Step right up, folks! We can get you better in six visits or less! Step right up!
If this sounds absurd to you, it should.
But it is the constraint many of our patients face from insurance limitations. Insurance companies are not medical professionals, and it is up to you and your physical therapist what your treatment plan should be.
Sometimes you may have a minor injury and see significant improvement in four visits, but more often than not, physical therapy is a long game and we cannot always get the full results we want in six visits. By the time most patients get to physical therapy, the injury or issue has been going on for a while. If it is an injury, we have to let it heal and then retrain the body how to move properly so that it does not become a reoccurring issue.
Retraining your movement takes time. Depending on how long your pain has been going on, we may have a very big iceberg and we have to be diligent on changing those movement patterns and finding the trigger. This could include retraining your breathing, regaining core strength, and calming inflammation all to get your body to move properly vs. compensating and ending up with pain.
Your body is all connected. You may have pain in your back that is coming from your gait and the way you land on your foot. Or you may have hamstring pain because the back is unstable. We have to retrain those muscles so they are not compensating and causing pain in other areas. But before we can do any retraining of movement, we have to calm the inflammation and make sure the injury is healed. This takes time.
How much time is very individualized to each patient. Usually, your physical therapist’s first evaluation will give you a good estimate of recovery. This can adjust once the acute problem calms down. For example, you may start out with two times a week, and then move to once a week, once a month, and then finally a home exercise program.
For postpartum women, we see them to retrain their breathing and work on posture and movement. After giving birth, moms need to relearn how to breathe into their diaphragm and pelvic floor rather than their chest and ribs. This helps significantly with pelvic floor recovery and can usually be done in three to four visits. But if mom gets pregnant again, her breathing will compensate and revert, and she will have to retrain proper breathing and posture again.
As your body moves in the world and your expectations change, you may need to change and come back to support what you want to do.
Then there are big injuries like an ACL tear. We typically start physical therapy right after surgery and any sports-specific therapy around 12 weeks post-surgery. In that time, we are trying to make the ACL stronger and retrain the movement so that the risk of reinjury is lower. This healing happens over a long period of time, usually nine to 12 months to complete rehab, not six to eight visits. We have to work on performance, which happens over time and there is no way to “rush” this progress in a 45-minute session. They have to build on each other.
Think of perfecting a golf swing, you are not going to get it on the first or even the tenth lesson. You have to stay with the training and get a little better each time.
All that said, we understand most people do not have the pocketbook or patience to come to physical therapy in perpetuity. And that is not the recommendation. What we do want to do is provide you the level of care you need for your injury. Not an arbitrary six visits that is not grounded in medical rationale. That’s why we provide packages and out of network benefits. We can also help you navigate HSA and FSA plans.
And aren’t the one to two visits a month worth not having a surgery or reinjuring yourself? You have to take care of yourself now or pay for it later, and we would much rather work with you to be proactive and get you stronger than yesterday!