Physical therapy…What’s the Point? Q & A on PT with Dr. Hyman

1.  What’s the goal of physical therapy (PT)?

The primary goal of physical therapy is to optimize your body mechanics, so that you may return to sport or chosen physical activity.

While pain relief is not the primary purpose of physical therapy, most often the pain goes away and stays away when body mechanics issues are corrected.

Ideally, all persons with a sports or back injury should see a physical therapist first, before seeing a medical doctor.  The majority of the time, physical therapists will lead you successfully back to full function without a hitch.  In some cases, problems persist despite physical therapy, and then ideally your physical therapist will refer you to a musculoskeletal specialist medical doctor.  I like to use a 4 visit threshold — you should see improvement in PT within 4 visits, and if not, then seeing a specialist doctor is appropriate.  Why not first see your primary care physician?  Well, in most cases your primary care physician will rely on a physical therapist to evaluate and treat an injury.  So if you’ve already been responsible enough to participate in PT, then you’re ready for specialty care with a sports medicine physician.

2.  What should you expect from a PT visit?  

Expect to arrive 10-15 mins early, dressed for exercise.  The sessions usually last 45-60 minutes.  During the initial assessment the physical therapist will get to know you and your problem by taking a history and performing an extensive physical examination. Each follow up session typically involves some period of reassessment (i.e. talking about how you’ve been doing since last session), a physical examination to check biomechanics, sometimes an intervention (i.e. hands on treatment that might feel like massage, stretching, or joint manipulation), and then additional exercise instruction.

We expect you to attend physical therapy sessions once or twice per week for several weeks before we follow up together.  Typically within 4 visits a person will notice some improvement.  The overall duration of physical therapy depends on several factors including the complexity of a condition and its chronicity.

3.  Why spend the time and resources to participate in PT?  Why don’t you just hand me a printed exercise handout?

A physical therapist is a medical exercise specialist, and they are able to design a customized exercise program to help you achieve your particular exercise goals. Each person’s body mechanics are different.  It is the physical therapist’s expertise to understand what normal flexibility and strength looks like.  Every person has areas of inflexibility and areas that are weaker than what is optimal.  Often making tailored corrections to your flexibility or weak areas will make all the difference and allow you to return to full function.

Exercise handouts are designed to treat the “average” person in a general sort of way.  Perhaps up to 50% of the time this approach works.  However, we take your recovery seriously, and we prefer better odds.   With physical therapy intervention for most conditions, the likelihood of improvement goes up to 75-85% in our experience.

Sometimes I’m asked why I can’t just teach the exercises at our office visit.  The simple answer is that I’m not a specialist in teaching people how to properly exercise.  Additionally, most physical therapists understand how to assess biomechanics on a more sophisticated level than most specialist physicians.  So they can both assess complex biomechanical issues, and they are experts in creating an exercise plan to correct those issues.  Just to overemphasize, when I have an injury or issue, I personally go to see a physical therapist because I won’t appreciate my weak spots nearly as well as a physical therapist.