How do you know if You’re Getting Good Physical Therapy?

I’ve been told more times than I can count “I’ve tried physical therapy” when someone is describing a pain they’ve been having for years to me. A lot of the time, the conversation stops when I start asking followup questions, “What did you work on? Who did you see? How many times did you go?” Certainly, Physical Therapy does not solve all life’s ailments. But not all physical therapy is created equal. When you go to one restaurant, do you then tell everyone you’ve tried restaurants? Maybe you went to a Michelin star restaurant and you left hungry. Maybe you went to AppleBees and you left wishing they served things that weren’t different shades of brown. Why is it that healthcare providers get a free pass when it comes to discussing the quality of their services? 

Well, let me posit a few rhetorical questions for you to think about.  When you buy a car do you stop into multiple dealerships to make sure you’re getting the best car?   When you buy a house did you look at more than one house?  Even if you didn’t, did you use other houses to get a reference point for price? 

You can’t fault a Ford Salesmen for wanting to sell you a Ford car. It’s what they do. When you walk into a surgeon's office do they give you suggestions on how to avoid surgery? Maybe. More likely do they offer you a solution centered around surgery (or do they offer conservative options only as a way of delaying the inevitable surgery)?   Surgery is a wildly skilled service. To become a technically gifted surgeon you need years and years of training.  What would compel someone to go through sacrificing decades of their life, working long hours, enduring back pain, and giving up all hobbies?  It’s an interesting question to think about.  What would it take to convince you to go down this pathway?  Would it be money?  Authority?  Status?  Or would it be something more altruistic like the belief that people need better surgeons and it's worth it regardless of profit.  

One of the biggest problems to objectively assessing your healthcare options is…pain!  People don’t see physical therapists or surgeons unless something hurts.  That pain tends to turn your thought inward and create a sense of urgency that subdues your normal rational thought.  You are much more likely to listen to anyone who claims they can take your pain away because you want it gone yesterday.  The unfortunate reality is surgeons in particular, but most health care providers, don’t have enough time to get to know you.  Physical Therapy is often plagued by this same obstacle. This leads me to my first and most important criteria: (Yes i’m finally at the point where i’m answering the question)

1. How much time did they spend with you? 

1. If your provider sees 20 people a day (or 50 if they’re a surgeon) how much time do you expect them to spend with you?  Most insurance restrictions result in the necessity of providers working in teams.  Did you spend your time with the PA and not the surgeon?  If you were completing physical therapy did you spend your time with a tech or PTA?  

2. Is the solution presented multi-factorial?

1.  Diagnosing a problem can be easy, if you have a torn rotator cuff you need to fix it….right?   Maybe.  The human body is complicated.  We didn’t survive for thousands of years by shutting down the body and waiting for death whenever an injury is sustained.  Knowing what the injury is certainly is important but why did it happen?  How do we prevent it from happening again?  Does your solution fit you specifically or is it the same solution everyone else was given?  If your goal is to get stronger does everyone get stronger doing 5x5 set/rep schemes?  As with all things, it depends.  It depends on your composition of fast twitch to slow twitch fibers, your lifting history, your attitude towards lifting, your current fitness level, the list goes on.  

3. What is Plan B?

1. If the surgery didn’t go well, what's the plan?  If the PT isn’t working for your low back pain what’s next?  Any good provider is well equipped with the next plan not because they don’t think plan A will work but because humans are so complicated it is a certainty it will not work as expected.  Plans needs to have the capacity to evolve.

4. Did they recommend any other professionals? 

1. Any good therapist should know a good massage therapist, a good chiropractor, a good personal trainer, a good nutritionist and a good surgeon.  Nobody can solve everything alone.  The best scenario for any patient is to know they are a part of a community of skilled providers who trust each other and all have the patient’s best interest at heart.  Any good surgeon should know a good physical therapist (in and outside of the clinic they own).  If either professional does not provide these resources it may be worth considering another professional.