Separating Good and Bad Physical Therapy: When to Walk or Run Away

Recently there has been a large boom in the physical therapy field, and I am sure you have probably noticed a number of PT clinics popping up in your area. Unfortunately, not all of these clinics are looking out for the best interests of their patients, and can give the entire practice of physical therapy a bad name. In my office, we have a number of patients that have left a different PT office (no company names will be mentioned here), and tell us their horror stories of poor treatment. They are the fortunate ones, because they have continued with their treatment, and have found an office that will attempt to offer the best level of service and care possible. The problem is the hundreds or thousands of people with pain or problems that go first to a subpar clinic, receive subpar care, and think that is representative of what physical therapy is as a whole. That patient goes home and says, “I don’t need physical therapy, they did nothing for me,” and they never try physical therapy again.

I am hoping that by informing patients of what physical therapy should look like, and what it should not look like, they are able to find an office that will provide true physical therapy, and help them with their issues. Read below to see what to expect, or when you sound Walk or Run from a physical therapy office.

The Evaluation: On your first visit to physical therapy, you will be given an evaluation. You will meet with a licensed Physical Therapist, and tell them what you are coming to therapy for. The therapist will then ask questions and take measurements (usually at least of strength and mobility) to determine how your treatment should proceed. For some issues, the evaluation may not take very long, and for other issues it may be quite extensive, but look out for these red flags:

You are evaluated by anyone other than a licensed Physical Therapist – Run: this is illegal, only licensed physical therapists are legally allowed to perform evaluations.
You feel that you don’t have time to tell your therapist everything pertinent to your current injury or issue – Walk: this may be a red flag, try to express to the therapist that you need to explain more to them, if they don’t give you the time, then find someone that will.
The Physical Therapist does not touch you – Run: Although not all treatment sessions may include manual therapy (or hands on therapy), there are things that just can’t be determined just from looking at a patient. Physical therapists need to touch patients to feel layers of muscles and joint mechanics.

Treatment Sessions: Treatment sessions are your time to recover, heal, strengthen, improve, relax, or all of the above. You should focus on taking each session seriously and so should your therapist. There are some things that may get in the way of that though:
You are only receiving passive modalities at treatment sessions. This means that you go to a physical therapy office and only get things like hot packs, cold packs, electric stim, ultrasound, and then are sent home. Some offices use these modalities as part of their treatment (I am personally not a fan), but it should not be the majority of the session – Run: this is not skilled physical therapy, and it will not make you better. You may feel some relief from laying on heat or ice, but it will not resolve the underlying issue that brought you to physical therapy in the first place.
You are passed around to a different therapist every visit – Walk: this is not an egregious issue, but I believe in consistency. I think it is important to monitor the progress of the patient and be able to make adjustments as needed, which is difficult to do if you are always meeting them for the first time. There is also a lack of rapport and trust between the patient and therapist, which I think really improves the physical therapy experience.
Your session consists of being put in a gym with little to no supervision. – Run: Let me start by saying, not every physical therapy session has to have manual therapy in it. There are many issues that require no manual therapy at all. That does not mean that you should be thrown into a gym to fend for yourself. Exercises in physical therapy should have a purpose, and if you do not perform those exercises correctly, then you are not achieving that purpose. The physical therapist does not need to hold your hand and count repetitions for you, but they should check your form, and give you purposeful exercises, rather than just things they can bill you for.

The Office: A physical therapy office is a place that, depending on your injury or issue, you may spend a lot of time in. If you ever feel uncomfortable, or feel like it is not the right place for you, you should find another office to go to. Be aware of some of these things as well:

Although it is difficult to do, try to go into physical therapy knowing your insurance benefits. There are unfortunately a lot of people out there that try to take advantage of people. If you don’t know your benefits, ask them to be explained to you by the office. If they are not clear and straight forward with your benefits – Run: Insurance benefits and payments are usually the first thing dealt with in a PT office, and if an office is being unethical or even illegal with this, then it is definitely not the place you want to be.
I believe it is important for patients to feel comfortable at their physical therapy appointments. If there are things about the office that cause you anxiety or stress, it will not be a healthy and therapeutic place for you – Walk: this could be a small issue that can easily be resolved with communication, but it can become a Run if it is unresolved. You will not be able to properly take care of yourself if there are external issues in the office causing you to feel uncomfortable.
Communication is key. If at any time you feel that you cannot speak to your physical therapist or talk to them about your issues – Run: physical therapists are not mind readers, there has to be communication for successful physical therapy.

As the field of physical therapy grows, so will the amount of offices that you are able to choose from. Wherever you decide to have your physical therapy done, watch out for the red flags, and make sure it is a place that you feel will truly help you become an improved version of yourself. You are giving time and money to a physical therapy office, and there are certain standards that you should expect in return.