What to expect from PT (From 6/17/13)

What should a patient expect from PT?

I have an expectation of what most people might say. When I talk to my friends or family members they typically tend to ask me: “Hey, I have (insert random problem here), what’s causing that? Can you show me some exercises for that?” These certainly are good questions, but I think they may underestimate what physical therapy actually is and does.

So what should you expect from PT? Well you should expect to have you problem thoroughly evaluated, and you should expect to be taught some exercises to help fix your problem. But there are many other things you will do or encounter with your therapist. On your first day you should plan to be ready to move and exercise. Most of the time, your therapist will take an advanced medical history from you, and perform a physical exam. This physical exam could include range of motion and strength testing, as well as neurological testing of your sensation and reflexes. Your therapist is also going to touch you…a lot. Part of our job as therapists is to appreciate the quality of the tissues, and the only way we can do that is by using every sense we have available to gather information about you. By touching you we can feel tightness, movement quality, tissue temperature, swelling, cracking or grinding, or many other things. There are a variety of tests and measures that physical therapists use, and they are often specific to your condition.

After your physical exam is complete, your therapist will discuss exam findings with you, discuss your goals, and create a plan of care with you to meet those goals. Most of the time, you will also receive some treatment and/or a home exercise plan on your first day as well. I think many people believe that this is the extent of what physical therapy will cover. However, once you and your therapist make a plan, the fun can really begin.

Some of the most common things you will do in physical therapy are:

  1. Therapeutic exercise: Motion is lotion. Exercises designed to help you move better will almost always be a part of PT.
  2. Functional Training: Exercise is only useful if it is done in ways that mimic our function. Doing bicep curls is great, but learning to bend your arm while lifting an object is better. PT’s are movement specialists, and are the experts when it comes to your pain and movement.
  3. Activity modification: Your PT will tell what activities to focus on and what to avoid. The ultimate goal of course being that you return to your prior level of function.
  4. Manual therapy: This is a broad term that includes anything your therapist does by touching you. Some common things might be massage, stretching, resistive exercise, joint mobilization, or spinal manipulation.
  5. Traction: If you have back or neck pain, the traction machine may be the treatment of choice for you. Traction is not appropriate for everyone, but is a great tool that PT’s use.
  6. Ultrasound or Electrical Stimulation: These are great adjunct tools PT’s use, however, ultrasound alone will not cure your ills. Used appropriately both ultrasound and electrical stimulation can help relieve pain and facilitate healing.
  7. Hot or Cold Packs: Great for pain relief and relaxation, PT’s use hot or cold packs often to help their patients.
  8. Gait Training or Muscle re-training: Ever heard of muscle memory? PT’s work every day to help create new muscle memory, and re-write old muscle memory. All of the bad movement habits you have may be contributing to your pain, so your PT will help you form new habits that will help you heal.
  9. Differential Diagnosis: Have you ever had a medical mystery? PT’s are trained to diagnose many medical conditions. Because you will see your PT with greater frequency than many other health care providers, they will have more time to evaluate your condition and potentially catch any mystery conditions that could have been previously missed.
  10. Other– Physical therapists are trained in a variety of disciplines and may be able to do many things you would not have suspected. For example, did you know that many PT’s are trained to perform advanced wound care? Because of this they may choose to inspect that incision site after surgery just to make sure everything is healing correctly, and treat the skin if anything is needed.

The list above is certainly not all inclusive, but it does represent a lot of what PT’s do, and what you should expect treatment wise from your therapist. So after going through all that treatment, what should you expect to feel with therapy? Well, everyone’s experience may differ, but in general you should expect to work hard while in therapy, and work harder while at home. You have to work hard at keeping up with home exercises to maintain what you accomplish while in therapy, and as a result, you may be sore. This is normal. Feeling tired or sore after therapy usually means you were working hard. Remember to listen to your body though, and stop if soreness becomes pain.

Our goal as physical therapists is to make people move, feel and live better. Hopefully, when our patients better know what to expect from PT, they will see greater benefit. Expect to work hard and above all feel better.

Patrick