Elbow Pain, Could the Shoulder be to Blame?

by Julia Glick, PT

As therapists in a clinic located inside of a large tennis club, we are seldom surprised when a number of our patients each year present with lateral epicondylitis – or, as it is more commonly known, tennis elbow. Lateral epicondylitis pain usually occurs over the outside of the elbow where many of the forearm muscles attach, an area that experiences a lot of strain in tennis. However, even those of us who aren’t on the courts every week should be aware of it: it is also common in people who spend a lot of time at the computer or perform lots of gripping during their day. 

Despite the fact that lateral epicondylitis pain feels like it is centered in the elbow, it is important to look at the whole arm. Many people who come to us for tennis elbow have unsuccessfully tried exercises on their own that focus on the wrist and elbow, and are surprised when we turn our attention to the shoulder. Most specifically, the muscles that control shoulder blade position, such as the lower trapezius and serratus anterior, are crucial when treating the elbow, as the position of the whole arm is determined by the orientation of the shoulder blade. 

In fact, several research articles have come out in the past few years that focus on the role weakened shoulder blade stabilizers plays in lateral epicondylitis. Lucado et al. and Day et al. found that people with lateral epicondylitis had significantly weaker lower trapezius and serratus anterior musculature than people without any lateral elbow pain. In a case study performed by Bhatt et al., the research team only treated a woman’s shoulder blade stabilizers and were able to resolve her lateral epicondylitis. Essentially, these studies agree that the muscles that help pull the shoulder blade back and keep it stable also control the position of the arm and elbow: when it comes to prevention of elbow pain, shoulder blade strength and position matters.

Interested in finding some exercises that target the lower trapezius and serratus anterior to help maintain the shoulder blade in its optimal back position? I’ve included some below:

Easier Lower Trapezius

Lie on stomach and roll up a small towel under forehead and place hands on back of head/neck. Squeeze shoulder blades back and down toward opposite pants pocket and lift up elbows. Hold for 5 seconds and perform 5-10 repetitions.

Harder Lower Trapezius (Y)

Lie on stomach and roll up a small towel under forehead. Lift your arms up so they make a “Y” shape. Squeeze your shoulder blades back and down toward opposite pants pocket and lift your arms. Hold for 5 seconds and perform 5-10 repetitions. 

Serratus Anterior Wall Slides

Put your forearms on the wall and push your shoulder blades apart and into the wall. Keep this pressure into the wall and slide your arms up and down. Perform 5-10 repetitions.

Try these exercises and let us know what you think! If you do have pain that is persistent, please stop by to speak with one of our skilled clinicians, who can help you with your injury.

Resources: 

Bhatt, J., Glaser, R., Chavez, A., & Yung, E. (2013). Middle and Lower Trapezius Strengthening for the Management of Lateral Epicondylalgia: A Case Report. Journal Of Orthopaedic & Sports Physical Therapy, 43(11), 841-847. doi: 10.2519/jospt.2013.4659

Day, J., Bush, H., Nitz, A., & Uhl, T. (2015). Scapular Muscle Performance in Individuals With Lateral Epicondylalgia. Journal Of Orthopaedic & Sports Physical Therapy, 45(5), 414-424. doi: 10.2519/jospt.2015.5290

Lucado, A., Kolber, M., Cheng, M., & Echternach, J. (2012). Upper Extremity Strength Characteristics in Female Recreational Tennis Players With and Without Lateral Epicondylalgia. Journal Of Orthopaedic & Sports Physical Therapy, 42(12), 1025-1031. doi: 10.2519/jospt.2012.4095

Ice versus Heat: A Hot (or Cold) Topic

by Constance Taras, PT

One of the questions we most commonly field when patients have first sustained an injury is “Should I ice it, or would heat be better?” Both heat and ice are conservative, beneficial modalities, but to better understand the benefits of either, let’s first look at the physiological effects of each:
 

Typically, the more traditional approach is to apply ice to musculoskeletal injuries, but the type of musculoskeletal injury is important. For acute injuries that are swollen, warm, and painful (such as ankle sprains), ice can temporarily numb the area and decrease pain signals from the nerves, therefore decreasing pain. Ice also constricts the surrounding blood vessels so that less fluid and fewer cells arrive at the injured area. While this could theoretically slow down healing to the area as it does restrict the flow of healing mediator cells (leukocytes) to the area, it also means that less swelling is present. Less pressure on all the surrounding structures could mean less pain and improved range of motion.

However, what if we are dealing with a more chronic injury? Chronic injuries often suffer from decreased blood flow to the injured area, and as a result have a harder time healing. Application of heat, therefore, is the more beneficial modality, as it increases the rate that blood and repairing cells reach the injured site to improve the overall healing process. We also tend to recommend heat over ice in the case of a muscle in spasm or a tight muscle: the improved tissue extensibility provided by heat helps to relax shortened and tensed muscles in order to decrease spam and ultimately pain. Heat also allows improved stretching and increased range of motion, whereas ice could cause the muscle to tighten further, decreasing range of motion at a joint.

But an equally important factor to consider is how heat or ice makes you feel! If ice makes your pain worse or vice versa then it may not be the best option for you, even if clinically it makes more sense (unless it is contraindicated by other health conditions, such as diabetes, Raynaud’s disease or hypertension). If you are unsure what is the best modality for you and your specific injury, reach out to a Lakeshore physical therapist to help you build a customized plan!

References:

Malanga et. al. Mechanisms and efficacy of heat and cold therapies for musculoskelatal injury. Postgrad Med 2015; Early Online 1-9.

Thoracic Outlet Syndrome: A Pressing Matter

by Julia Glick, PT

 If you follow the NBA you have most likely heard that Markelle Fultz, the Philadelphia 76ers’ guard, has thoracic outlet syndrome (TOS). We most commonly hear of athletes from baseball developing this, but rarely basketball – in fact, basketball player Ben Uzoh wasn’t diagnosed until he retired, even though he had previously experienced TOS symptoms. It also took visits to more than 10 clinicians before Fultz was diagnosed with neurogenic TOS. But what does that mean and why was it so hard to diagnose? 

The thoracic outlet is the area between the first rib and collarbone, through which the majority of the nerves and arteries/veins that enter the arm pass. In TOS something in this space narrows and compromises either the nerves or vasculature (arteries/veins). A person with TOS usually has pain, temperature changes, or numbness/tingling at the neck, shoulder, arm, or hand.

Part of what makes it so difficult to diagnose is that there are no standard diagnostic criteria for TOS. There are also several presentations: neurogenic, vascular, and non-specific. With neurogenic TOS, the brachial plexus (nerves that pass through the thoracic outlet) are compressed and will usually cause pain and/or weakness. Features of vascular TOS tend to look more like coldness and numbness, as the arteries and veins are compressed. Regardless of presentation, these symptoms are often difficult to reproduce because they can change based on the position of the head, neck, shoulders and arms.

There are no specific causes for TOS, which often makes it even harder to diagnose. Past trauma or overuse, such as in overhead sports, could possibly increase the likelihood of developing TOS. Anatomically, someone is more at risk if they have an extra upper rib or have any type of tightness of fascia or muscle that decrease the amount of space of the thoracic outlet.

Presently, there are several treatment options for TOS: physical therapy, injection, and first rib removal surgery. In physical therapy, the goals are to restore full range of motion of the shoulder and neck, decrease any restrictions that are impinging on the nerves as they pass through the thoracic outlet, decreasing pain, and improving strength. Fultz has been attending physical therapy, and his agent has reported improvements: they hope he will return in the 2018-2019 season. Here’s hoping for a full recovery for Fultz! 

References: 

Baumann, M. (2018, December 4). What baseball can tell us about Markelle Fultz’s latest diagnosis. https://www.theringer.com/nba/2018/12/4/18126446/markelle-fultz-thoracic-outlet-syndrome 

Bell, S. (2018, December 10). What is thoracic outlet syndrome, and what does it mean for Markelle Fultz? http://www.espn.com/nba/story/_/id/25455660/what-thoracic-outlet-syndrome-does-mean-markelle-fultz

Povlsen B, Hansson T, Povlsen SD. Treatment for thoracic outlet syndrome. Cochrane Database of Systematic Reviews 2014, Issue 11. Art. No.: CD007218. DOI: 10.1002/14651858.CD007218.pub

Retrieved from: https://twitter.com/wojespn/status/1070074789409153024  

Retrieved from: https://twitter.com/ESPNNBA/status/1077668580706209792

Smith, J. (2018, December 4). Sixers announce Markelle Fultz out indefinitely, reveal plan for injury. https://sixerswire.usatoday.com/2018/12/04/sixers-markelle-fultz-out-indefinitely-shoulder-injury/ 

Wojnarowski, A. (2018, December 5). 76ers’ Markelle Fultz has thoracic outlet syndrome, to miss 3-6 weeks. http://www.espn.com/nba/story/_/id/25453907/markelle-fultz-philadelphia-76ers-expected-miss-3-6-weeks-shoulder-rehabilitation

Direct Access for Physical Therapy in Illinois!

by Lauren Sweeney, Office Manager

August 17 was a day like any other in our office: we treated patients, we answered billing questions, we scheduled future appointments for care. But it was unlike any other day in one very important regard: we no longer had to ask patients, “Do you have a prescription from your doctor?”

Up until last month, Illinois state law required patients to have a doctor’s prescription prior to seeking treatment from a licensed physical therapist. On August 16, however, Governor Bruce Rauner signed into law a bill that allows patients in the state of Illinois to have direct access to physical therapy treatment. Patients seeking physical therapy may now simply book an appointment to do so, no differently than they would with their GP or dentist.

This is hardly a revolutionary idea, either. Illinois was one of the last states in the nation to adopt the bill, which is expected to reduce the need for unnecessary X-rays, MRIs, and opioid prescriptions. According to a recent BlueCross BlueShield study, direct access to physical therapy led to a 31% reduction in total health care costs and a 90% reduction in opioid use.

Research also reveals that patients who visited a physical therapist directly for outpatient care had fewer visits, leading to lower overall costs. A study published by the Journal of Orthopedic and Sports Physical Therapy discovered that patients who decide to choose physical therapy as their first treatment option for spine management saved an average of $1543 in their overall care as compared to patients who chose the traditional medical referral route. Both groups showed similar clinical improvement in their symptoms. 

That said, the law does come with stipulations: a physical therapist must refer a patient to a health care professional if the patient does not demonstrate measurable or functional improvement after 10 visits or 15 business days, whichever occurs first. Additionally, this law does not affect Medicare patients, who are still required to have a prescription for physical therapy prior to treatment per federal law. Most patients, however, now have the ability to seek treatment that is safe, effective, non-addictive, and non-invasive for many painful conditions.

Our physical therapy community is confident that with fewer barriers, the patient can choose physical therapy as a first treatment option, leading to a speedy, safe and less expensive recovery.

Resources:

https://www.jospt.org/doi/abs/10.2519/jospt.2018.7423

The State of Rehab 2018

by Sally Fansler, PT It is hard to believe that I have been in the physical therapy industry for more than three decades. Over the course of my career as a physical therapist, I have seen our profession flourish in many different settings. We are able to fundamentally help patients by learning the science of the human body and connecting our skills to restore dysfunction and freedom of movement. There are few experiences more rewarding than to see the pain disappear and the musculoskeletal system change based on the skills we share with our patients.   One of the best ways to grow as professionals is to learn what obstacles we face: based on a physical therapy industry survey with more than 5000 participants, recent trends revealed several stumbling blocks that have cropped up in the field of P.T. One of these is that the trend toward consolidation of clinics to larger companies continued in 2017, which can impart a financial struggle for the one-on-one care business model to compete in a market that is more and more saturated. The study also revealed that for many clinics, the average daily volume of patients increased with more use of assistants and techs. This obviously translates to less time physical therapists can actually put their hands on each patient. Not surprising with the current health care climate, the study noted an intensifying squeeze in insurance reimbursements. The insurance companies have ever-changing rules and regulations, which puts stress on each clinic and each provider. And lastly, the survey noted that each physical therapist spends 20% more time on documentation over the past 10 years due to compliance demands and insurance requirements.   It is not surprising that these factors could change the overall vibe of an outpatient physical therapy clinic. But this same survey also revealed that the number one reason people pursue a career in the field of physical therapy is to help people. That fact translates into genuinely good people with a solid dedication to patient care in our field. I am confident that no amount of frustration over declining reimbursements, increased regulations, or time-consuming documentation can stifle the passion engrained in physical therapists and the physical therapy profession as a whole. Study cited: "The State of Rehab" WebPT

Staying (David) Wise on the Slopes

By Jill Jonda, PT

The 2018 Olympic games have come and gone! As we sat in front of our television screens, watching elite athletes perform with skill, speed, and drive to win, a lot of us tend to want to get out there and try to channel our own Olympic skills. As we saw athletes like Mikaela Shiffrin, Lindsey Vonn, and David Wise swiftly ski down a slope or half pipe without missing a beat, we may have thought, “I can do that!” Those athletes make complex arduous maneuvers look effortless. Unfortunately, when people who may not be as skilled try things that Olympic athletes make look so easy and natural, we tend to see more injuries. Before you hit the slopes, it’s important to be aware of common injuries and how to prevent them.

Because of the structure of the ski boot, the angle it puts on the knee, and of course the variability in the terrain of the snow, one of the more common body regions injured while skiing is, in fact, the knee.  Some of the most common knee-related injuries associated with downhill skiing include medial collateral ligament (MCL) sprain, anterior cruciate ligament  (ACL) sprain or tear, and meniscus tear. An injury to all three of these areas is often referred to as the “unhappy triad.”

That may sound pretty intense, but it’s no reason to cancel your trip and try to get your deposit back on your skis and helmet. If you want to have a good time and avoid the risk of injury, follow these steps listed below:

First, you want to understand your skill level.  All too often injuries occur because we end up doing too much too soon and get ourselves into quite a pickle.  If it’s your first time out in a while, take it easy and stay on the easier hills. Better yet, schedule a training session with one of the professionals and get a tune-up on your skills.

Second, it’s always important to warm-up before any type of physical activity, and is especially important for a demanding activity, such as downhill skiing.  A dynamic warm up will help to increase blood flow, prepare the nervous system for increased activity, and improve overall range of motion which all helps to reduce the risk of injury.

Third, it’s important to strengthen key muscles that help prevent aberrant movement of the knee. The hip abductor muscles (specifically, the gluteus medius muscle) help to stabilize the pelvis when weight is shifted onto one leg, which, in turn, prevents inward and torsional stresses on the knee.  If the femur bone becomes internally rotated and adducted (or “knock knee”), this causes a valgus force at the joint, which is the setting of most of these knee injuries. In the same way, the abdominal musculature is also essential in maintaining control and stability while skiing.  A strong core can help to block too much trunk displacement over one leg if you happen to “catch an edge” or lose your footing over a patch of ice and can prevent a fall.  Strong quadriceps and hamstring muscles also assist in demonstrating proper knee joint mechanics, especially as you squat closer to the ground to pick up speed as you ski down the slope.

Here are some options for strengthening exercises you can try before your next ski adventure:

Remember to always be safe and know your limits if you want to stay injury-free on the slopes.  If injury does occur, however, go see your physical therapist!

Tape on Me: Kinesiology Tape and Physical Therapy

by Jill McCormick, PT

If you’ve watched sporting events recently, you may have noticed professional athletes sporting cool-looking tape on their shoulders or knees. It’s not some obscure form of body modification – it’s kinesiology tape. Believe it or not, kinesiology tape has become so mainstream lately that you may have even seen someone standing next to you in line at the grocery store with this unique-looking application.

Unlike the old-school athletic tape, kinesiology tape has both stretch and memory. This allows for unlimited movement of the joint or limb while keeping it in place. It is designed to stay on for days at a time, even in the shower or pool. While you may remember first seeing it on the US Women’s Volleyball player Kerri Walsh, t’s not just for athletes or sports injuries. This tape is used in physical therapy to treat all kinds of pain and injuries, including shoulder tendonitis, hamstring strains, low back pain and running injuries.

Upon application, it lifts the skin, allowing for increased circulation and reducing inflammation. The recoil effect helps support muscles, ligaments, fascia and even bones. Furthermore, the sensory effect of the tape on the skin can reduce pain signals to the brain, bring the brain’s attention to muscles that are atrophied or underutilized, and calm a muscle that is overactive or in spasm. Seemingly like magic, patients often see an improvement in range of motion and decreased pain immediately!

In summary, kinesiology tape can be used on sports and non-sports injuries alike and it often helps reduce pain and increase range of motion on the spot. While it isn’t magic, it certainly can seem like it and it can be a very valuable and effective adjunct to your physical therapy program. If you are unsure about whether kinesiology taping is a good option for treating the injury you have, Lakeshore Physical Therapy has therapists with expertise in the taping technique and can provide recommendations to help you to heal properly.

Swimmer's Shoulder: What You Should Know

by Stephanie Korso, PT

Swimming is a phenomenal way to improve cardiovascular fitness, burn lots of calories, strengthen muscles and prevent disease. As a non-contact sport, there is little risk for acute and catastrophic injuries, but there is still risk for injury. Prevention, early recognition and early treatment are key to managing swimming injuries and remaining active.

The most common swimming injury is swimmer's shoulder, which refers to any shoulder pain related to swimming. Up to 90% of swimming injuries involve the shoulder, and as many as 73% of swimmers may report shoulder pain during their career. The repetitive nature of swimming contributes to overuse and predisposes swimmers to shoulder injury.

Although swimmer's shoulder can involve any shoulder dysfunction, such as tendinosis or impingement syndrome, shoulder instability is the most common. This is because the same factors that improve swimming performance also contribute to shoulder instability:

Increased Shoulder Range of Motion
Increased shoulder range of motion helps reduce drag and allows for greater stroke length, both of which contribute to increased swimming speed. However, increased range of motion also contributes to increased ligament laxity and increased strain on rotator cuff muscles, which contributes to decreased stability.

Increased Shoulder Adduction and Internal Rotation Strength
Up to 90% of forward propulsion in swimming comes from the upper body. The pectoralis major and latissimus dorsi muscles, responsible for shoulder adduction and internal rotation, are the primary muscles that create the propulsive force needed in swimming. Increased strength in these muscles contributes to increased swimming speed, but it also leads to muscle imbalance and further instability.

Prolonged, Fatiguing Shoulder-Intensive Training
An experienced swimmer knows that swimming involves both shoulder strength and endurance. Training involves long work-outs that fatigue muscles. As rotator cuff and scapular muscles fatigue, shoulder instability increases.

The primary goals in management of swimmer's shoulder are to reduce inflammation, increase stability and return the athlete to full activity as soon as possible. Initially, the athlete will need to modify activity so that no pain is experienced. During this time, the athlete will implement exercises to decrease muscle imbalances, improve rotator cuff and scapular strength, and improve muscle endurance. The athlete may then gradually increase activity as pain decreases. Physical therapy is often helpful not only to guide progressions of strength exercises, but to also improve spine mobility and help release overworked pectoralis major and latissimus dorsi muscles.

As the saying goes, prevention is better than the cure. Therefore, incorporating exercises to strengthen the rotator cuff and scapular muscles into training regimens prior to onset of pain is optimal.

References:
Weldon EJ III, Richardson AB. Upper extremity overuse injuries in swimming. Clinical Sports Med. 2001; 20(3), 423-438.

Weiss Kelly A. Non-contact sports: Running, swimming, and dance - identifying common injuries. Pediatric Annals. 2010; 39(5), 279-285.

Khodaee M, Edelman GT, Spittler J, et al. Medical care for swimmers. Sports Med. 2016; 2(27).

Sailing the Seas of Insurance Coverage: Deductibles, Copays and Coinsurance, Ho!

by Lauren Sweeney, Office Manager

When last we left our intrepid pirate Sue, she had figured out what it meant for a service to be covered by insurance, and she understood what it meant if a provider was in or out of her network. Being a pirate, however, Sue is concerned about the bottom line. What is all this going to cost?

Like most companies, all of Pirate Health Network's plans have a deductible, an amount that a patient is expected to pay for their healthcare in a calendar year (in addition to the monthly premium). While this amount can vary enormously by plan, higher-deductible plans seem to be an increasing trend. According to a recent CNBC study, the average deductible for a Bronze-level plan on the Exchange is around $5000, and 44% of employers planned to offer high-deductible plans as the only option for employees over the next three years.

Let's say Sue's plan has a $2000 deductible - does that mean she needs to pay $2000 before she gets more than just her in-network discount?

Maybe, but maybe not. Remembers those rules we talked about previously when we discussed covered services? There are three that insurance companies tend to make:

1. Deductible and coinsurance - Sue will have to pay the allowed amount per PHN's contract until she has paid $2000. After that point, her insurance will split the allowed amount with her. She'll have to pay at most half, but usually less (10-20% is pretty standard).
2. Deductible and copay - Again, Sue will have to pay the allowed amount per PHN's contract until she has paid $2000. After that point, however, her insurance will tell her that she only owes, say, $30 each time she comes in.
3. Copay - PHN would say that Sue just owes $30 each visit and doesn't have to meet her deductible first. This is probably the rule that people most often think go when they think of health insurance.

Here's the catch, though - each covered service is usually treated differently. Sue may have a copay for visits to a general practitioner, but have a higher copay to visit a specialist, and may need to meet her deductible before a coinsurance applies for physical therapy services. It's no wonder there can be so much confusion about benefits!

Luckily, Sue's been paying attention. She knows that physical therapy is a covered service, most of the providers in her area are in her network, and she's called Pirate Health Network to find out how physical therapy is covered. Her physical therapy provider has also called to verify her benefits - just like we do at Lakeshore PT - so both she and her provider are on the same page as to what she can expect to pay and what PHN will pay. Because she doesn't have to stress over understanding her coverage, Sue can focus her energy on strengthening her shoulder (and dreaming of the day she can finally get those gills).

Sailing the Seas of Insurance Coverage

by Lauren Sweeney, Office Manager

Since the introduction of the Affordable Care Act, medical insurance has been a hot topic of discussion. Overnight, seemingly, people had to go from having passive knowledge about how insurance works to becoming their own insurance brokers. As our healthcare landscape continues to shift, it's easy to feel out to sea.

So let me introduce you to Sue the Pirate:
Sue is insured through the Pirate Health Network (PHN), and she's got some questions about her plan.

• What services are covered through her insurance?
• Which practitioners are in or out of her network, and what does that mean?
• What can she expect to pay when she seeks out various medical services?

In insurance terms, a service being covered just means that the insurance company has rules in place regarding payment for that service - for example, it may go toward deductible, or the patient may have a copay. Most insurers have rules in place about how they pay for physical therapy, since it's a common evidence-based treatment. If Sue wants to have experimental surgery to have gills installed in her neck so that she can breathe underwater, chances are that her insurance company doesn't have rules about that and she'll be on the hook for the ENTIRE cost.

Okay, so Sue's going to wait on getting those gills, but she is having shoulder pain that she wants to get checked out. She knows that physical therapy is a covered service under her policy, and she knows some providers are in-network with PHN and some are not. Does that make a difference?

Yes and no. If a provider is in-network with a carrier, that means that the carrier has a contract with the provider that helps to manage patient costs. When Sue goes to her doctor to check out her shoulder, her doctor may say that the billed amount of the visit was $100, but if her doctor is in-network with PHN, they may have a rule that states that doctors can only charge $75 for an office visit (this is called the allowed amount). Essentially, Sue is guaranteed a discount for going to an in-network provider.

Just because a provider is out-of-network, however, doesn't mean that a patient shouldn't go there. While it's probable that Sue will pay a little more out of pocket (and some plans have no out-of-network benefits at all, so it's important to know if yours does), out-of-network benefits aren't ALWAYS that different from in-network benefits. Some plans even have a shared in- and out-of-network deductible, which means that the patient only has to meet one deductible for insurance to begin paying expenses.

Oh, that's right - we haven't even gotten to deductibles, coinsurance and copays yet, or what all that might mean for Sue. Don't worry - we'll get to that in our next installment.

Good vs. Exceptional

by Sally Fansler, PT

Whether it is their first or their fiftieth time seeking physical therapy, patients want to put their health in the hands of a physical therapist that can help them achieve their goals. A good physical therapist has a solid education of the musculoskeletal system as well as training in biomechanics, neuroscience, physiology and kinesiology. Well-credentialed with a license in the state in which they practice is also a given requirement. But if you are seeking an exceptional physical therapist, there are some additional traits to look for in your provider.

Identifying a specific dysfunction takes natural problem-solving skills, and an exceptional therapist uses keen observations, deductive reasoning, and asking the right questions to get to the root of the issue. Any therapist can give a general exercise program to strengthen an area, but drilling down to the key problem to fix the issue takes a higher amount of skill and tenacity. For example, if a patient attends physical therapy with runner's knee, a program that exercises every muscle around the knee may hit the dysfunction, but it also may not resolve it. Using clear differential diagnosis skills and testing, the exceptional therapist will be able to address the exact cause of the pain, be much more specific, and ultimately much more successful. This allows the runner to return to training more quickly and efficiently.

Having the patience and proficiency to zero in on the source of a patient's pain is just one piece of the puzzle - the therapist has to be able to form a connection with the patient as well. The ability to establish rapport and a strong patient relationship early on is essential for the patient's success. A sense of understanding, empathy and sincerity helps patients feel as though they and their therapist are equal participants in their recovery. With a humble disposition, the exceptional physical therapist puts the concerns of the patient first and honestly wants to make a difference.

At Lakeshore Physical Therapy, our therapists average 12 years of experience (I did my share to elevate that average)! They are naturally gifted, but also take care to cultivate their talents to provide care that goes above and beyond rehabilitation. We realize that decisions about a patient's health should never be just another case or a job and we do our best to convey that every day.

Customer Service - Giving 100% With Every Step

by Joni Modaff, Office Coordinator

In my 5 years of experience working at Lakeshore Physical Therapy as an Office Coordinator, giving my best to customers (or in our case, patients) has always been my top priority. As the first point of contact - whether by phone or in person - my interactions set the tone of the office experience. Because our patients often walk in the door with physical challenges or in pain, I strive to make each visit a welcoming and positive one.

While the term "customer service" means something different to each individual, I have found that these 5 Best Customer Service Tips to help achieve customer satisfaction:

1. Anticipate the Needs of the Customer - put their best interest first
2. Greet with a Smile - a friendly handshake or greeting goes a long way
3. Make Time for the Customer - prioritize their needs
4. Make Customers Feel Comfortable - address by first name and get to know their expectations
5. Be Accountable when Mistakes Occur - rectify situation quickly, professionally and with an apology

In any type of field or career, the above tips will help build a strong relationship with customers that will keep them coming back. I had the opportunity to see how much of a difference strong customer service made from the other side of the desk when my ailing uncle needed to go into a nursing home. We had to a find a place that would be best for all his needs, as well as make sure we felt comfortable with the various staffing personalities. The place we chose made my uncle feel right at home with their warmth and exceptional service. Needless to say, I would recommend the facility.

Referrals are the best compliment an individual or a place of business can receive, and I take pride in creating an environment that makes people comfortable to suggest their friends and family receive care from us. We do our best to incorporate all of these tips at Lakeshore Physical Therapy and continue to make our customer experience one that won't be forgotten!

Reference:
CSM - The Magazine for Customer Service Managers and Professionals by Ian Miller