Why you should see a physical therapist FIRST

Your Health is Important.

Your Friend: “You have [insert body part here] pain?” You: “Yes, but I already made an appointment with my physician in a couple of weeks.” Conversations to this effect happen every day in this country. Even more so if you insert “Yes, but I already made an appointment with my *chiropractor* in a couple of weeks”. Rarely, if ever, do people think to make an appointment with their physical therapist first. It’s seldom that one may even have “a” physical therapist. However, I’m going to expain why you may want to reconsider…

Pain inspires action

Pain is by far the biggest motivator for people seeking first-line medical care. Musculoskeletal pain (pain pertaining to the muscles and the bones/joints) is one of the most common types of pain experienced. It is also the leading cause of disability worldwide. Musculoskeletal conditions cause many to retire early, limit their social lives, and overall decrease the quality of life. This is due to the the decreased mobility and significant burden associated with these conditions.

Fortunately, physical therapists are experts in these conditions. We specialize in pain relief related to these conditions as well as optimizing movement for an improved quality of life.

Can I see a physical therapist without a referral from the primary care physician?

Mot of the time, yes! All 50 states have some form of what is called “direct access”, which is the ability to see a physical therapist for an evaluation without a physician referral. Some states have stricter regulations than others. In Ohio, I as a physical therapist have the autonomy to see patients and take them through a plan of care with very little stipulations. As a caveat, Medicare often requires a physician referral before they will reimburse for physical therapy services. This is an insurance restriction rather than a legal one, however.

A brief scenario

I think the best way that I can explain the benefits of seeing a physical therapist first is by taking you through a hypothetical scenario. Although hypothetical, consider that I’ve seen this happen time and time again.

Say your back hurts, for example…

Let’s use low back pain as an example. Low back pain is THE leading musculoskeletal cause of disability in the world. Say you are at work one day and your back begins to hurt. It’s subtle, but you would rather be safe than sorry. You decide to call and make and appointment at your primary care physician’s office. How far in advance do you typically have to schedule for the “first available”? 3 weeks? A month? Longer? This is often the case in the current healthcare model with the primary care physician as the “gatekeeper”. You either aren’t aware of the options available to you for specialists or your insurance won’t pay for it unless you “play the game” and go through the process.

Either way, you wait until your appointment a few weeks later. By this point, your lower back is killing you by the end of your work day and it is no longer a subtle annoyance. The primary care physician acknowledges your pain and condition, but informs you that there is little she/he can do for you in the office. So she/he decides to write you a referral for a specialist for a consultation, typically an orthopedic spinal surgeon. You then get in touch with the orthopedist’s office to schedule the consultation. How long does this take? The earliest openings are often 3-4 weeks out again, if not longer for depending on the specialist.

You essentially start the “game” and the process over. You wait until the appointment for something to be done. Meanwhile, although your insurance pays because you are “playing the game”, you often still have a per-visit fee as a co-pay or co-insurance - and that is only if you have met your deductible for the year. See how broken the current healthcare model can be? That is a post topic for another day in itself.

The spinal surgeon appointment

Finally, the spinal orthopedic surgeon appointment arrives. By now, your low back pain is in bad shape. You aren’t able to play with your kids the way you would like, you’re grouchy due to the pain, and you’ve contemplated taking time off of work that you know you can’t necessarily afford to do. The orthopedic specialist does a thorough evaluation and explains what may be going on and what the plan looks like. She/He may or may not take x-rays based on the issue. He may recommend you to get an MRI for more information. Unfortunately, your health insurance won’t authorize or pay for you to get an MRI until you have gone through 6 weeks of physical therapy. (See how backwards that is? Medical professionals go to school for an insane number of years to make medically-justified decisions - only to be told what they can and can’t do by the insurance company. Again, I’m getting off topic.) After discussion, the surgeon refers you to start physical therapy and plan on the MRI if therapy is unsuccessful after the necessary 6 weeks. They may or may not prescribe you pain medication or muscle relaxers to get through in the mean time.

The physical therapy process

So you call to schedule the physical therapy evaluation, which is typically (though I’m sure not always) within a couple of days or the next week. You may have some relief at this point secondary to the medication, but you know that the issue has not been “fixed” yet. You attend your physical therapy evaluation which provides you with hands-on techniques to begin to relieve your pain, as well a home program of activities for pain relief as needed. The physical therapist will educate you on posture changes and ergonomic modifications you can make to your daily personal and work activities to prevent your pain from worsening in the process.

Over the coming weeks, your pain begins to lessen. After a while, you are pain free and the focus begins to shift to strengthening and correction of the underlying issue to prevent the issue from coming back in the future. You finish your plan of care with the physical therapist and report to the spinal orthopedic surgeon at the follow up that you are doing well and don’t feel as though you need an MRI or any further treatment. Happy ending for all, right?

What could have gone better?

Okay, so I’m not saying the physical therapy is magical and can fix all. Some people will wind up needing the MRI and further treatment, but as a physical therapist it is usually easy to identify these individuals and you will know before 6 weeks if you are seeing results. However, I do see issues with this very common scenario in our healthcare system.

  1. The patient (potentially you!) could have gone straight to the physical therapist as the specialist for the treatment for non-specific low back pain. This would have saved a significant amount of both your time and money.

  2. It was a BIG assumption on my part that the spinal orthopedic surgeon (specialist, in this case) referred this person to the physical therapist. There are times, for one reason or another, that they may not get referred. They may recommend a “wait and see” and tentative rest approach with prescription of pain medication to see how the pain responds. They may recommend injections that may or may not work. The patient may have preconceived ideas as to what physical therapy is and not wish to try. Unfortunately, some of these patients never make it to a physical therapist for any of these reasons.

  3. Lets say for the sake of discussion that the treatment this patient needed was not physical therapy and they truly needed injections, surgery, or different medication. Would I still recommend them see a physical therapist first? The answer is yes, and allow me to explain. Physical therapy is a doctorate level profession and has been for over 15 years. Part of the reason for this transition was for increased autonomy of the physical therapist and ability to screen appropriately and refer to other providers as necessary. Physical therapists are trained to recognize patients and conditions that are not appropriate for physical therapy treatment. Low back pain in our example is typically a musculoskeletal condition, for which the physical therapist would be the specialist. It makes much more sense to have this patient see the specialist in the area of their condition FIRST and for that provider to refer out, if necessary.

  4. It is typically not even a thought for people to see a physical therapist first. People will often see their chiropractor or primary physician, thinking that if they need physical therapy that those individuals are needed to write a referral. This is a huge knowledge gap in society and is largely a fault of physical therapy as a profession. Efforts are in place now to help promote awareness of direct access and the benefits of seeing a physical therapist first for musculoskeletal conditions, but we just aren’t there yet.

What I hope for you

As a physical therapist, I think it is important to advocate for myself and my profession and increase awareness to those people that I can help. Pain is not normal, and there are things we can do. You don’t have to just “deal with it” or “tough it out”. I have a saying that “people in pain are not sane”, and there is a lot of truth to it. Pain changes the brain and can turn you into shell of yourself, and a grouchy one at that. My entire life has been dedicated to helping people and what is important to THEM, and that is why I founded Revolution Performance. I specialize in helping active adults get out of pain and back to the activities that they enjoy. Start living your best life and take care of your body!

About the Author

Dr. Ryan Queen is a doctor of physical therapy, certified strength and conditioning specialist, and level 1 certified precision nutrition coach, in addition to holding certifications in other adjunct treatment modalities and paradigms.

He created Revolution Performance as a gym-based physical therapy practice and wellness coaching service after becoming frustrated by the conflict of interest that health insurance company restrictions bring. His vision with the company has always been to provide high quality, holistic care while forming life-long relationships.

His mission is to help busy, hard-working adults get out of pain and dysfunction, whether from a current injury, a past one, or just daily aches and pains. In addition, Ryan has a passion for creating a proactive environment where issues are addressed before they become debilitating, or even before they exist.

After working 40 hours a week at a full time job while going to physical therapy school, Ryan knows how it feels to think you do not have enough time in the day to take care of yourself in all facets of health. It has been a goal of his to share the information and strategies he has learned to help others improve their overall health and become more productive.

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Medical Disclaimer: All information on this website is intended for informational and educational purposes only. The authors and partners are not responsible for any harm or injury incurred. It is important to seek professional guidance about your condition or injury. No guarantees have been made or implied regarding specific results of the services described.

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