Muscle Medicine: The Revolutionary Approach to Maintaining, Strengthening, and Repairing Your Muscles and Joints (44 page)

HOW TO MANAGE YOUR DOCTOR OR THERAPIST

Dealing with injury can be emotional and disorienting. To get the most benefit from a visit to the orthopedist to discuss treatment options, bring a friend or family member as a more objective “second set of ears.” Have the person take notes or tape-record the visit.

Bring a list of no more than five important questions to ask. Talk to the doctor’s support staff about the smaller stuff such as, “Where can I get an ice pack?”

Don’t get frustrated by a quick visit. What you don’t see is the doctor reviewing your chart, studying your X-rays or MRIs, talking about your case with colleagues. The time you actually spend in his office is just the tip of the iceberg, usually a time for assessment, not for treatment.

E-mail is a great way to communicate with your doctors. That way they can respond to you when they have an available moment rather than try to coordinate two busy schedules for a phone call.

In therapy, you should not be left unattended on an exercise machine or a device. The therapist should be focused on you, not trying to take care of multiple patients at once. If that’s the situation, find a more suitable therapy program and be willing to pay out of pocket for it. Your body is worth it.

SEARCHING OUT THE SUBCONTRACTORS

As we said earlier, for less severe musculoskeletal injuries, it may not be necessary or even desirable to put yourself in the hands of one practitioner and have him or her make all the big decisions. Here, you may want to assume the role of contractor and investigate a range of therapies, and perhaps even put together a package of therapies to address different aspects of the same problem. Perhaps your physician suggests acupuncture, but you’re afraid of needles. You might want to look into acupressure or Trigger Point Therapy, where pressure from a therapist’s thumbs and fingers may achieve a similar effect.

Good research is the key. Go back to our brief discussion of manual therapies in
chapter 7
for a starting point, then follow up online. Established muscle therapies such as ART (
www.activerelease.com
), Graston Technique (
www.grastontech nique.com
), Myofascial Release (
www.myofascialrelease.com
), Orthopedic Massage (
www.orthomassage.net
), and Trigger Point Therapy (
www.triggerpointbook.com
), and many others are all well represented on the Web. Sometimes the particular school of therapy is less important than finding a skilled therapist who works in your area. Word of mouth can often lead you to that person.

What should you look for during that first visit with a muscle therapist? To begin with, you and the therapist should agree on a clear plan of action. First, how does the therapist intend to get you out of pain? Then, how will he or she try to find the source of the pain and fix the problem? Is there a plan for occasional maintenance visits or advice on prevention strategies so that the problem does not return? Ideally, you will have exercises to do on your own time to continue treatment at home. Most manual muscle therapy (as opposed to chiropractic and physical therapy rehabilitation and conditioning) is not covered by insurance, so plan accordingly for out-of-pocket costs.

The therapist should be able to give you a rough idea of how many sessions may be required to resolve or improve your muscle issue. Obviously, a lot depends on how entrenched and complicated the muscle injury is. Some problems can be resolved in a single session, some may take weeks of treatment. If you’re not seeing positive results after three or four sessions, you should discuss it with your therapist and possibly reconsider your choice of treatment. This doesn’t mean that
the therapy doesn’t work, only that it or the therapist is not a good match for your particular problem.

THE TEAM CONCEPT

You should always look for a muscle therapist who can see the big picture and identify issues outside of his or her scope. The therapist should have collegial relationships with other types of health-care providers and the experience to recognize, for instance, when a painful joint should be looked at by an orthopedist, or some other specialist if an underlying medical condition is suspected (a tumor? diabetes?). Maybe a physical therapist should be brought in to strengthen weak muscles if that is what’s holding back recovery. A chiropractor can treat joint misalignments.

As you can tell, we strongly believe in the team concept—our own collaboration has taught us that every therapy or treatment has an important role to play. For instance, if diet and weight are troubling issues, see a nutritionist. A knowledgeable trainer can inject real value into a gym membership and play a crucial role in helping clients with the transition from a structured physical therapy program to working out at the gym.

It’s true that not every talented health-care practitioner is a team player. Your surgeon, for instance, may have formidable technical skills but not be very engaged in your postsurgical rehab. You could wind up in a “cookie-cutter” physical therapy program that offers little individual attention and no manual therapy expertise because your insurance doesn’t cover it. Then it’s your responsibility to find a surgeon or physical therapist who meets your standards and be willing to pay out of pocket for it.

To take an example from the manual therapy world, let’s suppose you’re getting great results with a traditional acupuncturist who lives and breathes only acupuncture. That’s fine, but now it’s your responsibility to seek out the appropriate care for any problem that falls outside that particular skill set. If the therapist sends out the signal, subtly or not so subtly, that going outside his or her method for a complementary treatment, or even just a second opinion, is not acceptable, find another therapist. For that matter, if a surgeon discourages you from seeking a second opinion, that’s a bad sign as well. But don’t confuse that with the orthopedist who
holds you back from jumping into an exercise program or the muscle therapist who cautions you about making a fast decision about surgery. They’re respecting the body’s healing time line, not rejecting other styles of care.

By now, you’ve seen the limitations of a system in which health problems are treated by separate groups of specialists who sometimes don’t have much contact with one another. The body isn’t an inanimate object like a car that you can drop off at one shop to get the dents knocked out and at another to get the brakes fixed, and then pick it up expecting it to work without a hitch. The body is a living organism. All the moving parts affect one another; all aspects need to be considered. That’s why we believe in a flexible team approach to deal with the range of musculoskeletal problems, from mostly muscular to mostly joint. We have plans to open a hip center where the best talents—orthopedics, manual therapists, and physical therapists—are all collected under one roof. We hope it will be a model that others find useful. This book is just a first step.

Dr. Kelly

I am just as happy, if not happier, when someone comes in for surgery and I can say, “I don’t think that is the way to go. Let’s deal with the muscle.” They’re usually skeptical. They’ll say, “I’ve been dealing with this for so long. I just want it fixed.” And I have to say, “Be a little patient. Trust me on this one.” And I’ll send them to Dr. DeStefano. My approach is not trying to be a surgeon so much as a health-care professional—trying to figure out the best solution to the problem. And I don’t want to do surgery on people if they’re not going to do well. Maybe 10 percent of patients don’t do so well, but they take up 90 percent of my time—“I’m still not getting better, what’s wrong?” That’s painful to hear. And that’s a strong incentive for a surgeon to help people get better without surgery if they can.

ACKNOWLEDGMENTS

DR. ROBERT DESTEFANO

So many things have to come together in order to write a book that it seems impossible to individually acknowledge and adequately thank everyone who has had a part in this enormous undertaking. If we have missed anyone, we are truly sorry.

Thank you to all of my patients who have supported me over the past twenty-five years and entrusted me with their health, as well as the health of their family members, friends, and colleagues. A special thanks to Ms. Carolyn Reidy for her encouragement and support of this project from the beginning and throughout the process. Thank you to Dr. Bryan Kelly, whose vision allows him to help his patients completely: both through his amazing talent as a surgeon and his incorporation of other health care professionals.

To Susan Stanley: partner, friend, scholar, and exceptional manual therapist. Without her help, this book would not have gotten done. Thank you.

To Joe Hooper for putting our thoughts into a simple, meaningful manuscript that people can understand. Thanks to his wife, Kate, for her help. To Michael Gostigian and his family for help on so many levels: thank you for modeling for the book, for representing our country in three consecutive Olympic Games as a modern pentathalete, for contributing to the fitness section, for keeping me aware of the importance of exercise, for so many referrals to our offices, and for teaching those around you to live life fully by your example and not just words. Most of all, thanks for your friendship. Thanks to Megan Fanslau for modeling for the book and her help in the office, which she always gave with a smile. Thanks to Zach Schisgal
for a wonderful job of editing and coordinating this book, and for helping to make it a reality. Special thanks to Shawna Lietzke, for always being there to answer questions, and for all of her hard work. Thanks to Mike Llerandi for his friendship, advice, and contributions to this book. Thanks to Eric and Brooke Lagstein at Be Creative Photography for their contributions and pictures. Their expertise and advice were priceless.

Thank you to my children, Jason, Amy, and Julie, who teach me the most about life and keep me honest and true. You are everything to me. To Gayle, their mother, for her tireless commitment to and care of our children. Thanks to my family for everything, especially my mother and father for their love and support and for bringing me into this beautiful world.

Thank you to all of my friends and family who supported this book, and my fellow professionals and colleagues who so generously help others. To Dr. Mike Leahy, creator of Active Release Techniques, and his family: thank you for the opportunity to help others and for opening my mind to the treatment of muscles and their role in health care. Thanks to Dr. Janet Travel—so far ahead of her time—and Dr. David Simmons for the work they’ve pioneered in the field of Trigger Point Therapy. To Dr. John Mennel and his manual manipulation expertise, and Dr. Raymond Nimmo—a true inspiration.

Thank you to Dr. Russell Warren, Dr. Scott Rodeo, and all of the physicians at the Hospital for Special Surgery. To Dr. Jen Solomon, Dr. Frank Lipman, Dr. Marc Polimeni, Dr. Kenneth Conti, Dr. Dan Geller, Dr. Marcus Forman, Deanie Barth, MSPT, and Dr. Lisa Callahan: thank you for your referrals and confidence.

Thanks to Ronnie Barnes for teaching me the most valuable lesson of my career: to be a piece of the treatment puzzle when working with a team of medical professionals in an integrative setting. To Byron Hansen, Steve Kennelly, Leigh Weiss, and the New York Giants’ athletic training staff. To Joe and Ed Skiba, Ed Wagner, Tim Slaman, and all of the New York Giants’ equipment room staff.

Thanks to the Mara and Tish families for giving me the opportunity to serve such a professionally run organization—the New York Football Giants. And to Coach Coughlin, and all the Giants’ coaching staff.

Thank you to all of the New York Football Giants players who I have helped over the years, and who have supported me and value the treatment I provide. There are too many to list, but special thanks to Jeff Feagles, Amani Toomer,
Michael Strahan, Eli Manning, Tiki Barber, Chase Blackburn, David Diehl, Antonio Pierce, and Howard Cross.

Thanks to Chris and Katy Gebhardt and family, to Dr. Marvin and Wendy Lagstein and family, Howard and Pia Cross and family, the Llerandi family, George and Brooke Perez and family, Darren Prince and family, Dr. Mark Delmonte and family, Tom LaTorre and family, James Carr, Esq., and family, and Dr. Bob Zimmerman— all of whom inspire, challenge, and motivate me.

Thanks to Harlan Schlecter, Geri and Kit Laybourne, Natalie Moody, Mr. John Tishman, Donald Schupak, and Sister Carol Zinn—my mentors and guides through life.

Thanks to Pat Manocchia for the opportunity to work with him, his clients, and his staff, and to learn and share in a truly innovative, integrative environment. Thank you to the Manoccchia family. Thanks to all at La Palestra who have helped me in so many ways over the last ten years, especially Greg Peters, Shannon Plumstead, Mark Tenore, Kofi Sekyiamah, Mike Pardo and family, and Greg Cimino, for his constant and expert legal advice on all of my projects.

Thank you to all my associates and office staff over the years, especially Dr. Kyler Brown, Dr. Keren Day, Dr. Justina Ngo, Dr. Andrew Veech, and Dr. Marie-Claude Goyette, as well as Kathy Salcedo and all the staff who have assisted me to help our patients and keep our offices running smoothly.