Access Physical Therapy Without a Physician Referral - Get Moving Again

By Alyson Vasconcellos, PT, DPT, Clinic Director at California Rehabilitation and Sports Therapy – Fountain Valley, Brookhurst St.

Mental health is a taboo topic for so many. It ignites anxiety to talk about for those who struggle with it. We talk about ACL (Anterior Cruciate Ligament) tears, broken ankles, and concussions on national news outlets daily, but for some reason we have been conditioned not to talk about having a psychological diagnosis. You can see when someone has a physical condition by their limp or if they are wearing a brace, but you can’t always see when someone is dealing with a mental health condition. We televise athlete’s physical therapy appointments, but we don’t talk about their mental therapies. That stigma to keep it private makes it all the more dangerous.
I will never forget the shame I felt as I bumped into friends running out of a particularly difficult therapy appointment with my new psychologist as a junior in college. Questions raced through my head as I ran down the street back to campus: Do they know where I was coming from? Do they know why? Will they judge me? Will they still want to be my friend?
These fears fueled the general anxiety disorder and major depressive disorder diagnoses I had recently received. There was a name and even an ICD (International Classification of Diseases) code for the symptoms I was experiencing. It was not just in my head; it was real. And I was completely embarrassed by this reality, and even more so by the fact that people might now know about it.
I had just started therapy but that would be my last session for several years due to the humiliation I felt for simply needing help with a mental condition.
I’ve been anxious for as long as I can remember. Striving for perfection in every aspect of life. Panicking about the most minor of things. Sometimes it feels like a battleground in my mind as I recount events over and over again, beating myself up mentally and questioning my every move.
I had my first real panic attack until 2008. I had just lost my father and was recovering from a broken ankle that significantly interrupted my daily life. People could see my crutches and walking boot for my physical injury, but no one knew about the turmoil that was going on in my head. Sitting in my college physiology course, I was suddenly triggered by the topic at hand. My heart started beating faster. My temperature was rising as if the heater had been turned up. I was physically sweating, and my breathing got heavy. It was uncontrollable. I didn’t even know what the professor was saying anymore. I blacked out. I woke up in the quad of my college campus sitting on a bench with no recollection of how I got there.
These panic attacks started to become regular events. I felt like I was spinning out of control. One day as I felt the anxiety sitting in, I got up and went to the mirror. I looked myself in the eye and said, “You are crazy.”
I went through the rest of college and graduate school trying to hide from my feelings. Pretending they didn’t exist. Maybe they would just go away, and I would grow out of them. But just like a broken ankle, mental health issues don’t just “go away” if left untreated. They linger and create other problems that snowball.
At 24 years old, I was working my first job as a physical therapist. I was living on my own and was finally a professional. I doubted every move I made and overanalyzed every patient interaction. I was sure I was failing. I found my way back to therapy as my anxiety and depression were taking a strangling hold on my everyday life. I’ve now been working with the same therapist on and off since 2013. She is part of my medical team and truthfully has empowered me in so many ways, even to write this piece.
Through many hours of work with my psychologist and through personal development, I have learned there are tools to manage anxiety and depression. Those feelings don’t have to rule me, and they don’t get to have as much power as they once did over my life. I have been to dark, scary, and disturbing places. Places I don’t talk about with most people and places I don’t like to revisit. But I have learned that sharing pieces of it makes them less powerful. Talking about the fact that I experience certain emotions releases some of that control. More importantly, it has taught me that I am not alone. It gives others an open door to share their experiences and creates a safe space. This has helped me in friendships, building patient trust and building relationships with colleagues and team members alike.
As physical therapists, we have a unique experience to build trust and relationships with our patients. We put our hands on them. We spend time with them. They often open up to us more than they may expect to, even more than they do with friends and family. Research shows pain and injury can be heavily intertwined with a psychological component and we can be an outlet for all of the above. We need to be aware of how our patients’ mental state is affected by their physical condition. As I’ve become more comfortable talking about my own experiences, I’ve been able to connect with patients in a different capacity. We need to encourage patients to be open with their emotions that may be linked with the physical symptoms they are experiencing.
Mental health is more an issue now than ever as we face isolation and polarization amidst our social media society and pandemic life. It is a silent injury for most. You can’t see that I have anxiety and depression like you can see Trevor Lawrence has a shoulder injury. However, mental illness can be one of the most debilitating and painful injuries of all. And we must help to de-stigmatize this term and allow people to be honest.
According to the National Alliance on Mental Illness (NAMI), 1 in 5 adults and 1 in 6 children in the US experience a mental illness yearly, yet only approximately 40 percent undergo treatment. And the average time to seek treatment after symptom onset is 11 years. Just as not addressing a physical ailment can manifest into a bigger problem, ignoring mental health issues can also result in more damage down the line.
I’ve always been tough. I even have the word “strength” tattooed on my hip. Most people just see the tough exterior. But sometimes, the biggest strength comes from finally being vulnerable. Finally asking for help. Finally sharing your story. Finally releasing the stronghold that an injury – mental or physical – has on your life. That is when the healing really begins.

https://www.nami.org/mhstats

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