How to Choose a Physical Therapist
Hello, and welcome to The Chisel, the blog for Michael Angelo PT. I’m Mike Angelo, and I want to begin by discussing what you should be looking for in a Physical Therapist. Come along for the ride.
Physical therapy clinics have changed a lot over the years. Some are insurance based, some cash based. Some are big, open gyms, and others are small with independent rooms. Many fit on a spectrum between these extremes.
Most people “just want their exercises” and others want a hands on approach. What you want and need, and what a therapist can offer, will tell what you’re looking for in a therapist and clinic. I’m going to tell you what I do, and guide you to making the decision that makes most sense for you.
I have been a therapist for 8 years now and have practiced in small outpatient clinics, hospital based outpatient clinics, skilled nursing facilities, and inpatient hospital settings. I currently work in a small clinic that is part of a physician practice. We are not physician owned, but work directly with the providers.
I also see patients independently, and can see them in my own space, or at their home. In all these settings, I provide one on one care.
What is one-on-one physical therapy?
In many outpatient clinics, therapists see 2-4 patients per hour, spending minimal time with their patients and having a physical therapy tech or aide complete an exercise program with them. You will get seen, however it is very difficult to have a custom tailored program when you aren’t being supervised by your therapist for the majority of your treatment. (In another post, I will dig deeper into why this phenomenon exists and what we can do to address it for patients, clinicians, and clinic owners alike.)
One-on-one physical therapy is when you see your therapist for the entire duration of your treatment, usually for 45-60 minutes. In this setting, a therapist is able to take the time to really get to know you, monitor your progress, and make adjustments that are necessary. They also have the opportunity to perform more manual based techniques to help improve your mobility quicker and progress you faster.
What is Manual Therapy?
Manual physical therapy is the application of techniques requiring a therapist to utilize their hands or other body parts to mobilize your tissues and joints. This can include soft tissue mobilization, joint mobilization /manipulation, myofascial release, dry needling, proprioceptive neuromuscular facilitation (PNF) and other various manual techniques that have been developed over the years.
Manual Therapy is utilized in conjunction with exercise, postural education, and other techniques to create a well rounded therapy program. Any one technique used independently can help you, but building a comprehensive program is the key to getting someone better, faster.
When I was a new therapist I did a lot of soft tissue and joint mobilization (mechanical improvements), but I didn’t follow up with the neuromuscular and motor control components of a proper physical therapy program. In my next post, I will discuss the three pillars of care.
Why time matters: Getting to know your patient /therapist
It is just as important for a therapist to get to know you, as it is for you to get to know your therapist. Frequently, I have been able to learn more about my patients day to day activities since we can talk for 45 minutes during their care, Things that you may not think are affecting your pain may actually be contributing significantly. We can address these things since we have a lot of time to get to know one another.
For example, let’s say you’re seeing me for low back pain. We’ve treated you a few times, and you’re feeling better, but something is just not getting addressed. You told me about the time you lifted a heavy box of books, felt a pull in your back, and now you’re here. You’re doing your exercises, and coming to all of your appointments. Why, then, do I still hurt?!?
If we only had 15 minutes to work together, we may not have the time to talk about the nuance of some daily activities. Maybe you wake up in pain, and we didn’t talk about your sleeping position, or maybe you have pain while standing at the kitchen counter and we didn’t chat about your counter height and posture /core strength required for these activities. Regardless, if we have more time together, we have more time to dive deep into your needs. That’s the key to finding the right therapist.
So, what am I looking for in a PT?
1- One-on-one time with a therapist- ask how long you will be seeing your physical therapist before you see the tech. This is the most important factor.
2- How am I paying? Some clinics are insurance based and others are cash based. Insurance based clinics are less likely to offer one on one care, but some still exist (Simon’s Physical Therapy in Tucson for example.) Cash based clinics usually offer this, but you will pay cash out of pocket. Don’t be scared off though, they will usually provide you with a superbill, which will allow you to get reimbursed for at least part of your out of pocket costs. Call your insurance company to see what they will cover!
3- How often can you see me? You’ll want to be able to have good follow up, and will want to see your therapist 1-2x per week. If the front desk is on top of it, the schedule won’t be too overbooked. Verify this before scheduling your initial evaluation.
Whether your therapists is more hands-on or more exercise based is going to be based on your preference. As a manual therapist, I believe in the power of careful and skillful touch to aid in healing. Utilizing exercise for an independent program at home is a powerful adjunct to a good manual therapy program. There are great exercise-based therapists out there though, so find what works best for you!
Michael Angelo, PT, DPT, CFMT
Doctor of Physical Therapy
Certified Functional Manual Therapist
Owner /Founder of Michael Angelo Physical Therapy