A PT Primer

You know what they say: write what you know. As it turns out, I know a lot about physical therapy. I have been an off-and-on participant for nearly 25 years, so here are some tips to help maximize the benefit.

First, I should disclaim: in my opinion, physical therapists, the good ones anyway, know far more about recovery than doctors do. Physicians will tell you: six-to-eight weeks for bones to heel; or two weeks till the stitches come out; or three-to-four weeks after surgery before you need to check in. What they’re actually telling you is how long it will take for a bone to knit or a surgical site to heal, not how long it will take you to get back to living your life as if no such physical insult occurred at all. For instance, count on a full year post back surgery and just about as long after a serious knee injury. Case in point: I broke my ankle — a clean break of the fibula that required no surgical intervention — in October. My doc told me 6-8 weeks for the bone to heal. But then he ordered twelve weeks of PT for a total, fun-filled recovery period of a minimum of five months. I say minimum because rarely does one graduate from PT raring to go. There’s that pesky, insanely boring but necessary home exercise program. So, once again, I must figure on the best part of a year given over to getting over this injury.

Tip #1: Do not assume that all physical therapists are equally competent. Even if your world-renowned surgeon presents you with a list of recommended PT practitioners. They are not.

Tip #2: If you sign on with a physical therapist or PT clinic and are unsatisfied, know you can change. You can have the order transferred to another outfit or get a fresh one from your MD. Remember: you are both the patient (which doesn’t mean you have to be) and the client. You are the consumer.

Tip #3: Resist the urge to buy your therapist a holiday gift. Making a friend of your therapist is trickier than you might think. They are good people, they are helping you, you learn about their children and their hobbies over the course of your therapy. A relationship is formed; you like as well as need this person. This can be very seductive and lead to a) dragging your therapy on well past its therapeutic benefit and/or b) wasting limited sessions on too much chat.

Tip #4: The moment that you learn you are a candidate for physical therapy, start shopping around. Word of mouth, especially for similar recoveries, is probably the best way to find a good therapist (caveat: just so long as the recommending mouth isn’t guilty of the aforementioned affection blight)

Tip #5: Book your first visit immediately on learning PT is in your future and even before you have the order from your doc. It can take valuable recovery weeks to get that initial appointment and you want to begin the second you have the go-ahead. If the doc delays your PT, simply change that appointment to accommodate the setback.

Tip #6: Unless you are 25 and have a straight-forward, simple injury, avoid at all costs assembly-line PT clinics. How will you know? Well, they look like this: after the initial evaluation (which lasts an hour), you are passed on to a young minion who oversees your PT program but must defer to the evaluating therapist for progressive changes. In other words, you’re paying (or your insurance is paying) for a professional you may hardly glimpse after the first visit. (Caveat: one noteworthy exception is the New England Baptist Back Boot Camp. This is an enlightened program of exercises sculpted to your needs and conceived to be as close to real-world back use as is possible. Once your program is established a minion will follow you as a kind of quality control — correct form, weigh adjustments, etc)

Tip #7: Some PT modalities are assigned in a kind of pro forma fashion. Electric stimulation, ultrasound and massage are three examples. Make sure to ask what benefit you should expect to experience from each modality and if you do not experience that benefit, say so! PT sessions are only one-half hour. It’s up to you to see to it the therapist makes the most of that time. Not all modalities work for everyone. Massage, for instance, feels wonderful but is it the best use of precision minutes of PT time?

Tip #8: Whenever possible identify and sign on with the top therapist for your specific recovery. You don’t want a generalist if you’re recovering from back surgery. You don’t want a knee guy if you have a neck issue. You don’t want a twenty-something, gung-ho buff male if you’re a 70 year old woman with arthritis. OK, you may want him but not as a therapist.

Tip #9: Whenever possible find an established practitioner with his or her own private practice. Some of these folks don’t take insurance but the one-on-one expertise is worth it if you’re wallet can take it. Some, though, do take insurance, even Medicare. Take it from me, there is no better PT experience than one-on-one.

Tip #10: PT is hard. It can be painful. The home exercise regimen can be boring in the extreme. Don’t cheat. Don’t cut corners. Soldier on, knowing it won’t last forever. And in that fact lies the ultimate motivation: you’ve only got so many sessions. Make the most of it. Or rue the consequences.

— Belle Songer