There’s a reason why some of us jokingly tell our patients that physical therapists lose the ability to count during PT school. That’s because while the patient is performing their exercises, the therapist is thinking about all sorts of variables in order to deliver the best care possible. Unfortunately, the public at large has not been educated on the thought process behind these exercise decisions. This has been reflected in recently reported articles and conversations on the web. We at the American Academy of Orthopaedic Physical Therapists (AAOMPT) hope that patients will have a much clearer picture of what goes into these choices after reading this post.
First, the physical therapist needs to examine and properly diagnose the patient’s condition.
The physical therapist has to figure out the specific tissue that is causing pain. The therapist needs to identify all of the movements or deviations in movement that might be intensifying this pain. As an example: there may be one specific joint in the neck that is irritated. Specific motions can cause pain when this joint is used. The in-depth understanding of human anatomy, how the body moves (A.K.A. biomechanics), how tissue heals is why physical therapy has gone from a bachelors program to a doctoral post-graduate degree. It is also why we further specialize into residency and fellowship programs. Making the right diagnosis is complicated, but physical therapists are properly educated and trained to ensure accurate diagnosis and patient safety.
Second, the physical therapist needs to create a treatment plan specific to the patient’s needs.
Although many people have neck pain, not all back patients will be prescribed the same exercises or hands-on treatment. This is because the goals that are established for therapy are 100% based on the functional desires and lifestyle of the patients. The therapist must combine their understanding of human anatomy and biomechanics with their understanding of the patient’s goals and desired level of activity in order to establish a program that is tailored specifically to that individual. A person with neck pain who wants to return to their previous level of playing a musical instrument will receive completely different treatments than someone with back pain who wants to return to playing tennis.
Part of your treatment plan will likely involve a home exercise program.
Physical therapists are limited on time they can spend with patients. Typically individuals receiving outpatient treatment are only seen 1-3 hours each week, placing a large responsibility on that person to continue the work that is started during their time with the physical therapist. Part of the physical therapist’s expertise is in providing properly dosed exercises based on the goals that the patient and physical therapist have set together (such as improving mobility, coordination, motor learning, endurance, strength, or power). Hands-on manual therapy interventions by your physical therapist – improving the mobility of joints, muscles, fascia, or nerves – may be necessary to help individuals properly perform pain free exercises.
The physical therapist then takes the findings of their examination and treatment and coordinates with the patient to establish a home exercise program. Initially, some of these exercises might seem similar from patient to patient or appear quite basic. This is where education from the therapist is important. As a patient, your physical therapist should explain how these selected movements are a part of larger functional movements or movement patterns that you are working toward. The physical therapist should further explain how these patterns make up or relate to the actual activities that the patient has set as their goal.
One last example.
A physical therapist recently examined a patient who was having chronic (long-standing) neck pain. The individual had previously undergone a large array of different medical interventions without relief. The physical therapist determined that a “facet” joint of the cervical spine was the root cause of the patient’s problem. After talking with the patient about how the neck moves and seeing how poor their posture was, the physical therapist was able to get the patient to understand the idea of a more ‘neutral’ (or ideal) spinal position. With this understanding and assistance from the thereapist, the individual was then able to turn their neck without increased stress on specific joints and tissue in the neck, resulting in pain-free movement. The patient shed tears having not had that relief in over a year. They also became the most diligent patient that the physical therapist ever had. This was because the patient understood how and why their pain was occurring, and now saw the means to have a pain-free lifestyle.
Everyone’s aches and pains are unique and different. A physical therapist can help identify what is causing yours and help you get back control of your life.
So the next time you notice your physical therapist is not counting along with you during your exercises or has a furrowed brow as they stare at your back, understand that the gears are turning vigorously. The exercises and other treatment they provide for you may involve small motions, but it is the small motions that develop into the activities we all cherish most.