When a physical therapist goes to PT

I recently experienced being a PT patient myself, and it was a good reminder of what a complex experience this is for my patients. I was reminded of the importance rapport with the therapist, listening and trying to make sense of all the information provided to me, practicing exercises that were neurologically challenging, and then needing to figure out how to fit in an exercise program between sessions on a consistent basis.

Exercise programs are challenging to follow when our lives are already busy. Often, it sounds so simple and straightforward to complete the exercise program when you’re in your PT session. But once you leave the session and return to your life, it quickly becomes apparent how challenging adding one more thing can be. I used the concept of “habit stacking” to help me consistently do my exercises. Habit stacking involves using an already established habit to help form a new habit. Daily established habits like eating a meal or brushing your teeth can be leveraged to help start a new habit. I needed to complete my exercises three times a day. They could be done seated, so I did them after each meal. I already had an established, three-times-per-day habit (eating meals), so it took very little energy and planning to simply add a new part to this old habit.  

I was also reminded about the lack of quick fixes with long term results. In fact, I wasn’t even offered a quick fix! Lasting results come from consistent work over a long period of time. Although I haven’t been perfect about sticking to my exercise program, I’ve been consistent enough that I am beginning to see some results. It didn’t happen on day one or even week one. I started to feel some changes during week two. Nothing earth-shattering had happened, but I could tell I was making progress, and that was encouraging. I know if I continue to stick with my program, those results will continue to grow.

Often, patients come back to us for a second visit and note that nothing has changed. Lack of progress after the first visit isn’t a sign that PT isn’t working. Rarely does one PT visit cause any significant or long lasting improvements. When people do feel significantly better after the first visit, those effects are likely due to the placebo effect and wear off over time (notable exception: vertigo caused by benign paroxysmal positional vertigo (BPPV)). 

If your symptoms get worse from the exercises prescribed after the first visit, that is a problem and you should let your therapist know. Our bodies (nervous system, muscles, tendons, and bones) respond to progressively harder exercises, but not quickly. It takes 6 weeks for initial strength gains to be seen in muscles. It takes much longer to experience significant changes in strength. Changes in pain can certainly happen much more quickly as pain is not directly linked to physical factors alone (stay tuned for another blog post that explains this in more detail).  

The goal after the first visit is to introduce something new to your body without making your symptoms worse. That lack of aggravation in the face of a new experience is the beginning of teaching your nervous system to become more resilient, which is essential for long term pain relief. Typically, it’s not until visit two that you begin to feel a significant change. Why? Because you’ve laid the foundation for resiliency from visit one. Once that foundation is established, increasing demands can be put on your nervous system, muscles, and tissues, and their resiliency can grow. Your body becomes more robust and can better withstand things that were once aggravating. That is why we usually space our visits out by a week or more; it takes time for your brain, nervous system, muscles and other tissues to adapt to new challenges.  

We are becoming more and more conditioned to expect quick results when seeking services for pain and discomfort. Other “pain points” in our lives have been satisfied by all the amazing technological advances we have at our fingertips: Google any question and get an immediate answer (though not always the most accurate one). Order your groceries online and pick them up at the store or have them delivered. Order anything online and have it delivered within a day or two. In the case of pain and injury, our biology has not changed, despite the world around us constantly becoming more convenient. In fact, we would all be wise to be wary of so-called “quick fixes” that are also very easy to find with a google search!  

We must learn to have different expectations for healing than we do for ordering toilet paper from amazon. Expecting changes quicker than is biologically possible can lead to an endless search for “quick fixes”, with no long term results, increasing hopelessness about your condition and an overall frustrating and depressing existence. In the grand scheme of our lives, the time we spend in pain will likely be small. While in pain, it won’t feel that way. But with realistic expectations, trust in our bodies to adapt and heal, and the right support and guidance, you greatly increase your chances of long lasting relief and a happier life.