I laughed politely. Not that I thought the joke wasnt funny, because it was fairly humorous.

It was
more the circumstances surrounding the joke that kind of pissed me off. I was sitting in the drab
examination room of yet another medical doctor receiving a fourth diagnosis. Ive never had a high
opinion of doctors, but at least this particular one had personality. He insisted on being called, Dr.
Steve, as his last name was a seemingly random flotsam recovered from the scene of an alphabet soup
delivery truck accident. The joke he had just told me went like this:
Dr. Steve: Do you know what the most statistically significant predictor of future back pain is?
Me: Weak musculature of the spinal stabilizers combined with less than ideal posture and
compromised movement preparation? (I replied imitating the overconfident snobbery a person can
only gain after spending 8 years in medical school.)
Dr. Steve: No. (pausing for comic effect) The best predictor of future back pain is.a past
history of back pain!
And with that seemingly obvious declaration, Dr. Steve chortled his way out of the room to recover
what I presume was either my medical records, X-rays, or perhaps even to flirt with the extremely
attractive and abundantly buxom secretary out in the lobby. Dr. Steve was a Chiropractor and I
wondered if the joke also served as an informal business model. Step one: Identify those with back
pain. Step two: Treat the symptoms but never actually approach the patient with a solution to the
underlying problem. After receiving a fairly non-descript diagnosis and choosing a treatment plan I left
Dr. Steves office with no intention of ever returning.
I drove towards my small apartment, stopped at Walgreens to fill my script and then set course for
the nearest tavern. I grew up in an area of the Midwest mostly populated by immigrants from Germany
and Switzerland and in no small part due to their cultural legacy, I can drink alcohol any time of the day
without feeling guilty. In the community where I was raised there was a noted distinction between a bar
(where alcoholics and deadbeats gathered) and a tavern (socially acceptable place to socialize, eat, drink
and be merry). America has a curious effect of diluting these cultural lessons, which allows subsequent
generations to only retain what they like and admire about their heritage.
With this in mind, I ordered a double Jameson on the rocks and a Samuel Adams in reserve in case
the whiskey made me thirsty. After confirming my initial suspicions that the attractive brunette
bartender was flirting without making promises, I pondered my current medical situation. I had been to
four different doctors, all specialists in different areas of medicine. I scratched the doctors, diagnoses,
and treatments on a bar napkin in order of stupidity from least to greatest.
1. Dr. Rogers, Physicians Assistant. Strained lower back muscles/Sprained Sacrum. Rest, ice the
injured area, anti-inflammatory medication.
2. Dr Duhig, Sports Medicine Physician. Lower Cross Syndrome. Referral to Physical Therapy for
joint mobilization, corrective exercises, and myofascial trigger point treatment.
3. Dr. Steve, Chiropractor. Hips and pelvis out of alignment. Traction/joint manipulation 3 times a
week for at least a year.
4. Dr. Olibarber, V.A. Orthopedic Surgeon. Chronic degeneration in the L4/L5 disc. Spinal fusion of
the L4/L5 lumbar vertebrae
I sipped my drinks and considered my next move. Surgery was out of the question. Several friends of
mine had this procedure at their local Veterans Affairs Hospitals with decidedly mixed results. Spinal
fusion lets you sit in a chair pain free, but the loss of flexibility and range of motion reduces athletic
capacity to an unacceptable level. I had tried rest and anti-inflammatory drugs, but with little long term
success. Which left either the Chiropractor or the Physical Therapist.
The medical profession in America has evolved into an unusual industry compared to the rest of the
world. Much of the developed world has socialized their medical care systems, recognizing that the
values of medicine mix poorly with those of capitalism. In the underdeveloped countries, a doctor is a
revered part of the community, akin to the special status given to holy men and shaman. I had often
thought of copying their medical payment model and bringing a chicken as payment to my next doctor
visit. I laughed out loud as I had a sudden vision of handing the jovial Dr. Steve a Rhode Island Red
Rooster every week for the next year. I ordered one more round for myself and gave the bartender my
standard disclaimer. Dont give me another, or Ill be asking you for a ride home later. She laughed
and pretended that the idea wasnt totally out of the realm of possibility. The euphoric feelings of
successful flirtation influenced my judgment that day in two ways: I left a larger than normal tip and
decided to give physical therapy a try.
After talking at length on the phone with a representative from my health insurance, I was given
a short list of Physical Therapists that were in the approved network. I generally dislike insurance
companies, sharing the assessment that the industry is nothing more than licensed extortion. So
struggling to maintain a positive attitude, I called my cousin who is a surgical nurse for consultation. My
cousin usually gives frank appraisal of medical doctors, procedures, and hospitals so she acts as the
family subject matter expert. She advised me to choose a physical therapy company that had a number
of clinics as this would guarantee the delivery of standardized care. Its a somewhat disturbing
revelation that not all doctors have the same level of skill. The most common social acknowledgement
of this is the old joke about, what do you call the person who graduated with the lowest grade point
average? A doctor! I scrutinized my approved network list and highlighted the two names that
reflected obvious corporate marketing strategy, which were ATI Physical Therapy and Accelerated
Physical Therapy. Naming your business with a word that begins with the letter A is the oldest trick in
the book, designed to prey upon the childhood habit of obedience to the alphabet. I rely heavily on my
oppositional behavior to defeat such crude commercial manipulation so I chose ATI Physical Therapy
and made an appointment.
The ATI facility was in a nondescript strip mall, wedged in between a burger joint and a Mens
Warehouse. When I walked through the door, there was a receptionist desk and the rest of the large
room resembled a combination of a Golds Gym and doctors office. On the walls were detailed
anatomy posters and two larger motivational phrases spelled out in two foot block letters. The one that
caught my eye was credited to Laird Hamilton and said, Make sure your worst enemy doesnt live
between your own two ears. I was introduced to a team of Physical Therapy professionals who would
treat me four times a week for the next three months. They seemed nice enough, and very professional
and I was impressed by their overall positive attitude. The lead therapist I would work with was named
Marna and was fairly short about 51 and very petite. After completing a series of exercises called a
functional movement screen, Marna announced that she would be giving me a massage while the other
two completed the paperwork. I thought to myself, I think Im going to enjoy this.
I grew to appreciate Marnas sense of humor in the coming months, but the greatest joke she
played on me was representing myofascial trigger point therapy (MTP) as an innocuous massage. If
youve never experienced this technique, its probably the closest thing to legal torture. Basically this is
a physical manipulation to restore deep tissue sliding surfaces. Muscles, tendons, and ligaments need to
slide across each other to function normally and when they dont inflammation and range of motion
issues usually occur. Myofascial trigger point therapy is designed to help restore the normal sliding and
to affect deep tissue requires a combination of force and movement. Marnas preferred technique was
to use the points of her elbows and put all of her 105 pounds behind them. This causes pain and
discomfort and a proficient therapist will push you to your pain threshold. The upside is that MTP
produces results and almost immediately afterwards, you have less chronic pain in the affected area.
The advertisement should read, You may suffer now, but youll feel pretty good afterwards!
Six months later, my lower back pain had subsided and I was back in the gym, almost as if Id
never missed a workout. Physical therapy was an experience I will never forget. I often think of what
would have happened to me if I had chosen surgery instead of physical therapy. It was my experience
that the most important healing aspect of physical therapy was the psychological aspect. Dont get me
wrong, it also involves a ton of exercising to strengthen muscles and restore mobility. Thats definitely
the physical part. But the therapy portion of the practice was even more important, and that is
what impressed me the most. Physical therapy will not magically restore function or heal injuries with
the wave of a wand. But the most valuable lesson I learned from the experience is about pain. For a
physical therapist, pain is not always bad. Its a spectrum, on one end the body is sending a stop signal.
This is the point where you should immediately halt physical activity to prevent damaging your body.
But on the other end, there is an expectation that patients are going to endure some amount of
discomfort and pain. This kind of pain is part of the healing process.