Healing the Body, Healing the Mind | Samantha Rodriguez and Stephanie Dunker of ATI Physical Therapy

When we just lessen our pain, just overall we're able to sleep better. And when we sleep better, your day is just so much better, you feel rejuvenated, you can actually think more clearly, which overall just helps have a better outlook on a day to day basis, put you in a better mood when you can finally sleep without being in 8 outta 10 pain.

And I think also and Sam could probably speak to this even more. But physical therapy involves a lot of patient education. So we're teaching them coping strategies, sleeping positions strategies like frequent position change or positions to avoid or pain relief strategies that you can implement when you're having a bad day, ways to make sure you have more good days. Also teaching about the root cause of the pain, basically empowering patients to have better control over their symptoms. And that empowerment can make them feel less helpless, make them feel more in control of their lives.

Welcome to the Mental Health Entrepreneur Podcast. We are here to inspire creative ideas and connections for entrepreneurs and advocates working to address our mental health crisis. As you listen, I hope you will experience new ideas and and motivation to innovate in your business, your community and in your life. Welcome back everyone to the Mental Health Entrepreneur Podcast. I'm your host, Rachel Harrison and with me today are Samantha Rodriguez and Stephanie Dunker from ATI Physical Therapy. Welcome to you both.

Thank you.

Thanks, Rachel.

Yeah, so let's dive in. Let's talk a little bit about ati. I know that ATI is a physical therapy practice. Can you give me a little bit of maybe how ATI started and some of the mission and vision of ati?

Sure. ATI got its start in Chicago. It was started by a therapist who was doing functional capacity exams out of his garage in order to get clients back to work. And it grew from there. We're now all over the country, so we have all the resources of a really big company. But each clinic has the feeling of a mom and pop. So if you go into one of Samantha's clinics, like our Frederick Clinic, you're going to be a name, not a number. You're going to know your team that's working with you. So we're really proud of that.

I love that, I really do. And I think that speaks to mental wellness and collaboration within your company.

So.

So that's excellent. I would love to hear some of your views of how mental wellness and physical therapy intersect.

Well, mental wellness is very important in the rehabilitation process and we're working with a lot of patients who are in pain. Sometimes it's a brand new injury and sometimes it's chronic pain. And when you have chronic pain, when you've been in pain for a long period of time, it's gonna affect you, it's going to affect different aspects of your life. And so then it's going to lead to a lot of other issues. So chronic pain is actually different than regular pain. Regular pain is part of the human experience, so it can be protective. Like if you reach out and touch a hot stove, pain is going to make you pull back so you don't have a serious injury. It's also part of the normal healing process. So, you know, if you have an injury or a surgery, you're going to go through a phase where it's inflammation and pain and that's normal. And then you're going to have healing of the tissue and then strengthening of the tissue. Normally, that's where PT comes in. And we help to guide the patient along that healing process to make sure that they have a full recovery. PT uses exercise, manual therapy, other treatments in order to decrease pain and improve functional mobility. But when we see patients in chronic pain, this is where that pain has outlived its usefulness. So it's no longer protective, it's no longer a part of that healing process, like an injury or a surgery or it's cropped up out of nowhere. Like with a patient who suffers from fibromyalgia, they, you know, not sure where it comes from. So those patients have chronic pain that's going to affect them very differently than if you say, sprain your ankle and you're markedly better in six weeks. So we're looking at pain that can persist months, years, and even over much of a person's lifetime. So there's going to be definitely a significant impact on mental health.

And I think too, one of the great things about physical therapy and being in that field is we see our patients two, three, sometimes four times a week for one month or four months or six months, however long it takes to really get them back to their prior level of function. So we get to know our patients on a really personal level. And oftentimes we are, sadly enough, the only person who will listen to their complaints about their pain and what they're not able to do and what they want to get back to doing. And we really help those patients on a day to day basis over many weeks to get back to achieve those goals, which is really awesome from our end.

And so going back to this pain of what's quote, unquote, normal or typical pain versus how it evolves into chronic Pain. How do you make that distinction? What's kind of of the difference between the two?

So with pain, we know that it's like our survival signal in our brain, right? So when something is wrong, let's say you prick your finger, those signals from that tissue get transferred through your spinal cord and to your brain. Once it reaches your brain, it's kind of sorted into a few different areas of the brain. So one of them being the thalamus, which acts as your brain's relay station for almost all of the sensory information. And then we also have two, the cerebral cortex, which is responsible for thinking and processing information from the senses. But it's also where the body can help to interpret the intensity and the location of pain and comparing it to past experiences. Also too, the limbic system, which is made up of the amygdala, the hippocampus, that's where we really get an idea of where all of our emotional aspects of pain are processed. And that's where we see sometimes an amplification of the perception of pain. And that emotional response is pretty strong in linking the pain to your mood and anxiety levels. So when pain is constantly going on for extended period of time, let's say maybe weeks, months into years, that's kind of when we're in that more chronic pain grouping versus just acute pain. That's happened last week and now we're treating it today.

That makes sense. But you have tools that can help with both is what I'm hearing.

We do. Now, every patient is different. So in physical therapy, when you show up for day one, we have a one hour long evaluation where we really get to understand what are the issues at hand, what are the patient's biggest complaints and what are their goals. As a physical therapist, we get to make the distinction of how are we going to treat this patient and what are the techniques and the modalities and skill sets we need to use in order to get this patient's pain pain levels down. So whether it's a combination of therapeutic exercise or activities, or do we have to take a deeper dive into doing some desensitization techniques to make the brain understand, like, hey, this soft touch isn't actually like a painful thing. So. So it's almost like retraining the brain or we have other modalities such as like an electrical tens unit, which we can help with pain relief as well. So sometimes it's not always just one treatment on how to treat pain for a patient. It's kind of the grouping of what we're going to do in every single session to help bring the pain levels down.

A lot of times when people have been in pain for a really long time, we see other physical issues too. They tend to guard a lot, tighten up the muscles. They tend to be less active. So we're seeing a lot of deconditioning and sometimes just getting people comfortable. Moving again is a big part of what we do.

That's fantastic. And just in hearing you describe the processing in the brain, obviously the limbic system is a very big part of what we treat as well. And it's interesting to hear that intersection with pain. So I'm curious, have you either referred out for mental health treatment at the same time as physical therapy or had someone who's already doing that work? I'm just curious of how the one impacts the other.

I absolutely have referred out. I will ask if the patient has somebody that they feel like they can speak with. And sometimes they do, sometimes they don't. Sometimes they're more comfortable with, say, a clergy person, just trying to find out what's that first step for them for mental health. I have frequently referred out or spoken with the patient and found that they're already receiving concurrent care. Yeah. How about you, Sam?

Yeah, so actually, the handful of patients that I have referred out to mental health specialists, they were actually patients who maybe didn't realize they needed mental health help. Oftentimes those were the patients who would come to physical therapy and would just be very upset throughout the whole session just based on, like, what they are going through. So we were the ones to kind of talk them through it on a session by session basis and then kind of make that judgment call of like, hey, maybe, you know, we do need to refer you out and really get to speaking to someone who can help you through this further and kind of guide you along this path. And then in pt, of course, we'll continue working on getting you back to your goals. And one of the nice things, too, is with our patient intake information, there are questions on there that are screening for mental health. So if someone does kind of check off one of those boxes, the physical therapist will actually see, like, hey, this patient does show, like, a positive sign for some type of mental health issue to kind of keep it on our radar as well. Just so it's kind of in the forefront of our mind.

Well, and I think too, from the other side of that, working with patients on their pain as you do, I would think can also support their mental wellness, because if that pain reduces any amount, I mean, obviously the ideal is going away. But if it reduces at all, my guess is there are also positive impacts into their sense of wellness overall, including mental wellness.

Yeah, absolutely. I think just decreasing that pain by whatever percentage we're able to, which often is the most realistic goal, it's generally not realistic to expect we're going to make it all go away. But sometimes we can have a really significant pain reduction, and that's great. When we're able to try to get them moving again, improve their physical functioning so that they're better able to take care of their responsibilities, their kids, their house, groceries, work, all of our roles, if it improves their function within those roles, it improves their outlook remarkably.

When we just lessen our pain just overall, we're able to sleep better. And when we sleep better, your day is just so much better, you feel rejuvenated, you can actually think more clearly, which overall just helps. Have a better outlook on a day to day basis, put you in a better mood when you can finally sleep without being in 8 out of 10 pain.

And so much cellular repair takes place at night that if you're not sleeping well because of pain, then you know it's going to have a snowball effect

on your health overall. Yeah, definitely.

And I think also, and Sam could probably speak to this even more. But physical therapy involves a lot of patient education. So we're teaching them coping strategies, sleeping positions strategies like frequent position change or positions to avoid or pain relief strategies that you can implement when you're having a bad day, ways to make sure you have more good days. Also teaching about the root cause of the pain and basically empowering patients to have better control over their symptoms. And that empowerment can make them feel less helpless, make them feel more in control of. Of their lives.

Yeah. I'm curious how you both got interested in the field of physical therapy.

So when I was in high school, I was doing some observation hours at a local outpatient PT clinic and my grandmother started going to physical therapy just for general strengthening and conditioning. And she would come home every day and just rave about how awesome she felt and how much she loved her PT and how much she loved going. And basically just after hearing her speak so highly of PT day in and day out, I was like, okay, like if someone can make my grandmother feel this great, like I want to do that for someone else's grandmother, aunt, uncle, cousin, whoever. So it's been PT ever since senior year of high school.

Wow, It's a good story. How about you, Stephanie?

Yeah, mine was also senior year of high school. Yeah, But. But a little different still. Grandmothers, but somebody else's grandmothers. One of my first jobs is I worked in a nursing home doing activities. So I would paint nails and do movies and different activities with the people who live there, the residents. And one of the things I would do is help get them around to where they needed to go. And I would take them to their PT appointments and just make sure that they were getting there on time. And again, they just, they loved it. They always felt better afterwards. They looked forward to their sessions because they knew they were going to be feeling better doing more. And the PT department was always such a bright, cheerful place. I knew I wanted to make an impact on people and that just seemed like a really great place to do it. So actually I actually got my start in long term care and then transitioned to outpatient therapy from there.

Okay, nice. I know you're very location specific, so I'm going to kind of zoom down into just the specific Frederick location, since that's something you can both speak to. But I'd love to know, like, what are some of the ways that you're hoping to impact the community? What are some of the big dreams for either your location or even ATI in general?

Our biggest focus is really just helping as many people in the Frederick community as we can and making sure that our community knows we're there and we have the availability to help patients, no matter what age they are, no matter what type of insurance they have or what type of injury they have. We pretty much have seen it all in our Frederick location. So just making sure that our patients, or just our community in general knows that we're there and we're ready to help them.

Nice.

I can speak to ATI in general. We just rolled out a new tagline. It's make every life an active life. And that just speaks to our mission to just have as much influence and as much impact in the community as we can. And an active life looks different to different people. So I think it's. It's just all about impacting the community one person at a time, listening to what they need and helping them get to where they can be amazing.

So how do you think that people that are in the mental health space specifically can collaborate or work with you? What would that ideally look like?

Sam and I were talking about making referrals out to mental health. When we treat patients, we've always got that on our radar. There's boxes on the intake. When we hear that a patient may be in need. We're definitely Looking out for that to make sure that they're getting the care that they need. I think likewise, if a mental health clinician is working with someone where physical pain is an aspect of the patient's presentation, then consider a referral out. And physical therapy is a great referral for pain because we do hands on as well as exercise as well as modalities. So we can really do a thorough assessment and give the patient the treatment that they need. So I really think that mental health and physical therapy go hand in hand, especially when it comes to treating pain.

Mm, no, I do too. I agree with you. I think about, for my training and background in emdr, we have a chronic pain protocol that can really reduce a lot of that amygdala based, limbic system based suffering that you're talking about. And so I think there's a lot of power in pairing that with also the techniques that you all have at your disposal to help with that too. So that's fantastic. I like that. Is there something that you really want people to know, either from the entrepreneurship side or innovation side, or just to people who might be in pain and in need of services? What would you want to leave people with?

Ooh, that's a good one. I think just being aware that physical therapy exists because a lot of my evaluations are all first time physical therapy goers and they often don't know what to expect on day one of physical therapy. But just know we're our physical therapists are out there for you and we can help treat any type of condition, pain diagnosis that you have and we're here when you need us.

I have a question on that. Can people self refer to physical therapy?

Yeah. So in the state of Maryland, we are actually a direct referral state, meaning physical therapists. We have our doctorate. So you do not necessarily need a referral to come into physical therapy, which is really great. Physical therapists can do your evaluation, can diagnose, and we have the education and background that if maybe we do think you need to see a medical professional or medical doctor, we'll refer you out. And then if they need to send you back, they can. But yeah, you can just come right into physical therapy without a script for the most part.

That's really good to know. I did not know that. I learned something.

Yeah. The one thing we have to look out for is that some insurances will not cover without a script, but we can tell patients that when they come in or call for an appointment, we could let them know.

It's good clarification. Too.

Yeah, unfortunately.

Got to work with the insurance process.

Yeah, we're still working on that one. I think the thing I would like to add there is just a message for the public in general and people with pain so specifically is it can frequently, especially if you've been in pain for a long time. It's a scary thing to think about. Pt. We don't always have the best reputation. You know, they say pain and torture is what PT stands for. Yeah. That is not necessarily true. And it may be a little difficult at first to break out of that pain cycle, but overall, we're here to get people feeling better. And like Sam said, people don't necessarily know what to expect and they're fearing the worst. But the therapists are caring, very cognizant of your limitations and will ease you in to moving again.

That's good. Don't be afraid of it. They're not there to hurt you.

We're not scary, I promise.

Neither of you look scary at all I can vouch for. Thanks. All right, well, thank you so much for joining us today. I really appreciate it. It was great, great to chat with you.

Thank you so much. This was really fun.

Thank you.