Physical therapy can mean a lot of different things to different people depending on their experience with it. My first question to a patient who comes to see me is: Have you ever done physio before? When and where? and did you find it helpful? The reason I ask is because not all physical therapy is the same (unfortunately). This article will clear the air on what to look for when searching for a physical therapist, red flags you can use to detect bullshit physiotherapy, what quality and effective therapy looks like, and present new ways of looking at physical therapy as a tool to optimize your quality of life, prevent injury and increase performance.
Finding a physical therapist should be an active process. Before committing your time and money to a therapist or clinic, make sure you find one that’s effective and has your best interests in mind. The fact that I even have to say that irritates me but that’s the reality in the industry when you start involving big business with a hungry profit motive. Here are a few good “interview” questions to ask a potential therapist or clinic before getting your first assessment:
How many times a week will I be coming?
This is a bit of a trick question designed to weed out therapists that want to get you to come as many times as your insurance permits. If they answer anything but “it depends”, hang up the phone and call the next one. If they say 2-3 times a week that’s an especially big red flag. The sad truth is that when big companies get their greedy hands on physiotherapy, they look to maximize profits by getting their therapists to promote a high visit frequency even if the injury doesn’t call for it.
What kind of things will I be doing during visits?
Its called PHYSICAL therapy for a reason – it should involve physical activity as the primary tool to improve your body. The days of sitting on a therapy bed hooked up to bullshit machines like ultrasound and electrical stimulation (which do nothing to help your injury) for bulk of your visit need to come to an end. If they say any kind of weird machine before saying the words movement or exercise, move on to the next clinic/therapist on the list.
How many patients do you see per hour?
Anything more than 2 per hour is a joke, move on to the next place. A lot of big chain clinics force their therapists to see 3-4 patients an hour. Its impossible to make an effective change with someone in 15 minutes, doesn’t matter how good you are, not to mention paying $75 for 15 minutes of face time with a therapist is a rip off.
Those are just a few good ones that will eliminate a lot of the poor candidates out there
The most effective physio is done when you don’t have an injury
Most people go for physiotherapy when they have pain but pain is usually a lagging indicator. Unless you hurt yourself playing a contact sport or from some bad luck (like crashing into a tree while skiing), pain typically only starts after you have done damage to your body and have been moving poorly for a long time. The best way to rehab an injury is prevent it from happening at all – here’s the best part: 97% of all injuries I see in clinic are preventable if individuals had gotten their posture and movement screened and corrected before injuries settled in.
Getting your movement screened twice a year by a competent therapist is the cheapest and most effective use of physiotherapy. Your body is designed to last 100 years without breaking down – even things like osteoarthritis are preventable if you move properly.
At optimize we offer movement screens for people without pain that want to make sure they’re moving properly, have good mobility, and are avoiding putting themselves at risk of injury. One of the biggest elements in staying healthy is doing regular maintenance on your body to prevent injury. Take ownership for your body (you only get one) and take an active role in keeping it working optimally. A movement screen at optimize will let you know the 3 biggest areas you need to work on to avoid future injury and teach you how to address them.
Barbell Physiotherapy
Resistance training is one of the most effective ways to become resilient to injury and keep your body functioning optimally. The gym is a lab to rehearse proper movement patterns and build a coat of armor around your bones – its called muscle. With that said, not lifting with proper technique can turn resistance training into a harmful activity instead of something immensely beneficial. Physiotherapy can help – find a therapist who lifts and has a setup in their clinic where they can coach your technique to make sure its correct. A good therapist can also guide you on what exercises are best suited to your goals, educate you on training frequency and make sure you know the importance of recovery and body maintenance that needs to go along with your weight training. If you’re having pain with your squat, deadlift or your snatch and your physio doesn’t look like they have ever lifted a barbell in their life, might be a good idea to find a therapist that speaks the same language.
REAL physio
An effective physical therapist teaches you how to fix yourself. Every human has the ability to learn basic maintenance on their body to stay healthy. A good therapist educates you and gets you to understand why you have pain, how to work on things at home to get out of pain, reviews your movement patterns and helps you correct them, motivates you to make positive changes in your life to increase your health, and has your best interests in mind.
Real physio involves quality face to face time with a physical therapist (not just assistants), involves education on all things related to the health of your body including sleep, diet, daily positions, reducing sitting, and a quality therapist helps you navigate the sometimes complicated health system we have in Canada.
What many people (including a lot of physios) don’t realize is that the site of pain is often not the site of the true issue. A therapist that just treats your pain will not make any lasting changes unless they look beyond the site of symptoms and address your movement patterns.
Body maintenance
A key element of effective physical therapy is teaching body maintenance. We do a lot of things with our bodies that we weren’t designed for like sitting, wearing footwear, and using handheld electronics all day. Those things have a profound effect on your body and the more time you spend doing them, the more time you need to spend reversing their effects. Sitting at a computer for a day might not kill you but after 10 years it creeps up on you as shoulder pain, neck pain, back pain, carpel tunnel and the list goes on. Being taught how to use a foam roll, a softball and lacrosse ball to work on your body is a mainstay of our treatment approach at optimize and it should be a big component of every physiotherapy treatment. If you aren’t being taught how to do basic maintenance on your body, find another therapist.
There needs to be a shift in the world of physical therapy and it starts with people being better informed about what REAL physiotherapy is and choosing where they spend their time and money based on who can provide quality and effective physio. Don’t settle for shitty physio, its a waste of time and there are better alternatives out there.
Lets Recap:
- Demand better physio by interviewing your therapist before committing your time and dollars
- RED FLAGS: multiple visits a week for months on end, little time spent with the actual therapist, a clinic that looks like a meat market more than a clinic, ++time spent sitting on a bed hooked up to a machine
- REAL physio: learning proper movement, learning how to maintain your body, time spent with a physiotherapist and not just assistants or machines, fix the source of the problem and not just treating the pain
- The right physical therapist can help improve your lifts by increasing efficiency. Reduces injuries and increases PR’s
- The best physio is done when you’re not injured: get your movement screened regularly and adopt a regular practice of maintaining your body.
To all the PT’s out there: practice what you preach and be a healthy human and good mover. Working to improve your own body will make you a better therapist.
Quality physio works. If you aren’t improving after 4 visits, find another therapist because your current one isn’t doing the right things.
Hope this helps navigate the currently muddied waters of finding the right physical therapist and increases your faith that REAL physiotherapy helps and can make a big difference in your life.
Cheers,
–Nick
