Frequently Asked Questions (FAQ)
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 paperwork or 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 therapist.
- The therapist will discuss the following:
- your medical history
- your current problems/complaints
- pain intensity, what aggravates and eases the problem
- how this is impacting your daily activities or your functional limitations
- your goals with physical therapy
- medications, tests, and procedures related to your health
- The therapist will then perform the objective evaluation which may include some of the following:
- Palpation or 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.
- Range of Motion (ROM) - the therapist will move the joint(s) to check for the quality of movement and any restrictions.
- Muscle testing - the therapist is checking for strength and the quality of the muscle contraction. Pain and weakness may be noted. Often the muscle strength is graded. This is also part of a neurological screening.
- 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.
- Special tests - the therapist may perform special tests to confirm/rule out the presence of additional problems.
- 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 for treatment is subsequently developed. This includes how many times you should see the therapist per week, how many weeks you will need therapy, home programs, short-term/long-term goals, and what is expected after discharge from therapy. This plan is created from input from you, your therapist, and your doctor.
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're covered by Worker's Compensation, bring your claim number and your case manager's contact information. If you are being 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 several weeks of care. It depends on your diagnosis, the severity of you impairments, your past medical history, etc. You will be reevaluated on a monthly basis and when you see your doctor, we will provide you with a progress report with our recommendations.
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.
Physical therapists are experts in movement and function. They do not restrict 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. With the boom in the golf and fitness industries, a number of physical therapists are engaged in consulting with recreational golfers and fitness clubs to develop workouts that are safe and effective, especially for people who already know that they have a problem with their joints or their backs.
The cornerstones of physical therapist 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 licensed physical therapists or by 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. New York does not legally require patients to see their physicians before seeing a physical therapist. All you have to do is ask your doctor if physical therapy is right for you. Some insurance companies require a physician's prescription for payment.
We believe that we can provide you with the highest quality of care available and do it in a cost-effective manner. You will work closely with your physical therapist and in most instances, your case will be managed by the same physical therapist from the beginning to the end of your experience with us.
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.
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.
There are many types of treatment. Here is a list of some common interventions:
- 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.
- Cryotherapy or Cold Therapy - Cold therapy is 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.
- TENS - transcutaneous electrical nerve stimulation is 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.
- NMES or neuromuscular electrical stimulation - 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Stretching/Flexibility Exercise - exercise designed to lengthen a 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.
- PNF - proprioceptive Neuromuscular Facilitation is a system of manually resisted exercises performed in diagonal patterns that mimic functional movements. Initially used in developmentally and neurologically impaired patients, but now used in almost every aspect of neuromuscular retraining from athletes in sports facilities to the very weak in hospitals and nursing homes.
- 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.
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.
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.
You have the right to choose any physical therapist. The best thing to do is give us a call. Sometimes, your insurance plan may not pay for a specific physical therapist, but if this is the case, you still could see that physical therapist but you may have to pay out-of-pocket for the treatments.
The best thing to do is give us a call and we will attempt to answer all of your questions.
In 2006, New York passed a law allowing patients to go directly to physical therapists. In most cases, if you are not making significant improvement within 30 days, the therapist will refer you to/back to your physician.
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, Worker's Comp, or charges you based on CPT (Common Procedure Terminology Codes).
- 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.
- The patient is expected to make the co-payment, if necessary, on every visit.
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.
- Do they have a service that can address your problem?
- Do they take your insurance or are they willing to work with you if they are not a preferred provider?
- What are the hours of operation?
- Can they provide satisfaction results?
- Do they accept your insurance?
- The therapist should provide the treatment.
- Can you briefly interview the therapist before the first visit?
- Ask your family and friends who they would recommend.