Frequently Asked Questions (FAQ)
During your first visit you can expect the following:
- Arrive at your appointment with your paperwork completed (you can download it from our website - see the paperwork or forms link)
- You will provide us with your referral for rehabilitation.
- We will copy your insurance card.
- You will be seen for the initial evaluation by the rehab specialist.
- The rehab specialist will discuss the following:
- your medical history
- your current problems/complaints
- pain intensity, what aggravates and eases the problem
- how this is impacting your daily activities or your functional limitations
- your goals with rehabilitation
- medications, tests, and procedures related to your health
- The rehab specialists will then perform the objective evaluation which may include some of the following:
- Palpation or touching around the area of the pain/problem. This is done to check for the presence of tenderness, swelling, soft tissue integrity, tissue temperature, inflammation, etc.
- Range of Motion (ROM) - the rehab specialists will move the joint(s) to check for the quality of movement and any restrictions.
- Muscle testing - the rehab specialists is checking for strength and the quality of the muscle contraction. Pain and weakness may be noted. Often the muscle strength is graded. This is also part of a neurological screening.
- Neurological Screening - the rehab specialists may check to see how the nerves are communicating with the muscles, sensing touch, pain, vibration, or temperature. Reflexes may be assessed as well.
- Special tests - the rehab specialists may perform special tests to confirm/rule out the presence of additional problems.
- Posture assessment - the positions of joints relative to ideal and each other may be assessed.
- The rehab specialists will then formulate a list of problems you are having, and how to treat those problems.
- A plan is then developed with the patient's input. This includes how many times you should see the rehab specialists per week, how many weeks you will need therapy, home programs, patient education, short-term/long-term goals, and what is expected after discharge from therapy. This plan is created from input from you, your rehab specialist, and your doctor.
Make sure you bring your rehabilitation referral (provided to you by your doctor) and your payment information. If your insurance is covering the cost of rehabilitation, bring your insurance card. If you're covered by Worker's Compensation, bring your claim number and your case manager's contact information. If you are covered by auto insurance or an attorney lien, make sure you bring this information.
You should wear loose fitting clothing so you can expose the area that we will be evaluating and treating. For example, if you have a knee problem, it is best to wear shorts. For a shoulder problem, a tank top is a good choice, and for low back problems, wear a loose fitting shirt and pants, again so we can perform a thorough examination.
Treatment sessions typically last 30 to 60 minutes per visit.
This is highly variable. You may need one visit or you may need months of care. It depends on your diagnosis, the severity of you impairments, your past medical history, etc. You will be reevaluated on a monthly basis and when you see your doctor, we will provide you with a progress report with our recommendations.
More than half of Americans are suffering from pain. Whether it is a recent episode or chronic, an ABC News/Stanford study revealed that pain in America is a serious problem. Yet, many don't even know that physical therapists are well equipped to treat pain and their causes.
Rehab specialists are experts at treating movement and neuro-musculoskeletal disorders. Pain often accompanies a movement disorder and rehab specialists can help correct the disorder and relieve the pain.
You have probably heard of the profession of rehabilitation. Maybe you had a conversation with a friend about how rehabilitation helped get rid of his or her back pain, or you might know someone who needed rehabilitation after an injury. You might even have been treated by a rehab specialist yourself. But have you ever wondered about rehab specialists-who we are and what we do? Many people are familiar with rehab specialists' work helping patients with orthopedic problems, such as low back pain or knee surgeries, to reduce pain and regain function. Others may be aware of the treatment that rehab specialists provide to assist patients recovering from a stroke, e.g. assisting them with recovering use of their limbs and walking again.
The ability to maintain an upright posture and to move your arms and legs to perform all sorts of tasks and activities is an important component of your health. Most of us can learn to live with the various medical conditions that we may develop, but only if we are able to continue at our jobs, take care of our families, and enjoy important occasions with family and friends. All of these activities require the ability to move without difficulty or pain.
Because rehab specialists are experts in movement and function, they do not confine their talents to treating people who are ill. A large part of a rehab specialist's responsibilities are directed at preventing injury, loss of movement, and even surgery. Rehab specialists work as consultants in industrial settings to improve the design of the workplace and reduce the risk of workers overusing certain muscles or developing low back pain. They also provide services to athletes at all levels to screen for potential problems and institute preventive exercise programs. With the boom in the golf and fitness industries, a number of rehab specialists are engaged in consulting with recreational golfers and fitness clubs to develop workouts that are safe and effective, especially for people who already know that they have a problem with their joints or their backs.
The cornerstones of rehab treatment are therapeutic exercise and functional training. In addition to "hands-on" care, rehab specialists also educate patients to take care of themselves and to perform certain exercises on their own. Depending on the particular needs of a patient, rehab specialists may also "mobilize" a joint (that is, perform certain types of movements at the end of your range of motion) or massage a muscle to promote proper movement and function. Rehab specialists also use methods such as ultrasound (which uses high frequency waves to produce heat), hot packs, and ice.
Most forms of rehabilitation treatment are covered by your insurance, but the coverage will vary with each plan. Most states do not legally require patients to see their physicians before seeing a rehab specialist. Most of the time all you have to do is ask your doctor if rehabilitation is right for you.
Who is better to see, a PT that works for a physician or a PT that owns a private practice? We leave it up to you to draw your own conclusions but here are some facts. The studies indicate there were more treatments (visits per patient were 39% to 45% higher in physician owned clinics) and the cost was greater for those patients that attended a physician owned physical therapy practice (both gross and net revenue per patient were 30% to 40% higher) (1).
Another study indicated that licensed and non-licensed therapy providers spent less time with each patient in physician owned clinics and physical therapy assistants were substituted for physical therapists. (2)
Another, older study concluded that "Therapists who had treated patients through direct access were significantly more likely to believe that direct access had benefited them professionally and benefited their patients than were therapists who had not practiced through direct access."(3)
We believe that we can provide you with the highest quality of care available and do it in a cost-effective manner. You will work closely with your physical therapist and in most instances, your case will be managed by the same physical therapist from the beginning to the end of your experience with us.
- Mitchell, J., Scott, E., Physician Ownership of Physical Therapy Services: Effects on Charges, Utilization, Profits, and Service Characteristics, Journal of the American Medical Association, 1992.
- "Joint Ventures Among Health Care Providers in Florida," State of Florida Health Care Cost Containment Board, 1991.
- Domholdt E, Durchholz AG. Direct access use by experienced therapists in states with direct access. Phys Ther. 1992 Aug;72(8):569-74.
For many patients, one of the primary objectives is pain relief. This is frequently accomplished with hands-on techniques, modalities such as ultrasound, electrical stimulation, and/or heat or cold therapy. Movement often provides pain relief as well. Your rehab specialist will provide you with the appropriate exercises not only for pain relief but to recover range of motion, strength, and endurance.
In some cases, rehab techniques can be painful. Recovering knee range of motion after total knee replacement or shoulder range of motion after shoulder surgery may be painful. Your rehab specialist will utilize a variety of techniques to help maximize your treatment goals and minimize your pain. It is important that you communicate the intensity, frequency, and duration of pain to your rehab specialist. Without this information, it is difficult for the rehab specialist to adjust your treatment plan.
There are dozens of different types of treatment interventions. Here is a list of treatment interventions:
Active Range of Motion (AROM) - the patient lifts or moves a body part through range of motion against gravity. AROM is usually prescribed for arthritis, gentle strengthening without trauma to joints.
Active Assistive Range of Motion (AAROM) - Therapist assisted active range of motion. This is usually prescribed for gentle stretching or strengthening for a very weak body part.
Stationary Bicycle - with or without resistance. This is usually prescribed for improving the strength and/or range of motion of the back or lower extremities as well as cardio-vascular endurance.
Gait or Walking Training - The analysis of walking problems by visually examining the interaction of the low back and the joints of the thighs, legs, and feet during the various stages of walking, including, initial contact, loading response, mid stance, terminal stance, pre swing, mid swing, and terminal swing. Many back, thigh, leg, ankle, and foot problems may be caused by or manifest themselves in subtle gait abnormalities.
Isometrics - Muscle contraction without joint movement. This is usually prescribed for strengthening without stressing or damaging the joint, e.g. arthritis, or exercises to be performed in a cast, or right after surgery if recommended by the therapist/doctor.
Isotonics- Muscle(s) contracting through the ROM with resistance. This is usually prescribed for strengthening.
Soft Tissue Mobilization - therapeutic massage of body tissue, performed with the hands. Soft tissue mobilization may be used for muscle relaxation, to decrease swelling, to decrease scar tissue adhesions, and for pain relief.
Mobilization - hands-on therapeutic procedures intended to increase soft tissue or joint mobility. Mobilization is usually prescribed to increase mobility, delaying progressive stiffness, and to relieve pain. There are many types of mobilization techinques including Maitland, Kaltenborn, Isometric Mobilizations, etc.
PNF - Proprioceptive Neuromuscular Facilitation is a system of manually resisted exercises performed in diagonal patterns that mimic functional movements. Initially used in developmentally and neurologically impaired patients, but now used in almost every aspect of neuromuscular retraining from athletes in sports facilities to the very weak in hospitals and nursing homes.
Posture Training - Instruction in the correct biomechanical alignment of the body to reduce undue strain on muscles, joints, ligaments, discs, and other soft tissues. There is an ideal posture but most do not have ideal posture. Therapists educate patients about the importance of improving posture with daily activities. Stretching and strengthening exercises may be prescribed to facilitate postural improvement and to prevent further disability and future recurrences of problems.
Progressive Resistive Exercises (PRE) - Exercises that gradually increase in resistance (weights) and in repetitions. PRE is usually prescribed for reeducation of muscles and strengthening. Weights, rubber bands, and body weight can be used as resistance.
Passive Range of Motion (PROM) - the patient or therapist moves the body part through a range of motion without the use of the muscles that "actively" move the joint(s).
Stretching/Flexibility Exercise - exercise designed to lengthen a muscle(s) or soft tissue. Stretching exercises are usually prescribed to improve the flexibility of muscles that have tightened due to disuse or in compensation to pain, spasm or immobilization.
Cryotherapy or Cold Therapy - Cold therapy is used to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but also an effective pain reliever for even the most chronic pain.
NMES or neuromuscular electrical stimulation - the application of electrical stimulation to aid in improving strength, e.g., the quadriceps muscle after knee surgery or injury. NMES is also used to decrease pain and swelling and to relieve muscle spasm.
Neck Traction - a gentle longitudinal/axial pull on the neck, either manual or mechanical, intermittent or continuous for relief of neck pain, to decrease muscle spasm, and facilitate unloading of the spine.
Heat - heat is recommended to decrease chronic pain, relax muscles, and for pain relief. It should not be used with an acute or "new" injury.
Iontophoresis - medications are propelled through the skin by an electrical charge. This modality works on the physical concept that like charges repel each other, therefore, a positively charged medication will be repelled through the skin to the underlying tissues by the positively charged pad of an iontophoresis machine. Iontophoresis is usually prescribed for injuries such as shoulder or elbow bursitis.
Pelvic Traction - the longitudinal/axial pull on the lumbar spine, either manual or mechanical, intermittent or continuous. Pelvic traction may be helpful for the relief of low back pain and muscle spasm.
TENS - transcutaneous electrical nerve stimulation is a relatively low voltage applied over painful areas through small self-adhesive electrodes. The electrical stimulation "disguises" or "overrides" the sensation of pain. It is a small, portable unit, used in intervals, to control pain and reduce dependence on drugs. It is usually prescribed for relief of pain.
Ultrasound - ultrasound uses a high frequency sound wave emitted from the sound head when electricity is passed through a quartz crystal. The sound waves cause the vibration of water molecules deep within tissue causing a heating effect. When the sound waves are pulsed, they cause a vibration of the tissue rather than heating. The stream of sound waves helps with nutrition exchange at the cellular level and healing. Studies have shown that ultrasound is helpful for ligament healing and clinically, for carpal tunnel syndrome, and muscle spasm.
Whirlpool - immersion of a body part into water with small "agitators" to provide a gentle massaging motion. A warm whirlpool provides relief from pain and muscle spasm and is often preparatory to stretching or exercise. Cold whirlpool is used to decrease inflammation and swelling.
Massage may be part of your treatment. Rehabilitation specialists are trained in a variety of techniques that may help with your recovery. Deep tissue techniques, may be part of the rehabilitative process. Massage is used for three reasons typically - to facilitate venous return from a swollen area, to relax a tight muscle, or to relieve pain. Contrary to common thought, massage does not increase circulation.
Flare ups are not uncommon. If you have a flare up (exacerbation), give us a call. We may suggest you come back to see us, return to your doctor, or simply modify your daily activities or exercise routine.
In most cases, you have the right to choose any rehab specialist. The best thing to do is give us a call. Sometimes, your insurance plan may not pay for a specific rehab specialist, but if this is the case, you still could see that clinician but you may have to pay out-of-pocket for the treatments.
The best thing to do is give us a call and we will attempt to answer all of your questions.
Forty-three states have some form of direct access for physical therapists - Iowa being one of them. Also, in Iowa, occupational therapists can accept direct referrals.
Billing for rehab services is similar to what happens at your doctor's office. When you are seen for treatment the following occurs:
- The rehab specialist bills your insurance company, Worker's Comp, or charges you based on CPT (Common Procedure Terminology Codes).
- Those codes are transferred to a billing form that is either mailed or electronically communicated to the payer.
- The payer processes this information and makes payments according to an agreed upon fee schedule.
- An EOB (Explanation of Benefits) is generated and sent to the patient and the therapy clinic with a check for payment and a balance due by the patient.
- The patient is expected to make the payment on the balance if any.
It is important to understand that there are many small steps (beyond the outline provided above) within the process . Exceptions are common to the above example as well. At any time along the way, information may be missing, miss communicated, or misunderstood. This can delay the payment process. While it is common for the payment process to be completed in 60 days or less, it is not uncommon for the therapy clinic to receive payment as long as 6 months after the treatment date.
Some patients will need to continue with home exercises. Other patients will have completed their rehabilitation and can return to normal daily activities. Others may wish to to continue with a gym exercise program. It is important that you communicate with your therapist so he/she can set up long-term goals for you.
Physical therapists, occupational therapists and speech language pathologists are licensed by their respective state licensing boards.
- Do they have a service that can address your problem?
- Do they take your insurance or are they willing to work with you if they are not a preferred provider?
- They should be conveniently located. Since sitting and driving often aggravate orthopedic problems, there should be a very good reason for you to drive a long distance for rehabilitation.
- What are the hours of operation?
- Can they provide satisfaction results?
- Do they accept your insurance?
- The therapist should provide the treatment.
- Can you briefly interview the therapist before the first visit?
- Ask your family and friends who they would recommend.