What Makes a Good Physical Therapist and a Successful PT Experience
Although all Physical Therapists (PT) and Physical Therapist Assistants (PTA) have similar training and schooling, not all are equal. There seems to be confusion about the goals of physical therapy, what a PT/PTA can do, and what makes a PT/PTA skilled. Further, there are many things that can hinder the success of physical therapy - insurance, treatment approach, etc. Below are a few facts and some helpful information so you can choose a good PT/PTA as well as a good physical therapy clinic.
Discloser: Although there is great research regarding the below information, there may be specific scenarios in which there are exceptions to these statements. I encourage everyone who reads this blog to make informed decisions on their care and to speak to their providers with any questions.
1) PT's are movement specialists – Not Massage Therapists:
Often I hear stories of my patients only receiving “massage like” treatments from previous physical therapy experiences. They are shocked when I request exercise and movement to assist with their symptoms. If you have had a PT experience where you were ONLY given passive treatments (massage, trigger point work, myofascial release techniques, passive
stretching) I suggest you question your PT. PT’s do have training in massage as well as extensive knowledge of anatomy, but they are truly great at assessing movement and targeting muscle groups to assist with recovery. Yes there are a FEW exceptions to prolonged passive treatment: Maybe you just had surgery and there are specific instructions from the surgeon, maybe you have flexibility restrictions due to recent injury, or maybe you have several secondary injuries preventing mobility. Regardless of the short list above, passive techniques should be temporary. It is difficult to justify appointment after appointment of massage based treatment without trial of other treatment approaches to improve symptoms. Please understand, passive techniques and even massage is appropriate from time to time; however, it will not solely cure your symptoms or injury. I suggest finding a massage therapist if you are interested in only massage/passive techniques.
2) Modalities for treatment alone will not “cure” you and thus should be sparingly used:
The term modality may be foreign to you. Modalities refer to special equipment that assist
with a variety of things including: pain, circulation, swelling, muscular contraction/relaxation, or joint distraction. Below is a list of some common modalities you may find in a PT clinic:
· ESTIM (TENS, IFC, NMES)
· Ice/hot packs
· Contrast baths
· Kinesio Tape
Modalities should be used in conjunction with other treatments. I have heard horror stories and frankly fraudulent situations of patients only receiving a modality for PT treatments. Again, as I said with massage techniques: Modalities without other treatment not cure your symptoms. The effectiveness of modalities have been questioned for many years with multiple studies finding little to no physiological effects. Please do not misunderstand these words, not all modalities are created equal and if properly used, may be of benefit in combination with other treatment forms.
3) Insurance companies can hinder someone’s progression:
Before signing up for physical therapy, be sure to do your research with your insurance company. Each insurance plan has limitations and allowances regarding your visits to PT. Not only are most insurances subject to a deductible and copayment but often they limit the amount of visits you can attend. Furthermore, insurance companies can limit your visits per case/injury or per year regardless of how many injuries you may have. Further you can see
the benefit of knowing this information prior to having surgery that requires physical therapy following. I recommend that you call your insurance company prior to any surgery or potential PT visit to assure that you will have optimal time to recover. Occasionally, a patient is misinformed and is limited by their care due to insurance restrictions that could have prevented. From a physical therapy scheduling stand point, we may opt to see you less frequently to assure best care. For example: Instead of seeing you 1-2 times a week for only a month, we may decide to only have appointments 1x every 2-3 weeks over the course of multiple months.
4) A home exercise program is key to success:
I can confidently say: "A home exercise program is the most important part of physical therapy." Physical therapy appointments typically range from 30 minutes to 1 hour depending on need and clinic. This being said, if you are only scheduled 2x a week you are only receiving care for 1-2 hours at most. This is simply why a home exercise program is so important. The exercises and time you put in between treatment sessions is when you will make the most progress. Treatment sessions are not meant to cure you, but to guide your recovery and assist with your symptoms. Home exercises should be tailored to your needs and adapted as appropriate. The most frustrating thing for a physical therapist is a patient that does not perform their home exercises – And yes, often we can tell when you don’t. If you are not performing your home exercises or you are not given home exercises physical therapy is likely to be ineffective.
5) Flowcharts are helpful but not needed:
A flowchart is a system to track exercises and progression. They often look like a table that measures reps and sets of various exercises. Occasionally PT’s can become reliant on flowcharts which ultimately leads to poor treatment and care for a patient. If you find yourself performing the same exercises over and over, you should inquire about progression and change in approach. There are rare times when specific exercises are required to be repeated over and over, but in a classic physical therapy situation, your exercises should be adapted and progressed as they become less challenging and as your symptoms improve.
6) Physical Therapists can specialize:
Often Physical Therapists will specialize in one particular area such as orthopedics or vestibular rehab, which not only makes them a better PT overall, but sometimes even more knowledgeable than your doctor. This may be a hard thing to believe, but often a primary care doctors are focused on the “big picture” of your health – which is a good thing. Your
primary doctor plays a vital role in getting you to a specialist – surgeon, PT, etc. Occasionally you may receive a diagnosis from you doctor that may be inaccurate based on your symptoms. A classic example of this is “hip pain”. Frequently a patient will arrive with a diagnosis of hip pain from their doctor but once evaluated more thoroughly, the pain is actually found to be coming from their back. Physical Therapists are trained and specialized on determining the root of symptoms based on evaluation and testing more so than some physicians and with this are more likely to assist you with your pain.
7) PT vs PTA vs PT Tech:
Physical therapy often involves a team of people which have similar roles but different strengthens and weaknesses. A physical therapist (PT) is specifically trained for evaluation, diagnosis, and treatment all while establishing a plan of care. A physical therapist assistant (PTA) is trained to follow the PT’s plan of care with freedom to adapt such plan of care as medically necessary. Think of a PTA to a PT as a PA to a physician. Both a PT and PTA are licensed professionals capable of full rehab services. A PT tech is educated on assisting a PT or PTA with patient care without the allowance to make changes in the plan of care. Often PT techs assist with modalities or exercise prescription that has been carefully detailed by the PT or PTA prior.
8) I’ve seen a Chiropractor 20+ times, how will physical therapy fix me?:
Historically Chiropractors and PT’s have had an unspoken rivalry. I’m not sure if this is because they grew as a medical service nearly at the same time or if society decided that one is better than the other leading to popularity competitions. I believe most chiropractors and PT’s do not have trouble with one another and respect each other’s skills but I also believe each service should be used appropriately. Here is my take: Chiropractors adjust "malalignments", assist with posturing, and improve mobility. PT’s do the same thing in many cases. Although there is some overlap, the path to achieve the above is not the same. PT’s focus on muscular insufficiencies, movement patterns, and external forces that may influence symptoms. This being said, in some cases, PT treatment is more of a “long term” fix. In my opinion, repetitive chiropractor work is continually and temporarily fixing a problem without addressing why the problem is occurring. This is not to say that we should never seek a chiropractor. If you have a traumatic injury, let’s say slipping on the ice and falling for purpose of this example, a chiropractor is a great place to start (once fractures and life threatening injuries are cleared by a physician). Following a fall, it is likely that you could create some malalignments and pain, but the key here is that we know exactly why you feel this way and with one adjustment your body should not revert to the poor alignment again. If a secondary issue causes repetitive malalignments, simple chiropractic treatment will not fix the underlying issue and further investigation is needed: enter a physical therapist.
9) Seeing a physical therapist first may save you time and money:
Did you know that some emergency departments are starting to hire physical therapists? Your initial reaction may be: they do exercises, why are they in the ER? PT’s are trained thoroughly to diagnosis and rule out many life threatening situations. This may save you both
time and money as you walk through the ER doors. Examination by a PT may rule out need for Xray’s/MRI/ultrasounds/etc or rather rule these options in resulting in quicker physician orders and attention. Outside of the emergency department, I believe physical therapists are awesome people to utilize for basic injuries such as a sprained ankle. Often these injuries yield significant bruising and pain but do not require diagnostics such as an Xray – A PT can help to decide if this is necessary thus saving you time and money.
I hope that the above information was eye opening and encouraging. Like I stated at the top of this blog post, there may be some exceptions, but ultimately I hope this allows you to choose PT and be aware of the quality services and complications that are found in the PT world. Please feel free to reach out with any questions or concerns!
Jake Miller, PTA