The Straw that Broke the Camel’s Back

We have all heard the common proverb “It’s the last straw that breaks the camel’s back“, referring to how something presumably minor can, overtime, cause a catastrophic and sudden reaction, due to the cumulative effects of the individual actions. Whether this refers to car tires wearing down overtime until the tire eventually blows a flat, a tree covered in ice during a snow storm that slowly bends more and more until it finally snaps, or continually “squeezing” into those tight jeans until finally one day you try squeezing into them and they rip at the seam, the overlying idea is that it was not one single event that led to the destruction; instead, it was gradual wear and tear over time. The same holds true for a large majority of injuries to the human body.

“It’s the little details that are vital. Little things make big things happen.”

– John Wooden

Many of the injuries we treat are not due to a single traumatic event, but are more often from chronic wear and tear, or as we describe it, repetitive microtrauma. Whether that be rotator cuff tears, carpal tunnel syndromes, lateral Epicondylagia/Tennis Elbow, Bulging/Herniated Discs, Arthritic related conditions, knee pain, tendonitis, etc., the underlying cause of the dysfunction is due to repetitive microtrauma leading to tissue breakdown and pain. 

What causes repetitive microtrauma?

The simple answer is an underlying movement dysfunction and/or sustained postures, which results in muscle imbalances, soft tissue restrictions, joint dysfunctions, adverse neural symptoms, impaired stability/motor control, and eventually structural adaptations. Our job as physical therapists MUST be to not only treat the site of pain, but to identity and treat the underlying movement dysfunctions which led to pain and limitation in the first place. In other words, we must identify and treat the cause of the cause.

If my pain goes away, why does it matter?

When a patient comes into OSSPT with a rotator cuff tear, whether it be post-surgical or for conservative treatment, our first priority is to provide a proper environment to allow adequate healing to the damage tissue. Then we must identify and treat the underlying movement dysfunctions which led the rotator cuff to tearing in the first place, to prevent future recurrences. Simply giving generic range of motion and strengthening exercises is not enough and will result in short term improvements, at best. If we don’t fix the underlying cause of the cause, the likelihood of future re-injury is high.

Physical therapists wonder why so many of their patients return to the clinic weeks/months/years later complaining of the same symptoms they were previously treated for, often, blaming the patient for being non-compliant, a failed surgery, age, etc., without ever looking internally. We, as a profession, need to spend more time educating and proving to patients that we are more than just a profession of people who give out “stretches and stuff” as some claim, and prove to patients we are an invaluable member of the medical team, because right now, we are heading in the wrong direction as a profession, having become a bunch of overqualified exercise supervisors. If we keep heading this direction, doctors will continue to disregard our abilities, insurance companies will continue to cut reimbursement, and patients will continue to devalue the services we provide, until eventually, it will be the straw that broke the camel’s back for our profession.

Here’s to the Crazy Ones…

“Here’s to the crazy ones, the misfits, the rebels, the troublemakers, the round pegs in the square holes… the ones who see things differently — they’re not fond of rules… You can quote them, disagree with them, glorify or vilify them, but the only thing you can’t do is ignore them because they change things… they push the human race forward, and while some may see them as the crazy ones, we see genius, because the ones who are crazy enough to think that they can change the world, are the ones who do.”

– Steve Jobs

What made Steve Jobs so special was not his genius. We are surrounded by “geniuses” everyday. What truly made Steve Jobs so special was his laser focused vision, his imagination, his optimism, and his determination. It was his unwillingness to accept the status quo. He wanted more from his employees and his company.

When Geoff and I opened OSSPT we committed ourselves to only hiring those same likeminded people who wanted more for themselves and for others. We searched for individuals who might be considered the crazy ones, the misfits, the rebels, the troublemakers, the round pegs in the square holes”. We didn’t want the typical physical therapist; we wanted the outlier. We wanted the physical therapist who voluntarily works full time, while simultaneously completing a very expensive and time consuming 2.5 year orthopedic residency program because he/she wanted to provide a better quality of care to his/her patients. We wanted the physical therapist who works 45 hour work weeks then spend his/her days off completing extensive manual therapy fellowship training. We wanted physical therapist who is not satisfied with being “average” or “typical”… and we luckily found just that.

Our physical therapists have the most advanced training possible and are the most highly qualified to treat your specific needs. You can quote them, disagree with them, glorify or vilify them, but the only thing you can’t do is ignore them because they change things… they push the human race forward.” We are challenging the traditional treatment model of chasing pain, treating symptoms and not causes, searching for short term relief in spite of long term improvements. We are striving to change the norm and in some small way, change the world. While some may see them as the crazy ones, we see genius, because the ones who are crazy enough to think they can change the world, are the ones who do.”

So what makes our staff so special? It’s our laser focused vision, our imagination, our optimism, and our determination to truly make a positive and lasting impact on our patients. We are not satisfied with being average. We are not satisfied with doing the norm and while we have a long way to go, we are tirelessly working every day to improve. The norm has been failing patients for years and they deserve better, and that is what we aim to provide. If all our individual contributions result in a tiny positive change to the world for the better, then we have succeeded. So… Here’s to the crazy ones!

Our Profession Owes You an Apology

When an individual has a heart related condition, they see a cardiologist… When an individual has a skin related condition, they see a dermatologist… When an individual has a cancer related condition, they see an oncologist.

In every area of our lives we search for the experts, why should physical therapy be any different?

The quality of care we have come to expect from the physical therapy profession has become so low that the assumption is that all physical therapy is the same; however, this could not be further from the truth. When a physical therapist graduates from school, in a sense, they become a “jack of all trades”. They have a very broad knowledge base making them novices in all aspects of physical therapy including orthopedics, pediatrics, acute care rehab, neurological, spine,  sports rehabilitation, etc; similar to how graduates of medical school have developed a foundation of cardiology, neurology, immunology, etc. The major difference between medical school and physical therapy school, is that for the majority of physical therapists, the structured training ends after PT school, unlike medical school graduates who then advance to a multiyear residency program focused on a singular specialty, often followed by fellowship training to further specialize.

As any orthopedic surgeon would agree, not until the residency and/or fellowship programs do they become confident in providing the quality of care necessary to make measurable improvements for their patients.

“I fear not the man who has practiced 10,000 kicks once, but I fear the man who has practiced one kick 10,000 times.”

– Bruce Lee

Why don’t more physical therapists undergo additional training?

The unfortunate, but honest answer is that it’s not required and patients aren’t demanding that their physicians refer them to the experts. Most patients do not search for the best physical therapy clinic to attend and often go wherever the doctor recommends. Unfortunately, many of these referral decisions are based on location, personal relationships, or financial ties with that clinic. Furthermore, Less than 10% of physical therapists have completed a post graduate residency program and less than 2% of physical therapists have completed a manual therapy fellowship program, so the public often does not even know these residency and fellowship programs exist.

Does this mean that you can not be a good quality PT without completing a residency or fellowship program? 

Definitely not. I know quite a few good PT’s who have not completed residency and fellowship training, but I know for a fact that  these same PT’s would love to  complete a residency program if the costs were not so high, the time demands were not so much,  if their employers were more supportive, and if insurance reimbursement was paid based on results.

How is OSSPT any different?

First, every one of our therapists has completed fully accredited advanced orthopedic and/or sports residency programs. Also, our physical therapists have completed or are actively completing a manual therapy fellowship program to further improve his/her skills. Additionally, our company is independently owned by the same physical therapists treating you in the clinic with no outside influence by any hospitals, medical groups, or corporations, so patients can take a lot of confidence in knowing that the only reason physicians recommend us is based on the quality of care we provide and our excellent results. Finally, we are such strong advocates of residency and fellowship training that we cover the entire cost to complete the programs for all new physical therapy employees.

Moving forward, I challenge you, the patients, to demand more from us. Do your homework and seek a higher level of physical therapy care. We spend hours debating the best restaurants to eat, searching the internet for the best shopping deals, and researching the best physicians and surgeons, then blindly go to the nearest physical therapy clinic to our home/work without thinking twice. Ask friends for recommendations, ask your physician if they have any financial ties to the clinic they are referring, drive the extra 5 minutes to receive a superior level of care, understand you have a right to choose where you want to attend physical therapy.

If you have the choice of a superior level of care, for the same price, with the same therapist each visit, why not choose OSSPT? If you have more questions or would like to specifically discuss your case please reach out to me personally at or call us at 405.735.8777 to schedule an evaluation.