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• Noah: Hey guys, welcome to another installment of our monthly interview series with one of my favorite physicians. Today, we’re over at SPARCC in Tucson, Arizona with Dr. Mo.

  First off, Dr. Mo, you want to tell me a little bit about yourself? Name, title, family, pets, etc.

   

  Mo: Mo Mortazavi — I have a wife and two little kids. They’re 6 and 7. We have a dog named Jakey and two rats. My wife, Andrea, is a pediatric hospitalist medical director at TMC for pediatrics.

   

  Noah: If people want to find you, what’s the address for your practice, phone number, etc.?

   

  Mo: We’re just south of Grant, across from TMC basically in that medical park. 5199 [East] Farness [Drive] is where our building is, and for those that are in the field of medicine and remember the old Pima County Medical Society building, we’re sitting in it right now. This is it. We have some blueprints in the clinic of the old Pima County — when it was Pima County Medical Society, but somewhere along the road maybe 10 years ago that shifted to become a clinic, and actually it was a concussion center at that time in 2016 I want to say. That’s what it was set up for, and for whatever reasons, they didn’t quite get off the ground. By 2017-18, we were really looking for a dynamic facility that was bigger and had a combination of rooms and rehab gyms and those sorts of things, so that we could do everything we needed to do, and this facility fit that.

   

  Noah: Would you say that concussion care is one of your specialties?

   

  Mo: Yeah, it’s pretty much — it is my main specialty at this point through the sports medicine board, but at this point I’m practicing 75, 80 percent concussion and mild traumatic brain injury with a pretty significant split toward sort of the more complex concussions with the prolonged symptoms. Still mild traumatic brain injury for the most part, but these are all ambulatory patients.

   

  Noah: How did you get involved in this kind of care?

   

  Mo: Long story short, probably just demand. My fellowship training was predominantly musculoskeletal sports medicine and maybe 20, 25 percent concussion, which I would say is pretty normal for sports medicine fellowship training — nonoperative, of course. But I was lucky, I had a group of guys out there at Colorado where I trained like Mike Kirkwood, etcetera, that were ahead of their time in terms of understanding prolonged symptoms, what we call complex concussions — concussions that don’t just get better in a couple of weeks — and began to be really interested in that area, part of my fellowship research project and presentation were centered around presenting on, what we referred to back then as post-concussive syndrome or now, the more accurately, persistent post-concussive symptoms, which is under the umbrella of mild traumatic brain injury. I just took that interest and carried it over with me to UC-Davis, which is the first faculty position I had, so I noticed that teenagers that aren’t getting better at 6-8 weeks didn’t really have anywhere to go, and so I starting saying, I can manage this person, or I can try to anyway. That was over 10 years ago now. When I came to Tucson, immediately there was very clearly a demand, not just for concussion and concussion care (all sports concussions and all that stuff), but for those that were having prolonged symptoms. At that time, I was at the U of A, and we were sort of building a program from scratch there for pediatric sports medicine. [Dr.] Sydney Rice, who’s a pediatrician in the behavioral and development specialty, also sort of had a niche for working with some of those patients, so we were able to team up together, and I was able to learn a lot from her. There was already a stream of patients or demand for complex concussion coming at the U of A because Sydney was there, and I ended up seeing a lot of those patients with her, or for her. Ultimately, just continued to build my knowledge around it, my interest and research, and that’s really predominantly where my research and probably my care is right now, which is the complex concussions or those with prolonged symptoms.

   

  Noah: If you could pinpoint one case that resonates in your brain, can you talk us through a little bit — whether the case went the way you wanted it to or not — one case where you were like, I really like this. This is something that’s going to lead me in this. You mentioned demand, but also it sounds like you’re passionate about it. Maybe it was just an accumulation over time, or was there one case where you were like, I kind of got into it at this point?

   

  Mo: That’s a great question. The reason I love complex concussion, and concussion in general, but particularly complex concussion, is there are so many interesting cases like that. Whereas, you might have an interesting knee, but a knee is a knee at the end of the day — and a shoulder is a shoulder. But a brain, and how different manifestations of symptoms and deficits with brain injury, there’s no bounds. To me, that’s a great question because there’s so many cases that are super interesting, that are worthy of case reports, and over the years, I’ve had many. Even though you told me to prepare something for that based on what you sent me, it’s still hard. I would say a case that comes to mind — of many, so this isn’t necessarily the most compelling, but that had an impact on me — was a girl. Well, two very similar cases. I’ll briefly talk about both of them. Both were teenagers in high school, and both were concussions and presented with such atypical, sort of scary presentation. In one case, it was a girl who had a concussion in her sport. It didn’t seem that bad and kind of was under the radar. Probably got evaluated sort of briefly, maybe by a coach, a trainer, a referee or whoever. Things seemed fine, and she went about her business. No Return to Learn plan. No real alterations of her activity. Luckily, she wasn’t a high-risk contact or collision sport or athlete, but just the loads, the cognitive loads of school and not having any accommodations or any adjustments there. Over the next 1-2 weeks, it accumulated to the point where not only did she start to struggle, but she presented one day to her pediatrician — her parents took her to the doctor emergently because she couldn’t talk. She was getting aphaisc. I remember getting a call from her pediatrician saying, “You ever seen this? She’s aphasic. She’s not able to get words out.” Appropriately, they did MRIs of the brain and the spine and all this, and made sure that she wasn’t having a stroke or something like that. Once all that was clear, she came to [SPARCC], and I remember meeting her and her family and managing her. Really, it was all just a concussion with prolonged symptoms, and the early intervention that was necessary wasn’t there, so things evolved and got worse, which can happen. She presented in a way that was extremely daunting and scary, obviously to the family. A lot of these patients, they don’t get better like that (snaps fingers), so it takes time with rehab and Return to Learn plans, which [she] obviously [had] to get pulled from school for a little bit, and then we have to gradually work her back in. Over a couple of months — and do some therapy on the side — in her case, she needed physical therapy, but also some cognitive therapy, speech therapy.

   

  Noah: OT as well? 

   

  Mo: Oh yeah, absolutely. She had vestibular ocular dysfunction that was subtle enough initially, where she wasn’t falling over walking so she didn’t get the early intervention there, but there were deficits, especially visually, ocular motor. Once we start to address all that with the appropriate treatments, she started to improve, probably, again, over a couple of months, so she didn’t just bounce back right away. Just being able to see the family settle into, OK, this doesn’t mean permanent brain damage. Something terrible hasn’t happened. Because when you see that, and you’ve never seen that before in your own kid or yourself, the reaction is going to be pretty scary, right? Just the reaction alone, the anxiety related to that alone, could be crippling, right? Once they sort of knew what they were dealing with, understood why this could happen, even with what seemed like not that big of a deal of an injury, and that they had treatment, and they could expect 100 percent recovery, which is what happened to her — maybe 3-6 months out, somewhere between there — those type of cases really resonate with me because we’re really able to help people through not only the injury, but how a family process a scary injury that goes through theses different phases. 

   

  Noah: What kind of advice would you have for somebody who’s been involved in some sort of head injury? … Like, they are at the park, and a baseball hits them in the head? What do you think a basic go-to should be for the average person?

   

  Mo: Traditionally, we all come from a background — you go back 20, 30 years ago when we grew up — as long as everything kind of seemed OK, we didn’t have to make a big deal out of it. For the most part, that still holds true, but I think start with the mechanism. If I just barely bump my head on the wall and I feel fine and I continue to feel fine, it’s probably OK. Baseball to the head at a significant speed, even if I feel OK, you have to remember that if the adrenaline can get up to a certain point that you can be in that fight-or-flight response and not really be insightful to some of the deficits you’re having, right? Beyond that, you may have deficits that you only become aware of when you get challenged, say cognitively or exersiontively after that. I’ve had patients, who, that will happen. They feel OK. They go home, and they kind of take it easy and rest and stuff like that. They don’t realize until they take a math test, until they go out and try to workout really hard, maybe a week later, that they’re not OK. I think all that needs to come into play for folks when they try to figure out do they need — is there enough going on here to get evaluated? Brain injuries is an important enough thing where if it’s a question mark, you should veer on the side of getting evaluated. Whether you need to immediately run to the emergency room or see somebody the next day depends on what your symptoms look like, but there’s generally pretty good triage protocols for this sort of thing, so at a minimum, you would call in, and you would say, “Johnny got hit with a baseball. He doesn’t have symptoms. He’s got school tomorrow. He’s acting a little tired.” Then, you could get good recommendations for, Do you need to go to the ER right now? — which there are very good established red flags for when somebody would need to go to the ER to get a CT to make sure something catastrophic isn’t happening. Versus, OK, you probably don’t need to do that, but here’s what you need to watch for, especially over the next 24 hours, 24-48 hours. You probably should get evaluated because [Johnny] is maybe endorsing some fatigue. He has yet to be challenged. If we’re anticipating that there may be some problems with the challenge, say it’s the finals test tomorrow or the big game tomorrow, we prefer not to find out about it in that way. Let’s throw you in the fire with a possible brain injury and see what happens. We prefer to get the evaluation, make the right decision about what the next steps should be, and again, being conservative.

   

  Noah: Awesome. Just a couple more questions. How do you incorporate when to utilize things like physical therapy into your management? Is it typically symptomatic?

   

  Mo: A lot of factors play into that. For us, we understand that the evidence-based research is very much in support of early intervention with vestibular ocular rehab, cervical rehab, Return to Learn, and exertional rehab. So, a lot of that is rehab, right? The other key component early on is recognizing people’s visual and cognitive deficits as they pertain to work or school. I think that’s also critical. We pretty much are thinking along those lines with every injury we see. Then, depending on their symptom burden, depending on physical deficits on exam and on the cognitive testing that we do — we’ll do the exertional testing, etc. — then we can triage out. Out of 100 patients that show up on Day 1 with a concussion, getting an evaluation, if you only have resources for 30 of them, to get early intervention with rehab, then who are those 30? If you have resources for all of them and they meet the indications, great. But in reality, that’s probably not where our medical infrastructure is. Ultimately, what we do is we still educate about all those things, we still have people get handouts and teach them … some home exercises they can do for balance, for cervical, etc. The threshold then for formal PT — again, there’s always case-by-case exceptions — but the general threshold we would be looking at is severity of presentation. If someone presents with really severe symptoms or deficits — their balance is really off; cervical’s really a problem — we need to get PT going right away because they’re going to be at the top of the line for getting those resources. Those that seem to be doing pretty good, and we went with home exercises or whatever, once 3-4 weeks comes around, if they’re still not recovered or almost recovered, that would be another reason. Those with prolonged symptoms — I touched on that earlier — I take care of a lot of those patients, and by definition, that’s beyond 1-3 months out in terms of symptoms from your injury, all of them really should be in generally some form of rehab: PT, OT — 

   

  Noah: Home exercise plan, somewhere in that range.

   

  Mo: We understand that research-based early intervention really points — to improve outcomes, to improve time of recovery — points to Day 1, doesn’t point to Day 30, right?

   

  Noah: That’s absolutely true. One of the things I worked on when I was in the ER with any sort of whiplash. We would try to get them to start treatment that day.

   

  Mo: Depending on the injury or whatever, they may need a day not doing a whole lot. [Whiplash is] a great example when they would need it right away. Exertional rehab is something we generally do after 24 hours, but we want to, again based on the research, we know that there’s therapeutic benefits that you can access as early as 24-48 hours. There may be case-by-case factors that come into play. We are counseling and educating early intervention for every patient pretty much Day 1 based on what they need. When they get into PT, when they have the privilege to be able to do that, depends on those other factors.

   

  Noah: Last question, what do you like about the relationship that SPARCC and APM have?

   

  Mo: I see APM as a team that has great expertise, great variety — I think that’s also important. You have one person you go to for this; another person you can go to for that. It’s hard to be a Jack of all trades across all of sports medicine.

   

  Noah: Jack of all trades. Master of none, right?

   

  Mo: Right. So it’s nice to have go-to people, whether it’s a complex concussion or whether it’s a knee or whether it’s cervical. Different athletic backgrounds are key too. You guys have that too, where we can say, “OK, you’re a dancer. We’re going to get you someone who understands dancers. You’re a thrower. We’re going to get you someone who understands throwers. You’re a runner. We’re going to get you someone who understands runners.” We know from being physicians with sports backgrounds ourselves that that relatability is important, and also understanding the sport on that level is really important.

   

  Noah: Athletes are athletes. We don’t just turn it off. We recognize each other, and it’s easier to communicate to a patient you have some sort of likeness. There’s more trust there. That means there’s a greater likelihood that they will commit to what you want them to do. 

   

  Mo: That’s right. I think the evaluation and the diagnosis and our approach to treatment, from the doctor’s side, the more you know about that specific sport, say it’s gymnastics. … Whether you were actually a gymnast at some point or whether you’ve covered that sport long enough that you really know it well, it comes into play, and it’s important. I think for PTs, it’s even more critical because you’re going through the whole biomechanical rehab process with them, and every step of the way, that’s going to matter.

   

  Noah: I agree with you completely on that. Well, Mo, thanks again for your time. If you guys ever need any help, he’s the guy.

   

  - Noah Interviews Dr. Mo with SPARCC in Tucson

• Noah: Hey guys, Welcome to our second interview with the wonderful practitioners of Tucson. Today I am with one of my longtime friends — a funny story is that we used to work together in the ER at Saint Joe’s or the emergency department. I was PT, and she was a nurse. I left, and now we work together even more. So Jessica Ganz is a friend of mine. Jessica, you wanna tell us a little about yourself?

   

  Jessica: I worked with Noah at St. Joseph’s Hospital, and I was a nurse there for quite some time in the ER — probably about five years — before I went back to school and got into Nurse Practitioning.

   

  Noah: Because I left there in 2013.

   

  Jessica: Yes, exactly, and you left kind of right when I started my embarking in my education journey.

   

  Noah: Exactly, exactly.

   

  Jessica: And so I went and got my nurse practitioner license while continuing to work there and then I actually got hired on with them as a nurse practitioner.

   

  Noah: Oh really? Cool.

   

  Jessica: And I continue to work for them for a little while to gain some good experience and get some off hours under my belt, and while I was there I continued to experience the frustrations I think everybody deals with in the healthcare system. 

   

  Noah: Sure, sure, sure

   

  Jessica: Not only patients but also providers and caregivers, etc., and I started kind of dreaming about ways I could get away from that. It was very hard because there’s not a lot of options to get away from the mainstream of healthcare, My husband and I went on a trip to for our honeymoon to Hawaii, and while we were there we had some opportunities to brainstorm about ideas. That’s when we came up with a concept of Ohana, which follows a direct primary care concept, which is a personalized relationship with your patient.

   

  Noah: Sure, sure, sure.

   

  Jessica: That gets you away from all those middleman, but double dip into healthcare.

   

  Noah: Absolutely.

   

  Jessica: And I went to a summit and I learned about it after that, and the rest is history, and that is kind of how this business was born. So now I work in primary care/urgent care.

   

  Noah: So you say your specialty is kind of like urgent care/primary care?

   

  Jessica: Yeah, so we do family medicine here.

   

  Noah: Sure.

   

  Jessica: Newborns all the way up, and then we do some urgent care stuff when patients need specific modalities.

   

  Noah: What’s your youngest patient?

   

  Jessica: Let’s see, about a week old

   

  Noah: OK, and your oldest?

   

  Jessica: Eighty-six.

   

  Noah: So everybody from a week old to 86.

   

  Jessica: Yeah.

   

  Noah: Yeah, you see the whole spectrum.

   

  Jessica: The whole spectrum, and you get involved with a lot of families which is just so fabulous and has brought me — I really kind of started losing the passion for healthcare through the mundaneness and the arbitrary people just getting their faces into situations where they don’t belong, such as people that are way higher up on the spectrum and in the healthcare industry and putting their two cents into things that they don’t belong in. You see that a lot in the hospital setting and you see it in insurance companies, etc. And so being in this type of environment, it’s really taking a lot of that away and allowed me to do what I really absolutely am passionate about and enjoy.

   

  Noah: Let’s circle back real quick. Why did you become a nurse in the first place?

   

  Jessica: Good question. Actually when I was a little girl, I thought that I wanted to be a trauma pediatric nurse. I was adamant that that’s what I was going to do with my life.

   

  Noah: When I was a little girl I didn’t know what that was.

   

  Jessica: My family was in medicine. Every single aunt and uncle, almost every single aunt and uncle in my family and cousins they all are in medicine, starting back with my grandfather who is a dentist in the military. We have a long-standing medical line: My mom was a nurse, so I knew about it from that. I just did a lot of volunteer work when I was younger.

   

  Noah: So you went into nursing and then what was the pivot that took you out of the trauma part and to follow this line?

   

  Jessica: For those who have ever worked in any type of emergency medicine, a lot of hardship that comes with that, and for me, I really struggled with emotionally dealing with a lot of those things that I saw. I kind of had a little conversation with myself [about] what I could do to be happy again in medicine, and I felt like if I was part of people’s lives and trying to create better lifestyle to try and prevent those scary things that can happen to people in emergency settings, that I would make more of an impact.

   

  Noah: So you would say one of the biggest things of why you started your own thing is you really wanna be part of the solution of all the problems that you saw working in the ED, knowing about some of the things that your parents and grandparents did you wanna be part of the solution.

   

  Jessica: Correct. 

   

  Noah: Awesome. If you had to pick one, I know this is a tough question, one very challenging case that you were a part of, whether it was a successful case or not anything that you’re comfortable sharing?

   

  Jessica: Good question. I’m not quite sure I could pick one particular case; however, I can say that I’ve been a part of a lot of cases both in this practice, as well as outside of this practice, that are been very difficult, and I want to say that the most common ground that they all share all of them share is difficulty with the system. It’s getting people in for appropriate times for referrals. It’s dealing with insurance companies. It’s dealing with non-transparent pricing

   

  Noah: Absolutely.

   

  Jessica: It’s dealing with referral offices. It’s dealing with a lot of time constraints on time — time seems like a huge huge constraint that I feel like I’ve dealt with. So I feel like my most difficult cases have all have always really been the most difficult because of extra forces that make them most difficult. You know you can have a patient that’s overweight, doesn’t take care of themselves, diabetic, and it comes to you in a complete train wreck and slowly through small step process as you’re able to work with that patient on trying to get their life back in order as long as they’re on board for that. But it’s those extra ancillary situations that really make those situations really troublesome, and that’s what’s really great about this practice is because I’m able to pull those middlemen out. I’m able to help people with their lifestyle so much easier than I was able to in another situation.

   

  Noah: Absolutely, multidisciplinary.

   

  Jessica: Yes, absolutely, and I think unfortunately that is something that is very — sadly — very missed.

   

  Noah: Let’s shift us to the next question. You’re obviously aware I’m a Physical Therapist and you are a Nurse Practitioner, but I think would be cool for our viewers today is most nurses have never work hand-in-hand with a PT. We’ve had a unique relationship where we work hand-in-hand in the ED but also our offices are now literally across the hall from each other, so can you share your experience in working with me and other PTs [at APM]?

   

  Jessica: I think probably one of the most important things in regards to primary care and any specialty care — and especially when you’re talking about things like physical therapy because patients are going so often to physical therapy as opposed to maybe going to podiatry a couple times a year — is continuity of care and communication. That is something that is significantly lacking in the primary care setting and not because people don’t want to talk. It’s because of time constraints and system constraints in [the system]. With us, the nice thing about not only being across the hall, but also having a relationship with you, is that I am able to check in on patients when need be. We can text back-and-forth about situations going on. I can walk across the hall when situations are going on.

   

  Noah: I can walk across the hall and help you with somebody.

   

  Jessica: Yes, it’s nice to have the interworking relationship, and another thing that’s really nice about finding alternate ways to healthcare — which I think that APM has been so instrumental in that as well — is building those relationships with your with your colleagues around town you know.

   

  Noah: Absolutely .

   

  Jessica: And to be able to text [you], and say, “Hey, thanks for doing that for me.”

   

  Noah: Totally.

   

  Jessica: And you helped me save this man’s life. I appreciate you doing that for me.

   

  Noah: You know what’s funny is one of the previous people who we talked about, Dr. Ty Endean, we’ve had a group text going on before you know it all for the betterment where it wasn’t even his patient, and we just want the second opinion — so having those relationships in town where we’re all just focused on patient outcomes

   

  Jessica: Yes.

   

  Noah: Basically the only goal is the best care we can possibly offer.

   

  Jessica: Yes.

   

  Noah: Frankly everything else is bulls–t you know and that’s what’s great about working with you know.

   

  Jessica: Yeah, absolutely.

   

  Noah: Super. I think that’s all the questions I have. Anything else you want to leave — maybe your phone number or anything?

   

  Jessica:  Yeah, so we’re at Ohana. Our full name is Ohana Direct Primary Care, right across the hall from you on Carondelet Drive, and our phone number is 520-262-2500. Patients can call or text that, which is awesome.

   

  Noah:  Beautiful. Thank you

   

  - Noah Interviews Jessa Ganz, NP

• Dr. Noah Abrahams: “Hey, guys Dr. Noah Abrahams Physical Therapist in Tucson, Arizona, here at Applied Physical Medicine. We are starting our monthly series with the top physicians in Tucson. Today we are with my good friend and top orthopedic surgeon Dr. Ty Endean. We’ll get started with him. Ty, do you mind giving me a little background: Name, Title, Family, Who you are as a human being? “

  Dr. Ty Endean: “I’m an orthopedic surgeon here in Tucson. I’m married with two children. I have a nineteen-year-old now sophomore at Colorado State getting a degree in Bio-Chemistry and Chemical Engineering. And then I have a seventeen-year-old son who’s going to be a Senior in high school, and then he’ll be enrolling in Oklahoma State on a full-ride athletic scholarship in January. He’s an offensive lineman. He’s a little feller like me at 6’6” and 290 pounds.”

  Dr. Noah Abrahams: “Where’s your office in Tucson, address, contact info, etc.?”

  Dr. Ty Endean: “My office is right next door to the new hospital at Northwest Medical Center on Houghton, on the corner of Houghton and Old Spanish Trail. The phone number there is 520-618-5500 and if someone wanted to reach me by email it’s my name: ty.endean@northwestmedicalcenter.com.”

  Dr. Noah Abrahams: “I’d like to start with some medical stuff because that’s why everyone is here right? So how long have you been an orthopedic surgeon? And have you always been in Tucson or elsewhere too?”

  Dr. Ty Endean: “I’ve been a surgeon since 2003 and I’ve been here my entire career.”

  Dr. Noah Abrahams: “What do you like about Tucson?

  ”Dr. Ty Endean: “Ahh, Tucson’s a great city just because there’s a lot to do outside. We have about nine months of awesome weather and about three months of vacation. The community is great. It’s been very nice to my family and me and I like living here.“

  Dr. Noah Abrahams: “What do you like about being an orthopedic surgeon and do you have a specialty you like to focus on?”

  Dr. Ty Endean: “I’m a sports medicine doctor by training and by professional choice but I’m a general orthopedic surgeon. I’ll see all patients, all problems, all ages. What I like about orthopedics is you can help someone so you can diagnose their problem, and help them on the road to recovery whether it’s physical therapy, education, or surgery (which is rare). As a sportsperson, I tell my patients I like to get them back into their game.”

  Dr. Noah Abrahams: “Is there a specific condition you think you can help with the most or you like to work through everybody in the sports through all ages?”

  Dr. Ty Endean: “I think what I help people the most with not so much sporting activity it’s just being real with them. Understanding their problems. Speaking to them in their language not doctor talk and conveying what they need or what they don’t need. Sometimes people just need to be told that they’re ok and go away.”

  Dr. Noah Abrahams: “That is true. Why would you say you chose medicine as a career? Why are you a physician?”

  Dr. Ty Endean: “I like Science, and I like working with my hands. I come from a family that owns physical businesses and while they’re successful I saw my father and uncles falling apart in their fifties and sixties. And now that I’m in my fifties I’m not falling apart by professional choice it’s by a recreational choice and so I wanted to work with my brain. I can always use my brain I can’t always use my body.”

  Dr. Noah Abrahams: “That’s so true. I mean I feel like that’s why I’m involved in medicine too. It forces me to think about things in different ways and that’s why I have relationships with people like you where I can text, call, or I can just say ‘hey I’m stuck on something, am I on the right track here? Am I lost? Do you know? And sometimes I feel like I’ve had some very challenging cases which brings me to my next question. Is there a specifically challenging case that you’ve been a part of whether as the lead or a surgeon, or whatever?”

  Dr. Ty Endean: “I can’t think off the top of my head of one specific case but I have had multiple cases that I call ‘MacGyver Medicine.’So there’s no book to that answer, there’s no experience that’s an answer to the specific problem. You have to take principles, experience, and education, use your colleagues, talk, and devise a plan. Then you have to execute it to perfection and for me, it’s all about the team approach. While society and medicine say I’m the top dog because I’m the doctor, that’s not how I think about it. I can learn something from any person.”

  Dr. Noah Abrahams: “Everybody. Even the patient. Right?”

  Dr. Ty Endean: “More often the patient.”

  Dr. Noah Abrahams: “That brings my next question which you and I are going to roll our eyes heavily with this one. What’s your biggest frustration in medicine today?”

  Dr. Ty Endean: “My biggest frustration is just medicine in general. I think we’ve lost our ability to deliver excellent health care. I think it’s driven by accountants and people just don’t care and that’s what honestly sets you and me apart from other people is we care about our patients and we convey that.”

  Dr. Noah Abrahams: “True, true. You mentioned that you spend so much time talking to patients. Is there an ago-to message or number one thing which you try to share with every patient when you’re with them? Would it be advice?”

  Dr. Ty Endean: “I try and share empathy, compassion, accountability, and honesty. A lot of people don’t want to hear what you have to say so you have to learn in the course of your conversation how to deliver that meta or that message. Example: Obese patients have knee pain, they’re too heavy, and they need to lose some weight. There’s a compassionate way to go about that than just saying ‘you’re too fat go lose a hundred pounds.’ You have to empower the patient to take care of themselves, otherwise, we’re not doing our job.”

  Dr. Noah Abrahams: “What if you have somebody who is overweight and you think they need to lose weight? What’s your thought process? Do you talk to them about nutrition, physical therapy, personal training…everything?”

  Dr. Ty Endean: “I don’t do a lot of that. I talk to them about physics and forces across their body joints. I don’t tell them how much weight to lose. I will say that they may be above their normal just like I’m above my norm and I talk to them diffusely about exercise and nutrition.”

  Dr. Noah Abrahams: “What do you like about physical therapy? What’s your relationship like personally and professionally?”

  Dr. Ty Endean: “For me personal and professional is the same thing because I integrate myself. What I like is the ability to converse. I like patients or therapists to call me. I like people that ask me questions. I like people to seek out information like you and I have done many times. You have a difficult patient. You’re like ‘Ty it’s not your patient, what should I do?’ I’ll give you my two cents whether it’s right or wrong but that relationship that we build over and over through time is what gives excellent care to our patients.”

  Dr. Noah Abrahams: “You and I mentioned we worked together for many years. We met for the first time at L.A. Fitness years ago. I still remember I was doing front squats and a drop set and we started talking. And you’re like ‘what do you do?’ We started talking for about fifteen minutes. This was back when I was working at St. Joe’s. Then I filled you in when I left. When I started APM you were one of the people I reached out to so I like to hear your opinion. Why do you like working with us at APM?”

  Dr. Ty Endean: “I think you guys embody in physical therapy what I try to embody in orthopedics. You care about your patients. You deliver excellent care. You ask for help when it’s necessary. You notify me as a physician when it’s necessary. You’re not embarrassed to go ‘I don’t know or, ‘I think I may have goofed this up… not that this happens but it does for all of us. And I like that. I hate that therapy has gone corporate where there’s no communication or no love for the patient. It’s just a number and I’ve never felt that from your practices as a physician to the point I’ve gone there as a patient. I feel strongly enough about you and your business that I have been a patient.”

  Dr. Noah Abrahams: “Are there any take-home messages that you want to leave with our audience today?”

  Dr. Ty Endean: “To find people who care about you and use them and make sure that your health care providers are communicating not just with each other but listening and communicating with you.”

  Dr. Noah Abrahams: “Spot on.” Thank you for your time, appreciate it.”

  - Interview with Dr. Ty Endean

• I had bunion surgery and 12 weeks later I had to have surgery to loosen the scar tissue on my big toe.  When I first saw Blake, I could barely bend my big toe and my other toes were stiff too.  Blake took care of me and now after 6 weeks I can easily bend all my toes and the scar tissue is soft.  My foot feels so much better!  I will have surgery on my other foot later this year and I will definitely ask for Blake to be my therapist afterwards!

  - Debbie Harris

• I injured my C7-T1 vertebrae and had an Anterior Cervical Discectomy and Fusion.  I came to see Blake after surgery and he and his team have taken me from a weight limit of 10lbs, constant pain and numbness in my upper back and arm to being nearly pain free and now armed with the stretches and exercises to keep me going.  Thank you Blake, Dan, Lalo, Matt, Lee and Vickee.

  - Zach Collins

• Back in October of 2019 my shoulder felt like it locked up and I couldn’t move it properly which led to instability and pain.  I let it go on for several more months and it just got worse.  On April 28th, I had my first appointment at APM and it just got way better since then.  My shoulder now feels more stable, range of motion is back and the pain is gone.  I can more effectively carry out my job, workout and continue my hobbies.  Before coming to APM I couldn’t do a proper push-up or pull up.  Now, I feel confident with the care I have received and the continued care through my home exercise program, that I will be back to doing everything I used to.

  - Steven Maultsby

• I had a total knee replacement on June 15th.  On June 19th, I started PT with Blake and the crew!  I walked in with a walker and after a week, no walker or cane!  They listened to everything my doctor wanted my propress to be.  No one can believe I had knee surgery!  Great team here!  I’m good as new!I had a total knee replacement on June 15th.  On June 19th, I started PT with Blake and the crew!  I walked in with a walker and after a week, no walker or cane!  They listened to everything my doctor wanted my propress to be.  No one can believe I had knee surgery!  Great team here!  I’m good as new!

  - Mary Bieneman

• I can’t be more grateful for the commitment that I have received from Dr. Noah Abrahams and his team at Applied Physical Medicine. After my motor vehicle accident, I had limited range of motion in my neck which prevented me from doing anything on my left side. After visits with Noah and fabulous communication, we’ve made huge improvements. Now I’m back to moving around which keeps me free from feeling depressed due to lack of activity. The exercises that I’ve learned allow me to continue to work at home on the impacted areas to keep them strong.

  - James B.

• 

  I had been to three doctors, had multiple x-rays, scans, and tests, and no one knew where the pain was from. I came to see Noah, my last stop before noninvasive surgery to investigate, and in SEVEN minutes he knew what was wrong. SEVEN MINUTES! And no surgery! So here I am 18 visits later and I can sleep on my hip. Touch it. And have more total strength than I’ve had in a long time. And it wasn’t only Noah who made me stronger – Yolanda, Matt, Dan, Lalo, Angela, Derrick, Lee, & Chris – All helped me get better. Thank you!

  - Jodi C.

• 

  When I hurt my back at the gym I found that 10 on the pain scale was way higher than I imagined. After a few days, I came to see Noah. He did an evaluation and came up with a recovery plan. I was feeling better after the first visit. After two short weeks, I am back to my normal routine. I can wipe, put on underwear and tie my shoes! Thank you, APM!

  - Joseph B.

• Everyone is very helpful and friendly. I received heat & electric treatments, massage and exercises. I am able to walk further without my knee aching and can stand longer in the kitchen without pain. I always tell people where I go for therapy and how much I learned to handle my problems.

  - Joyce B.

• When I first arrived, I was having pain in my hip, leg, ankle, and foot. I was having a difficult time walking long distances (exercise/2 miles). Sitting for long periods of time was very uncomfortable. In a manner of weeks I had gained more mobility, less pain, and less discomfort. The exercises were making such a difference in my life that I was able to do more daily activities with ease. The entire staff makes you feel comfortable and worthy, and they all care about your well-being. I feel blessed with the accomplishments I have made since being a patient at this facility.

  - Julie B.

• 

  After a motorcycle accident, 20 years of shoulder dislocations, and three surgeries, Noah, Matt and company have made me feel like a normal human for the first time in 20 years. For the first time that I can remember, I can use my left arm and shoulder with no fear of it popping out of socket again. Because of this, I have been able to go back to one of my hobbies and loves… Dancing! Thank you to Noah, Matt, and crew for everything you have done and making me feel like a normal human again.

  - Justin E.

• I was having lower back and hip issues before I came in to APM. I would experience pain after short drives in the car and would experience intense pain during some workouts. After a few sessions of dry needling and various stretches and exercises, I no longer experience pain. Thank you!

  - Justin G.

• Noah, Dan, Larry, Derrick, Lalo, etc…. everyone is such a pleasure to talk to. Everyone takes care of me with such gentleness. They all welcome to me like one of their own. I look forward to coming back. I won’t go anywhere else. Noah and all the staff are a dream.

  - Keith S.

• 

  I came to a PM with knee pain. I had pain was squatting and it slowed me down w/ my regular powerlifting training. Noah help me identify that the issue was originating from a foot injury. I’m back to full workouts and I’m peaking for a powerlifting meet later this month. #ComeBackKid

  - Kerrie G.

• 

  Wonderful! Everyone here is so knowledgeable and helped with my back and knee. I can run and jump and it is all because of Kara and the awesome team. Thank you so much ❤️

  - Kristen K.

• 

  Oh my gosh! My knee was unable to move & bend. I was in such pain constantly. With only three weeks of PT I feel confident and happy that I can resume my life with freedom of movement and freedom from pain. Staff is so helpful and friendly and encouraging. I will be able to continue the exercises on my own now. Thank you, Noah & Yolanda & all the staff. You are life savers!

  - Kristine M.

• 

  I crashed hard mountain biking more than a month ago. I could barely walk properly much less participate in sports that I love. Physical therapy has got me back up and running in no time. I can now run a little bit and ride my bike harder than a few weeks ago and that is what matters to me.

  - L A M.

• I could not use my left arm or hand without radiating pain in my neck and leg – two weeks of therapy fixed the problem.

  - Lila Kay W.

• Thanks for all the help, I am much more confident now. I can safely check behind me while driving! No more driving into the blind spot! My neck and shoulder have responded well to physical therapy at Applied Physical Medicine. -Lisa M.

  - Lisa M.

• 

  I had excruciating pain down my left leg. I could barely walk or sleep. Now I have none of the symptoms. I am functional and can carry up chores and I feel I am living a normal life.

  It is great to have my body back and doing my usual chores and activities. I have my life back. God bless all of you great people. What a blessing you have been.

  - Lorna D.

• I started with vertigo, because of my dizzy problem I fell and ended up with a L2 compressed fracture!

  This physical therapy helped me tremendously with all my issues. Here they do work as a team! Extremely great with patients, they give you personal attention. The team is great. I receive balance treatment and strengthen my back and my hip.

  The best team ever. Special Thank You to Lalo, Noah, Yolanda, and Sarah! The office team is always friendly!

  - Lydia N.

• 

  I came to APM because of a new pain in my shoulder. Before my first appointment, and old low back pain returned! Noah & his team work great. They worked through both problems with manual therapy, stretching, and strength exercises. Safe progression was of high importance, with close monitoring of activity, and education. Therapy enabled me to continue my training routine with kettlebells and barbells. Great people – friendly, caring, and helpful.

  - Marie T.

• 

  Coming here has helped me a great deal. I could not reach with my left arm or lift. It was almost frozen. Now I can reach much better and lift light items and my pain level is much less. Everyone is pleasant and professional. I highly recommend APM – Tygiel Physical Therapy.

  - Marlene P.

• Noah and his staff worked with me both before and after my recent lumbar fusion. Always very knowledgeable and very professional, they are also caring, encouraging, and fun to work with.

  They are flexible and able to suggest alternative exercises when the first approach is uncomfortable or doesn’t help.
  I continue to do the exercises that Noah and his staff recommended and receive massages regularly from Lyla to help keep me limber and pain free.

  - Mary J.

• 

  I came to Noah and company due to lower back pain from a deadlift gone wrong. Once I got over my own stupidity and actually did what they suggested, the pain went away (shocker!)

  If you start coming long enough, you don’t want to leave because a) you get your own theme song from Noah, b) the staff is amazing, c) you get roped into buying coffee for Noah, d) The pain goes away. Thanks everyone for helping me!

  - Mary M.

• I suffered from BPPV (vertigo) for 3 weeks and was unable to work. Finally got into see my ear/nose/throat specialist — quickly diagnosed as BPPV left ear. APM squeezed me into their schedule the next day and after two runs through the epley maneuver – the spinning stopped. Thank you Noah & APM.

  - Mathew R.

• 

  I injured my left shoulder doing ring muscle-ups. After PT my range of motion increased and pain is almost gone. Ready to start kipping again! Thank You Noah + Staff!

  - Mel G.

• Thanks to Noah, Yolanda, Matt, Dan, Lalo, & Larry, I can now enjoy professional LARPing like I used to. Without them, I wouldn’t be able to Magic Missile or Thunderbolt like I had. 😀 In all seriousness, these guys & gals helped me recover from being rear-ended and I couldn’t be more thankful. You guys ROCK!

  - Michael M.

• 

  Noah and his staff treated me for vertigo. I really like Noah – but don’t tell him I said so. All the staff are wonderful and caring. Noah picked up on the fact that I was not very steady – so we have been working on that and I am much improved. Thanks to Yolanda and Noah.

  - Radford F.

• 

  I was referred to Noah after having lower leg pain from being old. After a few appointments my pain started to improve. I am finally able to walk around the block without pain. I highly recommend Noah and his staff, they are professional, caring, and laid-back… I think it would be fun to hang out in the office w/ them!

  - Randy S.

• 

  This place and staff was awesome. Four months and I have improved – couldn’t squat or do lunges… Now getting easier. Hate to be done. Going to miss Angela, Yolanda, Dan, Larry, Geraldo, and Noah. Thanks for your help.

  - Regina G.

• 

  When I finally conceded to myself that I needed PT I was directed to Applied Physical Medicine and to get Noah. He is great. However, he went on a long vacation and Cara became my PT. Yolanda also sent me once. I remained with Cara and I was getting healthier and without pain. The staff know I hired is very professional, CARING, fun and encouraging. I am truly grateful to the following people: Noah, Kara, Leigh, Kris, Lo, Lyla, Larry, Angela, Derrick, Dan, Yolanda, and anyone else who worked with me. Everyone works in a cooperative way. What a fantastic experience to go from excruciating pain 290% back to myself. Thanks!

  - Rhonda S.

• 

  First of all, I want to thank each and everyone here at APM/Tygiel for working with me and getting me well again. When I first came here I was in so much pain that every time I had to get up from my chair I cried. I might look like a million dollars, but this 80-year-old feels like a million dollars!! It is amazing what a group of people that work together can make such a difference! Thank you all. No pain.

  - Rita D.

• I can’t tell you how much this has helped me, just in my general well being. I am more limber and have more energy. I just feel healthier. None of my functions were keeping me from doing whatever I wanted to do, but my ease of motion is much better, too.

  Thank you Noah, Lalo, Matt, Dan, and Yolanda. You were great! So was Lee!

  - Sally G.

• 

  For all these weeks I’ve been getting therapized here with the good folks at APM – Tygiel Physical Therapy “The pain“ you ask? Oh, there’s pain. Not physical pain. That’s gone now. What’s filling the dark void is emotional pain. Saying goodbye to the his wonderful caring people. They will be missed!

  - Sanford S.

• My experience with Cara and staff has gone beyond expectations! Prior to coming in, I had recurrent headaches, neck and low back pain. With the help of Cara and staff I am headache and pain free. 🙂 I can head out for a long ride or run and return home without worrying about having a headache/pain for the rest of my day.

  - Sarah S.

• 

  I went to urgent care my foot hurt so bad I was in tears. I came to APM. Now I can go for walks again. I work 50 to 60 hrs a week. I can’t believe how I have NO pain now.

  Thanks to the whole team.

  You’re the best.

  - Shriley H.

• 

  The first time I came in I felt very comfortable. There were several exercises that felt strange like lunges and standing on something soft and tapping a stool. I was told that Noah did the hiring. He should go into business for other offices. I got to know almost everyone that works here and felt as if I had met new friends. The exercises were explained very well and they were there constantly to keep me safe. Lee started the visit just the way I like. I would recommend this place to everyone.

  - Shirley P.

• 

  Well, well, I had trouble raising my arm up after surgery now I can! Yahoo! Great place to get help and staff is friendly – they make it fun too! Thanks to all involved, I appreciate all your help. Going to miss Dan calling me! : ) Lalo you’re great, enjoyed talking to you and Yolanda was wonderful. Noah you have a wonderful staff working for you. Keep it up and best wishes.

  - Sondra D.

• 

  I have been diagnosed with hypermobility type Ehlers-Danlos syndrome (hEDS) by Dr. Eric Gall about 25 years ago. Fortunately for me, the entire staff at APM is very knowledgeable about hEDS. The pain in my right hip and right thumb, typical in hEDS I am told, had increased over about 2-3 years. My abilities to drive the car and use the potter’s wheel and socialize with friends were becoming more and more restricted as well as my ability to do light housekeeping, cooking, and self care. My overall core strength and mobility were declining.

   

  After taking Applied Physical Medicine treatments three times weekly for approximately two months, I am delighted to be able to drive the car with ease and create tall (12”) clay vessels on the potter’s wheel. The outstanding team of remarkably skilled and caring professionals under the direction of Dr. Noah Abrahams has helped me to continue driving into participate in pottery which is been a dominant interest for me for the last 20 years. I am 78 years old and the ability to participate in Clay and other art interests is essential to my mental and emotional well-being. I cannot think of the good people at applied at physical medicine enough for making it possible for me to continue activity is very important to me and to allow me to live alone and independently in my own home.

  - Susan Y.

• Thank you for your care. I feel much better compared to the time I came here for the first time. The atmosphere in the office is wonderful. The staff took good care of me and followed Noah‘s instructions, and the results reflect the efforts done by the team. The original reason for me to come in was pain in my psoas, which is gone as of now. My lower back feels better than before, as does my right ankle. Thank you very much to all of you!

  - Tidi O.

• 

  Been here in ‘94 for hip problem. Then when I got pain in the back of my legs (when I walked, sit) I told the doctor I wanted to come back to APM. They did so good for my hip. I also had a problem with my right shoulder, and it’s getting some better too. What I like the most here is the staff. They are so cheerful and make you laugh. They make you feel like their family and your best friend.

  - Velva D.

• 

  Was experiencing increasing loss of upward right shoulder motion. Having successfully recovered from a similar problem with APMs help, I was hopeful that I could get back into PT and get some relief to my shoulder problem. All those who worked with me were knowledgeable and patient with me and my shoulder is indeed better.

  - Walter T.

• I am feeling so much better with my back, neck, wrists, and hands. When I first came it was very painful to do many tasks with my hand and was wearing wrist braces, but now I have no pain and have full mobility again. I feel confident in being able to do new stretches when I feel sore to help alleviate/prevent symptoms.

  - Yessica F.

• 

  I twisted my right knee and could not walk on it. Since I have gone for PT for 2 months 3x a week I am able to walk and also kneel on that knee and I could not do that before. So it really has helped me get back to all my normal activities. I do recommend PT as it has really helped me.

  - Joan C.

• I came to APM in excruciating pain. I left after the first visit in much less pain. Noah made certain that pain never returned. Noah and his team crafted a treatment plan that successfully addressed my specific issues. Very attentive. Very caring. Very skilled. Success!!

  - Jo-Ann V.

• 

  I was experiencing pain and less range of motion for several months prior to coming to therapy. I stopped exercising all together which was depressing as it is a major stress reliever and outlet for me. I am happy with my therapy at APM. It was very individualized to my specific needs and situation. I am now exercising again – working towards getting back to my KB class. An unexpected benefit is that my posture is changing and my ENTIRE Body is getting stronger in a way that is supporting my global functionality in my life. Thank you APM!

  - Jennifer S.

• 

  I first came to APM with glute pain that was making it difficult for me to stay in shape for my job as a firefighter. The staff at APM was extremely helpful and nice. After only a few visits, I started to notice an improvement. Now, I am pain-free & in better shape. Thank you APM!

  - Jason G.

• Lower abs were weak after umbilical hernia surgery. Abs are now A-OK. Great experience and everyone was so helpful.

  - James R.

• 

  I was involved in a car accident and had trouble sitting or laying down due to back pain. After PT, I no longer feel any pain. Noah and his team did a good job fixing me up. Thank you.

  - Isham M.

• 

  I came in with upper back pain + within 2 weeks pain was gone and back to normal. Noah + staff are great.

  - Greg D.

• 

  I injured my left shoulder during bench press workouts. The injury limited my mobility and I was experiencing significant pain when lifting weight and in normal lateral arm movements. I was referred to Noah for evaluation and ultimately, the implementation of corrective therapy. My therapy sessions were conducted three times/week over almost 3 weeks. Noah and his team did an outstanding job in treatment and I’m going to exercise and stretching regimen. At the end of my therapy, I was virtually pain-free with unrestricted mobility. My experience with Noah and team was excellent and I would recommend them without reservation.

  - Greg A.

• 

  I could not bend my right knee. Could not play basketball, yard work and normal daily functions were nearly impossible to do. After working with the staff here I am able to do all daily functions. I am able to do shooting & dribbling with basketball. Actual play is probably still a few weeks away. I am being very conservative in my approach to playing.

  I am beyond satisfied with my experience here, and will definitely recommend staff to anyone who inquires.

  - Gilbert B.

• 

  I am a physical therapist and I spent months after a significant back injury trying to deal with my pain – I was hesitant to trust another PT to assist me but I knew I needed help to address my back pain. Noah was a savior – he is a skilled manual PT and his “can-do” spirit kept me motivated and I am happy to say I am much better thanks to his help and help from the staff.

  - Gail G.

• 

  Before coming to APM, I had pain in my lower back and left side of my neck. With controlled electrified shock and specific exercises, I was able to improve my mobility, as my pain diminished in both areas.

  - Frank R.

• 

  My problem was with my left shoulder. There were certain moves that I couldn’t accomplish because of soreness. My exercises consisted of weightlifting, yoga, and martial arts stretching. Since I completed my PT with APM, my shoulder feels much better. The treatment I received was excellent. The staff was excellent. Great quality of service. Thanks guys.

  - Frank R.

• 

  We are sisters. We play multiple sports – primary is soccer. We both came in with knee pain and having to wear braces. Litycia right knee and Rienna left knee, we came in and worked with Noah and his staff for 3 months. We had the tens unit, needles, massage, and the gym. Then we also had exercises to do at home. Now we can play without having to wear our knee braces and the strength building helped the pain. We have “graduated” from PT but still come in for “tune-ups” after long tournaments! Thank you everyone… L&R

  - Espinoza S.

• 

  My second time doing PT (instead of drugs). Very satisfied with the results! My life is now back to normal thanks to Applied Physical Therapy and your experienced staff!

  - Ellie O.

• I had a great experience with everyone that worked with me in my therapy. Everyone was caring and professional from the front desk to the folks in the treatment department.

  - Edilma P.

• 

  After 8+ months of pain in my glutes and back, and not being able to squat/deadlift at all, I was feeling helpless and about to give up. After ONE week of therapy, I felt like a different person and can squat again! I got drastically better with every visit and can finally do the things I love again. I could not be happier with my results and the love and support I received here!

  - Danielle H.

• My experience here was excellent. Was having problems with a shoulder injury. My shoulder has been healed and became stronger. I feel like Noah and the staff are very friendly like family.

  - Christopher M.

• Thanks to Noah and his team I can move without pain. I am a part-time nail tech and I was having lots of pain trying to do pedicures. During the height, my lower back would spasm. With the exercises and therapy they provided I can now move without pain! Thank you APM!

  - Christie T.

• 

  After my car accident, I had upper back and neck pains. The neck pains caused a lot of sleepless nights. Thanks to the APM staff and Noah’s magic hands caressing my body, my back/neck feels much better and I am able to sleep soundly.

  - Chris K.

• 

  After several years of lumbar epidural is for degenerative discs in my lower back, it went into sciatica. Not able to get another injection for several months, I panicked. I am a walker and had several trips coming up. So I called APM to see if they could help me. This was the best decision! Not only was I able to go on all of my trips pain-free, I am back to my morning walks in Sabino Canyon.

  - Cathy O.

• 

  Before starting my therapy with Cara, I could not squat and/or lunge without hip and IT band pain. Cara helped me diagnose the issue and helped me strengthen the muscles that were contributing to my pain. Now I can squat an exercise pain-free. Thanks to everyone here at APM!

  - Cassandra G.

• 

  I have chronic neck, shoulder, and low back pain for as long as I can remember in adulthood. After a day of dusting my right neck pain worsened which isn’t unusual for me. However, the pain accelerated after several days to the point where I couldn’t sleep, not even in a recliner. The pain was constant & sharp & after about a month extended into my right ear & right eye. I made an appointment with a neurosurgeon who, after my neck CT & MRI & head CT showed nothing too serious, prescribed PT for me.

  I have found the staff here to all be extremely friendly & knowledgeable, and my pain is now returned to its pre-injury level. The pain was so bad before PT that it affected all activity levels. I would highly recommend this facility to anyone needing their skills.

  - Carole K.

• 

  I was not able to lay down face up with my hands behind my head because my left shoulder would be in constant pain. And my left hand would go numb all day long for no reason. Through P.T. the numbness has subsided significantly and I can lay down with my hands behind my head pain-free!

  - Carmen A.

• 

  Everyone here is awesome. Came in after my second shoulder injury in the Academy couldn’t do anything with my left shoulder. Coming here helped get that mobility back. Definitely, my number one choice if I ever need anything again.

  - Callen S.

• 

  Again you all did a great job in getting me back in shape. I came in with pain in the left shoulder and very restricted movement. Thanks to you all – great job.

  - Betty S.

• 

  I came to PT because I have (chronically) bad knees, and I was concerned that my mobility was decreasing and my pain was increasing. My doctor suggested I try PT to improve the situation. I had met Noah at a health fair at work, and had previously come here for a free 30 min evaluation. But I did my homework before selecting APM, because it was not a convenient location to work or home. I read lots of reviews from 3 different sources, and was intrigued by the fact that APM was consistently rated high, no negative reviews, and many mentioned that Noah was great or even bordering on miraculous.

  So I came and met with Noah and was impressed by his positive, encouraging attitude and by his willingness to meet me where I was and work with me. (At that point I was feeling discouraged and at times hopeless.) But Noah helped flip that feeling and got me back on track.

  I have been to PT several times before and I believe that at least 50% of the healing comes from keeping up the spirit to persevere. All the staff here have been great at that, and very respectful, and this point is not lost on me.

  So I still have pain but the trend is reversed. Instead of getting worse, I believe it can gradually get better or at least get to a more manageable level.

  Importantly, I have learned strategies for stretching and strengthening that I can take forward, and I intend to do so. I do have more “good days” now with my knees and look forward to that continuing.

  Thanks for everything. I’ve already recommended you to two people. See you in a few months.

  - Ardis H.

• 

  I was referred to Noah by a local gym. We were trying to address my hip issues. Noah quickly identified the problem, recommended corrective action and had me back training in no time. Noah and his team are world class healers. Will be back to maintain the feeling of being strong every day. Thank you!

  - Antonio U.

• 

  Knee replacement. Able to move much better – not so much pain. Back much better. I am walking and bending so much better. Everyone here is so wonderful, this has helped me feel better. Great to be around people who are happy. It rubs off! Thanks to each one of you. God bless.

  - Anna M.

• It’s been a great experience. I can now move my neck without any pain. People are great and very supportive. They also explain the exercises and why I do them. Great place if you need Physical Therapy.

  - Ann V.

• I came in with abdominal pain while deadlifting. After 3 quick sessions with the therapists, the pain was eliminated and I’m back to lifting heavy and pain-free!

  - Amber S.

• 

  When I hobble through the doors my first day, I was met with friendly helpful staff. I had to cut my honeymoon short and spend the time icing and heating my back and a recliner. I thought that I would never get to sleep in my bed again. My lower back pain was so intense I was limited to sitting or hobbling through the house with my new best friend, “Kane.“

  After my very first visit, I noticed positive changes and with consistent visits I was able to get back to normal. I can sleep in my own bed and walk my awesome dog again. I can’t say enough positive things about EVERYONE here. Thank you for teaching me how to get back on my feet and thank you for all the great encouragement and fun conversations w/every visit. You are the BEST!

  - Alicia B.

• The team at APM has helped me to grow stronger and loosen up my legs. They used to ache really badly before but now they aren’t an issue.

  - Aleks K.

• I was rear-ended, and after my back hurt so bad I couldn’t do basic activities at home or work. After the help of all the amazing people here I’m back to my normal and “too flexible” life. Thank you all, shout out to Lalo for not making me do the BBB 🙂

  - Abrianna O.

• I was having mobility issues due to strenuous Brazilian Ju Jitsu training. At the recommendation of my strength trainer Jesus Acuña I came to APM. Within two months, after having pain on and off for three years, my shoulder felt renewed and one hundred percent functional. Thank you!

  - Aaron B.

• I have worked as a Registered Nurse for about 15 years now and am extremely aware of how important body mechanics are when performing as a nurse. However, no matter how cautious you are, 15 years of nursing does cause some wear and tear on the body. I started working with Noah Abrahams in the Emergency Department approximately three years ago as a co-worker. I heard over and over by patients that he treated how wonderful he was/is. Several co-workers had worked with him in a patient/therapist setting and also gave rave reviews. I had been suffering from sciatic type pain intermittently for years but it was only in the past 2 years that it was really affecting my job. Everyday activities were now causing excruciating pain and patients were noticing my discomfort at work. I approached Noah Abrahams for evaluation and treatment of this sciatic type pain. He in the past year has given me back a sense of control. I very rarely have a sciatic flare up; when I do I have been taught how to relieve the pain myself. I can now go to work and know that I can perform my job without dreading every bend and turn. Not only has he been able to provide rehabilitative therapy for my sciatic pain but he has also been helping me to maintain my back health/strength. Over the past year, my treatments have been progressively more preventative verse rehabilitative. Noah Abrahams has instructed me on strengthening exercises and stretches to maintain entire spine/back health. He understands that my life is occasionally stressful and that I tend to carry my stress in my back, causing shoulder, upper back, and neck discomfort. He evaluates and adjusts our sessions dependent on what is going on in my life; some days it is dry needling, or manual manipulation of spine and muscles and on really stressful days, its strengthening excises and stretching. I get personalized treatment every day. Noah Abrahams has also adjusted session times dependent on changes in my life; during periods of increased stress, we go to two sessions a week, during relaxed easy going times and its back to once a week. Noah Abrahams is also available for that emergency session on days that I did something wrong; had to wrestle some 200+ pound patient, pulled up a 400-pound patient one too many times or just had my son jump on me wrong. Noah Abrahams is a phone call away and is always willing to help.

  - KS, RN.

• I was in pain and had dysfunction that started in my upper back and went into my neck and arm. I had tried multiple modalities to try to restore the function and alleviate the pain, to no avail. I called Noah as an attempt to find some sanity and relief. Noah told me I was likely to have some marginal improvement but it would probably take more than just a couple treatments to get a substantial benefit. Noah needled my body on Friday, Saturday, and Sunday and did some manual manipulation and active release. Honestly I didn’t feel much better immediately after. It was days before I started noticing the results, but once I did the results- marginal at first became profound. Suddenly I could turn my neck without pain; the range of motion was greatly increased. My left side started to “wake up” and I noticed the effects of chiropractic care were much more pronounced as my adjustments held much longer after his treatment. It’s difficult to describe the gift Noah’s care has given me, but he has put me on the path to healing and my pain is gone, my function on my left side is coming back. HUGE improvements after 1 year of hitting my head against the wall in only a few treatments. The only downside is Noah is too far from where I live in California to treat me regularly. I recommend Noah’s service and knowledge without reservation; he not only is great at his profession but is caring and intelligent in his approach.

  - BD

• Thank you so much for all you have done. I’m back to competition form and I have you to thank for that. My hip feels amazing and I cannot wait to take the mound again and prove what I’m capable of. Your knowledge and expertise are more than I could have asked for. I will without a doubt come to you when/if ever needed again and would recommend anyone to do the same. Again, thank you and I wish you the best of luck!

  - Ryan P.

• I’ve been dealing with nagging tendinitis in my left elbow for almost 2 years. I have seen 2 different physical therapists, been on 2 different anti-inflammatory plans, and have seen an acupuncturist. Nothing seemed to work. My elbow never got better. I have been seeing Noah at Applied Physical Medicine for a few weeks now, and my elbow hasn’t felt this good in years. I am thoroughly impressed with the work Noah has been doing for me. He saw the big picture! Thanks to his knowledge and skills, my elbow feels great. I would recommend Noah and APM to anyone.

  - WS, RN.

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  As a professional triathlete, recovery and injury prevention is very important to me. I have been to a number of massage therapists, chiropractors, and physical therapists from around the world, and I take choosing my recovery team very seriously. I always look forward to visiting Dr. Noah Abrahams and his team at Applied Physical Medicine + Tygiel Physical Therapy in Tucson – he has one of the best practices that I have been to. I have personally worked with Noah for a couple of years now – he gets me in last minute and he has never let me leave his office if I was not feeling better. I highly recommend him for injury prevention or treatment of any physical ailment. This year, thanks to his help and care, I placed 2nd at the Tongyeong World Cup in South Korea US Olympic Team, Rio 2016.

  - Ben Kanute, US Olympic Team, Rio 2016