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September 2018 


Like clockwork, every time I bent over or sat too long, my hamstring muscle talked to me. What started as tightness that ran down the center of my right thigh soon became a nervy pain I could not ignore. I would fidget and squirm 

my way through car rides, desperately changing positions to ease the discomfort. One time, on a particularly long drive through Nevada, I laid the passenger seat down as far as it could go and strapped myself in lying on my stomach, looking out the rear window as my friend sped down the highway. Now that’s desperation! If only I had understood pain science then….

We know that pain is an output of the brain, and that when certain changes in the brain and nervous system happen, pain persists well after the tissue–in this case my sciatic nerve and hamstring–has healed. Because brains work on predictive models, and because I hurt every time I bent at the hip, eventually my brain started firing those pain signals even before I sat down. (Train your brain away from pain.) 

If so much of pain problems stem from brain changes, it seems reasonable that one could use one’s brain to improve the situation. We’ve said it many times before, but it bears repeating: if you can understand your pain and know that it will not damage your tissues, you can start to change things. 

The brain produces pain to motivate you to protect your body. It also primes muscles that would help you escape (i.e. run away). Those big, long muscles can shorten a lot, and produce a great amount of force to get you away from danger. With prolonged muscle contractions, acid builds up and the muscles start to feel stiff (Many of you know the feeling of stiffness that precedes pain). 

When the long muscles turn on, the shorter ones turn off. The shorter muscles are the very ones you need to stabilize your back. Now, you’re in a mess. And all because your brain was trying to protect you. 

How can you circumvent this cascade of events? Knowledge is power :

Education decreases threat and helps alarms abate. As a result, the bigger muscles you might use to flee a dangerous situation can start to relax and the small stabilizers turn back on. That’s the ideal situation, but that is not what we usually see. Everything does not necessarily go back to the way it was before you started to hurt. Back injuries turn off the stabilizer muscles unless you learn to turn them back on again. 

Send your stress down the road: 

Long-term movement changes make you behave differently and move differently, which has long-term consequences. Someone with an old back injury is more prone to repeated injuries. And while it’s important to address the physical changes, it’s imperative to try to work out the threats that are making the muscle system work so hard to protect you. To do that, we need to get “under the hood,” and educate you around old and worrisome belief systems that undermine progress. 

This stuff is complicated. 

 Your rehab program needs to be personalized. 

That’s why professional guidance is essential. And that’s why we’re here for you. 


Brokers are directing people towards Medicare Advantage Plans. You may come in having changed to an advantage plan without even knowing it or understanding what you’ve gotten yourself into. 

We get a lot of Medicare questions. Here is how the conversation might go: 

Patient: I have Medicare 

ALTA: Do you have Medicare Part B or an advantage plan? 

Patient: What’s the difference? 

Here’s the difference: 

Medicare Advantage plans are an alternative to Medicare Part B. You have one or the other, not both. With an advantage plan, you get your Medicare benefits through the plan, instead of through the federally administered Medicare program. 

ALTA: Unfortunately we can’t work with your Advantage plan. 

Patient: But it’s Medicare. 

Here’s why we can’t work with your plan: Medicare Advantage plans have more restricted networks. For example, some Medicare Advantage plans, like HMOs, use a provider network. You can only use providers that are contracted with your Medicare Advantage plan. Other plans may use a PPO that lets you see both in-and out-of network providers, but you may pay higher co-payments and coinsurance when using out-of-network providers.

Medicare Part A & B Medicare Advantage Plan 

One more consideration: How much do you use PT? If you have an injury and need a lot of PT – for example, 10 visits in a month, you could pay more out of pocket than you would with Medicare Part B and a supplement. Run the numbers and see what works best for you. As always, we are happy to answer questions. 

If you sign up for an advantage plan and are unhappy, you can switch back to Medicare Part B between January 1st and February 14th.


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