Should I see a Physical Therapist?

Let me start by saying that this article is really focused on outpatient physical therapy for primarily orthopedic conditions. Although many of the principles will apply to other areas of physical therapy, my professional experience is with orthopedics, so I am best able to discuss care in this arena.

When it comes to the role of the physical therapist in today's health care system, there are 2 things which I hear almost daily in my practice:

1. My doctor says I probably need __________(insert intervention here such as surgery, injections, medications, another specialist referral etc)

2. I tried therapy already and they just put ice on it. (or they just gave me exercises)

In my opinion, how a patient reacts and responds to these two statements can make the difference between getting better and going down a long road literally filled with pain.

Should I even be getting therapy?

Let's take a look at the first point. In most states, physical therapists still require a doctor's referral in order to evaluate and treat their patients. For this reason, it is not uncommon for a patient with low back pain to take the following route...

OUCH my back hurts → better see my primary care physician → muscle relaxers and/or pain medication prescribed → pain resolves somewhat but then returns → better go back to my Dr. and get referred to a specialist → Specialist will likely send me to Physical Therapy after discussing lots of other stuff and possibly giving me an injection → physical therapy

To be clear, this is certainly not always the case. Many general practitioners will recommend physical therapy right away, and many times other interventions are valid. But in other cases, this whole process takes weeks to months during which the patient is in pain and frustrated.

I believe part of the problem is that neither doctors, nor patients truly know what physical therapists do, or CAN DO for them. Here's the elevator pitch for what we therapist really do:

• We specialize in the musculoskeletal system (bones and muscles) and also how the nervous system interacts with it.
• Our job is to learn about your pain, physically examine you, and determine two things:

Is the source of your pain musculoskeletal in nature?

If yes, what's causing that pain?

• We're also trained to recognized the signs and symptoms of other problems, diseases, etc that can act like musculoskeletal problems so that we can refer you back to your MD if necessary
• Many times we help folks recover from orthopedic surgeries, broken bones and other known injuries.
• Our job is to get you back to living your life without pain!

There are many different philosophies when it comes to patient care (more on this in a second), but most therapists generally agree that common conditions can be well managed with conservative care -- as long as the patient is committed to working together.

For example, Physical Therapy is a great way to address chronic conditions such as:

1. low back pain
2. neck pain and/or headaches
3. ankle sprains
4. knee pain
5. tennis elbow
6. shoulder tendonitis

In many cases we can completely resolve these issues because we address the cause of the problem, and not merely the symptoms.

So How Come I just Got Ice?

This brings us to point number 2 from way up above. How do you pick a good therapist. I wish we were all created equal, but like all professions, there is a ton of variety (both good and not so good). Again, this is just my humble opinion, but when i talk to friends and family about choosing a good therapist, this is what I say.

• They MUST do a thorough evaluation, no exceptions: If your PT looks at the doctor's referral and takes it as the final word....go someplace else. Your therapist should talk to you about your health history, watch you move, feel your joint, muscles etc... and form their own decision based on their clinical expertise.
• They should be able to tell you what they think is wrong, how they plan to address it, and about how long it should take to see improvement. This can vary greatly depending on the problem at hand.
• Treatment should involve actually touching, moving, or manipulating the affected body part. This is where techniques will differ between therapists, but if you are simply given a modality such as ice or ultrasound without a second look, you are not receiving quality PT.
• Most treatment should include a long term management or educational component which will help YOU manage your condition in the future. This could include an exercise program, posture training, ergonomic set-ups, stretching, and many others. The key is to make you- the patient- independent and able to eventually "graduate" from physical therapy.
• Regular contact with your physician. A good therapist will send progress reports to your doctor regularly and call if symptoms are worsening (or they have a concern). There should not be surprises between the therapist and the MD.
• A good therapist believes you can get better! Most important point here.

I could elaborate on these points for pages and pages, so I'll just stop there. I welcome your comments and will try to add to this Hub regularly in the future.