Interview with Karen Calara, MSPT, CSCS
Karen, how did you become a physical therapist?
Tennis was a family tradition in my home. It was our activity we did together. I played competitively since I was 12 years old. At the age of 16, I was an extremely competitive junior player in Florida. I remember playing tennis 4-5x/week with tournaments on the weekends almost every week it seemed. One day, while playing tennis on a clay court, I was sliding to hit a forehand. I, then, had to quickly get back to the middle of the court for the next shot. As I was changing directions, I heard and felt a loud POP! in my groin area. I crumpled onto the court and could not get up. I was carried off the court, with what I thought was a simple groin strain.
The injury felt better in a couple of weeks, but within a few months, I developed an occasional numbness in my left thigh and nagging knee pain. For months, I struggled through the numbness and pain, thinking it would go away. It was depressing; I couldn't play my game. It was scary, because I did not to know what it was and what to do about it. My game suffered. I was not as quick on court and I stopped playing an aggressive serve and volley game. Instead of singles, I opted to play more doubles so I would not have to run as much. It was so hard. I was losing to players I had beaten easily before. I lost my #1 seed on my high school tennis team. I never returned to playing on clay courts. My confidence was low.
My coach convinced me to see a doctor and I was referred to a physical therapist. I was told it could be 4-6 months before I could really play tennis again! The physical therapist evaluated me and started connecting the thigh and knee problems to my flat feet, muscle weakness, and (to my surprise) a misaligned pelvis, due in part, to my groin injury. I pulled my pubic joint, actually my entire left pelvis, out of alignment.
With physical therapy, I was given exercises to strengthen my legs, and to stabilize my pelvis. I was given orthotics to help with my alignment. Being young and impatient, I wanted to start playing 100% right away. I did my exercises everyday and cut back on playing to allow the body to heal.
Within 2 months, I was back to #1 on my high school team, just in time for spring season! Not only was I playing doubles, but returned to singles competition as well. I had an amazing tournament season, actually playing better than I did before. That summer, I became a force at the net and advanced to the 4.0 level. I played in tournaments in singles, doubles, and mixed doubles divisions. I had an incredible season and painfree! And it was all due to physical therapy!
While working with my physical therapist, I became very interested in how much they knew about the human body: how it is put together, how it works, how it moves. As a result, I wanted to know as much about the human body as well. I realized, as a physical therapist, I could make a noticeable impact on people's health, wellness, and lives, especially for women and female athletes. So I decided to dedicate the rest of my professional career to helping women overcome physical limitations from life or injury so that they to can live painfree and go back to the life they love.
Why did you come to specialize in women's issues?
Because of my own groin/pelvic problem as a teenager, I gravitated towards treating the low back and pelvic area. I have taken many classes to assess and treat this area. After working with a client who was an OB GYN, I started seeing many women who were pregnant or just after having a baby. To me, it seemed like a natural progression.
I treat low back and all sorts of leg aches and pains. Women who are pregnant have low back and all sorts of leg aches and pain. I started taking more classes on women's health (prenatal and post partum issues, incontinence, osteoporosis). A common theme became obvious: Women become the nurturers in their families and often dismiss their own aches and pains.
Many women believe their conditions are normal part of aging (such as incontinence). They are NOT! I believe many physical problems for women start in the childbearing years, when women take on the "pregnancy posture" from nursing to caring for young children and never train out of it. This poor posture, overtime, can be the root of many conditions (low back pain, incontinence, and frozen shoulder to name a few). So it is important to educate women young (especially if they are starting organized athletics at a young age), to be stronger, stand tall, and learn good postural/body mechanics early on.
Karen, I see your credentials, but I am not sure what CSCS means. Can you explain it to me?
As well as a physical therapist, I am a Certified Strength and Conditioning Specialist, through the National Strength and Conditioning Association. Coming from a sports background, and being injured, I became very interested in how to prevent sports injuries through proper training for strength, flexibility, and sports specific training. I apply these principles to all my clients. We are all athletes at some level. Being a CSCS, gives me a wealth of resources and knowledge to draw upon to make exercise programs concise, progress timely, and most of all, fun.
Being a woman, I, especially, studied issues relating to female athletes (such as anatomy and physiology and how they relate to training, nutrition, and psychological factors). Unlike any other time in the world, more and more young women are participating in organized sports at an early age. More and more women are participating in sports and exercise (either for health or starting a new sport) at later ages. This brings about a whole new arena where there needs to be specialized knowledge to address the unique aspects of being a woman.
Karen, you speak about having an integrated approach. How does that benefit me?
Good question. Many physical therapists talk about having an integrated approach, but don't really explain what they mean.
With over 15 years experience and over 1200 hours in continuing education in sports medicine, sports training, and physical therapy, I am able to draw upon several techniques and approaches to help my clients get stronger, play harder, and live healthier. I use a biomechanical approach, manual techniques, functional training, and movement retraining to figure out the cause of the problem and prescribe a course of treatment to meet my clients' goals.
With an integrated approach, we hit all the areas contributing to the problem at the same time, which means you get better faster. It is a win-win situation for you.
What makes you different from other physical therapy clinics?
Because I have focused specialties in biomechanics and women's health, I am able to draw upon a depth of knowledge and resources to get the best results. I treat only one person per hour so you get my full attention from start to finish. You never feel like you are in a factory line. I consistently assess and reassess based on what you are telling me-- how you feel overall, how you feel that day and feel that moment, and where you want to go. The hour also gives us time to work on tissue tightness, flexibility, strengthening, and movement retraining in the same appointment under guidance. This gives us better results because it is so individual and thorough, but within the big picture to meet your goals.
Who do you typically work with?
I work with all clients of all ages and activity levels. Although, I do work with both men and women, I love treating women's issues from ACL injuries in young female athletes, to women who are pregnant, to women with mild incontinence issues, and to women with osteoporosis.
What health situations do you get the best results with?
I work well with lumbopelvic problems like low back pain, SI joint dysfunction; lower extremity problems at the hip, knee and foot; and upper extremity problems like shoulder tendonitis and bursitis. Because I look at the body as a whole, my clients often say things like "we may be focusing on my shoulder, but my low back feels so much better with these exercises as well."
Will you work together with my other health care practitioners?
As well as coordinating with your referring clinician, I love to work with other health care practitioners, such as massage therapists, chiropractors, and acupuncturists, to develop a total wellness program for our clients. This way, each practitioner can focus on our specialties and therefore, maximize our results individually and collectively for our client's benefits. We can set up a communication system that works best for the client and for each practitioner.
Karen, do I need a referral to work with you?
Yes. It is the policy at The Next Step Physical Therapy to have a prescription for all physical therapy treatment, regardless of whether or not your insurance company requires one. It is required by the state to have a prescription for all custom orthotics. So we follow the rules.
What should I bring to my first appointment?
Regardless of what you are coming in for, you should bring a pair of shorts or loose fitting pants, tank top or loose t-shirt; athletic shoes and examples of shoes you wear daily (especially if we are looking at your low back and down), your prescription, and insurance card.
What can I expect at my first visit?
The first visit usually focuses on the evaluation. We will assess your structure, alignment, range of motion, strength, flexibility and movement patterns. Depending on your condition, we may also videotape you. We will discuss your treatment plan, and what you are able to commit to your health. You will go home with a few key exercises to start you on a path to a healthier life.
How will you decide on the best care for me?
I will review the findings of the evaluation with you. Together we will discuss the treatment plan and what program works best for you.
What are your programs?
At the Next Step, physical therapy is geared towards correcting your problem, your aches and pains, through an integrated approach. Usually, insurance covers physical therapy services.
We also offer different, individualized fitness and sports training programs to meet your specific goals, whether to live a healthier life, or to train for sport competition. We have a great team together--nutritionists, personal trainers, yoga and pilates instructors to maximize your results. These programs include: sports programs (such as ACL Injury Prevention for Young Female Athletes), general fitness and weight loss, and special programs for women who have osteoporosis, who are pregnant or just had a baby, and who want to strengthen pelvic floor the fun and functional way. We emphasize functional fitness with all our exercises.
Fitness assessments include biomechanical analysis (walking, running, cycling, racquet sports, you name it!) to assess posture, strength and flexibility, and movement analysis; metabolic testing to determine your cardiovascular fitness; and body composition to determine lean body mass.
The sports and fitness packages are cash pay services.
The benefit of this is you have diversified programs in one place to help you on your road to a better you. We brought together the best team possible so you can take advantage of their knowledge and expertise as well.
How long are my appointments? How often will I come?
You are scheduled for 50 minute treatment appointments, one-on-one with a licensed therapist. This gives us more bang for your buck. In certain situations, I may see clients as often as 2-3x/week, but because of the longer appointment sessions, we are able to cover much more in therapy. Typically, I see patients 1x/week with an exercise program to do at home. I may see you once a week for a few weeks and then decrease the frequency. During this time, you will have homework to be doing to get even better results. It takes time for muscles to strengthen and for old habits to break. As long as you do your part in your home program, the results come faster.
What happens during the actual treatment sessions?
Treatment varies with each individual and condition. Overall treatment usually follows a certain course. We do a quick reassess prior to each treatment. Depending on the condition, I usually start my clients with either a warm-up activity, or a therapeutic modality (like laser therapy or ultrasound) if necessary. This is typically followed by manual techniques, functional strengthening and flexibility exercises and then movement retraining exercises.
How quickly will I see results and what can I do on my own to support myself during my care?
Most patients will see a change with each visit. Because we are often looking at chronic conditions (except, of course, in the case of acute injuries), permanent change happens over time.
It can take 2 weeks for muscles to learn a new motion, and then 4-6 more weeks to gain a grade in muscle strength. While an integrated approach maximizes results, each client is expected to take an active role in their treatment and health, especially in between sessions. Because it can take time to strengthen weak muscles and change movement patterns, as long as the client feels comfortable and is motivated to work on their own with their home program, I often see my patients less frequently, but over a longer period of time. This ensures I can get my clients to their goals while remaining fiscally responsible. However, if the injury is more acute, or my client's have difficulty finding time for their exercises, we may have to see the client in the clinic more often, but frequency usually averages 1x/wk (unless prescribed otherwise).
How can I get the best results when I am working with you?
Show up to your appointments on time, do the homework, think positively, and focus on the result you want and how your life will be different when you are stronger and move better.
Is treatment covered by insurance?
Yes!! Most insurance plans have physical therapy benefits of some sort. This makes it easier for you to take the next step in your health and wellness and live a life of ease instead of a life a pain and discomfort. We are providers on all major medical plans: Regence, Premera, Aetna, Uniform Medical, United Healthcare, First Choice, Cigna, Medicare, L&I, PIP. (As insurance plans change, please check with your insurance carrier that we are providers on your specific plan.)
How does payment work?
As we discussed, we take the insurance plans listed above. The way it works is we bill your insurance as a courtesy for you. Your co-pays are due at the time of service. If you are not covered by insurance, we also accept cash, personal checks, or Visa and Mastercard for your convenience.
What if I am not sure physical therapy will help my condition? Can I talk to you or get more information? Yes, absolutely! Please feel free to contact me at the office, 206-283.1030. On our voice message, we usually post open call office hours where we can be reached directly (unless on the phone with another client!) for questions. We also offer a free 15-30 minute injury assessment, if you are not sure what is going on or how to proceed with your care.
Karen, this sounds like just the care I'm looking for. How do I get started?
The approach I recommend is to see or contact your physician prior to the initial appointment. This will get you the prescription you need for treatment. You can call the office, 206.283.1030, or email, firstname.lastname@example.org, to set up your first visit. We look forward to helping you get back to living a healthy and active life!
For an appointment call 206.283.1030.