Lying on my back with four pound weights on my ankles, I lifted my feet into the air.  Ten times with the left foot, ten times with the right until I did thirty repetitions with each leg.  Meanwhile, I thought about how many times I have repeated this familiar exercise.  Looking up at the ceiling, all I could see were the patterned holes in the acoustical tile.  Suddenly, a cramp in my back, and the physical therapist tells me to arch my back to relieve the stress. 

This course of physical therapy began shortly after my second back surgery and I was released just a few months after it began, because health insurance limits for physical therapy had been reached.  What chronic patients like myself need is continuing physical therapy over a longer time, perhaps a lifetime. 

My experience with physical therapy began shortly after returning home from Vietnam in 1968.  I awoke one Sunday morning, alone in my apartment and unable to get out of bed.  I couldn't bend my back to get into a sitting position and every time I moved, the pain was excruciating.  My phone was across the room and after several minutes of agonizing maneuvering, I was able to roll out of bed onto my hands and knees, crawl across the room, reach the phone and call a friend who took me to the St. Albans Naval Hospital (now a Veterans Administration treatment center). 

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That Sunday morning was the beginning of continuing experience with back problems.  Over the decades, I was treated with pain killers, muscle relaxants, heat therapy, cold packs, surgery and physical therapy.  Other than surgery, physical therapy made the biggest contribution to reducing pain and increasing strength and agility.  But every time I achieved a satisfactory level of pain-free movement, physical therapy was stopped because of insurance limitations. 

Violetta Olesiak is now my physical therapist.  She represents the classic American success story.  Violetta was an Olympic speed skater in Poland.  She and her husband decided to come to America for a better life for themselves and their children.  She went to school for physical therapy, worked for Atlantic Healthcare as a therapist for 18 years, during which time she got a doctorate degree, and decided to open her own therapeutic center (Star Physical Therapy in Summit, NJ).  She now has a son in medical school and a daughter in an excellent university.  She opened the doors to her spacious, well-equipped facility in June and I was her first patient in that facility. 

Violetta is the best physical therapist I have ever had.  She is a constant presence in her patients' therapy.  She talks, cajoles, jokes and encourages continuing effort and constant improvement.  Every once in a while, even if she is across the room, I will hear her calling "Mr. Bassman do not do that."  Her admonition is followed with some excellent coaching and praise for doing the exercise more effectively.   And I have come to learn that when she sweetly "suggests" that I "try" a new exercise or increase weight during an old exercise, there is no declining of the offer.

When the workout is over, Violetta provides deep-tissue massage, to loosen knotted muscles and to help increase range of motion.  Violetta specializes in a new technique for relieving pain and restoring muscle function.  The technique is called dry needling, or myofascial trigger-point needling.  It's called dry needling because a very thin, solid needle is used rather than a hollow hypodermic needle.  The needle is inserted into your painful area and moved around.  This process differs from accupuncture because it looks for specific pain trigger points rather than the generalized pain channels that accupuncture treats. 

Like all new medical techniques, there is a degree of controversy over dry needling.  Few double-blind, placebo-controlled clinical studies have, as yet been conducted.  I suspect, that over the long-term, the technique will be vindicated as a pain-reduction and healing therapy.

Why all this interest in physical therapy?  I believe it is a misunderstood and too infrequently applied prevention and treatment regimen.  It doesn't get the respect it should, and many people think physical therapy is just for jocks and severely injured people.  I believe much of that attitude stems from its beginnings.

Physical therapy began in the 1880s as a treatment for polio, came into more widespread use during World War I to treat military injuries, became more prominent after World War II when there were thousands of badly wounded GIs and made its way into hospital to treat people with debilitating injuries.  With the growth of professional sports, the role of the therapist increased as it became more important to get players on the field for the next game. 

Over the years, much in physical therapy treatment has remained the same and much has changed dramatically. Therapy centers are still furnished with the same tables, the same parallel bars, and wooden stairs, but the traditional equipment has been augmented with Thera-Bands (large, colored rubber strips) arm bicycles, elliptical stepping machines, a variety of weight devices and other contraptions that make a physical therapy installation look like a modern gym. 

The room decor has been transformed from early military to modern.  No longer the two-tone, light green over dark green walls with a black stripe down the middle.  No longer the red and brown tile floors.  Physical therapy centers are now attractive, carpeted, bright and pleasant. 

The biggest change, from my perspective has been the professionalism and involvement of the therapists.  To become certified as a physical therapist today, one must have a doctorate in physical therapy.  This is reassuring, since physical therapists treat a much wider age range of people and maladies than many physicians.

When I began working with Violetta after my last back surgery, I felt as if I were a crippled old man, shuffling from place to place.  My left foot slapped the ground every time I took a step, my back was bent and my equilibrium was impaired.  I now walk with the confident step of someone much younger.

If I try to lift something too heavy, or when I sit too long, my back will hurt me to this day.  But most of the time now I don't think of my back and I find myself doing things I didn't do before my back collapsed prior to the last surgery. 

My Medicare allowance and private insurance limits no longer support regular visits with a physical therapist and I am concerned that without the structure of routine physical therapy appointments, it is unlikely I, or most people, will continue the exercises to maintain a level of flexibility and strength necessary to accommodate our injuries. 

If I had received continuing physical therapy treatments from the time I my injured back incapacitated me until now, perhaps I would not have had two back surgeries, followed by long and difficult physical therapy.  As our medical system searches for ways to improve care while reducing healthcare costs, perhaps insurance companies, including Medicare, ought to consider changing the rules to allow long-term physical therapy treatment, which would be a significant advance in patient care for folks like myself. 

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