10 Common Myths About Physical Therapy

Kolten Tea DPT, SCS, CSCS

1.) You Are Going to be Fixed in One Visit

It takes time, grasshopper, be patient. Some injuries happen in a single moment with a wrong twist here, or a wrong step there, but a lot of injuries occur over a period of time. They take a long time to manifest and it is going to take time to heal. With the age of the internet and instant gratification everyone wants that magic pill that is going to get them better immediately, or even yesterday. Sorry it doesn’t exist. Even the pills prescribed by your primary care physician are often a masking effect. They just take the pain away, they don’t fix the dysfunction and the pain likely returns in a few months. Additionally they can leave you with nasty side effects and potentially addicted. Google Opioid epidemic and read some of the stories if you think “It wouldn’t happen to me.” Addiction happens to all shapes and sizes.

2.) You Are Going to Get a Great Massage

Your therapist may do some soft tissue work but rarely is it a soothing spa like massage. There are a lot of hands on techniques used in Physical Therapy that help with both muscle and nerve inhibition. In other words, they help calm down the body’s alarm system and reduce pain. However, a 45 minute massage isn’t happening. If it does, then you are being mistreated and need to look for a different therapist. The manual therapy you may get will be targeted and used to complement other interventions within a treatment session.

3.) That Ultrasound/E-Stim/Hot Pack/ Really Made the Difference

Modalities are slowly becoming a thing of the past thanks to recent medical research. There may be situations and specific injuries where passive modalities are appropriate. Modalities may help with pain control in an acute setting but it is not what is going to make the difference in that treatment session. During a treatment session many other interventions are performed and even though we can’t always pinpoint that one intervention that made the largest impact, it’s usually a combination of progressive resistance exercises, targeted manual therapy, and skilled neuro reeducation.

 

4.) My Therapist Doesn’t Have the Knowledge to Diagnose Me

One of the biggest myths out there. Your physical therapist is very knowledgeable, skilled, more than educated at diagnosing and treating musculoskeletal injuries. Entry level Physical Therapists now attend 7 years of schooling and graduate with a Doctorate in Physical Therapy. Based on a recent research, Physical Therapists have the 2nd best knowledge of all musculoskeletal diagnoses, behind only orthopedic surgeons. That’s better than general MD’s, Chiropractors, and medical residents. If you can’t get into an orthopedic surgeon until 2 years from now (who by the way gets paid when they perform surgery) shouldn’t you see the next provider in line? Anyone that has been to Physical Therapy will often say they received the most detailed and thorough evaluation they’ve ever had.   

(see here  https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-6-32)

5.) My Therapist is Going to Fix Me

Your therapist is there to help get you going in the right direction but the person responsible for fixing yourself is guess who….. Yourself. The Therapist is there to educate, prime the body to heal itself, and progress treatment appropriately but ultimately it is the patient that performs the work and is responsible for performing their home exercises, and avoiding exacerbating activities. It’s your responsibility. It’s similar to rebuilding a car together. The therapist may do some of the work early on but the keys are always in your hand. If you don’t take care of the car and perform the needed maintenance the car won’t perform like it’s supposed to.

 

6.) I Don’t Have Time To Do My Exercises

This is one of the most common complaints that Physical Therapists hear and also one of the best predictors of patient prognosis. If you do your home exercise program you are more likely to get back to your prior level of function. If you don’t do your exercises, your chances of getting better go way down. I recently started replying to this excuse with “You do have time, it’s just not a priority in your life to get better.” I get many looks of shock and alarm but then point out the amount of time spent on facebook, Netflix, or shopping on Amazon in a given week and the patient begins to see there is time available to do what’s needed. Waking up 15 minutes earlier to do your exercises is not the end of the world.

7.) I Should See My Surgeon or Doctor Prior to seeing my Physical Therapist

Not the case. All states now allow Direct Access, meaning you can see a Physical Therapist without a prescription however there are different restrictions in each state which you can see here: http://www.apta.org/uploadedFiles/APTAorg/Advocacy/State/Issues/Direct_Access/DirectAccessbyState.pdf

Not only can you see a Physical Therapist as your first line of care but it likely will save you money in the long run (see below). How much is your co-pay to your primary care physician? And how long do they spend with you before saying you need Physical Therapy? 5 minutes? 10 minutes? Physical Therapists have the skill and knowledge to diagnose and even refer out to the right person if it is not a musculoskeletal impairment.

8.) Physical Therapy is Painful

I’m sure everyone has heard horror stories about Physical Therapists being painful but those days are behind us. With recent advances in pain science and better understanding of the nervous system those treatments of pushing pain levels into the 8-9-10/10 range doesn’t happen very often. They can happen but if they do it’s more than likely because someone didn’t do their exercises at home and the PT is trying to help play catch up. Some rehabs are more painful than others but Physical Therapy most of the time is pain relieving. I always scratch my head when I get a cancellation on my schedule because the patient is in too much pain. Isn’t that a main reason you should go to PT?

9.) Physical Therapy is Expensive

Quite the opposite! Actually PT is really inexpensive when you begin to look at the costs. Everyone’s situation is a little different based on their insurance coverage (don’t get me started on insurance) but in the long run it is much cheaper. That’s why most insurance companies require you to do 6 weeks of Physical Therapy before authorizing an MRI, because it’s saves them money!  Look at it this way, a treatment for PT costs around 60-100$. The average cost for a steroid injection is around $600 dollars and there is no guarantee is will work. The average cost of an MRI? It’s a whopping $2,600 and once again based on recent evidence an MRI may not be able to explain why you are in pain and may lean to unnecessary and more expensive treatments. So you could get 26 treatments of PT before covering the cost of your MRI! 26 visits is plenty of visits.

10.) I Shouldn’t Move Because I’m Injured

This is most often the opposite. As always talk to your therapist because sometimes you do need to rest and allow tissue to heal but most of the time it’s more beneficial and will speed up your recovery if you can move the injured area. The saying in PT is “Motion is Lotion.” The benefits of movement are exponential and too long list but a few examples are speeds up healing, decreases pain, improves strength. Most of all recent evidence  points to early mobility even after surgery/injury for a faster recovery. The more you can move the better your outcomes.

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