My physical therapist says I need to have 2 to 3 treatments a week. Why?
Once you have been referred to a physical therapist, or you decide to see one on your own, the PT will perform an initial evaluation. At the end of this first session the therapist will most likely recommend that you set up some treatment times for the next several weeks, usually to the tune of 2 to 3 visits a week. At this point an interesting dynamic happens…
If the patient is retired or is not working, whether that be a personal choice or due to an injury, and they have to pay little to no money out-of-pocket, it usually isn’t hard to get them to schedule for 3 visits a week. However, if the patient has a busy schedule and/or a high co-pay, co-insurance, or deductible, it can be a little harder to get them to schedule on a consistent basis. We can usually get 2 visits a week on the books but it’s a little tougher to get a firm commitment. Perhaps they will commit to 2 visits for 2 weeks but if they don’t see any improvement they may stop, as it’s costing them $30, $40, $50, or perhaps more each visit. As much as we can beg and plead for more time to get the patient better, they just won’t commit to further treatment due to the high cost. You know what? I totally get it.
Once I think about it, if I had to pay a $40 co-pay, or even a $20 co-pay 2 to 3 times a week for a month or more, I would have second thoughts on whether I should follow through with treatment or not. That money adds up fast! So what are we as therapists and you as a patient to do when we come upon this problem? Is there a compromise? I think it’s best to look at the reasoning each side has and then come to a mutual understanding somewhere in the middle.
From the physical therapist perspective, coming to treatment consistently 2 or 3 times a week is beneficial in several ways. Consistent, repeatable treatments allow for the body to build upon the gains that were achieved the previous treatment session. Once we’ve started working on getting the healing process going on whatever your issue may be we want you to come back to treatment rather quickly, so we can continue to promote healing by gently increasing stresses to the tissue. There are multiple research articles that concur that repeatable treatments helps to progress the healing process faster. That is why people work out multiple days in the week. They must continue to push their body so they can improve in their chosen activity. Getting treated just once a week is like treading water, you’re not going anywhere fast. By the time you come back to therapy any gains that you achieved last week will most likely be lost. This prolongs the overall length of treatment and in the end could end up costing you more money.
On the patient side of things the two most common reasons I hear for not wanting to schedule multiple visits in a week is time and money. Some people have very busy schedules with work, driving kids to after school activities, and various other appointments. There is only so much time in a day, and trying to fit another appointment in, one that might cost money and cause some pain, usually isn’t a priority. The aspect of cost unfortunately is quickly becoming a more serious issue as the economy continues to stagnate and insurances are covering less, requiring patients to pay more. If cost is a concern to you, please let us know and we will do everything in our control to make it more manageable for you. It is at this point where value comes in. Do you see value in coming to physical therapy? It is up to the physical therapist to show you the value of physical therapy and explain why it will be helpful to you. Physical therapy is an inexact science. Every injury does not follow an exact path towards recovery. We can give you time frames on how long you can expect before you injury completely heals, but these are just estimates. I’ve had plenty of patients with the same type of injury who heal up much quicker and much slower than expected. We will do our best to give you the most accurate information we can so you can make the best decision.
After going over the results of my patients evaluation with them and educating them on various aspects of their condition, we get down to scheduling. Most people, regardless of scheduling or cost are willing to try therapy for one month. Patients may or may not notice any changes in the first couple weeks of therapy. Sometimes patients have more soreness and pain as we begin treatment. Just like being sore after working out for the first time in a long time, the body takes a while to get used to all the attention the injured part is receiving. Going in to the second or third week of treatment the initial soreness has usually worn off and improvements should start to show. I don’t expect the patient to be completely healed in that time but they should at least begin to notice some type of change, whether it’s a decrease in pain, an increase in motion, or another indicator of improvement. I think that is a reasonable expectation that both therapist and patient can agree on. My thought is that if you are not noticing some type of improvement after three weeks something needs to change. Maybe it’s a new treatment technique or change in the overall treatment plan. Regardless something needs to happen. The therapist should never be the reason you are treading water! There is no perfect answer to this question, as there are so many factors involved. But I will tell you this. If a therapist demands you come 3 times a week for 4 weeks, ask them why. If they can give you a good answer backed up with solid reasoning, and you are willing, then go for it. If they say “because I said so” or something to that effect I would look elsewhere. Your time and money are important. Make sure you see a therapist that understands that and that wants to provide you with something of value.