Physical Therapists

An aching back from too much gardening. Carpal tunnel from long hours at a keyboard. A knee or hip replacement. That old classic, arthritis.

There are multiple issues—many of them painful and debilitating—that could cause you to land in a physical therapist’s office. A doctor (your primary care physician, an orthopedic surgeon, a rheumatologist) might refer you there to address a chronic illness, to rehab an injury, or to help you recover from surgery. A hospital could send you for days or weeks of cardiac therapy after a heart attack. And weekend warrior athletes can seek out a PT on their own to combat issues as varied as shin splints from marathon running to bursitis from hot yoga.

“Essentially, PTs utilize exercise and movement to solve pain issues,” said Washington, D.C., physical therapist Joe Norton. “To do that, we mix many different methodologies, from massage to manipulation to exercise.”

Here’s what it takes to become a physical therapist, what they do, how to identify the best practices, and how they might (or might not) help you.

How PTs Are Trained

All practicing physical therapists in the U.S. must earn a doctorate in physical therapy (DPT) from an accredited school or program. Applicants usually first get a bachelor’s degree.

Most DPT programs take three years to complete and cover content that includes biology, anatomy, exercise physiology, and biomechanics. Physical therapist assistants (PTAs), who work under PTs, study similar subjects in two-year programs.

To be licensed, graduates of both PT and PTA programs must pass the National Physical Therapy Exam, administered by the Federation of State Boards of Physical Therapy. For PTs, it’s a five-hour test that has 225 questions; for PTAs, it’s a four-hour test with 180 questions. Tests are graded pass/fail; according to the Board about 11 percent of exams are failed. Being licensed in one state generally means your credentials can transfer to any other state and the District of Columbia.

After earning a degree and passing the certification test, many physical therapists spend a few years doing clinical fellowships, usually in the area or specialty in which they wish to practice. “Many people don’t realize how many specialties there are in physical therapy, and all of the practice settings,” said Colleen Fogarty, a spokesperson for the American Physical Therapy Association (APTA).

APTA recognizes—and provides licensure requirements and exams for—10 specialties. In general, board-certified specialty licensure involves a certain number of hours working in the field as well as passing rigorous related exams. The specialties recognized by the APTA are:

• Cardiovascular and pulmonary
• Clinical electrophysiology
• Geriatrics
• Neurology
• Oncology
• Orthopedics
• Pediatrics
• Sports
• Women’s health
• Wound management

There are also many subspecialties. “For instance, I’m an orthopedic specialist, but I focus on running-related sports injuries,” said Norton. “If you have a problem related to tennis or pickleball, I’d probably refer you to someone else.”

How Do You Find a Great Physical Therapist?

Many people who find their way to PT do so because a doctor has sent them there. But laws in all 50 states and the District of Columbia allow patients some form of “direct access” to physical therapists. That means that if you have a pain- or function-related problem, you can essentially send yourself to a pro without a doctor’s order—though with some health insurance plans, having a prescription will make it simpler to pay for treatment and might reduce your share of the cost.

Physical therapists work in many settings. Some are employed by rehab hospitals, where patients are recovering from strokes, heart attacks, spinal injuries, or joint replacement surgeries. Others are in studios attached to the offices of rheumatologists or orthopedic surgeons, meaning doctors simply write orders for patients to go to PT and send them to an onsite or nearby facility for treatment.

But many physical therapists now work on their own, setting up one- or two-person practices to address specific issues—injuries related to certain sports (running, soccer, tennis), specialized pain issues (fibromyalgia, arthritis of the fingers and hands), or types of patients (children, women). Some pros even make house calls, particularly when treating the elderly or people with mobility issues.

If you are referred to PT by a physician, they likely will provide recommendations of suitable practitioners who specialize in your condition. You can also search for PTs by using your health insurance plan’s user portal; the better websites provide patient reviews and info on specialties and subspecialties.

Friends are also good sources of info about PTs; here at Checkbook.org, you’ll find thousands of recommendations and reviews of area practices.

Ask any pro you’re considering how they plan to treat you, and how much time you’ll get with the PT during your initial visit and follow-up sessions. The best PTs spend at least 30 minutes working with new patients to tailor treatment, rather than relying on assistants and one-size-fits-all approaches. The care you receive and the exercises you do should evolve as your treatment progresses.

As with any healthcare provider, during your first visit determine whether you and the therapist are compatible. Are they a good listener? Do they take a thorough medical history? Ask you about your goals? Express empathy? Provide options, if applicable? Do they provide reasons for their treatment recommendations?

Also, be wary of practices that over-rely on passive care (using machines, heat, or ice) rather than active treatments (supervised stretching and exercises). It’s often quicker and easier to churn through patients by hooking them up to devices, but individual attention often means better care.

The good news is that most physical therapy patients are satisfied with their care and results. In our surveys of consumers, about 95 percent of patients recommended their PTs, on a par with satisfaction rates for primary care doctors and acupuncturists.

Physical therapy is also effective. Most studies of patients with lower back or plantar heel pain found that patients who underwent PT reported significantly faster improvements, compared to those who just rested or took medication. Some studies have found that, for some conditions, undergoing PT yields better results than surgery.

What Do PTs Do?

According to the APTA, the role of a PT is to “use the latest evidence to design treatment plans for each person’s individual needs, challenges, and goals to improve mobility, manage pain and other chronic conditions, recover from injury, and prevent future injury and chronic disease.”

What that means when you show up for your first appointment—or meet a PT in a hospital setting—and what your appointments will look like should differ widely depending on your condition and goals.

“In a nutshell, we use the body’s natural pharmacy to help you feel better,” said San Diego-based physical therapist Ben Fung. During your initial appointment, you’ll tell the practitioner what the problem is (your knee is creaky and inflexible, your back hurts). They’ll have you perform simple tasks—bending over to touch your toes, rotating your elbow—to judge your flexibility and pain levels.

Then during most appointments—which can last 30 minutes to an hour or more—you’ll see the PT demonstrating exercises to improve your condition. They might prescribe that you do clamshells to strengthen a weak knee or upward dog stretches to loosen a stiff lumbar spine. You’ll get a handout with photos of people doing the exercise—or, increasingly, a link to a video demo—so you can do specific stretching or strengthening moves at home between appointments.

Therapists also perform physical manipulations, from targeted massage to assisted stretches to mild traction. Also in the toolkit? Ice, heat, ultrasound, traction systems, and TENS (transcutaneous electrical nerve stimulation), a kind of low-level shock therapy that provides pain relief.

“And dry needling has become a huge thing in physical therapy,” said Norton. With this technique, the provider inserts ultra-thin needles into or near myofascial trigger points, say, poking the filament-like sharps into your elbow for tendonitis or into your hip for bursitis.

It’s a hurt-so-good practice that stimulates your muscles, making them contract or twitch. This can help relieve pain and improve your range of motion. “It’s massage times 10. Therapists who aren’t using dry needles aren’t keeping up with current practice,” said Norton.

How Long Will It Take?

Most outpatient courses of physical therapy take anywhere from a few weeks to a few months, with sessions happening once or twice a week. You’ll be reevaluated along the way to gauge what is and isn’t working.

A big part of success is “compliance.” This means doing your part at home by regularly performing any prescribed exercises and stretches as well as resting and using heat or ice to stop swelling and pain.

Therapists will also give you tips on how not to injure yourself or cause yourself additional pain. That might mean stopping or limiting the behaviors that landed you in treatment. Your PT can also give you tips on ergonomic desk and computer set-up if you’ve got carpal tunnel syndrome related to overwork or advice on the hiking boots you should wear to cushion your creaky knees.

How to Pay for It

Before heading to your first PT appointment, check whether your insurance covers all physical therapy, whether the provider you want to see is in your network, and if you need a doctor’s referral to prequalify for treatment. In general, insurance plans cover services they deem “medically necessary.”

That can be a broad definition, depending on your insurance plan, but coverage generally extends to treatment related to worker’s compensation or work-related injuries and therapy that helps you meet medical and function needs (aka recovery from surgery, strokes, or other problems).

Pain management can be squishier, which means that getting an order from a doctor can help make insurance pay up. In some cases, PT treatment related to sports medicine might be considered therapeutic but not necessary, like a massage, making it harder to have insurance cover it.

“Most insurance policies cover physical therapy services,” said Fogarty. “Talk to your insurance provider about your coverage. For those who don’t, that will be stated before service.” Most plans cover a certain number of visits; you’ll sometimes need to reach a deductible before full coverage kicks in.

Good to know: Many providers in small private practices aren’t part of any insurance networks, meaning you’ll likely have to pay upfront and then file a claim with your insurer for reimbursement.

How to Be a Good PT Patient

Sort of like taking a college class—or working out with a personal trainer—your success at physical therapy often depends on how much effort you put into your recovery.

“We try to figure out what people will and won’t do on their own, and then come up with ways to motivate them or meet their schedules,” said Joe Norton, a Washington, D.C., physical therapist.

A few pointers on how to succeed at PT:

Come armed with a list of questions and goals. This will help the PT know what you expect from the process—renewed spine mobility, no pain in your jacked-up neck, a complete recovery from hip replacement surgery. It can also assist them in setting up a treatment plan.

Seek out a practice where the PT spends the entire session with you. In some larger practices, particularly ones attached to surgeons’ offices or hospitals, you may get just 15 minutes of a one-hour session with the pro and spend more time with assistants or simply icing down your sore spots. In general, the more face-to-face time you get with your PT, the better—and more effective—the treatment.

“Don’t keep secrets,” said San Diego-based physical therapist Ben Fung. “If something doesn’t feel right, or something feels concerning or painful, tell your therapist. That helps us diagnose what’s going on.” Before your first appointment, make a list of issues—what hurts, which body part isn’t functioning the way it should, why you’re in therapy in the first place.

Do your homework! Most PTs will give you a series of at-home stretches and exercises to do in between sessions. Get in the habit of executing those 30-a-day downward dogs and 45-a-day leg lifts. You’ll speed up your recovery and establish good practices for staying out of the doctor’s office in the future.

Don’t expect immediate results. It took you time to land in PT for your overzealous pickleball play or constant slouching in your office chair. Getting over your pain or mobility issues can also be a slow process. “It’s important to stick to the plan—recovery does take time, depending on what your current reason is for coming in to see a therapist,” said Fung.

Wear the right clothes and shoes. Think workout pants, trainers, and a T-shirt, not the dress or suit you wore to the office. It’s important to be mobile during sessions.