Thursday, March 30, 2023

The success of physical therapy depends on a few factors. A person’s complaints and symptoms, their diagnosis, the facility they go to, the therapist they see and the treatment they receive all contribute to a successful course of physical therapy. If you are experiencing any pain, or difficulty with movement, here are some questions that can help to guide you.

Do I need a prescription to go to physical therapy?

In the state of New Jersey, there is something called Direct Access. This allows patients to see a physical therapist for 30 days without a doctor’s prescription. This means that if you would like to start seeing a physical therapist, you can start by just making an appointment. That being said, every patient is required to see a physician if they wish to continue physical therapy after the initial 30 days of treatment.

Do I have a diagnosis that physical therapy can fix?

This has a two-part answer. First, it’s important to understand what physical therapists do in an outpatient setting. Physical therapists evaluate, identify, diagnose and treat pain, joint dysfunction and movement problems. Physical therapists have special tests and measures they use to evaluate range of motion, strength and movement patterns and examine where the cause and dysfunction is originating from. They help people by resolving their symptoms and restoring and maintaining their function. Physical therapists design treatment plans specific to each person’s needs, challenges and goals. They work together with you to develop strategies and help you achieve your goals. Physical therapy may be a stand-alone option, or it may support other treatments. Now to the second part of the question, what kind of problems can physical therapists help with? Any kind of pain that you are experiencing that has a musculoskeletal origin can be treated by a physical therapist. Any pain or stiffness experienced with movement or located at a joint in the body can be diagnosed and treated by a physical therapist. Some of the conditions we evaluate and treat include sports-related injuries, such as hip labral tears, ankle sprains, knee pain and tennis or golfer’s elbow; musculoskeletal dysfunction, including neck and back pain, which may or may not include symptoms that radiate into the arm or leg respectively, rotator cuff tears (shoulder pain) and hip and knee pain; conditions that affect the hand, such as carpal tunnel syndrome and trigger finger; neurological conditions, such as stroke, Parkinson’s disease, multiple sclerosis, vestibular dysfunction (vertigo) and dementia; female health and pelvic floor dysfunction, including urinary incontinence; and rheumatological diagnoses such as osteoarthritis and rheumatoid arthritis.

Does it matter what facility or office I get my services at?

Not all physical therapy practices are the same. How many patients are scheduled an hour at a clinic and how much one-on-one time a therapist will have to evaluate the patient are important questions to ask when choosing a clinic. Some facilities will schedule six patients an hour, which means that the therapist will only have 10 minutes to speak to and work on the patient. It’s also important to know if the space allows the therapist to always supervise the patient during exercises. Being shuffled through a series of exercises without any hands-on work or being left on a bike for 15 minutes is not good physical therapy. What kind of equipment the facility has is also important. Having a gym space with equipment is not necessarily important for all diagnoses, but for some it is imperative.

Does it matter who your therapist is?

In all fields, you will find that not all health care practitioners are the same. When choosing a physical or occupational therapist, do some research. Speak to friends and family. Post on chats. Look at Google reviews. Find someone who has “good hands” that will spend the time to listen to the problem and treat the problem. Experience, continuing education and manual skills are key skills for a therapist. The best PTs use their hands to mobilize your body and improve function that can’t be attained through stretching or strengthening alone. These hands-on skills mobilize fascia, allow scar tissue to heal more effectively and alleviate areas of inflammation and pain. Powerful and gentle hands are the best combination. It is important to understand that physical therapy is a partnership that involves constant dialogue between therapist and patient. It’s imperative to work with someone that you have a good rapport with, and someone you feel comfortable with.

What should I expect on my first visit?

On the day of your evaluation, we will collect your past medical history, history of current complaint and any information associated with your problem. Talking to the patient and asking them details about when the pain started, how the pain is generated and how it creates limitations in your life are really important in helping us identify the root of the problem. For example, if a patient tells me that they were bending forward while lifting something heavy and felt a severe pain in their back, the likelihood of it being a herniated disc is very high. The next thing a good therapist will do is to evaluate your posture. It is important to look at your posture from the front, from the side and from the back. Watching a patient walk is also important because this gives us a lot of information about weight bearing, avoidance, weakness and compensatory movements. Be ready to possibly have to get changed into a gown or wear shorts. If the problem is a foot, knee or hip issue, we will need to see the foot, knee or hip. We cannot evaluate a body part without being able to see how that body part moves. For neck and low back issues we often need to see and evaluate since it is all connected. The physical therapist will look at the body from a whole-body perspective, but will evaluate you based on the body part. A great example is shoulder pain. If you come in with complaints of shoulder pain, the therapist will need to see how your shoulder moves, but also how your shoulder blade moves. Your shoulder blade is the foundation from which your arm moves. If its starting point is elevated or turned, this will affect your movement and pain. Additionally, when you move your arm, your shoulder blade moves in very specific ways. If it is winging, or coming off the thorax while you move, we need to be able to see this. For a shoulder problem, the therapist will also ask you to lift your arm and move it in all directions, test your strength and perform some special tests to see if it’s the joint, the nerves or the surrounding musculature. We might ask you to do some functional activities as well to measure how your problem has limited your activities of daily living. A thorough evaluation will give the therapist a clear picture of the problem at hand. With a clear picture we can then develop a very individualized program for your specific diagnosis.

If you are experiencing pain, or had a serious injury or surgery, you want the best physical therapist in your corner. The process of selecting one can be daunting at times, and the way to find the ideal physical therapist is to do your homework. First and foremost, a physical therapist should possess excellent interpersonal skills and be passionate about caring for patients, so that they can best help their patients recover and reach their goals. Ask questions and do your research. It’s your right to get all the information you can before making a final decision.

Stay tuned for Article 2 for more information about specific diagnoses.

Michal Porath and Jessica Lowy are owners at Prime Orthopedic Rehabilitation. This is part of their Empowering Function Through Education series.

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