My physical therapy is extremely expensive and takes time away from work can you just do your own exercises

I just finished seeing a Pt. I went to get some stim, massage and to find out exactly which muscles are weak, tight, etc...and once I'm able to do the prescribed exercises with perfect form I stop going.

You can certainly do your own exercises at home. In fact we prescribe these as Home Exercise Programs (HEP). If you let your PT know that you're comfortable performing the exercises at home, they will likely be happy to give you the list and tell you to check back in with them if needed. Some clinics are even offering zoom type check ins at a much cheaper rate just to visualize you doing the exercises to insure proper form and technique.

Why you are paying a PT (a good one anyway) is for their ability to identify issues, prescribe correct treatment modalities for the issue, and progress those modalities when necessary.

I will be 100% honest with you in that I left outpatient PT quite a few years ago as I was fed up with the assembly line feel to the setting. 3-4 patients in the clinic at a time that youre having to work with. I went to a new setting where I work 1 on 1 with each patient and life is so much better. Patient's are happier as well as they don't feel like my attention is split between 3 other people.

PT's are smart, knowledgeable, but like all fee for service health practitioners, they are incentivized to get you in and out fast and come back often. Always make clear your goals with your PT, tell them what you want out of your visits with them, and if you feel you are going too often, tell them that. Some of them really want to seem like geniuses by virtue of having a plan, but they can be flexible.

I know a great PT for runners. He sees you once a week, then emails you a home program. When he sees you, he does hands-on care including dry needling, plus evaluates and modifies your home program.

Reality is that most runners hate corrective exercise and when left on their own do not do the exercises correctly. Or they will pick & choose the ones the exercises they want to do. It is why some tend to stay injured.

As long as you don't need documentation for insurances or a claim. Have at it.

Anyone know the backstory on how PT went from a BS to MS to DPT in a manner of a few years?

PTs decide they did't want to do a lot of work so now the PTAs do most of the hands on?

Alan

Spoken by someone who clearly has never conversed with a PT before. Me personally, I appreciate when my doctors go through more schooling rather than less.

In the office where I go the PTs are the only ones who test, touch and assign exercises. The others get the equipment ready, take the stim pads off our backs when time expires, and supervise the exercises.

If you can't find a solution on youtube you haven't looked hard enough

I am just asking...why the shift?

There are TONs of licensed physical therapists who only have a BSPT or MSPT.

Alan

I shadowed a lot of different clinics during my undergrad and can tell you PTAs/physical therapy aids have varying roles at different clinics. You'll see less PTAs doing the work as Medicare is cutting reimbursement on them.

PTs went from BS -> DPT for the use of direct access. If your insurance allows it, you can skip the MD/RNP/PA referral and go straight to your PT for treatment. It's a good idea in theory! Everyone knows that MDs/PAs charge too much and often overprescribe medication, which wastes your money. Seeing your doctor charges your insurance around $300.

If you can find a good PT it's worth it. My wife had anterior and posterior labral tears in her hips that didn't show up on the MRI. PT knew it was there from some special tests. Surgeon went in to do a iliopsoas release and was surprised to see the PT was right. The MRI cost more than $2k. That was just money down the drain.

Finding a good PT is hard, there are a lot of useless ones out there. PT school doesn't teach a lot of exercise science or exercise prescription. If I had a nickel for every time a runner/walker in a clinic was prescribed clamshells "because their glutes weren't firing" (a physiological impossibility) I'd have my PT school debts paid off. And don't get me started on "corrective" exercises.

This MD does a great job describing the issues with PT:

barbellmedicine.com

The Fatal Flaw of (most) Physical Therapy

Jordan Feigenbaum

By Austin Baraki, MD, SSC This past week I was alerted to a new article in the journal Physical Therapy by Falvey et al. titled “Rethinking Hospital-Acquired Deconditioning: Proposed Paradigm Shift” (abstract, thanks to Dr. S...

Link:www.barbellmedicine.com/blog/1988-2/

For the OP: the 2-3x/week for a PT visit is old. You don't need it. DO the exercises at home. Massage doesn't do anything but feel good. Same with any modality (heat, cool, needling, KT Tape, etc.) They do not provide enough stimulus to act on the muscle tissue, just provide "neurophysiological" (doesn't that sound smart?) stimulus (AKA it distracts you from the painful stimulus via "gate theory of pain"). What you need is a PT/coach to help transition you back to whatever it is you're unable to do ATM. If it's running, providing some form of coaching to slowing progress you to running again.

Often times the PT will tell you "don't run until it doesn't hurt". Which is garbage advice. Unless you have a tear or a broken bone, your muscles and tendons need mechanical stimulus to adapt/get stronger. The biggest issue runners with reoccurring injuries have is they stop running completely, start to feel better after 2-3 weeks off, and then start running near their old paces.

The other reason is so PT schools can charge more.

There's a lot of variation from one physical therapy clinic to the next. I've been to one where appointments are 20 minutes long with the therapist juggling multiple patients. I've also been to one where patients are 1 on 1 with the therapist for a full hour. Either way, they charge your insurance the same amount. If you can find a good one, it is worth it.

"Massage doesn't so anything but feel good"

That's not a bad reason for a 15 minute deep massage. The stim, kinesio tape might not do much either but that's what the insurance covers. I see in my insurance statement what they bill for and what is covered. Unfortunately their hands on work (stretching and massage) doesnt pay their Bill's but that piece of tape on my back does. I often joke with them about that as they put tape on my back. A small copayment for an hour visit is worth it.

The PT group I visit never told me not to run or exercise. They encourage exercise and know what is needed.

Regarding doing the exercises at home. A good therapist will prescribe the correct exercises after testing and a diagnosis, teach you them and make sure you're doing them correctly. In the past I've chosen exercises but did them incorrectly probably no differently than someone trying to learn hurdle drills. Just as a good track coach will make sure you're doing the right drills correctly a good PT will do the same.

Often on this message board people ask about their " injuries" not knowing if it's their piriformis, glute, which glute etc...I suspect it's better to see a PT and know which muscles need attention rather than just guessing.

Maybe I've just been lucky living in an area with so many PTs.

Go the PT once to get a set of exercises that you can do at home. Schedule your second appointment at least a week out to check that you're doing the exercises properly and add some additional exercises. Depending on how useful that is, schedule a third appointment a week or two to three weeks out. If your insurance has approved n appointments (often n=6), try to keep one or two of those in reserve in case you need to go back later for more advice.

If you're a motivated athlete, you are spending your time and money for the PT's expertise in diagnosing the imbalances that caused the injury and designing the appropriate rehab program. You don't need a PT just to keep an eye on you and get you to do the exercises but you may need the expert advice so you aren't trying to fix the wrong problem. Don't let them push you to do 2 appointments a week; that's a waste of time.

Lots of good stuff here, along with some other posts above. I'm stuck in a waiting room so here's my chuckling hot take to the whining displayed by some:

OP sounds like a classic grumpy, cheap, I-know-best letrsunner. love it. Never ceases to fail here. He sounds like he has one or all of the following going on: didn't seek out a good PT, doesn't understand the reality and breadth of modern PT, has a minor injury with a basic treatment plan, and/or has poor insurance and is butthurt cash paying for basic treatment.

Couple thoughts:

1) A PT won't always waive a magic wand and fix your injury. Yes, often the treatment plan is relatively common exercises, with repetition, that you could find on Youtube/Reddit. But! a PT (especially a good PT) will keep you on your treatment plan, doing your exercises and actually getting better. Sure, many people can google their own what-if exercises, but a vast majority (like Old Big East said and I experience constantly) would not then follow through on committing to a self-directed treatment plan.

2) Find a good PT. Search, ask around, call the top ortho doctors in your city/region, get referrals from people who know. With that or with the best you can get: go to a PT who will see you 1:1 for a minimum of 20min per visit, but ideally 30-60min. My partner (PT) sees patients 1:1 for 30min and then they do exercises/stem/ice/etc for 15-30min after. My partner also sees patients privately for $200-350/hr for in-person 60min sessions.

3) find a PT with certs beyond just their PT degree: PT Specialist certs, trainers license, dry needling, etc. Sure, all PT's do continuing ed, but I think it benefits an active/motivated patient greatly to work with someone who has broader knowledge, interests and expertise. And someone who is actively working to broaden their skill set to adapt to patient needs.

4) PT is a profession backed by science. Sure, it's not always a gate-kept situation like surgery, pharmacy or orthodontics where only the provider has access/training/knowledge to provide a solution, but there's still a ton of science backing a therapists approach to a treatment plan. It seems like this kind of thread pops up yearly, where a whiny/cheap/sanctimonious runner complains about PT. Often they have a minor overuse injury of their own doing, for their own lack of strength and prep, and somehow it's a PT's fault that the solution is basic things. Sometimes that's the solution, but some PT's are seeing 8 ACL's, three hips, a broken pelvis and two shoulders a week and getting those people able to use their limbs again. There's science to back that up, good ones know it and the best have the respect and support of their corresponding Ortho's.

Aside: PT is a good job but heavily underpaid for how the profession has grown and the cost of PT school now. I think it's great that DPT is the standard now, but pay needs to double to reflect it's role in modern society. Insurance company take stupid money from the general public for PT and therapists are still very underleveraged to get their due.

I screwed up my shoulder and went to see the local chiropractor that everyone sees for running injuries. He doesn't do back cracking and the stuff you think about with chiros, but his diagnostics and exercises have helped probably 90% of the runners who see him. He thought i had a torn labrum. I went home and looked up all of the exercises i could find and did them for several weeks thinking i had this in the bag. but they did not help. When i went to PT, the therapist was able to figure out the root cause of the injury (years of hunching over a computer and bike) and the exercises he gave me were not at all the ones i found online.

I only saw him once ever couple of weeks at first and then once a month. When i would go in, he would loosen up the shoulder and i would go through the exercises with him watching to make sure i was doing them correctly and add weight or different ones as i progressed.

The key to PT is trusting that the exercises will work and then doing them. After 5 months of being pretty OCD with the exercises, i was good to go.

We need to find 2000 runners for an experiment. All the runners will stretch their hamstring until it produces a soft tissue strain. The control group will just rest and return to running gradually. The other group will got to PT. I would put odds on the recovery time for both groups being the same.

On the other hand, I have had relatives (mostly elderly) who have had falls, surgery, etc. and went to PT to recover strength, range of motion, etc. PT seemed to be pretty integral to recovery in those instances.

Thus, I think PT is largely ill prepared for dealing with athletes, and especially distance runners.

I think you are being ripped off.

A good pt should give you the exercises to do at home. If you are just going to the pt to do exercises you are being ripped off. Follow ups are for assessing the healing and prescribing new exercises, not for just watching you do the exercises.