If your doctor has suggested seeing a physical therapist, you may wonder: What do physical therapists do? Or, if physical therapy is part of your hospital stay, what can physical therapists do in an inpatient setting?
Physical therapy, or PT, can look like many different things. Some PT is outpatient, taking place in gym-like facilities. There is also inpatient physical therapy, where PTs see patients at their bedside in the hospital or in dedicated rehabilitation units.
A strong focus on patient goals unites all physical therapy specialties, says Corey Nesser, PT, DPT, facility director and physical therapist at UPMC Rehabilitation Institute at the Rostraver Township outpatient rehabilitation location in Belle Vernon.
“If someone is injured and they can’t do what they want to do or need to do, I help them get back to what they want,” he says. Patient goals can range from running marathons again to being able to live independently.
A Pennsylvania policy allows patients direct access to PTs, so you don’t need a referral for an appointment. With this policy, you can see a PT for up to 30 days. If your treatment needs to be longer, you’ll need a referral to continue.
After the first visit, your PT will communicate with your primary care doctor to update your records.
How Can a Physical Therapist Help You?
People go to physical therapy for many reasons.
Nesser sees many patients with tears in the tissues of the rotator cuff in their shoulder or ACL in the knee. He also treats patients healing from broken bones or joint replacement surgery. Some people come to PT after strokes, concussions, childbirth injuries, heart attacks, cancer treatment, and other illnesses.
Patients also use physical therapy to help with low back pain or other joint pain. Our physical therapists offer both hands-on techniques and exercises to help strengthen surrounding muscles.
For example, in Pa., PTs can perform joint mobilization, including grade 5 thrust mobilization. This technique involves quickly moving a joint or part of the spine to relieve pain. “If a joint feels ‘stuck,’ this helps us ‘unstick’ it,” Nesser says. “We are trained to provide that level of expertise.”
Some of Nesser’s patients think of physical therapy as preventive — it helps them stay strong.
“I have a patient who is a sprinter, and he’s in his 70s. He wants to keep running and wants a ‘tune up.’ So, I help him be able to do what he wants to do,” Nesser says.
What Can I Expect From Physical Therapy?
A huge part of Nesser’s job is listening to people who come to see him. “When you listen and let the patient talk, most of the time, they will tell you what’s wrong with them,” he says.
He will ask questions and review any notes that came with their referral (if they had one). But what the patient says about their experience and goals supersedes anything written about them on a chart, he says.
From there, he evaluates a patient’s range of motion, pain, and willingness to move certain joints. “For each joint, there are special tests we perform that are for specific injuries,” he says.
With the patient’s goals in mind, the next step is to develop a plan. The plan usually includes a series of functional movements and exercises, starting easy and building in difficulty. It can also involve mobilization techniques or newer treatments like blood flow restriction.
“We have blood flow restriction technology at most of our outpatient offices,” Nesser says. “It’s a cuff that goes on your arm or leg and it occludes, or restricts, blood flow to that arm or leg.” Working out while wearing the cuff can help speed recovery.
“We’re on the front lines of all these proven rehab tools,” Nesser says.
What Are Physical Therapy Specialties?
Nesser’s focus on orthopaedic conditions, injury rehab, and sports performance in an outpatient setting is only one type of physical therapy. There are so many types of PT, including:
- Physical therapy for concussions, including exertion therapy (a guided return to working out after a concussion).
- Vestibular therapists can help with vestibular issues like balance and dizziness.
- Neurorehabilitation physical therapy focuses on people who have had a stroke or other neurological conditions.
- Oncology rehab is physical therapy for people after cancer treatment. These PTs would also provide therapy for lymphedema.
- Physical therapy can improve pelvic floor issues or other problems related to childbirth, menopause, or aging bones.
- Inpatient rehabilitation in a hospital setting can be helpful after serious injuries or acute illnesses.
You may also see at PT after a lengthy hospital stay, or when a condition is affecting your ability to move or is negatively affecting your quality of life.
What Does a Typical Physical Therapy Session Like?
Most of Nesser’s sessions are about 45 minutes to an hour — enough time for rest between activities and conversation. “People improve through having a sense of community,” he says, so he keeps that in mind when designing sessions.
“You’ll come in, do a few stretches to warm up, and then we start doing things that are more muscle-specific.” People may start sitting on the table, but he’ll try to get them on their feet, if possible. “I like to get people out into the gym doing more functional stuff,” he says.
Depending on the patient’s needs, he usually ends the session with heat or ice. “I like to give them a moment to just sit there, process the session, and ask questions.” Then he gives them a home exercise program to follow until the next session.
He usually sees patients for about 4-6 weeks. “That’s how long it takes for lasting strength to build,” he says. Some patients he may only see a few times; others he sees for much longer.
The best marker for when therapy is over is whether the patient has met their goals. “If I never see you again, it’s a great thing!” he jokes.
Learn more about how to prepare for a physical therapy session.
What Progress Can I Make in Physical Therapy?
Physical therapy can help patients experiencing a wide range of conditions, challenges, or injuries.
For example, a patient may start physical therapy a week after knee replacement surgery in pain. In the beginning, their leg may be swollen, in pain, and unable to bend or straighten all the way, according to Nesser.
“I tell them, ‘I’ve seen these before and I’m not going to you let you fail.'” And within a few weeks, Nesser says, they are typically starting to move and build strength.
Physical therapy can also help patients recovering from COVID-19, after being on ventilators and getting discharged from long hospital stays.
“I worked with a woman who almost died from COVID-19,” he says. “She had to learn how to get out of a chair and couldn’t even walk when she started. But by the time we finished her PT, she was doing 20 minutes on the treadmill.”
“Watching the progress people make is the best part of my job,” Nesser says.
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