Do I need a doctor’s referral to see a physical therapist?

In Quebec, a doctor’s referral is not necessary to start physiotherapy. In fact, most of our clients who did physiotherapy in the past come directly to see us. As long as there are no open wounds, possibility of a fracture or damage to the major organs, it is generally safe to start physiotherapy before seeing a doctor.

Medical doctors are, however, great sources for prescription of medications to medically manage pain or inflammation and to overlook drug interactions if a client has multiple medical conditions. Better control of pain & inflammation can help physiotherapists focus more on the mechanical problems.

Furthermore, referral to an orthopedic surgeon may be necessary if the orthopedic condition is beyond repairable with just physiotherapy along. With the advances made in the medical field, there are now many surgeries that are a lot safer and have more success rates than in the past.

Under which circumstance would I need a doctor’s referral?

A doctor’s referral may be requested by some insurance companies to justify your need for physiotherapy sessions. It may be a good idea to call your insurance company ahead of time to see whether a medical note is required before the start of physiotherapy.

Furthermore, if you have fallen or if you suspect a possible fracture, it may be best to see your family doctor to get an x-ray. An x-ray can help rule out a fracture which has to be treated differently depending on severity.

When should I consult a physiotherapist?

Acute Injuries:

If you have just fallen or were a victim of a physical trauma, it is best to consult with a GP to rule out the possibility of a fracture or any damages to the major organs. Otherwise you can go see your physiotherapist after a few days to a week.

In the first few days after an acute injury  (i.e.: sprains, tendinitis, muscle strains, etc), there would be too much inflammation that there is not much your physiotherapist can do. Almost any mobilization or maneuvers might make it worst since the inflammation still has not settled down. It is best to apply ice if it is inflamed and let your body rest properly!

Chronic Injuries:

In general, chronic conditions do take longer to recuperate. The reason being, the body has a tendency to compensate for weaknesses in any articulation. An example would be people with knee pain who have a tendency to put more weight on their other leg and their body would most often shift towards to other side alleviate pressure on the painful knee. It would for sure decrease the pain at the knee, but this puts excess stress on the back and on the pelvis over time. The longer you wait, the more damage is dealt to the body with or without your awareness since your body becomes so accustomed to these deformations.

How should I prepare for my first physiotherapy session?

It would help if you plan ahead of time and get there earlier to fill out some patient information forms. You can take some notes about the pain itself and any questions you might want your physiotherapist to answer regarding your condition.

Physiotherapy sessions usually involves a lot of movement testing so it is best to wear loose and comfortable clothing where the affected areas can be exposed more easily. Tank tops are great for shoulder injuries, whereas shorts would be ideal for back and lower extremity injuries. Some therapists might even make you run on the treadmill to analyze the way you run, so bring a pair of running shoes if running or walking are activities that can reproduce your pain.

What to expect from my initial evaluation?

You initial evaluation should take approximately 60 minutes. Your physiotherapist should be able to complete your assessment, tell you what is the most likely the cause of your pain, educate you on how to avoid making it worst, go over some exercises with you, and establish the treatment plan he or she has in mind for you. Depending on how complex your case is, some therapists may start treating you on the first day.

Could I get better by just doing the exercises that my physiotherapist recommends?

Physiotherapy is in no way equivalent to just providing exercise programs. People with minor injuries might recover with just an exercise program, but most patients respond better with exercises combined with physical treatments. Physiotherapists are healthcare professionals with an in-depth knowledge of anatomy and are trained to facilitate movements by freeing up bones and soft tissues that are “stuck”. In reality, not all orthopedic conditions are treated the same way. With some form of back pain, exercising could actually make it worse just by moving the back in the wrong direction. The same can be said about most joints, what works for one person may not work for you.

Furthermore, people suffering from orthopedic conditions go through different phases of healing. A progression of difficulty is needed at each phase to ensure that structures that need work are being constantly  challenged. Generic exercise programs are simply not customized to everyone’s needs and do not necessarily address all physical limitations that are present.

How to tell if my physiotherapist is good or not?

You should not just choose a therapist just based on years of experience or a specific approach that a therapist employs. What I personally find most important is compatibility and your therapist’s ability to communicate his thoughts & findings. This is the only way to ensure that you are both on the same page and know exactly what is to be expected from both parties.

How many sessions do I need?

The human body is equivalent to a puzzle which requires patience and perseverance. The length of time required varies greatly if it is a 500 piece puzzle or 1000 piece puzzle. Physiotherapy is worth pursuing as long as you are seeing progress or if you and your therapist are working towards achieving pre-established objectives. Objectives or goals that are measureable could be measure of pain, range of motion, strength, and ability to take part in a physical activity just to name a few.

How frequently am I supposed to see my physiotherapist?

Most physiotherapists would want to see you on average two times a week in the beginning for moderate to severe conditions. Eventually the frequency would be reduced when clients are ready to manage their condition more on their own. Orthopedic conditions require more stimulation in the beginning and also frequent visits in the beginning would ensure that clients are monitored more closely. Also, your therapist would progress the force used during the treatment session to match your current condition and try to bring you past your barriers every time.

What if I have financial barriers?

I think it is important to be upfront with any financial barriers so your physiotherapist can work around it. You may speak with your therapist to see whether you may be provided with more exercises in the mid to later stages of the healing process.

The worst thing you can do is to book a treatment session and not show up, it is very disrespectful and your therapist is basically waiting for you when he or she can be seeing another client instead. Just be honest and see if there are any other alternatives such as less frequent visits or follow up by phone or email.

Is it normal to have pain from physiotherapy?

Yes and no. Physiotherapy is all about getting more mobility at different articulations or joints. If a therapist is only working in a pain-free zone, then he is not stressing on structures that are impeding normal range of motion. Not all techniques are designed to be painful, but do expect some pain as part of the healing process.

What is considered normal in terms of pain tolerance?

During the treatment, pain may be produced but it has to be tolerable at all times. Clients usually feel pain a day or two after a treatment session, possibly due to mobilizations or other maneuvers used. However, pain generally subsides after a while. Just like the market, pain can fluctuate quite a lot but just focus on the long run. (i.e.: if you feel pain two days after a session but on the third day, you gain 30% more range & pain actually goes back down, then the trend is positive)

Just have more faith in your healthcare provider and communicate your findings so he or she can make adjustments accordingly.  Proper communication is the key to fast rehabilitation! We are all unique individuals and our bodies respond differently. It may sometimes not be a bad thing to experience a little more pain after physiotherapy since it might provide us with a better idea of what is going on. Again, the body likes to play tricks on us all and it is by carefully examining the way it responds to the treatment that we can better understand what it is trying to tell us.

What if the problem cannot be resolved with physiotherapy?

As physiotherapists, we are trained to detect RED FLAGS (i.e.: lesions to central nervous system, spinal cord lesions, cauda equina lesions, tumors, etc). Red flags are basically signs that there might be something non-mechanical that might be the root cause of pain. By ruling out systemic causes, we can ensure that we are indeed working on mechanical problems that physiotherapists can resolve most times. Those who presents with RED FLAGS or are non-responders would be referred back to MD for further investigation or to other healthcare provider.

It is common for physiotherapists to refer clients for acupuncture, osteopathy, massage, pool therapy whenever appropriate. Different disciplines can target the same problem but at a different angle and sometimes tissues just need to be stimulated in another way.

What is the difference between physiotherapy, osteopathy, and chiropractor?

In my opinion, there is no clear boundaries concerning the way that these healthcare professional practice. Each discipline, in theory, follows a different set of belief system concerning how to rehabilitate the human body. However, most of these disciplines nowadays borrow from one another to complement areas that they are lacking in. Regardless of which approach you choose, what is important is that you are truly getting better functionally and or symptomatically.