Why Physical Therapy 2x/week Doesn’t Work
Why Physical Therapy Didn’t Help Your Knee Pain
Don’t get me wrong, physical therapy can work. There is a time and a place for physical therapy. For those of you who don’t know, I have a Doctorate in Physical Therapy. But, going to physical therapy 2x/week for 4weeks isn’t going to cut it for someone who has longstanding pain. Physical therapy is most beneficial soon after a new injury and/or surgery, and for longstanding neuromuscular conditions that lead to weakness. But, for someone who has chronic inflammation and chronic pain 2x/week for 4 weeks of physical therapy isn’t what you need. I’m going to lay out a few reasons why physical therapy isn’t working for you.
Not giving it enough time
Going to the wrong PT
Not enough time with your PT to ask questions and get adequate answers
Not doing the homework the rest of the week
The program isn’t progressed (or regressed) appropriately
Not addressing pain relief techniques that can be done at home
So let’s unpack this a little.
Let’s start off with the most important one to me.
The not giving PT enough time.
Most patients go to physical therapy for 2x/week for 4 weeks. This is all well and good for a new acute injury, but not for a chronic condition. Let’s say you sprain your ankle on Monday and you call your physical therapist and get in to see her on Tuesday that’s the right way to do things. But, for most people they don’t get in that quick. And most people go to a physical therapist because their physician has referred them there. And physician’s write referrals to PT as 2x/week for 4 weeks because that’s the timeframe before they see you again. Then it takes 2 weeks to get in to see the PT, you go for 2 weeks and follow up with your physician. You say it didn’t work and he/she says to stop going. But, really it’s only been 2 weeks and likely only 2-3 visits of physical therapy. Most people won’t see results in their pain until the 6 week mark and they won’t see strength changes until the 3 month mark and they won’t see flexibility changes until the 1 year mark. So 2x/week for 4 weeks isn’t going to help pretty much anyone.
Seeing the wrong physical therapist
Maybe you’re going to the wrong physical therapist and that’s why it’s not working for you. Did you know that physical therapists can specialize? Or they can be general and treat everything. If you have a muscle or joint problem and you go see a Neurological physical therapist, they have some idea of what’s going on. But the Neuro PT typically sees conditions like stroke, traumatic brain injury or Multiple Sclerosis. They aren’t going to be best equipped to treat the chronic pain you have from osteoarthritis.
Not enough time with your PT to ask questions
The traditional physical therapy clinic fails most people. Most PTs in the clinic have between 20-50 patients on their schedule in an 8-10 hour workday. That doesn’t leave a lot of time for answering questions. They may have a physical therapy tech guide you through exercises and hand you some weights, but your physical therapist likely behind a closed door evaluating another patient. It’s just how the traditional system works right now. You may be able to find a physical therapist that works 1:1 with patients but that still may not be enough time because what happens when you have a question at home, and you need to wait a whole week to ask about it.
Only doing the exercises and treatments 2x/week
When you go to physical therapy 2x/week for 4 weeks but you only do the exercises, stretches, pain relief techniques while you’re there it won’t work either. The changes that need to happen will need 3-4x/week or for some things (like the pain relief technique) it will need to be daily. So if you only ice your knee 2x/week after your PT sessions because they put the ice on your knee, it won’t help much for the rest of the week because it needs to be done daily. Or those exercises for strength and flexibility need to be done 3-4x/week to make changes.
The exercises are too hard or too easy
Maybe everything is going right but the exercises aren’t being changed appropriately. The exercises need to be progressed in order for strength changes and flexibility changes to be made. If an exercise is too hard and/or is causing pain it needs to be regressed and made easier. If you don’t have the professional guiding you through these changes then maybe you think the exercises need to be this easy, or maybe you think “well no pain, no gain” right? Wrong. The exercises don’t have to be easy peasy and they definitely don’t have to hurt. There just may not be enough time and resources in the traditional clinic to guide you the way you need.
Not addressing the things you can do on your own at home for pain
Finally, sometimes in the PT clinic the types of things that a patient can do at home on their own for pain relief aren’t addressed. For example, if someone has tight joints when they first wake in the morning maybe there wasn’t any time to talk about it during the session, or it wasn’t pressing enough to talk about. But just the idea of getting in a hot shower every morning first thing in the morning can help someone move around easier. Or maybe not addressing the fact that ice needs to be done for 20-30 minutes at a time to be effective and needs to be done as often as possible in the first week to make a dent in the pain and inflammation.
Sometimes physical therapy is great. But, someone gets the short end of the stick and that’s usually someone who has chronic pain or chronic inflammation.
So to recap: Physical therapy has a time and a place. Typically, physical therapy works great for a new, acute injury or a new surgery. The sooner you get into physical therapy the quicker a problem with a muscle, tendon, joint or ligament will be controlled. Most often physical therapy doesn’t work for someone because they only went 2x/week for 4 weeks. This is too short of a time period to notice a change, it typically takes 3 months for longstanding pain and inflammation to get under control. Physical therapy may not have worked for you because you went to the wrong type of physical therapist. Physical therapists can specialize and if you go to one for a condition they don’t typically see they may not tell you that and just try and help you anyway. Physical therapists often have 20-40 patients on their schedule so they don’t have much time with each individual patient so questions are left unanswered and exercises are left too easy or too hard. If you’re only doing the techniques and things at PT 2x/week it likely won’t help because most of the changes need to be small habitual changes that happen daily, like handling pain and inflammation that need daily attention. So if you were told to go to physical therapy for 2x/week for 4 weeks and felt like it didn’t work, or it wasn’t right for you. You may be right, but also, you may have hit a snag in the traditional model and still could benefit from the things they teach you in physical therapy.
If you’re looking for knee pain relief check out this free guide I created just for you
