Frequently Asked Questions (FAQ)
Below are some frequently asked questions; simply click on the question of interest and the answer will appear directly below it.
More than half of all Americans are suffering from pain. Whether it is a recent episode or chronic, an ABC News/Stanford study revealed that pain in America is a serious problem. However, many do not even know physical therapists are well-equipped to not only treat pain but also its source.
Physical therapists are experts at treating movement and neuro-musculoskeletal disorders. Pain often accompanies a movement disorder, and physical therapists can help correct the disorder and relieve the pain.
You probably have heard of the profession of physical therapy. Maybe you have had a conversation with a friend about how physical therapy helped get rid of his or her back pain, or you might know someone who needed physical therapy after an injury. You might even have been treated by a physical therapist yourself. But have you ever wondered about physical therapists – who they are and what they do? Many people are familiar with physical therapists’ work helping patients with orthopedic problems, such as low back pain or knee surgeries, to reduce pain and regain function. Others may be aware of the treatment physical therapists provide to assist patients recovering from a stroke (e.g., assisting them with recovering use of their limbs and walking again).
The ability to maintain an upright posture and to move your arms and legs to perform all sorts of tasks and activities is an important component of your health. Most of us can learn to live with the various medical conditions we may develop, but only if we are able to continue at our jobs, take care of our families, and enjoy important occasions with family and friends. All these activities require the ability to move without difficulty or pain.
Because physical therapists are experts in movement and function, they do not confine their talents to treating people who are ill. A large part of a physical therapist’s program is directed at preventing injury, loss of movement, and even surgery. Physical therapists work as consultants in industrial settings to improve the design of the workplace and reduce the risk of workers overusing certain muscles or developing low back pain. They also provide services to athletes at all levels to screen for potential problems and institute preventive exercise programs. With the boom in golf and fitness industries, a number of physical therapists are engaged in consulting with recreational golfers and fitness clubs to develop workouts that are safe and effective, especially for people who already know they have a problem with their joints or their backs.
The cornerstones of physical therapy treatment are therapeutic exercise and functional training. In addition to “hands-on” care, physical therapists also educate patients to take care of themselves and to perform certain exercises on their own. Depending on the particular needs of a patient, physical therapists may also “mobilize” a joint (that is, perform certain types of movements at the end of your range of motion) or massage a muscle to promote proper movement and function. Physical therapists also use methods such as ultrasound (which uses high-frequency waves to produce heat), electric stimulation, hot packs, and ice. Although other kinds of practitioners will offer some of these treatments as “physical therapy,” it’s important for you to know that physical therapy can only be provided by qualified physical therapists or by physical therapist assistants, who must complete a 2-year education program and who work only under the direction and supervision of physical therapists.
Most forms of physical therapy treatment are covered by your insurance, but the coverage will vary with each plan. Most states do not legally require patients to see their physicians before seeing a physical therapist. Most of the time, all you have to do is ask your doctor if physical therapy is right for you.
You and others may be referred to physical therapy because of a movement dysfunction associated with pain. Your difficulty with moving part(s) of your body (such as bending at the low back, difficulty sleeping on your shoulder, etc.) very likely results in limitations with your daily activities (e.g., difficulty getting out of a chair, an inability to play sports, trouble with walking, etc.). Physical therapists treat these movement dysfunctions and their associated pains, and restore your body’s ability to move in a normal manner.
CHOOSING A PHYSICAL THERAPIST
In most cases, you have the right to choose any physical therapy clinic. Our practice is a provider for many different insurance plans.
The best thing to do is give us a call, and we will attempt to answer all your questions.
Forty-eight states have some form of direct access. Some state physical therapy practice acts require a diagnosis before a patient can see a therapist. Other states, including California, allow patients to go directly to physical therapists. In most cases, if you are not making significant improvement within 45 days or 12 visits, the therapist will refer you to/back to your physician.
Direct Access Reference
Is it better to see a PT who works for a physician or a PT who owns a private practice? We leave it up to you to draw your own conclusions, but here are some facts. The studies indicate there were more treatments (visits per patient were 39% to 45% higher in physician-owned clinics) and the cost was greater for those patients who attended a physician-owned physical therapy practice (both gross and net revenue per patient were 30% to 40% higher)1.
Another study indicated that licensed and non-licensed therapy providers spent less time with each patient in physician-owned clinics, and physical therapy assistants were substituted for physical therapists.2
An older study concluded, “Therapists who had treated patients through direct access were significantly more likely to believe that direct access had benefited them professionally and benefited their patients than were therapists who had not practiced through direct access.”3
We believe we can provide you with the highest quality of care available and do it in a cost-effective manner.4 You will work closely with your physical therapist, and, in most instances, your case will be managed by the same physical therapist from the beginning to the end of your experience with us.
- Mitchell, J., Scott, E. Physician Ownership of Physical Therapy Services: Effects on Charges, Utilization, Profits, and Service Characteristics, Journal of the American Medical Association, 1992.
- ‘Joint Ventures Among Health Care Providers in Florida,” State of Florida Health Care Cost Containment Board, 1991.
- Domholdt E, Durchholz AG. Direct access use by experienced therapists in states with direct access. Phys Ther. 1992 Aug; 72(8):569-74.
- Federal Office of the Inspector General, May 1, 2006. This report calls into question billing processes done by nonÐphysical therapist owned practices.
- Do they have a service that can address your problem?
- Do they take your insurance, or are they willing to work with you if they are not a preferred provider?
- They should be conveniently located. Since sitting and driving often aggravate orthopedic problems, there should be a very good reason for you to drive a long distance for rehabilitation.
- What are the hours of operation?
- Can they provide satisfaction-survey results?
- The therapist should provide the treatment.
- Ask your family and friends who they would recommend.
Many physical therapists specialize in the rehabilitation of amputees. Caring for the injured limb, functional and walking training, and training in the use of assistive devices (crutches, canes, prosthetic limbs, etc.) are all provided by a therapist who specializes in care for amputees.
Aquatic therapy takes advantage of the physical properties of water to assist with the rehabilitative process. Buoyancy, turbulence, hydrostatic pressure, and thermal properties of water can assist with the rehabilitation of a patient. Those suffering from chronic pain, osteoarthritis, fibromyalgia, rheumatoid arthritis, lumbar fusion surgery, or with a limited weight-bearing status are just a few of the many different patient populations that can benefit from aquatic therapy.
Many suffer from dizziness or BPPV (benign paroxysmal positional vertigo). Some clinics specialize in the rehabilitation of patients with vertigo. Patient education, strengthening, safety awareness, posture and balance exercise, walking exercise, and special techniques that affect sensory and balance centers of the brain and limbs are all important components of a rehabilitation program.
A small percentage of physical therapists practice in this discipline. Those who pass the board certification have the title of Cardiovascular and Pulmonary Certified Specialist (CCS) and work with patients who have had heart attacks, bypass surgeries, angioplasty, breathing problems, emphysema, and other heart/lung-related conditions. Physical therapists are well-equipped to work with these types of patients, because many of them have orthopedic ailments that limit their ability to function. In other words, a physical therapist can address the heart and lung problems, as well as the muscle problems, that are concurrently present.
A physical therapist who is board certified to perform electroneurophysiology examinations, such as nerve conduction studies and electromyography.
Physical therapists are well-trained to help with your fitness needs and wellness programs. If you need an exercise program, have trouble with your weight, are concerned about osteoporosis, have an issue with diabetes, or would like to learn how to prevent falls, physical therapists can help. The previous examples are just a few of the many programs offered by physical therapists.
Some therapists specialize in the rehabilitation of seniors. As the body ages, a variety of challenges arise. We stiffen, we lose strength, our balance skills decline, our bones become brittle (osteoporosis), our endurance decreases, and we take longer to recover from injuries. Balance and fall prevention are of paramount importance to the therapist who is working with seniors, and some clinics are solely dedicated to caring for those with balance problems. Most physical therapists work with seniors/geriatric patients. Some have obtained additional education, passed a board examination, and earned the Geriatric Certified Specialist (GCS) title.
Most physical therapists are well-trained to treat hand and wrist conditions. Some therapists have taken additional courses and training, and have passed a hand therapy certification examination. These therapists are called Certified Hand Therapists (CHTs).
Specialists in industrial rehabilitation help with those who have suffered on-the-job injuries. Moreover, they will evaluate work tasks, fabricate assistive devices, evaluate your ergonomic situation, and help redesign work flow/tasks to decrease the incidence of injury. Often, industrial rehabilitation specialists will evaluate your ability to perform certain job tasks with a Functional Capacity Evaluation (FCE).
We take it for granted, but a special component of the circulatory system – the lymph system – helps filter and drain fluid from our arms and legs. When this drainage system is damaged, painful swelling can result, which is called lymphedema. Some therapists specialize in the treatment of this condition. Special positioning, massage, and bandaging techniques are utilized by the lymphedema specialist.
Osteoporosis Rehabilitation and Prevention – Some practitioners specialize in the evaluation and treatment of osteoporosis patients. Working in concert with your medical doctor, the therapist will often design a specialized weight-bearing and resistance-training program for those with this silent disease.
Manual therapy is a broad term that describes a variety of hands-on treatment techniques that are applied to movement dysfunctions. Grade five mobilizations, Mulligan mobilizations with movement, Maitland and Kaltenborn techniques, functional technique, neural mobilization, joint mobilization, craniosacral therapy, strain/counter strain, myofascial release: These are some of the more popular manual therapy techniques. Many manual therapists will take continuing-education courses, obtain certifications in manual therapy, and sit for board certification from the American Physical Therapy Association and other organizations. Most physical therapists incorporate manual therapy techniques as a part of a complete treatment plan.
A large portion of physical therapists works with patients who suffer from these conditions. Functional retraining – including walking, wheelchair use, getting in and out of bed or chairs (transfer training), and moving in bed (bed mobility) – and retraining patients to use their shoulders, arms, and hands are just some of the services these therapists provide to those with neurological involvement. A certified specialist holds a Neurologic Certified Specialist title (NCS).
Probably the most common physical therapy specialist is the orthopedic specialist. These specialists care for post-surgical patients, arthritis, tendinitis/tendinosus, fracture rehabilitation, muscle sprains and strains, neck and back pain, hip and knee problems, shoulder, elbow, and wrist conditions. Some are board certified as Orthopedic Certified Specialists (OCS).
Pediatric therapists specialize in the rehabilitation of children. They may assist with kids who suffer from cerebral palsy, developmental disorders, neurological disorders, and/or orthopedic problems. Pediatric Certified Specialist (PCS) is a board certification that some may obtain from the American Physical Therapy Association.
Experts in assisting with recovery after injury and surgery. Many sports specialists help with retraining the athlete utilizing running, throwing, jumping, and sport-specific programs, to name a few. A therapist with the Sports Certified Specialist (SCS) title has passed a board-certification test.
Some therapists specialize in women’s issues, such as pregnancy problems, pelvic pain, and incontinence. Special treatment is available for women who have these problems. Many who suffer from incontinence do so needlessly. A physical therapist may be able to help.
Some therapists specialize in the treatment and care of wounds. This is accomplished by the removal of unviable tissue (debridement), the application of special dressings and prescription drugs/ointments, and the use of ultrasound, electrical stimulation, and aquatic modalities to promote healing. Exercise and patient education are also routine components of a wound-care program.
There are dozens of different types of treatment interventions. Here is a partial list:
Therapist-assisted active range of motion. This is usually prescribed for gentle stretching or strengthening for a very weak body part.
The patient lifts or moves a body part through range of motion against gravity. AROM is usually one of the first modalities prescribed for arthritis.
Used to cause vasoconstriction (the blood vessels constrict, or decrease, their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but is also an effective pain reliever for even the most chronic pain.
The analysis of walking problems by visually examining the interaction of the low back and the joints of the thighs, legs, and feet during the various stages of walking, including initial contact, loading response, mid stance, terminal stance, pre swing, mid swing, and terminal swing. Many back, thigh, leg, ankle, and foot problems may be caused by, or manifest themselves in, subtle gait abnormalities.
Heat is recommended to decrease chronic pain, relax muscles, and for pain relief. It should not be used with an acute or “new” injury.
Medications are propelled through the skin by an electrical charge. This modality works on the physical concept that like charges repel each other; therefore, a positively charged medication will be repelled through the skin to the underlying tissues by the positively charged pad of an iontophoresis machine. Iontophoresis is usually prescribed for injuries such as shoulder or elbow bursitis.
Muscle contraction without joint movement. This is usually prescribed for strengthening without stressing or damaging the joint (e.g., arthritis, exercises to be performed in a cast, or right after surgery if recommended by the therapist/doctor).
Muscle(s) contracting through the ROM with resistance. This is usually prescribed for strengthening.
Hands-on therapeutic procedures intended to increase soft tissue or joint mobility. Mobilization is usually prescribed to increase mobility, delay progressive stiffness, and relieve pain. There are many types of mobilization techniques, including Maitland, Kaltenborn, Isometric Mobilizations, etc.
A gentle longitudinal/axial pull on the neck, either manual or mechanical, intermittent or continuous, for relief of neck pain, to decrease muscle spasm, and to facilitate unloading of the spine.
The application of electrical stimulation to aid in improving strength (e.g., the quadriceps muscle after knee surgery or injury). NMES is also used to decrease pain and swelling, and to relieve muscle spasm.
The patient or therapist moves the body part through a range of motion without the use of the muscles that “actively” move the joint(s).
The longitudinal/axial pull on the lumbar spine, either manual or mechanical, intermittent or continuous. Pelvic traction may be helpful for the relief of low back pain and muscle spasm.
Instruction in the correct biomechanical alignment of the body to reduce undue strain on muscles, joints, ligaments, discs, and other soft tissues. There is an ideal posture, but most do not have ideal posture. Therapists educate patients about the importance of improving posture with daily activities. Stretching and strengthening exercises may be prescribed to facilitate postural improvement and to prevent further disability and future recurrences of problems.
exercises that gradually increase in resistance (weights) and in repetitions. PRE is usually prescribed for re-education of muscles and strengthening. Weights, rubber bands, and body weight can be used as resistance.
A system of manually resisted exercises performed in diagonal patterns that mimic functional movements. PNF was initially used in developmentally and neurologically impaired patients, but now is used in almost every aspect of neuromuscular retraining, from athletes in sports facilities to the very weak in hospitals and nursing homes.
Therapeutic massage of body tissue, performed with the hands. Soft tissue mobilization may be used for muscle relaxation to decrease swelling, to decrease scar-tissue adhesions, and for pain relief.
This is usually prescribed for improving the strength and/or range of motion of the back or lower extremities, as well as for cardio-vascular endurance.
Exercise designed to lengthen muscle(s) or soft tissue. Stretching exercises are usually prescribed to improve the flexibility of muscles that have tightened due to disuse or in compensation to pain, spasm, or immobilization.
A relatively low voltage applied over painful areas through small self-adhesive electrodes. The electrical stimulation “disguises” or “overrides” the sensation of pain. It is a small portable unit, used in intervals, to control pain and reduce dependence on drugs. It is usually prescribed for relief of pain.
Ultrasound uses a high-frequency sound wave emitted from the sound head when electricity is passed through a quartz crystal. The sound waves cause the vibration of water molecules deep within tissue, causing a heating effect. When the sound waves are pulsed, they cause a vibration (rather than heating) of the tissue. The stream of sound waves helps with nutrition exchange at the cellular level and healing. Studies have shown ultrasound is helpful for ligament healing, and, clinically, for carpal tunnel syndrome and muscle spasm.