There are nearly as many reasons to go to physical therapy as there are treatments once you get there, so it’s not surprising you may be wondering what to expect from the process. After all, there’s no, What to Expect When You’re Going to PT book that’s handed out when your doctor recommends making an appointment. So here’s a bit of information to give you a better idea of what that first appointment and the follow up visits will entail.

The First Appointment

Your mind might be swirling with questions, so this article about your first appointment is a good place to start. It covers what to bring with you, what to wear, and how long you can expect the appointment to take.

Sharing Information

In order for your physical therapist to provide the best treatments, try to provide a complete picture of your situation. Be sure to mention prior and current injuries and provide a comprehensive medical history. Share your hopes for treatment, whether that be as focused as strengthening your calves or as general as overall improved balance and stability. 

You might be surprised by the conditions physical therapy can treat, so although you come in for something like recovery after surgery, with effective communication you might also find yourself treating incontinence.

Who Will I Work With?

The Encore team works together with the same goal–to provide professional and effective treatment with a focus on the needs of the patient. For your initial visit, you’ll meet with one of our skilled physical therapists for a complete evaluation. This is the time to ask questions and provide as much information as you can about your condition and your goals. 

Many patients are surprised to see a new face when they arrive for their second visit. That’s because our qualified Physical Therapist Assistants (PTA) commonly meet with patients after the initial visit. The PTA will walk you through warm ups, stretches, exercises, and other movements that increase flexibility, strength, balance, and range of motion. For reduction of pain and inflammation, your PTA may also hook you up with heat, ice, ultrasonic treatment, and manual (hands on) therapy.

Your PT and PTA regularly share information and work together on your treatment plan so there’s no need to explain everything twice. Your PT will monitor your progress through conversations with the PTA and by meeting with you periodically throughout your treatment.

How Long Will it Take?

Near the end of your initial appointment, your PT will outline a plan for additional appointments, often starting at 2-3 times each week and slowly reducing in frequency as you improve. This can come as a shock if you’ve expected to have the issue resolved in a session or two, but be aware the number of appointments depends on several factors including insurance, budget, your schedule, and your area of concern. Typically you will make appointments for the first few weeks and reevaluate the frequency as you progress.

Depending on what you’re dealing with, PT can help in a few visits or can be ongoing for months.

What Can I Expect From Treatments?

Patients have all kinds of perceived notions about what physical therapy looks like. Regardless of the image you have in mind, it’s probably not that. The first rule is physical therapy should never hurt. You may have some discomfort during certain movements, but pain is a boundary to pay attention to. 

The goal of PT is to reduce or eliminate that pain by correcting the core issue. Typically that revolves around strengthening and improving flexibility. This is not an exercise class. Don’t expect to break a sweat or break records for an upcoming spin class. Most PT is centered around minute movements–with surprising results. You may feel like you’re doing basically nothing, yet soon you’ll see how those micromovements lead to improvement.

Anticipate Homework

Much of the work you do will be in between appointments. After each appointment, your PT or PTA will provide you with written or printed sheets outlining exercises to work on at home. The more closely you follow your homework plan, the more improvement you will see. During your next appointment your PT will ask how the homework is going, evaluate your progress, and suggest new work-at-home activities to continue your improvements.

Be Open to Suggestions

You might remember the childhood song, “The Skeleton Dance,” with lyrics like, “The foot bone’s connected to the leg bone.” Even though you seek treatment for pain in one area, the core of the problem may lie elsewhere. So don’t be surprised if treatment for lower back pain involves stretching your calves or relaxing your hips. Similarly, even though you might feel like the exercises aren’t challenging enough, trust your PT to keep you at the right level of progress. Feel free to communicate concerns, but give the process a chance and be patient as you work together to achieve your goals. 

 

Anterior Cruciate Ligament Injury (ACL) is a common ailment in the sports world, both for athletes in the big league and those at the backyard volleyball pit. Typically, the injury occurs when the foot is planted but the knee twists, causing damage to the ACL. Treatment and recovery take many forms, but your physical therapist can be a strong advocate for your success.

Early Intervention

The most common symptoms of a torn ACL are a loud popping sensation or sound in the knee, severe pain and inability to continue the activity, rapid swelling, loss of range of motion, and a feeling of instability when bearing weight. It’s important to seek medical attention if you experience these symptoms. With the ACL out of commission, the job of tackling weight and mobility transfers to the meniscus. If the meniscus tears, the risk of a long-term impact such as osteoarthritis increases significantly. With all of this in mind, it’s critical to get an accurate diagnosis and to stay off of your injured knee as much as possible to avoid further damage. The exam is basic and mostly non-invasive unless the doctor feels it’s necessary to insert a camera for a better look, a process called arthroscopy. You may also be sent in for x-rays or an MRI as needed to determine whether you should undergo surgery for the repair.

Treatment

The initial treatment for tears not requiring immediate surgery consists of rest, cold applications, and compression in the form of a knee wrap or brace. Many ACL tears heal with the proper care. If rest, ice, and compression don’t do the trick your doctor may recommend surgery. Whether you have surgery or not, you can rely on your physical therapist’s guidance throughout the process. 

What to Expect from Physical Therapy

Without surgery physical therapy will target increased muscle strength, agility, and balance. Your therapist will also help you identify movements that can defer pressure from your knee so you can increase activity without further injury. Since each person’s response to an ACL injury is unique, your physical therapy plan will be customized for your situation. 

If you undergo surgery, the recovery process will be somewhat different. In fact, your therapy will likely begin before you have the surgery in order to strengthen surrounding muscle groups, decrease swelling, and improve your range of motion. 

Following surgery, the goals of therapy are to improve knee health and prevent subsequent injury. With this in mind, you will likely wear a brace for the first month or two to keep the knee from hyperextending. You will also rely on crutches initially, slowly working with your therapist to increase the amount of weight you can bear on your leg. Along with protecting the area, your therapist will help with pain control, improving your gait, and reduction of swelling. Over time, they help you increase strength, range of motion, balance, and flexibility. As you improve your therapist will support you towards personal goals such as getting back to an activity like swimming, climbing the hill to the mailbox, or even returning to contact sports such as football.

Whether a result of aging, sedentary lifestyle, surgery, or injury, muscle weakness can contribute to other physiological issues and contribute to an increased risk of falls. According to the Center for Disease Control, one out of five falls causes a serious injury such as broken bones or a head injury. In fact, over 800,000 patients a year are hospitalized because of a fall injury, most often because of a head injury or hip fracture. Many factors contribute to a higher likelihood of injury resulting from a fall. Vitamin D deficiency, vision problems, and improper footwear are just a few. But a major cause of falls is lower body and core weakness, which is where physical therapy can help significantly. Even if you’re currently feeling stable, the proper strengthening can improve your general health and safety.

Why is Physical Therapy Better Than the Gym?

The internet, magazines, and information at the doctor’s office are loaded with strength-training advice. However, each person has strengths and weaknesses that a physical therapist can help identify and target. For example, perhaps you didn’t know tightness in your calves is resulting in back pain or that a weak core is contributing to neck pain. Maybe large muscle groups are doing the work of smaller muscles or vice versa. Perhaps you are out of alignment or have one leg shorter than the other, resulting in issues with stability. With a basic exam, your PT can identify these opportunities for improved strength and mobility that will likely not improve by working out at the gym alone.

Strengthening

The strength of large and small muscle groups, especially stomach and other core muscles are at the ‘core’ of supporting your entire skeletal system. Ensuring your muscular system is strong and functioning properly will allow you to strengthen muscles you may not even have known were being ignored at the gym.

 

Your physical therapist can provide strengthening exercises specific to your needs and target weak areas. Then your PT will monitor your progress, supporting you along the way and supplying incrementally more challenging, yet targeted, exercises as your strength and stability increases.

Mobility

In addition to strength, physical therapy increases flexibility, which in turn improves mobility. In short, when your body is more fluid you are better able to react to potential falls. Basic exercises will help lubricate sticky joints in order to maintain a stable stance even when turning or climbing a ladder.

Balance

Of course, balance is another key component to keeping you on your feet and protecting against falls. With the proper training, the increase in balance will create a strong and elastic foundation to help you land upright, cushion your fall without damage, or maintain a vertical stature even on uneven ground.

FearSometimes uncertainty is your own worst enemy. If fear of falling keeps you from participating in activities you love, physical therapy can give you the physical strength and the reassurance to overcome the anxiety holding you back. Approach your physical therapy with a goal in mind to help keep you motivated and allow your PT to work towards that goal with you. Whether it’s being able to bathe unaided or returning to the tennis court, your PT is knowledgeable about the steps required to get you from here to there. 

Although you may not associate your lower back pain with your calves, when something is off-kilter in one area, it easily affects more distant areas of the body. If you think about it, your abdominals and lower back muscles support the majority of your musculoskeletal network, literally from head to toe. Without a strong core, your hips and spine can easily get out of alignment. When your alignment is off, you’ll often feel it in your knees, ankles, shoulders, or neck. 

Your core is key to maintaining posture and keeping your body primed for movement. If you are recovering from an injury or have fallen out of shape from long hours working at a computer, here are a few ways you can easily incorporate some basic core exercises into your day, to achieve all the benefits core strengthening has to offer. 

Arm/Leg Reach

Start by getting into position on your hands and knees. Make sure you have proper padding for your knees on the floor. Ensure your shoulders are lined up above your hands and your knees are directly below your hips. While holding your stomach tight and keeping your back flat, carefully extend both your right arm and your left leg, using the opposite limbs for balance. Fully extend, creating a flat board the length of your body. Bring the extended arm and leg under your body until your elbow touches your knee, maintaining balance as you move. Then place your hand and knee back onto the ground position and switch, extending the left arm and right leg. Complete 10 reps on both sides.

Standing Knee Crunches

Everyone knows crunches represent the ubiquitous core exercise, but if the floor version is too hard on your back, neck, or shoulders, perform a standing version instead. Stand with your feet shoulder-width apart. With a tight core and relaxed shoulders, slowly raise one knee until it meets the opposite elbow. If the twisting motion required to lower your elbow is too much simply do the leg lift portion instead. Complete 10 reps. 

Elbow Plank

The plank is a basic move with a huge core-strengthening impact. A full plank is performed with straight arms, but a modified version is achieved on your elbows instead. Use the technique that is best for you based on the potential wrist, elbow, or shoulder ailments. Roll your toes under slightly, placing the weight on the bottom of your toes. Similarly, place your hands or elbows flat on the ground directly below your shoulders. Pull your stomach tight and do not allow any sag in your lower back. 

Your body should make a “plank” like a board. Hold for 10 seconds. Lower a knee to rest, then reset your position for another 10 seconds. As you become stronger, try to hold the proper position for 20 seconds, then 30 seconds, etc, working up to one minute. 

For an added boost, hold the plank position while pulling one knee beneath and across your body. Return it to the extended position and repeat with the opposite side. For a modified version, hold the plank on your elbows and knees until you build enough strength to move to your toes. 

Hip Lifts

Think of hip lifts as an opposite form of crunches where you raise your hips instead of your head and shoulders. To start, lay flat on your back with your arms straight down along the side of your body. Bend your knees with your feet flat on the floor. Using your feet and shoulders as an anchor, lift your hips until your body is flat from shoulders to knees. Lower and repeat, maintaining a tight core as you go. Stability is critical so focus on squeezing your glutes and abs as you lift and lower. 

Side Hip Lift

To work the opposite muscles of your core lay on your side with one ankle stacked on top of the other. Put a pad beneath your elbow and ensure it is directly below your shoulder. Then lift your hips straight towards the ceiling and lower back to the ground, maintaining balance and control. Do five repetitions and then move to the other side. If this exercise is too challenging, try to lift and hold instead of moving up and down. 

While these exercises are introductory, it’s important to check with your doctor or physical therapist before beginning any exercise program to ensure the movements are safe for you.

Also know you don’t have to set aside a lot of time each day to begin your progress. Instead, make these exercises part of your everyday activities. Drop and hold a plank while your coffee reheats. Throwdown a few hip lifts during the last minute of the spin cycle on the washing machine. Perform some knee crunches while brushing your teeth. 

Most of all, remember to focus on form over repetitions. The goal is to strengthen and improve support so doing an exercise five times correctly is preferable to doing twice as many imprecisely.