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  • Writer's picturethe PT & the Patient

What should you expect at your first physical therapy appointment?

Have you been referred to a physical therapist from your doctor? Are you considering going to a physical therapist due to pain or an injury?


In this article, we walk you through what to expect at your first appointment with a physical therapist. We will give you an idea of everything a good PT will ask you, as well as how the PT will work with your injury, and how the PT will instruct you to perform physical therapy exercises that will help your condition.



What you should expect to happen at the first appointment with a qualified and experienced PT?

  • Patient intake information review

  • Questions about your condition

  • Understanding your day to day

  • Discussing your recovery goals

  • Examination and tests

  • An opportunity for you as the patient to ask the PT questions about your condition, and any concerns you might have.

  • PT assignment of home exercise program to help you improve your condition


The PT will also go through a selection of the items below, appropriate to your condition:


  • Manual intervention / PT guided self myofascial release

  • Exercises

    • Low impact aerobic exercises

    • Strengthening exercises

    • Range of motion / stretching exercises

    • Pain relief exercises


Patient intake information review


When meeting your physical therapist for the first time, they’ll need to collect information about you directly. If you were referred from a doctor, your physical therapist will have reviewed the information they received from the doctor before your appointment. This may include any precautions, surgical restrictions, or protocols specific to your condition. It is important as a patient that you fully report your medical history because a physical therapist needs to take into account all aspects of your health to ensure the best course of treatment.



Questions about your condition


Your physical therapist should ask you questions about your condition. For example, they will want to know how your injury happened. If it had a specific mechanical source such as an auto collision, sports injury, fall, or other accident, the physical therapist will take this into account during your treatment and in their advice on how to safeguard against this type of injury in the future.



Understanding your day to day


Whether it was a traumatic injury or insidious onset (developed over time), they will investigate what you do for work, at home, and walk through your day so they fully understand what might have caused or exacerbated the injury. They will also use this information to advise you on how to avoid activities that would slow or complicate your recovery.


A good PT is like a detective for sleuthing the cause of your pain and other symptoms - they should also ask you about type, location, frequency and intensity of pain during different activities. This helps them understand what you are doing that changes your symptoms intensity. The purpose of this is to understand the underlying cause of the pain based off of the symptoms you are exhibiting.


They should also ask about and test for symptoms relating to your nervous system - any decreased motor function, strange sensations like pins and needles or numbness. This both affects the course of treatment and depending on severity, may require immediate intervention outside of physical therapy.



Discussing your recovery goals


Physical therapists should understand your personal goals for treatment and what you would like to accomplish with your therapy. Your goals may change the focus of your treatment. Your PT will also let you know what you should avoid doing temporarily and when it is safe to perform certain activities.


Your PT should ask what you are having trouble with or are unable to do. As a patient you should be open and honest about how the injury or pain is impacting your daily life. Don’t be afraid to talk about any impact on even personal matters, like being able to be intimate with your significant other, or being able to sit on the toilet. Anything that concerns you will also concern your physical therapist and should be discussed openly so they are aware of the problem.



Examination and tests


The physical examination helps the physical therapist evaluate your strength, range of motion, flexibility, posture, mobility, balance, coordination, skin integrity, muscle function as well as overall movement quality. They may need to observe how you sit, stand, walk or move a particular joint or limb. A good physical therapist should not push you beyond what you feel is comfortable without your consent. They will explain what they are about to do and perhaps a bit about why to help you feel comfortable before taking action. As a patient you aren’t “passing” or “failing” or even being graded. It’s simply a way for your PT to understand your condition better, set up a baseline of your current functionality (strength, range of motion etc), and understand how your injury affects your daily life and activities. All of this is in service of aiding your recovery.


For example, with lower back pain, the physical therapist will be trying to screen your pain on many factors, including the type of pain, the situation in which it occurs and information from your doctor or tests like a X-ray or MRI. However, the movement or situation that causes your pain may actually be more useful in terms of treatment than if it is caused by muscular, disc, bone or nerve related issues. For example, a study that found 30% of 20 year old patients that were pain free presented with bulging discs on an MRI. Knowing that your patient has a herniated disc informs the physical therapist but knowing that the patient can’t tolerate bending of the spine (flexion intolerance) will be as or perhaps more important for treatment. The physical therapist will run tests and measurements that rule in and rule out different diagnosis and causes for your pain.


As a patient, you want to be as straightforward as possible with the physical therapist. “Being tough” and hiding pain or exaggerating your pain response to “make it clear” are both counterproductive. For the latter, you can rest assured your physical therapist will be extremely careful with you and will be doing their utmost to avoid causing additional pain during your visit. Your physical therapist will be better able to help you with clear and honest descriptions of what you are feeling. Your physical therapy treatment is a process you and your physical therapist will be taking on together as a team, so clear and open communication is critical.



Manual intervention / PT guided self myofascial release


Physical therapists can perform manual interventions, primarily for some muscular components of the pain as well as provide guidance for PT guided self myofascial release. Both require physical contact. In the first example the physical therapist will typically use their hands for manipulation. In the second example the patient uses either their own hands or often a ball or other tool (to help with reaching the correct spot) to help treat soft tissues and joint structures to modulate pain, increase range of motion, reduce soft tissue inflammation, induce relaxation, or facilitate movement and more.




Exercises


Low impact aerobics are used primarily to increase your heart rate and as a gentle warm-up before strengthening exercises.


Strengthening exercises can be done with body weight exercises, bands or weights as well as larger exercise equipment. The goal is to strengthen weaker muscles that are causing imbalances or instability as well as build strength back to a muscle or muscle group after an injury, or increasing your mobility and range of motion.


Pain relief and range of motion exercises target specific areas where you have pain to build strength, encourage the proper motions and improve posture, as well as increase flexibility and regain range of motion.


As an example, exercises may be focused on conscious activation of muscles during particular activities, such as core activation, stabilization of muscles that are spasming or need to be strengthened or stretched due to muscular imbalances. They may also be mobilization exercises that re-educate your body on safe movements within a prescribed range, gradually increasing that range of motion over time.


In the initial appointment you may only receive a few simple exercises to perform that won’t exacerbate your injury. In other sessions and over the course of your treatment, your physical therapist will teach you how to properly perform new, more challenging exercises to help you continue your recovery. Over time you will be re-assigned a changing selection of exercises that become appropriate as your condition improves.



Education and ergonomics and Q&A


The physical therapist may also go over education of safe movements and postures in your everyday life or in a particular activity, or sport, as well as review ergonomics that are relevant.


For example they may give you advice on your posture and how you’ve set up your sitting position while driving or at your desk, your interactions at a workstation or movements in your job and how you interact with your environment in various situations at home or work.


You should ask questions. A good physical therapist will encourage this! The more you know about your own body, injury and what to do in various situations, the better off you’ll be.




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