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Finding a quality physical therapist

Posted August 18, 2007 at 02:00 PM by Julie R. Keen

Section: In The News, His Fitness, Injuries & Rehab, His Health, Physical Health

It is hard, at times, to find a quality physical therapist. As a practicing physical therapist for nearly 15 years, I have heard some incredible horror stories of people going to “PT” only to receive a hot pack, ultrasound, and a sheet of exercises.  The therapist might have had 5 or 6 other clients being treated simultaneously, and the new client had a barely 5 minute “consultation” before having the hot pack slapped on.

Of course there are also great therapists out there who can eliminate a chronic pain after only 2 or 3 sessions.  Those who can explain and teach proper body mechanics in ways that even the most uncoordinated clients can understand and put into practice. So how does the average person find the latter and not fall into the former?

Unfortunately, it is not always as easy as asking your physician or looking at the initials after the therapist’s name.  Here are some tips to let you know if you are receiving quality care. I always tell my students that there are four components to quality physical therapy treatment.  Some conditions require more of one than the others, but every one of these components should be addressed over the course of physical therapy treatment.

1.  MANUAL TECHNIQUES (like joint mobilization, passive stretching techniques, muscle energy, ART, deep friction massage).
2.  EXERCISES (resisted, active, active-assisted, and passive as well as home exercise programs).
3.  MODALITIES (as needed for specific purposes, including electrical stimulation, ultrasound, iontophoresis, ice).
4.  EDUCATION (about your condition, the treatment, and prevention of further/future injury).

The therapist should spend some quality time with you LISTENING to your story, especially during your initial evaluation.  He/she should ask you some questions about the onset of your complaint, and things that make it better and worse.  At the end of the appointment, you should feel like someone finally “gets” what you’ve been complaining about.  You should feel hope that this person can help you.  At subsequent appointments, the therapist should ask you what the impact of the last treatment was.  Is your pain better or worse?  How are the exercises going?  Are you able to do anything easier than before starting physical therapy?

The therapist should put their hands on you.  It doesn’t matter if you have a torn ACL, lower back pain, a painful shoulder, or are recovering from spinal fusion surgery.  If the therapist doesn’t touch you, run out the door for another therapist.  Your evaluation should definitely consist of some sort of hands-on techniques, and in many cases your treatment should as well.

Your therapist should re-evaluate your progress at least once a week.  If you are going to therapy for 3-4 weeks with no re-evaluation, and you are doing the same exercises over and over with no progression, then your therapist is not paying attention.  The therapist MUST re-evaluate at regular intervals to determine the best course of treatment.  This process will not be as extensive as your first visit, but should include some objective measurements, and also some questions about progress with activities and/or pain relief.

Are you learning something?  Your therapist should explain things about your condition and the impact that will have on your daily life.  For example, you go to the therapist with a complaint of lower back pain.  She teaches you better ways to move and sit to reduce the stress on your spine.  She teaches you how to lift your 25-pound child in and out of the car and the bathtub in such a way that you avoid straining.  She teaches you how to sit at your office job to reduce strain on your lower back.  This should not be the only component of your treatment, but it should be part of it.

Perhaps most important of all, are you getting better?  Of course, some conditions will get better on their own without physical therapy intervention, so this is not always the best indicator of quality treatment.  Conversely, some conditions worsen through no fault of the therapist.  But in general, you should be getting better faster than you would without treatment.  And if you are not, the therapist is aware of it and is adjusting treatment accordingly.

Many articles on finding quality healthcare providers talk about visiting websites of professional organizations and state departments of health to find good providers.  Unfortunately, this is flawed logic.  Membership in our professional organization, the American Physical Therapy Association, is voluntary, so not every member listed is guaranteed to be the right kind of therapist, and many high-quality therapist might not be members.  And the state only lists if someone has had disciplinary action taken against him or her.  So where do you look to get a quality therapist?

Word of mouth is certainly a good place to start.  Ask around at work or among family and friends if anyone has been to physical therapy.  Ask about the treatments.  Did they meet the criteria listed above?

Visit the APTA website and click on “Find a PT”.  Of course there might be quality therapists around who are not listed here, but this can be a good starting place.  Look at the people listed in your area, and notice if any of them have additional letters after their name.  Again, this does not automatically guarantee a great therapist, but what it means is that this person is invested in their profession and has received further education in his/her area of interest.

Some continuing education providers offer certifications in advanced techniques.  Many of these providers offer lists of graduates.  This is also a good place to start.  I am partial to the Maitland Certification Program (Certified Orthopedic Manual Therapist) by Maitland Australian Physiotherapy Seminars (MAPS) because I have taken many of their courses and know that you cannot pass that exam without being a quality therapist.  They have a list of graduates on their website .

If none of these pan out for you in finding a therapist, trust your instincts.  Go to your local therapist and be critical, applying the concepts discussed above.  If you don’t think you are receiving the best treatment, chances are that you are not.  But you might just find a great therapist, with no special extra letters after his/her name.  One who listens, and evaluates, and gives you the best treatment and teaches you about your condition and how to make it better and prevent it from coming back.  One whose name you can pass along to others.

Julie R. Keen, PT, NSCA-CPT is a 1995 graduate of the University of Connecticut’s physical therapy program.  She is not an APTA member, and she does not have any fancy extra letters after her name, nor any advanced certifications.  She is however a quality therapist, and a personal trainer.  Check out her website.

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Tags: body pain, chronic pain, education, evaluation, exercises, hot pack, injury, injury prevention, manual techniques, massage, modalities, physical therapist, physical therapy, progress, re-evaluation, rehabilitation, sessions, therapy

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