EP046: An Interview with David Jeter, PT
Physical Therapy and Diabetes: An Interview with David Jeter, PT
“You can be pain-free in a recliner, but that’s not musculoskeletal health.”
In this episode, Richie and Amber talk with physical therapist David (Dave) Jeter, PT, from Spokane, Washington. Dave has 25 years of helping people move better and feel better. We dig into simple, clear ideas you can use today—especially if you live with diabetes or prediabetes. PT can help with pain, movement, balance, and independence as you age.
Highlights at a glance
Pain myth: Pain is not always damage.
Start with a good physical exam before chasing images.
“The hip bone is the knee bone”: treat the neighborhood, not just the one sore spot.
Train the four pillars: mobility, strength, endurance, and balance.
With diabetes, pay extra attention to flexibility and healing time.
Balance after 60 is a superpower for staying independent.
Small work now saves big problems later.
What Is Musculoskeletal Health?
Most people think “no pain” means “healthy.” Dave says health is bigger than that. Musculoskeletal health includes:
Range of motion (how well you move)
Strength
Endurance
Balance and coordination
Pain levels
Functional ability (can you do the things you want to do?)
You can be pain-free sitting in a recliner, but that is not true musculoskeletal health. Your body was made to move, lift, carry, reach, twist, and walk.
Pain Myths That Hold You Back
Myth: Pain means damage. Truth: Pain is your brain’s signal about threat. It can be loud even when tissue damage is low, and it can be quiet even when imaging shows changes.
Myth: Imaging gives the answer. Truth: X-rays and MRIs often show “age changes” that many pain-free people have. A skilled physical exam is often better to guide care.
Myth: Fix the painful part only. Truth: The painful part lives in a neighborhood. If the nearby joints don’t move well, the sore spot takes extra stress.
Knee Pain? Start at the Hips and Ankles
Dave’s rule: “The hip bone is the knee bone.” The knee mostly bends and straightens. Rotation and side-to-side control come from the hip and ankle. If the hip or ankle is tight or weak, the knee takes a beating.
What this means for you:
If your knee hurts, your PT should also check your spine, pelvis, hips, ankles, and feet.
Simple hip and ankle work can make a squat look and feel better fast.
When you move better, you often hurt less.
Should You Get Imaging First?
Often, no. Here’s why:
A thorough physical exam can identify the painful structure and the movement problem causing extra stress.
Imaging can show things that were there before you hurt. That can scare you and change your mindset in an unhelpful way.
If red flags show up (big trauma, major weakness, fever, night pain, unexplained weight loss, etc.), your PT will refer you promptly.
Surgery vs. Physical Therapy
Surgery can be right for some people. But many people jump too fast. Dave’s approach:
First, improve the “neighborhood”: posture, mobility, strength, and control.
Many shoulders, knees, and backs feel better without surgery.
If you still need surgery, you will be a better surgical candidate and often recover better.
Massage: Nice, but not the Main Course
Massage can feel great. But if you only do passive care and skip active work, you will likely be chasing relief over and over. PT builds a full plan so you learn to move well and stay strong.
Why Balance, Flexibility, and Variety Matter
As we age, balance keeps us safe and independent. Flexibility keeps joints moving and tissues gliding. Variety keeps the body resilient.
Practical tips:
Add a balance snack: 3–5 minutes at the end of a workout. Try standing on one leg, then eyes closed if safe, or use a BOSU with support.
Flexibility day counts as a workout. Spend 30–60 minutes opening the chest, shoulders, hips, and thoracic spine. If you row or sit a lot, do extra “open up” work.
Endurance matters for daily life—walking, stairs, errands, play.
Special Notes for People with Diabetes
Frozen shoulder (adhesive capsulitis) is more common. You may notice a “brick wall” loss of motion, sometimes without much pain. PT can help restore motion and function.
Healing can take longer, especially after surgery. Be patient and consistent.
High blood sugar can stiffen tissues over time. This makes flexibility training even more important.
Neuropathy: There is no magic device that reverses established peripheral neuropathy. Cardio exercise and overall diabetes management may help symptoms and function. Be cautious with lasers and gadgets that promise quick fixes.
Can I Get PT Without Acute Pain?
Yes. If mobility is limited, that is a valid reason. If your doctor resists, you can:
Ask again, clearly: “I want physical therapy to improve my mobility and function.”
Use direct access: In every U.S. state, you can see a PT without a physician referral. You can pay cash or use an HSA/FSA. Many insurances also allow direct access.
How Much and How Often Should I Train?
It depends on your age, goals, and current level. General guideposts:
2–3 days/week of strength work
2–4 days/week of endurance (walk, run, row, bike, swim)
Flexibility: 1 dedicated session/week (30–60 minutes), plus short “mobility snacks” on other days
Balance: daily or near-daily short sessions (3–10 minutes), more focus after age 60
For weekend warriors
Warm up gradually, especially in the cold.
Don’t try to play like you’re 20 without building up.
The risks of doing nothing are often bigger than the risks of smart activity.
For 30-year-olds and younger
Dave’s pick: running. Runners do not have higher arthritis risk than non-runners and often have less. Build up slowly. Mix in mobility and strength so you stay durable.
For rowers and runners who skip warm-ups
If life is busy, do this: keep your sport session, then add a separate weekly flexibility session that opens what your sport closes. For rowing, focus on chest, shoulders, thoracic spine, and hips. For running, add calves, hips, and ankles.
Fall Prevention: Why It Matters
A broken hip can change everything, especially for older adults.
Balance + strength + endurance + flexibility = fewer falls and better outcomes if you do fall.
Weight-bearing exercise helps bone health more than water-only exercise. Water work is great for the heart and joints, but pair it with land-based strength and balance.
How to Help a Loved One Who Refuses Care
Tie movement to what they love: grandkids’ games, fairs, travel, gardening, church, or visiting friends.
Celebrate small wins: “Last month you could only walk in the house. Today you made it 20 minutes in the store.”
Keep goals functional and specific.
Action Steps You Can Start Today
If you have diabetes and shoulder stiffness, knee pain, or mobility limits, schedule a physical therapy evaluation.
Add 5 minutes of balance practice to your day.
Plan one 30–60 minute flexibility session this week.
Walk most days. If able, build toward a steady 30-minute walk. Later, consider a gentle couch-to-5K plan.
Think “neighborhood,” not just the sore spot.
Find Dave
Clinics: Acceleration Physical Therapy (Spokane, WA) — accelerationphysicaltherapy.com
Writing: Facebook — Start With PT
Have additional questions or need additional support? Email [email protected].
Take courage! You can do this, and we can help.
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