Choosing a Physical Therapist

Physical Therapy is another profession that varies with individual practitioners and choosing one that is the right fit for you can be challenging. Our friend and colleague Kendra Hatch, MSc PT has outlined some things to look for when choosing a PT. Her post, like my Choosing a Chiropractor post, was edited by my English savvy wife, and received no grammar, spelling or other edits. I cannot say the same for my post.

(She also helped us out with another very common question, what is the difference between a Chiropractor and a Physical Therapist? To read, click here.)

Exercises

Exercises should be a mandatory part of any physical therapist’s treatment. Not only do they have an important role in helping to maintain progress that a patient makes within a treatment, but they also help to prevent future injuries from reoccurring. A physical therapist should provide a patient with a progressive exercise program that the patient can complete at home, as well as exercises that may involve the use of equipment in the facility during the treatments. You can just ask the physical therapist if they will be providing a patient with a home exercise program that will be advanced as the patient improves.

Manual Therapy (hands-on treatment)

In private practice, physical therapists should spend some of the treatment time using a “hands-on” approach. The goal of manual therapy is to decrease pain and restore mobility to restricted joints and muscles. Depending on the injury, this may include techniques such as:

  • Joint mobilizations: gentle, oscillatory movements within a joint
  • Joint manipulations: a high-velocity thrust that may create a painless “popping” sensation in the joint
  • Soft tissue mobilizations: this includes soft tissue massage and deep tendon/ligament frictions

You can ask the physical therapist if manual therapy is a part of their practice. Many different physical therapists have taken advanced courses to further their manual therapy skills addition to their Physical Therapy degree or masters; I would look for a history of some of these courses in their background. To me, the most important courses that a manual physical therapist is likely to have taken include completing some of the certification levels for the Diploma of Advanced Orthopaedic and Manual Manipulative Physiotherapy (there are 5 levels…usually someone who has completed Level’s 1 and 2 has a good manual therapy foundation). Jim Meadows also has a great spinal manipulation program that many physical therapists have taken.

Education

An important part in helping a patient understand why an injury occurs and how to prevent it from having it happen again is giving them appropriate education. This may include advice on positions to avoid, proper sitting posture, proper lifting techniques, how to gradually return to sport/activity etc. A Physical Therapist can also help analyze someone’s running and walking patterns and give advice (along with appropriate exercises) on how it can be improved. A physical therapist should also understand and recognize when a patient may require the use of a brace, a gait aid (such as a cane), or foot orthotics, and be able to refer the patient to the appropriate person that can help them with this.

Modalities

Every private practice physical therapy clinic should have electrical and thermal modalities available to use with a patient (although not every patient requires the use of these). The goal of using modalities may be to help decrease pain, decrease inflammation, or restore circulation to an area. Examples of electrical modalities include ultrasound, TENS (transcutaneous electrical nerve stimulation), IFC (interferential current), and mechanical traction (for spinal injuries). Examples of thermal modalities include the use of heat and ice (often in conjunction with one of the above machines at the same time).

Acupuncture is a modality that is used regularly by a lot of physical therapists. It is a process that involves the insertion of sterilized needles at specific points in the body in order to help decrease pain, increase blood flow, and restore mobility to a particular area. A traditional acupuncturist will use acupuncture as the primary form of treatment; a physical therapist will use acupuncture as a “modality” only and will likely still use the other treatment techniques mentioned above in conjunction with the acupuncture.

Thanks again to Kendra for helping us with this!

Be Well,

Tyler Fix, D.C.