Some techniques, like doing exercises to increase quadriceps strength after an A.C.L. tear, get an A. Others, like using electrotherapy to improve heel pain for plantar fasciitis, get a D.
What to Look for in a Physical Therapist
So how can you tell if your P.T. is relying on the best science? During your first visit, the physical therapist will evaluate your symptoms, level of pain, how you move and your limitations for range of motion, strength and balance. That will become the basis of a diagnosis. This is not a medical diagnosis; the physical therapist wants to know what is limiting the function of, say, your knee, via muscle weakness or joint stiffness.
Dr. Moffat said that this initial appointment is a good time to decide whether you want to work with the physical therapist. “The most important thing is what the therapist does with their initial exam,” she said. “Do they really take the time initially to examine what’s going on and then determine what’s most appropriate for that patient?”
After the evaluation, the treatment they recommend should be evidence-based, drawing from the clinical practice guidelines, but it should also be tailored to your individual limitations and goals. It should also be active, incorporating strengthening and stretching exercises.
It’s important for the physical therapist to be empathetic and honest about what your course of treatment will entail, because the process can be painful. Whether or not you like your practitioner can also make a big difference in how you see the outcome. According to one meta-analysis, patients consistently rated their physical therapists based on how much they liked them as people, not on whether or not they got better.
And if you find yourself in a clinic where passive therapies like heat packs or ultrasound seem to be the main approach to treatment, “Find another place to go,” Dr. Gordon said. Those treatments may be useful for temporarily reducing pain or inflammation, “but they are not therapeutic in and of themselves. They are adjuncts to treatment.”
This approach to physical therapy may not use lasers or cryocompression pants or whatever the hot new toy is, and it requires work on the patient’s part, but it does work.