health and wellness

How to Make PT Work for You!

Fiona McMahon PT, DPT (Pronouns: she, her, hers)

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Okay, you’ve got the referral in your hand. You have found the clinic that seems perfect for you. You are ready to improve your health and go to physical therapy (GO YOU!). But what if it doesn’t work? Your Aunt Gladys did great after her treatment and is hiking after a hip replacement, but your brother Dale is still struggling with his knee pain. Why? Will you be like your dear auntie or will you be like your brother? Is there anything you can do to improve your chances of absolutely rocking physical therapy (PT)? The answer is yes. There is a lot you can do to help speed your progress in PT. One of the most common questions I get as a physical therapist, second only to “why did this happen to me?” is “how long will it take to get better?”. The answer is variable and to explain my answer, I have to hop in the way-back machine and bring back a picture of a standard distribution from high school.

standard dist

I explain that most of my patients fall in the middle of the bell curve, and are seen for 7-10 visits. These patients tend to be pretty regular with appointments and more or less do there home exercise program regularly, with room for lapses due to normal life events. The middle is a really good stable place to be. Now, there are always people far from the middle on the right side who just blow me away with how much better they do and how quickly they improve. They tend to be folks who don’t have many other conditions going on medically, manage stress well, and tend to keep pretty healthy lives. These folks also tend to be very dedicated about adhering to their home exercise plan. Also, in my clinical experience, this accelerated group tends to not have had their condition for a long time, which speeds their recovery. What about people on the left side, who stay in PT for a long time? This is definitely a tough group to be in and you can end up in this group due to factors both inside and outside of your control. People in this group may have many conditions contributing to why PT is taking so long. They also may not be able to keep regular appointments due to outside circumstances and adhering to a home program may be difficult, or they may have other medical conditions complicating recovery. Though this group is a challenging group to be in, we can still work on speeding up PT in small ways just as we can in other groups. We can’t always control our lives, how long we’ve had conditions, and our medical histories, but everyone has the ability to make the most out of PT. In this blog, we will discuss the factors that are in your and your physical therapist’s control to get the best out of your physical therapy experience. Set Realistic Goals with Your Physical Therapist When we physical therapists meet a new patient, we always make PT goals to help guide our treatment. These tend to be pretty dry and based on things like range of motion, strength, etc.,. But really, what is most important is what you want to do. Often times we think exclusively of our pain at the expense of function. Think very specifically about what you want to do or what you could do if your pain was more manageable. Do you want to dance? If so, for how long? What type of dancing? Do you want to sit at work comfortably for 1-2 hours? Do you want to get on the floor and play with your 1-year-old? Being specific about your goals serves a dual purpose. It helps us zero in on exactly how to conduct our treatment and it provides you with motivation when life gets crazy, PT gets hard, or you have a setback, and the last thing you want to do is your home program. Get Regular We work a lot on constipation here at Beyond Basics, but that’s not what I’m talking about. Regular appointments can help us augment a term we call “carry over”. Carryover is one of the most important things we try and achieve as physical therapists. It’s all well and good to improve pain, range of motion, or strength but if it only lasts a day or two, what good is it? Many of the things we do are cumulative and may require a few visits relatively close together to get things to stick. A practical way to get regular appointments is to schedule way out in advance to ensure you get the appointments that best fit with your schedule. I often have my patients schedule 10-12 appointments out. With the best case scenario being they don’t end up needing them, which is fantastic but they have them if they need them. I also encourage my patients to get on our clinic’s waitlist if they can’t get appointments. Many physical therapists will experience cancellations during the week, and can often fit patients in when it appeared at first that they were completely booked. If you can’t get in, speak up. Physical therapists don’t want you to lose your progress either, they will often work with you to make sure you get seen. Home Program The home program is one of the most important parts of physical therapy. Even if you are going to PT relatively frequently, 3 times a week or so for one full hour, you are still spending less than 2% of your time in PT, versus 98% of your time in the real world. Although I truly believe in the work of myself and my colleagues, most people really need to take PT home with them in terms of their home program. It takes a lot to change how your body moves and works. Muscles take time to grow, the nervous system takes time to learn how to use them and or calm down, and inflammation takes time to go away. It often takes a lot, either a large injury or years of repetitive microtrauma to get yourself at a point where you find yourself in need of physical therapy. It can take a lot of consistent work to get to recovery. A good home exercise program can really help shorten your time at physical therapy and ensure that the results you achieve stick around for the long haul. Don’t Let Perfect be The Enemy of the Good Some physical therapists can prescribe a ton of exercises. They usually do this because they see the potential for your improvement, but sometimes neglect the fact that the real world exists and spending over an hour a day on physical therapy is not always possible. Yours truly is often guilty of this. If you feel overly burdened by your home exercise program (HEP in PT lingo), don’t throw the whole thing out. Pick 1 or 2 exercises you can do consistently until you next see your PT. When you see your PT next, discuss your HEP with them. Your HEP may need a revamp, or your physical therapist may work with you to find ways for you to be more consistent with your HEP, or they may help you to prioritize your exercises into “must do”, “should do” and “nice to do” exercises. We don’t take offense to this type of frank talk, because it helps us help you get better. Your HEP Should Evolve as Your Needs Evolve The super buff guy or girl at the gym isn’t lifting the same amount as the day he or she started lifting weights. As he or she got stronger, they progressively increased the challenge of his or her program. The same thing should happen with PT home programs. Your program may not change week to week but the program should be regularly updated as you improve. If this isn’t happening ask your therapist why your plan has not progressed, they may have a good reason or they may welcome the nudge to push you to harder activities. Do Your Research Physical Therapy practices can vary a lot and some can be better suited to fit your individual needs better than others. What do you value? Would you rather have 1 on 1 time with your physical therapist, or would you thrive in a place surrounded by other patients working out together? Does your physical therapist have an interest in treating your condition? Has your physical therapist contributed to the field in ways outside of clinical practice, like getting advanced certifications, teaching new students, or contributing to the literature? The website of a prospective clinic is a good place to start. Often times, you can find information on what the general treatment approach is like, as well as the personal biographies of physical therapists you may be working with to see if they will be a good match. If you still have questions, call the clinic. Often times the front desk can set you up with someone to answer your questions. At Beyond Basics Physical Therapy, we value 1 on 1 treatment in order to give our patients the most individualized treatment possible. We believe this treatment allows us to treat our patients as efficiently and return them to full function quickly. We are the experts on pelvic floor dysfunction in both adults and children, but also offer expert treatment for orthopedic conditions with advanced orthopedic physical therapists. We offer phone consults to our patients to help them determine if we are the best clinic for them. If you are thinking we might be a good fit for you, give us a call today at 212-354-2622 for our Midtown location and 212-267-0240 for our Downtown location. Finding a good PT and going to physical therapy can seem like a lot, and sometimes it is. That being said, the rewards are often so spectacular. There is nothing like being able to do what was once painful or extremely difficult with the help of physical therapy or avoiding a surgery because of physical therapy. When setting out on your journey remember: do your research, do your HEP, and be open with your physical therapist about what’s not working and what is. After that, the sky’s the limit.

Fiona McMahon PT, DPT treats at our Midtown location

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