The Problem with Physical Therapy

I’ve had this topic in mind for a while now and just now have the opportunity to discuss it. Most of us have been to physical therapy at least once or know or someone that has been through physical therapy. Whether for a shoulder injury, knee issue, hip problem, etc., we’ve all been there. You get hurt, you go to the doctor, they refer out and there you are in physical therapy. I have been to five physical therapists in my life for SI joint dysfunction and have yet to find someone who knows how to completely help me. The closest I have come to having someone understand my condition still can’t quite figure out what’s going on.



The problem with physical therapy is very few physical therapists know how to communicate how to properly transition someone into a traditional exercise program.  They are aware of how to fix issues through corrective exercise, stretching, strengthening, and inflammation reducing modalities (dry needling, cupping, estim, etc.), but not how to properly transition their clients to continue to grow stronger after physical therapy.

I don’t blame physical therapists for this, as many Americans don’t lift weights and don’t have the knowledge base to lift weights on their own following physical therapy. But there are two problems to this poor transition.

  1. Patients who don’t weight lift or workout regularly don’t understand how to maintain their success following therapy
  2. Patients who are athletes or weightlifters are not taught how to properly transition back into a normal weightlifting program following an injury

For #1, I’ve had family members and friends tell me they feel lost after physical therapy. Most of the time, they end up injuring themselves again or aren’t aware they are supposed to continue or even progress the exercises they were given in physical therapy. In some ways, physical therapy is a fix that lasts only as long as you are in physical therapy. Of course some physical therapists communicate directions to their patients about what they should do following physical therapy but still many do not. Physical therapists are also many times working with several people simultaneously when they see you, so they don’t have your undivided attention either.

For #2, many physical therapists have never lifted weights in their life or have no concept of basic movement patterns. So when it comes to transitioning an athlete or weightlifter back to their normal routine, they are at a loss for how to properly answer our questions. I had a physical therapist tell me recently, “Oh, I wouldn’t do deadlifts, I’ve seen so many people do those and hurt themselves.” Of course for the every day person, this is a very true statement. But for someone like me who does deadlifts with good form with about 60-70 pounds being told this, it’s hard not to laugh. Of course there is room to injure yourself, but deadlifts are actually a very functional movement pattern (e.g. think picking a box up off the floor). Saying words like squats and deadlifts to a physical therapist can sometimes seem like you just told them it’s the end of the world. But really, squats and deadlifts (from a personal trainer point of view) can be easily regressed and modified to be mechanically better for some who have had previous injuries or mobility restrictions (e.g. think box squats, romanian deadlifts, kettlebell deadlifts, and goblet squats).

The point I would like to make here today is I encourage those who are in physical therapy to ask questions. Be an active participant in your therapy. Simple questions you can ask are:

  1. Why are we doing “X” exercise?
  2. What muscle does this exercise work?
  3. Can you tell me why we are strengthening “X” when I have “Y” pain?
  4. Do you lift weights?
  5. Have you worked with athletes before?
  6. How should I transition my therapy into a traditional exercise program? Is there anything I should really avoid for risk of really hurting myself again?

The more questions you ask, the more value it will bring to your therapy. Don’t just listen, take notes. You’re paying a lot of money to have a professional help you, so it’s important to learn as much as you can from them. If your physical therapist does not know how to answer these questions or doesn’t seem to answer confidently, perhaps you should seek out someone else. It’s also important to know that physical therapists have specialties too, similar to doctors. So if you have a serious shoulder injury, seek out someone who primary works with shoulder injuries. Not all physical therapists are created equal, so don’t be afraid to look up reviews or check their educational background as well.

In an age where healthcare is very expensive and time-wasting, it is important to be an advocate for yourself and be aware of potential issues that may arise with their care. A lot of injuries develop due to poor body mechanics, bad posture over time, and repetitive motions you do on a day to day basis that may be creating havoc on your joints (e.g. think of lifting things overhead a lot or being on the computer all day). Therefore, fixing your issues may require a change in lifestyle or posture to really make a long-term difference.

Many clients have mine have benefited from working with me post-rehab, as I have the knowledge base to work with their injuries to transition them to a normal exercise routine. With my specialty in corrective exercise I am able to truly assess my client to see where their strength and deficiencies are so I can put a personalized program together for them. Therefore, if you ever need any help, please do not hesitate to contact me.

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