If you’ve not been to physical therapy before, or are just getting started, you should know that it’s quite different from a regular trip to the family doc. PT focuses on patient independence and improving the things that matter most to you. If you bear in mind the recommendations below, you are bound to have a more positive experience and better outcome!
1. Ask for scheduling that makes sense
The amount of physical therapy (PT) that one needs is widely variable. At one end of the continuum, patients in a rehab hospital may partake in upwards of 2 hours of PT daily 5-7 days per week, and on the other, a child may simply need annual visits to fit new equipment as he or she grows.
Your prescribing physician may recommend 3x weekly for 4 weeks, most physicians defer this decision to the therapist, as this lies more within the scope of practice for PT. Aside from diagnosis alone, many other variables will dictate the volume and frequency of scheduling needed to achieve your goals. Some of these factors include
the acuity and severity of impairment/disability
postoperative restrictions in weight bearing or joint movement
how much assistance a patient needs for basic mobility
specificity of the treatment goals- return to sport/work often takes longer
how independent the patient and/or caregivers can be with home exercise prescription
financial and transportation considerations of the patient
Some patients are able to perform much of their rehabilitative program independently with fewer PT visits, particularly when strengthening is the primary focus. Strength building requires a lot of time, but patients should be considered independent in performance with correct form. Exercises often will need advancement every 2-3 weeks as well.
Other patients who are unable to perform exercises as independently or lack proper equipment, often benefit from more frequent sessions and closer supervision. The geriatric population with dementia is a good example in this group.
As patients progress from strengthening to more advanced treatments such as motor control training, gait retraining, balance development, and sport specific drills, visit frequency may change. Patients require closer supervision, more detailed instruction, and more feedback. At this time no two sessions look exactly alike.
Patient’s with soft tissue dysfunction who would benefit from hands on manual therapies such as trigger point dry needling, myofascial release, joint mobilization, Active Release Techniques, etc may benefit from additional treatment time. These techniques are often used to decrease pain and improve activation, however they should be considered complimentary to treatment at best, not confused for the treatment in and of itself.
PT is unique in health care in that patients will inevitably have homework. Patients also have some say in how often they come to PT. The therapist will estimate how long it will take to obtain a reasonable outcome, but frequency of visits depend on how much the patient is able to do on their own unsupervised. There are other factors as well, cost being a big one too.
I encourage you to discuss your scheduling preferences openly with the evaluating therapist. Undergoing an in-depth rehabilitation process is timely and costly, and patients should have a say to some degree. Ultimately this will help you feel more engaged in the process.
Patients who perceive that they are too busy to participate in PT are likely to have a poor outcome. Finding scheduling that will not interfere with life is imperative. Finding ways to get to PT without having to miss time from work is helpful. Find a clinic that offers evening or weekend hours if needed.
2. Engage your independence
I encourage patients to be as involved in their rehab as possible within reasonable means. In most scenarios, PT involves homework, and patients only relying on their time in the clinic are not likely to have a good or long-lasting outcome. If you feel like you could be doing more, tell your PT.
When patients are able to perform simple stretches and strengthening exercises independently, there’s more time in the clinic remaining for advanced manual therapy, motor control training, and return to sport activity. Patients staying caught up on ‘homework’ tend to progress faster.
Your PT should be engaging your level of motivation and independence. Physical therapy is a profession strongly geared toward patient education and the promotion of patient independence. If you are spending time doing things in the clinic that you’re already independent with at home, there should be a compelling reason. Speak up and make sure you’re doing your part.
The alternative, in my experience, leads to longer recovery times, poorer outcomes, and disengaged patients. If you feel like you could be doing more at home or generally don’t feel challenged by work in the clinic, discuss this with your PT. Chances are they’ve already put a lot of thought into it, but the additional feedback may be useful in making some changes.
3. Speak up when things aren't clear
Because of continued reimbursement cuts from insurance companies, physical therapists run the clinic like a well oiled machine. Unfortunately, that means there isn’t as much time for patient education. Your physical therapist is making detailed decisions about the course of your care for very specific reasons, but that doesn’t mean you shouldn’t understand.
If you don’t feel like you have a clear understanding of what you’re doing or why you’re doing it, always ask: it’s totally okay! Physical therapists, like other healthcare practitioners, can quickly revert back to medical jargon without noticing, but speak up. PTs are always great at using patient-first language or taking time to explain topics or terms that might be confusing.
Knowing the rationale and purpose of each activity isn’t always needed, but sometimes can help you perform it better or take it more seriously. I always try to discuss each activity in the more broad picture of the recovery process. You may only be considering the current session at hand, but your PT is considering today’s session as it fits into the context of your entire rehabilitation process.
Improving shared decision making, or involving patients in the medical choices that are made, is a current focus in healthcare today, one that has shown to improve the quality of care in different ways. Authors of one review report that “SDM interventions significantly improved outcomes in disadvantaged groups: increased knowledge, informed choice, participation in decision-making, decision self-efficacy, preference for collaborative decision making and reduced decisional conflict.”
4. Be Honest and Confident
Each session your PT will monitor your progress in a number of ways, including questions about pain, daily function, sports performance, compliance with your exercises, etc. Go with your gut when answering, but be honest and confident. Dishonesty or omitting information can lead to changes in your program that might not make sense.
In most situations patients should begin notice some progress after 3-5 sessions. If you’re not highly confident that things are different (better or worse), then they probably aren’t. Every patient problem is unique. Things like myofascial trigger point pain or cervicogenic headaches, are expected to improve within the session. On the other hand, pain from a pelvis fracture or healing joint replacement is anticipated to have a prolonged period of soreness and discomfort.
Trial and error is also a big component in treating patients. Each PT has a unique set of tools and skills that has worked well with patients in the past. This does not guarantee they will work for you. If you don’t find something particularly helpful, discuss it with your PT. Sometimes it takes a few tries to find the stretch or exercise that works best for you: it’s all part of the process.
The same can be said of modalities. Ice, heat, electrical stimulation, kinesiotaping, dry needling, etc are all used at some point for different reasons. They each have numerous applications, but might not be helpful for every patient. Moist heat application may be a useful tool in making exercises more tolerable for someone with persistent pain, but it might not be warranted with another.
Trigger point dry needling can be a strong catalyst in the resolution of muscle related pain and improvement of total muscle activation, but not all patients are fond of needles and some are medically unable to tolerate it. Ultimately, it is the patient’s symptom’s response that will drive these decisions, as well as other objective measures showing progress.
5. Be a Detailed Historian
There are plenty of statistics out there about how short the average face-to-face time can be with your primary care physician. PT is different. We need to hear your story. We take the time to do it.
By the time a patient finally makes it to me, they might have a two year history of their problem. Getting the full story is immensely helpful in both determining the correct diagnosis as well as the best plan of care. Occasionally a patient’s account is so detailed and thorough, that the physical examination serves only to confirm my suspicions.
Patients who are categorically vague about how their symptoms began, where their pain is, when it is better, when it is worse, etc…often require significantly more time to get to the root problem. My patients who can provide the greatest detail often have the quickest and best outcomes.
Giving a detailed account of all the other treatments you might have tried is extremely helpful. Many of my patients have already tried over-the-counter medicines, massage, chiropractic, injections, surgeries, or prior rounds of PT. Details regarding what has worked, what hasn’t worked, and what has made things worse is very helpful. Having this information can sometimes save a patient as many as 3-4 visits.
Physical Therapy is a unique Healthcare Experience
Whenever I see a patient for their first visit, one of the questions I always ask is whether they’ve ever been to PT before. There are a lot of misconceptions about what PT actually is, but ultimately, it is very different from many healthcare experiences you might have had.
PT is a highly interactive service that requires participation, teamwork, diligence, and most of all hope. Don’t just show up. Keep your head in the game, get involved, and do your part. Everyday I talk with my patients, I educate them, I motivate them, and I show them the way, but inevitably, they are the ones who put the work in and get to reap the benefits.