Physical Therapy FAQ: Part Two

Editor's note: This is Part 2 of Katie's article. Please read Part 1 of Physical Therapy FAQs first!

Physical therapists (PTs) are highly trained movement specialists who have a breadth of knowledge. My hope is that after reading this you understand PT in a new light, and will possess a better understanding of it's benefits.

What do PT treatment sessions for ankylosing spondylitis look like?

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 may include: 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?

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 sees you are improving and progresses you too fast. Let your PT know that you are feeling worse, how long the increased pain lasts after the 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.

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 best.

Will I have to do exercises at home?

PTs should always give their patients some kind of homework. It is important to do what they instruct you consistently, especially early on in your care. Exercise and treatments done in the clinic are good and useful, but doing these things one to two times a week will not be adequate to make long-term changes. Similar to school 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?

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 AS, 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 patients, 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?

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?

Absolutely! Although you may be discharged after 3-4 months of PT this doesn’t mean you can’t return. Again, AS is chronic and requires vigilance. I like to think of PT as 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.