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Physical Therapy: Expectations vs. Reality

Updated: Apr 15, 2022

What are things that pop into your mind when you hear "I need to go to physical therapy" or "My doctor recommended physical therapy"?

For me, my first introduction to physical therapy came as a result of tearing my ATFL ligament in my ankle after playing a game of basketball. I must have had too much fun on the first go around, because I made a couple more appearances in physical therapy as a result of dislocating my left..........then right ankle. My expectations of physical therapy were almost non existent at first, but I quickly began associating my experiences with massaging, stretching, exercises, and ice/TENS units.

As I progressed through graduate school, I heard countless people in the gym, clinic, and within my own family/inner circle say that they expected physical therapy to be mostly a massage, followed by a paper that you get that has clams, bridges, and some stretches to do at home. Don't let me forget the best part of the treatment, ice and that "zappy" thingy (aka TENS unit).

In this blog post, I hope to uncover the expectations that have circulated around physical therapy, but more importantly address the reality of what we do in PT.

Expectations Vs. Reality

Expectation: A massage is always part of PT, right?

Reality: While physical therapists may utilize techniques that fall within the umbrella of massages, we consider them soft tissue mobilization, which involves assessing and treating restricted areas within muscles, tendons, ligaments, and neural mechanical restriction sites. There may be times where we start with light manual therapy to calm the the nervous system, especially when patients present with a heightened fight/flight state or have a lot of pain.

Expectation: But I am going to do clams right?

Reality: While the clam (hip ER) exercise is a prevalent component in many PT clinics, we try to formulate exercises that are unique and specific to the needs of the patient. The best part about creating exercises is blending our fundamental knowledge of biomechanics/anatomy/physics with our individual creativity. We use our initial evaluation to find out what movements patterns need to be treated, with emphasis on the ultimate goal (being able to play with your kids, participate in golf, be able to run a marathon, etc).

Expectation: I won't have to worry about anything once I'm done with my PT. I will do the x2/week for 6 weeks and thats it.

Reality: I always say that I'm happiest when I don't have to see my patients anymore, which means that they have become independent enough to manage their injury without my help. My goal is to provide the patient with as much knowledge/education about the variables that have caused them to suffer the specific injury/complaint that they came in with. With that in mind, I always make sure to remind them that while pain may go away, the injury or the risk of injury may remain for an extended amount of time (DON'T STOP DOING YOUR HOMEWORK).

It's like an iceberg, where pain is the top, peaking out of the water, giving the warning that something is present. The variables in life (stress at work, increased sitting/desk work, lack of sleep, increase in new activity level, etc.) is the chunk of the iceberg that is underwater (may remain unknown to the patient). This is why it is imperative that patients that are discharged from PT continue the plan that was formatted by the physical therapy, because we have identified the submerged iceberg for you. You're welcome.

In Conclusion

As our profession evolves, I would like the expectations to match the reality of what we do. With each person that we treat and provide the utmost care and professionalism, is another voice to advocate for our profession. We should strive to treat each person in a holistic manner, taking time to educate/explain the "whys" of what we do, and set them up for success beyond discharge.

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Alex Zhidetskiy PT, DPT

Wellness Tribe PT

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