Frequently Asked Questions (FAQs)

During your first visit you can expect the following:

• Arrive at your appointment 15 minutes early with your paperwork completed (you can download it from our website - see the paperwork or forms link). Allow additional time if you need to fill out your paperwork at the clinic.
• Please bring with you your insurance card, photo ID and any paperwork from your referring provider including referrals, X-Ray, CT or MRI reports.
• You will be seen for the initial evaluation by one of our physical therapists.

• The therapist will discuss the following:
  1. Your medical history.
  2. Your current problems/complaints.
  3. Pain intensity, what aggravates and eases the problem.
  4. How this is impacting your daily activities or your functional limitations.
  5. Your goals with physical therapy.
  6. Medications, tests, and procedures related to your health.
• The therapist will then perform the objective evaluation which may include some of the following:
  1. Palpation - touching around the area of the pain/problem. This is done to check for the presence of tenderness, swelling, soft tissue integrity, tissue temperature, inflammation, etc.
  2. Range of Motion (ROM) - the therapist will move the joint(s) to check for the quality of movement and any restrictions.
  3. Muscle Testing - the therapist may check for strength and the quality of the muscle contraction. Pain and weakness may be noted. Often the muscle strength is graded. This is also part of a neurological screening.
  4. Neurological Screening - the therapist may check to see how the nerves are communicating with the muscles, sensing touch, pain, vibration, or temperature. Reflexes may be assessed as well.
  5. Special Tests - the therapist may perform special tests to confirm/rule out the presence of additional problems.
  6. Posture Assessment - the positions of joints relative to ideal and each other may be assessed.

The therapist will then formulate a list of problems you are having, and how to treat those problems. A plan is subsequently developed with your input. This includes how many times you should see the therapist per week, how many weeks you will need therapy, home programs, patient education, short-term/long-term goals, and what is expected after discharge from therapy. This plan is created with input from you, your therapist, and your referring provider.

After the evaluation and the formulation of the plan, your therapist will start basic treatment and set you up with helpful things you can start at home.

Expect to be at the clinic between 60 and 90 minutes for the first visit (including check in).

1. Make sure you bring your physical therapy referral (provided to you by your referring provider).
2. Payment information.
   • If your insurance is covering the cost of physical therapy, bring your insurance card.
   • If you are covered by Workers' Compensation, bring your claim number and your case manager's contact information.
   • If you are covered by auto insurance or an attorney lien, make sure you bring this information.
3. Make sure to bring in any X-ray, MRI or CT scan reports, or any lab reports consistent with your problem. Also please bring a list of any medications you take.
4. Please bring a photo ID as Federal law requires us to check it.
5. Loose fitting clothing (see next section "How should I dress?").
6. If you have foot or ankle problems or a running injury: please bring in your everyday shoes and your running shoes for us to evaluate.
7. Any braces that you are using.

You should wear loose fitting clothing so you can expose the area that we will be evaluating and treating. For example, if you have a knee problem, it is best to wear shorts. For a shoulder problem, a tank top is a good choice, and for low back problems, wear a loose fitting shirt and pants, again so we can perform a thorough examination. If needed, you can bring the clothes with you as we have plenty of private room to change. We also have gowns and shorts that you may use at the clinic.

Evaluations generally last 60 minutes. Treatment sessions typically last 30 to 60 minutes per visit.

This is highly variable. You may need one visit or you may need months of care. It depends on your diagnosis, the severity of your impairments, your past medical history, etc. Your therapist will generally review the plan of care, including number of treatments at your first visit. Occasionally the number of treatments are limited by insurances. If this happens your therapist will work with you to come up with solutions so you get the treatment that you need. You will be re-evaluated periodically and as needed. We will update you on any changes in your therapy plan and send progress notes to the referring provider when you go back to see them and generally every 30 days.

Ever been to a spa? Remember how good you felt when you left there? Well there is no reason why you can't achieve that same feeling with therapy. Howell Physical Therapy is the only area clinic that has created a spa-like environment and chooses treatment techniques to help you relax, de-stress and focus on your health. Why do we do this? Simply because this kind of environment can speed your recovery and response to treatment!

You have probably heard of the profession of physical therapy. Maybe you have had a conversation with a friend about how physical therapy helped get rid of his or her back pain, or you might know someone who needed physical therapy after an injury. You might even have been treated by a physical therapist yourself. But have you ever wondered about physical therapists--who they are and what they do? Many people are familiar with physical therapists' work helping patients with orthopaedic problems, such as low back pain or knee surgeries, to reduce pain and regain function. Others may be aware of the treatment that physical therapists provide to assist patients recovering from a stroke (e.g., assisting them with recovering use of their limbs and walking again).

The ability to maintain an upright posture and to move your arms and legs to perform all sorts of tasks and activities is an important component of your health. Most of us can learn to live with the various medical conditions that we may develop, but only if we are able to continue at our jobs, take care of our families, and enjoy important occasions with family and friends. All of these activities require the ability to move without difficulty or pain.

Because physical therapists are experts in movement and function, they do not confine their talents to treating people who are ill. A large part of a physical therapist's program is directed at preventing injury, loss of movement, and even surgery. Physical therapists work as consultants in industrial settings to improve the design of the workplace and reduce the risk of workers overusing certain muscles or developing low back pain. They also provide services to athletes at all levels to screen for potential problems and institute preventive exercise programs. With the boom in the golf and fitness industries, a number of physical therapists are engaged in consulting with recreational golfers and fitness clubs to develop workouts that are safe and effective, especially for people who already know that they have a problem with their joints or their backs.

The cornerstones of physical therapy treatment are therapeutic exercise and functional training. In addition to "hands-on" care, physical therapists also educate patients to take care of themselves and to perform certain exercises on their own. Depending on the particular needs of a patient, physical therapists may also "mobilize" a joint (that is, perform certain types of movements at the end of your range of motion) or massage a muscle to promote proper movement and function. Physical therapists also use methods such as ultrasound (which uses high frequency waves to produce heat), hot packs, and ice. Although other kinds of practitioners will offer some of these treatments as "physical therapy," it's important for you to know that physical therapy can only be provided by qualified physical therapists or by physical therapist assistants, who must complete a 2-year education program and who work only under the direction and supervision of physical therapists.

Most forms of physical therapy treatment are covered by your insurance, but the coverage will vary with each plan. Most states do not legally require patients to see their physicians before seeing a physical therapist. Most of the time all you have to do is ask your doctor if physical therapy is right for you.

Reference: APTA

You and others may be referred to physical therapy because of a movement dysfunction associated with pain. Your difficulty with moving part(s) of your body (like bending at the low back or difficulty sleeping on your shoulder, etc.) very likely results in limitations with your daily activities (e.g., difficulty getting out of a chair, an inability to play sports, or trouble with walking, etc.). Physical therapists treat these movement dysfunctions and their associated pains and restore your body's ability to move in a normal manner.

Who is better to see, a PT that works for a physician or a PT that owns a private practice? We leave it up to you to draw your own conclusions but here are some facts. The studies indicate there were more treatments (visits per patient were 39% to 45% higher in physician owned clinics) and the cost was greater for those patients that attended a physician owned physical therapy practice (both gross and net revenue per patient were 30% to 40% higher)¹.

Another study indicated that licensed and non-licensed therapy providers spent less time with each patient in physician owned clinics and physical therapy assistants were substituted for physical therapists.²

Another older study concluded that "Therapists who had treated patients through direct access were significantly more likely to believe that direct access had benefited them professionally and benefited their patients than were therapists who had not practiced through direct access."³

We believe that we can provide you with the highest quality of care available and do it in a cost-effective manner.⁴ You will work closely with your physical therapist and in most instances, your case will be managed by the same physical therapist from the beginning to the end of your experience with us.

1. Mitchell, J., Scott, E., Physician Ownership of Physical Therapy Services: Effects on Charges, Utilization, Profits, and Service Characteristics, Journal of the American Medical Association, 1992.
2. "Joint Ventures Among Health Care Providers in Florida," State of Florida Health Care Cost Containment Board, 1991.
3. Domholdt E, Durchholz AG. Direct access use by experienced therapists in states with direct access. Phys Ther. 1992 Aug;72(8):569-74.
4. Federal Office of the Inspector General May 1, 2006 - This report calls into question billing processes done by non-physical therapist owned practices.

More than half of all Americans are suffering from pain. Whether it is a recent episode or chronic, an ABC News/Stanford study revealed that pain in America is a serious problem. However, many do not even know that physical therapists are well equipped to not only treat pain but also its source.

Physical therapists are experts at treating movement and neuro-musculoskeletal disorders. Pain often accompanies a movement disorder, and physical therapists can help correct the disorder and relieve the pain.

In most cases, health insurance will cover your treatment. Click on our insurance link for a summary of insurances we accept and make sure you talk to our office manager so we can help you clarify your insurance coverage.

You will be evaluated by one of our licensed and highly trained physical therapists and he/she will also treat you during subsequent visits. Unlike some clinics, where you see someone different each visit, we feel it is very important to develop a one-on-one relationship with you to maintain continuity of care. Since only one physical therapist knows your problems best, he/she is the one that will be working closely with you to speed your recovery.

One of the main things that makes Howell Physical Therapy unique is that we will do our best to limit the pain that may occur as part of treatment. Physical Therapy does not have to hurt to be effective and anyone that has told you this is misinformed. In certain circumstances and with certain treatments, there will be some amount of pain necessary to achieve a treatment goal. What we do differently is add other treatments to limit the effect of the pain. For instance, we may use guided imagery to use brain techniques to help you limit pain. In other cases, we may use modalities to disrupt pain.

For many patients, one of the primary objectives is pain relief. This is frequently accomplished with hands-on techniques, modalities such as ultrasound, electrical stimulation, and/or heat or cold therapy. Movement often provides pain relief as well. Your physical therapist will provide you with the appropriate exercises not only for pain relief but to recover range of motion, strength, and endurance.

Your physical therapist will utilize a variety of techniques to help maximize your treatment goals. It is important that you communicate the intensity, frequency, and duration of pain to your therapist. Without this information, it is difficult for the therapist to adjust your treatment plan.

There are dozens of different types of treatment interventions. Here is a list of treatment interventions:

Active Range of Motion (AROM) - the patient lifts or moves a body part through range of motion against gravity. AROM is usually one of the first modalities prescribed for arthritis.

Active Assistive Range of Motion (AAROM) - therapist-assisted active range of motion. This is usually prescribed for gentle stretching or strengthening for a very weak body part.

Passive Range of Motion (PROM) - the patient or therapist moves the body part through a range of motion without the use of the muscles that "actively" move the joint(s).

Aerobic Training:Stationary Bicycle/Nordic Track/Treadmill/Elliptical - with or without resistance.These are usually chosen to work on cardiovascular/aerobic endurance but may also be used for strengthening and range of motion.

Gait or Walking Training - the analysis of walking problems by visually examining the interaction of the low back and the joints of the thighs, legs, and feet during the various stages of walking, including initial contact, loading response, mid stance, terminal stance, pre swing, mid swing, and terminal swing. Many back, thigh, leg, ankle, and foot problems may be caused by or manifest themselves in subtle gait abnormalities. This may also involve the evaluation of and practice with "assistive devices" including crutches, walkers and canes. We may also evaluate the mechanics or running/jogging if that is a source of problem.

Foot Orthotics - we can evaluate and fit you from start to finish for custom foot orthotics. We charge 1/3 the price of most custom orthotics for one of the best products out there, Sole Supports.