At one time or another, we all pull a foolish stunt. We lift a bag of mulch and feel that punishing twinge in the back. We spend the winter as couch potatoes, then toil all weekend raking leaves. Or maybe we slip on wet tile and break a bone, or get smacked by another car and can’t move our necks. And let’s face it, as we age, our muscles get stiffer, and our joints start to creak; any wrong move causes injury. Sometimes it’s enough to make us take to our beds for good.
Fortunately, physical therapists can get us up and mobile. Through manual therapy and proper use of equipment, they’ll help make the pain more tolerable or banish it for good. If, of course, we do our part.
We talked to two local physical therapists who run their own clinics — Nick Pesce and Jennifer Holbourn — to find out how therapy works, why it sometimes doesn’t, and why they love their profession of choice.
“Chronic pain serves no purpose than to make you miserable . . .”
As a child growing up in Memphis, Nick Pesce was intrigued by the human body and the mysterious ways it moved. “I would open and close my hand and watch in amazement,” he recalls. “I knew I wanted to learn just how it worked.” When the time came in high school to consider what he wanted to do with his life, he learned about a profession that sparked his curiosity. “I’d never heard of physical therapy,” says Pesce, who was interested in both science and sports. “So I volunteered at various clinics and found it was much more complex than I’d imagined. It was a great choice for me.”
Today he owns and operates Momentum Rehab at 54 South Prescott in East Memphis, a facility he and his wife, Kristi, opened in 2001. Before striking out on his own, the native Memphian, who received his physical therapy degree from the University of Tennessee-Memphis, worked at the VA, was director of rehab at the old St. Joseph Hospital, and later became vice president of rehab for a homebound medical care company. Explaining why he decided to open his own facility, Pesce says, “I saw how bureaucracy, or the business aspect of running an institution, could hinder the level of patient care. I thought I could do it better: provide a higher level of service and still make a living.”
“We look at the whole person because everything is connected,” says Pesce. “If one thing’s out of whack, chances are another part is trying to compensate.
With his staff of six, Pesce treats everyone from teenagers to centenarians. “We look at the whole person because everything is connected,” says Pesce. “If one thing’s out of whack, chances are another part is trying to compensate. So we review the physician’s diagnosis, do an overall screen, then focus on the problem area. We treat pain and dysfunction through exercise, education, and modalities such as ice, heat, and electrical stimulation.” But just as important, he adds, is manual therapy, which mobilizes joints and soft tissue in ways the patients can’t move themselves.
Pain usually drives people to seek physical therapy. “People can put up with short-term pain because it serves a purpose of telling them something is wrong,” says Pesce. “But chronic pain serves no purpose than to make you miserable and keep you from doing what you want to do. It affects your sleep and your mental well-being.” And while he’s heard the jokes that describe those in his profession as “physical terrorists,” he says people are usually referring not so much to painful treatment but to the hard work required to meet their goals.
We work progressively, very gently at first, so the patient can accommodate the discomfort.
“We take pain very seriously,” he says, “because that is the number-one complaint when people see us, and many patients fear that our treatments will hurt. One of the first things we do is allay their fears and let them know we’re here to decrease their pain.” Some conditions, he adds, such as frozen shoulders or joint contractures, do require aggressive stretching. “But we work progressively, very gently at first, so the patient can accommodate the discomfort. We also tell the patient in advance exactly what we are going to do, let them know what to expect, and work within their pain tolerances. Much discomfort can be avoided if patients do the simple home exercises we give them.”
Vital to the patient’s recovery are education and a treatment plan once they finish therapy. “Say you come in with low back pain. We’ll do the joint and tissue mobilization, which is similar to massage. Then we focus on strengthening, and showing you how to use your core muscles.” These are the deep stomach and back muscles that help keep the spine strong and stable. “We’ve learned through studies that, if patients don’t use those muscles, the back might get better but the muscle will atrophy, and they’ll be predisposed to injure their back again.”
“Be realistic about goals . . .”
We’ve all heard of “cures” for back pain touted on TV, with a 95 percent success rate. Don’t believe them, says Pesce: “Treating back injuries takes time and work.” And patients should come to therapy with the right motivation, not because your spouse nags you. “You have to want to come. And be realistic about goals and willing to put in time to reach them.”
“She told us we gave her her life back,” says Pesce. “It doesn’t get any better than that.”
Though results can take awhile, “we can almost always help,” says Pesce, “either a little or a lot, even with degeneration.” He recalls a woman who recently passed away, and whose photo is on his desk. Suffering from chronic pulmonary disease, thoracic stress fractures, and back pain, she was almost bedridden. “She was brought in and was very trepidatious at first,” recalls Pesce. But after several weeks of therapy, she was able to assume some activities she’d abandoned. “She told us we gave her her life back,” says Pesce. “It doesn’t get any better than that. All the problems that come with any job, something like that makes it all worthwhile, seeing her able to get around.”
Once patients are discharged, they can join Momentum’s wellness program that will help them stay on course with their treatment plan. “We’ve got people of all ages in the program,” he says, “and this will tell you how things are changing in terms of people living longer. I’d never have seen this when I started practicing 25 years ago. We had a luncheon for those who were over 90 years old — and we issued 15 invitations,” he declares. “And some of those couldn’t make it because they were traveling!”
Pesce notes other changes, too, for better or worse: Machines have more bells and whistles, therapists can benefit from improved diagnostic tests, and insurance companies have limited the length of time patients can receive treatment. But the same principles apply to the profession as they did when Pesce started, and the same qualities are as important as they’ve always been. “Have compassion, enjoy what you do, and know you’ll have to deal with all kinds of people to achieve goals — some highly motivated, some not,” he says. “And always be a good listener. The patient knows more about his condition than you do.”
“Tough as a nickel steak . . .”
Sometimes Pesce has to use a little tough love. Introducing 79-year-old Helen Tice, who has come to Momentum for chronic back pain and for therapy after two knee replacements, Pesce laughs and says, “You asked what makes a good patient. This isn’t one of them. She wouldn’t do anything I told her, so I had to hurt her knee, and she said, ‘No more, no more!’”
Tice, who was sent to Pesce by her neurosurgeon first in 2004, declares with a grin, “He is so good. He is straight and tough as a nickel steak.” Then lowering her voice to a whisper she confides, “He’ll chew my ass out if I don’t do what he says.” Widowed since 1994 and living at a retirement community — “just me and my little dog” — Tice says “the difference between this place and [another rehab group] is like the difference between drinking Jack Daniels and a glass of water. And the staff is so nice. When I first started coming, I’d be crying and they’d meet me at the door with tissues. They’re like family here.”
Summing up her confidence in Pesce, she says, “When he finishes with me this time, he’s going to come to [my retirement community] and look at the machines and work up a program for me there. That’s how much he wants to help.” M
“If you aren’t comfortable touching people, you shouldn’t be in this field.”
Taking care of people came naturally to Jennifer Holbourn, who was born and raised on England’s northeast coast. “I was a babysitter to everybody and I lived near lots of older people. My mother says I liked to dress up as a nurse and bandage anyone who’d let me,” says Holbourn. Also “very sporty,” she enjoyed track, high jump, tennis, and hockey, so she looked for a career that combined caregiving and body movement. “Physical therapy was perfect for me.”
Educated in England, Holbourn moved to Norway in the 1970s and received intensive training from a professor named Ola Grimsby, who developed master’s and doctorate programs now approved by the American Association of Physical Therapy.
Later moves carried Holbourn to Spain — where she worked at a sports resort and administered to such pros as the late golfer Seve Ballesteros — and then to the U.S., first to Florida, and in 1995 to Memphis. “I was headhunted by HealthSouth as administrative clinical director,” says Holbourn, “but I missed being hands-on with patients.” In 2005, she opened her own clinic, because “I wanted to control the quality,” she says. Located at 612 South Cooper, Holbourn Integrated Therapy shows its owner’s penchant for another profession, interior design, which she studied and practiced in Spain. Though the building has always been commercial, Holbourn’s touch makes its interior feel more like a home, with its soft lighting and music, aromatic candles, and each room painted a different hue.
Touching is a way of caring for people, letting them know you’re committed to getting them better. I want this clinic to be the manual therapy clinic in the city.”
A strong advocate of manual therapy, in which she holds a doctorate degree, Holbourn says, “If you aren’t comfortable touching people, you shouldn’t be in this field. Touching is a way of caring for people, letting them know you’re committed to getting them better. I want this clinic to be the manual therapy clinic in the city.”
Like Pesce, Holbourn sees a majority of clients with back or neck pain. She holds with the theory that human beings have a weakness in the back “because as quadrupeds we stood up too early, putting pressure on the lower spine and muscles.”
Making it harder to recover from an injury are three factors. One is not allowing sufficient time to heal. “A person will hurt themselves, feel a little better, then go out to play handball or rake leaves!” Holbourn says with a flash of indignation. “What are they thinking?” Another factor is being overweight. “That’s so common here in Memphis, and people should realize that every extra pound puts more pressure on everything — the back, the feet, the heart.” Finally, waiting too long to seek therapy allows the pain to settle in. “Patients may delay getting help because they think they need a doctor’s referral,” says Holbourn. But, although certain stipulations apply, patients now have direct access to physical therapy services, thanks to a 2009 amendment to Tennessee law.
“Exercise trains the muscles . . .”
In her treatment Holbourn uses ice, electrical stimulation, ultrasound, and other equipment on her patients. And she sees herself as a catalyst to make the body heal itself. “Exercise trains the muscles to get people back to living, working, and playing,” she says. “If we bruise or strain a muscle it heals quickly because it has a good blood supply. But for other areas you have to pull in the blood, nourishment, and oxygen to create a healthy environment.”
At the heart of healing through physical therapy is the manual technique she loves. “You can learn the technique but you can never teach anybody the right depth and the pressure. That comes with experience. Working the soft tissue feels good — stretching the patient, using my hands to mobilize the joint. That sets the manual therapist apart, helping the patient regain normal joint motion.”
At the initial evaluation and throughout treatment, Holbourn measures and remeasures a patient’s range of motion and strength. “That shows how you are improving. Count your exercises. If you do three sets of 25 [repetitions] one week and three sets of 35 the next, you’re getting stronger. And if it’s an exercise that requires lifting, the weight doesn’t matter as much as the reps. They teach coordination. And if you’ve hurt a joint and are making unusual movements to avoid the pain, reps will teach the normal way to move again.”
The most difficult affliction that Holbourn treats is fibromyalgia, inflammation of the fiber that lines all the tissues. “We’re still not sure what causes it, but the pain can be intense in one spot today and another spot tomorrow,” she says. “A patient will tell me, ‘I have this and I’ll never get better.’ I try to teach them a lifestyle. If you feel good one day, then do something fun. Take up some form of exercise. And I can do some manual therapy to dampen down the pain.”
“So just rock, gently . . .”
For those with joint pain in the back, hips, or knees, she recommends rocking. “Think of old people rocking on the front porch. They may not have known why, but the rocking made them feel better,” she says. “It gives a slight movement to a lot of joints, stimulating some receptors in the capsules around those joints. That capsule sends an impulse to the brain that overrides the pain. So just rock, gently, side to side or back and forth.”
“I tell them it’s not easy. It’s a conscious decision I make every single day to exercise and eat right. People need to realize they’re responsible for their bodies. I tell them, ‘Life is not a dress rehearsal.’”
Wanting the best for each patient, Holbourn can’t help but feel disappointment with those who won’t help themselves — especially those who are “sensible enough to realize that they’re doing themselves harm but not disciplined enough to take the advice to make their bodies better. If you go out and cut the grass with a back problem, you’re going to make it hurt. If you’re overweight, you’re going to wear out your joints and have pain.” Being slim and fit herself, she hears patients say, “Oh, that’s easy for you.” But she’s not buying that excuse. “I tell them it’s not easy. It’s a conscious decision I make every single day to exercise and eat right. People need to realize they’re responsible for their bodies. I tell them, ‘Life is not a dress rehearsal.’”
Naturally, she’s gratified by patients who attend treatment regularly, do their exercises, and take the therapist’s advice. “And when someone comes in hunched over with a bad crick, and I can help them stand up straighter and walk out that day, that’s rewarding,” she says. “I want everyone to have happy, healthy lives.”
Among those she has helped is Madra Jordan, who came to Holbourn’s clinic last summer after experiencing headaches, neck pain, and arm numbness from a bulging disc. Recommended to Holbourn by a colleague, Jordan says she was “amazed” at how quickly she achieved results and was symptom-free for nine months. When a busy lifestyle — which recently involved the strenuous task of packing for a move — aggravated her neck and shoulder again, she didn’t delay seeking Holbourn’s help. After two visits Jordan had less pain and stiffness, increased mobility, and improved sleep.
Not only does she praise Holbourn’s manual therapy — “truly her area of expertise” — but calls her a great motivator with a keen interest in her clients and a warm and nurturing clinic. “I drive 50 miles round-trip to see her,” says Jordan, “passing many alternate treatment centers. That’s because I am confident in her services. She has a wealth of knowledge in rehabilitation.” M