“I don’t know if I should be here.”
Physical therapy clients tell me this when their pain has vanished and they don’t know if they need physical therapy anymore. Or if they don’t think PT will help them in the first place.
So, is physical therapy always the best option? And is there such a thing as too much treatment?
This article explains when you need physical therapy, and when you don’t. Plus, you will learn the downsides of too much treatment and whether you need a doctor’s referral to see a physical therapist.
Let’s dive in.
Little-Known Perks
Good physical therapy is more than boilerplate stretches and strength exercises.
Hint: If your PT gives you the exact same exercises as every other patient, find a new one! You need physical therapy that’s customized to you to feel better faster.
Here are other ways a great physio can help you:
- Find strength and motion deficits
- Teach you how to manage pain
- Educate you on return-to-exercise strategies
- Instruct you on safe body mechanics
- Explain how to prevent re-injury
- Calm your fears about movement
When PT is Wrong
Sometimes PT isn’t the best option. For example, acute, mild low back pain typically resolves by itself, so guidelines say you don’t need physical therapy treatment right away (Alrwaily 2016). Mild pain is often like your neighbor’s sleeping Rottweiler – best left alone.
Other times, creatively-named conditions like frozen shoulder or Saturday night palsy may require extra attention from a medical doctor.
“Treatment Made it Worse”
Seeking treatment for every ache and pain is suboptimal. Here’s why:
Hypervigilance describes heightened attention to pain and bodily sensations. It’s linked to fear of movement, negative expectations, and chronic pain (He 2014).
Hypervigilant folks think they need physical therapy or other medical attention for every sneeze, twinge, and throat tickle, to their own detriment.
Why is over-treatment problematic?
Medical treatments can have harmful consequences. Think of medication side effects or added stress from doctor’s visits. These treatment-induced problems are called iatrogenic effects.
It’s why getting an MRI for back pain is usually a bad idea.
A Balancing Act
On one hand, you don’t need physical therapy any time you feel a brief ache or pain. Like it or not, periodic discomfort is a normal part of life. And too much medical treatment causes its own problems.
On the other hand, finding the right treatment fast accelerates healing. Delayed treatment delays recovery.
I’m always excited to treat recent-onset pain because it tends to resolve rapidly. However, clients recover slower when they have waited several months or years before starting PT.
Savvy health-care consumers strike a balance between hypervigilance and ignoring pain.
Weigh the Factors
These factors can indicate the gravity of an ache or pain.
Duration: 5-minute-old musculoskeletal pain may not require the same attention as 5-year-old persistent pain.
Intensity: Severe pain demands attention. Mild pain is more apt to ease on its own.
Onset: A traumatic injury (car accident, falling off a ladder) warrants a trip to the doctor. On the other hand, inner elbow pain after playing 18 holes will probably go away with rest…and a few golfer’s elbow exercises.
Of course, talk with a qualified healthcare provider if you have questions about your specific situation.
Can I Go Straight to PT?
Yes. If you live in the United States, you don’t need a physician’s note to go to physical therapy. It’s called direct access and it’s available in all 50 states.
Physical therapy is a great option for musculoskeletal pain. For low back pain, going to PT first is the best option – better than seeing a primary care doctor or specialist first.
And PT school teaches physios when to refer patients for further evaluation. A few insurance providers require a doctor’s order for PT, so check with your insurance company before you go through direct access.
Nail the Basics
Staying healthy and pain-free isn’t easy. With so much information out there, it’s hard to know where to focus your limited time and attention.
Fortunately, success in these 3 areas will exponentially improve your health and wellness. Can you guess what they are?
Readers: How do you decide when to see a doctor? How about a physical therapist? Do you tend to seek too little treatment? Too much? Share your thoughts in the comments.
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