Physical Therapy FAQs

Physical therapy is a conservative treatment that eases pain and brings back function and movement after injury. It uses a rehab plan built just for you, based on a check of your strength and how well you function.

When pain is part of everyday life, you move less. You miss work. You stop doing the things you enjoy. Therapists check your strength and how well you function. Then they build a rehab plan to improve those areas. They know how exercise works in the body, how to build muscle, and how the body moves. They pair that with the latest equipment to build a plan just for you. Home therapy is available if you are mostly stuck at home. Durable medical equipment: to help your body carry load or to ease muscle spasm, we may prescribe special back supports or electrical stimulators. These devices are meant to help your body heal.

1. What is Physical Therapy?

Physical Therapy is a conservative treatment. It treats, heals and prevents injuries and disabilities. P.T. focuses mainly, but not only, on pain relief and healing. It brings back function and movement and helps you adjust after an injury. P.T. also covers ergonomic (body mechanic) training, fitness and wellness, and most of all, education.

2. What can a Physical Therapy program do for me that I cannot do on my own?

Many patients may think they know how to exercise, manage their pain and rehab themselves. Patients often tell me why they do not need therapy. For example: “I have had this before and I know what works for me” or “I know what is causing this, because my neighbor had the same thing so I will just do what she did” Then they try to manage on their own. A Physical Therapist is a specialist, trained in proper rehab. We keep learning how to manage different problems and how to tell one injury from another. We work closely with the doctor who sent you to build a rehab plan made for you. Also remember that every person is different. We all have different bodies, different ways of moving, different alignment and different habits. A physical therapist and their trained staff watch each person. They work to fix bad habits, poor alignment and faulty movement. The most important part of therapy is education. Because of healthcare rules and payment changes, your doctor may not have time to explain exactly what your injury is and how it happened. Your therapist is trained in this. Often your therapist will be the one to explain your problem. They will lay out the plan to fix it and, we hope, keep it from coming back. P.T. focuses on education, correction and prevention.

3. How long is it going to take?

Everyone asks this. Everyone wants a timeline, and that makes sense. We all have lives to lead. Your physical therapist knows rehab takes time out of your life. My answer is always the same. Each person is different, so each person heals at a different speed. We can usually tell how you are doing within 2 weeks. I also tell my patients that rehab matters, even with a busy life. It takes time, just as the injury most often took a long time to build up to pain. One more thing patients must understand. We teach you and guide your rehab. But doing your Home Program is your job. It is a big part of how fast you recover.

4. Who benefits from therapy?

Many people, and really all people, can benefit from therapy. I am an active therapist. I work out, and I am always watching others. I rarely see anyone with perfect body mechanics, training habits or movement. That is where wellness comes in. The best fits are most often people hurt in accidents (work, auto, or falls) and athletes with overuse injuries. Others are people with arthritis, patients before & after surgery, and those who are out of shape or have strains.

5. What will I have to do in therapy?

Therapy most often covers pain relief and strength and flexibility training. It works on posture and alignment and on getting back movement, or range of motion. It builds endurance. It teaches ways to relax and ease stress. It trains balance, coordination and proper walking. It also covers education, safety, and a home exercise plan you build and follow. Remember, every person is different. So every rehab and physical therapy plan is different. Be patient with yourself, your doctor and your physical therapy staff. Healing takes time, hard work and follow-through. If you think physical therapy may be right for you, talk to your doctor or to a therapist. We will never say no to questions.

Correcting Sitting Posture and Instruction in Proper Lifting Techniques

The therapist may have spotted poor, or slouched, sitting posture at the first exam. That is most often the case, especially with a history like the one above. The PT can teach this patient to sit well using a lumbar roll. That is a special pillow made to hold the “lordotic curve,” or hollow, in the low back. Sitting better helps keep pain from starting. The lessons also cover good posture in the car, at the office, and anywhere else in the patient’s day. Breaking up long sitting with regular walks to the fax machine or copier also helps. The PT should also teach proper bending and lifting. With a history like the one above, tasks with repeated or long bending, like gardening, make the symptoms worse. Avoid those tasks for a while, until the pain is under control. Once the person can bend again, the PT should teach safe bending and lifting. That helps prevent low back pain now and in the future. Yes, this patient should avoid some tasks. But there are many things this patient can do pain free. This patient feels good playing basketball and working out at the gym, so those should continue. But AFTER exercise, the patient must take care to sit with good posture. Patients often feel good while they exercise, then get low back pain a few hours later while sitting still.

Aerobic Conditioning

Once a patient knows how to control the pain, they should move quickly into aerobic exercise. Aerobic activity helps bring nutrients to parts of the spine. Some of these parts, like the disc, have a poor blood supply. They rely on body movement and aerobic activity to move nutrients in. When a person sits still, fewer nutrients reach the spine to keep it healthy. Pick aerobic activities the patient enjoys and has time for. They should also fit the type of problem the person has. A walking program, an elliptical trainer, and an upright bike are most often good choices. Do the program at least three times a week for thirty to forty minutes each session.

Strengthening and Flexibility Exercises

Once the pain is under control, start stretching for the spine and legs. In the example above, this patient had to avoid bending forward because it made his pain worse. But once the pain settles, bending forward may feel stiff and limited, since he avoided it. So getting back forward bending is key to a return to full activity. Tight legs also need work. Tight leg muscles can make it hard to hold the postures and positions that keep back pain in check. As the back pain settles, add strength exercises to the PT plan. Strengthen the trunk muscles directly: the belly muscles and the muscles that straighten the spine. Also add tasks that hold the trunk steady while you strengthen the arms and legs. Leg strength matters too. It lets a person lift things off the floor with the legs, not the back. Add a home strength program that is easy to do and needs little equipment.

Minimizing “Bed Rest”

Gone are the days of long bed rest. Most often, even with sudden back pain, moving the right way and holding good posture works far better. So does a step-by-step return to activity. You control low back pain better, and you get back to normal life faster. Bed rest costs you muscle. It cuts joint lubrication. It cuts you off from people. And it badly upsets your sleep.

Desensitization

Patients with chronic nerve pain often feel strange sensations in all or part of the sore area. This often includes being extra sensitive to touch, pressure, or temperature. Desensitization can treat this extra sensitivity well, especially when combined with other medical and therapy treatments. Desensitization means applying “unpleasant” stimuli to the oversensitive area. These are things the body meets every day. They cause no pain on healthy areas of the body, so they do no harm or damage. The items used depend on what the sore area reads as painful. They may be different textures and fabrics, light or deep pressure, vibration, heat or cold. A desensitization plan touches the sore area for short periods, many times a day. These short bursts flood the brain with signals. The brain responds by getting used to the feeling. Bit by bit, the body’s pain response to that touch goes down. In short, your body gets used to it. The touch becomes bearable and no longer sets off full pain.

Use of Passive Modalities

A good back rehab plan focuses on getting you back to function and activity while you learn to control low back pain. Still, there are times when the use of “passive modalities” makes sense. In most cases, use passive modalities along with more active physical therapy. They can be used early in physical therapy to help control pain. But as the physical therapy plan moves along, the focus should shift away from them. Instead, activity and exercise should build step by step, along with lessons in treating yourself. Passive modalities mean putting some form of cold, heat, or electricity on the body to help manage pain. They are called “passive,” because the patient does not have to do anything. The patient rests while it is applied. The most common forms of heat are moist hot packs and ultrasound. Cold treatments, or cryotherapy, can ease pain as well. These include cold packs and ice massage to the low back. Fluoromethane is a spray the therapist can put on the skin. It is usually followed by a series of stretches with the therapist’s help. Electric stimulation can also control pain. Some types are TENS (transcutaneous electric nerve stimulation) and microcurrent. If TENS helps control pain, especially chronic pain, you can get a portable TENS unit for home use.

Physical therapy eases pain and brings back function and movement. Your therapist first checks your strength and how well you function. Then they build a plan around what they find. For nerve pain that leaves the skin oversensitive, desensitization can help, especially when combined with other medical and therapy treatments. If a TENS unit controls your chronic pain during therapy, you can get a portable unit to use at home.

Yes, once you have learned to control the pain. Aerobic activity helps carry nutrients to parts of the spine, like the disc, that have a poor blood supply. Walking, an elliptical trainer or an upright bike are good choices. Do it at least three times a week for thirty to forty minutes. As the pain settles, stretching and strength work for the trunk and legs come next, plus a simple home program.

Stay in bed. Long bed rest costs you muscle, cuts joint lubrication, cuts you off from people and badly upsets sleep. Even with sudden back pain, moving the right way, good posture and a slow return to activity work better. Slouched sitting also feeds the pain, often in the hours after a workout. A lumbar roll and regular breaks from long sitting help keep it away.

That is what desensitization does for nerve pain that makes an area oversensitive to touch, pressure or temperature. Your therapist uses everyday things on the sore area: fabrics, light or deep pressure, vibration, heat or cold. Sessions are short and happen many times a day. The brain gets used to the feeling. Its pain response drops bit by bit until the touch becomes bearable.

Not with activities that flare your symptoms. Does repeated or long bending, such as gardening, make the pain worse? Then avoid it for a while, until the pain is under control. Keep doing the things that feel good. As the pain settles, your therapist brings back bending and stretch. They add strength work. And they teach safe bending and lifting to help prevent the next flare.