FAQ

There are common questions and concerns regarding PT and the treatments I frequently perform and recommend. Here are a few, but please do not hesitate to ask whatever comes to mind. I do not assume anything is common knowledge. 

Frequently Asked Questions

Are there side effects?


It is difficult to anticipate how anyone will react to therapy sessions. It is possible to experience soreness or bruising after massage, trigger point release, dry needling, or certain therapeutic exercises. This is completely normal and usually if the patient is not alarmed by the reaction, it remains minimal and only lasts 1-2 days at most. After a deep muscular release either by manual therapy or subtle movement exercise, a patient may experience symptoms other than soreness, such as emotional upset, general fatigue or headache. This is most likely because these muscle holding patterns were originally in place for a reason, and after the release you either forcefully become aware of the reason, or your brain will try to create a new symptom to continue diverting your focus. Once again, as long as the patient expects some symptoms and is not alarmed, this too will remain minimal and short-lived.




Do you take insurance?


This is a cash-based practice, which means you pay at the time of the visit, in any form (preferably cash, check, venmo, paypal, but card is accepted as well). I then provide via email (or print-out if needed) a superbill for the patient to submit to insurance so they may be reimbursed. The patient should verify with their insurance regarding out-of-network physical therapy reimbursement policies prior to making an appointment if this is a concern. One major exception to this system is Medicare. Medicare will not reimburse an out-of-network PT session, and I will not provide a form to be submitted. If you or someone you know has Medicare and wants to be seen, please email or call me and we can discuss how to move forward.




Why out-of-network?


When you are in-network with insurance, in order to be reimbursed, you must abide by the insurance company's specifics regarding which diagnoses are provided, which treatments you provide and how much of each, and perform hours of tedious, repetitive paperwork that takes away from patient care time. For example, if someone has neck pain and I believe certain pelvic or abdominal movements will most adequately produce a change in the neck, I would not technically be able to document this, and insurance will not reimburse for it. As a practitioner, it is difficult to understand how a third party, regardless of his or her credentials, can dictate what the patient needs or does not need based on what they read. It becomes a game of manipulating what you write to not only stay true to what happened during the session but also to ensure the insurance company believes there is still reason to pay for treatments. This is also more simple for a conventional physical therapist, who may generally not mind the parameters required by insurance. I do not believe certain common structural issues which people commonly blame pain on actually cause pain, I do not believe certain degree of progressive exercise is aways needed in order for people's pain to decrease, I do not see the value of most pre-prepared functional outcome measures usually required by insurance, I understand that there are several factors other than physical ones that contribute to and complicate pain syndromes, and I often use very unconventional methods to help eliminate pain. I no longer believe it is even ethical to abide by the insurance rules, since with every new aspect of the mind and body I learn about, those rules become more hindering to the healing process than helping. With higher quality of treatment, there should be a significantly decreased number of treatment sessions, and the overall cost is usually less than an in-network PT bout anyway.




Does dry needling hurt?


The most correct answer is that everyone is different. I have experienced dry needling in every muscle, as we practice on each other during our courses. There are some body parts that are more sensitive than others, some closer to nerves, some muscles that are used more frequently and more powerful than others, and some people have a large amount of internal tension that is not always consciously perceptible before it is released. Either way, if it is done well, it is very quick and usually the results are worth any momentary discomfort. The most common thing I hear after the first dry needling experience is "that was weird". Other words used are startling, warm, and twitchy. I have performed dry needling on several people who say they are "deathly afraid" of needles, and after they finally consent to needling they often ask for it again reluctantly if the pain returns.




How often will I need to get dry needling treatments?


The "need" for dry needling, just like any manual therapy or other treatment, is always evaluated on a day-to-day basis. When a muscle trigger point has been inactivated by a needle and eliminates pain, even if it is temporary, this brain/muscle connection has been stopped. It is not a mask. Sometimes this first release is all that is needed. If pain returns, it is not because "the knots returned", it means the brain has signaled the same area for a decrease in blood flow because it is a habitual, conditioned response. We can stop it again with the needle, but as you would most likely learn in your first session, it is more important for you to practice getting rid of it yourself by understanding the root cause so that the change lasts. So each session I discuss with the patient what has happened since the previous session and we decide together what the plan should be for that day and for the future.




How often do I need to come to PT?


If you have chronic pain (lasting over 3 months) and/or pain from an unknown cause, it is probable that you only need 2-3 visits total once the source of the symptom is realized and you understand the deeper cause. If there are several socioeconomic factors in play with high levels of stress, it might take longer. Each situation is different. If there has been a RECENT trauma (in the past 6 weeks), such as a sprain, tear, or fracture, usually 4-6 weeks is necessary for the healing process and for PT to assist this. A patient who has experienced a neurological event (such as a stroke), is diagnosed with a neuromuscular disease, or has just undergone surgery may require 2-3 sessions per week for several months, and in this case cost may be negotiated.




Who can benefit from physical therapy?


In general, physical therapists can provide rehabilitation for post-surgical patients, people with chronic pain, sports and other injuries. People typically arrive with diagnoses such as rotator cuff tear, arthritis, herniated disc, "pinched nerve", stenosis, sciatica, plantar fasciitis, labral tear, tendonitis, carpal tunnel syndrome, thoracic outlet syndrome... etc. You usually do not need a referral from a doctor to see a physical therapist. I can treat conditions where any of these words and phrases have been thrown around, but there are often hidden issues that we believe are normal and do not actually need to exist. I find these issues to be the most common and the most plaguing of the general population, and sometimes overlap with the diagnoses described above. For example: Do you have back pain at certain times of the day or after certain activities that you attribute to working out, "doing too much", or getting older? Do you feel like or have you been under the impression that you need to stretch daily in order to feel good? Do you have chronic pain or dis-ease that no practitioner (including PT) has been able to figure out? Can you find relief but it is always temporary and it seems you just need to live with the pain? Do you avoid certain recreational activties/movements/yoga poses because you believe they are bad for you from experience of pain in the past? Do you think running is causing knee pain? If you answered yes to any of those questions, it's probably a good time for an evaluation! You'll most likely get some relief, but also learn about what is actually happening and what we can do to optimize how you feel daily without limiting your preferred activities.





Metta Integrative Wellness

720 W 36th st.

Baltimore, MD 21211 

http://metta-wellness.com/

Tel: (410) 207-1297

Baltimore Yoga Village 

3000 Chestnut Ave.

https://www.baltimoreyogavillage.com/classes/daily-classes/

Tel: (410) 662-8626