What is physical therapy?

Physical therapy is an approach to the diagnosis and treatment of neuromusculoskeletal disorders; that is, problems concerning the nervous, muscular and skeletal (bone and joints) systems by conservative measures. There are no invasive interventions such as injections or surgery involved in physical therapy evaluation and treatment. For a detailed listing and description of out physical therapy interventions, please consult the services page.

What can I expect during a physical therapy evaluation?

Physical therapy is used to maximize the efficiency of function in the human body. When our bodies are flexible and protected by strength, we are less vulnerable to injury. For most people with musculoskeletal problems, the initial physical therapy evaluation will focus primarily on the structural and biomechanical efficiency of the body. The examiner engages in a thorough evaluation assessing how the different spinal regions and the upper and the lower extremities are moving, looking for restrictions, poor quality of movements, compensations and areas of discomfort.

Although a person may be experiencing a problem in one or more specific regions of their body, the therapist takes a fairly holistic or ‘whole body’ approach to the assessment. This is because stresses or imbalances in one area of the body can have a significant effect on another area of the body. For example, shortening of the abdominal muscles can draw the rib cage down, forcing the head out of alignment with the rest of the body. This distortion can have a direct bearing on pain problems in the jaw, neck and back. The therapist, therefore, does a complete postural assessment, examining how efficiently your body opposes gravity. Usually the therapist analyses your posture with the aid of a plumbline and takes some photographs, so that you can see any significant postural imbalances that may be present.

In addition to the postural assessment, each patient receives a neurological screening. Palpation of the body is also conducted to evaluate pain, locate restrictions in the soft tissue and to assess arthrokinematics, or the quality of movement in the joints. At the end of the evaluation, the objective findings and the relationship of these findings to your presenting physical problems are discussed with you in detail. Out of the evaluation and subsequent discussion, a set of treatment goals and plan of care are devised. You can expect the entire physical therapy evaluation process to take approximately one hour.

Are all physical therapist facilities the same?

No. As with physicians, most physical therapists move into different areas of specialization by continuing education programs post-graduation. Still, most outpatient physical therapy (PT) facilities offer brief modality treatment (e.g. hot pack, ultrasound) and are geared towards exercise and strength training. Given recent changes in healthcare and insurance reimbursement, treatment at these clinics often necessitates that the therapist see two to three patients simultaneously in order for the facility to be financially viable. This may mean that the client is unlikely to get a high degree of personalized care and that actual ‘hands-on’ treatment is kept to a minimum. Although Integrative Therapies also utilizes modality treatments and exercise therapies, what distinguishes us most from other rehabilitation facilities is our personalized one-on-one care and the high skill level associated with our manual therapy. When appropriate, we also integrate physical therapy treatment with other services at the center such as biofeedback and acupuncture.

What is the approach to physical therapy at Integrative Therapies?

Our approach to treatment at Integrative Therapies is based on the belief that partnership and understanding are very important in the recovery process. As the goal of physical therapy is typically to restore function and promote independence, your therapist may spend part of your therapy time helping you understand more about your physical condition and what you can do on your own to speed up your recovery, and maintain the gains that you have made in therapy.

Although some aspects of treatment may be passive in nature, most interventions at Integrative Therapies are designed to enhance your awareness of your body, thereby enabling you to become an active participant or partner in your healthcare. The initial stages of physical rehabilitation often involve manual therapy techniques. Even though you may be lying comfortably on the treatment table, receiving ‘bodywork’, these sessions can provide powerful experiences for developing self-awareness and skills that help you get a handle on managing your symptoms.

The type of manual therapy that you receive depends largely on the results of your postural assessment, and other findings in your PT evaluation. The type of therapy used also depends on how far you have progressed in the rehabilitation process. Most clients, however, undergo some treatment with manual therapy to aid in postural balancing.

Muscular compensations and postural adaptations can develop fairly rapidly with major injuries or gradually over time with a series of minor injuries, in order to keep the body going. Sometimes the body’s alignment can become so compromised and joints so compressed that even a minor injury becomes difficult to get over. Assuming biomechanically unsound postures (e.g. sitting at a non-ergonomic computer station) or doing repetitive movements for too long can also upset the balance of the neuromuscular system. Using postural and movement cues from your body, the therapist employs techniques of soft tissue mobilization and myofascial release to "unravel" the effected areas, starting with the most superficial tissues, then moving toward the deeper structures. This stage of treatment is complemented with individually prescribed stretches to help maintain healthy muscle balance between sessions.

During this phase of treatment, the therapist may also address trigger points and referred pain with manual neuromuscular therapy. Emphases however, does not tend to be on treating the symptoms, but on addressing the underlying causative factors that maintain trigger point phenomena and pain. Clients may receive instruction in helpful ergonomic adjustments, guidance in postural re-education and training in flexibility and relaxation exercises. Body awareness and pain management may also be facilitated by surface EMG monitoring, biofeedback or movement therapy such as Trager®. Physical therapy sessions generally last from one to two hours and you can expect to receive the undivided attention of your therapist during this time.

Once the proper length and balance of the muscles has been restored and a measure of decompression has occurred in the joints, your therapist may add gentle joint mobilization to your therapy regimen. This form of mobilization is very different than a chiropractic adjustment. Instead of a thrusting maneuver, gentle oscillatory movements are applied to the articular structures, which aid in lubrication, nutritional delivery and functional mobility of the joint.

Initial stages of the rehabilitation process are aimed at modifying compensatory movements, faulty postures and pain. In the later stages, emphasis may be placed on stabilization and conditioning exercise and independence in a home program or therapeutic exercise class.

Following the appropriate sequence of the stages of rehabilitation is very important. Many individuals who come to Integrative Therapies have had prior physical therapy experiences where they were invited to engage in contractile conditioning exercises before the shortened ischemic muscles had been released. This can lead to increased pain and joint compression. If faulty movement patterns are not addressed, conditioning exercises may only serve to further ingrain destructive patterns.

To ensure proper progression of therapy and to optimize treatment outcome, each rehabilitation participant undergoes re-evaluations at regular intervals. The therapy goals and treatment plans are updated at that time. This information is shared verbally with you and is also typically sent to your referring physician (and case manager, if you have one) in the form of a written report.

The successful rehabilitation client is one who works in partnership with their therapists; one who is willing to expand their awareness and take an active role in applying therapeutic techniques. The ability to make a smooth transition toward self-responsibility in your treatment program is the key to lasting benefits.

Although exercise machines and equipment can sometimes be helpful in achieving and maintain therapeutic gains, they are usually not necessary for a successful maintenance program. Simple accessories such as a Thera-Band or physioball or even just the use of your own body (as is taught in many Yoga flexibility and strengthening programs) is often sufficient. These simple but effective strategies are incorporated into many treatment plans and are all part of our approach to supporting you in independent and healthy living.

What types of conditions are treated in physical therapy at Integrative Therapies?

Therapists at Integrative Therapies treat a broad spectrum of musculoskeletal and neurological conditions. These include but are not limited to: back, neck and shoulder pain, tension and migraine headaches, RSD, tendonitis and myofascial conditions, sciatica and piriformis syndrome.

Our staff also has a great deal of experience working with those who are attempting to cope with fibromyalgia, osteoarthritis, multiple sclerosis and temporomandibular joint (TMJ) or jaw dysfunction.

We see many post-traumatic conditions such as whiplash, post-traumatic headache and coccygeal pain secondary to fracture. Our team also provides rehabilitation services for individuals post-operatively; for example, post cervical and lumbar fusion, postoperative TMJ and titanium implant surgery. We also offer relaxation and manual therapies to cancer patients who are undergoing chemotherapy and radiation treatment and those dealing with various chronic pain conditions.

My doctor says there is nothing wrong with me. Am I a candidate for physical therapy?

Many of our patients have had the experience where in going to their doctor, they underwent testing and investigations, possibly including X-rays and MRIs only to be told that these were negative. This is very difficult for a person to accept when they know that they are having severe pain. However, the physician specializes in the diagnosis and treatment of disease and pathological processes. When the testing is negative, this is extremely good news. The next step for you may be to obtain a referral for physical therapy. Our evaluation is intended to help uncover some of the factors contributing to your pain or dysfunction. Soft tissue (e.g. muscle, fascia and ligament) problems, biomechanical imbalance and stress can cause a person to experience significant levels of pain, even in the absence of actual disease or obvious structural damage. Your therapist will be happy to work with you to help you find ways to reduce your discomfort and improve your functional abilities.

How many treatments will I need?

Depending on the condition, the active treatment program may involve six to twelve treatment sessions scheduled usually at a rate of twice a week. At this point, if the condition has improved as expected, the frequency will probably be cut down to one time a week or once every two weeks should further treatment be necessary. As your treatment progresses, more responsibility is placed on your shoulders to be actively involved in a home program, so that you will be fully independent in self-care at the time of discharge.

Are there contraindications to physical therapy?

As gentle as the techniques are here at Integrative Therapies, there are no true contraindications. Please note that disease, fracture and pathology should clearly be treated by your physician. Our techniques are not directed towards disease processes, however, they can be effective in the relief of pain secondary to compensations that have developed as an indirect result of the diseased process.

Are there any side effects to physical therapy?

Since we are changing what may be long standing postural and biomechanical relationships, you may experience some initial soreness as the appropriate tissues elongate and pressure in the joint changes. Joints that have had compromised movement are usually poorly lubricated and it may take a little while before proper fluid returns. In addition, patients may feel soreness in the musculature, as well as ‘a little under the weather’ during the first few treatments. This is usually related to the release of metabolites which have been stored inside the constantly contracted muscles for long periods. We instruct each patient on the management of these situations should they occur in order to minimize them and help them pass as quickly as possible.

It is fairly standard for most insurance plans to provide coverage for physical therapy, however, this is usually dependent on receiving an order from your physician stating that the services are medically necessary. Insurance companies offer a variety of benefit packages so it is important to find out exactly what services your personal insurance policy covers. The referral and insurance coordinators at Integrative Therapies will be happy to help you find the information that you need.