Medicare Patients Call to Action – Advocate for your Physical Therapy Care before Thursday 2/8/17!

A new Medicare Physical Therapy (PT) care cap is poised to hit Medicare beneficiaries hard. Previously, the cap of $1,980 per year could be extended for medical necessary (like two ailments that need PT in one year) but now the ‘hard cap’ of $2,010 cannot be extended for any reason. As you know, this amount is often not enough to cover full recovery. With the opioid crisis, choosing PT over prescription painkillers is widely acknowledged as the more effective, and far less costly option; both financially and in personal and social costs. As providers feel pressured to pause the course of care for reimbursement caps, these breaks in the care plan make patients vulnerable to regression and re-injury, not to mention preventing care for any new ailments. Some patients may even end up turning to more invasive—and far more expensive—care options, which leads to unnecessary spending and possibly less healing in the long run.

Advocate for yourself by contacting your legislators! Take 90 seconds to call your legislators now, and tell them to pass legislation by February 8 to permanently repeal the hard therapy cap. Ask them, as a constituent, to notify party leadership that it’s crucial to pass legislation permanently repealing the hard Medicare therapy cap by February 8. This hard cap on PT services went into effect on January 1, 2018 and every day the hard cap is in place many Medicare beneficiaries go without necessary therapy services.

With your participation, we may be able to make corrections to the PT cap that has been an issue for over twenty years. Thousands of have acted on this before, but with strong statistics and many cosponsors, the current bill to repeal the therapy cap has strong bipartisan support but needs solid constituent comment to pass the finish line.

Phone calls are often easiest and most effective. Your Montana legislators are:
Senator Jon Tester: (202) 224-2644
Senator Steve Daines: (202) 224-2651
Congressman Greg Gianforte: (202) 225-3211

“Hello, my name is ______. I live in __________, Montana and am a constituent. I’m calling to tell Rep/Sen __________ how important physical therapy is to my wellness and to pass legislation to permanently repeal the hard Medicare therapy cap by February 8. Every day the hard cap is in place Medicare beneficiaries go without receiving necessary therapy services. Other medical services – opioid painkillers and surgeries – can cost the patient and the medical system a great deal financially, personally, and are not only often less effective but have contributed to the nationally devastating opioid crisis. As my representative/senator, tell your party leadership to repeal the hard Medicare therapy cap by February 8. Thank you."

Way to advocate for yourself folks!

Bon Voyage to Jen

Granite Sports Medicine (GSM) is sad to announce that Jennifer Gauthier is heading off for new adventures in Flathead Valley. She’s been a great asset to our team for the past two and a half years and is a fabulous physical therapist whose kindness and diagnostic skills have elevated her clinical skills even further. She was a wonderfully supportive and fun team member and we think the world of her. She will be missed by all at GSM, especially Gunnar our team dog, who always slept under her desk. 

Jen says, "It has been a true joy to have worked with such wonderful colleagues and clients. I will sincerely miss this community and will cherish all of the connections and friendships I have made. I plan to stay in close touch with GSM, and hope that many of our paths will cross again in the future. How lucky I am to have something that makes saying goodbye so hard.’- A.A. Milne Thank you!!"

We’ll be keeping in touch with Jen and the door will be open at GSM if ever she moves back to the area. We wish her all the best in her next endeavors. Happy Trails, Jen & come back soon!

Thanks for a Fantastic 2017

2017 was a whirlwind of activity, benchmarks, and growth at Granite Sports Medicine (GSM). We celebrated our 5 Year Anniversary and this year’s activities reflect the growth and breadth of our services and community involvement. We’ve really hit our stride with an amazing team of dedicated professionals who work together like champs to provide personalized and specialized physical therapy to our clients. We’ve upgraded our front desk process and restructured our administration to provide even better service and efficiency. Thanks to everyone who’s been part of this year’s celebrations, support, wellness, and learning. 

Highlights from 2017 include:

- At the 2017 Prospera Business Network’s annual Business Excellence Awards we were honored to receive Montana Women’s Business Center’s Start-Up of the Year. 
- We hosted a well-attended roundtable discussion about the innovative and emerging field of Pelvic Floor Physical Therapy with our Pelvic Floor specialist, Alison Shannon-Lier PT, DPT and will continue outreach about this versatile service.
- The AMA (American Medical Assoc.) made new recommendations that patients access physical therapy for back pain instead of going to the Emergency Room, having unnecessary imaging, or taking prescription medication; making physical therapy’s role in combatting the opioid epidemic even more vital. 
- GSM sponsored various teams and activities throughout the year, including the Western Sustainability Exchange’s Farmer’s Market, Livingston Parks and Recreation youth basketball team and Ultimate Frisbee with GSM’s Alison Shannon-Lier. You’ll recognize Alison and her family participating in nearly every public athletic activity in the community!
- Max Bartlett and Jennifer Gauthier gave intensive weekly athlete clinics at Park High for students this fall, and they continued to offer free 20-minute sports injury assessment to Park High athletes. 

- Darcy Cook, in her ninth year of giving injury prevention workshops to fire and trail crews, worked with crews at Grand Teton Park, Yellowstone Park, Gallatin Forest service, and Zion National Park employees.

- For our 5th Anniversary, we celebrated for a full month with giveaways and contests and capped it off with a fun Cinco de Mayo party. Thanks to all of you who showed up to celebrate!  

Building on this year's successes, we look forward to continuing our momentum. After hosting our first continuing education class 2017, we will offer more classes in 2018 including the popular new Mobility|WOD; a guide to resolving pain, preventing injury, and optimizing athletic performance and a Level 2 KinetaCore Dry Needling. We will create an online registration and payment system on our website in the coming year further streamlining the registration and payment process, and continue to offer a Prompt Pay Discount, increasingly necessary for the uninsured and underinsured with high deductibles.

GSM’s Darcy Cook is a popular annual presenter at Park High’s Trades Day and will go to Bozeman High in January this year and share some physical therapy inspiration with students interested in the medical field. Physical therapist Max Bartlett is working with Cross Fit coaches to help their athletes prevent injury, and Pelvic Floor specialist Alison Shannon-Lier is furthering her education with male-specific pelvic floor classes and is seeing more people of all genders and ages benefit from her services.

Remind your friends, family, and coworkers that physical therapy is your first line of defense for muscular/skeletal health care needs - no referral needed - as the American Medical Association recommends: choose physical therapy first. Learn more and make your appointment online at

Thanks to all the wonderful people we have had the honor of helping on their healing journey, our active community, and inspiring peers. Cheers to a fantastic 2018!

Happy Trails to Gary!

staffHappy Trails to Granite Sports Medicine's Gary Miller who is moving out of the area. Foot orthotic clients refer to Gary as “The Foot Whisperer.”

Granite Sports Medicine (GSM) founder Darcy Cook says, “Many thanks to Gary for sharing his wisdom with our staff, our patients, and our friends! He has helped so many of us continue to be active and enjoy doing what we love. His expertise and sense of humor will be greatly missed. His level of knowledge has been invaluable to us all, and we all agree, subtalar neutral is the key to the universe!”

Gary says, “Many thanks to Livingston for the last 6 years - it was a lot of fun exploringgary Montana and Big Sky Country. Also thanks to Darcy and the great people at Granite Sports Medicine - great staff and a great clinic! Always remember: "Happy Feet = Happy Life!"

Darcy says that Max Bartlett will be attempting to fill Gary's "shoes" in foot orthotics and GSM will continue to offer off-the-shelf modifiable foot beds, but will no longer be offering the casted option, which was Gary’s specialty. 

Happy trails to Gary and Lisa and we wish them the best on their next adventure.

#PhysicalTherapy #LivingstonMt #GraniteSportsMedicine

Summertime Fun

"Of all the paths you take in life, make sure a few of them are dirt." - John Muir 

Granite Sports Medicine's Alison Shannon-Lier and Jennifer Gauthier went mountain bike riding recently, Jennifer says, "Movement is our medicine. Get outside this summer!"

Reflecting on the ride, Alison says, "It makes me think about how blessed I am to work with amazing, smart coworkers who also love getting out and playing hard, pushing me both in the work place and outdoors!"

Share photos of yourself getting outside this summer, we love to see our active community in action! Email

#Montanamoment #ActiveCommunity #getoutside

Granite Sports Medicine Celebrates 5 Years

Granite Sports MedicineCan you believe Granite Sports Medicine (GSM) is 5 years old? GSM is proud to the celebrate benchmarks, achievements, growth and success stories from the active community we’ve served in our first 5 years over the next month. Thank you Park County! Follow us on Facebook or stop by the clinic to see how you can participate in our Granite Sports Medicineanniversary month and win cool stuff!

To celebrate GSM’s 5 years of Success Stories from our active community, we are having lots of drawings for fun stuff. To enter, stop by GSM to fill out our quick “Say Something Nice” form, and we’ll enter you into a drawing for stainless steel GSM water bottles. We have a bunch so increase your odds by filling out a bunch!

If you aren’t able to stop by, share your testimonial online at or post a phots of you and a GSM logo doing something cool on our facebook page to be included in drawings for deluxe GSM soft-side coolers!  Granite Sports Medicine

At the end of the month, we will pick our 5 favorite “Say Something Nice” testimonials and each will win a cooler. The end of our 5-year anniversary month will culminate with a Cinco Tailgate party in GSM parking lot, 5/5/17 from 4 – 6 pm. We’ll have a full taco bar and more swag giveaways, so stop by and help us celebrate.  

GSM’s 5 Pillars
As part of a Prospera workshop on business startup many years ago, we created 5 Pillars that we felt were integral to the success of our business. It is interesting how these have summarized our culture at GSM and continue to be relevant.

  1. Strong community presence
  2. Client retention
  3. Positive work environment
  4. Efficient systems
  5. Fiscal responsibility

These pillars lead to a customer experience that makes a lasting impression, “The clinic, including the reception, is efficient, very professional and makes the patient more knowledgeable. The clinic is the most dedicated that has ever treated me. The patient is made to feel comfortable and cared for,” says a client and another adds, “Entering Granite Sports Medicine is a happy experience! There is an infectious enthusiasm that helps patients want to get better.”

GSM’s 5 Year Benchmarks:Granite Sports Medicine

  1. Remember the Main St Carwash?  We sure do, and we remember all the pigeons. Yuck. It was important to us to repurpose an old structure and contribute to cleaning up Livingston’s Main Street. Amazing that Randy Cook had the vision and the skills to remodel the old car wash into the extensive physical therapy hub GSM is today.  
  2. Client Retention/Customer Service: you made suggestions and we implemented them. No unnecessary paperwork at check-in, virtually paperless clinic, clear explanations of client’s insurance benefits, and making sure our customers understand the process. Quote: “The front office staff is always welcoming, fun and positive. They are great with patients, explaining costs and insurance thoroughly, and juggling appointments around work schedules.”  
  3. Winning the 2016 Montana Women’s Business Center’s Start-Up of the Granite Sports Medicine Prospera Womens Business Award Bozeman MontanaYear at Prospera Business Network’s annual Business Excellence Awards for exceptional contributions to the region's business community. “Prospera’s support has been a huge part of our success since opening our doors in 2012. Six years ago, I went into the Prospera office thinking, ‘Maybe I should open a physical therapy clinic,’ and here we are now with a beautiful 4,500 square foot facility and 9 employees. It’s been an incredible growth process and Prospera held my hand throughout; from developing a business plan, to formulating financial projections, securing gap financing, to building Human Resource manuals, and how to use social media. Prospera has been integral to GSM's success and I am so honored by this recognition. I feel like I went in as a pupil and recently graduated from their fantastic ‘Business Start-up School’,” says Darcy Cook.
  4. Hosting a sold-out first continuing education class in Level 1 KinetaCore Granite Sports Medicine KinetaCore Dry Needling Dry Needling. Part of our big vision was to be able to bring quality continuing education classes to Montana. Not only does it keep our PTs up to date but it elevates our entire profession. Our first class was a huge success and there will be more to come. 
  5. Incredible growth. We can’t thank our community enough for the support over the past 5 years. We are fortunate to have experienced incredible grow and recruit amazing staff members, for that we thank you, our supportive and active community.

GSM’s 5 Physical Therapists

GSM’s mission is to enhance health and wellness through innovative, evidence-based Physical Therapy interventions. It has been our goal to be the most current, progression clinic in Southwest Montana. Our physical therapists are passionate about the profession and pursue the highest level of evidence-based continuing education and certifications, offering clinical excellence.
We are proud to have all of our staff certified in Dry Needling as well as the following specialties:

  1. Founder Darcy Cook, MSPT; headaches and facial pain, and bonus: the physical therapist for the U.S. Snowboarding Team.
  2. Gary Miller, MS, PT, CPed; Orthotic Fabrication.
  3. Jennifer Gauthier, DPT; Vestibular Rehabilitation.
  4. Alison Shannon-Lier, DPT; Pelvic Floor Rehab.
  5. Max Bartlett, DPT; Certified Strength and Conditioning Specialist and Sports Physical Therapy.

A client says of GSM founder Darcy Cook, “It is evident she stays informed with the latest in physical therapy news and advances in technology regarding the profession. Darcy is organized and thoughtful about her individualized treatment protocols. Thanks to her and to the staff at Granite Sports Medicine, I left each visit feeling positive about my recovery. We are lucky to be able to receive such care in the state of Montana.”

GSM’s 5 Community Actions:Granite Sports Medicine Livingston Recreation Basketball

  1. GSM sponsors various teams throughout the years, including Livingston Parks and Recreation youth basketball team (photo) with GSM’s Alison Shannon-Lier as one of the coaches.
  2. GSM sponsors and joins Western Sustainability Exchange’s Farmer’s Market.  You may remember the awesome beer cozies we give away....
  3. GSM’s Gary Miller does free foot screens for the Park High track team.
  4. GSM’s Darcy Cook does physical therapy presentations at Park High’s Trades Day (back by popular demand!)
  5. GSM offers free 20-minute sports injury assessment to Park High athletes performed by Jennifer Gauthier and Max BartlettGranite Sports Medicine

Thanks for all the support, enthusiasm and for inspiring us with your recovery GSM clients and community! Here’s to many more years of healing and actively enjoying our wonderful region.

Granite Sports Medicine is located at 315 S Main Street in Livingston, phone (406) 222-4682. Sign up for our informative newsletter at, share your testimonial online at  and follow us on social media at

Rousing Recent Pelvic Floor Roundtable

Pelvic Floor Roundtable Granite Sports MedicineGranite Sports Medicine recently held a roundtable discussion about Pelvic Floor Physical Therapy. Alison Shannon-Lier PT, DPT introduced information about what pelvic floor therapy is and how it can be beneficial to many patients, both men and women. There is a need for increased knowledge about this progressive therapy. The general opinion of those in attendance was that pelvic floor therapy is of great interest.

One local physician expressed that she is a huge advocate for this type of therapy. She feels that it should be included in preventative care, and utilized after childbirth and hysterectomy surgery. In France, it is routine to have ten to twenty sessions of pelvic floor therapy after each birth. Dr. Shannon-Lier pointed out that there are other medical conditions this therapy can treat including abdominal surgery, pelvic surgery, hernia repair, back surgery, C-section, chronic low back pain and pelvic pain. Dr. Pinango, an OB physician at Livingston HealthCare, felt that earlier post-partum visits would be a good practice as it would help patients be prepared for the first six weeks of post-partum health.Pelvic Floor Roundtable Granite Sports Medicine

The topic of men and pelvic floor therapy was brought up. The U.S. Military sees quite a few male patients for pelvic floor chronic pain therapy. Anyone doing heavy lifting, straining or physical work should be aware of this therapy and what it can do for them.

Many great ideas and opinions were given by the community members who came. Dr. Shannon-Lier said, “Everyone’s opinions and questions were helpful for what the community needs.” Positive feedback from current patients and amazing testimonials of success were given to the group. One patient who was unable to attend sent a moving letter telling of her journey of misdiagnosis, decreased quality of life, and prescribed pain medication. She shared her success following treatment with Dr. Shannon-Lier stating, “I am no longer taking pain medication or sleeping with a heating pad.” 

Another takeaway from the event was that people should know that others have symptoms and pelvic floor issues; you are not alone. New patients have booked appointments and there have been many requests for informational packets.

Learn more about at Dr. Shannon-Lier, Pelvic Floor Therapy, and our recent pelvic floor blogs here and here. Make an appointment online at or phone 406-222-4682. Thanks to everyone who participated in this successful roundtable!

Pelvic Floor Roundtable Discussion 3/30/17

You are invited to a roundtable discussion about Pelvic Floor Therapy on Thursday, March 30th from 6 to 7 pm at Granite Sports Medicine, 315 S Main Street in Livingston. Granite Sports Medicine’s Pelvic Floor Physical Therapist Dr. Alison Shannon Lier, who was recently certified through the Pelvic Floor Rehabilitation Institute Hermann & Wallace and has been a practicing physical therapist for eight years, wants to share her new expertise at a roundtable discussion. Lier has been interested in Pelvic Floor Physical Therapy for 5yrs and is new to Park County, she's seeking input and opinion on how best to get the word out about the emerging field of Pelvic Floor Physical Therapy.

Come enjoy light snacks and beverages during a short presentation and share your thoughts with us. Your voice matters!

Unfamiliar with Pelvic Floor Physical Therapy? It’s the evaluation and treatment of pelvic floor dysfunction, caused by a wide range of impairments within the muscles of our pelvis. The pelvic floor muscles make up a sling within your pelvis and help support abdominal and pelvic organs, as well as help control bladder and bowel function, and sexual activity. 1 in 5 Americans – men, women, and children – suffer from pelvic floor dysfunction that goes unidentified or undiagnosed. Lier herself suffered from incontinence during middle school and high school and knows personally how frustrating and embarrassing it is. She’s also seen firsthand and with patients how pelvic floor therapy can more than improve someone’s symptoms. It can improve their quality of life as well.

To learn more join us March 30th and visit

Phone 406.222.4682 with questions.

Pelvic Floor Therapy 101

Granite Sports Medicine now has a Certified Pelvic Floor Physical Therapist on Pelvic Floor Physical Therapystaff, Alison Shannon-Lier, who also holds a Doctorate in Physical Therapy. Learn more about how Dr. Shannon-Lier became interested in this field here.

  • What’s a pelvic floor? It’s three layers of muscles at the base of our pelvis, directly related to bowel, bladder and sexual function.
  • What does it do? A healthy pelvic floor prevents leakage of urine, feces or gas and supports satisfying sexual experiences as well as supporting our internal organs.
  • What is pelvic floor dysfunction? These muscles, like any group of muscles, can be tight, weak, or dysfunctional, and cause pain.
  • Is this rare? No, one in five Americans suffer from pelvic floor dysfunction that goes unidentified or undiagnosed.
  • What does a Certified Pelvic Floor Physical Therapist (PFPT) do? They’ve had specialized internal pelvic floor training, in addition to their physical therapy education, and assess the body as a whole; looking at posture, core and leg strength, pelvic alignment, as well as the internal pelvic floor muscles and how they affect your daily life.
  • Who benefits from Pelvic Floor Physical Therapy? Men, women and children who’ve been diagnosed with a pelvic floor dysfunction or suffer from chronic back or pelvic pain (see list below). This therapy is less invasive than other treatments, such as surgery or medication, and often addresses chronic conditions that haven’t responded to other treatment. The PFPT can also educate patients on other contributing factors, such as dietary choices and emotional stress.

What to expect on the first visit? A thorough, but discrete and completely private, history will be taken by the PFPT, who also has a doctorate in Physical Therapy. The PFPT is trained in gender-specific external and internal physical examination of muscle length, skin integrity, postural alignment, muscle strength and causes of pain.

What to expect on follow-up visits? Frequency of visits will depend on the patient’s presentation and diagnosis, but usually, it will be once or twice a week initially. During treatment, the therapist will do both internal and external manual work to improve pain, muscle length, relieve any trigger points, and begin an appropriate strengthening program.

Frequently treated diagnoses: 

  • Pelvic pain
  • Tailbone pain
  • Sacral iliac (SI) joint pain
  • Low back pain
  • Leg or “sciatic like” pain
  • Vulvodynia
  • Interstitial Cystitis
  • Irritable bowel syndrome
  • Urinary incontinence (urgency, frequency, nocturia and stress)
  • Chronic pelvic pain
  • Endometriosis
  • Sexual dysfunction
  • Vaginismus

Contact us to make an appointment with Dr. AlisonShannon-Lier online here.

Why pelvic floor physical therapy?

AlisonHi, I’m Alison Shannon-Lier, a physical therapist at Granite Sports Medicine with a Doctorate in Physical Therapy, Bachelors in Rehab Science, and in 2016 I finished my Level 1 Certification in Pelvic Floor Physical Therapy. When I started talking about becoming a Pelvic Floor Physical Therapist a few years ago, people had questions. What’s a pelvic floor? It’s three layers of muscles at the base of our pelvis, directly related to bowel, bladder and sexual function. Like any group of muscles, they can be tight, weak, or dysfunctional, and cause pain. And what’s the appeal of Pelvic Floor Physical Therapy?

The simple answer is: there are thousands of Americans – 1 in 5 – who are underdiagnosed for pelvic floor dysfunction and are suffering in silence, people who need support and education and answers for their pain, embarrassment, and discomfort. Pelvic Floor Physical Therapy (PFPT) can help in many of these cases.

The more personal and longer answer: I suffered for years from stress incontinence through middle school and high school. It was embarrassing and frustrating. I was constantly worried about how I dressed, who I’d be with, and avoided situations that would lead to leaking. I didn’t know who to talk to, was too embarrassed to talk to my parents or friends, and dealt with it alone for years until college. In college I began to learn more about my pelvic floor in physical therapy school; about appropriate stretching and strengthening. I began self-treating and it helped some, but didn’t fully fix the problem.

When I became pregnant at age 25, I was managing my incontinence with an extensive training program, watching what I ate, and doing a lot of plyometrics with kegel exercises. But the problem came back full force when I was pregnant, leaving me frustrated and occasionally even having to change clothes at work. I was frustrated and annoyed but didn’t bring it up because I thought it was something I just had to deal with.

After I gave birth to my son, I was amazed to discover that my incontinence was gone, and has been for the last five years. I learned I wasn’t lacking strength, but that my pelvic floor muscles were too tight. The insufficiency was due to trigger points and muscle tightness, rather than weakness.

This could have been treated years ago if I had been less embarrassed and had the right information. That is what I want to provide to my community; I’m motivated to help men and women return to a normal life without anxiety when they laugh, want to jump on a trampoline with their kids or have sex with their partner. These are all things we should freely enjoy in our life and, with Pelvic Floor Physical Therapy, I can help diagnose and treat pelvic floor dysfunction so people can get these enjoyments back. 

Stay tuned for my next blog to learn more about pelvic floor symptoms and treatments. We’re all excited at Granite Sports Medicine to be providing education and services in the emerging specialty of Pelvic Floor Physical Therapy! Make your appointment today here.

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