FREQUENTLY ASKED QUESTIONS
What is Physical Therapy?
Physiotherapy (also known as physical therapy) is a health profession concerned with the assessment, diagnosis and treatment of disease and disability through physical means. It is based upon principles of medical science, and is generally held to be within the sphere of conventional (rather than alternative) medicine.
What Happens During My First Visit?
During your first visit you can expect the following:
- Arrive at your appointment with your paperwork completed (you can download it from our website - see the paperwork or forms link).
- You will provide us with your prescription for physical therapy.
- We will copy your insurance card.
- You will be seen for the initial evaluation by the therapist.
The therapist will discuss the following:
- Your medical history.
- Your current problems/complaints.
- Pain intensity, what aggravates and eases the problem.
- How this is impacting your daily activities or your functional limitations.
- Your goals with physical therapy.
- Medications, tests, and procedures related to your health.
The therapist will then perform the objective evaluation which may include some of the following:
- Palpation - touching around the area of the pain/problem. This is done to check for the presence of tenderness, swelling, soft tissue integrity, tissue temperature, inflammation, etc.
- Range of Motion (ROM) - the therapist will move the joint(s) to check for the quality of movement and any restrictions.
- Muscle Testing - the therapist may check for strength and the quality of the muscle contraction. Pain and weakness may be noted. Often the muscle strength is graded. This is also part of a neurological screening.
- Neurological Screening - the therapist may check to see how the nerves are communicating with the muscles, sensing touch, pain, vibration, or temperature. Reflexes may be assessed as well.
- Special Tests - the therapist may perform special tests to confirm/rule out the presence of additional problems.
- Posture Assessment - the positions of joints relative to ideal and each other may be assessed
What Do I Need To Bring With Me?
Make sure you bring your physical therapy referral (provided to you by your doctor) and your payment information. If your insurance is covering the cost of physical therapy, bring your insurance card. If you are covered by Workers' Compensation, bring your claim number and your case manager's contact information. If you are covered by auto insurance or an attorney lien, make sure you bring this information.
How Should I Dress?
You should wear loose fitting clothing, such as gym wear, so you can expose the area that we will be evaluating and treating. For example, if you have a knee problem, it is best to wear shorts. For a shoulder problem, a tank top is a good choice, and for low back problems, wear a loose fitting shirt and pants, again so we can perform a thorough examination.
How Many Visits Will I Need?
This is highly variable. You may need one visit or you may need months of care. It depends on your diagnosis, the severity of your impairments, your past medical history, etc. You will be re-evaluated every 10 visits and when you see your doctor, we will provide you with a progress report with our recommendations. Sessions typically last 45- 60 min in length.
What Types Of Treatments Will I Receive?
There are dozens of different types of treatment interventions. Here is a list of some more common treatment interventions:
- Active Range of Motion (AROM) - 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.
- Active Assistive Range of Motion (AAROM) - therapist-assisted active range of motion. This is usually prescribed for gentle stretching or strengthening for a very weak body part.
- Gait or Walking Training - 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.
- Isometrics - muscle contraction without joint movement. This is usually prescribed for strengthening without stressing or damaging the joint (e.g., arthritis, or exercises to be performed in a cast, or right after surgery if recommended by the therapist/doctor).
- Isotonics - muscle(s) contracting through the ROM with resistance. This is usually prescribed for strengthening.
- Soft Tissue Mobilization - 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.
- Mobilization - hands-on therapeutic procedures intended to increase soft tissue or joint mobility. Mobilization is usually prescribed to increase mobility, delaying progressive stiffness, and to relieve pain. There are many types of mobilization techniques including Maitland, Kaltenborn, Isometric Mobilizations, etc.
- Proprioceptive Neuromuscular Facilitation (PNF) - 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.
- Posture Training - 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 people 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.
- Progressive Resistive Exercises (PRE) - exercises that gradually increase in resistance (weights) and in repetitions. PRE is usually prescribed for reeducation of muscles and strengthening. Weights, rubber bands, and body weight can be used as resistance.
- Passive Range of Motion (PROM) - 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).
- Stretching/Flexibility Exercise - 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.
- Cryotherapy or Cold Therapy - 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 also an effective pain reliever for even the most chronic pain.
- Neuromuscular Electrical Stimulation (NMES) - 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.
- Neck and Lumbar Traction - a gentle longitudinal/axial pull, either manual or mechanical, intermittent or continuous for relief of pain, to decrease muscle spasm and facilitate unloading of the spine.
- Heat - heat is recommended to decrease chronic pain, relax muscles, and for pain relief. It should not be used with an acute or "new" injury.
- Iontophoresis - 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.
- Pelvic Traction - 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.
- Transcutaneous Electrical Nerve Stimulation (TENS) - 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 - 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 of the tissue rather than heating. The stream of sound waves helps with nutrition exchange at the cellular level and healing. Studies have shown that ultrasound is helpful for ligament healing.
Can I Go Directly To My Physical Therapist?
All fifty states have some form of direct access. In some cases insurance doesn't cover your care unless you have a prescription from your physician, which is not typically difficult to get from your primary physician, if paying cash or with some insurance companies a prescription is not required.
How Does The Billing Process Work?
Billing for physical therapy services is similar to what happens at your doctor's office. When you are seen for treatment, the following occurs:
- The physical therapist bills your insurance company, Workers' Comp, or charges you based on Common Procedure Terminology (CPT) codes.
- Those codes are transferred to a billing form that is either mailed or electronically communicated to the payer.
- The payer processes this information and makes payments according to an agreed upon fee schedule.
- An Explanation of Benefits (EOB) is generated and sent to the patient and the physical therapy clinic with a check for payment and a balance due by the patient.
- The patient is expected to make the payment on the balance if any.
It is important to understand that there are many small steps (beyond the outline provided above) within the process. Exceptions are common to the above example as well. At any time along the way, information may be missing, miscommunicated, or misunderstood. This can delay the payment process. While it is common for the payment process to be completed in 60 days or less, it is not uncommon for the physical therapy clinic to receive payment as long as six months after the treatment date.
How Do I Choose A Physical Therapy Clinic?
These are some things you may consider when seeking a physical therapy clinic:
- The therapist should be licensed in the state and the more experience the better.
- The first visit should include a thorough medical history and physical examination before any treatment is rendered.
- The patient goals should be discussed in detail during the first visit.
- Care should include a variety of techniques which might include hands-on techniques, soft tissue work, therapeutic exercises and in some cases heat, cold, electrical stimulation or ultrasound.
- Do they have the equipment, skills and knowledge that can address your problem (If for some reason, we are not best suited to help you, we can help find someone who is)?
- 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?
- You should feel comfortable and valued.
- The therapist should provide the treatment.
- Can you briefly interview the therapist before the first visit?
- Ask your family and friends who they would recommend.
Is My Therapist Licensed?
Physical therapists (PTs) and physical therapist assistants (PTAs) and Massage Therapist are licensed by their respective states. They all require continued education training to keep their license current, so we are ever learning and growing in our field.
What Should I Do To Contribute To My Experience?
Communicate any concerns and feel free to ask questions during your session. Give feedback as to where and what you are feeling, so adjustments can be made and patterns can be uncovered. Be patient, lasting changes take time. Drink plenty of water, be mindful of how you feel before and after your session, maybe keep a log of any changes in: pain level, location or duration, changes in activity level or sleep patterns, any changes in muscle soreness or joint stiffness, elevate mood or energy levels to report back to therapist and to monitor progress. Be compliant with any home exercise program or instructions given by the therapist.
What Will I Have To Do After Physical Therapy?
Some patients will need to continue with home exercises. Some may choose to continue with a gym exercise program. Others will complete their rehabilitation and return to normal daily activities. It is important that you communicate your goals to your therapist, so he/she can develop a custom program for you. In general its important to continue with your efforts at home to maintain gains most important machinery needs maintenance and your body is no different.. You may also find occasional Massage work helpful which is offered at our clinic.