Physical therapy is a branch of health care aimed at improving a patient’s functional abilities. This is achieved through evaluating and treating disorders of the musculoskeletal system. Physical therapy can help a wide variety of patients all along the lifespan.
The physical therapist (PT) performs services directed at preventing the onset and/or decreasing the development of conditions resulting from injury and disease. The physical therapist provides these services to people who have functional conditions resulting from musculoskeletal injuries such as sprains/strains and fractures. They also provide treatment for more serious conditions such as burns, arthritis, amputations, stroke, vertigo and multiple sclerosis.
A physical therapist is a professional healthcare provider who tries to meet an individual’s health needs and wants via communication with other healthcare specialists and the use of exercise, education, and various therapeutic modalities. This can include anything from teaching patients to walk again after an injury, or helping an athlete to improve his speed, strength, or agility on the playing field. Physical therapists perform many different functions in order to optimize a patient’s recovery. For those patients with health problems resulting from injury or disease, the physical therapist assists in the rehabilitation process to reduce the patient’s pain, and increase the patient’s strength, endurance, and stability. In addition to treatments given in the office the physical therapist must also work hand in hand with the patient to help develop a personal home therapy program for when they are no longer in the therapists care. This is done to ensure that the healing process continues and that there is no future reoccurrence of the treated condition. One of the more significant functions of a physical therapist is to aid patients in improving their ability to perform activities of daily living. This may include but is not limited to patient’s dressing themselves, eating, cooking, or taking care of their personal hygiene. Physical therapists also play a large role in injury prevention. Through education, physical therapists can help people become fit and teach them how to avoid injuring themselves either at work or at play.
You and others may be referred to physical therapy because of a movement dysfunction associated with pain. Your difficulty with moving part(s) of your body (like bending at the low back or difficulty sleeping on your shoulder, etc.) very likely results in limitations with your daily activities (e.g., difficulty getting out of a chair, an inability to play sports, or trouble with walking, etc.). Physical therapists treat these movement dysfunctions and their associated pains and restore your body’s ability to move in a normal manner.
Physical Therapist – A physical therapist requires completion of an accredited graduate level physical therapy program to be eligible to take the national board certification exam, and receive a proper license to practice. The vast majority of the programs are highly competitive, prestigious academic institutions, have strict undergraduate prerequisites, and are three year long doctorate programs.
Personal trainers – are not required to have any formal education, licenses, or certification to train clients.
Massage therapy – there are no set educational or clinical standards set to become a massage therapist. In California, there is no requirement for a licensure, it varies city to city.
Current entry level requirements for a physical therapist include obtaining a Masters or Doctorate degree in physical therapy from an accredited university. One may earn an undergraduate degree in any field of interest, but must complete a core set of science and biology classes to be eligible to apply. Physical therapists must then pass the National Board Exam and the California State Law Exam in order to practice.
Entry into massage school requires a high school diploma. In states that regulate massage therapy, one must have 500 supervised hours upon graduating from an accredited school and pass a national certification exam. As of January 1, 2007 the state of California does not regulate massage therapy, however regulation may occur at the local level.
The requirements to become a personal trainer involve being at least 18 years old and often times CPR certification is required. There is no national standardized test to obtain a personal trainer certificate, and requirements can vary wildly. Some require you to take a certification exam at a testing center or you can send your exam in by mail.
Physical therapists (PTs) and physical therapist assistants (PTAs) are licensed by their respective states.
Orthopedic Physical Therapy – Probably the most common physical therapy specialist is the orthopedic specialist. These specialists care for post-surgical patients, arthritis, tendinitis/tendinosus, fracture rehabilitation, muscle sprains and strains, neck and back pain, hip and knee problems, shoulder, elbow, and wrist conditions. Some are board certified as Orthopedic Certified Specialists (OCS). Manual Therapy – Manual therapy is a broad term that describes a variety of hands-on treatment techniques that are applied to movement dysfunctions. Grade five mobilizations, Mulligan mobilizations with movement, Maitland and Kaltenborn techniques, functional technique, neural mobilization, joint mobilization, craniosacral therapy, strain/counter strain, myofascial release, etc. These are some of the more popular manual therapy techniques. Many manual therapists will take continuing education courses, obtain certifications in manual therapy, and will sit for board certification from the American Physical Therapy Association and other organizations. Most physical therapists incorporate manual therapy techniques as a part of a complete treatment plan. Geriatric Physical Therapy – Some therapists specialize in the rehabilitation of seniors. As the body ages, a variety of challenges arise. We stiffen, we lose strength, our balance skills decline, our bones become brittle (osteoporosis), our endurance decreases, and we take longer to recover from injuries. Balance and fall prevention are of paramount importance to the therapist who is working with seniors and some clinics are solely dedicated to caring for those with balance problems. Most physical therapists work with seniors/geriatric patients. Some have obtained additional education, have passed a board examination, and have earned the Geriatric Certified Specialist (GCS) title. Sports Rehabilitation – Experts in assisting with recovery after injury and surgery. Many sports specialists help with retraining the athlete utilizing running, throwing, jumping, and sport-specific programs to name a few. A therapist with the Sports Certified Specialist (SCS) title has passed a board certified test. Fitness and Wellness – Physical therapists are well trained to help with your fitness needs and wellness programs. If you need an exercise program, have trouble with your weight, are concerned about osteoporosis, have an issue with diabetes, or you would like to learn how to prevent falls, physical therapists can help. The previous examples are just a few of the many programs physical therapists offer. Hand Therapy – Most physical therapists are well trained to treat hand and wrist conditions. Some therapists have taken additional courses and training and have passed a hand therapy certification examination. These therapists are called Certified Hand Therapists (CHTs). Women’s Health – Some therapists specialize in women’s issues such as pregnancy problems, pelvic pain, and incontinence. Special treatment is available for women who have these problems. Many that suffer from incontinence do so needlessly. A physical therapist may be able to help. Industrial Rehabilitation – Specialists in industrial rehabilitation help with those that have suffered on-the-job injuries. Moreover, they will evaluate work tasks, fabricate assistive devices, evaluate your ergonomic situation, and help redesign work flow/tasks to decrease the incidence of injury. Often, industrial rehabilitation specialists will evaluate your ability to perform certain job tasks with a Functional Capacity Evaluation (FCE). Pediatric Physical Therapy – Pediatric therapists specialize in the rehabilitation of children. They may assist with kids who suffer from cerebral palsy, developmental disorders, neurological disorders, and/or orthopedic problems. A Pediatric Certified Specialist (PCS) is a board certification that some may obtain from the American Physical Therapy Association. Aquatic Physical Therapy – Aquatic therapy takes advantage of the physical properties of water to assist with the rehabilitative process. Buoyancy, turbulence, hydrostatic pressure, and thermal properties of water can assist with the rehabilitation of a patient. Those suffering from chronic pain, osteoarthritis, fibromyalgia, rheumatoid arthritis, lumbar fusion surgery, or with a limited weight-bearing status are just a few of the many different patient populations that can benefit from aquatic therapy. Cardiac and Pulmonary Rehabilitation – A small percentage of physical therapists practice in this discipline. Those that pass the board certification have the title of Cardiovascular and Pulmonary Certified Specialist (CCS) work with patients who have had heart attacks, bypass surgeries, angioplasty, breathing problems, emphysema, and other heart/lung related conditions. Physical therapists are well equipped to work with these types of patients because many of them have orthopedic ailments that limit their ability to function. In other words, a physical therapist can address the heart and lung problems as well as the muscle problems that are concurrently present. Neurological, Spinal Cord Injury, and Traumatic Brain Injury Rehab – A large portion of physical therapists work with patients who suffer from these conditions. Functional retraining including, walking, wheelchair use, getting in and out of bed or chairs (transfer training), moving in bed (bed mobility), and retraining patients to use their shoulders, arms, and hands are just some of the services these therapists provide to those with neurological involvement. A certified specialist holds a Neurologic Certified Specialist title (NCS). Balance, Dizziness, and Vertigo Rehabilitation – Many suffer from dizziness or BPPV (benign paroxysmal positional vertigo). Some clinics specialize in the rehabilitation of patients with vertigo. Patient education, strengthening, safety awareness, posture and balance exercise, walking exercise, and special techniques that affect sensory and balance centers of the brain and limbs are all important components of a rehabilitation program. Amputee Rehabilitation – many physical therapists specialize in the rehabilitation of amputees. Caring for the injured limb, functional and walking training, training in the use of assistive devices (crutches, canes, prosthetic limbs, etc.) are all provided by a therapist who specializes in care for amputees. Wound Care – Some therapists specialize in the treatment and care of wounds. This is accomplished by the removal of unviable tissue (debridement), the application of special dressings and prescription drugs/ointments, and the use of ultrasound, electrical stimulation, and aquatic modalities to promote healing. Exercise and patient education are also routine components of a wound care program. ECS (Clinical Electrophysiologic Certified Specialist) – A physical therapist who is board certified to perform electroneurophysiology examinations such as nerve conduction studies and electromyography. Lymphedema Rehabilitation – We take it for granted but a special component of the circulatory system, the lymph system, helps filter and drain fluid from our arms and legs. When this drainage system is damaged, painful swelling can result. Some therapists specialize in the treatment of lymphedema as it is called. Special positioning, massage and bandaging techniques are utilized by the lymphedema specialist. Osteoporosis Rehabilitation and Prevention – Some practitioners specialize in the evaluation and treatment of osteoporosis patients. Working in concert with your medical doctor, the therapist will often design a specialized weight-bearing and resistance training program for those with this silent disease.
Although California is a “Direct Access” State, meaning a patient can see a Physical Therapist without physician referral, most insurance companies require a physician referral for physical therapy treatment. It is highly recommended that you obtain a referral (also called a “prescription”) for physical therapy before you begin treatment. Referrals can come from either your primary care physician or from a specialist and should include your name, the date, and your diagnosis. Once you receive your referral, you will need to schedule your initial appointment for physical therapy within 30 days of the date on the referral. After 30 days, the referral will expire, and an updated one will need to be obtained.
More than half of all Americans are suffering from pain. Whether it is a recent episode or chronic, an ABC News/Stanford study revealed that pain in America is a serious problem. However, many do not even know that physical therapists are well equipped to not only treat pain but also its source. Physical therapists are experts at treating movement and neuro-musculoskeletal disorders. Pain often accompanies a movement disorder, and physical therapists can help correct the disorder and relieve the pain.
You will need to bring your prescription for physical therapy and your insurance card. There will be paper work to fill out upon your arrival which can be downloaded on our website. See Forms. You should come dressed in comfortable clothing such as what you would wear to the gym. The initial evaluation typically lasts 1 hour to a 1 hour and 15 min during which the following services will be provided:
1. A thorough evaluation of your injury will be performed.
2. Education will be provided regarding your injury/diagnosis.
3. Handouts will be issued to you with information on your injury and how to reduce stresses to the involved body part.
4. Treatment of your injury will be performed.
5. A home exercise program will be assigned with handouts that include pictures and explanations of the exercises.
A typical physical therapy visit is approximately an hour long consisting of manual treatment, such as increasing joint mobility or soft tissue mobility, therapeutic exercises and modalities (as needed) such as electrical stimulation. The manual treatment and exercises prescribed are focused on your individual needs.
Make sure you bring your physical therapy referral (provided to you by your doctor) and your payment information. If your insurance is covering the cost of physical therapy, bring your insurance card. If you are covered by Workers’ Compensation, bring your claim number and your case manager’s contact information. If you are covered by auto insurance or an attorney lien, make sure you bring this information.
You should wear loose fitting clothing so you can expose the area that we will be evaluating and treating. For example, if you have a knee problem, it is best to wear shorts. For a shoulder problem, a tank top is a good choice, and for low back problems, wear a loose fitting shirt and pants, again so we can perform a thorough examination.
Treatment sessions typically last 30 to 60 minutes per visit.
This is highly variable. You may need one visit or you may need months of care. It depends on your diagnosis, the severity of your impairments, your past medical history, etc. You will be re-evaluated on a monthly basis and when you see your doctor, we will provide you with a progress report with our recommendations.
In most cases, health insurance will cover your treatment. Click on our insurance link above for a summary of insurances we accept and make sure you talk to our receptionist so we can help you clarify your insurance coverage.
You will be evaluated by one of our licensed and highly trained physical therapists and he/she will also treat you during subsequent visits. Unlike some clinics, where you see someone different each visit, we feel it is very important to develop a one-on-one relationship with you to maintain continuity of care. Since only one physical therapist knows your problems best, he/she is the one that will be working closely with you to speed your recovery.
There are dozens of different types of treatment interventions. Here is a list of treatment interventions: Active Range of Motion (AROM) – the patient lifts or moves a body part through range of motion against gravity. AROM is usually one of the first modalities prescribed for arthritis. Active Assistive Range of Motion (AAROM) – therapist-assisted active range of motion. This is usually prescribed for gentle stretching or strengthening for a very weak body part. Stationary Bicycle – with or without resistance. This is usually prescribed for improving the strength and/or range of motion of the back or lower extremities as well as cardiovascular endurance. Gait or Walking Training – the analysis of walking problems by visually examining the interaction of the low back and the joints of the thighs, legs, and feet during the various stages of walking, including initial contact, loading response, mid stance, terminal stance, pre swing, mid swing, and terminal swing. Many back, thigh, leg, ankle, and foot problems may be caused by or manifest themselves in subtle gait abnormalities. Isometrics – muscle contraction without joint movement. This is usually prescribed for strengthening without stressing or damaging the joint (e.g., arthritis, or exercises to be performed in a cast, or right after surgery if recommended by the therapist/doctor). Isotonics- muscle(s) contracting through the ROM with resistance. This is usually prescribed for strengthening. Soft Tissue Mobilization – therapeutic massage of body tissue performed with the hands. Soft tissue mobilization may be used for muscle relaxation, to decrease swelling, to decrease scar tissue adhesions, and for pain relief. Mobilization – hands-on therapeutic procedures intended to increase soft tissue or joint mobility. Mobilization is usually prescribed to increase mobility, delaying progressive stiffness, and to relieve pain. There are many types of mobilization techniques including Maitland, Kaltenborn, Isometric Mobilizations, etc. Proprioceptive Neuromuscular Facilitation (PNF) – a system of manually resisted exercises performed in diagonal patterns that mimic functional movements. PNF was initially used in developmentally and neurologically impaired patients but now is used in almost every aspect of neuromuscular retraining from athletes in sports facilities to the very weak in hospitals and nursing homes. Posture Training – instruction in the correct biomechanical alignment of the body to reduce undue strain on muscles, joints, ligaments, discs, and other soft tissues. There is an ideal posture, but most people do not have ideal posture. Therapists educate patients about the importance of improving posture with daily activities. Stretching and strengthening exercises may be prescribed to facilitate postural improvement and to prevent further disability and future recurrences of problems. Progressive Resistive Exercises (PRE) – exercises that gradually increase in resistance (weights) and in repetitions. PRE is usually prescribed for reeducation of muscles and strengthening. Weights, rubber bands, and body weight can be used as resistance. Passive Range of Motion (PROM) – the patient or therapist moves the body part through a range of motion without the use of the muscles that “actively” move the joint(s). Stretching/Flexibility Exercise – exercise designed to lengthen muscle(s) or soft tissue. Stretching exercises are usually prescribed to improve the flexibility of muscles that have tightened due to disuse or in compensation to pain, spasm or immobilization. Cryotherapy or Cold Therapy – used to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but also an effective pain reliever for even the most chronic pain. Neuromuscular Electrical Stimulation (NMES) – the application of electrical stimulation to aid in improving strength (e.g., the quadriceps muscle after knee surgery or injury). NMES is also used to decrease pain and swelling and to relieve muscle spasm. Neck Traction – a gentle longitudinal/axial pull on the neck, either manual or mechanical, intermittent or continuous for relief of neck pain, to decrease muscle spasm and facilitate unloading of the spine. Heat – heat is recommended to decrease chronic pain, relax muscles, and for pain relief. It should not be used with an acute or “new” injury. Iontophoresis – medications are propelled through the skin by an electrical charge. This modality works on the physical concept that like charges repel each other, therefore, a positively charged medication will be repelled through the skin to the underlying tissues by the positively charged pad of an iontophoresis machine. Iontophoresis is usually prescribed for injuries such as shoulder or elbow bursitis. Pelvic Traction – the longitudinal/axial pull on the lumbar spine, either manual or mechanical, intermittent or continuous. Pelvic traction may be helpful for the relief of low back pain and muscle spasm. Transcutaneous Electrical Nerve Stimulation (TENS) – a relatively low voltage applied over painful areas through small self-adhesive electrodes. The electrical stimulation “disguises” or “overrides” the sensation of pain. It is a small, portable unit, used in intervals, to control pain and reduce dependence on drugs. It is usually prescribed for relief of pain. Ultrasound – ultrasound uses a high frequency sound wave emitted from the sound head when electricity is passed through a quartz crystal. The sound waves cause the vibration of water molecules deep within tissue causing a heating effect. When the sound waves are pulsed, they cause a vibration of the tissue rather than heating. The stream of sound waves helps with nutrition exchange at the cellular level and healing. Studies have shown that ultrasound is helpful for ligament healing and clinically, for carpal tunnel syndrome, and muscle spasm. Whirlpool – immersion of a body part into water with small “agitators” to provide a gentle massaging motion. A warm whirlpool provides relief from pain and muscle spasm and is often preparatory to stretching or exercise. Cold whirlpool is used to decrease inflammation and swelling.
For many patients, one of the primary objectives is pain relief. This is frequently accomplished with hands-on techniques, modalities such as ultrasound, electrical stimulation, and/or heat or cold therapy. Movement often provides pain relief as well. Your physical therapist will provide you with the appropriate exercises not only for pain relief but to recover range of motion, strength, and endurance. In some cases, physical therapy techniques can be painful. For example, recovering knee range of motion after total knee replacement or shoulder range of motion after shoulder surgery may be painful. Your physical therapist will utilize a variety of techniques to help maximize your treatment goals. It is important that you communicate the intensity, frequency, and duration of pain to your therapist. Without this information, it is difficult for the therapist to adjust your treatment plan.
Flare ups are not uncommon. If you have a flare up (exacerbation), give us a call. We may suggest you come back to see us, return to your doctor, or simply modify your daily activities or exercise routine
In most states, physical therapists cannot make a medical diagnosis. This is something that your medical doctor will provide for you. Physical therapists are important members of your medical team. At this point in time, physicians are typically the health care providers that will provide you with a medical diagnosis.
Billing for physical therapy services is similar to what happens at your doctor’s office. When you are seen for treatment, the following occurs: The physical therapist bills your insurance company, Workers’ Comp, or charges are based on Common Procedure Terminology (CPT) codes. Those codes are transferred to a billing form that is either mailed or electronically communicated to the payer. The payer processes this information and makes payments according to an agreed upon fee schedule. An Explanation of Benefits (EOB) is generated and sent to the patient and the physical therapy clinic with a check for payment and a balance due by the patient. The patient is expected to make the payment on the balance if any. It is important to understand that there are many small steps (beyond the outline provided above) within the process. Exceptions are common to the above example as well. At any time along the way, information may be missing, miscommunicated, or misunderstood. This can delay the payment process. While it is common for the payment process to be completed in 60 days or less, it is not uncommon for the physical therapy clinic to receive payment as long as six months after the treatment date.
After performing a complete evaluation of your condition, your physical therapist will determine the appropriate course of treatment to maximize your recovery. Massage can be a component of treatment, however massage alone is rarely the most effective course of action. Exercise, stretching and modalities are also very important tools in restoring function and minimizing pain. Your therapist will customize a treatment plan to meet your specific needs.
The term accepting insurance can be misleading to patients, as it implies that the provider is in-network with the insurance plan. Many providers, in order to not turn away potential business, will inform the patients that they “accept” his/her insurance plan. In turn, the patient interprets “accepts” as “in-network”, but in fact, the provider is “out-of-network” for the insurance plan. Being out-of- network means the patient usually is subjected to large financial penalties, such as a large deductible, copay, and co-insurance. So always ask your provider if he/she is IN-NETWORK with your insurance plan, and be wary of providers that state they “accept” your insurance. IN- Network means that the provider is contracted with the individual’s insurer and pre-determined rate is set for provided services. Because there is a pre-determined rate it is less costly to the individual.
Some patients will need to continue with home exercises. Some may choose to continue with a gym exercise program. Others will complete their rehabilitation and return to normal daily activities. It is important that you communicate your goals to your therapist, so he/she can develop a custom program for you.