Physical Therapy Questions

I finally got to start physical therapy for my broken ankle yesterday. The session began with a therapist who seemed highly qualified and genuinely interested in helping me to recover. He did a thorough evaluation and great lower leg massage. Then he turned me over to another employee for the exercise portion.

The second employee was really just a "station mover". He started by putting me on a stationary bike, told me to pedal for 10 minutes and then walked away. He returned 12 minutes later to move me to another station with a circular board, told me to rock my foot back and forth 20 times, and walked away again. This pattern was repeated for 45 minutes with the employee moving me from station to station, giving me brief instruction on each exercise, and then leaving.

I was totally bored the whole time. I watched as all of the other employees did the same thing with their patients - moved them to each station, told them what to do, and then left. Everyone in the room, patients and employees alike, seemed bored. There was no cheer, little eye contact, and virtually no talking.

Maybe I was expecting too much but I thought that the employees would stay with patients while they exercised to ensure proper form, prevent boredom, and serve as coaches and cheerleaders. I'm not sure that I want to do this for 2 hours a week for the next 2 months. Except for the massage and special compressive ice wrap, I can do all of this "therapy" at home.

What's your experience with physical therapy? Did I go into this expecting too much?

Not the experience I have had. One of my teammates is a PT, so when I was having trouble with my knee this summer I went to her.

If you book an hour with her, you get her the whole time. Most of the session is devoted to evaluating and manipulating your problem area. At the end she has you do some exercises to show you how and sends you home with instructions and if you need them simple pieces of equipment (like I got a giant rubber band thingy...)

I've been in two different clinics - generally the PT doesn't stay with you the entire time. Especially if that time is something like 10 minutes on a bike. They did stick with me on the various small exercises, such as flex and extend your foot 15 times, and all new exercises were supervised. A PT isn't your personal trainer, do you really need someone to sit with you for 10 minutes on a bike?

When you're doing specific exercises, and I've had lots of them for my knee, in one clinic the PT would get me started, then go on to the next client; I'd finish and he'd have me start something else. In the second clinic, the PT stayed with me for exercises and some wound area massage for 1/2 hour, then I was turned over to an aid to complete my work-out therapy. The first clinic was a bit more like a 3-ring circus, with banter between the clients/patients in the main gym. The PT was amazing that he kept up with all of us - but he also limited number of patients per hour. The second clinic had more therapists, and it was one-on-one until the end when I was turned over to an aid to complete my exercises and then they usually juggled a couple of us at a time. Once I completed one exercise, I generally knew what was next and would continue on without waiting for the aid.

Sometimes people are quiet because they're concentrating. What looks like an easy exercise for you isn't so easy if that's the body part that's being worked on.

I agree that I don't need an employee to stay with me while I ride a stationary bike for 10 minutes but I would have felt better if he would have supervised my other exercises, especially since this was my first visit. I might have been less disappointed if the employees were working with multiple patients at a time but this didn't seem to be the case. The employees appeared to have ample time to spend with the patients but seemed to prefer the company of their coworkers while their patients performed the exercises.

I had a clinic set up like yours. They decided to supervise me doing the exercises about 4 weeks in after ignoring me the whole time, and then told me I was doing most of the exercises incorrectly. I didn't go back after that. At the time, I was going to help with posterior tibial tendonitis in both ankles.

(I was irritated enough when he made me run on the first day (at this point, I could barely walk without pain) and then claimed that I was obviously in pain because I ran like a cow. Sorry, sir, I'm running like a cow because this HURTS LIKE ****)

I don't mind if they walk away, even to see other patients (at my current PT, all of the appointments overlap) - but if they walk away to stand around and chat, at least watch me as you're doing nothing.

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Originally Posted by Eden

Not the experience I have had. One of my teammates is a PT, so when I was having trouble with my knee this summer I went to her.

If you book an hour with her, you get her the whole time. Most of the session is devoted to evaluating and manipulating your problem area. At the end she has you do some exercises to show you how and sends you home with instructions and if you need them simple pieces of equipment (like I got a giant rubber band thingy...)

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This was my experience as well. I spent the entire hour with the PT. During that time, we mostly did exercises where he closely observed my form. The last 10 minutes or so was spent on a Wii Fit doing balance work.

When I went for PT for my knee, the therapist stayed with me for the first few sessions to make sure I was doing the exercises correctly. Then it changed so I was on my own, but everyone was all in one room so he could see me while he worked with another patient on the table, and could comment if I did something wrong.

Back in '93-'94 when I went for my ankle, the first PT I went to didn't help much. After a while my doctor said I wasn't making enough progress so he told me to go to a different PT, who was much better. I honestly don't remember details about how much supervision I had with each of them. But I did learn not to waste time with a PT that doesn't seem to be helping. Especially since insurance is much more limited for PT now than it was back then.

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Originally Posted by jessmarimba

(I was irritated enough when he made me run on the first day (at this point, I could barely walk without pain) and then claimed that I was obviously in pain because I ran like a cow. Sorry, sir, I'm running like a cow because this HURTS LIKE ****)

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Actually cows run pretty well :D:

http://www.youtube.com/watch?v=bzNha9zH58A

I had PT for my neck and shoulder a couple of months ago. The guy stayed with me all the time for all the exercises. There usually was one other PT in the room with their client as well. Everyone talked to everyone else. It was kind of fun. The two PTs were both cyclists so I learned a lot from them too.

I just got home from PT for my feet and ankles.

My therapist watches me throughout any new exercise, and at least the first couple of reps of any exercise I've done before in case I need any form tweaks. She might take care of paperwork or do something else while I'm in the middle of a long set. She might get the next patient started on their warm-up toward the end of my session, or vice versa, but that's the extent of overlap between appointments.

I originally started seeing her for SI joint issues, so I went looking for a McKenzie-trained therapist. There were a few within about the same distance from me, and I chose this therapist in large part because her clinic had little bios and pictures of all their PTs on their website. Every other clinic had bios of the doctors only. I think the regard in which the clinic holds their PTs, transfers down to how important the clinic and the therapists themselves see their work as being, and how much time and attention the patients get. Plus, even if everything else were equal, I'd rather my and my insurance company's dollars went to a clinic that treats their therapists with the highest respect. JMO and very limited E ;) .

I've had 2 experience:

I've seen a PT at Duke Sports Med (actually 2 different ones), and she is awesome. It's a similar situation to Oakleaf - she's with me most of the time - I warm up while she finishes with the appt before me, and she might start a warm up with someone else while I'm finishing up. Otherwise, she's paying attention for the hard part.

I've also seen a PT as part of a WC injury (knee). She saw 2-3 patients at once, paid no attention to what I was doing or whether I was inappropriately hurting, and generally made things worse. I ended up paying out of pocket to see someone better, since she sucked.

So it sounds like TE members are in 2 different camps. Some of us are OK with doing our exercises alone while most of us prefer some supervision from an aid or the PT themselves. I'm obviously in the "prefer supervision camp".

I called to discuss my expectations with the clinic director. It turns out that the director is the same therapist who worked with me yesterday. We agreed that the aids would continue to direct my workouts while following these ground rules when they introduce each new exercise:

• The aid will explain the objective of each exercise, for instance whether it's to increase flexibility, build muscle, improve balance, etc.
• The movements of each exercise will be clearly demonstrated or described.
• The aid will show me which muscles I should focus on in the case of muscle building.
• "Cheating" will be demonstrated or described so that I know which movements to avoid.
• The aid will observe all of my reps for each new exercise to correct any bad form that I may develop as I become fatigued, (or bored:rolleyes:).

The director agreed that the clinic seemed rather solemn while I was there yesterday. He told me that the atmosphere was usually much more jovial. He attributed the quietness to the mix of patients and aids who were there at the time and thought that would I find the clinic a much more cheerful place in the future.

I like my therapist enough that I'll continue visiting the clinic for another week. I'll change clinics if the new exercise supervision or depressing atmosphere doesn't improve.

Something that I failed to mention in my first post is that the physical therapy was super helpful in spite of the lack of exercise supervision. The therapist and I must have done something right because I'm soooo much better after just one visit. I went into the clinic with a pathetic limp/hop and leaning heavily on a cane. Now I'm walking slowly but almost normally while using the cane more for stability than support. I still have a lot of ankle strength and flexibility to gain and a moderate amount of pain to overcome but I see light at the end of the tunnel:D Physical therapy rocks!

I am an OT and work closely with my PT staff. We are a very upbeat group/crowd of therapists....Sometimes a little to upbeat:D

There are times when we do leave our patients on the bikes and sometimes we sit next to them to monitior...for lack of better words..their status. In the setting where I work we have pretty strict productivity standards so we often try to use that time for paperwork as paperwork counts against us even though we have to do it.:( Although I sometimes just like to talk with them to get to know them as well.

During the specific exercises I want him/her to do I do stay with them the entire time until I am sure they are doing it correctly. No sense in wasting anyones time if the exercise is not done right the first time.

Hope your ankle gets better soon!!

I have seen 4 PTs. All of them worked individually with me and I was never left alone. The first visit at the first one I got an electrical stim treatment, which an aide gave me. I didn't like the group atmosphere of the first 3 places, although I guess that is typical. It felt creepy to be lying on a table and having the PT do some of the massages, etc, exercises with me in an open setting.
The last one I went to was a MacKenzie trained person, one of about 10 in MA. It was all in a private room, just me and him. He shared his office with a chiropractor, so it was not a huge PT place. Come to think of it, the second to last one was also a MacKenzie person, too, but she worked at another branch of the second I went to. He had referred me to his colleague, as he thought she would know more, which she did.

Be careful about your billing.

Some clinics will charge full one-on-one units for time spent while patients overlap or while you are working with an aide. (Aides are trained on the job, with no schooling or licenses.) That is a big no-no. Biiiiiiiig no-no.

Time spent exercising under the direction of an aide should be free of charge. Time spent while you are sharing the therapist's time with another patient should be charged at a lower group rate.

ETA: I worked for 2 1/2 years in a clinic that practiced fraudulent billing, and to this day I wish I'd blown the whistle.

Yesterday's appointment was a prime example of being careful what you wish for! Seriously though, the session absolutely met my expectations. The exercises were thoroughly explained and there was lots of good communication between the PT, the aide, and me. Some of the exercises were duplicates of what I did the first time, but as I suspected, I wasn't performing them as well as possible. The staff better explained how to maintain proper form and then corrected me as my form deteriorated toward the end of the reps. They also gave me some new, more challenging exercises. I worked hard enough that I did NOT leave this session feeling better than when I went in but I feel quite a bit of improvement this morning.

Thanks for chiming in on this discussion Solobiker and KnottedYet. It's good to get a perspective from people who work in the field as well as patients who have participated in physical therapy. The PT's and their aides in this clinic do work with multiple patients at one time but it worked well for me yesterday...maybe even better as the patients did chat and encourage each other this time. I'll check on how the clinic bills.

All in all, yesterday's session was great. I can't wait to go back!

And I got a free T-shirt because it's Physical Therapy Month.

What's not to love? :D

I had a broken ankle and had 4 months of PT. My PT or PTA let me be when I was either on the treadmill or bike. I basically was always monitored because of my ROM and the instability of my ankle. If you get a PT that isn't working for you, don't be afraid to ask for someone else, this is your time and money.