Providing Elite Physical Care with Randy Bauer

RPM physical therapist Randy Bauer guides us through his holistic approach to recovering movement that he uses on everybody from Olympic athletes to Average Joes.

When Randy Bauer was in college, his focus was on football. That is until an injury on-the-field opened his eyes to the world of physical therapy. He began to work with collegiate athletes to help them preserve their personal health assets.

“It was being involved with the athlete in the day to day. It wasn’t just seeing them at a game, it was dealing with their practices, being out on the playing field and really seeing how these different athletes practiced,” he said.

Bauer has now been working as a physical therapist for over thirty years and has provided care to a large number of elite athletes, from track star Edwin Moses to tennis player Michael Chang.

In this episode of Powering Health and Wellness with RPM Rehab, Bauer breaks down what it takes to train elite athletes, the importance of building meaningful relationships with every client and how every facet of our lives can define our ability to move.

Adjusting to the world of athletes

Clients with a wide range of abilities often come into Bauer’s office at RPM Rehab. In his long career he has seen an extensive list of elite athletes, from the collegiate level all the way up to Olympic competitors.

For patients with such a skill level, he finds he has to adjust his therapeutic approach.

“They maintain their conditioning, and their training level is impeccable,” said Bauer. “You see a different level in the way people prepare themselves through a season, how  they recover for off-season and how they prepare themselves for the upcoming season.”

In his experience, Bauer has noticed that these professional athletes are models in taking their personal health assets seriously. They always come prepared and ready to maximize their sessions.

“When your livelihood is dependent on it and your longevity in the sport is dependent upon it, you’re going to put that effort in.”

One reason athletes have so much success in their therapy sessions is because they have an acute awareness of what their body needs. One of the most important things any patient can do is listen to their body.

This intense focus on personal health and wellbeing is something anyone – whether an athlete or not – can bring into their lives. 

“My emphasis is educating people inside the clinic and outside the clinic on how they can maximize their health and longevity around what they do.”

Maintaining meaningful relationships

In order to watch someone improve their overall health and well-being, you have to stick with your clients. One of the keys to success is building a meaningful relationship between therapist and patient.

“That’s something I’ve really enjoyed: the relationships that I have developed with not just the athletes that I see, but the various patients and the generations I might see in one family.”

Over the years, Bauer says he has seen the difference this kind of long-term investment in patients can make. He’s seen one patient for a little over thirty years.

“Over time, I’ve seen a few joints being replaced in that one person. And maybe a back surgery,” said Bauer. “And that develops a close tie with the individual and that extends to other clients that I have and that’s why I enjoy being in the community.”

These intimate relationships unlock whole new possibilities for therapist and patient. By getting to know a patient’s personal history, their comfort levels and their physical limitations, Bauer is able to work through these obstacles to reach new levels of growth.

But, what is most important is that this relationship allows him to bring out the best in his patients. 

“That might be feeling relaxed in the setting that they’re in. It might be motivating them to do more when they’re not in the office to help their condition. And it’s follow up communication. That’s where I would say my success is: the development of relationships.”

A holistic approach to physical therapy

When approaching a new patient, it’s important to look at more than just what they bring into a session. Physical therapists need to take a holistic look at the people who come into their office.

“You need to know how they’re using their body day in and day out,” said Bauer. “You need to know what they’re doing to provide the adequate energy supply to work. Because that’s what you’re trying to do: step up their tolerance to work.”

This means considering things like what a patient’s diet looks like, how much sleep they get each night and the amount of relaxation built into their day. All of these things will play a role in their therapy sessions.

“There has to be a look at the total patient.”

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Healing the Body and Mind Through Water

Former Director of the Washington State University National Aquatics and Sports Medicine Institute Bruce Becker MD shares how aquatic therapy can unlock healing in both the body and the mind.

Bruce Becker MD doesn’t mind seeing people at their worst. He says, through his years  as a physician working with aquatic rehabilitation, he has taken the most joy from taking his patients from where they are, following illness or injury, to where they want most to be.

“It is really one of the most holistic medical fields I can possibly think of. I mean we don’t have an organ system: what we have is a human,” said Becker. “That’s an entirely different way of looking at healing and recovery.”

The former Director of the National Aquatics and Sports Medicine Institute, Becker spent his career using warm water immersion to achieve recovery that not only assisted on a physical level, but also with mental well-being. 

In this episode of Powering Health and Wellness with RPM Rehab, Dr. Becker explains the multifaceted benefits of aquatic therapy and shares his hopes for the future of the practice.

The instant ease of water

The first time patients step into the pool, they often observe the instant benefits of beginning the healing process in water. For many, Becker says it can ease the road to recovery.

“I watched how they did in the water: spinal cord injury patients and stroke patients in particular. The results were amazing.”

One of the most amazing powers of water is its immediate healing effect. When Becker brings patients with chronic pain into the pool, he often gets emotional results. The water instantly relieves some of their daily pain.

“I can remember a number of cases when I would get a patient in the pool and they would just sigh in relief or they would, at times, even cry,” said Becker. “For the first time, in water, they were pain-free. It was quite remarkable.” said Becker.

This relaxing and naturally healing quality of water is what makes aquatic rehabilitation so successful. It can often serve as the perfect first step towards recovery. 

Many times, stepping into the pool can be the difference between a patient complaining about physical therapy and a patient excited to continue their therapy. 

“There’s a big difference between the kind of early phase, post-op rehab that can happen using the water versus what happens in the gym. I go down to the gym and I see patients with grimaces on their faces. I go down to the pool and I see them smiling,” Becker said.

Psychological healing

The power of the pool doesn’t stop at its physical effects. Aquatic rehabilitation has proven to be useful as a recovery tool for the mind.

Throughout his career, Becker has used warm water immersion therapy with injured veterans suffering from traumatic brain injury and PTSD in close collaboration with the Wounded Warrior Project.

“It made a big difference in their recovery outcomes,” said Becker. “I saw warm water immersion as incredibly useful in the management of PTSD.”

There’s a complex science behind why warm water immersion can aid in recovery of these mental conditions. The therapy helps to change the central nervous system in an important way: it regulates the fight-or-flight response within a patient.

“What happens in PTSD is that the nervous system component has been called up so often during a series of traumatic events that it never really relaxes back to baseline. Warm water immersion allows that automatically to down-regulate.”

This neurophysiological process benefits the patient in many ways. It reduces blood pressure, heart rate, respiratory rate and, most vitally for PTSD patients, improves brain function.

“It allows your brain to more widely range, it improves memory, it improves a whole bunch of things from the standpoint of actual cerebral activity function.”

The future of aquatics

Despite all these clear benefits, these forms of aquatic therapy aren’t that common in the physical therapy field.

Becker hopes in the future that aquatic rehabilitation’s lasting impact both physically and mentally will be more recognized in the mainstream.

“The fact that it isn’t more widely used has been a major frustration for me. It isn’t very commonly used and the existence of therapeutic pools is not really widespread across the world and the United States. It really ought to be a mainline opportunity.”

He has published a number of studies detailing the benefits of this type of rehabilitation therapy. However, Becker believes there needs to be a shift in the attitude of funding disease prevention initiatives. 

“I wish that the recognition of wellness promotion were more actively pursued at a federal level and there were more grant opportunities.”

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The Advantages of Aquatic Therapy with Julianne Alford

RPM – Spokane Clinical Director Julianne Alford imparts knowledge she’s learned from worldwide training on how to use the water environment to facilitate  functional improvements and improve mobility.

Twenty years into Julianne Alford’s physical therapy career, an injury to her shoulder stopped her in her tracks. No longer would she be able to treat like she used to unless she adapted to a whole new medium: water. 

“The first time I got into the water as a clinician, I had my arm back,” Alford shared. “I realized I could marry all the skills that I had on land with that of water and treat a whole new source of clientele in the water.”

Alford went on to train in world-renowned centers in key thought centers across Europe until she mastered aquatic rehabilitation practices. In this episode of Powering Health and Wellness with RPM Rehab, Alford shares her passion for aquatic therapy and explains all the ways in which water-based rehabilitation can increase support, strength and stamina in the pool.

The power of water

When you move your therapy practice into the pool, it opens up a new world with a whole new range of possibilities for improving physical health. 

Whereas on land patients have to fight gravity, the pool offers them freedom from this sometimes limiting force. In water, people benefit from the effects of buoyancy which helps lift and support them while they work through their exercises.

“Everything you do, it’s unweighting those painful joints. It’s unweighting those painful spinal structures. It’s supporting your body. It’s alleviating that stress of that gravity. And it allows that person to be upright,” said Alford.

Water is also more viscous than air, meaning you face far more resistance to your movements when submerged, which Alford says can be used in numerous ways to build better mobility.

“I can take an individual and say, ‘I can use the viscosity to support you or I can use the viscosity to strengthen you.” 

Another property that makes water such an invaluable resource is the hydrostatic pressure. When you stand in the pool, the pressure is greater on your feet than on your chest level – increasing the workload of your heart by 40%.

In this way, Alford says water is like a third partner, alongside you and your patient, assisting with the physical therapy.

“I’ll tell a patient when they first come in the water, you’re benefiting from being in the water and I haven’t even touched you,” Alford said. “And that’s the greatest gift water gives is hydrostatic pressure.”

Pool parameters

The pools for physical therapy aren’t your average pool. Alford believes it’s important that pools be adjusted to assist rehabilitation efforts as much as possible.

That includes temperature. For aquatic physical therapy, you want water that is warmer than the average pool – at about 92 to 94 degrees Fahrenheit.

“The purpose of using that is to make sure when you get in, if you’re not moving, we don’t want you to shiver, but we also don’t want you to be too warm and relaxed,” she explained. “It’s to be comfortable enough to move around and exercise, but not to overheat your body.”

In Spokane, Alford runs a clinic with a pool designed specifically to meet the needs of her practice and her patients. The depth of the pool varies from 3 feet up to 7 feet in order to allow for a wide range of movement, both shallow and deep water.

“It’s a 20 by 30 foot pool, so it’s a very large area to treat,” said Alford. “You want to make sure that a person is exercising at the appropriate level for them. So I don’t want to take a 5”2’ lady and put her in 6” water.”

Lastly, the chemical makeup of the pool can determine a lot about who you can treat. Alford uses bromine, rather than chlorine, to treat her pool because she says it’s the least harsh option for her patients’ skin. She also recommends a strict routine on how much time they should spend in and out of the water.

“There’s a whole hygiene on how you get in the water, how you get out of the water and what you do with your bathing suits. And we explain that to all of our clients.”

Increasing endurance

Another amazing aspect of aquatic therapy is that it can be used not only for severely debilitated patients, but also for elite athletic training. 

In fact, studies have shown that participation in aquatic therapy significantly strengthened athletes. Alford explains that sometimes patients can “out-endurance those athletes that were on land because their cardio-pulmonary function was so much stronger in the water.”

Alford has found this cross-training method very successful for athletes of all backgrounds, from high school athletes all the way to Gonzaga University basketball players. 

“In a lot of ways, not only did we keep them on the field through their injury and protect them,” said Alford, “but then after they were done they continued because they liked the performance enhancement. They were stronger.”

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Orthopedic Surgery, Bone Health and Physical Therapy

Orthopedic Surgeon Alan Greenwald explores the training, skill, discipline and technology it takes to preserve health through procedures – and the important steps that come after.

After 40 years of being an orthopedic surgeon, Alan Greenwald MD has yet to grow old in the profession. Performing surgery has changed over time and with technological evolution, but Dr. Greenwald’s purpose has remained the same: to help people move.

“It’s a medical specialty where you can literally fix people, get them up and get them walking. You can take people out of a wheelchair and let them walk again. Or fix a broken bone and help it mend. It’s a very gratifying speciality that provides us with really rapid results and improvements.”

In this episode of Powering Health and Wellness with RPM Rehab, Dr. Greenwald takes us through the intricacies of orthopedic surgery, the importance of the Physical Therapy that follows and the ways he believes the industry can grow.

Transformative technology

One of the most engaging parts of orthopedic surgery is the almost incomprehensible technology that’s advanced along with the practice. 

“We can take materials that have been synthesized and make the body reprogram itself in a fashion to make bone where there is no bone. Or, heal tissues where it’s not possible normally to heal tissue,” said Greenwald. “So we are able to jumpstart the biology.”

These developments in technology have allowed for professionals like Dr. Greenwald to perform less-invasive and more efficient surgeries on those in need. With the technological gains and improvements, the industry has been able to continue to grow and change.

“It has revolutionized fixing people from making big incisions and big cuts to small incisions, and working through little tiny tubes with fiberoptic scopes and using technologies that I never dreamed of as a resident,” Dr. Greenwald shared.

Now, surgeries – like shoulder operations – are shorter, less complicated and offer a quicker recovery time for patients. 

And, the technology doesn’t seem to be stopping anytime soon. Even after decades in the profession, Dr. Greenwald is always continuing to learn new things and utilize state-of-the-art innovations.

“It’s been a nice and interesting ride, and it keeps changing. I don’t think it’s going to stop during the time I’m practicing.”

The need for post-procedure therapy

Even with the amazing technology available today, it takes more than just surgery to regain movement and strength after an injury. After a procedure, patients still may not feel equipped to continue their lifestyle and fully resume their usual activity level.

“It’s possible to recreate the anatomy that was damaged by an injury or an accident,” said Dr. Greenwald. “However, it takes more than just putting these tissues back in place to get the patient back to a functional lifestyle.”

That’s where therapy comes into play. Orthopedic surgeons rely on Physical Therapists to work patients through their pain and fears and to restore them to their pre-surgical, or pre-injury, functional levels.

“It takes an awful lot of effort to get from the operating room to, for example, throwing a ball,” said Dr. Greenwald. “It requires a very concerted and time-driven mechanism that is orderly.”

This process takes not only time, but a willingness to encourage patients and inspire confidence in their progress. Dr. Greenwald says the best way to restore physical health is to establish this trust then work toward movement, strength and coordination.

The impressive technologies found in the operating room aren’t enough. It takes collaboration between surgeon and Physical Therapist for complete patient healing.

“Patients aren’t able to generally do this on their own. Most people don’t have the skill or the sense of security or the confidence to do it by themselves.They often require a lot of help.”

Preserving bone health

Twenty years ago, the American Academy of Orthopedic Association mandated orthopedic providers take on the role of monitoring bone health.

But, Dr. Greenwald says that this personal health asset is currently being ignored. In fact, 90% of patients with fragility fractures go unacknowledged.

“It’s a silent disease. And I’ve been working hard in the last years to encourage physicians – especially orthopedic surgeons – to acknowledge that these patients that they’re seeing and treating need additional help.”

In addition, there are steps patients can do to avoid bone health issues in the future. By taking calcium supplements, stopping smoking and limiting alcohol consumption, you can take a step to have stronger bones later in life.

“It’s often very preventable. So the recognition of that kind of disease in the process is paramount for bone doctors.”

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The Future of Physical Therapy

Physical therapist Chuck Martin shares observations he’s made during his forty years in the field and offers a glimpse into where the industry is headed next.

Chuck Martin has spent almost half a century on the front lines of the physical therapy industry. Every new patient reinforces for him the importance of taking good care of your body — a concept he says you can trace back far into history.

“An argument could be made that physical therapy goes back 5,000 years,” he says. “Properties have been used by individuals to heal themselves and to help heal others for a long time.”

In this episode of Powering Health and Wellness with RPM Rehab, Martin shares his predictions for the likely equally long future of physical therapy: how COVID-19 has impacted treatment, the achievement of direct access and why physical therapy should be used on a more consistent basis.

Becoming the Practitioner of Choice

The future of physical therapy lies in the growing need for consistent, regular functional assessments. Martin says physical therapists should expect to see people at a much higher frequency.

“If you think about when you go to see a cardiologist, a cardiologist doesn’t usually just treat you for a little while and then let you go,” says Martin. “It’s usually we’ll look at your advancement, see where you are, then we’ll see you in another six months or a year.” 

Physical therapy is beginning to advance to this same kind of pattern. By seeing patients biannually, even after care for a specific problem or injury has finished, physical therapy professionals are able to effectively monitor changes in functionality and mobility within patients.

“That’s going to be the future,” Martin believes. “We’ll see them every six months or once a year to sort of look at how they’re moving, how they’re tweaking, trying to keep that train on the track as opposed to having the train jump off the track.”

With more consistent check-ins, Martin says patients will be able to remain active for a much longer time, and even avoid needing walkers as they advance in age.

“I’m a firm believer that if we keep people moving, and people keep their fitness and their stretching up, that there’s no reason why they can’t remain healthy and active up into their nineties.”

Growing Autonomy

An important recent development for physical therapists has been the transition to patients having direct access to care. In the past, it was necessary for patients to get a referral from a physician in order to begin sessions with a physical therapist. 

“As the desire for more autonomous practice grew, there began to be a push for physical therapists to have direct access,” Martin explains, “which means the patient could make the selection to come directly to a physical therapist.” 

Martin says before direct access, patients often had to wait extensive periods before they were able to get seen by a doctor. This was an ineffective way for treating both injuries and mobility issues.

“Often what happens when you have an injury, it may take three to six weeks to get in to see the physician and another two to three weeks to see the physical therapist,” he says. “So now you’re two, two and a half months out from the time you were injured before receiving the care you need.”

Today, to some degree or another, all 50 states have changed their laws to include direct access to physicians, allowing for earlier treatment for patients.

“By being able to come directly to a physical therapist, treatments can start earlier and interventions can be developed earlier.”

Telehealth Transformation

The past year and a half has pushed physical therapists to adapt to a virtual world. It also opened up opportunities for telehealth care to take an even bigger role in physical rehabilitation. And Martin hopes that growth continues beyond the pandemic.

According to Martin, now it’s as easy as setting up a video conference with your practitioner of choice to address the daily wear and tear we feel on our bodies.

Another advantage of telehealth services is the ability to provide some level of care from almost anywhere in the nation, thanks to the “Physical Therapy Compact.” The PT Compact is an interstate agreement between participating states intended to provide collaborative access to physical therapy services, regardless of where the patient lives.

“If I have a license in Washington state and I pay a fee and pass a small test, I can then be considered to be licensed in all these other states, which allows me then to do telehealth across state lines,” Martin explains.

For physical therapists, this means expanding their reach to new patients in desperate need of help. And for the consumer, Martin argues, a much wider access to life-altering therapy for all.

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Investing in your physical health and mobility with John Hawes

CEO of RPM Rehab John Hawes shares the wealth of knowledge he’s earned from more than 30 years in the physical rehabilitation industry — and the value he sees in taking care of your body today.

With decades of experience in medical rehabilitation services, John Hawes has witnessed the magic of physical therapy at work. Years ago, the CEO of RPM Rehab challenged himself to learn everything he could about healthcare in order to make the most impact.

“I read every article, I read every journal, I listened to every smart person I could find to talk with. And I actively sought out conversations with people to engage in this conversation on what’s going on,” said Hawes. 

In this episode of RPM Rehab, Hawes shares what he learned with us and introduces the wide range of potential that lies in physical therapy and prioritizing your physical health and mobility.

The scope of treatment

In the waiting room of a physical therapy clinic, you see people of all ages and all walks of life. That’s because we all share a common concern: taking care of our bodies.

“Rehab professionals, especially physical therapists, work with a full range of patients from newborns and infants all the way up to the very elderly,” said Hawes.

And, although you may think correcting something as common as lower back pain is simple, Hawes says that oftentimes there’s a wide range of potential problems that could be the source of pain.

“There are a lot of very, very complex conditions and situations that people can present — with complex pain conditions, complex changes to the skeletal structure, complex issues of muscle deterioration and just a lot of different things that can affect movement and how we function.”

Our bodies are nuanced in how they operate and how they heal. Hawes says even the slightest injuries can impact a whole range of muscle movements without us noticing.

“Your quads are a little sore, so when you walk you change the way you walk a little bit and that puts stress on some other part of the body,” said Hawes. “And that’s what rehab professionals work on.”

A preventative tool

One of the common misconceptions about physical therapy is that it’s only used as a way to repair damage done by injury or disease. But Hawes says it can also serve as a way to check-in on your physical health. 

In fact, Hawes has observed a shift in the industry: more and more people are coming into physical therapy to prevent future problems.

“This transformation in the healthcare industry is moving from caring for things when something’s wrong to preserving and building on and figuring out how to invest and develop and optimize each of those personal health assets that we have.”

These check-ins on the functionality of our bodies can be vital in maintaining our mobility and avoiding injury. 

“Functional assessments are used to identify what’s working well, what’s not working well, what do we need to focus on to develop in strength, or where do we need to increase flexibility, or what part of the body do we need to work on improved mobility.”

It can also be used as a means to better prepare for an athletic challenge. So if you’re planning to run a marathon, you can consult a physical therapist on how to prepare that goes beyond athletic training alone.

“What’s sort of the optimal way for you to train? What’s the optimal way for you to build endurance? For you to build strength? To balance that with flexibility, cardiac control, respiratory control, with relaxation, with getting enough rest, with nutrition?”

Protecting your mobility

After years in rehabilitation services, Hawes has learned that one of the most important things people can do for themselves is to prioritize care for their health.

”The greatest asset that each of us will ever have is our health and our wellbeing,” said Hawes. “And that’s very complex: what makes us healthy, what’s involved in maintaining our health.”

Hawes coins this as protecting your ‘personal health assets’. He says you should view things like joint health, cardiac health and levels of strength and mobility as something to continually devote time in. 

“You take steps to protect your 401K or your investments, to protect your house, to invest and develop it,” said Hawes. “You need to invest in and protect your personal health assets as well.”

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