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Brett Sears

How Long Should You Attend Physical Therapy?

By June 11, 2012

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I evaluated a patient this afternoon who was dealing with low back pain and sciatica. He states he had pain in his leg for quite some time, and it got significantly worse about 6 months ago. His doctor at the time sent him to physical therapy with a diagnosis of hip bursitis, and the patient reports he did a lot of stretching in physical therapy with no significant relief.

The patient finally saw an orthopedic surgeon, and surgery was performed on his low back to relieve pressure on his sciatic nerve from a herniated disc. My patient reported initial relief from the surgery, but he continues with leg pain and abnormal sensation, so his doctor referred him to physical therapy once again to manage the post operative recovery.

While talking with my patient, I asked him how long he spent in physical therapy. He told me he went to 20 sessions of physical therapy. I was surprised. My patient told me that the physical therapy never made him feel better, and in fact occasionally he left feeling worse.

I asked him why he went for 20 sessions if he was getting no relief. He replied that he went until his insurance company wouldn't pay any longer, and then he was discharged.

Now why would anyone continue with a treatment that wasn't too successful until insurance wouldn't pay? A more important question: Why would a physical therapist treat a patient unsuccessfully for 20 sessions and then discontinue therapy once insurance ran out? Shouldn't your physical therapist be making clinical decisions?

Look, I know that all physical therapists (and other healthcare professionals) practice within strict confines of insurance regulations, and sometimes these regulations seem unfair. But to have a patient contnue on a course of treatment that offered no relief and very little progress seems a bit unfair...to the insurance company.

I know that every condition is different, and that everyone heals at different rates. In my opinion, if you are not making progress in a reasonable amount of time, your physical therapist should refer you on to a more appropriate treatment. If you are progressing and making gains in range of motion, strength and function, surely continue along. If not, ask your physical therapist if you should be continuing in PT. A good physical therapist knows what he or she can treat. A great physical therapist knows his or her limitations.

So how long should physical therapy take? Should you stop PT just because your insurance company won't pay? Let me know what your personal experience has been.

Comments
June 19, 2012 at 4:15 pm
(1) I highly recommend them says:

Thanks for sharing such a good opinion, paragraph is
nice, thats why i have read it fully

May 2, 2013 at 8:05 pm
(2) Robert says:

If a persons in constant discomfort; like I am, Therapy continues as long as possible and affordable, believing the day will come when the pain is gone!

May 14, 2014 at 2:06 pm
(3) Sally says:

I have always had insurance that limited me to 10 physical therapy sessions, which most doctors consider to be just getting started. Unfortunately, this has resulted in things not healing as well or as quickly as they should, ultimately forcing me to return a year later for more therapy. I am currently rehabbing a rotator cuff and reached my 10 visit limit and have been fighting ever since for continued therapy because both the doctor and the therapist feel that I need a lot more. This results in regular fights and appeals with the insurance company that should not have to be waged. Having a health care system set up where insurance actuaries are given full power to make health care decisions for patients and taking that entirely out of the hands of providers is dangerous and stupid and does NOTHING to improve outcomes. We should fight harder to kick insurance companies to the curb and enact single payer or universal health care like every other industrialized nation on earth.

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