Gone are the days of passive healthcare when a patient comes into the clinic simply relying on a doctor’s recommendation. Virtually every patient I see now has a handful of questions they’ve formulated after searching on the internet. Many of these patients haven’t even been to a doctor yet, as California law now allows Physical Therapists to evaluate and treat patients without prescriptions under legislation called Direct Access. This immediate connection to therapeutic care allows for a higher success rate, as patients aren’t left dealing with pain while waiting to see their physician. Rather, they can seek out help immediately when their condition starts impeding their quality of life, and as a result, prevent nasty habits from forming that might lead to long term overuse or further injury.
Why is all this Direct Access information important, you ask?
Well, because finding the right Physical Therapist is now kind of like shopping around for your favorite chef, hair stylist, or barista. While rating programs like Yelp, Google +, and Facebook might help consumers make smarter decisions on what doors to walk through, they don’t sell the service or product. It’s up to the provider to meet your needs and satisfy your wants. We live in a society built around that very principle, and the best companies are paying attention to the trends.
To help you narrow down your options, and get the best treatment possible, here are the 5 most important things I believe you should demand from your Physical Therapist before committing to a program.
1.) Show me the difference
This has been instilled in my heart since being raised in the “Show Me” state of Missouri. Patients want to see and feel a change with their particular condition before investing. Your physical therapist must be able to deliver. If no objective data is taken, nor mechanical analysis performed regarding the task you’re having difficulty with, and, you spend the entire hour talking and laying on the table, then your condition better involve pain while lying down and talking since that’s all the physical therapist objectively assessed.
More specifically, if you’re having trouble running, and the therapist never looks at how you run, or breaks down your single leg squatting capabilities in 3 planes, then how can they discover the “why” behind your particular condition and come up with an appropriate plan of care for getting to the source of your dysfunction?
2.) Show me the money
The therapist must be realistic in their proposed plan of action for getting you healthy. After gathering information regarding how they plan to pay for their care, I prefer to give my patients options. Think of this as a necessary step in ensuring that you get the most bang for you buck from the physical therapist that’s serving as your guide to full recovery. If the therapist doesn’t come up with a plan that works for you and your pocketbook, then it’s time to take your business elsewhere. While I find that most patients who pay for their own physical therapy tend to heal faster than those using insurance, I’m still respectful of the need to keep care effective and reasonable. Some patients will have unlimited funds, while others will be unable to afford more than 1 visit per week. The therapist must be able to direct you on how to best to spend your money. This plan should be based on how bad or chronic your condition has become, your individual goals, and the time you have available to contribute to healing. There are plenty of options out there, whether you’re a professional athlete, retired businessman/woman, or hard-working mom/dad. These options should be thoughtful, and explained to you before you invest.
3.) Show me the source of the pain or dysfunction
This is different from #1 in that it involves a more complex look at the body as a whole, rather than a simple local assessment of the body part in pain. Don’t let the therapist slap electrodes on you during your first visit promising that it’s going to heal your area of pain. Ask them instead to look at your overall posture, observe several movements you routinely go through, and point out the particular “kinks in the chain” that are inhibiting efficient movement. This will not only provide you with the information you need to heal, but it will help prevent the beast from rearing it’s ugly head ever again!
4.) Show me the ability to put your ego in check
I can’t tell you how many times I’ve made it through steps 1 through 3 only to find out that a patient has chosen to be with me because I seem understanding and eager to help. If your therapist comes across as over-confident or self-consumed, I can assure you they most likely are, and this will lead to problems down the line. If you find they’re only discussing their experiences and not asking an ample amount of questions about your condition, then they’re going to skip over the important things that might motivate you, or make the difference in your healing. If they say things like, “I’ve seen this a thousand times” and begin offering advice before conducting a thorough history of your condition and movement analysis, then you can be assured that they’re treating from a protocol. The thing I’ve learned most from protocols is when “a” is to be followed by “b” that is to be followed by “c”, often this is ensures nothing but “u” becoming number. If the therapist talks about treating the elite and is throwing around fancy names, you know they’re about to sell you something and often that something’s stamped with a GUARANTEE on it. When really all they’re selling you is a “Guaranteed Piece of S%&#!” (Tommy Boy – couldn’t help it!).
A therapist that has the ability to check their ego will realize that physical therapy is a part of your day, but not the ONLY part of your day that matters. When you can’t get through a 16-part program every day, you shouldn’t be told that’s the reason why you’re not healing. You should never be shamed into thinking you’re just not worthy of healing. Rather the therapist should be adjusting your program to reflect the one or two things you should be doing every day and helping you “trim the fat” on a complex program.
5.) Show me the steps to reach my goals without taking everything away
The best therapists will use as many tools as necessary to help motivate you to achieve your goals. That involves getting to know what makes you tick physically, mentally, and spiritually. If they realize you’re driven from seeing and physically understanding what you do wrong in each movement, then they’ll get out a camera to record you or use a mirror to show you the break down in your mechanics. If you’re more of a mentally driven individual, then your therapist should offer readings or take the time to put into words exactly what’s going on with you in a way you can understand. If you’re more of a spiritually driven individual, then your therapist should help connect you with a like-minded therapist (if one is available) or refer you to outside help from another professional that can address this need. I routinely refer to yoga therapists to help those that might be driven by a more meditative state to see results.
Furthermore, we all know that no athlete or person wants to be told to stop doing what they enjoy doing in life because it’s hurting them. If you’re told by your physical therapist that you can’t do anything you really enjoy anymore because it’s causing your pain, then they’d better have some alternatives and rationale for taking it away. Lets take running, for example, since it’s one of the most common overuse injury-causing activities to the lower body. If the therapist tells the patient they can’t run anymore – because it’s causing inflammation in the area of concern and slowing their healing rate – then why not have the patient ice and compress after they run, first, to see if that allows them to still show continued progress with their plan of care? If that doesn’t work, then show the patient objectively what they’re missing physically and give them little things to work on that will return this physical capability. Take regular re-measurements of the objective deficit and set weekly, monthly goals that a patient can become motivated to achieve. These simple targets are known to be the carrots that the most successful physical therapists utilize to achieve compliance with prescribed plans of care.
We live in fast times where online searches have made us our own doctors, nutritionists, and home improvement gurus. In a matter of minutes, with just the click of a button, you can go from knowing nothing about a topic to being the subject matter expert. Although this serves as a nice way to gather info about what you think might be going on, it doesn’t replace the need for seeking out experienced clinical professionals to provide hands-on assessments of flexibility/strength and thorough biomechanical analyses. This process requires a physical therapist to do what we were trained to do…play detective!
Now, before you hire just any detective to investigate, make sure you seek out only those therapists that possess all 5 things listed above. This will keep you from becoming a number in the healthcare system, and assure you quality is never lost when it comes to tailoring a program to your specific needs. Stop by Catalyst to feel for yourself the difference in what a skilled team can do for your health.
