I love physical therapy. It’s true that I might be biased; I’ve spent a lot of years and a lot of dollars studying it, and I’ve been living the dream for 11 years working in it, refining it, learning more and realizing that there’s so much more to know. I love it enough to admit that it isn’t perfect, and to want to try to find ways of doing it better.

Let’s start with this super exciting graph:

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This is what we refer to as “normal”. This is our basic expectation for life. This is what we see in the people all around us. For the sake of the discussion, let’s assume all of our “normals” are relatively fit individuals, and that they are able to live their lives and do the things that they want to do for work, at home and in their sports and play.

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These red guys are people that have had an injury.  They have enough pain and/or loss of function that they can’t ignore it. These are my patients. Our goal is to get them back to the “normal” line and out of pain as quickly as possible. However, here’s where the healthcare model starts to get a little complicated.

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That line? That’s typically all that insurance cares about. If you are relatively pain free, your ranges of motion meet some definition of “functional”, and you can perform your job and normal activities of daily living, then they aren’t going to pay for more physical therapy. That is often short-sighted, but this is not the time or place to challenge insurance. Instead, I want to challenge the rest of us about this line. A lot of times, if insurance says that you’ve reached MTB (maximum therapeutic benefit), people assume that’s the best they’re ever going to be and they’re going to accept that line as their new normal. They won’t keep trying to get any better than that.

Now, let’s talk about my favorite patients.

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My favorite patients are the ones who recognize and challenge a place I call “The Gap”, represented here by the area in yellow. There is a place where insurance ends, but there are still gains that can be made. Some people may never quite reach their old normal, but they will jolly well get as close as they possibly can! Other people get so far as to reach or even surpass their old normal. These people are my favorite because they constantly teach me to set aside my expectations and often prove that limitations are in the eye of the beholder.*

The Gap is not an easy place to navigate. Insurance doesn’t cover it, and often it takes time and energy to figure out how to cross it. Some ways that people address it are by paying for more PT out of pocket, working with a personal trainer, getting coaching, or spending time studying on their own. Some simply do a little more here and a little more there.

For some people crossing The Gap is the difference of walking with a cane, or walking unassisted. For others, it is the difference between doing all their activities, but with increased pain and fatigue at the end of the day, versus feeling good while living life. For still others, it is the difference between being frustrated in their sport and being able to train and perform at whatever level they would like, whether in competition or for recreation.

Most of us settle for The Gap because we don’t know what else to do, or we don’t realize how much the little things add up in the long run. There is no one answer or one discipline to lead us to better health, but I hope to use this platform to begin to address  the little gaps that I work with on a daily basis.


*Within reason. These are not people to get caught up in fantasies, but people that test the edges of their limits and push them out little by little wherever they can.

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