Finding Good Physical Therapy

At the core of good physical therapy is “eyes and hands”. The therapist observes how your body interacts with its environment (e.g., walking, sitting, standing, moving, reaching, etc.) and then uses their hands to “look” under the skin at the underlying musculo-skeletal structures. The therapist then synthesizes this information with your symptoms. At the end of this process, it should reveal the source of your symptoms and a method for eliminating or managing those symptoms.

So as a patient, in very practical terms, how do you locate a good practice and after beginning treatment, if you’re receiving good physical therapy? The first part of the preceding question is relatively easy to answer. Finding a good practice usually requires that you ask the right questions before you start attending physical therapy. At the end of this article, we have a list of questions to ask a prospective practice and the answers that indicate a quality place. After you begin therapy how do you know if you are receiving good physical therapy? This is a more complicated question and to answer it you need to know the essential elements of good therapy and assess if your therapist is consistently applying those elements.

All good therapy consists of observation, evaluation, analysis, planning (including goal setting), implementation, and review.
Good physical therapy begins with a thorough evaluation. This should be a verbal, one-on-one interview between you and the therapist (while you probably answered a written questionnaire, much more is learned spontaneously during conversation). The interview should include your medical history, test results (if applicable), lifestyle (e.g., activity level, work and family demands, etc.), and subjective status (i.e., tell me what’s wrong). Following the interview, under the premise of “a body tells no lies”, the clinician should examine your alignment (top to bottom) and perform functional tests designed to reveal areas of strength and weakness. Initial evaluations typically take anywhere from 45 to 60 minutes. And the testing process should not end there! It should continue throughout your course of treatment (although more quiz than a test) and if done properly, should take very little time away from rehabilitation. Retesting will tell you and your therapist that you are making progress.

At the end of the initial evaluation, it is very important that your therapist has formulated (and you have agreed to) a treatment plan and established reasonable treatment goals. So very early in your rehabilitation you should know the short and long term therapeutic goals. This is so important it should be restated. Know in the beginning where you want to be at the end. Without a mutually agreed upon set of goals, you might as well discontinue treatment! Otherwise, you and the therapist will spend a lot of time, energy, and money, tapping around in the dark without ever actually going anywhere.

Now you are “in program” and regularly attending physical therapy. What constitutes a good treatment session? It usually consists of several elements, which vary in emphasis as you go through a course of physical therapy. The first is a passive portion of the treatment (and should be kept to a minimum). It may consist of ice, heat, ultrasound, or electrical stimulation. But, do not confuse these passive modalities with rehabilitation. They should be relatively short in duration and used as a means of tissue preparation for the manual techniques to follow. The “manual” techniques involve gentle manipulation of soft tissue and/or the joints to loosen restricted structures which begin the process of returning to functional movement. Finally, you should be instructed and guided through therapeutic exercises designed to address your issues. These exercises, learned during treatment, generally form the basis for a Home Exercise Program. As a precautionary note, therapeutic exercises and Home Exercise Programs are not designed to be a general gym/workout program. These are targeted strengthening and stretching exercises that need to be carefully taught by the therapist and thoroughly understood by the patient. The exercises may not be easy to learn or perform correctly. They require real dedication by the therapist and active participation by the patient to insure the exercises are performed properly. While Home Exercise Programs are not always easy to teach or learn, when done correctly, it brings the biggest rewards. A good therapeutic exercise program results in a quicker and fuller recovery, patient independence, and the tools to independently handle future symptom flare-ups.

All of this treatment should be leading to functional reintegration. As therapy progresses, you should be steadily moving towards real world function and a return to your optimal (possibly previous) level of activity. When you have returned to your previous or highest level of function, treatment should end.

Finally, some cautionary advice. Each patient has a unique case that requires the skill and clinical experience of a physical therapist. Good physical therapy takes time and the undivided attention of a very educated professional. With each treatment you should see the same licensed physical therapist, uninterrupted for 45 minutes. If your therapist is seeing other patients simultaneously, or you find yourself in the hands of an assistant, or left to your own devices in a gym, then you are not getting optimal care.

Questions to Ask Prospective Physical Therapy Practices

1. Do you only use licensed physical therapists?
a. The answer should be YES.
2. Do you use Physical Therapy Assistants?
a. The best answer is NO.
3. How long does each treatment last?
a. Should be approximately 45 minutes.
4. Does my physical therapist stay with me for the entire treatment?
a. The answer should be YES.
5. Do I see the same physical therapist at each visit?
a. The answer should be YES.
6. Do you have private treatment room?
a. The answer should be YES.
7. Do I have a scheduled appointment or just show up during the hours you are open?
a. The answer should be that you need to make appointments.

I hope this was helpful.


Published on by Eveline Erni.