10 Frequently Asked Questions for Physical Therapists
October is National Physical Therapy Month
Stephanie Humphries, Right at Home owner in Cedar Rapids, Iowa, has been a licensed physical therapist since 1999; she spent many of those years working directly with physical therapy clients in their homes. Stephanie answers common questions people ask about the physical therapy process.
1. What is physical therapy?
Physical therapy (PT) helps people recover from surgery, an accident or injury. PT also helps when a person’s body is not functioning at what is considered normal for them—perhaps they had a heart attack, stroke or fall; or are dealing with a neurological disease; or even facing aging and incontinence. Physical therapy helps when the body is changing in a way that is affecting function and quality of life. A physical therapist evaluates a person from the standpoint of their mobility, balance and strength. What are they having difficulty doing? What do they want to get back to doing? The basic premise of physical therapy is that you’re looking at the person’s physical dysfunction and determining the steps to take to improve the person’s physical condition.
2. What happens in a therapy session?
There’s always an element of patient education to help people discover what they are doing on a daily basis that could be contributing to their problem. The physical therapist may need to re-educate a person on lifting something correctly or moving properly. During a PT session, the therapist usually applies hands-on techniques such as joint mobilization for a stiff joint, or soft-tissue work of stretching or massaging tight muscles. Some physical therapists also do manual manipulation, which uses careful, directed manual force to improve mobility in joints, connective tissue or skeletal muscles.
PT always involves exercises of some sort, from a low-level stretch all the way to a well-rounded strengthening program. Physical therapy modalities are rehabilitation technologies that relieve pain, reduce swelling, decrease muscle spasms and improve circulation. These modalities include ultrasound, trigger-point pressure, dry needling, soft-tissue oscillation, electrical stimulation, traction, biofeedback, heat and ice. The exercise prescription and hands-on techniques are central to each PT session.
3. Why do I have to do these exercises? Some of them make me sore.
Physical therapists sometimes push people beyond their limit or comfort zone a little bit, encouraging them to go beyond what they think they can do. Physical therapists try to look at things objectively and implement different tests with patients. We try to empower people to kind of fix themselves. We don’t want them to have to keep coming back. Ultimately, we’re trying to get people to a point where they can maintain themselves and do their exercises at home or at the gym and go on with their lives. We push people so they can be independent and not reliant on us, medication or other treatments.
4. Why does physical therapy take longer than I had thought?
Physical therapy is not a quick fix. Americans in general are notorious for looking for that quick fix. PT follows the way our anatomy and bodies operate. There’s a certain amount of time that is required for certain types of tissue in the body to repair themselves. If you try to speed up the process, you could experience a re-injury. So physical therapy takes some patience and perseverance, and you’ve got to keep up with the program to experience the gains. Physical recovery happens in stages, and you have to be present for the whole program, from beginning to end, if you want lasting results.
5. Do I really have to do home exercises?
Oftentimes people go to therapy only two or three times a week depending on their insurance and payment options. The responsibility for improvement falls on the individual, too. The stretching and strengthening exercises are really something that has to be done almost daily. You’re not going to get the progress or improvement you need just relying on going to your therapy visits, so you have to do exercises at home. And, by the way, we can always tell if someone is being good about doing his or her home exercise program or not.
6. What’s the difference between physical therapy and occupational therapy (OT)?
Physical therapy deals with the entire body, anywhere from the inner ear and vision to the arms and legs. Physical therapists look at the body as a whole and are focused on getting people up and walking and working on balance, overall strength and core strength. Occupational therapy specializes a little more in the upper extremities, arms and hands. OT is very task-related and goes more into depth with someone’s fine motor skills and memory-type exercises and cognitive strategies. Often PTs and OTs collaborate with others on a therapy team—doctors, nurses, social workers, speech therapists, recreational therapists and music therapists.
7. What does physical therapy look like when done in the home?
You can implement all of the usual techniques, but doing joint- or soft-tissue techniques can be a bit of a challenge because it’s easier in a clinic with an adjustable table to get people in the right positions. When you’re in people’s homes, you have to get creative. You have to evaluate their homes and make suggestions on how to rearrange furniture and household items to make their home as safe as possible. Or you suggest adaptive equipment or even home modifications. You can bring therapy equipment with you, but sometimes you just use objects that are in people’s homes such as cans of soup for hand weights.
8. Will I definitely improve with physical therapy?
I think that everyone, to an extent, will experience a certain level of improvement. That’s if the patient is putting forth the effort that they can, and, of course, the therapy team is doing everything they can. But even though you’ve done everything you can, not everyone gets significantly better. That’s a conversation physical therapists may have with people, especially after a stroke, brain injury or spinal cord injury—those are pretty major events.
More often than not, people do not return to the way they were prior to whatever event they faced. Once the body sustains a trauma, it really doesn’t completely go back to the way it was. So there’s a level of education in explaining how the body heals itself and how scar tissue can limit movement. For example, with a bone fracture, the bone does not look like it did before it broke. Physical therapy tries to optimize that person’s function and environment so they can hopefully continue to live independently and get back to things they enjoy and find purpose doing, whether it’s a job, hobby or just being able to spend time with their grandkids.
9. How does physical therapy differ for older adults?
The timeline of healing and recovery is going to be longer, because with the aging process, seniors don’t heal as quickly as someone younger. But at the same time, I still think seniors are not a population of people who should be discounted. I don’t want people to say, “You’re 90, who cares?” You look at the individual, what their life is like, how active they are and their motivation. You may not be as aggressive with some of the modalities and exercises for seniors, but you continue to treat them like you would anyone else. You just expect their physical recovery to take longer.
10. How can a home care professional help with physical therapy?
When care clients come home with an exercise program, caregivers can encourage their clients to do the exercises. The caregivers are not prescribing the exercises. Many clients get pictures of their physical therapy exercises, and caregivers can go through the pictures with the clients. Oftentimes, care clients respond better to a caregiver than maybe their spouse or family member. Caregivers are also helpful when a client is a fall risk or their balance is off and they still need to get up and walk or get their heart rate or breathing up. Also, caregivers are trained to recognize anything unusual with their client, and the caregivers report those changes to their supervisor. That’s the value of the regular interaction between the client and caregiver. They get to know each other, and the caregiver recognizes when something is off.