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Ep. 78 - LiveWell Talk On...Back Pain (Carol Schueller, PT, DPT)

episode 78

Ep. 78 - LiveWell Talk On...Back Pain

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Host: Dr. Dustin Arnold, chief medical officer, UnityPoint Health - St. Luke's Hospital

Guests: Carol Schueller, manager, St. Luke's Therapy Plus

Dr. Arnold :
This is LiveWell Talk on back pain. I'm Dr. Dustin Arnold, chief medical officer at UnityPoint Health - St. Luke's Hospital. Joining me today in the studio to discuss back pain, which is a common ailment that impacts just about everyone at some point in their lives, some people more severe than others, is Carol Schueller, who is St. Luke's Therapy Plus manager. Hi Carol.

Carol Schueller:
Hi.

Dr. Arnold :
What is Therapy Plus? For the longest time I thought it was something different than physical therapy. You know, I would write an order for physical therapy, then I'd hear Therapy Plus. And it took me, it was a while to go: Oh, okay, that's the same thing. So why don't you tell us what it is.

Carol Schueller:
Sure. Therapy Plus is the name of our outpatient orthopedic clinics, we primarily deal with outpatient orthopedics at the four locations, and it was a name that was suggested 25 years ago. And one of our therapists suggested it as a name to associate with the different clinics. And since then it's stuck and that has followed us as we've built our Therapy Plus clinics at the various locations.

Dr. Arnold :
And how many clinics do we have?

Carol Schueller:
We have four currently. Our original one was downtown above Work Well Clinic in the 830 building. And then currently we are in Hiawatha, Marion, and at Westdale as well.

Dr. Arnold :
And has the COVID probably slowed it down a little bit perhaps, but are you back up to pre-COVID norms?

Carol Schueller:
It did slow down just a little bit. But now we are reactivating. We're allowing extra time for cleaning between patients and all our patients are wearing face masks as are our therapist. And they're wearing face shields. But we are definitely reactivating and keeping very busy.

Dr. Arnold :
So, what therapies do you provide there? I mean, physical therapy obviously, but give me kind of the spectrum of, or continuum of care that's delivered.

Carol Schueller:
Sure. So physical therapy is the primary thing that we have available at the four clinics. And we will treat patients with injuries or after surgeries. And we also have occupational therapy that's available at our downtown clinic and that specializes in work rehabilitation and does the hand therapy as well as upper extremity rehabilitation.

Dr. Arnold :
Okay. I know from my background in sports medicine and being a team doctor for various football teams that, you know, I send people to therapy for that. But so I guess the take away—you don't need to have surgery and orthopedic surgery to have therapy. Sometimes you need it just for a routine, well, common injuries, correct?

Carol Schueller:
Right. Yes. We'll see patients that will have injuries from just something at home, or maybe it's from overuse that they're starting to have some aches and pains. Back pain is the number one thing that we see patients for, but also shoulders, knees could be a variety of things that we will treat.

Dr. Arnold :
And I think over the years there's been different studies. As we're going to talk, I'll ask you about back pain, that in combination with therapy, surgery can be avoided sometimes. Correct?

Carol Schueller:
Absolutely.

Dr. Arnold :
Yeah. Tell us about back pain. What you see, how it presents.

Carol Schueller:
So a lot of times we will see patients with back pain. Most of the cases that we see are nonsurgical patients that have just had pain from an activity, or just had ongoing back pain. We'll treat that with an evaluation the first visit. And then we'll spend about an hour with the patient, talking to them about what causes their pain, what makes it worse, what things that they've tried to make it feel better. We'll assess the range of motion, strength, and do some special tests to try and zero in on where the pain is coming from. And we have a variety of treatments that we will provide. Sometimes it's, almost all of our patients have exercise to get stronger or for some stretching. And then sometimes we'll utilize some different modalities to help with pain relief.

Dr. Arnold :
You know, a little inside info here, I worked with you to get dry needling as a service, which is taking off.

Carol Schueller:
It is.

Dr. Arnold :
I know it's busy. I think at one time we had two therapists. I don't know how many there are now.

Carol Schueller:
Right. Right now we have three therapists that are certified in the fourth is very close to certification. That's been very popular. And in regards to back pain, it will help if someone has a muscle knot or an area of tightness and the dry needles will be inserted into that tissue to try and help to loosen that up. It has been very successful. Patients have done very well with that included in their therapy treatment. It's different than acupuncture. Acupuncture will, the needles will go in and stay in that location, where dry needling it goes in to try and elicit a muscle response to help with the pain relief.

Dr. Arnold :
Yeah, I kind of describe to people as it's like hitting—your computer freezes up, you hit control, alt, delete. You know, and it unlocks. That's kind of what the, you just poke it in there, and which is interesting from that standpoint. In back pain, how long is the average—I know it's probably hard to answer because it depends on what they're presenting with, but what is the length? How many times does someone have to go to therapy?

Carol Schueller:
Right now our average is around seven visits. We do what's called care connections outcomes, and the patient will fill out a survey before they start therapy and at discharge. And it shows that their pain improves and their function improves in an average of seven visits. So around seven right now. But it does, it varies based on the patient's injuries. Some will be less, some might be more.

Dr. Arnold :
And then, you know, being we document in Epic, because I get the reports of my patients that go, which is always nice. And you don't always—little pitch here for the company—but you don't always get that when they go to outside physical therapy.

Carol Schueller:
It allows that continue of care where the provider can read the notes.

Dr. Arnold :
Well you can read it and you can say: Whoa, that's going good, or this isn't going as well as I thought, I better call them up. But back to back pain, what are some warning signs that a patient may say, or the therapist may say, we need to have you talk to Dr. Arnold or whoever their physician is?

Carol Schueller:
So we'll look at increasing pain, which would be a concern. Any sudden weakness in the leg would be a concern. Any bowel or bladder issues, those would be the signs that we would look at as far as making sure we get back to the referring physician.

Dr. Arnold :
And if the numbness and tingling goes down the leg, that's what you meant by the weakness. Carol, one of the, kind of the urban myths or legends or fallacies is that back pain—if you have back pain, you need bed rest. Tell us about that.

Carol Schueller:
Right now, a lot of the literature is showing that patients are better off by staying active, just even walking around and trying to keep up with daily activities as much as they can. And we will encourage that as we do the therapy, is have patients try and maintain a normal lifestyle as much as they can.

Dr. Arnold :
We always used to say in the hospital is that most patients die in the bed, so get your patient out of the bed.

Carol Schueller:
Keep them moving.

Dr. Arnold :
Keep them moving. Absolutely. So you've got an anniversary coming up for physical therapy, or Therapy Plus.

Carol Schueller:
We do. Therapy Plus will have their 25th anniversary coming up. It was delayed a little bit due to COVID.

Dr. Arnold :
So you started when you were six?

Carol Schueller:
I know, and we have four people in the core staff. Four of our therapists and one assistant that was with us from the very beginning, 25 years ago. So we're pretty proud of that. We've really grown over the years and feel that being co-located in the buildings with the physician offices has really helped us with our growth. We're more convenient for patients where they live and work to come to therapy.

Dr. Arnold :
Yeah, it's a great resource. Just outstanding resource. How does someone get referral to Therapy Plus?

Carol Schueller:
To therapy, they can talk to their physician or provider and get a referral. We, if it's an Epic provider, then they can send that through Epic, which works out really well for communication. We will also check with patient's insurance and we'll be very transparent with them on their financial responsibilities before we'll see them. So that's been a very positive aspect of our care as well.

Dr. Arnold :
All right. Well, awesome. Carol this is great information. Thank you for coming by. Once again, that was Carol Schueller, manager of Therapy Plus at St. Luke's Hospital. For more information, visit UnityPoint.org. Thank you for listening live to LiveWell Talk On. If you enjoyed this episode, don't forget to subscribe. And if you want to spread the word, please give us a five-star review and tell your family, friends, neighbors, strangers about our podcasts. We're available on Apple Podcast, Spotify, Pandora, or wherever you get your podcast until next time, be well.