society that craves shorter, more attractive and actionable information, people in the wellness sphere have piled into the social media space with “answers.” This creates a very noisy atmosphere of patients doing things that sound like they work but are generally misplaced.
First, a little about me. I graduated from Syracuse University in 2003 and completed my Doctorate of Physical Therapy at the MGH Institute of Health Professions in 2008. I have worked for Harvard Sports Medicine Department and various outpatient orthopedic practices before starting my own physical therapy company in 2012, Core Physical Therapy.
Since graduating from physical therapy school, I have always been a bit of a skeptic about how diagnoses were treated and curious why they existed in the first place. When a patient came in with a traumatic injury, such as an ACL tear, muscle strain, a fall or the like, that made sense to me. There was a proportional force that disrupted the tissue, leading to injury. That was easy to see and understand. But most patients presenting in the clinic were not telling me that story. Most patients' pain had a gradual onset, or the apparent source of their pain was disproportionate from what they were experiencing. A particular patient told me that she was bending over to pick up a pair of socks on the ground and her back “exploded in pain.” That didn’t make sense to me. Why would this person have such intense symptoms after doing something fairly benign?
In those early days of my career, I looked for answers from some of the more seasoned physical therapists in the big box clinic where I was working. The answers tended to follow a fairly simplistic pattern:
"#Overuse”
“Bad form”
“#Muscleweakness”
“#Tightmuscles” or “Tight hip flexors”
“Poor core strength”
“#Badposture”
I wasn’t very satisfied with those answers. They seemed too easy and convenient in a system as complex as the human body. After all the anatomy, physiology, neuroscience, kinesiology I'd studied, how could it be that simple? The patients seemed content, though; they could wrap their heads around those answers, at least for a while. They would come to physical therapy three times a week as instructed and do all of their stretches and strengthening exercises. But at a certain point they would get frustrated, hitting a wall or even failing to make any meaningful progress.
Then there were the treatment philosophies that didn’t make sense. Most of the treatments were centered around whatever tissue broke. Take plantar fasciitis for example: most treatments were centered around trying to heal the tissue in the foot. The physical therapist would scrape and ultrasound and massage the area, without reason or explanation. Apparently our role was to make the tissue heal faster. I watched one physical therapist march a poor patient around the clinic for three months without any sort of improvement. I thought that this was literally the definition of insanity: doing the same things over and over and expecting a different result. It seemed like the expectation was that our mere intervention had some magical healing powers. The patient never got better and left after 20+ visits. That's hundreds of dollars spent with nothing to show for it. The physical therapist never once questioned why this pathology came to be, why the treatments failed to produce results and continued to feed the patient simplistic answers. I knew there had to be more to it than this.
“Realize everything connects to everything else.”
- Leonardo da Vinci
In 2010, I was accepted into the North American Institute of Orthopedic Manual Therapy’s (NAIOMT) certification program, where I finally started to get answers. I spent the next two years learning that most pathologies that do not have a reasonable explanation are often a downstream effect of a mechanical dysfunction of a joint, as a result of weakened tissue caused by a spinal facilitation or a non-orthopedic medical cause. I realized that these pathologies need to be looked at like a formula, not as isolated incidences of tissue disruption. These were mechanical and orthopedic issues running in the background, and the final stage was the trigger, not the cause. The ratio of healing to breakdown was slanted in the wrong direction, causing a “wearing down effect” leading to dysfunction. By recognizing the dysfunctional joint or the underlying spinal issues, you can see that the diagnosed pathology was the result of an unbalanced equation. This changed how I viewed physical therapy forever.
One thing I want to do in this blog is discussing these mechanisms, and how directing treatments at the cause, not the end result, makes people heal faster.
My second revelation was when I began my practice of Dry Needling through Myopain Seminars. I took this class as a skeptic, but it was becoming the hot topic in physical therapy. At the time I had been dealing with some lower back pain for about three years. I had done all the NAIOMT stuff I had learned and I got significantly better. Yet I continued to deal with a low level, dull back pain that would drift to the back of my right hamstring. I just couldn’t kick it or define it. During the first class on the first day, the person practicing on me pushed right on the upper part of my right glutes and wow… there was my pain completely! I never had anyone pinpoint it like that before. She needled the area and holy cow, it hurt. The next day it felt like somebody had whacked me in the right butt cheek with a baseball bat. On the third day it was gone! I never thought muscles could cause and refer pain like that. Now mind you, I never had a glute problem (so I thought), but it was there and it was the missing piece. When I put my NAIOMT training together with my Dry Needling training, it all ran together AND IT MADE SENSE.
Here I'll also discuss how Dry Needling can help clean up muscular issues once the source of the dysfunction is found.
The third revelation was when I wanted to start my own practice. I was disillusioned by the business models of the big box companies. I wasn’t being rewarded for getting people better faster; in fact, I was being penalized. My “numbers” just weren’t there. I was told success looked like 12 visits per patient case. In fact, a memo from the CEO of one of these companies basically stated that the patient should be told they have to come to physical therapy 3 times per week for 4 weeks. Wow.
Here's the truth: low quality or incomplete healthcare will always be more lucrative than good healthcare. It is a fee for service industry. The more the patient comes in, the more money we make.
I would rather get the patient better and be the go-to for their community moving forward. I will dedicate a portion of this blog to helping current and future patients be better consumers of their physical therapy care.
I'm looking forward to re-starting my blogging and helping patients get the most out of their care. If you have any questions or comments, feel free to hit up my contact form. I look forward to getting you better!
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