Debunking some myths about physical therapy

I know more than I should about physical therapy.

As a clumsy person with a chronically limited attention span and a substantial lack of foresight, I nonetheless undertake a lot of activities where those failures are glaring — climbing unsteady ladders and carrying uneven or excessive loads — or winter biking in icy conditions. (Thanks again, Lewes Fire Department ambulance crew, and again, I’m sorry.)

PT has become a rite of passage as we age and deal with pain, physical limitations, surgery and/or mishaps. 

And as a regular patient, I’ve had success, but also learned there are misconceptions. Perhaps my experience can provide some clarity about PT.

Myth 1. It’s a waste of time.

About 50 million Americans see physical therapists annually, and about 80 percent are pleased with the results. Even more admit it mitigated their level of pain and appreciate that it’s the lone medical treatment where they play an active role.

By one calculation, the risk/reward balance for PT is considerably better than for surgery, where some estimates say 25 percent of people are dissatisfied.

PT can replace surgery or use of pain medications and dramatically cut healthcare costs.

Myth 2. It’s just for injuries.

Tessa Meyerkopf, PT, DPT, of Beebe Physical Rehabilitation said therapists address many conditions, including pelvic floor dysfunction, chronic pain, vertigo, neurological disorders and stroke recovery. She said PT can be beneficial preoperatively, prior to a joint replacement surgery, for instance, to add strength and address range-of-motion issues.

“Balance and fall prevention are major reasons for physical therapy, but not everyone is aware we treat vestibular disorders, which can cause symptoms such as dizziness, vertigo and balance issues,” she said.

Myth 3. It will hurt.

Meyerkopf said while PT shouldn’t be excessively painful, moving and exercising sore body parts is likely to be uncomfortable, and they might feel tender after a session.

“The pain should feel similar to what you feel with a workout,” she said, noting that patients should speak up if something hurts.

“We always ask how long they were sore. Up to 48 hours is normal, especially after the first session or when starting something new,” said Jen Andrew, clinic director at the ATI Lewes and Rehoboth clinics.

She noted that patients with varying fitness levels will respond differently to movement and exercise.

“Our model is simple: Every patient should walk out feeling better,” said Sim Kaur, a certified sports clinical specialist at Elite PT in Rehoboth and Harbeson. “While some soreness is expected when muscles are being challenged appropriately, patients should never leave a session in more pain.”

Myth 4: Are physical therapists really professionals?

Their casual dress and “therapist” title might lead you to wonder about credentials, but Kaur pointed out that for the last decade, a doctorate is required along with rigorous training about the body, mind and data.

As undergraduates, PT students take anatomy, physiology, biology, chemistry, physics, psychology and statistics, then spend three years in research and clinical work, and complete both national certification and state licensure exams. PT assistants get an associate’s degree, and must pass the national and state exams.

Myth 5: They have one plan.

Work with a physical therapist should be among the most collaborative you’ll have with a healthcare professional, Andrew said, noting that you should look for a firm that meets your specific needs for things like dry needling or hand treatment — even suitable hours, locations and atmosphere.

“They should listen to your concerns and individualize your program based on your needs, abilities and lifestyle,” said Meyerkopf. 

Good therapists should check regularly for four things: range of motion, muscle strength, real-world activity capabilities and outcome measures specific to your condition.

“A great physical therapist works with you to address your needs,” said Kaur. “You should see positive changes within a week, and if not, after two to three visits, they should be consulting with others, like physicians or colleagues. Be an advocate for yourself if things aren’t improving.”

Myth 6. More of the same repeated exercises.

While exercise plays a key role in long-term success, Kaur said it's important to reduce pain and improve function with manual techniques like massage, joint mobilization and stretching.

Therapists vary use of targeted exercises, manual therapy, hydrotherapy and electrical stimulation tailored to individual patient needs.

Myth 7. After a visit, I can do it at home.

Naw. Ongoing therapy can evaluate you and change practices to meet your specific needs.

“Most clients don't do their home exercise program, which is important to bridge the gap between sessions and make gains faster,” said Andrew. “Also, people only give PT a handful of sessions, expecting immediate results, which rarely happens.”

Myth 8. I need a doctor’s referral.

All 50 states now allow you to get physical therapy independently, but there may be limitations on the service without a referral, Andrew said. You should check on insurance coverage without a referral, too.

Kaur noted that insurers are reducing reimbursement rates, causing some clinics to increase the number of patients they see in an hour. “That just leads to less time spent with each patient, limiting the ability to make real, lasting change,” she said.