What Is a Physical Therapist and How Can They Help You Feel Your Best
What Is A Physical Therapist
I had the opportunity to sit down with Dr. Matt Rome to discuss physical therapy and how it can help you feel your best. It started with a simple question, “what is a physical therapist?”
As you know, I am always interested in knowing how to support ourselves to be the healthiest and happiest version. We have talked about healthy cookies, superfoods and premium ingredients. I believe physical therapy is a critical element of any integrated healthcare regimen.
That’s why I sat down with the best in the business to understand better the role it can play in our ongoing healthcare.
Dr. Rome explains in detail what his role is as a practitioner and how you should consider physical therapy when facing aches and pains. Your body is a complex machine that is capable of remarkable things. Like all machines it needs the best mechanics to perform optimally or recover when necessary.
Having built a highly respected practice, Dr Matt Rome of Equilibrium Physical Therapy explains what a physical therapist is and how a qualified practitioner can empower YOU to improve your life!
David Goldberg: Hey guys. So today we’re really lucky, we get to sit with who has become recently one of my more favorite people Dr. Matt Rome of equilibrium physical therapy in New York City. Hi Dr. Matt, how are you?
Dr. Matt Rome: Hey nice to be here, pleasure to be here. This is a fun opportunity and looking forward to sharing some thoughts with you guys.
David Goldberg: And I must admit my background it’s a little bit more exciting than yours. So I think already brought to a good start at least for me.
Dr. Matt Rome: Yes, yes. Well it is actually about 86 degrees in New York City today. So I can’t complain about that although I’m not sitting in a [inaudible]. So a little bit more to strive for I guess.
David Goldberg: Well, I am really appreciative of you making the time and we actually got to this point because I came in to see you about two weeks ago with some issues that had been bothering me for a number a month. I think it would be helpful if maybe you could just share a little bit of your background and what your practice is and what you guys specialize in and then you know I’d love to get into some of the details about advice that you offer to people in general about feeling their best every day and then when issues do arise, how do we do our best to mitigate the effects of those issues. So maybe you’ll share with us a little bit about your background and what your practice is?
Dr. Matt Rome: Yeah, absolutely. So I would like to start out with explaining a little bit about physical therapy because it’s become a little bit ambiguous as to what physical therapy is and the difference between the medical side and the wellness side and then there’s so many different styles of practice as well. So equilibrium physical therapy in New York City that’s my practice I found about seven years ago is founded more about upon the individualized personal attention.
So traditionally as insurance companies are fighting us with declining reimbursement rates, a lot of physical therapy practices are gravitating toward higher volume models, where it’s a big open room with lots of tables and a physical therapists will see you for 20 minutes and then pass you along to a technician or an aide to carry out the remainder of your treatment.
So what equilibrium is is a more of a boutique style studio where the treatment we have open studios and a nice custom built out setting but also private rooms with high low tables, board-certified relations where we spend an hour with you one-on-one. So whenever someone is looking to to optimize performance really get a good clinical eye on their body one of the most important things besides having an educated clinician is having someone who’s going to spend the time in and pay proper attention to each. So that’s how we founded our model in physical therapy New York City.
Then moving on from that is just making sure that you get good clinicians who specialize in niche areas that are are gonna be most specific to the reason why you are coming in it, whether that’s you know a stenosis or arthritic issue in the spine, arthritis in the hip or shoulder, a tendinopathy, a recurrent chronic condition, we’re sitting to keep traumatic issue, so we have board-certified specialists, there’s nine of them now by the ATTAs, so you can get sports, pediatric, geriatric, orthopedic, electrophysiologic, there’s a lot of different board specialties now. So making sure you get a very qualified physical therapist to pair with your specific needs is really key. So kind of that’s the background where my practice is founded.
David Goldberg: And it’s interesting to me because even as a layman when I hear the term physiotherapist, can you just give us a little bit of detail about how that– what does that actually mean, how is that different than other doctors we might both be?
Dr. Matt Rome: Yeah. So well it’s a great question, because it’s changing now you know with the emergence of new laws, we have direct access laws where physical therapists or physiotherapists are now primary care providers for the neuromusculoskeletal setting. So what that means is that you can come to your physical therapist in most states without a physician’s prescription and we are specialists in the neuromusculoskeletal field. So we’re not going to prescribe medication, we’re not going to order imaging for you, but we can rule in or rule out cases that may Imaging and will set you up with the position who can order the imaging that we would request of them.
But oftentimes we can diagnose a pathology and keep you in house in the clinic without the need to go to other specialists get unnecessary medical tests when they’re not really needed. So the physical therapy setting is now can be used as your first point of contact into the medical industry which is a great development within the field. So that’s you know whether it’s any muscular pain, neurological pain, shoulders, hips, knee, ankle a skeletal malalignment issue, a muscle imbalance issue, whether there’s pain or you’re looking just to look at your skeleton and optimize performance based on understanding your body and how you move.
David Goldberg: So it’s interesting. I mean you know obviously I’m a big advocate of trying to start early to stay as healthy as you can for as long as you can and one of the most common things that I think people experience is obviously pain or discomfort within joints or muscles and all too often it seems like there is a resort there which is good to hear that it’s changing to either go to prescriptions or to even procedures, which seems to me just to be kind of the easiest thing and you know one of the things that you and I had a great conversation about is this idea of [inaudible], right?
So when I come see Dr. Matt and for instance my issue was, I think we have three but my biggest issue was my left shoulder and I in my labrum in particular and you showed me a whole series of different exercises and things that I should be doing to strengthen it to improve it, but as with all things if I don’t do it and adhered to the protocol that you suggest then which takes time, right? So I guess I’m curious to hear from you on that perspective is when people come in and they have a specific ailment like my shoulder for instance and you’re offering them some sort of protocol to support that ailment, what are some of the biggest hurdles that you see with your patience in terms of actually getting better?
Dr. Matt Rome: Yeah, I mean and you know that adherence and compliance is a huge one. So we drill that home on day one, education we provide really specific detailed information on how you need to continue your therapy at home, provide video resources, print it print out resources, we always change and manipulate your home program. But the idea is to keep it as simple as possible to assist with adherence. Because just like anything in the medical world it’s what we call a lifestyle change and I remember back in grad school, we did these things called lifestyle change projects it was basically learning how– if you’re going to advice someone to do an exercise or take a supplement or to change any type of their behavior that is going to affect their daily routine you need to experience what that feels like, because it does take some work, sometimes things are more less challenging than others, sometimes it’s a simple 1 or 2 minute thing a day, but sometimes it’s longer and that’s a really important thing in therapy and a lot of time we talk about the difference between active and passive therapy. So people often come into my office, they want just passive therapy and we provide that. We provide joint manipulations, mobilizations, a lot of stretching, nerve lives but the most important part is the assistance from the patient at home to take what we teach them, because they’re not coming into physical therapy five to seven days a week. We’ll see them once a week, twice a week, sometimes three times. But most the time it’s that one to twice a week. You need to supplement that with a good educated home program and so in hearings is definitely key.
David Goldberg: I think that’s interesting because it requires and this is maybe a broader conversation, but it does require that lifestyle change which in particular is least I’ve noticed in myself even as I’ve gotten older changing certain habits gets harder and adopting new things and adding new things to my regimen and removing things, it’s just an additional thing that takes us out of our routine to create hopefully a better one but another thing to consider.
What I would love to do if it’s okay with you, I’ve been dying to ask you this question which is you see I’ve seen your office and you see a lot of people on a daily basis from ultra-marathoners and tough athletes all the way through to people who are aging and I’m curious to know maybe one or two of the most common things that you see happen with people’s bodies as they age and some of your suggestions towards how we can start earlier to mitigate those issues?
Dr. Matt Rome: Yeah, I love that question, because the physical therapy field is now kind of being bombarded with all these other types of practices that are focused more on the wellness side and collaborating wellness with rehab and the preventive medicine field is fantastic and it’s not just something that you can do to prevent injury, but it’s taking those steps that understanding what type of injuries you’re actually prone is susceptible to and then preventing us. You’re not just jumping in blindly and say, I need to do this to prevent this, it’s like you know you let you look at your body type. And so one of the big things that I see all the time are, you know, really happen from the ground up or the top down and you want to look at the body type to understand that.
What I mean by that is that understanding your skeletal alignment is so incredibly important and this is important before you have pathology, before you have an injury, before you have degenerative changes in your spine, your hip, what not your knees.
So basically everybody has a different body type, right? They have a different skeleton, they have a different spinal structure, their hips attach in the socket different ways you can either be we’ll called [inaudible 00:10:36] that can cause a toe in or toe out. Your tibia is your lower legs can bow in bow out, the way that your foot hits the ground, you can what we call pronate or supinate and then on top of that there’s other sorts of compensatory practices and strategies that your body takes in order to deal with the alignment that you have. So are you hypo mobile where you have restricted motion or are you hyper mobile and give excessive motion?
So you could have one body type but be stiff and not compensate or you could have the exact same body type and actually be very mobile and you can compensate in different ways. Every single pattern leads to a different stress on a bony structure, a soft tissue structure, so even though you don’t have pain, even though you don’t have injury, when you look at a skeletal alignment you can see what type of injuries you’re susceptible to.
So what I advocate to a lot of my performance patients who are looking to optimize performance, prevent injury is doing a full what we call lower quarter skeletal malalignment exam and then if necessary we can fabricate orthotics and you don’t necessarily need something so aggressive, but if we can identify your foot and say, hey you’re landing on the– you’re walking on the outside of your foot called a supinator, you’re not attenuating force by what we call having that arch collapse that medial longitudinal arch and then you really need some help attenuating force. Because that force is shocking up right through the side of your leg, side of your foot up until you’re up into your hip and can affect your alignment and your spine as well. So in that type of situation we want to provide a more compliant surface under their foot like a cork or a leather or foam conversely if you’re having a very, very you know floppy type of prototype or yard just collapsing, your knees are coming in inward we call what we call a valgus stress at your knees, it can cause a lot of knee arthritis on the outside of your knees, ligament to stress on the inside so then we want to use something a firm support like a graphite or a plastic to support the integrity of the arch. So these are just simple ways to prevent further injury by understanding your specific body type.
David Goldberg: I think to me it’s particularly interesting because you know I’m not a doctor, I wasn’t trained like this and for people that have kind of been following along with our story commute always comes down to as a patient more often than not the expert is it logical, is what the practitioners ain’t mean is it logical and what you’re saying makes sense if how my foot strikes the ground every time I walk, every time I run, is not exactly perfect for how the rest of my body is structured, eventually over time it’s going to result in some sort of issues so building ground up to support that process for the downstream effect of a collapsed arch or whatever it might be is, it makes kind of sense.
So it kind of beckons a second question to me which is just purely out of curiosity you know as people age where do you tend to see the most amount of issues like as we hit our thirties and forties, is it from there does it go off is it let’s start with our knees and then as we hit our fifties and sixties that move to our hips and our sixties and seventies moved to our back or is it really just different to everybody based on like you’re talking about the fact that all of our variables are different?
Dr. Matt Rome: Yeah, I mean it is different for everybody, variables are always different I mean there are your patterns, you know low back pain is one of the most common issues in the world. It’s kind of inevitable at some point your life that you may experience some low back pain, but still understanding why you have that low back pain is important. There’s a lot of different things that can cause low back pain.
Once you start getting into your 30s and early 40s is the first you know a lot of times people feel that they’re aging. Sometimes it hits you in your twenties sometimes people can make it to their fifties but usually it’s around that thirties where people are feeling a little bit aches and pains a little bit, but just understanding that you know to check things out and get things evaluated usually at that point in your life there’s not really significant progressive arthritic change. So often issues in the back could be more what we call discogenic or you know disc injuries, you can have nerve root compression from a disc injury. There are some anomalies where you can develop early arthritis, there’s some instability issues, we call them spondylolisthesis or slippage of the spine in the back.
So you can actually have a lot of these things at a young age sore more common as we age, but just I would say back pain is the one to really look out for. When you get into your thirties and forties and understanding how to prevent that as best as possible and keeping your core strong, keeping your lower back strong and again understanding your alignment and your possible preferences are really important.
And then again knees are big one. We walk a lot. The way that we’ve evolved is now walking on pavement and hard ground we weren’t always doing that you know in our history. So a lot of that increases that will call the ground reaction forces up through our body and so we get a lot more compressive wear on the knees, we get arthritic change in the knees.
One of the most common knee issues I see is not necessarily actually arthritis of the main tibiofemoral joint you know you can sit that the tibia on the femur like that, you can have arthritis either on the inside or the outside of that joint. We see a ton of we called patellofemoral pain syndrome and the syndrome is a catch-all, it’s not a true diagnosis. The syndrome is a common combination of a bunch of symptoms and so truthfully patellofemoral pain syndrome can come from a lot of different types of issues whether it’s a tight IT band pulling the patella, but ultimately you can get some arthritic wear behind the kneecap, you can get some soft tissue inflammation, some fat pad inflammation underneath the kneecap. But that’s probably one of the most common things that we see as we get into the thirties is just generalized pain underneath the knee and there’s a lot we can do from that, from understanding your alignment and treating you in a physical therapy getting on a good plan.
David Goldberg: And this brings up so many questions for me and I know that we don’t have all day with you, but there’s a few more I’d like to get in which is you know, so okay got that and it sounds a really the most effective way to understand what’s going on in our own body. It’s really the only way to understand as there’s no catch-all they come see an expert like you who can help us understand better what’s happening and start looking for [inaudible 00:17:16] collapse, your arch is collapse, you might not be having this issue now but patterns would recommend that this might be your next issue and this is what we can do.
The first question that I kind of brings up is as you think about fitness and physical activity you know, one of the things that I constantly hear from people and there’s actually a person in my life is going through this now who has opted to go through a procedure which my opinion is that he’s way too young, he’s way too physically active and fit to do this but he’s opted for a procedure is, how are there particular physical exercises that you see have far reduce risk of exacerbating potential issues and are there exercises that you feel are on the higher risk spectrum and not to go too much into detail, but just seriously if I’m going to work out what’s the lowest impact thinking I can do and then what is something on the other end of the spectrum that might be high impact?
Dr. Matt Rome: Yeah. Well that’s an incredibly loaded question because you know of course it has to be so specific to you and to say something that could be, they could exacerbate someone’s condition may not exacerbate someone else’s good condition and someone else’s peak you know in terms of pushing to them the limit may not be as challenging for others. But I would say if there is pathology then you need to take that into account in terms of how you’re prescribing a program.
If we’re taking a healthy person with no pain, no pathology then there’s a lot of different ways that you can really push someone aggressively and it’s also– it’s maybe not the answer you want here but I would say one of the best ways to push someone as hard as they can is to find something that they enjoy. So whether that’s you know for some people its Olympic lifting CrossFit, swimming you know some people hate free weights and they like they like body supported training which can be extremely challenging, it’s a lot of you know the these pull-ups and these dips and these body weight supported exercise which I love, I do a lot of that clinic.
So really finding someone, finding a way to challenge someone and within a program that they enjoy is the best type of exercise in terms of what not to do just make sure you get someone who teaches you proper form and technique. Because watching some videos online doesn’t always get there. You know you can watch the videos online and know what to do but then you still do it wrong, having someone in there with providing verbal cues, tactile cues, making sure you’re contracting correctly and you’re keeping the right position and posture is really really important.
So I see a lot of people when I’m in the gym doing these floppy core exercises, they’re not contracting their called transverse abdominus to report correctly, they’re not in that neutral spine position and they’re not– it’s kind of a waste of time. So making sure you do everything correctly is that it’s the most important way to check on yourself.
Dr. Matt Rome: The only thing that’s so interesting to me again is the patient now kind of observer and all of this said there are a couple of three lines that are seem to always be true which is one, doing the right things chronically generally means you have to do less of the things to achieve the outcome that you want and if you’re matically reduces the potential risk associated with those things and it’s just interesting to me because it is I think become part of our culture that better, faster, cheaper is an approach that we like to taking and it makes sense, right? Like if I could wake up in the morning and I got a pain and I just take a couple of pills and even though they might be causing other issues that’s something that you know people and geared towards easily, I can do it, no problem.
So I want to switch gears here for another second because I do feel like we could talk about a lot of things for a long time, but I’m particularly interested and this might be another good question but procedures to me are something that should be taken with great consideration and not to say that they are always wrong that’s definitely not true. [Inaudible] I’m sure and with a great practitioner they’ll tell you when it’s needed, but is there a general rule of thumb or a way that you look at and say well when somebody has gone beyond a certain point that like is it a pain threshold, is it a mobility threshold, the combination of them, but like at what point is, your beyond the point at which we can try to pull you back where a procedure is the only way to move forward and the reason that I ask this is because to me, I love Western medicine, I love all of the advances but there are increased risks even you’re just growing under general anesthesia that I don’t think everyone fully internalizes before going into a procedure and that same note it feels often that people say, “Well I’m too far gone.” So I’m curious to know kind of if there is something there or not really.
Dr. Matt Rome: No, I really do love that question because we get that all the time and the rehab setting, people are just coming to us and all they want to hear from us is you don’t need surgery or don’t need this procedure. And I love to say, I love to affirm then reinforce that if possible but the truth is, it’s a combination of a variety of things. The decision that should be made with your physical therapist, with your physiatrist which is more of a rehab sports medicine doctor that’s non-surgical and of course an orthopedist or whatever specialty you’re going to see, it’s a procedure for.
The most important things that we don’t we don’t rely specifically on imaging. You know an imaging can show one thing, but if it doesn’t correspond with true, in the clinic pathology, in the clinic pain that’s the issue. So you can have, if we take an MRI of a hundred people with zero low back pain or in between age of 40 and 50, you’re probably going to see some disk herniation. So you’re going to see some mild degenerative conditions, you’re going to see some beginning of what would cost enosis, So if that person is not having pain, they don’t need a procedure even if they see pathology on radiographs or MR imaging.
So understanding how to don’t simply rely on an image, it’s how it’s how you’re presenting clinically and then also understanding what are your other options and so there’s been a big movement but now over the past say five years it’s really grown as regenerative medicine, regenerative therapy. And so stem cell injections, platelet-rich plasma, PRP injections, a lot of these things aren’t covered by insurance, but their the clinical efficacy around them is emerging and that’s going to help eventually reimbursements for them. But right now instead of just jumping right to a steroid injection, you know there’s a surgical– there’s some other options to consider. So seeing a really good physiatrist who’s really dedicated to regenerative therapies, non-surgical management, I would say was always the first plan of attack and ultimately if you hit a point where that the imaging also corresponds with your levels of pain and functional limitation then that is where you drive for more of a surgical procedure, but there needs to be that functional limitation, recreational limitation and daily pain where you’re actually driven to get a procedure rather than just, “Hey, I’m seeing some pathology on imaging, maybe this needs to be fix, maybe not.”
David Goldberg: And I think that to me is again super logical, right? Like if you’ve really exhausted all options and you’ve evaluated what this thing is causing you in terms of pain and mobility is as you said I think functional and recreational matched with the pathology the actual reality of it, which brings me kind of I think to my last question which might be the hardest. I’m curious to know how we use the stress affects people whether that’s workplace stress or family stress or financial stress or the stresses of life, do you see that oftentimes that does manifest in physical pain or like is there any correlation there between stress and anything that you see on your end and the reason I asked because it seems to me at least when I wake up and I’m not in my best mood, my body doesn’t feel as good as it does when I’m in my best mood, right? So I am curious whether that’s all up here or if there really is some truth?
Dr. Matt Rome: Yeah, well coming from someone who’s never experienced any stress in my life that’s a tough one answers. I’m definitely kidding. Running any small business or you know it provides stress but also you have personal stress, you have work-related stress there stress about the pain creates what we call a pain inflammatory cycle which can be kind of initiated by stress and so more stress, more pain, more and more inflammation more inflammation, more pain, more stress.
As far as the evidence behind that you know stress the stress hormone cortisol is we’re always trying to research and correlate that with different responses physiologically in your body what happens with other neurotransmitter releases with stress hormones you know, whether they’re excited [inaudible] inhibitory hormones there’s a lot that goes on as far as a neural chemical process within their body.
But in terms of how can that affect your physiology but how the hell does that also affect your perception on how you’re feeling so there’s a lot of different things, but going on there. But the bottom line is stress can be good and stress can be bad, but we have to find that happy medium to navigate it, but there has been significant correlation between a stress response and pain and so that’s definitely something to understand and finding a way to deal with the psychological component of the stress and limited its physical manifestations is definitely a big part of the rehabbing.
When being in a treatment room as a physical therapist one-on-one with a patient for an hour, we do both. I always see you know whenever I’m hiring a new physical therapist I would say the most important thing is, well there’s a few important things, but it’s not just your clinical expertise, right? It’s your personality, your energy, how do you net with the patient because there’s such a profound psychological element to pain, injury and recovery that you need to reduce those stress levels and work with the patient on the psychological side to also work on the physical.
David Goldberg: And I think that is to me I mean you hit the nail on the head, you know especially when you talk about stress inflammation response and inflammation response creating pain and creating more stress and it becoming a cycle that sold itself is, it seems to be that is the only ubiquitous truth that I’ve found in any type of modality of healing, is that it all adds up every little stuff in a positive way matters and even though there are setbacks you have to continue with the positive things that are going to make you feel better, because that’s the only way to get the momentum shifted back towards the positive is away from the negative stuff we want to stay away from.
So we’ve taken a lot of your time. I will include this also in the comments below on YouTube and on the website but when people want to come see you, who I recommend everybody come to you, at least once in their life hopefully soon, how do they get a hold of you, how do they find you?
Dr. Matt Rome: Sure. You can come see our website its equilibriumpt.com. Equilibrium physical therapy, you can always just shoot me an email it’s [email protected] and just reach up to me, I happy to respond to any questions and we would love to help out anywhere I could it’s been a fun experience. Also just another way to reduce stress maybe sitting up in a canopy and in Costa Rica I recommend that as well. So I’m up on a plague suit. But no, this has been fun, I love being able to share this share information and thoughts. This has been a kind of fun conversation. The more we can get some of this information on wellness and preventative rehab and management out there and creating a healthy lifestyles for people as a passion, so that’s nice.
David Goldberg: Yeah, I think to me that’s the mission, right? I love talking with people like you who are professionals and in particular people who are practicing every day because that to me is like to be an artist that never paints, if you’re a painter like what do you really know about painting, right? It’s like you’re seeing real people in front of you every day and we appreciate you making the time and we’ll make sure to post all of your contact information below. Thanks for making the time, we really appreciate it.
Dr. Matt Rome: All right David, great, well enjoy it out there.
David Goldberg: I will. Have a great day.