Barriers to a successful physical therapy

 I am writing this article due to a common trend I have been seeing in my practice; more and more patients coming to me after several bouts of unsuccessful  therapy at other practices.  This has prompted me to look into their cases and search for trends  that may be causing this.  Why am I able to get them better, when others  have not?  There are several things I have found that contribute to an  unsuccessful outcome, but when these are addressed, often patients that  have not responded to treatment at other practices are finally able to  get see results and ultimately get better. 

  One of the biggest problems I have found is related to directly to the  patient management.  I often see pitfalls in patients with  chronic low back pain.  Recently I saw a patient who had recurrent back pain  that did not respond favorably at 2 other facilities.  When I asked him what he  had done, he gave me a list of good exercises, but what stuck out most to me was that he did  the same exercises every session for 2-3 months!  There was no  progression at all.  When he looked around, he saw all other patients  doing the same exact exercises.  Treatments need to progress over 

 time, especially with low back pain.  Certain basic exercises are  critical that need to be progressed to incorporate into functional  activities.  Every patient will respond to these exercises differently,  so every patient needs to be given an individualized routine.

 

Another problem that I have found is a lack of direct time with the  therapist.  Therapeutic exercises need to be performed in a specific  manner which often requires extensive direct instruction from a skilled  clinician, not an aide.  The response to these exercises is critical.  If  your therapist is not giving you the time to follow up throughout the  treatment to see how you are responding to your exercises, they are  doing you an injustice and setting you up for a poor outcome.

 

Proper care all starts with a correct diagnosis.  Many times I see  patients that have had poor response to treatment because the wrong  thing has been treated.  Finding a correct diagnosis is not always easy but can be done with a thorough examination.  A proper physical therapy  examination will look at the patient as a whole and individualize  treatment based on the specific needs of the patient.  At the end of the  evaluation the therapist should have given you a clear description of  what the problem is and more importantly what you can do to a healthy state.  Don’t be afraid to ask questions!  If you understand your  condition, you will be more likely to comply with treatment.  This is true for all injuries.  This leads me into the next common barrier.  Patient non-compliance.   If there is anything you can take responsibility for, it is your home  program.  All patients should be provided with an individualized home  program.   It is then your responsibility to continue with it.  If you continue with a thorough home  program you should be able to progress yourself to maintain gains and  prevent, or at least delay the recurrence of pain.  A good option for this is  a practice that incorporates fitness services so patients are able to  continue once they are done with therapy.  One of the important trends  now in therapy is to incorporate fitness services into the care in order  provide overall change in the health and lifestyle of the patients.  According to Dr. Merrick Wetzler of South Jersey Orthopedic Associates, “….I cannot emphasize enough the importance of individualized progressions and adding the right treatment at the correct time.  This combined with enough attention in the form of direct, one-on-one care from a therapist and a complete understanding of the diagnosis and treatment options are essential  for patients  to achieve their goals and return to life or sport.  May practices do not properly do this and the result is frequently a negative outcome...as a physician and as a consumer, I would strongly recommend finding a practice that addresses these needs to ensure the best possible outcomes and success.” 

 

Now its time to take control of your care.  If you feel like you have  not responded to therapy in the past, don’t give up hope.  Think back on 

 your therapy and think about what I mentioned above.  Did your therapist  give you 1 on 1 time?  Did they progress you with your routine and make 

 sure you were doing exercises right?   Did they spend ample time with  the evaluation and educate you on your condition?  Did you forget to 

 hold up your end of the bargain?  If you didn’t get the kind of treat  you deserve, you have the freedom to find another practice that can help  you succeed where others have failed.  See what the difference is.  Give  us a call and set up a time for a free consultation to see what the 

 difference is and what we can offer you.

 

 We look forward to getting you better!

 

 Feel free to call us or email me with any questions you might have

 

Dr. Kevin Schnitzer PT, MPT, DPT 

Physical Therapist, Moorestown Director