Ideas about physical therapy generally conjure up certain images. Maybe one image consists of a person who, at the advice of their doctor, goes to a physical therapist or clinic in order to do a lot of strenuous, awkward exercises. In reality, outpatient physical therapy is much more than getting people to do a lot of exercises.

Physical therapy in a highly individualized setting is as different as each patient. And, especially in respect to low back pain and other conditions treated by physical therapists, there are as many different treatment philosophies/techniques as there are physical therapists.

Straight to the Door

Physical therapy is now so successful in treating pain and dysfunction that most states, including Tennessee, allow patients to come directly to physical therapy without a prescription from a medical doctor.  This is known as direct access.

Even with direct access, the physical therapists at Rehab etc. still work very closely with physicians, consult with them and refer patients if we feel a problem is outside of the scope of physical therapy.

What does having direct access mean to the average person suffering from low back pain?  It means that there is another viable and proven option for treating low back pain. This is a tremendous advantage for patients because it shortens the typical time required to initiate appropriate treatment and it helps to cut costs because it eliminates the ordering of unnecessary tests or medications.

Finding Your Physical Therapist

When looking for a physical therapist there are several things you should consider:

• Is the clinic close to where you work?  If you have to drive 30 minutes, it may discourage you from the required regular attendance. Physical therapy is very interactive and requires a good relationship between the therapist and the patient.  The only way to establish this relationship is to actually show up for therapy.

• Is the staff friendly?  You should feel comfortable with all of the staff, not just the physical therapist. I have heard from patients that the physician or therapist was great, but the staff wasn’t friendly—and the patient stopped going.  Again, physical therapy is a very interactive treatment approach.

• Do you get to see a physical therapist every visit?  In some offices the patients see the physical therapist on the first visit and then do not see the therapist until they are being reassessed or discharged from therapy.

• What type of patients does the therapist usually treat?  You do not want to go to a therapist who primarily treats knees if you have back and neck pain. Ask the therapist what his or her treatment approach is in regards to your specific problem.

• Is your health insurance “in network” with the facility?

• Do you have to follow your doctor’s referral or recommendation  or can you go elsewhere for physicaltherapy? As a  patient, it is in your best interest to find our own physical therapist.  Call around to clinics and ask if they have someone who specializes in manual  therapy.  You can find therapists online or

in the phone  book.

The First Visit

During the first visit of a person with low-back pain, for example, a physical therapist will conduct an assessment.  This will include past medical history, family history, past surgeries, what type of work they do and the physical demands of their job, recreational habits or interests and what types of activities or movements effect their symptoms.

This is very similar to a history taken by a medical doctor, only the physical therapy history will tend to focus more posture, ergonomics and movement.

Next, patients will undergo a physical assessment.

The physical assessment will begin during the first few minutes and will last throughout the visit.  A physical therapist will look at how the patient is sitting or if they can even sit at all –  how they get out of a chair, and even how they walk to the treatment room.  The physical therapist will also test nerves, muscles and joints to see how they are functioning in isolation and together.  Then they will monitor movements specific to the patient’s pain to determine what areas are involved. All of this will go into creating a list of impairments.

The impairments and treatment options will then be discussed with the patient.  It is the impairments that a therapist uses to establish a physical therapy diagnosis, which is a movement-based diagnosis rather than a medical diagnosis.  Although the two are related, the movement diagnosis is more useful to the therapist and to the patient in this instance because it tells why a disc is or joint or muscle is being damaged.  Low back pain can be generated by any of the following:  Lumbar discs, ligaments, nerves, muscles, and joints.

By knowing the impairments, a physical therapist can treat these and restore normal function, and in most cases limit or alleviate symptoms.

It should be noted that the success of a physical therapy program will depend greatly on an individualized program established by the therapist and monitored by both the therapist and patient. This individualized approach is more effective than a cookie cutter approach for every impairment and every patient.

Once physical therapy begins, a patient should expect improvement within the first three to four sessions.  If not, a patient needs to discuss the situation with the therapist.  Communication between the patient and the therapist is critical in the overall success of their treatment.

For more information on an individual approach to your physical therapy, visit Rehab etc. at myrehabetc.com.

Jim Hambrick, PT - Jim Hambrick, PT is co-founder and co-owner of Rehab etc.  After attending undergraduate school at Mississippi State University, he attended Physical Therapy school at the University of Tennessee, Memphis.  After practicing for approximately 5 years, he opened his first private practice clinic in 1993.  He has received advanced training and certification in Myofascial Pain management.