I enjoy my job and treating people of my community. I want to see all individuals who I start a plan of care with meet their long term goals. I want every person of my community who enters my clinic to achieve their functional goals. Sometimes… this doesn’t always happen. I am hoping this blog post will assist in the communication of why their physical therapy plan of care might fail. I hope this article will allow current or future patients to be aware of issues effecting physical therapy success.
Why your physical therapy may fail:
- Wrong evaluation: As in all fields of medicine or professions of deductive reasoning, the evaluation is the most important aspect of your physical therapy plan of care. Success depends on this. The clinical examination will determine the core of care and the specific interventions to apply to the injury. A physical therapist will need to differentiate between a musculoskeletal injury and a neurological presentation. For example: A female patient presents with pain to behind the thigh. She reports this seems like her hamstring. With continued testing it is found her symptoms are related to poor neuromobility to the nerve root of the lumbar spine. Treatment solely to the hamstring would not have corrected her issue and left the clinician or patient frustrated with the continuation of pain. Also, an improper evaluation will prolong your physical therapy care. First step to successful physical therapy is to have an accurate evaluation.
- Life happens: Sometimes I meet patients and have a clear plan of care to assist with their dysfunction but we cannot work together… because they are not here. Life can become complicated, racing kids to different activities, work schedules, care of a family member or other. If you cannot make your physical therapy appointments consistently… it is hard to make a difference with your injury. It is important to begin your physical therapy plan of care when your life allows, or you make the time to be consistent.
- Compliance matters: We can have the correct diagnosis, correct plan of care and your life allows you to complete your physical therapy, however we still might fail. I had a physical therapist clinical instructor at my third rotation in physical therapy school, Ed Stafford, who said to a patient, “ The home exercise program I gave you works best… when you do it”. I kind of chuckled but it is true. The home exercise program is used in two ways. This allow me to give you an avenue to progress your physical therapy when you are not in the office but also this allows me to determine what is working. If you return to my clinic and tell me certain exercises are creating pain, this is great information. This allows me to determine what is working and why, but also what is NOT working and why. However, if you are not able to (see #2) or have not been completing your home program, we cannot progress together to meet long term goals. Essentially, your physical therapy will fail.
- Exacerbations-flare ups- new injury: these are all issues that prolong physical therapy and prolong pain. If you would like to make the most gains in your physical therapy we will need to avoid these issues. If you came to my clinic with a bruise on your thigh and needed to improve healing to return to running without limits, I could give you the best treatment in the world with soft tissue mobilization, ultrasound, electrical stimulation, laser, KT tape or other, but before you left I punched you directly in your bruise as hard as I could? You would call me insane and would not return for a follow up. Correct? This is similar to your physical therapy plan of care. I will work to reduce your irritation and improve your symptoms, however if you return to home and continue activities that create pain… this is similar to me punching you in the arm. For example: if you have a knee injury on the right leg. I will treat this injury in the clinic and you will return to home. If you have pain with walking and go for a hike… you will delay your improvement. Even walking with small pain will over time be cumulative and will be similar to me punching you in your bruise after your physical therapy treatment. Overall, it is important to progress with activity not creating pain to meet your overall goals.
- Too damaged: Sometimes physical therapy is not the only answer. Sometimes you will come for an evaluation and you have too much damage to the rotator cuff. You will not be able to lift the arm…. No matter how much I work with you. This is a time I will refer you to an orthopedic surgeon for a consultation. I will pride myself in helping you achieve as much function as possible or reduce your pain to a low level, however, sometimes there is too much damage.
- Not being positive: I tweet many articles of interest to me related to health, fitness, and physical therapy. I continue to read the impact of positive thinking. I have found the best outcomes are achieved for people who have an optimistic attitude. These individuals come to the clinic looking to make a difference in their life and are thirsty for any activity or treatment modality to assist their care. Overall, I have found these people achieve the best outcomes.
- I write this blog to assist my current patients, former patients and future patients to achieve their goals and improve function. I want every person I treat to achieve the greatest level of function. I list today the predictive situations for why people do not meet their long-term goals with physical therapy, so my hope is to proactively mention these and allow avoidance of these barriers to their physical therapy, and in the end I can assist you to meet… your functional goals.