Ask the Expert: When To See a Physical Therapist

In honor of National Physical Therapy Month, HSS Physical Therapist Valerie Papanikolaw answers questions on when to see a physical therapist.

Q1. Which chronic ailments do physical therapists treat?

Physical therapists are licensed to treat a variety of ailments of a musculoskeletal origin. The most common chronic issues physical therapists treat are related to the normal aging process and “wear and tear” on our bodies, principally osteoarthritis.  Osteoarthritis (or OA) can affect any joint in the body that has been exposed to overuse for many years. The most common areas of the body affected by osteoarthritis are the knees, hips, and spine. Although physical therapy cannot prevent the onset of osteoarthritis or reverse its effects, general strengthening and flexibility training will help to abate the aging process and slow its progression, all with the end goal of improving function and participation in daily and leisure activities.

Another branch of chronic ailments that physical therapists often see is autoimmune diseases, such as rheumatoid arthritis and systemic lupus erythematosus. Although the cause of these diseases is autoimmune dysfunction, they manifest in musculoskeletal impairments. As a result, physical therapy becomes an integral part in the management of these diseases and especially when “flare-ups” occur.  When symptoms become exacerbated, physical therapy can help to lessen the functional impact and decrease pain for improved quality of life.

Q2. Do I need to see my doctor before seeing a physical therapist?

Regardless of context, it is always advisable to see your doctor if you have any new or recurrent medical concerns. However, in many states you can see a physical therapist without seeing your doctor first. Depending on if the state has Direct Access, you may not need a prescription from your doctor before seeing a physical therapist. Physical therapists are trained to look out for the possibility of symptoms originating from a disease process outside of a musculoskeletal origin. For example, many cardiac, respiratory, and gastrointestinal disorders can cause referred pain to various parts of the body that often mimic the pains of arthritis or a musculoskeletal injury. Certain medications can also have side effects that impair muscle, tendon, or ligament health. If there is any doubt, the physical therapist should refer you back to your physician or to a specialist for further examination and testing.  Nonetheless, consulting your physician before seeing a physical therapist is always advisable.

Q3. What sorts of acute injuries require physical therapy for recovery?

After any acute injury, it is important to first consult with your physician before seeing a physical therapist. Many of the acute injuries seen by physical therapists are ligament sprains (i.e. ankle sprain), muscle strains (i.e. hamstring strain), or inflammation in a tendon (i.e. Achilles tendonitis). These types of acute injuries can occur in patients of any age and activity level.  Back pain is another common complaint warranting a physical therapy referral.  An acute onset of back pain can be precipitated by variety of activities, and its cause may be due to multiple factors.  Back pain can be caused by an injury to a back muscle, ligament, vertebral disk, or to the vertebral bone itself. Therefore, seeing a doctor after any acute injury is always recommended to ensure the injury has been identified correctly so it can be treated most effectively.

Q4. What should I expect during my first visit?

Your first physical therapy visit is generally broken down into three parts: History, examination, and evaluation.

1)    During the first portion of your initial evaluation, the physical therapist will take a thorough history of your current condition (i.e., what caused your current complaint, what makes the pain better/worse, what functions in daily life are most impaired), your past medical and surgical history, any medications you are taking, and the results of any previous medical testing you have undergone. The physical therapist will also ask what you hope to achieve from physical therapy; each patient’s goals are subjective, and your treatment should be centered on the activities to which you want to return.

2)    The second portion of the initial visit, or the examination, will consist of the physical therapist taking objective measurements specific to the area of injury. These tests will assess your range of motion, strength, balance, and integrity of ligaments, nerves and other structures.

3)    The final portion of the initial visit is the evaluation. This entails the physical therapist compiling the subjective (history) and objective (examination) findings and coming to a clinical physical therapy diagnosis of the cause of your symptoms. From this conclusion, the physical therapist will determine your plan of care and the interventions necessary to achieve your short-term and long-term rehabilitation goals.

Q5. What are some questions I should be asking?

Much of a physical therapist’s practice involves educating patients, so asking questions helps empower you and improve your rehabilitation experience.  Increasing self-awareness and knowledge about your condition facilitates becoming an active participant in therapy.  After your initial visit, your next questions should involve what can be done at home to help achieve your goals. Your physical therapist will give you a home exercise program. Make sure you ask the questions necessary to fully understand the technique and objective of each exercise.  It is essential you are compliant with your home exercises outside of your physical therapy sessions to maximize your progress and improve results.

You should also talk your physical therapist about body mechanics to ensure your everyday movements are not exacerbating your symptoms.  For example, if reaching overhead or lifting a bag consistently hurts you, demonstrate these movements to your therapist so he/she can teach you new ways to move in a biomechanically safe and less painful way.  Your physical therapist can also help you assess if your workplace setup is negatively affecting your posture.  If sitting at your computer for prolonged periods of time makes your symptoms worse, ask what changes can be made to your office setup to keep your body in a neutral (and pain-free) alignment. Furthermore, it is advisable to ask if there are any activities to modify or avoid temporarily to ease your pain and symptoms.  Never hesitate to ask your physical therapist questions an educated patient is a successful patient!

Valerie Papanikolaw is a physical therapist in the Rehabilitation Department at Hospital for Special Surgery.  She received her Doctorate in Physical Therapy from Quinnipiac University.  She has worked on the Acute Care service providing post-operative treatment and education to adults and is now caring for our smallest patients as a member of the Pediatric Rehabilitation team in the CA Technologies Rehabilitation Center at the Lerner’s Children’s Pavilion.  Valerie is also the Center Coordinator of Clinical Education, serving as a mentor for our graduate students and volunteers throughout the Rehabilitation Department.

The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.