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How do I know if I need physical therapy?

Jul30th 2020
  1. The most basic reason is you have had a recent strain or sprain from a fall, car accident, sports injury, etc. and you want to ensure it will heal properly and in the shortest time possible.
  2. You have ongoing pain that is extending beyond the usual time frame for healing.
  3. Your pain is better from an injury but you have ongoing functional or performance deficits.
  4. A musculoskeletal condition that is getting worse.
  5. You have pain that starts when you try to get more active or push yourself more.
  6. You had surgery and you feel you are not improving in your mobility, strength, gait, or lifestyle as expected.
  7. If surgery was recommended as a possibility but you have not tried PT first.

There is a concept we teach our patients when they are ready for discharge that allows them to test themselves to see if they are losing their motion, strength, or control. This gives them an early insight to push their exercises more and get back to baseline. Yet anyone can follow this proactive approach to understand their body better and know if they should seek a PT’s help. Each screen is set up as a series of tests, the more tests that are positive in that category, then the more PT should be considered.

  1. Cervical Screen
    1. Is your rotation markedly different left compared to right?
    2. Is there pain at the endrange of motion?
    3. Do you have to compensate strongly by twisting your trunk to see to your right/left when driving?
    4. If you look up, does it cause you sharp pain in your neck or increased tingling in your arms?
    5. Do you have ongoing headaches?
    6. Does your neck prevent you from sleeping well?
  2. Shoulder Screen
    1. Are you able to sleep comfortably on your shoulders?
    2. Can you reach up your back with minimal pain and fairly equal motion?
    3. If you move our arm quickly do you get a sharp jolt of pain in your shoulder?
    4. Can you reach across your body without pain or catching?
    5. If you lay on the floor and reach overhead with both arms, are they close in motion? Can you get close the floor without arching your back?
  3. Lower back Screen
    1. When standing and bending backwards, can you extend in your lower back a good ways without pain?
    2. When standing with hands by your sides, slide your hand down the side of your leg, do you move left and right equally, is one markedly different in motion or pain in your lower back?
    3. When lying on your back with knees up, can you twist your knees to the right and left with the same degree of motion and comfort in your lower back?
    4. When standing, can you bend forward with your knees straight and return to vertical with comfort?
    5. When sitting for prolonged periods (2-3 hours), do you develop numbness or leg symptoms?
    6. Is it hard to go from sitting to stand and walk without some slow adjustment or pain in the back or hips?
  4. Hips
    1. Can you lie on your back and pull your bent knee across your body without pinching in the groin.
    2. Can you walk with the same stride left and right?
    3. Does it feel like when you walk that your upper body moves a lot to one side, like one leg feels short?
    4. When walking, does your hip catch and cause you sharp pain.
  5. Knees
    1. Can you stand and push your knee back fully straight without pain?
    2. Do your knees bend about the same amount when lying on your back and flexing them as you pull your heel towards your buttock? Is the quality of the endrange the same or does one feel hard and painful?
    3. Does your knee ever give out unpredictably?
    4. Do you get pain with going up or down stairs in your knee or thigh muscle?
  6. Ankles
    1. When you walk especially up hills, do you get pain in the front of the ankle?
    2. Can you stand on one foot and be in control of your balance? If not you could have deficits in the foot and up into the hip/pelvis.
    3. Does your ankle ever give out or “turn” unpredictably?
    4. Do you feel unconfident walking on uneven terrain like lawns or trails with your balance or ankle control?

These are simple questions and tests but they can give you some insights on whether you are subtly losing motion or control. If the results of these tests continue to get worse or you feel the results are quite limited now, then consider seeing a PT even if your pain is not a big issue. By addressing musculoskeletal problems early in the imbalance phase the problem is much easier to solve and you also avoid the additional micro-trauma to joints and tissues by being proactive in your musculoskeletal health. As you get older and aging sets in, you will be glad you did not wait for pain to be the only motivator to get help.