About the author
Every year, for almost 2 decades, thousands of people have consulted Dr. Tobin Forbus looking for answers to common and complicated problems that affect their ability to participate fully in the life activities they enjoy. Dr. Forbus has worked in a variety of settings including Director of a hospital in Philadelphia, Clinic Director in the Poconos of Pennsylvania, and Clinic Director of a Shenandoah Valley outpatient practice. In each setting, he became unsatisfied with the quality of patient care that was being required of the therapists after corporate owners took control of the practices. In a desire to be able to provide the exceptional care to his patients that he knew they deserved, Synergy Rehab and Wellness was born in
September of 2011. Synergy has been blessed to flourish due to our dedicated patient care model and we now have several Doctors of Physical Therapy who share Dr. Forbus’s mission and vision for exceptional patient care and manual therapy excellence.
Synergy’s Mission is to offer hope, unconditional love and extraordinary care to allow us to change our patient’s lives and improve their health so significantly that they can pursue the physical, emotional and spiritual growth experiences that make life worthwhile. Our Mission
At some point in nearly everyone’s life, they will face an unplanned and unexpected health challenge that will simply not resolve on its own. After the standard approaches of rest, anti- inflammatories, heat or ice, and waiting it out have failed, each person must decide what the best path is to resolve their pain or limitation. While Google searches and friends and family advice are plentiful, they do not always lead us to the best solution that will help us resolve our pain as quickly as possible and get back to enjoying our lives to the fullest. If you are like the many patients we see every day, you may have already talked to your family doctor, been given a round or two of prescription medication, perhaps even seen a specialist or had injections, but your problem persists. It is at this point where many people feel stuck and do not know what to do next. Some decide to go on ignoring their pain, some continue to take prescription medication and cover up their symptoms with lotions, potions and choose to avoid the activities that cause their pain. All who choose this path go on living a life that is less than they had hoped and planned and miss out on some of life’s greatest joys. Others, like you, take action. They are not satisfied to live a sub-par life and give up on spending time with those they love and doing the activities that would make their life more fulfilling. This report is for that person. The person who is ready to ask questions, get answers and make decisions so they can take ACTION to regain their independence, previous activity level and live life to the fullest! In this special report, I trust you will learn more about the answers to questions people just like you have asked me over the nearly 20 years of my career. Information is power and you must gather the facts to make the best decision. You are taking the first step by requesting this report that will get you closer to regaining your wellness, health and vitality. Find your path and pursue it whole-heartedly! Don’t settle for less than the best life you can live. I trust you will find this information helpful in your search and we are always here to help with any further questions you may have in the process.
To Your Health!
Dr. Tobin Forbus
The 10 Most Common Questions That People Ask When Looking For A Solution To Their Pain
Q1: “ When should I expect my pain to get better and when do I really need to get some help? ” A: Most simple sprains, strains and new aches and pains should be fading significantly within the first 2-3 days. While it is often ok to use the R-I-C-E (Rest, ice, compression, elevation) method for a few days and see if the pain subsides, there are limits to how long you should wait. If your pain has persisted more than 3-5 days and is not getting better -or has decreased, but persists at a lower level for more than 3-4 weeks, your body may need some extra help in the recovery process. Many factors influence healing time and a thorough evaluation and early treatment will lead to you fastest and most complete recovery. Many patients wait far too long to ask for help with their pain, and then can wait weeks to see their family MD and months to see an Orthopedic specialist, then often to end up at our office months later for an issue that we could have addressed long ago (see bonus answer #2). To compound the problem, many conditions are slower to respond to treatment when ignored or initiation of treatment is delayed. Even worse, compensating for problems in one area will often lead to issues in other joints or muscles. If you have been trying to “just live” with your pain and enduring it for months or covering it with medications, you need to seek expert help to assist your body in the healing process and prevent negative effects on the
surrounding joints and tissues. Take Away Summary:
If your problem is not improving at all after 3-5 days, or is lingering at a lower level after 3-4 weeks, seeking help sooner than later will allow faster and more complete healing of your injury.
“ This has been going on a LONG time. Can I really expect to get better at this point? ” A: In short, yes! At Synergy, we often see patients who have had pain for many months (or even years) and have failed to respond to other methods, and we still fully expect them to respond to care at our facility. Many of our patients have tried medications, injections, massage, Chiropractic, classes at the gym, Physical Therapy at other facilities, and even surgery! -but still have pain. At Synergy, on average, most patients will feel significantly better in 8-12 sessions and our patients report a 98+% satisfaction with their care. Every patient is unique in their response to treatment based on many factors including: other health issues, baseline fitness, and how long they have had the problem, so some will respond faster than others. The difference at Synergy is the 60-90 minute initial session where we will evaluate things that likely no one else has ever checked to determine the true root cause of your pain, and expert manual therapists who spend one on one quality time each and every session to address the underlying issue. We successfully help people with chronic pain issues every day and this is one of the reasons many patients regularly travel 30-60 minutes to attend therapy at Synergy Rehab and Wellness. Take Away Summary: Yes! The Doctors of Physical Therapy at Synergy believe that you can and will improve with our care model.
Q3: “ Who will respond best to Physical Therapy treatments at Synergy? ” A: Proactive people aged 35-65+ who have a positive attitude, passion for remaining active, a strong desire to keep working, want to remain independent, and who prioritize their health as one of life’s greatest assets are characteristics of those who will respond best to care at Synergy. Our therapists share these same priorities, and when we are unified in our purpose and goals, we can accomplish results in a remarkable way. In addition, if your problem falls in these common areas we treat, you are 90+% likely to have positive results with Synergy’s care. We have more options of treatment than most any other clinic in the area to find solutions to problems affecting: ■ Neck /shoulder ■ Low back ■ TMJ ■ Hand ■ Hip ■ Knee ■ Foot /ankle ■ Balance and vestibular issues
Take Away Summary:
People with a strong desire to get better who want to work with Doctors of Physical Therapy who believe that they can get better will do exceptionally well at Synergy.
“ Isn’t Physical Therapy just going to give me a bunch of exercises and make me do them each time I come in? ” A: At most corporate and hospital owned PT facilities, probably yes. At Synergy Rehab and Wellness, usually not! While your physical therapist may recommend some stretching and strengthening exercises, the foundation of our treatment model is one on one manual care. This means that you will be seen in a private treatment room (not an overcrowded gym with tables packed together), given individual attention, exceptional manual therapy, educated on the true cause of your pain. Only once your pain is more controlled, will we issue some home exercises to help carryover the improvements you will feel from your PT sessions. While we agree that exercise is an important part of your recovery, we prefer to have you do your home exercises at home , and focus our time on more functional activities and advanced movement patterns when you are here with us.
Take Away Summary:
Most physical therapy clinics, yes. Here at Synergy, usually not.
Q5: “I’ve had friends recommend I see a Chiropractor. What is the difference between Physical Therapy and Chiropractic treatments?” A: Here at Synergy, we believe that there is no single path to wellness. We know and have friends who are Chiropractors. They are good people and help many people with mechanical back problems. The difference in our professions lies in the depth of the evaluation and the approach to each individual’s problems. While many Chiropractors believe that most, if not all, health problems are related to spinal misalignment and lack of nerve flow due to these misalignments, Physical Therapists take awider, more inclusive approach. Physical Therapists can certainly perform spinal manipulations similar to Chiropractors and Osteopaths, but we do not stop there. We look at multiple systems including spinal, postural, musculoskeletal, nervous, and fascial and try to determine why there are mechanical problems so we can address the root cause (hint: it’s usually an asymmetry of length or strength). In addition, we are experts at assessing movement, posture and other factors that contribute to pain. Ultimately, our goal is to address your issue so well that you will be able to fully resolve it and have a plan to deal with any minor setbacks with what you’ve learned at Synergy. Science and research have not found any need for weekly or biweekly “maintenance” or “spinal hygiene” sessions. We want you to be in control of your own health and teach you how to do it. Take Away Summary: We like Chiropractors, we just feel we do a much more thorough system assessment to determine the root cause of the pain and / or spinal misalignment to keep it from continuing to happen.
Q6: “ What is the greatest benefit to coming in to Synergy? Isn’t all Physical Therapy the same? ” A: The greatest benefit of coming to Synergy is getting quality, private time with your Doctor of Physical Therapy to perform an extensive, detailed evaluation and determine the correct diagnosis. We follow that by providing exceptional manual therapy care each visit and expert exercise prescription. (Without trying to brag, we are THE neuromusculoskeletal and movement experts within the medical community). No other profession has the extensive body of research, training and focus to identify the true cause of your pain and offer immediate and research proven solutions. Secondly, NO!!! -all physical therapy clinics are not the same. There are generally two major schools of practice in outpatient Physical Therapy. One is the high volume, corporate-owned, profit-driven and exercise-based physical therapy. In this environment, you will likely see your therapist 10-15 minutes (at most) then perform your home exercises with a non- licensed technician for the remainder of your time. Even worse, we have had patients tell us that they were treated almost exclusively by student volunteers at other local facilities! In contrast, the other school of practice is a manual therapy-based treatment approach. While this approach is almost exclusively found in private practices, not all private practices will give their therapists adequate time to perform manual therapy as a primary treatment. This is why we regularly have patients come to our facility from 30-60 minutes away. Not all PT is the same, and those that know the difference are willing to drive a bit to receive the best care possible. Take Away Summary: All physical therapy is NOT the same. Synergy’s greatest asset is our exceptional Doctors of Physical Therapy who have time to perform detailed diagnostic evaluations to determine the root cause of your pain and perform exceptional manual therapy techniques to fix it.
Q7: “I’m in my 40’s and 50’s and things seem to be popping, clicking, aching and I just have random pains all the time. I’ve been told this is normal and I need to just learn to live with it, does that sound right?” A: While this is a commonly held belief of many patients, and unfortunately even in certain medical circles, we do not believe this to be true. Your body is an amazing creation full of self-healing potential. It will send warning signs and speak softly to you about changes you need to make; but if you ignore it, it will get your attention through producing pain. Yes, it is normal for your body to change over time, including normal degenerative changes; however, resolving to stay active and healthy is the only way to ensure you do not end up in chronic pain. Most joint problems begin with warning signs like the “clicks and cracks” you’ve been hearing. That means you are a perfect candidate to address the issues causing these noises BEFORE they become very painful and functionally limiting. Your Doctor of Physical Therapy will work with you to develop a manual therapy and exercise prescription plan to restore range of motion, stabilize noisy joints, and strengthen your muscles to decrease the pressure through your joints preventing the “normal decline” many have come to accept. Take Away Summary: Heck no! Don’t allow other’s pessimistic attitude to determine your future. You can roll the years back and regain your former strength, activity level and active lifestyle with our help at Synergy.
Q8: “ Isn’t Physical Therapy expensive? ”
A: Not in my humble opinion. As a matter of fact, I think it is one of the greatest values you can find anywhere in healthcare! What other Doctor spends over an hour with you on your first visit to find the true root cause of your problem? It all comes down to priorities and the value that one places on their health. We will freely spend money on car maintenance, home maintenance, dental work, leisure, technology and recreational activities, but how much do we invest in maintaining and improving our most precious asset, -our health? If someone offered to make you completely pain free right now, take you back to your fitness level of 20 years ago, and get you back to all the activities you love and can’t currently do, what would that be worth to you? Physical Therapywill literally save youmoney in the long run. Nomore prescriptionmedication to take, pain rubs, missed work, or more serious health conditions that could develop from ignoring your pain. Physical Therapy is remarkably affordable when compared to other health interventions such as dental work, surgery, massage, personal training, acupuncture, etc., and the time spent with your licensed therapist is probably the single best value you can get for time spent with a healthcare expert.
Take Away Summary:
No, it is actually one of the greatest values you will find if you believe that health is a priority worth investing in.
Q9: “ I’ve heard physical therapy is painful and all you do is exercise- whether it hurts or not, is that true? ” A: Typically, no. At Synergy, we do not believe in the “No Pain, No Gain” approach. We do treat a wide range of patients including those starting just days after a shoulder surgery or knee replacement and sometimes, the best way to help these particular patients is to stretch into some discomfort to assure they do not develop scar tissue that will affect them the rest of their lives. Outside of these less common cases, our approach is gentle, but deliberate in our focus to help you get back to the activities you are missing out on. In order to do this, we will often utilize the “ No Strain, No Gain ” approach once your major pain complaints are resolving. Initially, it is our commitment to one on one manual therapy care that will help resolve your pain, and then we can address any weakness or activity limitations. Working closely with your skilled and compassionate therapist will assure your recovery will be as pain-free as possible. We always listen and encourage your feedback and will adjust your plan to help make it the best process for you -after all, it’s your body and your health, we want to be the best facilitators to accomplish your goals. Take Away Summary: Physical therapy should be a collaborative and focused effort that should never push you beyond your comfort level. We work with you to find the right balance of pushing for progress while making sure we do so in a way that respects each individual’s input.
Q10: “ Why didn’t my doctor recommend physical therapy? ”
A: There are many possible reasons for this. To some degree, Physicians will often try the easiest thing first, which is typically prescribing medication and waiting to see if the pain will go away. We understand and agree with this in the early stages, but this approach has major limitations after 3-4 weeks of persisting pain. It is also true that some Physicians do not truly know what takes place in a clinic such as Synergy, and are missing an opportunity for their patients to receive the exceptional level of care that we provide. We now have an extensive body of research consistently showing the value of physical therapy compared to other interventions, but most Physicians do not read our journals and may not be fully informed. Additionally, many family Physicians will refer to specialists if you are not responding to the medication approach, which may take many weeks or months to get an appointment. Some are unaware that the special tests our Doctors of Physical Therapy perform are just as accurate at diagnosing many issues as an MRI, and we can then initiate treatment MUCH sooner and get you started in your path to recovery. Lastly, often your Physician still considers physical therapy an excellent conservative treatment option, but you just need to ask. Thankfully, many doctors already recognize the scientifically based improvements that patients will make while in manual physical therapy – we happen to see their patients all the time. Take Away Summary: There could be several reasons, but if you believe it will help you, ask the MD to send you! They will almost certainly agree and support your proactive approach to your recovery.
THE 3 MUST-ASK QUESTIONS TO MAKE SURE YOU GET BETTER FASTER AND DON’T WASTE YOUR TIME AND MONEY
Think about it. How much time do you get with your family physician or specialist these days? Is it the same as it was 20-30 years ago? Unfortunately, the same decline in face to face care has also happened in most hospital and corporate owned physical therapy clinics. It is not unusual for PTs to spend 10-20 minutes max with a patient and see 15-25 patients a day, often treating multiple patients at the same time in an overcrowded, public gym space. If you have a choice between a Physical Therapist who sees 9-10 patients a day compared to a PT or Chiropractor who sees 15-25 patients per day, who do you think will provide a more quality, personalized treatment approach? This is literally your choice and you have every right to ask and not settle for less than the best care available. If you are hoping to resolve your pain as quickly as possible and get back to the activities you love, don’t you owe it to yourself to see a therapist who will give you undivided attention for 30-60 minutes and treat only an average of 9-10 patients per day? 1 How much time will your practitioner spend with you and how many patients do they see a day?
2 Is this a private practice or corporate owned facility? We have discussed the differences to some degree earlier in this report, but to reiterate, there is a TREMENDOUS difference in the focus and goals of a company that is owned by a large, publicly-traded corporation and a privately owned healthcare facility. Consider this… are the corporate executives more concerned about you as a patient, or their bottom line profit and keeping their stock-holders happy? In order to do this, the company has to be more profitable each and every year. Now, do the math… Insurance companies pay less for the same therapy services nearly every year. How does a corporate run company continue to demand increased profits each and every year for their executives and share holders? – You got it: Increased productivity requirements from all the physical therapists which means less time with each patient and a disconnect of caring from health”care” with therapist who feel pressured to simply scramble to attain the lofty and often unattainable productivity requirements. This is exactly why Synergy came into existence. I saw this corporate mentality and decline of patient care in two different private clinics where I was Director and a hospital where I was Director and could not sleep well at night providing that kind of care to patients I truly cared about. I initially had no desire to open a PT clinic, but did so out of a need to find a place where I felt patients could truly be cared for, and therapists could develop relationships that could change lives. That is the Synergy mission and we are blessed to be able to do this every day.
3 Are your practitioners trained in multiple different manual therapy and osteopathic techniques to help relieve my pain quickly and effectively? First, let’s review the distinction of the two major schools of outpatient PT treatment: Manual therapy vs exercise therapy focused care. Much of the pain and limitations you are experiencing are coming from changes to the joints and surrounding tissues that only doing exercises will not correct. Skilled manual therapy interventions can be key to your quickest and most complete recovery. Our therapists are each expertly trained manual therapists in a variety of different approaches including manipulation, mobilization, muscle energy, strain- counterstrain, proprioceptive neuromuscular facilitation, myofascial release, instrumented soft tissue release, dry needling, Mulligan and McKenzie approaches among others. The breadth of training of our Doctors of Physical Therapy means that if one approach is not working, we have many more options to try. There is no “one trick pony” at Synergy. Compare that with other approaches where if their focus of treatment is one single type of care and it does not work, you are left to seek out another facility and start all over. We are problem solvers who love to try a variety of approaches to resolve your pain and get you back to the life you want to live.
1 “ You are just getting old and have to learn to live with your pain. ” As a practitioner who deeply cares about my patients, there are few phrases that are more frustrating for me to hear than this one. Almost every day I hear patients tell me that they have been told this by well-meaning friends, family and physicians and that they just need to learn to accept and deal with their pain and limited activity level. Most of the time, these are patients who have just gradually declined and slowly begun having more aches and pains until they reach a point where they simply cannot do the same activities they used to. They have often been focused on others in their lives including children or parents and have simply put their own health on the back burner. Instead of motivating this kind, giving person to take back control of their health and fight to regain what they have lost, they are given a prescription and recommendation to “ just live with it ” and accept their limitations. Absolutely not!!! If you want to regain your health, it is not a passive path. You have to be proactive and determined that you WILL regain what you have given up for the sake of others and it is YOUR TURN to focus on regaining the quality of life you deserve. We are your best advocates and want this for you as much as much as you want it for yourself. There is nothing that gives us more satisfaction than to help someone who is motivated and willing to work to change their lives for the better. You can do it! –and we can help!
2 “ You just need to keep taking pain pills or other medication for the rest of your life. ” This is perhaps the second most frustrating myth that is common in people dealing with persisting pain. It is a dangerous and false notion that is implied to the patient when the only treatment offered is the continual prescription of medication. If that is all you are every offered, you may come to believe that this is the only option. I am here to say that this is NOT TRUE!!! Whether your pain is due to a known injury or is from an unknown cause, no pain is due to your body being deficient in pain medication or muscle relaxers. These medications are simply masking your pain and unless you address the root cause of your problem and will never RESOLVE your problem. The only way you will ever truly resolve your pain is to get a thorough evaluation by an expert problem solver and address the root cause of your pain. You do not have to live on pain pills and muscle relaxers the rest of your life!
3 “ Having an MRI and getting surgery will usually fix my problem. ” This is another common misconception. While there are certainly some conditions that do require MRI and surgery, more and more research is showing that conservative care is equal in outcomes to surgery and is much less painful, risky and expensive! In most cases, you should be cautious about surgeons who recommend surgery without recommending you try conservative approaches such as physical therapy first. Sometimes the desire for a “quick fix” can backfire and leave patients with new or worse problems than they started with. Even worse, sometimes an MRI will show problems that a surgeon will rush to operate on, only to find out it was not the true cause of the pain to begin with. A study in the New England Journal of Medicine showed NO correlation between MRI findings and patient pain complaints. In addition, it showed that depression was a more accurate predictor of future low back pain than the MRI findings. The New England Journal of Medicine said, “Many people with knee osteoarthritis (OA) and a meniscal tear may be able to avoid surgery and achieve comparable relief from physical therapy.” The Annals of Internal Medicine showed that physical therapy worked as well as surgery for easing symptoms of lumbar spinal stenosis, a common cause of lower back pain. NIH.gov found that patients with low back pain sent first for MRIs were more likely to have surgery or injections, see a specialist or visit an emergency room than those who were first sent to see a Physical Therapist. In addition, the average cost of care for these patients was $4793 more than it was for those that tried physical therapy first. Here are a few examples of the benefits of trying therapy first from the recent literature:
BONUS ANSWER #2:
Do I need a referral from my doctor to start physical therapy? Yes and no… In the Commonwealth of Virginia, patients who carry Medicare as their health insurer do require a prescription; however, if you are one of the millions of Americans with any insurance other than Medicare, or no health insurance, you can be seen right away for physical therapy. The state of Virginia allows us to see you for 30 days without a prescription from your Doctor. This gives you the opportunity to be seen right away and begin the process of getting out of pain. In the meantime, we will send your doctor our evaluation and work together with them to give you the best plan for success.
Conclusion You have just read the most common questions patients just like you ask us when faced with life-altering pain. You have probably already done some research, feel like you have an idea what is going on, but just haven’t decided on the best path to fix your issue. We are certainly biased, but feel we are the best option in the Shenandoah Valley and surrounding areas to help with the problem you are facing. It just so happens that several publications agree! We have been awarded Best PT Group by “ Virginia Living ” magazine for 2014, 2016, and 2017, and Best Outpatient Care Gold Winner for 2016 and 2017 in “ Our Health ” Magazine. So, feel free to check us out! Read our reviews from other patients just like you who have had success with us and compare us to the other clinics in our area you will find online. We are confident you will not find a better choice to help with any problem you are facing. I hope you have found this information valuable and it has helped relieve any skepticism or doubts about the benefits of the care at Synergy Rehab and Wellness that can literally produce life-changing results. I hope this report will prompt you to take ACTION to achieve your goals and take the next step back to an active, pain-free lifestyle. We are here to help and hope this will be the beginning of a new chapter in your life. Our passion is your health and happiness. Today, tomorrow, and for a lifetime. If you are ready to take the next step, you can contact us here:
If you would like more information, please see our website, Google reviews, Facebook reviews, and download FREE informative reports on your specific condition at www. synergyrehabandwellness.com Dedicated to Restoring Your Health,
Dr. Tobin Forbus PT, DPT, MS Owner and CEO, Synergy Rehab and Wellness
Health Advice Disclaimer We make every effort to ensure that we provide you with sound injury and prognosis advice throughout this report. However, our advice is based on typical injuries we commonly see in Physical Therapy clinics. The information is not intended to be all-inclusive or comprehensive and every person and condition are unique. It is impossible to give 100% accurate diagnosis and prognosis without a thorough physical examination by a licensed Physical Therapist and any advice offered throughout this report cannot be deemed fully accurate without this examination. No guarantee of specific results from information in this report is expressly made or implied.
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