Flager Law Personal Injury Hour Podcast | 01-06-24 | Brian Kirby

Physical Therapy, Concussions & Injury Recovery Explained

When you’re in a car crash, slip and fall, or other serious accident, the damage isn’t always obvious right away.

You might walk away from the scene feeling “okay,” only to wake up the next morning barely able to get out of bed, or months later dealing with nerve pain, balance issues, or a concussion that never fully resolved. By that point, you’re not just fighting your injury — you’re also fighting insurance companies and a broken medical system.

On this episode of the Flager & Associates Personal Injury Hour, attorney Adam Flager and physical therapist Brian Kirby of Capstone Physical Therapy and Fitness sit down with host Joe Dougherty to unpack:

• Why many accident victims don’t feel badly injured at first

• How delayed treatment can turn a simple problem into a long–term condition

• The difference between chiropractic care and physical therapy

• How concussions and vestibular issues are diagnosed and treated

• Why having a connected network of doctors, therapists, and a personal injury lawyer can change the outcome of your case

If you’ve been injured in Pennsylvania or New Jersey — or you just want to understand how injury recovery really works — this episode pulls back the curtain.

---

Why You May Feel “Fine” at the Scene — And Awful Days Later

One of the biggest myths Adam and Brian address is the idea that if you’re not in extreme pain at the scene, you’re not really hurt.

Right after a crash or fall, your adrenaline is pumping, your heart rate is up, and your focus is on logistics — exchanging information, calling police, figuring out how to get home. In that state, it’s easy to overlook a stiff neck, a sore back, or a headache.

As Adam explains, many clients tell him:

“I thought it would get better. I didn’t realize it was going to last this long.”

Once the adrenaline wears off and your muscles tighten, the real pain often shows up later that day, the next morning, or even several days after. That’s true for:

• Back and neck injuries

• Disc issues

• Soft–tissue injuries

• Concussions

The problem? Insurance companies love to use that delay against you — claiming your injuries couldn’t be serious or weren’t caused by the accident. That’s why early documentation and early treatment matter for both your health and your case.

---

“Big Damage = Big Injury”? Not Always.

Another misconception Adam tackles is the “big damage, big injury” myth.

Juries, adjusters, and even some doctors assume:

• Heavily damaged car = serious injury

• Light vehicle damage = minor injury

But the science doesn’t support that simple equation. Everyone’s body is different, and the “eggshell plaintiff” rule in law recognizes that some people are more vulnerable than others. If a minor crash triggers a serious condition because of your unique body or prior vulnerabilities, the at–fault party is still responsible.

Adam talks about real–world examples where people walk away from what looks like a “small” accident, only to end up with herniated discs, surgery, or long–term pain months later. That doesn’t mean their case is weak — it means you can’t judge injury severity by looking at a bumper.

---

How Waiting Too Long Can Turn a Treatable Injury Into a Surgical One

Brian sees it every day in his practice:

• Someone “toughs it out” after a crash or work injury

• They start walking differently to avoid pain

• Hips tighten, posture changes, and stress shifts to the back

• A minor disc bulge becomes a herniation

• Eventually, conservative treatment may no longer be enough

Physical therapy’s role is to put your body in the best environment to heal:

• Strengthening the right muscle groups

• Protecting injured structures long enough for tissue to heal

• Teaching you how to move without constantly “re–tearing” the same area

When people wait months before starting therapy, they sometimes cross that line from:

“We can probably fix this without surgery”
to
“You may now be looking at a surgical solution.”

The takeaway: early PT isn’t about being dramatic — it’s about preventing long–term damage.

---

Physical Therapy vs. Chiropractic: What’s the Difference?

Many injured people are confused about whether they should see a chiropractor or a physical therapist.

Brian breaks it down simply:

• Chiropractors focus more directly on the skeleton — making adjustments when joints are misaligned.

• Physical therapists focus more on the muscular and movement systems, rebuilding strength, mobility, and stability so your body can hold good alignment and move properly.

In practice, the two often work together. A chiropractor may adjust a joint, but if the surrounding muscles are too weak to maintain that position, the benefit won’t last. That’s where PT comes in: stabilizing and retraining your body so the results stick.

---

Concussions, Vestibular Therapy, and the “Invisible” Injury

Concussions are some of the hardest injuries to prove and to treat:

• CT scans and MRIs often come back “normal”

• There may be no visible damage, but symptoms are very real:

  • Headaches

  • Light sensitivity

  • Dizziness or vertigo

  • Trouble focusing

  • Personality or mood changes

Adam points out that this makes concussions challenging in front of a jury. You can’t show them a broken bone, but you can show them:

• A spouse describing personality and behavior changes

• A patient explaining how they now struggle with screens, bright lights, work tasks, or driving

Brian explains the vestibular system — the inner–ear structures that tell your brain whether your head is moving up, down, or side to side. When that system gets disrupted in a concussion, it sends scrambled signals to your eyes and brain, leading to dizziness, nausea, and balance problems.

Modern concussion rehab isn’t “sit in a dark room forever.” It’s:

• Short period of rest

• Gradual re–exposure to activity and stimuli

• Buffalo Concussion Treadmill Testing to see how symptoms respond to increased heart rate

• Customized exercises to retrain balance, gaze stabilization, and coordination

Some patients make a full recovery; others improve but never get entirely back to baseline. Either way, the right therapy shortens recovery and reduces the risk of long–term issues.

---

Building the Right Medical Network After an Accident

One of the biggest frustrations Joe and Adam talk about is how often family doctors refuse to treat accident cases.

Even if you’ve seen that doctor for 20 or 30 years, once they hear “car accident,” many simply won’t get involved — they don’t want the paperwork, the billing headaches, or the possibility of testifying.

That leaves injured people stuck, asking:

“Who do I see? Who will actually treat me?”

This is where having a personal injury firm with a trusted medical network matters:

• Adam’s team looks at where you live and work, and when you’re available

• They connect you with independent doctors and therapists who are:

  • Skilled

  • Willing to treat accident cases

  • Conveniently located

  • Good communicators

If it’s a 30–minute drive each way, three times a week, most people won’t stick with treatment. That hurts their recovery and their case. So convenience isn’t a luxury — it’s part of the strategy.

---

Why Communication Between Lawyer, Doctor, and PT Is Critical

Brian and Adam both stress that communication and compliance are everything:

• If a patient suddenly stops going to PT because it hurts more than expected

• If they don’t understand why therapy is hard

• If they feel like they’re not getting better fast enough

…it’s easy for them to disappear, lose progress, and weaken their claim.

What Brian likes about working with Flager & Associates is the closed loop:

• Brian’s office calls and says, “Your client hasn’t been in.”

• Flager’s team reaches out to the client, finds out what’s wrong, and encourages them to stay engaged.

• Brian adjusts the treatment plan if needed so the patient can tolerate it better.

Instead of everything “going south” — no treatment, no recovery, no case — the support system pulls the person back on track.

---

Who Capstone Physical Therapy & Fitness Helps

Throughout the episode, Brian runs through the types of conditions they see at their clinics in Northeast Philadelphia, Morrisville, and Southampton:

• Post–accident injuries (auto, slip and fall, work injuries)

• Low back pain (the number one musculoskeletal complaint)

• Knee, shoulder, and neck problems

• Sports injuries

• Balance issues and fall prevention in older adults

• Vertigo and vestibular disorders

• Complex, multi–site pain where one injury has led to compensations elsewhere

Their approach is holistic and practical: treat both the original injury and the compensations, so patients can return to as close to their pre–injury lifestyle as possible.

---

When to Call Flager & Associates (Legal) and Capstone PT (Medical)

If you’ve been injured in an accident caused by someone else’s negligence — a car crash, truck crash, slip and fall, dog bite, or dangerous product — do not wait to get help.

Two phone calls can drastically change your outcome:

Flager & Associates, P.C.

• Website: FlagerLaw.com

• Phone: 215-953-5200

• Offices in Trevose, Philadelphia, and New Hope

• Serving injury victims throughout Pennsylvania and New Jersey

Capstone Physical Therapy & Fitness

• Website: CapstonePTFit.com

• Phone: 215-677-1149

• Offices in Northeast Philadelphia, Morrisville, and Southampton

Your job after an accident is simple but not easy: get the right care and focus on getting better. Let your medical team guide your recovery, and let your legal team deal with insurance companies and the paperwork.

TRANSCRIPT

Joe Dougherty (Host):
All right, ladies and gentlemen, we’re in the Delaware Valley. Welcome to the Flager & Associates Personal Injury Hour here on WWDB Talk 860. We have a fantastic broadcast. We have our host on the show, Adam Flager. How are you, sir?

Guest / Audience:
Hey Joe. Happy New Year. Happy New Year, everyone.

Joe Dougherty (Host):
Happy New Year to you too, my friend. Definitely looking forward to 2025, and we’re going to open up the year with a fantastic broadcast. We have Brian Kirby of Capstone Physical Therapy. How are you, Brian?

Brian Kirby:
Doing great, guys. Thank you. Thanks for having me. It’s a pleasure to be on the show. You know, we have a little bit of fun. We talk a little law, a little medicine, a little sports — whatever it takes. But certainly, it’s a festive New Year, and it’s great to be back on the air.

Adam, if you would, remind our listeners a little bit about yourself and the firm.

Adam Flager:
So, I’m Adam Flager from Flager & Associates. We are a personal injury law firm serving Pennsylvania and New Jersey with all types of personal injury matters: motor vehicle accidents, slip and falls — you know, it’s about to snow today and again in a couple days. So slipping on something like ice, untreated sidewalks, things like that, but also uneven concrete, or something spilled in a store and you fell on it, or something fell on you in a store.

We handle those. We also handle dangerous products, which would be product liability, dog bites — all that fun stuff, so to speak.

Joe Dougherty (Host):
And all those things, due to the negligence of others, all have a medical side, obviously. When somebody’s injured as a result of somebody else, what ends up happening is those situations — and people find out fairly quickly — is they end up going to their family doctor.

A lot of people, as we’ve talked in the past, may or may not feel very injured initially. I think I’ve talked to you about my wife and her situation years ago. We got hit — we were in a car accident when we were 19 years old. We got hit from behind.

The kid wasn’t really focused — literally, we were at a light, and he just hit us. He felt fine, but she started having pinched nerves every couple of weeks. Next thing you know, she’s got a big scar right there from surgery. A year later, it blew out.

So you never really know what’s catastrophic and what’s not at the scene.

Adam Flager:
Not at the scene, exactly. Think about it — anytime something crazy happens, your adrenaline is pumping, and there’s a lot going on in your head. Because of all that, you don’t really know how you feel in the moment. Your blood pressure is up, you’re amped.

It’s sometime later that day, when things calm down — or the next day, or the day after — when your muscles contract and tighten up. Half the time, when we talk to our clients however many days later, it’s, “I couldn’t get out of bed.”

Joe Dougherty (Host):
What’s interesting about it — and we’re going to bring Brian in in a minute, because we have a lot of questions and information we want to provide to our listeners — is how traumatic it can be.

Every few months, this thing would flare up — almost like a pinched nerve. Eventually she was in bad pain and finally went to the surgeon. The surgeon looks at it and says, “Okay, you know, it’s a disc issue.”

The day we had surgery planned — this was in 1983–1984 — there was 18 inches of snow on the ground. We couldn’t get there easily, and she was in a lot of pain.

We finally suffer through all that; she gets the surgery, and I can tell you this: for three weeks after that surgery, I’d never seen such pain in my entire life because the nerve had been compressed for so long. I remember those three weeks — the steroids were driving her crazy and all that.

But three weeks later, I’m thinking, I’m watching somebody who may never heal. I was so scared. It was amazing.

My whole point is, now, I thank God eventually things got better. Back then, the surgeries — they just fused it. There was no modern approach like today; now there’s a lot more medicine and a lot more therapy they can do.

But what I’m saying is, if you had been at the scene of that accident — minor fender bender, minor visible damage — you’d think nothing of it. Not even close to “catastrophic injury.” We didn’t put two and two together until three or four months later. The only thing that could have possibly hurt her was that crash.

So the point is: you never really know what you’ve got on the spot. Some people, God forbid, have injuries where it is that bad. But in many cases, the medical side is such a big part of it, and yet, a lot of times, people have no idea where to go.

Adam Flager:
And unfortunately, that can work against you too. People think, “Oh, your car is totaled, so you’re really injured. If there’s not as much damage, you’re not hurt.” The science is not as supportive of that as people would like to make it seem, but there’s still that perception — whether it’s an insurance adjuster, opposing counsel, or a jury.

People think: big damage on your car means big injuries.

Sometimes there’s the concept of an “eggshell plaintiff,” which everyone learns in law school. If you have an eggshell for a head, something might hurt you that wouldn’t hurt someone else — but it’s still the responsibility of the person who caused the accident.

So perhaps your wife had something that set that off that wouldn’t have affected you or someone else. But if that was A causing B, then the person who caused A is still on the hook.

Guest / Audience:
Well, it’s interesting, because—

Joe Dougherty (Host):
Of course, you know it was connected to the surgery. But to give you an idea of how you have no idea where to go: when we walked in, we never related it to the accident. We never got a lawyer. We never did anything. We just got the car fixed.

Because we were so young, and it didn’t hurt right away, we didn’t put it together. I still remember when we asked the surgeon — or when the surgeon asked what happened — he flat out told us, when we were scheduling surgery, “If this is a car accident case, I’m not doing it.”

We were like, “What are you talking about?” At that point, we just needed it done. We didn’t even relate it to anything legal; he just asked, “What happened?”

That’s the same type of thing that happens when you go to a hospital. You hurt yourself, you get injured in one way or another. It happened to me over the summer — I stepped out of bed and I hurt my foot.

When I got to Jefferson Hospital, the first thing they asked was, “Was it a work injury, or did you get into an accident?” They know who to bill. It almost felt like they were going to throw me out. I’m like, “No, unfortunately, I slipped getting out of bed.”

The point is: the medical network and all those professionals are not easily accessed by individuals. You can’t always just go to your family doctor. Why not?

Adam Flager:
I’ll tell clients all the time: listen, if your family doctor will treat you — that person who might’ve known you for 10, 20, 30 years — great. But a lot of times, even though you’ve had a relationship for decades, once they find out it’s a car accident, they will not touch it because they don’t want to be bothered.

So you have to find good doctors or good therapists who not only are excellent clinically, but also take these cases — who handle motor vehicle accidents or slip and falls.

That’s why having someone like Brian and his team is so valuable. You could be the best doctor in the world, but if you’re not going to treat my clients and help them get better, that’s of no help to us.

If you’re not conveniently located, that’s also no help. You need good providers who handle these things and are convenient to the client — especially with physical therapy. If you have to travel 30 minutes for physical therapy two or three times a week, you’re not going to show up — which means you’re not going to get better, because Brian can’t help you, and it’s not helping your case either.

Joe Dougherty (Host):
I’ve heard attorneys say to individuals who maybe have emotionally been shot and just couldn’t get out of bed, “No treatment, no case.” In other words, there are a million people out there, and these people are in pain.

Let’s bring in Brian Kirby.

Brian, welcome to the program. Tell our listeners a little bit about yourself.

Brian Kirby:
Sure. Thanks, guys. Thanks for having me again. My name is Brian Kirby. I’m a physical therapist in the area with Capstone Physical Therapy and Fitness. It’s a full-service physical therapy company.

We’re located in Northeast Philly, right near the Topgolf — that’s on Norcom Road in the Norcom Community Center. So we’re there in Northeast Philadelphia.

Joe Dougherty (Host):
Where the Iron Workers Hall is — right around the corner. Okay, so that’s where you all get together and hang out.

Brian Kirby:
That’s right. We’re also in Morrisville, PA — that’s 201 Woolston Drive, right near Morrisville, Yardley, Newtown — so that’s where we can handle people from Bucks County out that way.

We also get some people from Jersey right over the bridge — from the Trenton area, Mercer County. And then we have another office in Southampton at 715 Cherry Lane.

Joe Dougherty (Host):
Tell our listeners a little bit about the company — the organization — the team, the facilities, and the culture at the facilities.

Brian Kirby:
Thank you. Yeah, we’re very proud of our whole team. It’s me and two other therapists. Mark Donovan started the company back in 2007; I joined him about seven or eight years ago. Then we have Jackie Ditmeyer.

Mark and I have both been practicing for about 25 years. Jackie is now in about her fifth year of practice. We each specialize in different things.

One thing that I think separates us is that we treat the whole body as a unit — like a chain — a holistic approach. We try to find the root cause of the problem.

A lot of times, you go into places and it’s like, “Oh, my neck hurts,” and they just go right to the neck. But sometimes other parts of the body are setting that area up for success or failure.

We absolutely treat the problem you’re coming in for, but we also try to figure out what else can put your body in the best environment to let it heal itself naturally. Other things going on can affect it.

Joe Dougherty (Host):
That’s what I was going to ask you. I know with work injuries it happens a lot, but how does it work with personal injuries that may or may not be work-related?

With work injuries, the workers’ comp insurance company may accept one injury but not another. So you’re talking about an important point: how does that work with personal injuries?

Adam Flager:
Sure. The other side is always going to try to limit certain things. Some things they have to accept. You get in a car accident, you go to the ER, they take an X-ray, you have a broken bone — we know where that came from.

But when we’re talking about injuries to your neck and back, especially in areas people commonly injure and may already have wear and tear, the defense will say, “Was that really from this accident, or was it something else?”

And with what Brian was talking about, we often have clients who have an injury somewhere, and then they finally get to a specialist who says, “Yeah, I know you’re experiencing pain in this part of your body, but it’s really coming from another part. That’s what’s sending the signal, whether it’s a nerve issue or something else.”

If you’re only doing, “Here’s where the pain is felt,” that’s different from asking, “Where is this originating from? What’s causing it?”

A lot of times, we’ll have these situations and the other side will say, “No, it’s really from something else.” That’s why we need good doctors and good providers to document everything, so we can get a report that says, “Actually, no — this is all related. Here’s why. Here’s the medicine behind it. Here’s the reasoning.”

Joe Dougherty (Host):
How often does that happen, where it’s not just one injury? Maybe it hurts really badly in your shoulder, but your neck is the cause of it — or vice versa?

Brian Kirby:
Oh yeah, it happens more often than not. More often than not, it’s not just as simple as one body part.

You have to put that puzzle together. “Okay, this person has pain in their back, but the original injury was their knee. The knee caused them to walk in a certain way that put increased pressure on their back.”

We tie that together. That also comes into coding. You might start with something coded as a knee injury, but then you link it together and say, “This caused the issue in the back,” or, “This caused someone to walk differently, and now they’re having a problem with the foot or hip on that side, or even the other side.”

As long as you put that together, the way we develop our treatment plans is to treat the whole body — treat the cause and the compensation — to try to get patients back as close to their pre-injury status as possible. That’s not always possible, but that’s the goal.

Adam Flager:
It happens so often. We talk to clients all the time: one leg is bad, and they overcompensate, and now the other leg is bad because of the overcompensation.

You really have this complex system — our body — and everything is related. You know that children’s song, “The knee bone’s connected to the…” — it’s silly, but it’s true.

Maybe it’s good that we’re teaching kids that everything is related, because you don’t just have an injury in a vacuum, in isolation. It’s all connected, and it all affects other parts.

Guest / Audience:
What’s interesting also—

Joe Dougherty (Host):
A lot of times, as we all know, people — especially if it’s not a broken bone — try to handle things on their own.

I’m not saying they want broken bones, but if you break your tibia or fibula and they cast it, no one’s arguing with that — they saw the beam fall on your leg. They’d love to turn you down and deny you, and I’m sure they’ve tried in the past, but they can’t.

However, a lot of individuals might pick up something or do something, and there’s a work injury that happens because of somebody else. They try to handle it on their own.

They say, “I’m not litigious. I’m not that person.” They find themselves wrapped up in a pretzel. They think, “I grew up in a neighborhood where you’re going to treat me good.”

They find out they don’t really have any friends at the insurance company, and they’ve been trying to navigate this on their own. They end up with injuries caused by walking funny, compensating, and now, months later, they’re not getting the care they need.

By getting jammed up by an insurance company that often doesn’t have their best interests at heart, they end up with these extra types of injuries because they weren’t treated right out of the box. They walk into your office and—

Adam Flager:
—And it’s been a while. A lot of times, it has been a while. There are a couple of things. One might be, “I thought it was going to get better. I didn’t realize this would last longer.”

Sometimes it’s that they have so much going on: property damage claims, trying to get their car back, setting up one claim and another claim. All of that is taking away their time and energy from getting treatment.

One of the big things we always tell clients is: that’s why it’s important to come to us early — so you can focus on your job. Your job is to go to the doctors and get better. My job is to do all that annoying stuff with the insurance company.

If you’re doing that, then you’re not going to Brian, you’re not getting physical therapy, you’re not following up with an orthopedist, you’re not doing the things that will get you better. And if Brian can see you early on, he can do a lot.

Joe Dougherty (Host):
Can you prevent those issues a lot of the time, or at least help keep them from getting worse?

Brian Kirby:
Yeah, help keep them from getting worse — definitely. With car accidents, we can’t prevent the accident itself, but after the fact we can get people on the right track.

It happens all the time: someone puts it off, thinks, “I’m tough enough; this is going to get better.” Then they start moving differently, their hips get tight. Now when they go to stand up, it puts increased stress on the back.

Now the back is in a worse spot because they didn’t put their body in the right environment to heal naturally.

Joe Dougherty (Host):
So, the network of doctors — what’s the process?

Adam, somebody comes in — whether it’s an auto accident, a slip and fall, or another situation — but they’re pretty beat up. They walk in. They try to go to their family doctor, the family doctor they’ve been seeing since they were five years old. That doctor suddenly is not their best friend, and now they really don’t know what to do.

That’s one of my points: it’s so easy for somebody to get lost, especially good people who are just trying to get better.

I get a kick out of the fact — and I’m being sarcastic when I say this; it infuriates me — that somebody will try to give the world the benefit of the doubt and say, “I’m going to handle this,” and the one thing that gets screwed over is their health.

So they walk into your office. They can’t find that medical network because those people don’t really advertise. What’s the process — and ultimately, how do they get to Brian? We’ll talk about the network of doctors you work with, Brian, in regard to physical therapy and the doctors prescribing it.

Adam Flager:
Yeah, sure. You always want to know: have they treated before? Have they treated at all for this? Where have they treated?

Do they have a family doctor? Will that doctor treat them?

A lot of times, people might have a family doctor or maybe a cardiologist for a heart condition, but that doesn’t mean they have an orthopedist, a physical therapist, or a neurosurgeon.

So it’s: where do you live, and where do you work?

Ultimately, you might live somewhere, but where you work might be really close to a bunch of doctors, whereas where you live is not. I want it to be convenient for you. If it’s not convenient, you’re not going to go.

Who cares that I give you a recommendation for a great provider if you’re not going? It doesn’t help.

So we figure that out, and we also ask what their schedule is. “If I don’t start my day until 11 a.m., okay, you can do a 9 or 10 o’clock appointment and then go into the office. If I’m done at 3 o’clock, you can do a 4 or 5 o’clock appointment.”

“Do they have weekend hours? Night hours?” We’re trying to set them up for success so that it’s a provider who is good and convenient.

I’m not just going to send you anywhere. There are certain doctors I could send you to, but I’m not going to, because they might have a reputation as mills or something like that. I don’t want to send you there because I want you to get better.

I’m not in the business of making your treatment last longer than it needs to. I think we lose credibility — our firm does, and the plaintiffs’ bar as a whole — if we do that.

So I’m not going to do things that hurt our reputation, because if it hurts our reputation, it hurts my ability to negotiate a good settlement.

So we figure out where you are and then say, “All right, here’s the type of specialist you need. Here’s a good person who’s convenient. Here’s the number — let’s go.”

Joe Dougherty (Host):
In your world, Brian, what kinds of doctors do you work with in that network — the ones who prescribe physical therapy for somebody injured in a personal-type accident?

Brian Kirby:
I rely a lot on Adam — he has a good network of doctors — and I have my own network as well: orthopedists, neurologists, primary care doctors who will treat these patients. It’s about finding the right one.

One thing I will say is that the big hospital health systems have bought up a lot of primary care practices. I’ve had patients whose doctors, when they were independent, could do more for them.

I’d say a quick answer is: independent doctors are often better than the big systems for these situations, because some of the large systems won’t allow those docs to go through the extra work Adam mentioned — the detailed documentation to really spell out what’s going on with a person so they’re covered like they should be.

There are a lot of independent practices out there in the area, and we’re connected with many of them.

Joe Dougherty (Host):
When you see a patient, do you collaborate with the prescribing doctor?

I’ve heard many times that good physical therapists often know more about rehabilitation than the doctor who sends the patient over. The doc may know how to diagnose and do the surgery, but then they rely on good physical therapy.

Guest / Audience:
That’s why we have you say that. Yeah, that’s very nice. But if you’re out there and you’re offended — too bad.

Brian Kirby:
No, that’s exactly right. A lot of the docs are great at doing the assessments. They get the diagnosis. We do the treatment.

We’re also — me, Mark, and Jackie — great with communicating back to the doctors. We might say, “Hey, you sent them over with a script saying it’s their lower back, but their thoracic spine is an issue also.”

It’s a team atmosphere. They’ll usually say, “Oh, great. Send them back, I’ll take a look at that,” or, “Add that to what you’re treating.”

Joe Dougherty (Host):
Let’s go over the types of injuries and conditions you guys treat. I was on the website. Obviously you’re talking about back pain, neck pain, shoulder pain. As a physical therapist, what kinds of injuries come through your place?

Brian Kirby:
The number one is lower back pain. The number one reason anyone goes to seek help from a medical practitioner for a musculoskeletal problem is low back pain.

When it comes to motor vehicle accidents, that’s probably also at the top: low back pain, followed by knee pain.

When I say “pain,” that’s global — you can tease it out into patellofemoral pain, ACL strains, sports injuries, and that kind of stuff.

But in general, it goes: low back problems, knee problems, shoulder, neck — and then everything else: foot, ankle, elbow.

Joe Dougherty (Host):
And how often — I know we don’t have an exact percentage — but how often can therapy be something that works instead of surgery?

I assume surgery happens when you’ve gone as far as you can. When you talk about low back pain, and it is scary — I’ve done a number of broadcasts over the last 10 years, and karma is a crazy thing.

I’ve always thought, talking about a lot of these issues: one time I bent over at a gas station to grab something on the lower shelf — this was a couple of years ago — and I’m thinking, “Oh my God.”

Adam Flager:
He bent down and couldn’t bend back up.

Joe Dougherty (Host):
Yeah, I came back up, and I’m thinking, “I’ve got a problem here.” It’s a scary thing — very scary.

What’s the difference between what a physical therapy program provides and what chiropractic care provides? A lot of people confuse them.

Brian Kirby:
That’s a great question — the difference between physical therapy and chiropractic.

I’d say the number one difference is: chiropractors go more directly at the skeleton itself. They’re skilled at handling misalignments — getting things back in place safely. That’s their expertise.

What we do is more the muscular side of things — trying to rehabilitate someone, build strength, and restore function.

A lot of times we work in tandem. There are some chiropractors who send patients my way and vice versa.

If they have someone where they’ll call and say, “Hey, they’re not holding my manipulation — I do an adjustment, but they just can’t hold it because they don’t have the strength,” then we work on stabilizing their core and teaching them ways to move from other joints to help keep things where they need to be.

Joe Dougherty (Host):
If you don’t treat, and I didn’t really realize this, a lot of times when somebody gets injured — especially if it’s a work injury or a personal injury — is it possible, especially with joint issues, that if somebody waits too long, it can affect their long-term recovery?

Brian Kirby:
Absolutely.

Joe Dougherty (Host):
To the point of no return — where you might have been able to take care of this conservatively, without surgery, but now it’s gotten to the point where you might need surgery?

Brian Kirby:
Yeah.

Joe Dougherty (Host):
Does that occur a decent amount with people who are stubborn?

Brian Kirby:
Absolutely.

Using the example you gave — your lower back — if you bend over, you can literally herniate a disc from bending over to pick something up. You can get a bulging disc from bending over.

You have fibers in your back that protect your disc. If you tear some of those, it could be as simple as bending and twisting the wrong way. Initially, your body starts laying down scar tissue to heal it, but it’s not that strong.

What we do is work on the muscles to keep you in a better position and teach you to move from other areas — to let that area heal the right way.

But if you keep re-tearing it, or you turn something from a bulge — which is a tear of the first layer of fibers — into a herniation, where that second layer of protection fails, now you have disc material that squirts out.

Then you get degeneration, where the disc size starts to shrink down. If you wait long enough, it can become a bone-on-bone situation. Sometimes it will even fuse on its own as a way of healing. In those situations, yeah — now you’re looking at surgery.

Joe Dougherty (Host):
My brother got surgery, and it sounds like that’s what happened — the material in the disc basically exploded out. He waited as long as he could. I took a walker up to him in the middle of a snowstorm.

He was just stubborn. He thought he could handle it, and he couldn’t — he could no longer handle it. So many people are like that.

We’re going to take a quick break, but when we come back, we’ll talk about the types of clients you work with: work injuries, personal injuries, sports injuries, and other conditions you might treat.

We’re going to have more from the Flager & Associates Personal Injury Hour in just a minute.

Have you been injured in an accident? Is the insurance company giving you the runaround? You need a Philadelphia personal injury lawyer who knows how to get results. You need Flager & Associates, P.C., located in Trevose, with offices in Philadelphia and New Hope.

The law firm of Flager & Associates proudly serves injury victims throughout Pennsylvania and New Jersey. Whether you’ve been injured in a car accident, a truck accident, a motorcycle accident, a slip or trip and fall accident, or as a result of a dog bite or a faulty product, contact Flager & Associates and get the results you deserve.

Call Flager & Associates personal injury firm at 215-953-5200 or find us on the web at www.FlagerLaw.com and request a free case evaluation today.

That’s 215-953-5200, or on the web at www.FlagerLaw.com. Request a free case evaluation today.

Joe Dougherty (Host):
All right, ladies and gentlemen, welcome back to the Flager & Associates Personal Injury Hour here on WWDB Talk 860. We’re having a fantastic conversation with our host, Adam Flager, and of course, Brian Kirby, who is a physical therapist from Capstone Physical Therapy.

We’re talking about the different types of injuries and all that. One of the things you mentioned during the break, Brian — and Adam and I always talk a little sports and have some fun — is that Jalen Hurts, our quarterback here in Philly, has a concussion now.

You and I want to talk about how you treat those types of situations. But I want to throw something out there, because I’ve had — I’m sure you’ve noticed by now — I’ve had a couple concussions. I remember them, but barely. Both were from playing football.

One was in high school — I got hit from the side. I knew enough to understand that concussions often happen from hits to the side of the helmet, not just head-on collisions. That’s what happened to Hurts.

He still hasn’t been cleared from the concussion protocol. Let’s get into that side of it.

By the way, Adam, I’m assuming that if somebody gets into an accident caused by another person’s negligence and suffers a concussion, that would be a potential case, correct?

Adam Flager:
Sure. We see it a lot. In a motor vehicle accident, your head can slam into the window — especially in a side impact — and that doesn’t feel good.

You can have a slight loss of consciousness, brief loss of consciousness, or you can fall. We just signed up a case recently where someone fell on a sidewalk, took a nasty hit, and their face took a big piece of that impact. It knocked the person out, and they came to when they were already in the ambulance. Those are serious injuries.

Joe Dougherty (Host):
Both of my concussions — one was playing flag football. I got run over by the whole offensive line. Flag football is supposed to be safer, right? My head hit the ground.

Both times, I blacked out briefly. That was the common denominator. That’s how I knew it was a concussion.

Here’s a question regarding personal injury: let’s say it’s a concussion. Are there different challenges because it’s not as easily diagnosed as a disc injury or a broken bone?

Adam Flager:
It’s definitely harder. You break a bone, you take an X-ray: there it is. You have a herniated disc, you get an MRI: there it is.

Most of the time with concussions, you’re going to get a brain CT or possibly an MRI, and it’s going to show nothing. That doesn’t mean you didn’t have a concussion.

If you talk to neurologists, it doesn’t mean you don’t have a concussion. It just means you didn’t have a brain bleed, or some other more obvious structural damage.

It’s harder in the sense that people understand a shoulder injury, a neck injury, a back injury — those are easy to conceptualize. A concussion is more like an invisible injury.

That’s why getting the right treatment is so important — getting them into a neurologist, which can be a lot more challenging. There are tons of orthopedists; there are not nearly as many neurologists.

You might have a three-month wait. Now, Jalen Hurts doesn’t have to wait three months, and thank God for that — I wish no one had to wait.

Brian Kirby:
The average wait time is actually closer to six months now. If they have connections, they can get in quicker. For some people — especially kids with acute concussions — we find providers will get them in faster.

Adam Flager:
But still, you’re talking about a long time, and you’re not getting treatment during that period. That’s a real challenge.

If you can’t get into a neurologist right away but you can get in somewhere else, you can still start therapy. It’s different therapy. With a shoulder injury, they’re doing stretches and exercises for the shoulder.

With a head injury, your brain needs exercises too — and Brian and his team can handle those things, which is a huge advantage because not all physical therapists can do vestibular therapy. That’s what it’s called when you’re dealing with concussion-related symptoms.

Joe Dougherty (Host):
Vestibular therapy — I know it’s called vestibular. I was the one who taught you that.

Adam Flager:
You did. You told me how to spell it. Iron workers know about that; we learned it in apprenticeship.

Joe Dougherty (Host):
How do you prove it? What challenges do you have in front of a jury?

Let me throw out a scenario that’s probably not uncommon: someone gets concussed and has major issues. The insurance company, kind as they are, chooses to take this one the distance because you can’t see the injury on a scan.

With Jalen Hurts, he still hasn’t cleared concussion protocol. You mentioned the eggshell plaintiff theory. We’re two, two and a half weeks in, and he still hasn’t cleared.

I’m sure that in an eggshell plaintiff situation, when it comes to concussions, some people have these effects for a long time.

What are the challenges when you go in front of a jury, and how do you handle that?

Adam Flager:
A lot of times, there are impacts you can bring out that people really relate to. In the same way that, “My shoulder hurts, I can’t lift a gallon of milk or reach overhead,” you have real-life impacts from a head injury.

They’re just different.

Maybe, “I look at a screen all day, and the light is too much for me.” Or, “I can’t handle bright lights; I need to be in a dark or quiet space.”

Their personality might change. A spouse who knows them inside and out might say, “Joe was off after that concussion. His demeanor changed. His personality changed.”

When you have family members in that person’s life who really know them, and they testify that “This is not the same person,” you bring it in that way.

You also look at work. “I used to be able to complete all these tasks at work. Now, I forget what I was doing two minutes later.”

When you bring in those real-life examples, it helps people understand something that’s otherwise harder to grasp than “my neck hurts” or “my back hurts.”

Joe Dougherty (Host):
That makes a lot of sense. I imagine it’s not just diagnostics. It’s everything that comes with it.

Adam Flager:
Exactly. Everyone’s different. Think about sports — Sidney Crosby on the Penguins had multiple concussions.

Guest / Audience:
The Penguins — where did they come from?

Adam Flager:
Not our team, but yeah — Crosby, unfortunately for us Flyers fans, has a lot of hardware.

He had concussions and missed extended time. Eric Lindros missed extended time. Other guys have concussions and are back in a week or two. You don’t know how it’s going to affect you.

I have clients who, a year or two later, say, “I’m mostly better, but there are still certain things I slip up on that I never did before.”

Joe Dougherty (Host):
From a layperson’s standpoint, the way you just described that — putting someone’s loved one on the stand — I don’t want anything to happen to me, but if it does, I want you representing me.

If I’m sitting in front of that jury and we can’t take a scan and show visible damage, how do we prove to them that there are massive effects?

Adam Flager:
We show, for example, “Joe used to do all these radio shows. He used to drive in, handle interviews, manage everything live on air. Now he’s getting lost mid-interview. He’s forgetting what he’s talking about. He had to cancel some shows; he had to reduce the number of shows he could do, because it was too much.”

You mentioned the computer screen earlier. That kind of detail really paints the picture.

Joe Dougherty (Host):
Let’s segue into the medical part: vestibular rehabilitation.

You get a client who comes in injured — whether it’s a sports accident, auto accident, whatever. Take it from there. You’re assessing somebody. What’s the process?

Brian Kirby:
It’s funny, because it’s very individualized. There are different offshoots.

Vestibular refers to the inner ear — if you’ve ever seen a blown-up model of the inner ear, it looks like three hula hoops in different planes of motion. They control your sense of whether your head’s moving up and down, side to side, or rotating.

If that system gets thrown off because of a hit to the head, then the signal to your eyes and brain gets jumbled. It sends the wrong information.

There are different maneuvers that can help with that. Concussion rehab is broader — it can involve visual offshoots, like sensitivity to light, or auditory offshoots, like sensitivity to loud noises.

Joe Dougherty (Host):
So your treatment is sometimes custom to their specific issues?

Brian Kirby:
Exactly. It’s customized to what they’re dealing with. We look at everything — all the systems. We look at their balance, their cognition.

One of the biggest things we look at is cardiovascular response. There’s something called the Buffalo Concussion Treadmill Test. You put them on a treadmill, get their heart rate up, and monitor their symptoms.

We use a symptom scale — those faces from a happy face to a very sad face representing different levels of discomfort. We ask, “How bad are your symptoms?” Whether it’s light sensitivity, headache, dizziness — whatever their symptoms are.

It’s like a stress test — a neurological stress test. You’re stressing their brain. When you stress the cardiovascular system, especially with sports, it can magnify post-concussive symptoms. That’s why they have to hold athletes out longer.

Joe Dougherty (Host):
Once you establish what the symptoms are and confirm the diagnosis — vertigo, for example — how do you put together a program? Do you treat the symptoms?

Brian Kirby:
Yes, we treat the symptoms, but in a structured way.

The old-school approach was to put someone in a dark room and tell them to stay off screens and do nothing. That’s still the case — but just for the first few days.

After that, you gradually reintroduce stimuli. We try to keep them “sub-maximal” — we take them up to the point where symptoms would spike, then back off.

If it’s vertigo, we might train them to track an object with their eyes while doing exercises, or balance tasks. Or we’ll do visual tracking exercises — looking from one dot to another — while maintaining balance.

Joe Dougherty (Host):
How long does a session typically last?

Brian Kirby:
The first visit is usually a little over an hour — probably an hour and a half to get the evaluation done, depending on how complex things are. Sometimes longer, but about an hour and a half for that first visit.

Joe Dougherty (Host):
In both of your worlds — I can sit here and have this conversation all day, but I don’t know what it’s like to be an attorney with a family in front of you who’s lost a limb or has a wrongful death situation.

It’s easy to say, “A lawyer does A, B, and C,” but you have no idea what it’s like having that family in the room.

In your world, Brian, somebody’s sitting in front of you who has real issues. You’re dealing with their pain tolerance.

What can they expect? They’ve got an injury — maybe scar tissue — and pushing through rehab hurts.

How do you handle working with someone who’s going to have to push through a lot of pain?

Brian Kirby:
A lot of it is developing rapport and trust. They need to trust that I’m there to help them.

That first visit, I try not to exacerbate symptoms too badly. I don’t want to make them feel significantly worse that first day.

Joe Dougherty (Host):
Imagine someone had a knee replacement. That’s a good example. I never saw my father cry, ever, no matter who passed away. But after his double knee surgery, I could see a tear in his eye.

That trust level — I’m looking at you right now and thinking, “My knee — I’m afraid to push it.”

It wouldn’t be the first time someone walked into a place and walked out worse than they came in. In your world, you’ve had a lot of success.

How do you build that confidence?

Brian Kirby:
A lot of it is explaining what to expect.

With a total knee replacement, pain is part of the rehab — no matter what. So I explain that up front: “Pain is going to have to be your friend a little bit here.”

But I’m not going to push you to the point where you can’t walk out of here.

We measure: “Here’s your range of motion when you came in. Here’s your range of motion now.”

Success stories help. There’s a saying, “It hurts less when you’re winning.” When people see progress, they understand the pain has a purpose.

Joe Dougherty (Host):
Once you build that rapport — because a lot of times people don’t want to push themselves — how do you motivate them?

Someone who’s never exercised before, who has vertigo and doesn’t want to get off the couch — is that a process of building the relationship?

Brian Kirby:
Absolutely. These are great questions.

Motivating people is the most important thing and the hardest thing — motivating someone to help themselves.

We sometimes say it’s like a piano lesson. You don’t really get better from the lesson; you get better from the practice.

When they come in, we say, “We’re going to do this and this. It might be tough.” But the most important thing is what they do at home. If they work on their exercises when they’re not with me, then when they come back, we can take them to the next level.

Joe Dougherty (Host):
It’s talking sometimes — having that conversation about goals. So they know why they’re doing it and what they can hope to achieve.

Brian Kirby:
Exactly. Goal setting is critical.

Joe Dougherty (Host):
Talk about the communication between the doctor and the lawyer. People are vulnerable; sometimes they want to quit. I’m sure you get those calls, Adam. How do you deal with that?

Adam Flager:
We communicate well together.

If someone’s not coming in, maybe they just need us to reach out and say, “Hey, you haven’t been in for treatment in a while. Let’s get you back in. Let’s get you back on schedule.”

Physical therapy, as you touched on and as Brian mentioned, doesn’t always feel good. You’re not going to the spa — you’re going to physical therapy because you’re injured.

It might cause less short-term pain if you just sit on your couch, but long term you’re still going to be in pain six months, a year, two years down the line because you didn’t push yourself.

Our clients who have the best results are the ones who do what they’re supposed to do: they go to physical therapy, they don’t miss appointments, they do their home exercise programs.

They do the morning stretch because they wake up stiff. They do it at night before bed.

Guest / Audience:
So they have regimens at home sometimes?

Adam Flager:
Oh yeah. And if they do that, they get better.

I always tell them: talk to your therapist, talk to your orthopedist. If you’re experiencing pain, it might be normal pain, or they might need to tweak the treatment a bit. The answer is not to just stop going.

The answer is to talk to your provider and work it out. Your body is injured — to repair it, you might have to go through some discomfort.

Brian Kirby:
This is what’s great about Adam and his crew.

I deal with a lot of different doctors and lawyers. When I call Flager & Associates and talk to their team — sometimes paralegals, a lot of times Lisa — they’ll call me back and say, “Hey, so-and-so hasn’t been in for a while.”

Or I’ll let them know, “They haven’t been in.” Then they call the patient and ask, “What’s the issue?”

Often the issue is, “It hurt more than I expected, so I didn’t want to go back.”

Instead of it just going south — them not getting treatment, them not having a case, them not getting better — that communication bridges the gap.

When Adam and his team reach out and say, “Hey, we’ll talk to Brian; he’ll back off a bit if needed,” it becomes a support system.

Joe Dougherty (Host):
It’s a support system. That’s important for a client.

A couple more things: when it comes to concussions — before we wrap up, because I want to know what to expect when Hurts comes back — have you had a lot of success helping people?

Is it possible to recover from concussions with therapy?

Brian Kirby:
That’s the big question. The answer is: it depends. Each person has their own individual issues. Some people get 100% back, and some people don’t.

Guest / Audience:
Unfortunately.

Brian Kirby:
For someone like Hurts, they have baseline testing. Players get cognitive and physical baselines taken before the season.

People in car accidents — the ones Adam sees — don’t have baseline measurements to compare to, which makes it tougher.

But the actual treatment can absolutely have a positive impact.

Joe Dougherty (Host):
And treatment can help?

Brian Kirby:
Oh, absolutely. It can.

We figure out their specific symptoms and offshoots, and work on those issues. The one that’s probably most effective is the vestibular work — retraining the brain to handle the messages coming from the inner ear to the brain, to the eyes, to the feet and ankles.

Balance is incorporated with that. Working on overall balance is a huge component. It does work.

Joe Dougherty (Host):
We only have a couple minutes left. Of course, you handle injuries and work injuries. What other types of conditions do you treat — fibromyalgia, elderly patients? We only have about a minute and a half, but give us a wide array of other types of things you handle.

Brian Kirby:
With elderly patients, the main problem we try to help with is fall prevention and maintaining independence. Falls can be devastating.

Preventing hip fractures and falls is huge. Hip fractures are deadly — the stats show a high percentage of people die within the first year after a hip fracture. So preventing that is critical.

Fibromyalgia is a very tough one to treat. It’s a multimodal condition — you have to treat the whole body.

Joe Dougherty (Host):
And I was going to say — does nutrition impact recovery?

Brian Kirby:
Yes, absolutely. That’s not my expertise, so in those situations we send them back to their doctors and possibly to a nutritionist or another health professional. But it’s all part of the team effort.

Joe Dougherty (Host):
This has been fantastic — the fastest hour in the history of radio.

Adam, if you will, contact information, my friend.

Adam Flager:
Sure. Again, I’m Adam Flager, Flager & Associates.

You can find us at FlagerLaw.com — that’s F as in Frank, L-A-G-E-R, then law, L-A-W, dot com.

Phone number is 215-953-5200.

Joe Dougherty (Host):
Fantastic.

Brian Kirby, contact information?

Brian Kirby:
Capstone Physical Therapy and Fitness. You can reach us on the website at CapstonePTFit.com — that’s Capstone, C-A-P-S-T-O-N-E, then PT Fit, as in Physical Therapy Fitness, dot com.

Phone number is 215-677-1149.

Joe Dougherty (Host):
Fantastic.

I want to thank everybody for tuning into the Flager & Associates Personal Injury Hour here on WWDB Talk 860. We want to thank our host, Adam Flager, and of course, Brian Kirby of Capstone Physical Therapy.

On behalf of Adam and Brian, I’m Joe Dougherty. Thanks for listening, everybody.