All You Ever Wanted to Know About Physical Therapy. Plus 9 Ways to Know If Your PT is Right For You.

photo by the one true b!x

If you’ve never been to a physical therapist, lucky you. That means you’re in pretty good shape. (Wanna share the good fortune with a friend?) In case you recently walked under a ladder, broke a few mirrors, and opened an umbrella in the house, I’ve written this guide to finding and making the most of physical therapy.

What is physical therapy?
The physical therapy (that’s PT in injured-human speak) specialty focuses on injury rehabilitation. The goal of PT is to improve physical functioning, like walking up a flight of stairs for someone with a meniscus tear, swinging a tennis racket for someone with shoulder tendonitis, or writing with a pen for someone with a hand fracture.

What does a physical therapist do?
Physical therapists are trained in the musculoskeletal system and will diagnose and treat injuries and muscle imbalances. A therapist’s toolbox includes exercise, physical manipulation (nothing crazy here; think moving a limb to improve range of motion), heat, ice, and some wackier devices—more on those later.

Where can you find a physical therapist?
Chances are, if you’re in enough pain to need a physical therapist, you’re in enough pain to visit a doctor. And though most states don’t require you get a doctor’s note before signing up for PT (my second didn’t need a scrip, my last did), it’s a good idea to see your doctor beforehand. Many will have a list of preferred therapists they work with and trust—mine did. Some physical therapists work in doctor’s offices or hospitals, and others work out of private practices or gyms.

What’s a typical PT session like?
The deal is different for every injury, but there are some things that should happen regardless of what throbs:

Consultation: When you first show up for PT, your therapist should sit down with you to find out what ails you, take a detailed history of your pain, and do a physical exam. It went like this for me: My therapist tested my knees’ range of motion, watched me walk, asked me to perform basic exercises, and checked my legs’ mechanics—diagnosis: slightly bowed legs, flat feet, and knees that roll in.

Follow-Up Visits: Each time you go to PT, your therapist will ask how your injury feels, check basic functions to monitor progress, and prescribe exercises. My physical therapist started each of my sessions with a little cold laser before she tested my knees’ motion by sliding it inward. Next, I’d complete all of the exercises she prescribed last time. If I had progressed since my last PT, my therapist would replace an old exercise with something newer, harder, and more effective. We’d end each session with electric stimulation and two freezing bags of ice.

What else will a physical therapist do to me?
Torture you. Just kidding. There’s good ol’ fashioned massage, but that’s just the beginning of all of the wonderful things a physical therapist can do for your injured area. My therapist used a cold laser on the backs of my knees, where I have Baker’s cysts. The device emits a low-level laser (you just feel the cold metal, not a burning Dr. Evil-type “lazer”) that’s supposed to get deep into an injured area to reduce pain and inflammation. Some physical therapists also use ultrasound, which emits high-energy sound waves, to reduce pain.

But the most awesome pain-busting device is the electric stimulation machine, or TENS unit (that’s Transcutaneous Electrical Nerve Stimulation to you). The idea is that electric pulses produced by the unit tame pain signals in the brain and tell the body to make more pain-zapping chemicals called endorphins.

The first time I used a TENS unit, I thought my physical therapist was planning to electrocute me. (Ice + electricity. You do the math.) She attached two sticky, square patches to each of my knees, plugged in some electrodes, and started to amp up the electric pulse coming from the handheld device. The feeling is funny at first—a mix between gentle tickling and the feeling you get from accidentally sticking your finger in a socket—but normalizes over 15 minutes.

How do you find a good physical therapist?
Physical therapists must take a national and state licensure exams in order to practice, but all licensed therapists aren’t created equal. Believe me, I know. Here are some tips for finding a good physical therapist:

1. Find someone who treats your whole body. Reader SB put it perfectly: “Physical therapists who only focus on your knees are the wrong ones. Many tracking problems come from other imbalances, i.e. hip, limited ankle motion and strength, upper back, etc. Fine someone who looks and works on your whole body.” Truth is, I’ve been to physical therapists who examined my knee, gave me a few exercises to perform … and that’s about it.
2. Make sure your physical therapist explains why you are injured. For me, weak hips played a roll, so my PT focused on strengthening them, too.
3. Find a physical therapist who watches as you exercise. It’s important that your therapist sees when you’re making mistakes and can correct you.
4. A physical therapist should challenge you. I’m not talking about a game of chess here. I mean you should progress over the course of your PT. If you’re still doing the same exercises in week two as you did on day one, you’re either not making any progress or your therapist is slacking off.

So, what are some warning signs of a bad physical therapist?
If your therapist does any of the below, turn around and hobble out that door as fast as you can!

1. Your physical therapist spends more time talking to her coworkers than she does to you.
2. Your physical therapist speeds through your checkup like she’s trying out for NASCAR.
3. You feel pain during any exercise—and your physical therapist doesn’t seem to care.
4. You feel uncomfortable with your physical therapist for any reason at all.
5. Your therapist gets annoyed or angry with you if you have trouble doing an exercise.

Want to learn more about PT—or find a physical therapist near you? Check out the American Physical Therapy Association’s Web site.