Preparing for Success in Physical Therapy 

“The more I practice, the luckier I get”-unknown.   

This quote was first introduced to me by my father many years ago.  My dad had responded to my jeering following a particularly lucky shot (in my personal opinion) that capped his victory in a game of HORSE.  HORSE is a basketball game for those unfamiliar.  What my father was playfully asserting here was one of the most important life lessons that I have ever learned: preparation is the key to success!  What I would like to communicate today is a bit of a “How-to” guide for preparing for your best outcome with rehabilitation from outpatient physical therapy.   

Preparing for the Initial Examination 

Did Tom Brady just show up and dominate the NFL for the last 2 decades based on natural talent alone, or was it the countless hours of practice that helped him to become the best quarterback of all time?  Brady fell to the 6th round of the NFL draft with 198 players selected before him due to a myriad of factors.  He split time as a college quarterback (even as a senior), sported a less than stellar NFL scouting report and was buried deep on the Patriots depth chart before ultimately taking over for Drew Bledsoe midseason due to an injury.  It was not sheer athletic prowess, but relentless preparation and determination was foundational to his success.  Now obviously, we are not all professional athletes.  We are a community of people with all sorts of different backgrounds and different values and that’s ok!  It is our differences that make us stronger as a whole.  I would suggest that all of us who are medically able, can find success in Physical Therapy with the right preparation and determination.  I will begin with some key suggestions to achieving your best outcomes here in Physical Therapy, along with addressing a common questions regarding expectations.  I will then describe what you might expect during your follow up visits along with some general health and wellness tidbits and accompanying CDC recommendations.   

The Evaluation 

1.  Be an observer:  As a clinician, I will rely on information that you provide to help diagnose your illness and design an efficient plan to promote pain relief, healing and a return to your normal everyday function.  Think about your symptoms and how these symptoms have affected your ability to perform your daily activity.  Where specifically is your pain?  What makes your pain worsen?  What makes you feel better?  Is it a change in position, over the counter or prescription medication, ice or rest?  How long have your symptoms been present?  Do you have pain/discomfort constantly, or is do your symptoms come and go throughout the day?     Again, answers to these questions provide clues about your specific condition!  Not only does it help differentially identify your specific illness, it also helps to guide your treatment.   

***If you have trouble remembering what activities or movements seem to make you worse, consider typing it into a note file in your mobile phone!   

2.  Bring a list:  Possible lists may include medications, past surgeries, MRI reports (if you have them) along with any questions you may have.  For those of us with more complex medical histories, it would be helpful to any medical provider to have a thorough background from which to create the safest and most effective plan of care for you.   

3.  Is it going to hurt?:  My patients know that I preach modification to avoid significant pain provocation.  My very familiar refrain is “If it hurts to do 10 repetitions, we will do 8.  If 3 sets is too much, we will stop at 2.  If it hurts to raise your arm past shoulder height, we will avoid the range of movement overhead.”  While some intermittent discomfort may be experienced, we avoid putting patients in a scenario where they might experience significant pain provocation. Initiating exercise may cause some delayed onset of muscle soreness one to two days following exercise.  This is a normal response.  Ultimately, your feedback will help guide us!  We want everyone getting better.  We don’t want anyone getting any worse. 

4.  Dress for success:  It is cold in the northeast during the winter months!  This much we all know.  We physical therapists, like your medical doctor, will need to perform an examination on your injured body part(s).  So if you have an injury to your knee, for example, please be sure to wear clothing that allows us to visualize your knees.  A more thorough examination will lead to more efficient and individualized treatment for you!   

 5. Get ready to be active:  As the name would suggest, physical therapy will very often rely on your physical participation.  I will touch on this more in the next section.  Additionally, please be sure to arrive in a timely fashion to get the most of your one-on-one time with your therapist! 

Physical Therapy Treatment Visits 

Physical therapy treatment will likely include several different types of interventions.  We typically include activities such as manual therapy which includes soft tissue mobilization and mobilization of your joints.  We use different “modalities” which may include use of technology such as an electrical stimulation or therapeutic ultrasound to help manage pain and encourage tissue healing.  Foundational to many physical therapy plans of care is a physical component.  This may include therapeutic exercises such as range of motion, stretching or strengthening activities.  We may integrate some balance training or gait training should your plan of care necessitate.  As you progress closer to your goals for returning to your usual function, dynamic activities to improve functional performance or therapeutic activity might also be utilized.  We are also excited to offer dry needling at all ORI locations!  

Ultimately, your best Physical Therapy outcome will depend on several factors!  Here is a short list of several additional considerations that will help to set appropriate expectations for healing and foster your best outcome.  

1. Tissue Healing:  Many of my patients are surprised to learn that they must still heal even after surgery!  I wish I could say that once you have had surgery, your pain will spontaneously disappear and life as you knew it would resume without dedicating additional time and effort.  Unfortunately, this is often not the case.  Following surgery, we will often have some inflammation and subacute “repair” that will take place before the involved structures are ultimately “remodeled”, healed and prepared for everyday use without risking further damage to this structure.  The below graphic provides a nice synopsis of timelines for soft tissue healing.  

2.  Nutrition:  I am not a nutritionist or dietition, but I wanted to just include some interesting additional information that I thought was pertinent to health and wellness as well as an interesting study that I had reviewed relative to protein intake.  Firstly, sedentary adult males need 2200-2400 calories/day while active men require 2800-3000 calories per day according to the FDA.gov.  Younger, sedentary adult females require 1600-2000 calories (age dependent) while the recommendation for active adult females ranges from 2200-2400 calories.   

Food	Protein (grams)
3 ounces tuna, salmon, haddock, or trout	21
3 ounces cooked turkey or chicken	19
6 ounces plain Greek yogurt	17
½ cup cottage cheese	14
½ cup cooked beans	8
1 cup of milk	8
1 cup cooked pasta	8
¼ cup or 1 ounce of nuts (all types)	7
1 egg	6
Source: USDA National Nutrient Database, 2015

 

Recommended Daily Allowance (RDA) for protein intake is .8grams/kg of body weight.  This is a minimum nutritional requirement!  Research on this topic is ongoing, but the American College of Sports Medicine (ACSM) states “To increase muscle mass in combination with physical activity, it is recommended that a person that lifts weights regularly or is training for a running or cycling event eat a range of 1.2-1.7 grams of protein per kilogram of body weight per day, or 0.5 to 0.8 grams per pound of body weight.”  The 1.2 g/kg of body weight recommendation pertains to the endurance athlete while the 1.7 g/kg recommendation is for the strength training athlete.  Interestingly, it was suggested by Tipton in Sports Medicine that “higher protein intakes (2-2.5 g/kg/day) seem to be warranted during periods of immobilization” (1).  While a complete review of nutritional requirements and protein intake is well beyond the scope of this blog, I did just want to propose that nutrition is the fuel for your recovery!  A diet of whole foods, including plenty of fruits and veggies, lean meats, grains (if desired) and healthy fats, while minimizing processed foods and refined sugars would help bolster the healing process. 

1.  Minimizing Alcohol Intake:  Did I lose you already?  I know this one will be unpopular, but hear me out!  Tipton’s research also revealed that alcohol suppresses lipid oxidation and has been shown to impair muscle protein synthesis in both humans and rats.  It also has been shown to impair wound healing in laboratory rats and thus should be limited during recovery.  So it may be best to go easy on the alcohol consumption during your recovery. 
2. Hydration:  Make sure to stay well hydrated!  The CDC recommends 125oz/day for men and 91oz/day for women.  These numbers do include fluid contained within the foods you consume.  Additional fluid intake would be appropriate for athletes. Simply put, water is a primary component of our cells and makes up more than half of our body weight.  It is essential to maintaining proper electrolyte balance, transporting nutrients, removing waste and optimizing both neurological and muscle function. 
3. Sleep:  The CDC recommends getting at least 7 hours/night of sleep for best health and well being. 
4. Do your homework!:  This is the most important part of what we do as clinicians and what you can do as a patient!!!  We physical therapists spend much of our time instructing you on what to do and what to avoid.  Paramount to your recovery is a comprehensive home program and like I said, nothing great was ever achieved without practice!  Therefore, practice we must to achieve our best possible outcome.  You can have the perfect surgery with the best surgeon and rehab team, but if you do not take the time to practice, you will likely not achieve the results you desire.  Make sure to maintain ongoing communication with your PT relative to your home program to make needed adjustments. 
5. Communication:  Building on this key thought that has been a theme in this blog, the key to success in any relationship is good communication.  To reiterate, your Physical Therapist must know not only if a particular intervention creates discomfort, but also if you find the activity to not be particularly challenging.  We are striving to progress you forward with activities that are “appropriately challenging”, pushing you to your limits while protecting your injured body part from excessive strain.  Again, we don’t want anyone getting any worse. 

It is my hope that I have provided our patients with a fairly thorough overview of the rehab process.  It is important to be prepared and know what to expect out of not only the initial exam, but the treatment and the multitude of factors that may impact your recovery.  Of course other dynamics such as our medical history (comorbidities), age and the extent of the tissue damage will also contribute to the end result.  Healing and return to function is truly a multifactorial equation.  Being injured involves loss of function and an inability to resume the activities that you love.  We are here to tell you that we understand.  We sympathize with you.  Together, with hard work and determination, we can help to reduce your pain and facilitate the return to your ultimate functional goals.  In closing, I would just like to express my gratitude by extending a sincere thank you to all of our patients for allowing us to participate in your care.  We appreciate you!  Be well.  

(1).  Sports Med. 2015; 45: 93-104 Published Online 2015 Nov 9