Therapy Insight:

Addressing Frequently Asked Questions in Physical Therapy

• Do I need a doctor’s referral before I start?

No! In Massachusetts we have this handy thing called “direct access” which means at the first sign of pain or injury you can call your favorite PT (at Clash obviously 😆) and make an appointment. This is a good thing because PTs are the human movement and pain experts. Your PCP is not an expert, but more of a liaison directing you to the next person who is. Oftentimes when you see them first your treatment gets delayed because you end up seeing a specialist first, and it can take months to get an appointment, then possibly getting imaging or injections before PT is even mentioned. This causes your bottom line to increase with deductibles and copays. It also lengthens your timeline for recovery by months. 

• Should I get imaging first so we know what’s going on?

No! It is well researched that for things like arthritis, meniscus tears, rotator cuff tears, and disc herniations that the sooner PT interventions are started the better the outcome. Also, people who have surgery for these conditions have the same long term functional outcomes as those who forgo surgery for a conservative approach. Now, there are always exceptions, for instance if you have a suspected Achilles tendon rupture, you have lost function of a limb or limbs, or if there is a suspected fracture you should definitely seek out imaging. But, if you just have pain w/ motion and certain functional activities it is likely that you don’t need to expose yourself to the radiation because seeking out PT will help you to restore painfree function and even optimize function for better performance.

• If I have a tear do I need surgery?

Again, no! Now, this always is an “it depends” situation, but that being said, most people do just as well with conservative treatment for things like partial tears of the labrum (hip or shoulder), partial rotator cuff tears, meniscus tears, ligament tears, and there is even emerging research suggesting that conservative management of ACL tears can lead to the same outcomes. Why would you expose yourself to an invasive procedure that opens you up to infection, blood clots, scar tissue, and other risks if you can get the same result without it? PT for the win again!

• Is it safe for my knees to move past my toes?

Heck ya! (We know you’re sick of being told No after those first 3 questions 😅). This is actually super healthy for your knees because the compression helps to feed your cartilage with essential nutrients and moving through full range of motion helps the joint fluid stay fluid versus getting thick and viscous due to poor motion. Now, if you have pain with this or you lack the strength and range of motion then you shouldn’t do it. However, you should work on your deficits in order to improve your capacity for this position as it is an important developmental human movement, which will ensure healthy joints and independent, high quality life. 

• Can I run after a joint replacement?

Well, technically yes. There are some surgeons that will tell you to avoid high impact activities out of extreme caution, but there is no reason why you can’t run and jump as long as you are aware of the risks vs rewards. Whenever we do anything physical there is always a potential risk for injury, so when we train and play we are always basically assuming the risks because we have decided that the reward is great enough to take it on. Running (jumping, doing anything intense, etc) after a joint replacement is no different. Once you have had the joint replaced and gone through the appropriate course of rehab it will be extremely solid. There’s not going to be a high risk at that point of disrupting what’s there. However, because this artificial joint is cemented in your body, if you were to take a fall you will be more likely to fracture the bone above and/or below the replacement. This is something to consider if you are planning to hike or run on trails that are highly challenging. Some doctors will also say that the more impact forces you expose the prosthetic too, the faster it will “wear out”, for which there is not currently any conclusive evidence to back up. As with any physical activity you should possess the right amount of mobility, strength, and stability before taking it on, whether or not you have had a joint replacement. If you are uncomfortable with assuming the risks of highly intense exercise after a joint replacement you should still seek out ways to move. One of the main goals of such a surgery is to allow a person to regain pain free mobility in order to restore quality of life and be able to do things they were unable to do prior. So even if running isn’t your jam, find other ways to stay physically active after!

• Don’t my feet need support and cushioning to reduce impact?

Sorry, we are back to the NO! As with (almost) all things, this does depend, but the MAJORITY of people simply do not need support and cushion for their feet to function. Now, if someone has been utilizing orthotics and highly cushioned shoes for years we won’t have them throw them in the trash day 1. We will come up with a plan to build strength and tissue tolerance in the feet and hips, retrain movement patterns, and educate on foot function to allow a person to transition to a more foot friendly shoe safely. We also account for people’s goals, current impairments, and injury history. If someone has foot dysfunction and simply doesn’t want to do the work we may just figure out what adaptations are needed to allow them to function best. We would do the same if the person had anatomy that would require modifications such as an arthritically rigid Big Toe, an extra navicular bone, or if they had surgery altering their bone structure. That being said, this is typically the exception versus the norm and MOST of our clients can transition to a minimalist or semi-minimalist shoe just fine, with most reporting improved function and feeling better than ever. 

• How do I improve my posture?

Well, that depends. Firstly, we want to point out that there is no such thing as “perfect posture.” We are actually fine with you slouching, sitting criss cross, standing with your feet pronated etc. What we don’t want to see is that you can’t get out of certain postures when you go to move. This typically happens because we spend too much time in certain positions, most notably sitting at a computer, often after some sort of extended commute. This will cause your bones to change shape, certain muscles to become tight while others become weak and lengthened, and loss of range of motion. This is when it becomes problematic to slouch. Our advice? Make sure you are keeping the back side of your body strong with hinging, calf raises, and pulling activities. Take walks often. Also, make sure you change positions as frequently as you can throughout the day, this may mean investing in a sit to stand desk and even taking time to sit or lay on the floor if you are able.