Community Forums Recommend Your Physical Therapist / PT Discussion Physical Therapist FAQ for Spondyloarthritis

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      Physical Therapist FAQ for Spondyloarthritis

      • What training do PT’s have?
      o PT’s are highly trained movement experts who have a Master’s or Doctoral degree in physical therapy. Beginning in 2020, in the United States, all new PT’s must obtain a doctorate in physical therapy in order to practice. In graduate school, they receive comprehensive training in not only the musculoskeletal system (bones, muscles, joints, ligaments), but also in the neuromuscular (nerves, brain, spinal cord), cardiopulmonary (heart and lungs), and integumentary (skin) systems. They must pass a board exam in order to become licensed. PT’s are lifelong learners, the requirements vary state-to-state but attendance of continuing education courses throughout the year is common.

      • How can I find a PT?
      o The best way to find a PT is to ask your doctor whom they would recommend. Another great idea is to ask friends and family. Although everyone’s experience with PT is different, word-of-mouth is often quite helpful.
      o Since spondyloarthritis may not be a common diagnosis seen in most clinics, it may be helpful to call prior to scheduling and inquire. Ask if any therapists there have experience treating this condition. If not, ensure they are at least willing to do some research. All PT’s are highly trained medical professionals but the school they attended and experiences they have had can vary.

      • What issues related to spondyloarthritis can a PT help me with?
      o Migraine and tension headaches
      o Temporomandibular joint dysfunction (TMJ)
      o Spine related pain (neck, mid-back, low back, sacroiliac joint)
      o Sciatica
      o Costochondritis and/or rib pain
      o Poor posture
      o Peripheral joint pain (shoulders, hips, knees, ankles)
      o Enthesis (tendon-to-bone inflammation)
       Achilles tendonitis is one example
      o Plantar fasciitis
      o Cardiovascular deconditioning and fatigue
      o Imbalance

      • How to prepare for the visit?
      o The physical therapist will be asking you many questions about your pain and activities. It may be helpful to write down in a notebook answers to the questions below to make the conversation efficient.
       What is your pain like in the morning, afternoon, night?
       What activities make your pain worse? Better? (sitting, standing, walking, stairs, cleaning etc.)
       How would you describe your pain? (dull, ache, sharp, shooting, burning, numb)
       How has your pain impacted your life? (work, recreation etc.)
      o The above questions help your PT formulate a diagnosis, plan of care, and to make individualized goals
      o Tip: Wear loose and comfortable clothes such as a T-shirt and jogging pants

      • What to expect during the examination?
      o The PT will assess how well you move by asking you to replicate various movements of your spine and extremities. The PT may also assess your strength and measure the flexibility of various joints. You may be asked to do things like stand, walk, and roll from your back to your side, or side to your stomach.

      • Will it cause pain?
      o If you cringed at the thought of some of the above movements, you are not alone. Although the above description of potential movements is common during a session, it is not expected. Your PT should ask you throughout the session if you feel comfortable performing the movements. Don’t be afraid to speak up if something hurts or if you are not able to get into a position such as your stomach. However, it is common to feel some discomfort especially during the first visit. The PT is trying to determine how well you move and what movements create discomfort. This helps them to formulate a tailored plan of care. An open line of communication is key to therapy!

      • What do subsequent treatment session look like?
      o After the evaluation, your therapist will begin treatment. Everyone’s session will look slightly different so try not to compare what the PT is having you do with other patients in the clinic. Sessions may consist of passive and active treatments.
       Passive treatments are usually used early on or during a flare up. Passive treatment includes modalities such as: heat therapy, cold therapy, therapeutic massage, joint mobilizations, ultrasound therapy-a form of deep heat, and/or TENS-electrical stimulation for pain modulation.
       Active treatments help you to learn how to manage your pain independently. Active treatments include: stretching, strengthening and stability exercises, cardiovascular training, balance, and posture re-education.
      • What if PT is making me worse?
      o There are many reasons why this may be the case. In the beginning, this is actually quite common. Your body is not used to moving in new ways. Muscles that are weak are now being strengthened and this can cause muscle soreness. Sometimes you may also try to do too much too quickly or the PT see’s you are improving and progresses you too fast. Let your PT know that you are feeling worse, how long the increased pain lasts after session, and give them feedback on what you believe made it worse. The PT will modify your treatment. It can be difficult, but try to give PT sessions and your home program a good 3-4 weeks to work prior to giving up.
      o If you are in a flare PT can still be quite beneficial. Communicate to your PT when the pain you feel is a flare type pain. It isn’t a bad idea to remind them that this means your joints are inflamed and you need to take it easy. It is ok to direct your care at times. You and your PT are a team. They have the education but you know your body.

      • Will I have to do exercises at home?
      o PT’s should always give their patient’s some kind of homework. It is important to do what they instruct you in consistently, especially early on in your care. Exercise and treatments done in the clinic are good and useful, but performance of these things one to two times a week will not be adequate to make long-term changes. Similar with academic homework. If you don’t practice the new skills you are taught you will most likely not learn. The same concept goes for the human body!

      • What is the goal of PT?
      o A misconception about PT is that you will be discharged feeling 100%. Although we do want you to feel better than when you came in the first day, a more realistic goal is independence in self-management. There is no cure for spondyloarthritis, but a PT can equip you with the knowledge to take control of your pain and your care. The best gauge of when you are ready to be done with an episode of care is when you feel educated enough on the exercises and pain management techniques to continue on your own. For my patient’s, this typically occurs in 8-12 treatment sessions. From my experience, spreading these visits out by coming in only once a week and performing a home exercise plan the other days is most effective. This also helps overcome insurance limitations. Having a chronic, progressive condition requires lifelong adherence to mobility and strengthening exercise.

      • If PT is helping, why can’t I keep attending indefinitely?
      o Unfortunately, insurance often dictates our ability to see patients for what we in the PT world call “maintenance care”. This is why most PT clinics have to discharge you at some point, and why care cannot be ongoing. Many insurances also only cover a set number of sessions. PT’s often discharge you prior to using all of these up, especially early in the year, in the instance that you would injure yourself and need PT for a separate issue.

      • Should I go back to PT in the future?
      o Absolutely! Although you may be discharged after 3-4 months of PT this doesn’t mean you can’t return. Again, spondyloarthritis is chronic and requires vigilance. I like to think of PT like I think of the dentist. You wouldn’t go to the dentist once and then never return, right? Of course not! The same goes for visiting a PT. If you haven’t had an episode of PT care for over a year, your pain is worsening, your mobility is decreasing, or you just generally feel things are declining, it is time for another bout of PT.

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