When I was studying for my Doctorate in physical therapy, 9 out of 10 of my parents’ friends (mostly in their 50s and 60s, therefore more experienced with body aches than my peers) were utterly excited for me, confiding that they loved their physical therapist, and they were much better.
Another approximately 1 in 10 raised an eyebrow, and slowly let it be known that they (or their significant other) were disappointed by at least one PT. Usually the disappointment stemmed from the therapist misdiagnosing a major problem (or otherwise over-extending treatment), treating the wrong area, or causing the patient more pain.
One of the things that exacerbates the issues above is lack of individual attention to patients by physical therapists (usually due to clinic policies).
It’s safe to say that physical therapy as a whole helps many many patients, however, you’ll have a better chance of finding a skilled PT and PT helping you if you carefully consider your own specific needs and goals first, and follow some of the guidelines below.
You’re the Boss.
Before you read on, remember that you are your own “CEO” of your health team. You have hiring and firing capabilities (i.e. not only do you get to choose your practitioners, you don’t have to go back to any medical practitioner you didn’t jive with), but more importantly: you also have management, communication and follow-through duties.
Carefully think through the “hiring” of your medical team, “manage” those you have hired by giving them all information necessary in a concise way, kind and clear feedback around what is working for you, and follow through with the requests they make of you.
Bring a notepad or a recorder to your appointments so that you remember any suggestions, practice your exercises the same day they are issued to you so that the small details are fresh in your mind, and ask questions or share insights at the beginning of each session.
You have the great privilege (as well as responsibility) of being the main liason of all of your health care needs.
With no further ado, here’s what to consider when you need to pick a physical therapist :
Physical therapy is (often) not a quick fix. You’ll rarely reach your fullest goals in less than (for example) 5-6 visits because you need to both undo soft tissue / physiologic and anatomic changes from your injury and strengthen and stabilize to make sure the issue doesn’t return. I’ve successfully treated patients in just 1-2 sessions, but I expect many shoulder or chronic (>6 months) pain problems to require a minimum of 10 visits, for example. I don’t keep people on as patients past the point where they are making meaningful changes, but I do keep basic healing timelines in mind.
Post-surgical patients often have a 3-9 month healing timeline and need to dole out PT visits throughout. This isn’t a greediness on the PT’s part, but a realism about full return to the patient’s “prior level of function”, if that is their goal.
Given that you’ll need a few appointments, if your time is ultra-limited (i.e. you honestly would only be able to attend appointments before work or after work or only on Tuesdays and Thursdays after 4pm), convenience has to be your #1 decision-making factor. Look for a physical therapist who is near you and/or is in a setting where s/he may scheduling more than one patient at a time (or overlap patients somewhat) or has late or early hours. Or ask if your workplace can accommodate a different schedule.
The clearest way to assure that physical therapy won’t work is if you can’t schedule it, can’t keep your appointments, or chronically show up 12 minutes late to your 30 min appointment due to traffic. (Also if you don’t do your home exercises — more on that later).
Another component of physical therapy convenience is staying within a system that houses all of your medical information. This is more important if you have very complex medical background (multiple surgeries, systemic diseases). I currently spend about 20 hours a week working within the region’s largest medical network. Our computer systems allow me to see a patient’s x-rays, MRIs, image reports, surgical reports, prior doctor’s notes and medications, prior hospitalizations, etc all form the laptop I have in the examination room. However, I can only see those if each occurred at a network facility. If you have a complex medical history, this could be a key mandate to assure treatment is coherent.
If your circumstance is more straight-forward, then only consider this kind of convenience if you deem it truly important. You can (and should) always bring along appropriate x-ray reports, your prior home exercises, and notes you took from other doctor visits to your PT initial evaluation and follow-ups.
2. Quality of CLINIC
My strong preference is for patients to seek out clinics that only schedule 1 hour (or longer) initial evaluations (first visit) and at least 30 minute follow up visits one on one. Sadly, this is becoming more rare but without it, quality of care goes substantially, no matter the skill of the practitioner.
I’ve worked as a physical therapist, physical therapy student or a physical therapy tech in 9 different outpatient clinics. From what I’ve seen, the quality of patient outcomes is not just dependent on the physical therapist (outside of the patient herself). It is also dependent on how the clinic operates as a whole.
I am much more capable of being a kick-ass PT when my entire team is functioning smoothly: when scheduling is easy, reminder calls made, when the front desk alerts me that my next patient is ready or that someone has cancelled, when the electronic medical records are easy to navigate so that I can quickly remind myself of what has worked and what hasn’t, when I don’t have to be bogged down with personally scanning and faxing and looking into insurance reimbursement, and when I have brilliant peers I can bounce ideas off of if I get stumped… you see the idea. The same will be true for any skilled professional.
I’m also much more capable of creating fabulous patient care when I have longer sessions. This is why, when I treat patients through my private physical therapy practice, I schedule 1 hour one on one each and every time. Patients simply get better faster.
The physical therapy degree is a doozy (more time than law school!). It prepares us to be very general: so we may have the fluidity to work in outpatient orthopedic settings, neuro or geriatric settings, acute care and even wound care anywhere in the world.
I don’t believe a physical therapist must specialize narrowly in order to be a great PT, but I’ll tell you about my personal experience, which will reflect my professional philosophy: the time I spent working in inpatient rehabilitation and acute hospital settings has made me a better PT period, even in outpatient settings. That said, for the past 5 years, I have purposefully only worked in outpatient rehabilitation, which means there are many diagnoses that I’ve seen over and over again. Every diagnosis that I’ve treated still allows people to live in their homes and mostly go about their normal lives. This mimics the population that shows up to yoga classes, and this is on purpose so I can blend my two loves.
I don’t have the kind of specialty recognized within the physical therapy world other than general orthopedics, but I came to PT with 10+ years experience as a yoga and meditation teacher, have achieved the current highest standard of yoga teacher certification (E-RYT 500) and I continue to deepen my yoga and meditation studies, which inform me as a physical therapist tremendously. Movement arts teaching (yoga asana and occasionally mat pilates) since 2001 means one of my greatest therapeutic strengths is in teaching intelligent clinical exercises. I have worked alongside five different Certified Functional Manual Therapists (CFMTs), and have primarily taken continuing ed courses on the subjects of functional movement, fascial release, and courses with the Institute of Physical Art (that certifies CFMTs).
This gives a coherent and holistic educational background focused on functional capacity, body weight movement, meaningful myofascial release and other manual techniques sustained by practical / portable exercise and mindful attention to pain management.
I treat anyone from age 5 to 105, athletes to couch potatoes, and everyone in between, and I love it. My patients keep me on my toes, always learning more about the human condition.
4. Communication Quality
It should be easy to shoot an email off to your PT as questions or emergencies arise outside of PT. It should also be ok to email your PT with a few questions before you schedule an appointment: “Have you treated my condition before?”, “Will you be able to help me get back to running even though my last PT said I was not allowed to run again?”.
This is a personal preference, but I strongly believe in sharing my email address with my patients. I’m not in either of my clinics daily, and I likely won’t get voice memos in a timely manner. In addition, I suspect that most patients are less likely to call than to email. I want it to be easy for a patient to communicate to me if an exercise is causing more pain or if they are having trouble scheduling and need to be on my waiting list. Some things are just easier to share by email also, like the names of my favorite orthotics, or a gym machine that a patients wants to know if it’s ok to use.
Another component of communication: I need clear patient histories in order to be efficient. I always appreciate when a patient is honest with me and lets me know if they don’t yet notice a difference, but are diligent with their home exercises or if they are not doing their exercises.
5. BONUS TIP: Plan in advance for daily self-care
Occasionally a patient is so blastedly busy – with a legal case (so many attorneys in my town) or being a new parent, travel, etc., that they deem it nearly impossible to complete the tasks (exercises mostly) that I assign. But in most situations, it’s a matter of making the time to do your “PT homework” as I call it. Our brief 30 minutes or even a luxurious 1 hour together weekly is going to accomplish much less when the other 6 days and 23 hours undo our good work.
Your daily home exercises help continue the efforts from our sessions, saving you time over the long run! I see miracles happen when patients are diligent with their prescribed exercises.
Secondly, healing through physical therapy cannot be divorced from the basics:
- are you drinking enough water,
- eating enough fiber and protein,
- getting up from your seat frequently
- and sitting up straight when you do sit?
- Do you get enough sleep?
- on a firm-enough mattress?
There you have it — my big suggestions for being a physical therapy patient and finding a great fit for a physical therapist.
Quality of Clinic (one on one?)
Specialty that serves you (ex: my specialties are yoga and orthopedics)
If you have a craptastic experience with a PT, I’m sorry. In many settings we are very limited in our efficacy by the insurance / corporate / hospital model. Exercise prescriptions are not lucrative, so there is little research funding in my field and many unknowns around prognosis, and progressions.
In real dollars, PTs work harder than they ever have to meet “productivity standards”, and make less with more burden from educational debt than ever before. Some work weekend shifts or see private clients in addition to demanding full time jobs, and workplaces rarely invest meaningfully in our continuing education anymore. Although this may sound like a strange segue, these factors stressing the lives of physical therapists absolutely affect patient care.
Keep hope alive anyway. Here’s the full summary:
- Know what you want from PT
- Seek recommendations from friends, and seek reviews on Facebook
- Find someone relatively convenient, where you will be able to arrive on time or early
- Communicate your needs to your PT
- Use email to do the above if appropriate
- Do your home exercises !!!
- Be the Chief Executive of your health
There is a total art as well as science to what we do as Physical Therapists, a lot depends on the setting and the very personal rappoire you have with your PT. Heal well and let me know how it goes!