During your first visit you can expect the following:

• Arrive at your appointment with your paperwork completed (you can download it from our website - see the patient forms link)
• You will provide us with your prescription for physical therapy.
• We will copy your insurance card.
• You will be seen for the initial evaluation by the physical therapist.
• Your physical therapist will discuss the following:
  
  
  1. Your medical history.
  2. Your current problems/complaints.
  3. Pain intensity, what aggravates and eases the problem.
  4. How this is impacting your daily activities or your functional limitations.
  5. Your goals with physical therapy.
  6. Medications, tests, and procedures related to your health.
• The therapist will then perform the objective evaluation which may include some of the following:
  
  
  1. Palpation - touching around the area of the pain/problem. This is done to check for the presence of tenderness, swelling, soft tissue integrity, tissue temperature, inflammation, etc.
     
     If your complaints include vaginal or rectal pain, an internal muscular exam will also be done to assess for dysfunction.
  2. Muscle Testing - the therapist is checking for strength and the quality of the muscle contraction. Pain and weakness may be noted. This may also need to be done internally. Muscle strength is graded on a 0-6 scale. This is also part of a neurological screening.
  3. Neurological Screening - the therapist may check to see how the nerves are communicating with the muscles, sensing touch, pain, vibration, or temperature. Reflexes may be assessed as well.
  4. Special Tests - the therapist may perform special tests to confirm/rule out the presence of additional problems. This may include biofeedback to the pelvic floor muscles.
  5. Posture Assessment - the positions of joints relative to ideal and each other may be assessed.

The therapist will then formulate a list of problems you are having, and how to treat those problems. A plan is subsequently developed with your input. This includes how many times you should see the therapist per week, how many weeks you will need therapy, home programs, patient education, short-term/long-term goals, and what is expected after discharge from therapy. This plan is created from input from both you and your therapist.

Make sure you bring your physical therapy prescription (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.

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.

The initial evaluation will last 45-60 minutes, and follow-up treatment sessions typically last 30 minutes each visit.

This is highly variable. You may need 6-8 weeks 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.

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 have probably heard of the profession of physical therapy. Maybe you have had a conversation with a friend about how physical therapy helped get rid of his or her back pain, or you might know someone who needed physical therapy after an injury. You might even have been treated by a physical therapist yourself. But have you ever wondered about physical therapists--who they are and what they do? Many people are familiar with physical therapists' work helping patients with orthopedic problems, such as low back pain or knee surgeries, to reduce pain and regain function. Others may be aware of the treatment that physical therapists provide to assist patients recovering from a stroke (e.g., assisting them with recovering use of their limbs and walking again).

Most individuals do not know that there are physical therapists who specialize in women's health. There are very few in the U.S. in this field.

Because physical therapists are experts in movement and function, they do not confine their talents to treating people who are ill. A large part of a physical therapist's program is directed at preventing injury, loss of movement, and even surgery. Physical therapists work as consultants in industrial settings to improve the design of the workplace and reduce the risk of workers overusing certain muscles or developing low back pain. They also provide services to athletes at all levels to screen for potential problems and institute preventive exercise programs.

The cornerstones of physical therapy treatment are therapeutic exercise and functional training. In addition to "hands-on" care, physical therapists also educate patients to take care of themselves and to perform certain exercises on their own. Depending on the particular needs of a patient, physical therapists may also "mobilize" a joint (that is, perform certain types of movements at the end of your range of motion) or massage a muscle to promote proper movement and function. Physical therapists also use methods such as ultrasound (which uses high frequency waves to produce heat), hot packs, and ice. Although other kinds of practitioners will offer some of these treatments as "physical therapy," it's important for you to know that physical therapy can only be provided by qualified physical therapists or by licensed physical therapist assistants, who must complete a 2-year education program and who work only under the direction and supervision of physical therapists.

Most forms of physical therapy treatment are covered by your insurance, but the coverage will vary with each plan. Most states do not legally require patients to see their physicians before seeing a physical therapist. Most of the time all you have to do is ask your doctor if physical therapy is right for you.

Reference: APTA

You will be evaluated by one of our licensed and highly trained physical therapists and she will also treat you during subsequent visits. Depending on your diagnosis, you may also be seeing a licensed physical therapist assistant intermittently, who is following the directions of your physical therapist.

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 that 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 GCS (Geriatric Certified Specialist) 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 SCS (Sports Certified Specialist) 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, diabetes is an issue, 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.

Women's Health - some therapists specialize in women's issues such as pregnancy problems, pelvic pain, and incontinence. Special treatment is available for women that have these problems. Many that suffer from incontinence do so needlessly. A women's health speciality (WCS) exam has recently been approved and the first sitting for the exam will be 2009. This is the specialty that our therapists are trained in.

Pediatric Physical Therapy - pediatric therapists specialize in the rehabilitation of children. They may assist with kids that 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.

ECS (Clinical Electrophysiologic Certified Specialist) - a physical therapist that 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.

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 uncomfortable, but your physical therapist will do her best to keep you as comfortable as possible while still accomplishing the results you are looking for.

There are dozens of different types of treatment interventions. Here is a list of treatment interventions:

Biofeedback - this modality is performed by placing small sensors on the muscle that the physical therapist wants to assess. As you contract that specific muscle you can see the electrical activity given off by that muscle as a line or bar graph on a computer screen. This technique is used to ensure you are using the correct muscles and to assess muscle recruitment and endurance.

Isometrics - muscle contraction without joint movement. This is usually prescribed for strengthening without stressing or damaging the joint.

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. This may be performed internally or externally, depending on your symptoms.

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.

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 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.

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 decreasing pain and swelling and to relieve muscle spasm.

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.

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.

Massage may be part of your treatment. Rehabilitation specialists are trained in a variety of techniques that may help with your recovery. Deep tissue techniques may be part of the rehabilitative process. Massage is used for three reasons typically - to facilitate venous return from a swollen area, to relax a tight muscle, or to relieve pain. Contrary to common thought, massage does not increase circulation.

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.

Forty-three states have some form of direct access. Some state physical therapy practice acts require a diagnosis before a patient can see a therapist (this is the case in California). In most cases, if you are not making significant improvement within 30 days, the therapist will refer you to/back to your physician.

Direct Access Reference

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.

Physical therapists provide you with a rehab diagnosis, or the underlying cause of your medical diagnosis. For example, in many cases of urinary incontinence, the underlying problem that would be addressed in physical therapy is pelvic floor muscle weakness or dysfunction.

Billing for physical therapy services is similar to what happens at your doctor's office. When you are seen for treatment the following occurs:

1. The physical therapist bills your insurance company based on CPT (Common Procedure Terminology) codes.
2. Those codes are transferred to a billing form that is electronically communicated to the insurance company.
3. The insurance company processes this information and makes payments according to an agreed upon fee schedule.
4. An EOB (Explanation of Benefits) is generated and sent to the patient and the physical therapy clinic with a check for payment and a balance due by the patient.
5. 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, mis-communicated, 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 6 months after the treatment date.

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.

Physical therapists (PTs) and physical therapist assistants (PTAs) are licensed by their respective states.