Sgt. Wade Fowler lived with shoulder pain for years. It hurt to drive his car, fasten his seat belt or even change the radio station. It hurt to take his gun out of the holster and aim it at something.

Fowler, 51, a Williamson County Constable, says he thinks his injury — tears in the rotator cuff and tendons — was caused by overuse, but he specifically remembers unloading lumber about 10 years ago and having "a searing pain" in his shoulder.

He lived with it for more than eight years. He avoided taking opioids, because, as a constable, he has seen the damage they do, but he was taking 14 to 15 ibuprofen pills a day.

Some of it was from an idea of being "invincible" as a Marine, a constable and a person who dead lifts 650 pounds and does jiu-jitsu, he says.

"I didn't want to get cut," he also says, meaning he was trying to avoid surgery.

"I'm not a big fan of doctors," he says, but when his son, who is a wrestler, needed physical therapy for an injury, his view of doctors and physical therapy changed.

Fowler started seeing Dr. Ben Morgan at Texas Physical Therapy Specialists, which has a new program called PT Over Pills that includes education about pain neuroscience, virtual reality therapy, working the joint and soft tissue, and using dry needles to release pain in the muscles.

Pain comes in different forms, Morgan says. There's the type where you stub your toe and the area hurts, but it goes away on its own. There's the kind where you have an injury and the pain doesn't really go away but it's in the general area of the initial injury. And then there's the kind where patients get into a pain cycle that might spread beyond the initial injury to other parts of the body.

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Three months from the initial injury is the window to be able to do the most good with physical therapy and avoid the cycle in which your body becomes more sensitive to pain, Morgan says. "If we catch it early, we can take care of it in a few weeks," he says.

That doesn't mean physical therapy can't help after that window. It can, but it might require more therapy and time.

"We want to catch people and get them into physical therapy," Morgan says. And he wants to get them into physical therapy before they start to become dependent on pain relievers such as opioids that increasingly become less effective the more you take, and before relying on surgery as the fix. To help that, Texas Physical Therapy Specialists started working with insurance companies to allow patients to go directly to them instead of having to get a referral from a doctor.

The National Center for Biotechnology Information published a study in December called "Physical Therapy as the First Point of Care to Treat Low Back Pain." It found that patients who started with physical therapy had 80.4 percent less chance of being prescribed opioids, a 27.9 percent less chance of needing advanced imaging services like an MRI and a 14.7 percent chance of going to the emergency room. They also had lower out-of-pocket costs. The Centers for Disease Control also recommends physical therapy instead of opioids in its 2016 Guideline for Prescribing Opioids for Chronic Pain.

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Morgan had Fowler start small. Fowler remembers an exercise during which he lay on his side and tried to lift a 1-and-1/2-pound weight with his hand across his chest and up to his side. It seemed easy, but it hurt.

"A one-and-a-half pound dumbbell kicked my butt for a long time," he says.

Then he was told to stand by the wall and roll a tennis ball in his hand against the wall, kind of like "The Karate Kid" "wax on, wax off" technique. "You don't feel anything for 15 to 20 seconds, but very quickly you feel this tightening." Then he felt himself sweating and hurting. And he asked how long into the three-minute drill he was. It had been 25 seconds.

"You feel silly, like a kid, but it works," Fowler says.

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They also practiced the motion of pulling out his gun from a holster by using a laser pointer on a map on the wall, and having him to do that motion over and over again.

Within a few weeks he was noticing a change. "It's the little stuff," he says. "I slept, and I didn't hurt. I picked up my kid (without pain)..." Then one day it became, "Expletive, I don't hurt today," he says.

For patients who are using pain relievers or opioids, Morgan slowly starts talking to them about not needing them. He'll ask, "Do you still need it?" And often, they realize they don't, but it just became part of their ritual.

"It really didn't take long," Fowler says. "He kept promising me, 'You're going to to get better.'" And then one day, as Fowler went to change the radio channel in his car, he realized it didn't hurt any more.

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