Orthopedic PT with a whole-body lens
Back pain that hasn't gotten better with standard PT. Hip pain imaging can't explain. Often the problem isn't where the pain is.
I treat orthopedic conditions the way a pelvic floor specialist has to treat them: as part of a system, not as a spot on the body. Back pain often shows up because the mid-back isn't moving. Hip pain often shows up because the pelvic floor is compensating. The pain is real. The location just isn't always where it's coming from.
If you've been to PT before for a musculoskeletal issue and the pain came back, or never really left, that pattern is the one I see most often. The assessment I run on your first visit is designed to catch what the last one missed.
Who I most often see
Most of my orthopedic patients are women in their 30s to 50s, and most are dealing with pain that started during or after pregnancy. Back pain leads the list. After that, in rough order:
Low back pain
The most common reason people come in. Usually it's not just the low back. Hip mobility, thoracic mobility, core coordination, and pelvic floor tone all feed into it.
Sacroiliac (SI) joint pain
That deep, one-sided pain near the base of the spine. Common postpartum, and often mislabeled as regular low back pain.
Hip pain
Anterior, lateral, or deep glute pain. Frequently connected to how the pelvic floor is holding tension on one side.
Neck and mid-back pain
Often driven by breathing patterns, jaw tension, or the postural load of caring for a baby. All treatable, but often not with local work alone.
"Mommy's thumb" (De Quervain's) and carpal tunnel
Wrist and thumb tendonitis from lifting and holding a baby. Very responsive to hands-on treatment plus load management.
Why standard PT often stops short
The biggest thing patients get wrong when they come in: they want me to look only where the pain is. Almost always, the driver is a joint above or below the painful joint, and sometimes further removed than that.
A patient with lateral elbow pain (tennis elbow, golfer's elbow) is often overloading the elbow because the shoulder blade doesn't have enough strength or mobility to contribute to their swing. Treating the elbow makes the pain quiet for a week. Treating the shoulder blade makes it not come back.
Same pattern shows up everywhere. Knee pain from hip weakness. Hip pain from a rigid thoracic spine. Low back pain from an immobile mid-back. The pain is a signal from the loudest joint in a chain that's struggling somewhere else. If the chain never gets assessed, the pain comes back.
Where does the pain actually come from?
My lens is bigger than the pain itself. Because I have pelvic floor training on top of orthopedic training, there are three connections I look at that most orthopedic PTs don't:
The foot and the pelvic floor
How well you pronate and supinate your foot tells me whether you can engage and release your pelvic floor properly during a squat, a deadlift, or anything else that loads the hips. A foot that can't move well often shows up as a pelvic floor that can't coordinate under load. Which shows up as back pain that won't quit.
The jaw, the neck, and the pelvic floor
Jaw clenchers and people with chronic neck tension almost always have a tight pelvic floor. I can tell a lot about pelvic floor tone from those two areas alone, before I ever do an internal exam. If your jaw and pelvic floor are both bracing, treating just the neck is going to leave the pattern in place.
The thoracic spine, the diaphragm, and the pelvic floor
If your mid-back is stiff, your diaphragm can't drop on the inhale. If your diaphragm can't move, your pelvic floor can't move either. They work together as a pressure system. A rigid thoracic spine is often the reason a "core exercise" isn't producing the result it should.
The reason I bring this up on the orthopedic page: these are the connections that get missed when someone with back or hip pain has been through standard PT and the pain came back. It's rarely about doing the exercises wrong. It's about assessing the wrong link in the chain.
What happens on your first visit?
Your initial evaluation is 90 minutes, one-on-one. For someone with back pain that hasn't resolved, here's the sequence I move through, roughly in this order:
Lumbar spine range of motion
First pass at the painful area. What moves, what doesn't, where the pain reproduces.
Thoracic spine range of motion
If the mid-back doesn't move, the low back compensates. This is one of the most common missed drivers.
Posture and hip mobility
How the chain is stacked, and whether the hips are moving. Immobile hips are another common back-pain driver.
Core, diaphragm, and breath
Can you contract your core, can you take a full 360-degree inhale, do you have a longer exhale than inhale, and are there any old scars pulling on the abdomen. All of it feeds into low back load.
Nerve mobility and local joint tests
Neurotension testing to check nerve irritation, plus localized joint mobility and pain reproduction on the lumbar spine itself.
Pelvic floor exam (with your consent)
If the earlier findings don't fully explain the pain, or even if they do, an internal pelvic floor exam tells me whether pain is being referred from there. This is the piece a typical orthopedic PT doesn't include, and it's often the one that closes the loop.
You leave with a clear explanation of what's driving your pain and a specific home program targeted at the actual drivers, not the location of the pain.
How long does it take?
It varies. Most patients notice a real shift within 2 to 4 weeks of starting. Sometimes something changes after the first visit. Sometimes it gets a little worse before it gets better, because a system that's been compensating for months is finally being asked to work differently.
What I can tell you is that pain that's stuck for months or years is usually a signal that something isn't being addressed, not that the pain is untreatable. The pattern is more important than the timeline.
What does orthopedic PT cost?
Initial evaluation $150-$200 (90 min) · Follow-up $125-$185 (60 min)
No referral needed in California. I provide superbills for PPO insurance reimbursement.
See full pricing options →Orthopedic Physical Therapy FAQ
No. California is a direct-access state. You can start with me without a referral from your doctor. If you want a referral for insurance reimbursement, I can provide a superbill after we work together.
Two things. First, I assess the whole body before I treat the local pain. Back pain often comes from the mid-back, the hips, the diaphragm, or the pelvic floor. Second, every session is 60 minutes of one-on-one time, not 15 minutes between shared patients. That changes what I can actually see and treat.
Most of my orthopedic patients have already been through standard PT. The most common reason it stalled: the assessment focused on the area of pain rather than the joints and systems above and below it. My first visit is a full-body assessment before we do any treatment, which usually surfaces something the earlier PT didn't look at.
I'm out-of-network with insurance, which means you pay for the session and I provide a superbill you can submit for PPO reimbursement. Out-of-network keeps the sessions long and one-on-one instead of forcing 15-minute visits.
Not sure if this is the right fit?
Tell me what's going on in a free 15-minute call, and I'll tell you honestly whether I can help.