Three types of physical therapists you should avoid - Be My Healer
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Three types of physical therapists you should avoid - from a physical therapist

I am a doctor of physical therapy. The reason I am writing this post is not to accuse, but to help people find the best available care possible.

If you are shopping for water a heater or a mattress, as a consumer, you will likely do your homework online, familiarize with brands, compare specs, and read reviews from other customers. You may also drop in the local retailer to ask for answers and recommendations based on your situation and concerns. After all, you want the best for your money.

​As patients, our choices for providers are limited by the insurance we carry, or lack of insurance in some cases. This is tragic and sometimes misleading. When we are looking at specific types of health care providers, such as physical therapists, there is a lack of opinion there. 

There is a large gap in skills, experience and motivation in most professions. This is also true for the field of physical therapy. A lot of doctors and surgeons consider physical therapy as "benign." Well, there are "benign" PTs. And then, there are "superpower" PTs. If you are serious about ridding your pains, you want to increase your chance of finding the "superpower" physical therapist in your area.

What does a physical therapist do? - A general overview

According to the  American Physical Therapy Association

Physical therapists can teach patients how to prevent or manage their condition so that they will achieve long-term health benefits. PTs examine each individual and develop a plan, using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. In addition, PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness- and wellness-oriented programs for healthier and more active lifestyles.

Physical therapists provide care for people in a variety of settings, including hospitals, private practices, outpatient clinics, home health agencies, schools, sports and fitness facilities, work settings, and nursing homes.​

APTA

The setting we are specifically discussing is the outpatient orthopedic setting. If you live independently and suffering from pain, injury or functional weakness, this is where you will be referred your doctor ( or in many states, yourself).

So, what do we actually DO? Like physically, DO. Some people think we connect people to a TENS units and set a timer. Other people think we are like a fitness instructor, pacing you through a list of exercises. In theory, this is a good list of the things we are meant to perform:

  • We exam and diagnose your pain: you know where you hurt, and it is our job to find out the structures causing the pain and symptoms, prescribe treatments and estimate prognosis
  • We treat you manually: we put our hands on you, feeling your muscles and joints. We massage, Gua Sha, release, and stretch tissues to promote better function and healing
  • We play with your joints: we "crack" your spine and mobilize your joints. (Note: in some states, spinal manipulation rights are under legal review and restrictions),
  • We educate, and educate, and educate: after feeling your tissue and joints, understanding your history, and getting to know you, we can't help but to yack on and on. We will tell you what we found, what we did, what you should do, and what your family can do to help you to heal faster.
  • We prescribe exercises: and modify them for you, so that you are exercising safely and effectively.
  • We give you homeworks: and expect you to do it. It's like following your medication intake schedule; home exercises are drug-free prescriptions, all for a good reason. 
  • We prescribe modalities: That is the TENS, heat, ice, ultrasound or laser. 
  • ETC: I may have missed something ...

Okay, now for the information you're here for...

​First type: Physical therapist who does NOT plan to lay a finger on you. (Unless you do not want to be touched)

I know this sounds creepy. Have I gotten your attention?

Manual assessment and treatment, combined with experience and skill, is the most powerful type of treatment you can receive from PT to kick-off your healing. First, identifying the problematic tissue or joints, and correcting it on spot, will lead to the most immediate result in pain relief. You know you are in good hands if your therapist can "wow" you with ​fast targeted hands-on techniques, improving your pain by 50-70%. Secondly, the healing touch of a practitioner can re-assure patients and build trust. And the patient's expectation and mindset can affect the prognosis of treatment by a significant margin.

manual therapist

Not all those therapists who perform manual work are equally skilled. You may come across therapists who can work on you for 3 months straight, have it feel really good, but not actually improve your condition by much. However, if your therapist is not even willing to manually treat you, you are missing out (oh I don't know how to put this) on the main course! Without manual work, lots of conditions will improve very slowly through stretching and exercising, but some may have no improvement.

The big question is: why would some therapists steer away from manual treatment? The answer is likely due to insurance reimbursement. Most insurance pay much less for manual treatment for the same amount of time. That means: I can perform manual treatment on you, risking hurting my hand, wrist, or back, or I can sit back and instruct you through exercises and be more profitable. This difference in price is to prevent treatment focused on manual work completely, which will result in weak and less independent patients, though they may feel good during the sessions.

So, if your therapist is willing to do what's right and necessary, regardless of the reimbursement price, you know he or she cares about you and helping you feel better. These therapists are highly sought out by physicians, because they want their patient to be in good hands. "Superpower" physical therapists practice among those whose are doing manual treatment. 

Ask for manual physical therapist when you are shopping for PT. Read their website and social media profile if needed to get a sense of their opinion on treatment style. Most skilled manual therapists are proud of their practice style and will sound passionate about it if you ask.

Type two: physical therapists who do not assess pelvis and sacrum alignment (if your pain is in lower back)

Now, we are about to get a bit technical. This part of article is for those with lower back and hip pain.

Misalignment in the pelvis and sacrum can cause severe pain, especially with movement. Lots of people fail to identify this cause of pain in the lower back and buttock region. Yet, SI (sacroiliac) joint dysfunction is not that uncommon for the population.  However, assessing those joints requires some pretty nifty skills and experience. Once properly treated, the pain will feel significantly less immediately for majority of patients who suffer from SI joint dysfunction.

However, in order to be fully assessed and treated, even to rule out this dysfunction, we want someone who takes this issue seriously enough to learn and practice these skills. Practice makes perfect. Every therapist makes decisions regarding what and how much they are willing to invest in new and advanced skills. 

You can call in the clinic of your interest and ask specifically for therapist's opinion on pelvis and SI alignment and their experience in these cases.

Type three: Physical therapists who do not produce results

Depends on the severity of your condition, you may need to continue PT for one session, or many months. You should not attend PT forever or until your insurance cuts you off. 

A good PT will be able to estimate a length of your treatment. (6 sessions once a week, 12 sessions twice a week, or ​18 sessions starts with twice a week, something like that.) You may experience aggravation of your pain or injury, and stay a few sessions more. Or you may be a trooper and experience no symptom faster. 

During the course of treatment, you will experience improvement in symptoms as you go. You may feel less pain, more endurance in daily life, and more functional tolerance through exercises. That's why it is important to keep track of your improvement, such as "I can get in and out of my car with no pain now" or "I can reach the top of my head to brush my hair now," or "I can sleep through the night now."

If you are not experiencing any improvement at all by visit 6, your therapist should be as upset as you are, if not more. I would normally research articles and textbooks, even YouTube videos on the weekend and evenings, to find clues to explain for my patient's lack of improvement. ​I would prepare 3-4 different treatments to try in the following sessions to test out theories and finding the missing pieces. Sometimes I was successful, others not. By visit 8, if you are still haunted by zero improvement, you should initiate a serious talk. You should either return to your doctor seek other options, or get another opinion from a different therapist to see if you can hear something new. 

Do not let anyone waste your entire approved visit before asking questions.

You should ask your therapist on your first visit to estimate the length of treatment based on his or her assessment. Stay in tune to the treatment progress and do all your home exercises. (If you don't do your exercises, you will be the one to blame. Sorry)​. Be open to your therapist if you need to find other options. (Please don't no-show to your appointment. This will hurt your relationship with all your doctors, and your no-show may go on your insurance record.)

Your therapist may have all done everything possible to help you, yet you receive no result. This is true for all types of treatment under the sky. However, you want a therapist to care about you enough to maximize your chance under his or her care, and be willing to give you up hoping for the better.​

Final Thought: Just because you were treated by a PT before and your experience was less than impressive, please keep an open mind. A good therapist takes pride and responsibility in their career, skills and experience. Next time, when your physician hands you a referral for PT, do not head straight to the clinic on the top of the referral. Take your time to shop around for a therapist that matches your philosophy and expectations. Your extra research may make a ton of difference in your recovery and healing experience.

Thank you for reading, and I hope you find this post helpful.

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