Doctor Answers Physical Therapy Questions

Hi, I'm Courtney Mears,

and I am a doctor of physical therapy

and a board certified orthopedic clinical specialist.

Let's answer some questions from the internet.

This is Physical Therapy Support.

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@Schminxer asked, How long does physical therapy last?

This is a really broad question.

My patients, I typically see them around six to eight weeks.

Give or take.

The fix after physical therapy,

it really depends on how good you are

about your home exercise program,

how long you typically decide to stick with it.

And again, just depends on what's injured.

What are you trying to get back to,

and what your functional goals are.

@FOLIELOADED asked, I'm gonna ask my PT tomorrow,

but our physical therapy and rehabilitation exercises

supposed to make your body parts ache.

Every time I do them it hurts more.

Typically whenever you're given something new,

it might hurt a little bit

or you might be a little achy here or there,

but all of that's very normal.

Just like if you did a little workout

that you've never done, sometimes you're a little sore

maybe for like a day or two,

but then it should get better over time.

A lot of PTs use that 0 to 10 scale.

So you'll see zero means I'm in no pain,

10 means, Oh my gosh, I have to go to the emergency room.

And so you could typically be around

like a two or a three, and then we're good to go.

@_Curt_2Dope asked, Why does physical therapy

include so many science classes?

That's because what we do is science.

A lot of what we're doing involves a lot of physics.

We have to understand different

pharmacological interventions,

which involves a lot of chemistry classes.

A lot of us have to,

you know, think about the research side of things.

So you have to be able to analyze

and understand a lot of that information.

And everyone now coming out of a physical therapy school

is earning a doctorate.

So they're just taking you to the next level

to make sure you have a really wide understanding

of what you're doing with patients.

@JayesYourDrug asked, Does physical therapy really help

with having a bad back?

So if we look at this,

there is a lot going on with the back.

I don't ever tell people they have a bad back.

Everyone looks a little bit different.

When you go to PT, they can tell you,

is it actually your back

or is it your hips or is it something completely different?

I think physical therapy helps with pain and with function,

but again, I don't think anyone really has a bad back.

This thing is so cute.

I love her. [laughs]

@StarKillerKoF asked, So how does physical therapy work?

Do I go somewhere to do it,

or is it a thing that you do by yourself at home?

Nowadays, it could actually be both

just because we have so many more options out there

with the use of telehealth.

But I would say you have two different ways to go about it.

You're gonna be able to go into your standard clinic

and be one-on-one in person with your PT

or you might be through the screen

and going through them with exercises

or what can you do in your home environment.

But in both situations, you're gonna be with somebody,

not just by yourself.

You'll always get homework, I think.

You'll always have something to do.

You're obviously going to a PT

because you're looking for help,

but in order to make it last,

you're gonna have to put in the work

by yourself too at home.

@Physiot06546448 asked,

What is aquatic therapy?

This is really PT in the water.

So you're in the pool.

Typically a rehab pool is heated,

so it's a little bit different than your community pool.

The water gives you some type of compression,

but the water also gives you a lot of support.

So for some people you wanna be unweighted

so it loads you a little bit less

and it makes you just a little bit more comfortable to move.

But even if you're in the water,

we're typically asking people

to then do everything you learn there on land

because we're not fish,

and we have to be able to do things on land anyways.

This might be my chronic pain patient or my older patient,

so maybe they have a lot of arthritis on one of their joints

and they just need to unload that joint a little bit.

And so this just allows them to be more comfortable

but get the movement that we're trying to achieve.

@companionrag asked, I think I need physical therapy

for my jaw or something.

The pain is getting consistent and unbearable.

TMJ tips welcome.

Most people don't realize that PTs can treat jaw pain.

The jaw is a joint just like any other part of your body.

You have muscles that are around it

just like any other part of your body.

Typically for a lot of my patients,

I prescribe them some soft tissue work.

So we'll be working like a little bit of massage

through these big muscles here.

If you can find out how to relax your jaw,

that's gonna be the number one.

So what I tell people is tongue on the roof of your mouth,

teeth slightly apart, lips closed,

and see if these can relax a little bit.

And if you can get that throughout your day,

you're gonna be golden.

If I was gonna be doing a self-massage at home,

I typically try to find this really high bone up here

at my cheek and then I find my jawbone here at the bottom,

and this is where I'm gonna be doing my soft tissue work.

If you're clenching down, it's not gonna work

'cause you're just gonna be fighting yourself.

So again, you wanna be relaxed,

and you're just gonna kind of push and pull,

push and pull.

@UdontNeedtoKnowY asked,

How the hell does physical therapy fix a pinched nerve?

A pinched nerve really just means

that there's some type of pressure on the nerve.

A lot of the times what I see is posture related.

So if people are really hunched over

or moving a little bit different,

it can put pressure on different parts of the spine

and those spinal nerves.

Strengthening if they're really, really weak,

either through their back muscles

or maybe their core muscles.

But it doesn't fix the pinched nerve,

it just helps give you support all around it.

Nerve symptoms present as numbness, tingling, burning,

but it could also just present as pain.

When we look here at the spine,

all of these little yellow lines are nerves

that are coming out.

For some people, these spaces that these nerves come out of

are a little bit smaller,

whether that be from arthritis

or if they've had a disc herniation,

and physical therapists are there

not only to help treat this

but to help you compensate if we need it,

because we don't fix what your bone does,

but we might be able to help you move better

so that you don't make that nerve angrier.

@nehapateldc asked, Did you know that physical therapy

isn't only for the injured?

Physical therapy sessions can also help athletes

become stronger and more injury resistant,

thus allowing them to perform better than they normally do.

Absolutely, true.

I think where physical therapy is going

isn't just for people who are coming in for injuries,

but really trying to prevent an injury.

Every population, every age group,

everybody could use a little TLC to their muscles

or their mobility

just to make sure you're living the best life you can.

@EyeAdministrative197 asked, MCL grade 3 tears.

How long did your MCL take to heal?

MCL, if we're talking about the knee,

it's your medial collateral ligament.

It gives you some stability around

the middle part of your knee to prevent it from,

you know, feeling unstable.

Depending on the grade of tearing,

MCLs don't heal on their own.

Grade 1 is just a little bit of stretch.

Grade 3 now we're seeing a little bit more tearing,

a lot of stretching,

and it just means that our process in PT

might take a little bit longer.

If you have a sprain where it's stretched out,

maybe you can get some support around your joint

to make it feel better,

but it doesn't necessarily mean

that the tissue itself is healed back to 100%.

Might have a little bit of scar tissue now.

You might have a little bit more of an odd movement pattern,

but this is where, you know, if you can go to a PT

as soon as you can so we can fix those things,

it just puts you on the track to success a lot faster.

@7springdaze asked,

I need someone to explain the difference

between occupational and physical therapy to me

like I'm a five-year-old.

Our professions are very similar,

but occupational therapy,

when you're at point A and point B,

they'll help you do those activities at those points.

And then if I'm working with a PT,

they're gonna help me get from point A to point B.

If you weren't a five-year-old,

I'd say a PT really helps with the gross motor skills,

strength, mobility, flexibility,

and OTs might be working with you on more fine motor tasks,

but both are gonna be helping you

back to your activities of daily living.

@ghadcunter asked,

Physical therapy versus gym/personal training.

Both of us do exercises with people,

both of us correct how movement is being done,

but I like when people see a PT first

because then they can really get down to the nitty gritty,

like What should I really be doing

to get back to this goal?

Or how can I do X, Y, Z safely by myself?

And then maybe you go to the gym,

you know exactly what you're doing

so that you prevent the injury from happening.

That way you don't have to end up at the PT anyway.

@MementoQuest asked, Did you know physical therapy

strengthens your muscles, but what about your brain?

Anytime you do any type of movement,

you're creating these new pathways in your brain.

This is what we call neuroplasticity.

And when you learn a new motion

or how to correct something,

you're getting all those pathways going

and you're just enhancing the way you think.

So you're really aren't just strengthening your muscles,

you are strengthening your brain,

all of your cognitive abilities.

And there's also other portions to PT

where maybe that's all they focus on.

One of them is neurologic specialty in physical therapy,

and they're really working with a nervous system.

So some people have changes in their brain,

maybe they've had a stroke,

maybe they have a neurologic disorder like Parkinson's.

And so what PTs in that specialty do,

they're really working on rewiring the brain

to help with their balance,

to help them with their motor function,

to get them back to what they wanna do too.

@yrs_ asked, Does VR physical therapy exist?

Definitely.

A lot of people are now using this,

and we see it being used to help people with their balance.

So they're putting them in a different environment

with one of those really big headsets,

and they're trying to get them to reenact

how they would be walking down the street

or if someone came up right in front of them

and they have to react to move.

But other specialties are also using this

to help people relax

and help calm their nervous system down.

A lot of our chronic pain patients are using this nowadays

and a lot of great research is coming out about it.

@mrcnns1 asked,

Do you recommend blood flow restriction training?

First, the person has to qualify for this.

So if you had something like a blood clot,

you're not appropriate for this.

Definitely not,

but a lot of patients do benefit from this.

And what blood flow restriction training is,

so we take one of the limbs,

whether it's the upper body or the lower body.

We put a really big blood pressure cuff around it,

we pump it up, and it restricts blood flow.

What that does is it creates this environment for muscles

to grow faster, what we call hypertrophy,

and you're also able to do more with less.

And so this is really nice for people

who don't tolerate really large loads,

but you still wanna get more muscle growth,

better endurance, and again, better outcomes.

A Reddit user asked,

To what extent can psychological anxiety

lead to chronic physical symptoms?

So there's a center in your brain

that processes what pain is to you,

and this little center, if everything is very heightened,

like for those who experience anxiety

might light up a lot more than for your typical person.

When everything's heightened,

something like a loud sound can feel a lot different

to that person.

While I see a lot of these people,

it's usually a multidisciplinary approach.

So they might be seeing somebody like a psychologist

or a mental health consultant,

just to make sure that we're both addressing their needs,

but it's really this like balance of how we address it.

It's definitely not just in your head.

@mich_lew asked, How do physical therapists

always know when you aren't doing the stretches at home?

#calledout.

When I have my patients,

I'm always testing 'em right when they come into the clinic.

I'm asking, Well, show me what you did last time.

And if, one, they don't remember,

I definitely know they didn't do it.

But two, if we aren't getting where we're supposed to be,

I know something's going on,

and it just has to be called out.

We do catch everybody. [laughs]

@pdig917 asked,

Ice or heat?

Big question in physical therapy.

I would tell people if they're immediately post-op,

so they just had a surgery,

ice is probably a better option

because they probably have a lot of swelling,

a lot of inflammation,

and we're really trying to get things to calm down.

But if you're someone who feels really tight all the time

or like your muscles are just stiffening up

and your joints are stiffening up

and you've been experiencing that for years,

heat might be a better option for you.

At the end of the day, it's really what you prefer.

So if it's the winter for me,

I'm usually not choosing ice and I'm going heat.

@powerarm asked, PT perspective on cortisone shots.

Cortisone is an anti-inflammatory.

So if you have a lot of inflammation in a specific joint,

and if you can't move because there's not a lot of space,

you're probably gonna be

in some amount of pain or dysfunction.

So when you get the cortisone injection,

it just again helps everything calm down

so that we can get you moving a little bit better.

A lot of what we do in PT

is really helping that person load a specific tissue,

but if that tissue isn't ready to be loaded,

then we're just gonna be at the standstill.

@dhduxn asked,

What is the difference between physical therapy,

physiotherapy, and sports medicine?

Physical therapy and physiotherapy, same thing.

It just depends on what country you're in

and who's talking to you about it.

But the difference between physical therapy/physiotherapy

and sports medicine is the broadness

of what you're able to practice.

Sports medicines deals with athletes

and a more active population.

So it could be your high school athlete

who's playing recreational soccer on the weekends,

but it could also be your professional athlete

who's in the NHL.

Physical therapy has a much wider range on what we do

and who we treat.

@riskeverything asked,

How much a physiotherapy is pseudoscience?

So I think in any profession,

there is some type of pseudoscience,

but for what I do and how I practice,

I'm always going back to the research.

I'm never just, you know, shooting from the hip here.

Whatever I'm putting into practice with patients,

I'm making sure that it's been tested

and it's tried and true, and that ultimately it works,

because there's a lot out there now in our profession

that we know about in relation to stretching,

strengthening, manual therapy techniques,

and we know what the best intervention is

for the right person in diagnosis.

@AliciaGaxi92206 asked,

How do you stop peeing yourself

every time you sneeze/cough after giving birth?

Asking for a friend.

So you have muscles within your pelvis,

it's your pelvic floor.

Those muscles, just like any other muscle in your body,

need to be trained.

After giving birth,

a lot of these muscles are getting relaxed

because of a different hormone that you're producing

to get ready for birth and open up your birth canal.

After birth too sometimes,

you have different structures in your spine

that are also a little bit more relaxed

or they're just being used a little bit differently.

So if you feel like you're a little incontinent,

definitely head up a physical therapist to get seen

and to get treated for it

because it's not something that you have to live with.

@ameerexists asked, Why are physical therapy stretches

so much [beep] harder than lift weights?

Great question.

It's probably because your PTs isolating the exact muscle.

And when you're at the gym lifting your weights,

your body's taking the path of least resistance.

So it's always good to see a PT

just to make sure that you're hitting the exact right spots.

@EricRobertson asked,

How is cupping therapy actually part of physical therapy?

Why not herbs?

Why not magnets?

And why does cupping escape scientific scrutiny?

I don't think it escapes scientific scrutiny

because even I'm a little bit hesitant

to use this with people,

this is a therapy that we might use

because it's readily accessible for a lot of people.

You can buy a set on Amazon for 20 bucks.

So instead of going to PT,

maybe this is something you can do in between.

Typically you're right,

it's like a band-aid on what we're trying to complete,

but if it makes you feel better, why not?

@joeygiggles asked, How does mirror therapy work?

Mirror therapy is really trying to almost retrain your brain

to not be in pain.

Typically what we're doing is we're putting a mirror

near a limb or body part

that that person is interpreting with their brain as normal

and we're trying to make that connection in their brain

that the other side is also okay.

@poopoosandwich asked, Who invented physical therapy?

Some guy was just like, 'Hey, let's move his arm

the complete opposite way and see what happens?'

So there's a couple different theories out there

for who started physical therapy and how he became to be.

During the polio pandemic,

someone was like, Hey, I want to get people back to moving

who are really weak.

And what she did was actually aquatic physical therapy.

So that's how our profession got going.

And once we realized that people who move do better,

we just kept growing and growing.

And now we do it all.

@Eleanor95670977 asked,

How do physical therapists

help treat patients with pneumonia?

It's not my specialty, so I don't typically treat this,

but there is chest physical therapy.

So they use different percussive techniques,

and typically their hands are like this,

creating little cups

and they're pushing and pressing on little parts

of the lobes of your chest to help all those secretions

that might be coming from pneumonia dislodge

so that you can be able to cough them out.

@l_growingbones asked,

How does yoga assist in physical therapy?

So I think yoga has a lot of great qualities.

A lot of people are doing yoga to be stronger,

to gain more flexibility.

And this can be really useful in PT

because we're working on a lot of the same activities.

Yoga is usually the activity though

that I'm helping people get back to.

So I'm working things maybe in more isolation

to help them get back to their goal of a certain yoga pose

or to be able to tolerate a single leg stand

while they're completing a tree pose.

But if you're stretching that much and not strengthening,

you're gonna be unbalanced,

and your body's gonna be a little bit dysfunctional.

@joelmarinez asked, Well, that was a new experience

in physical therapy.

They use this thing that looks like a dull knife

to break up some scar tissue and fascia.

Let's see how this feels later today.

Some physical therapists use metal tools or plastic tools,

and they really are scraping the tissue.

The research behind this is a little spotty,

but the idea is, is that you're creating a type

of microtrauma to that tissue which increases blood flow.

And when you increase blood flow to an area,

that helps heal tissue and get nutrients to it

so that it heals faster.

@KittyPlays asked,

Anyone have experience with a TENS machine?

Got my first one today,

and so far it's working to relieve my pain.

Awesome.

Would love to know any tips and tricks on how to use it.

A TENS machine is a transcutaneous

electrical nerve stimulation machine.

There's little sticky pads

that you'll put on different parts of your body,

and the machine sends an electrical current to that pad,

which stimulates muscle contraction

or nerve stimulation where you might feel a slight buzz

or just a different sensation.

Essentially what we're trying to do is modulate pain.

So when you feel that buzzing or that twitching,

it's sending that signal up to your brain

and it's telling your brain, think about this.

And it beats the pain signal.

So when you're using it,

I'm glad you're getting relief in your pain

'cause that's exactly what it should do.

@personalisedmilk asked,

Who wants to hit me with the Epley maneuver

before I throw up?

So the Epley maneuver is used for people

who are experiencing dizziness,

specifically those who are experiencing dizziness

due to benign paroxysmal positional vertigo.

Most people just call it vertigo,

but that's the long name for it.

There's crystals in your ear,

and sometimes those crystals get dislodged,

which is what's causing people's dizziness.

So what this maneuver is trying to do

is put that crystal back into place,

thus leaving you dizzy-free.

@SN1 asked, LOL over 40 and your back hurts

from just lying down too long.

It's like your body goes, 'Oh [beep] we're getting up?

Yo, I thought you were dead,

and I'm not gonna lie, I just stopped working.

Hold on, I'll fire back up.'

As we get older, we get a little stiffer,

we become a little less flexible.

So when you don't move, there's no joint fluid

that's lubricating a lot of your joints.

And when that happens, things feel a little creaky.

So then when you get back up, you get that joint fluid,

you're lubricating all the joints that you have,

and then you're feeling good is new.

If you're feeling a little stiff

when you wake up in the morning and you're in bed,

just move your knees back and forth

just to get things again lubricated a little bit.

Or if you're sitting and you're really hunched over,

just try sitting up nice and tall,

and maybe you're doing a couple shoulder blade squeezes

to lubricate those joints back there,

and just correcting your posture in general.

@embe_rose asked,

I wonder when people are gonna start wearing kinesio tape

just to look cool in sports.

Kinesio tape is this stuff.

It's a flexible tape

that we've probably seen a lot of athletes wear.

It kinda stretches.

The idea behind it,

it's that it's lifting some of the tissue

to increase blood flow to an area,

but some people also use it

to feel a little bit more support

when they're completing an activity.

Typically, I don't use this too often,

but you do see it a lot out in the public.

There's different prints out there,

some have a camo print,

some have different stars or hearts on it,

but it all does the same thing.

@PColeman84 asked, Can physical therapy

help with scoliosis patients or is surgery the only tool?

Surgery is definitely not the only tool.

Some people have scoliotic curves in their spine

and they have no pain.

And some people have really large scoliotic curves

that we have to help different muscles stretch out

or different joints kinda loosen up,

but we can definitely help with this.

And surgery's definitely not your only option.

@BraydenWysPT asked, Did you know that physical therapists

can treat pain and limbs that have been amputated?

Physical therapists have developed many techniques

for treating 'phantom pain'.

So some people, when they have a limb amputated,

their brain still thinks it's there

because your brain is interpreting that the limb is there.

It's sending signals and creating pain

and something that is no longer.

So what mirror therapy does is,

it's having you look at the limb that still exists

and it's retraining your brain

to thinking that the limb that doesn't exist anymore

is absolutely okay.

So you can think of this

as kind of like a brain game retraining.

Okay, that's all the questions for today.

Thanks for watching PT Support.

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