Q&A with Christian M. Hoffman, Therapy Director and Dry Needling Specialist at Physicians Health Source in Ohio
Christian M. Hoffman, BS, MPT, had always wanted to help athletes recover from sports injuries. He wanted to help people, in general, through both hope and healing. He received his BS in Rehab Science and his MPT from the College of Mount St. Joseph in 1998 in Ohio. He is currently pursuing his DPT at Andrews University in Michigan. Today, Christian works as a physical therapist at Physicians Health Source in Cincinnati, Ohio, and specializes in the dry needling method working mostly with low back and neck pain.
Q: What motivated you to become a physical therapist?
A: I always wanted to get into healthcare. But like most PTs, I was involved in sports and thought it would be fun to help athletes recover from injury. Also, a brand new program opened up in my neighborhood. I was at the University of Dayton, but applied and was accepted to the College of MSJ charter class.
Q: What kind of facility is Physicians Health Source?
A: My setting is a multi-disciplinary clinic. We offer pain management, PM&R, chiropractic, psychology, and physical therapy. We see mostly chronic pain, work injuries, and motor vehicle injuries.
We also do sports medicine. About 60% of my practice is back and neck pain. As for the therapy department, we offer land-based exercise, aquatic therapy, assisted soft tissue mobilization, dry needling, cupping, traction/decompression, and thrust mobilizations, as well as the classic modalities.
Q: What is the history of Physicians Health Source?
A: The business began in 1999 when Dr. John Ruch, DC, and Dr. Jeff Elwert, DC, merged their practices together. They then began to hire medical staff and therapy staff. I joined in 2002 and left for a while, but have returned to a full-time therapy director position.
Q: Can you elaborate on your work with the dry needling technique?
A: I began to look at dry needling when Dr. Elwert, a chiropractor, became certified in acupuncture. He started to get great results immediately. I had heard of dry needling, researched it, and signed up for training.
You quickly realize that dry needling is different from traditional Chinese acupuncture. The technique is similar, but the rationale is completely different. Dry needlists do not deal with meridians and qi. We perform our musculoskeletal evaluation looking for trigger points, tender areas, and short-ended muscles. Then, we use needles to relieve pain and relax spasmed soft tissues. It is used in conjunction with traditional physical therapy.
The basis for dry needling is fully western and bio-medically based. Needle insertion sets off a cascade of neurophysiologic processes that can be beneficial to patients suffering from pain. The research has been very promising. It is also very safe when proper training is provided.
Q: Why do you think this technique is so beneficial to patients?
A: It has been extremely effective thus far and provides another option. Nothing is cure all. There are so many opinions out there on the proper treatment of low back and neck pain. It makes my head spin sometimes.
I am certified in a type of instrument assisted soft tissue mobilization as well. I will continue to constantly seek out new techniques to help my patients. Each patient is different and each treatment must be as customized as possible to get positive results. The more you have to offer, the better.
Q: What is your day like as a therapy director?
A: I participate in our multi-disciplinary meetings, evaluate and treat all patients referred, and manage the rehabilitation staff.
When it comes to patients, I usually treat those with low back and neck pain. I also see a lot of patients with work injuries, both chronic and acute.
Q: Are there other areas of interest for you as a physical therapist, either clinically or educationally, that you plan to pursue?
A: After my DPT degree is finished, I want to sit for the OCS board exam. I will also attend additional training in dry needling techniques.
Q: What are the greatest challenges you face in your job?
A: Chronic pain is the most challenging part. I usually see patients who have had multiple rounds of therapy among other treatments. They have been in pain for years and are typically taking narcotic medication. There is often a failed surgical intervention as well.
I have to provide them with a different approach or I will lose them. I am the last person they want to see. They can barely get out of bed in the morning, much less exercise. The mind and body operate differently for people with chronic pain. They feel injured, but the body and mind no longer recognize the injury as in the acute patient. The healing process stalled out before it was completed for a number of reasons.
My approach is to restart the natural healing process, which is done by focusing on various soft tissue approaches. Whether through needle insertion, deep instrument assisted soft tissue mobilization, manual myofascial release, or cupping, a lesion is created to enter the soft tissue back into the inflammatory phase. Bruising is often the result and the patients are advised of this. The bruising occurs due to capillary disruption from scar tissue breakdown. The natural healing system of the body is then kicked into gear.
From then on, I try to control the soft tissue maturization/remodeling phase through continued cross frictional techniques and progressive tissue loading via resistive training. The plan is to start mostly passive and end actively.
Q: Do you feel that the role of physical therapists has changed over recent years?
A: I guess the DPT has changed some things, but the true impact won't be felt for years. Too many people are against it and I have always wondered why. Doctor doesn't mean physician. Doctor is a degree that should be able to be attained by anyone in any subject.
Q: What do you feel is of the greatest concern to PTs today?
A: Reimbursement and outside influences are affecting our scope of practice. We have to continue to research and publish as we push our boundaries further.
Also, I work for and with chiropractors. This is often regarded negatively in our profession. I have been to numerous conferences/classes where chiropractors were bashed. I just want to say that the Chiropractic/PT model can work, and work well, if there is mutual respect and focus on a common goal.
Q: What is the most rewarding part of working with patients?
A: As therapists, we are the part of healthcare that gets to spend a lot of time with patients. I enjoy the time I get to better explain their situation and explain to them what to expect. I enjoy the hope as well as the healing that I provide to my patients.
Q: What is the most important thing you've learned so far?
A: I have learned that things are rarely as described in a textbook. Everyone is an individual patient and no two same diagnoses will present the same way. The more I learn, the more I realize how much I don't know.
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