Get The Most From Your Physical Therapy Treatment
See the Same Physical Therapist at Every Session.
First and foremost, you need to see the physical therapist–not the physical therapy assistant, not the athletic trainer, and not a massage person. Shrinking physical therapy insurance payments have created innovative methods of providing “physical therapy” with less expensive employees. A consistent set of well-trained eyes and talented hands is one of the best ways to assure that every session of your physical therapy treatment is beneficial. Communication between co-treating physical therapists is often poor. I know it should be recorded in the clinic notes, but today’s documentation is written to optimize billing and not patient care. You will get the best results with consistent communication with the same therapist.
Do Not Wait.
The sooner you get to the physical therapist the better. The earlier we can intervene with physical therapy treatment, the more likely we are to prevent deconditioning, the development of hypersensitive pain pathways, and fear of activity. Lower back and neck pain patients that begin therapy within fourteen days of pain onset have better outcomes and spend much less money. Very often pain is 50% better after one session of therapy. The state of Michigan now has direct access and you can see a physical therapist without the need for a physician referral.
Do Not Miss a Scheduled Therapy Sessions.
After the initial evaluation, your physical therapist should discuss a treatment plan and goals for your recovery. Make every effort to attend as scheduled. The primary reason is that all of the studies on rehab success document that consistent attendance is key. The second reason is related to insurance coverage. Medicare and private insurance are paying less and less for outpatient physical therapy. Your insurance company will authorize a portion of your treatment and base further authorization and reimbursement on your attendance to that plan of care. I know you were told that your insurance covered sixty sessions a year, per diagnosis, for eternity. What they did not tell you is that your physical therapy benefits are subject to approval by a third party–someone on a phone, many miles away. That person does not get paid more money to say “Yes”. Don’t give them the easy reason to say “No”.
Perform Your Home Exercise Program.
Your recovery is dependant on what you do outside of formal therapy. You will spend two sessions a week with the physical therapist. The rest of the week you need to perform a home exercise program to resolve pain, remodel tissue and retrain movement. Most mechanical orthopedic pain problems require two sessions a day of home exercise. Many spinal problems will require you to perform an exercise every two hours. The commitment is for three to six weeks. Very often, people with pain problems continue to suffer because they are unable or unwilling to perform a consistent regimen of rehab exercise.
Eliminate the Cell Phone.
Physical therapy is a patient participation activity. You need to be able to communicate with the physical therapist, understand the pathway of progress, and learn some new movement skills. Physical therapists have a limited amount of time to problem solve and then complete copious data entry. Cell phone distractions inhibit progress. Research has demonstrated that the mere presence of a cell phone increases anxiety and decreases learning capacity. One more bit of advice- find another therapist if he or she answers or carries a cell phone during any aspect of your care.
Modify Your Lifestyle as Requested by the Therapist.
Very often, it is what you don’t do that has the biggest impact on your recovery. For a period of time, you may have to change your posture, modify fitness activity, or limit household chores. This may take two weeks or two months, but it is often the only path to success. The mechanical irritation that brought you to the clinic has to be managed in order for your body to recover. Pain / disability will linger for months in the physical therapy patient unwilling to make alterations in lifestyle.
Send the Evaluation Survey at the End of Your Therapy Treatment.
The trend in the physical therapy business world is to seek patient satisfaction surveys after the first session of care. Your e-mail Net Promoter Score (NPS) is the name used by corporations to market the clinic to future physical therapy clients. Corporate officers often have bonus arrangements based on higher NPS numbers. The entire clinic staff has been trained to elicit a high NPS score from every new patient. Tell them you are going to wait until you have finished all of your therapy sessions and have traveled through the billing process. You will get better treatment when they are waiting for that NPS.
Do Not Attend in an Over Medicated State.
Many physical therapy patients have been given medications to help manage pain symptoms. They are taking a muscle relaxer, non-steroidal / steroidal anti-inflammatory and some type of opiate medication. Very often these medications are mixed with sleep medications, anti depressants, and diuretics. The latest “alternative pain management” method is the pre-treatment bong blast. Over medicating hampers your capacity to remember instructions and achieve better neuromotor control. Changes in pain behavior are the therapist’s clues that things are getting better or worse. Patients on too much medication are often unable to help with an accurate reporting of pain behavior.
Do Not Ask the Physical Therapist for Medications, Imaging Tests, or Work Restrictions.
Your physical therapist has no ability to help you with any of these concerns. Our input to your doctor, employer, rehab nurse, or case worker is limited to the physical therapy evaluation and progress with ongoing care. Medications and imaging tests are to be directed by your doctors. Work concerns are to be directed to the physician and rehab nurse.
Emphasize the Active Aspect.
Become well versed in an active program of rehabilitative exercise that has been prescribed for your specific needs. Learn as much as you possible can about activity modification, posture correction, and rehabilitative exercise. Work with the physical therapist on becoming proficient in your home exercise program. You should continue to improve after completing formal care, so ask for appropriate home exercise progressions. Heat, ultrasound, ice, electrical stimulation, taping, massage, and the ever-growing litany of passive modalities have a place in physical therapy. That place is small and unimportant.
Michael O’Hara PT, OCS, CSCS