What Really Happens In Physical Therapy: A Review

About a year ago, the editors of Consumer Reports wrote an article titled, “What Really Happens in Physical Therapy.

My first reaction was, “Well, it’s about time…this conversation is long overdue.”

As physical therapy becomes increasingly more mainstream, we, as an industry, owe our customers value and daily demonstrations of our worth.  As reported in the article, millions of people are referred to physical therapy every year.  The number of self-referred patients grows every year as well, as the public takes advantage of their right to direct access. Our customers are savvy and straightforward answers are critical for excellent outcomes.

In the article, Consumer Reports talked with experienced therapists at the American Physical Therapy Association who then recommended five items in order to maximize excellent results while participating in physical therapy.  These recommendations, naturally, brought up other issues and thoughts.

1. “Don’t waste too much time with ice and heat.”

That’s true…mostly.  I believe that the value of a physical therapist lies in their hands and brains.  Time and effort placed on modalities (medical/treatment devices) to deliver passive results is misdirected.  These items serve a good purpose but do not take the place of action.  Personally, it is a rare patient that doesn’t receive ice/cold pack after an appointment with me.  I want to minimize discomfort/inflammation post-treatment and this is one of the easiest ways to achieve that.  Heat, in all its variations, feels good and serves as a way to “warm up” to activity but it really is not necessary.  A physical therapist is quoted in the article – “It (heat) makes patients feel good, but it’s not very helpful.”

Well…since when is making a patient feel good not helpful?  Ask patients what they look forward to in physical therapy.  During an appointment that is very hard work and is often challenging and unpleasant, is an activity that “feels good” a bad thing?  My point is – get as much information from your therapist that you can and then make an educated choice but keep both eyes on a bias for action.

Other, more technical modalities (ultrasound, electrical stimulation, infrared/cold laser, etc..) also have their place and can, indeed, be helpful relative to the pathology and status of your recovery.  Talk with your physical therapist about them, make an informed decision about their use, but remember…nothing takes the place of active rehabilitation.

2. “Do push yourself when exercising.”

That’s true…mostly.  The cornerstone of any effective rehabilitation is based on the SAID Principle – Specific Adaptation to Imposed Demands.  This means that the human body adapts and improves relative to the demands placed upon it.  Training, in all of its variety, boils down to controlled abuse.  The body (and the mind for that matter) is being stressed.  Your body then responds and adapts by becoming stronger, faster, and more resilient as it prepares for more abuse.  Thereby, we get stronger and adapt to the forces placed upon us.  But the “More is Better” and “No Pain/No Gain” approach is pitifully basic.  It’s just not that simple.  I’ve seen countless examples of people who pushed themselves beyond a rational limit that then turned into pathology.  Constructive rehabilitation requires hard work and it won’t be pleasant.  But, ultimately, it has to be tolerable.

3. “Don’t rely on passive motion machines after knee replacement.”

That’s true but this really is not in the realm of physical therapy.  Your physician is typically the source of this order.  Personally, I’ve treated patients that have used these devices and those that have not.  It never really seemed to make that much of a difference.  But several exceptional doctors, that refer to us, routinely order these for their patients.  They must have solid reasons for doing so.  If you have questions about these devices, ask your physician.  But I do go back to one core point – the one word that I do not support, in even the title of these devices, is PASSIVE.  Given a choice, it is always better to do rather then having something done to you.  Bias ACTIVE vs PASSIVE.

4. “Do get pushed around.”

Back to # 1…a physical therapist’s value is in his or her hands and brains.  Your therapist will spend a significant amount of time working individually with you with hands-on stretching and strengthening techniques.  Cooperate to the best of your ability.  These are often the most helpful activities that you will engage in during your time in physical therapy.  They will produce the best results.  Just like vigorous exercise, this will not always be pleasant but should always remain tolerable.

5. “Don’t expect much from whirlpools.”

Back to #1, again.  But it does depend.  A whirlpool to initiate and warm up to your activity is great but not necessary.  Ten to fifteen minutes on the stationary bike is better and, once more, it is active rather then passive.  On the other hand, an iced whirlpool after physical therapy (for an acute ankle sprain, for instance) is an outstanding choice.  Talk with your physical therapist and have an open and honest exchange of information.

It’s encouraging that our industry has matured enough to be the topic of review in Consumer Reports.

Exchanges of information on a domestic level will only bring out the best in us.



What is Direct Access

Direct Access is exactly what it sounds like: Patients having direct access to physical therapy services without a doctor’s referral. A direct access license is available to physical therapists in Pennsylvania and many other states. There are five elements to the Direct Access model of care including examination, evaluation, diagnosis, prognosis, and intervention. Once your initial examination/evaluation is completed, our physical therapists will develop a Plan of Care for your treatment. This will be submitted to your doctor for their review.

Who can use Direct Access?

Most insurances will cover treatment without a referral as long as the physical therapist has his/her direct access license. Medicare, Medicare replacement plans (Security Blue, for instance), and government issued insurance plans usually will not reimburse direct access treatment. If you have any questions about your insurance plan, please contact your local Panther Physical Therapy office for more information.

Why choose a Physical Therapist with Direct Access?

Direct Access extends consumer’s choice and eliminates barriers to entry. This decreases the time it takes to start treatment. It improves access to a profession that promotes prevention and wellness. Early access to physical therapy has many benefits including decreased medical costs, enhanced recovery, and decreased use of sick time. Direct Access helps the patient see positive functional results, feel confident in their recovery, and experience reduced pain as they progress. It is dynamic and comprehensive care.

Picking the right physical therapy office can be daunting. By choosing a physical therapist with Direct Access, it allows you to begin treatment sooner since you do not have to wait for an appointment with your physician. Therapists can provide their patients with the quality of care that they need, when they need it, and in a manner that best suits them- No Prescription Necessary.

How to Get the Most Out of Physical Therapy

Check Your Insurance

Prior to starting therapy check with your insurance provider to determine your therapy benefits. Find out if you have a visit limit and how many visits are allowed. Check if you have a copay, co-insurance, and / or deductible that must be met. By knowing what to expect with these details up front, it will minimize surprises down the road.

Arrive Early

Try to arrive early for your scheduled appointments. During your initial appointment, you may want to arrive up to 15 minutes early to allow time to fill out the required paperwork. Arriving early will allow you time to change if necessary and be ready for the start of your appointment to maximize time with your therapist.

Openly Communicate

If you have questions or do not understand something, do not hesitate to ask your therapist, especially if it pertains to your home care. If at any time you experience increased pain, it is important to let your therapist know. Some pain is natural with therapy but your therapist will know if it is normal and expected or something that needs to be addressed.

Discuss Your Goals

Determine what you personally want to accomplish with your therapy program and discuss your goals with your therapist during your initial session. Therapy programs are established based on each individual’s needs. Your goals should be part of the process in determining your program.

Dress Comfortably

If you are going to therapy straight from work, take a change of clothes with you. Some of your therapy goals will involve improving your range of motion and flexibility. You will need to be able to move through a full range of motion which is difficult in tight fitting, restrictive clothing. Also bear in mind that your therapist may need to expose the injured area for certain types of treatment.

Maintain an Open Mind and Positive Attitude

The mental aspect of therapy can be every bit as important as the physical component. Committing fully to your therapy program will impact the speed and quality of your recovery.

Focus on Your Treatment

Do not bring friends or family to therapy sessions unless it is a necessity. Turn off your cell phone during your appointments. Schedule your sessions at times in which you will not be rushed. Doing your program accurately and at the appropriate speed will affect your outcomes. It is difficult to focus on the task at hand if you have constant distractions. Your progress will be limited if your therapist has to shorten your session because of time constraints.

Stay Hydrated

Drink plenty of water and stay well rested throughout your rehabilitation. Proper hydration and rest is important when recovering from any injury.

Complete Your Home Exercises

Your therapist will prescribe a home exercise program for you. Create a schedule to do your home exercises and be faithful with completing it. Your home exercise plan is every bit as important as your scheduled therapy appointments and should be a daily priority. Take your home exercises seriously and do them as prescribed, including the appropriate number of repetitions and daily frequency.

Challenge Yourself

As you get stronger throughout your therapy, increase your resistance and/or repetitions with your exercises. Your therapist will periodically progress your program. If your exercises begin to feel too easy, speak up about adding resistance, repetitions, or extra sets.

Discuss After-Care

Consult with your therapist about your after-care when formal treatment has concluded. In many instances, you will continue with your home exercise program for several more months.