FAQs – Physical Therapy

San Francisco Sport and Spine Physical Therapy - orthopedics, low back pain, sports injuries & pain management

Q?

Can I go directly to my physical therapist?

A.

YES! As of January 1, 2014 you have direct access to your California physical therapist.
We are happy to see you for your musculoskeletal issues.

When you call we will check your insurance carrier's requirements for a referral, if any and let you know. And, if you are not making significant improvement within the first few visits, we will refer you to/back to your physician.

Q?

How do I choose a physical therapy clinic?

A.

These are some things you may consider when deciding on a physical therapy clinic. Make sure to ask any and all of these when scheduling:

  • Who will you work with and who provides treatment? We have only licensed physical therapists and do not use aides, assistants or trainers to assess or provide treatment.
  • Can you speak the therapist before the first visit? Call us. We're happy to have a PT speak with you.
  • What happens during the first visit? It should include a thorough medical history and physical examination before any treatment is rendered.
  • What will you work on? Your goals should be prioritized and addressed.
  • What treatment will be rendered? Treatment should include a variety of techniques which include exercise, education, hands-on techniques (i.e. joint mobilization), soft tissue work, stretching and body mechanics. In some cases heat, cold, electrical stimulation or ultrasound may be indicated, but should not be the primary treatment.
  • Is the clinic conveniently located? Since sitting and driving often aggravate orthopedic problems, there should be a very good reason for you to drive a long distance.
  • Is the physical therapist licensed? You can verify a California license here: http://ptbc.ca.gov/.

Q?

Who will see me?

A.

You will be evaluated by one of our licensed and highly trained physical therapists and 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, and optimal recovery.

If you should want to change physical therapists or locations for any reason, we will gladly accommodate you, and the therapists will review your case together to make as smooth a transition as possible. 

Q?

Is my therapist licensed?

A.

Physical therapists (PTs) and physical therapist assistants (PTAs) are licensed by the State of California. You can verify a license here: http://ptbc.ca.gov/.

Q?

What happens during my first visit?

A.

During your first visit you can expect the following:

  • Arrive at your appointment with your paperwork completed, or complete it upon arrival
  • Please bring any information from your physician if you have already seen her/him, such as a referral for physical therapy, any radiologic studies, any reports, i.e. x-ray, MRI, operative, etc. The more information we have, the better.
  • We will copy your insurance card.
  • You will be introduced to and evaluated by your new physical therapist.

The therapist will conduct a "subjective" exam and discuss the following:

  1. Your Goals.
  2. Your medical history.
  3. Your current problems/complaints.
  4. Pain intensity, what aggravates and eases the problem.
  5. How this is impacting your daily activities or your functional limitations.
  6. Medications, tests, and procedures related to your health.

Your physical therapist will then perform an "objective" exam which may include some of the following:

  • 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.
  • Range of Motion (ROM) - the therapist will move the joint(s) to check for the quality of movement and any restrictions.
  • 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.
  • 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.
  • Special Tests - the therapist may perform special tests to confirm/rule out the presence of additional problems.
  • Posture Assessment - the positions of joints relative to ideal and each other may be assessed.

 She will then come to an overall "assessment" of your condition and share that with you. 

She will suggest a "plan" of care that she judges optimal for your recovery. Together, you will discuss the assessment and proposed plan and make any adjustments or changes necessary for you and your individual circumstances.

You may have noted that the quoted items above combine to form S.O.A.P. This is a standard medical format to assist in clinical decision making is usually referred to as a SOAP format or SOAP note. 

Q?

What do I need to bring with me?

A.

That depends on what your goals are.

If your goal is to return to running, please bring your running shoes and clothing that will allow your physical therapist to see and palpate your legs. If your neck or shoulder is the issue, then a tank top or sports bra that you feel comfortable wearing in front of your physical therapist will help them. If you have long hair, you may want to bring a hair tie or clip.

You know your body and what we will likely be looking at, so please bring what you think is relevant for your first visit. And if in doubt, just call us and ask. It may sound crazy at first, but if cycling is your goal, you may want to bring your bike. This is a good one to call us about, as it may be better to bring something like that on your second or succeeding visits.

But do make sure you bring your physical therapy referral, if you have one (provided to you by your doctor) and your insurance carrier/payer information. If your insurance is covering the cost of physical therapy, please 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 any other payer, please make sure you bring this information.

Q?

How should I dress?

A.

Please wear comfortable 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 or bring shorts. For a shoulder problem, a tank top or sports bra is a good choice, and for low back problems, wear a loose fitting shirt and pants, again so we can get to the area and perform a thorough examination. If you're not sure, please call us and ask.

Please also refer to the "What should I bring with me" question above.

Q?

How does the billing process work?

A.

Billing for physical therapy services is similar to what happens at your doctor's office. When you are seen for treatment, the following occurs:

The physical therapist completes charges based on what you did together in your treatment session. We will submit bills to your insurance company, Medicare or Workers' Comp for you.  

The charges are based on Common Procedure Terminology (CPT) codes, standard codes that all medical providers use to describe their services. 

The insurance carrier or payer processes the bills and makes payments according to their fee schedule.

You will receive an Explanation of Benefits (EOB) from your insurance company or Medicare. Any payment may be sent directly to you or to us. If payment is sent to you, then we will request that you pay us, unless your balance has already been paid. If there is a balance due, we will send you a statement.  

It is important to understand that there are many small steps (beyond the outline provided above) within the process. Exceptions to the above example are common  as well. At any time along the way, information may be missing, miscommunicated, or misunderstood. This can delay the payment process. While it is common for the payment process to be completed in 60 days or less, it is not uncommon for the physical therapy clinic to receive payment as long as six months after the treatment date.

Q?

Can my therapist provide me with a diagnosis?

A.

In California, a physician may make a medical diagnosis. Your physical therapist will perform an assessment and inform you of their findings, and provide a physical therapy diagnosis. 

Q?

Can I go to any physical therapy clinic?

A.

Yes! Unless you are being directed by a Workers Compensation adjuster, it is your right to choose your provider.

This does not mean that your insurance carrier will necessarily pay. And that is why we check benefits for every patient prior to their first visit. This way we limit any unpleasant surprises for all of us!

If there is any doubt, give us a call and we will do our best to answer all of your questions.

Q?

Will I get a massage at physical therapy?

A.

While we don't generally refer to what we do as massage, similar techniques may be part of your treatment. Deep tissue techniques and joint mobilizations may be integrated into your treatment with the aim of getting you back to full function and achievement of your goals. Massage and deep tissue techniques are used primarily for three reasons - to facilitate venous return from a swollen area, to relax a tight muscle, or to relieve pain. Contrary to common thought, massage does not increase circulation.

Q?

How long will each treatment last?

A.

Your first visit will most often last one hour. With paperwork, parking, changing, etc. please allow 75-90 minutes for your first visit and arrive a few minutes early. We run on time or as close to it as possible.  

Successive treatment sessions typically last 45 minutes per visit. You and your physical therapist may decide another amount of time, like 30 or 60 minutes is optimal for you and your plan of care, and may make those decisions together. 

Q?

What types of treatment will I receive?

A.

There are dozens of different types of treatment interventions. Listed below are a few:

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.

Stationary Bicycle - with or without resistance. This is usually prescribed for improving the strength and/or range of motion of the back or lower extremities as well as cardiovascular endurance.

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.

Isometrics - muscle contraction without joint movement. This is usually prescribed for strengthening without stressing or damaging the joint (e.g., arthritis, or exercises to be performed in a cast, or right after surgery if recommended by the therapist/doctor).

Isotonics - muscle(s) contracting through the ROM with resistance. This is usually prescribed for strengthening.

Soft Tissue Mobilization - therapeutic massage of body tissue performed with the hands. Soft tissue mobilization may be used for muscle relaxation, to decrease swelling, to decrease scar tissue adhesions, and for pain relief.

Mobilization - hands-on therapeutic procedures intended to increase soft tissue or joint mobility. Mobilization is usually prescribed to increase mobility, delaying progressive stiffness, and to relieve pain. There are many types of mobilization techniques including Maitland, Kaltenborn, Isometric Mobilizations, etc.

Proprioceptive Neuromuscular Facilitation (PNF) - a system of manually resisted exercises performed in diagonal patterns that mimic functional movements. PNF was initially used in developmentally and neurologically impaired patients but now is used in almost every aspect of neuromuscular retraining from athletes in sports facilities to the very weak in hospitals and nursing homes.

Posture Training - instruction in the correct biomechanical alignment of the body to reduce undue strain on muscles, joints, ligaments, discs, and other soft tissues. There is an ideal posture, but most people do not have ideal posture. Therapists educate patients about the importance of improving posture with daily activities. Stretching and strengthening exercises may be prescribed to facilitate postural improvement and to prevent further disability and future recurrences of problems.

Progressive Resistive Exercises (PRE) - exercises that gradually increase in resistance (weights) and in repetitions. PRE is usually prescribed for reeducation of muscles and strengthening. Weights, rubber bands, and body weight can be used as resistance.

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).

Stretching/Flexibility Exercise - exercise designed to lengthen muscle(s) or soft tissue. Stretching exercises are usually prescribed to improve the flexibility of muscles that have tightened due to disuse or in compensation to pain, spasm or immobilization.

Cryotherapy or Cold Therapy - used to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but also an effective pain reliever for even the most chronic pain.

Neuromuscular Electrical Stimulation (NMES) - the application of electrical stimulation to aid in improving strength (e.g., the quadriceps muscle after knee surgery or injury). NMES is also used to decrease pain and swelling and to relieve muscle spasm.

Neck Traction - a gentle longitudinal/axial pull on the neck, either manual or mechanical, intermittent or continuous for relief of neck pain, to decrease muscle spasm and facilitate unloading of the spine.

Iontophoresis - medications are propelled through the skin by an electrical charge. This modality works on the physical concept that like charges repel each other, therefore, a positively charged medication will be repelled through the skin to the underlying tissues by the positively charged pad of an iontophoresis machine. Iontophoresis is usually prescribed for injuries such as shoulder or elbow bursitis.

Pelvic Traction - the longitudinal/axial pull on the lumbar spine, either manual or mechanical, intermittent or continuous. Pelvic traction may be helpful for the relief of low back pain and muscle spasm.

Ultrasound - ultrasound uses a high frequency sound wave emitted from the sound head when electricity is passed through a quartz crystal. The sound waves cause the vibration of water molecules deep within tissue causing a heating effect. When the sound waves are pulsed, they cause a vibration of the tissue rather than heating. The stream of sound waves helps with nutrition exchange at the cellular level and healing. Studies have shown that ultrasound is helpful for ligament healing and clinically, for carpal tunnel syndrome, and muscle spasm.

Q?

How many visits will I need?

A.

This is highly variable and really depends on your goals and current condition. It is important to take into account that normal tissue healing time is around 6-8 weeks and training effects (physiological change in response to strengthening or stretching exercises) are also 6-8 weeks. These may overlap. You may also want and need a bigger response, depending, again, on your goals. All of these factors must be taken into consideration, and that's why there isn't a good one-size-fits-all answer. 

For some simple and straightforward conditions you may only need to work with your physical therapist for 3-4 visits. We generally like to follow up and advance or correct mechanics and exercises after the first visit, so it is rare to see a physical therapist only once. 

If your condition is more complicated, chronic or you have particularly enthusiastic or ambitious goals, then you may expect that your plan of care will take longer. This does not necessarily mean the frequency of visits will remain the same. Your visits may become more spaced out as you become more independent, stronger and are working less on movement and more on strength and endurance. 

You and your physical therapist will discuss your individualized plan of care near the end of your first visit. Depending on your goals and injury or issue, your plan of care could look something like this: 2 times per week for the first 2 weeks, once per week for 4 weeks, and once every other week for 4 more weeks (or 2 visits over 4 weeks). This, including the initial visit and evaluation would total 11 visits. 

Make sure to discuss your plan with your physical therapist and any adjustments or modifications you require or want. 

Q?

Are there physical therapy specialists?

A.

There are! Many physical therapists specialize in a specific clinical area. At san francisco sport and spine physical therapy, we specialize in musculoskeletal conditions from the jaw to the big toe. This often includes a combination of orthopedic and manual physical therapy. We also work with many athletes, as well as older adults. 

Orthopedic Physical Therapy - Probably the most common physical therapy specialist is the orthopedic specialist. These specialists care for post-surgical patients, arthritis, tendinitis/tendinosus, fracture rehabilitation, muscle sprains and strains, neck and back pain, hip and knee problems, shoulder, elbow, and wrist conditions. Some are board certified as Orthopedic Certified Specialists (OCS).

Manual Therapy - Manual therapy is a broad term that describes a variety of hands-on treatment techniques that are applied to movement dysfunctions. Grade five mobilizations, Mulligan mobilizations with movement, Maitland and Kaltenborn techniques, functional technique, neural mobilization, joint mobilization, craniosacral therapy, strain/counter strain, myofascial release, etc. These are some of the more popular manual therapy techniques. Many manual therapists will take continuing education courses, obtain certifications in manual therapy, and will sit for board certification from the American Physical Therapy Association and other organizations. Most physical therapists incorporate manual therapy techniques as a part of a complete treatment plan.

Geriatric Physical Therapy - Some therapists specialize in the rehabilitation of seniors. As the body ages, a variety of challenges arise. We stiffen, we lose strength, our balance skills decline, our bones become brittle (osteoporosis), our endurance decreases, and we take longer to recover from injuries. Balance and fall prevention are of paramount importance to the therapist who is working with seniors and some clinics are solely dedicated to caring for those with balance problems. Most physical therapists work with seniors/geriatric patients. Some have obtained additional education, have passed a board examination, and have earned the Geriatric Certified Specialist (GCS) title.

Sports Rehabilitation - Experts in assisting with recovery after injury and surgery. Many sports specialists help with retraining the athlete utilizing running, throwing, jumping, and sport-specific programs to name a few. A therapist with the Sports Certified Specialist (SCS) title has passed a board certified test.

Fitness and Wellness - Physical therapists are well trained to help with your fitness needs and wellness programs. If you need an exercise program, have trouble with your weight, are concerned about osteoporosis, have an issue with diabetes, or you would like to learn how to prevent falls, physical therapists can help. The previous examples are just a few of the many programs physical therapists offer.

Hand Therapy - Most physical therapists are well trained to treat hand and wrist conditions. Some therapists have taken additional courses and training and have passed a hand therapy certification examination. These therapists are called Certified Hand Therapists (CHTs).

Women's Health - Some therapists specialize in women's issues such as pregnancy problems, pelvic pain, and incontinence. Special treatment is available for women who have these problems. Many that suffer from incontinence do so needlessly. A physical therapist may be able to help.

Industrial Rehabilitation - Specialists in industrial rehabilitation help with those that have suffered on-the-job injuries. Moreover, they will evaluate work tasks, fabricate assistive devices, evaluate your ergonomic situation, and help redesign work flow/tasks to decrease the incidence of injury. Often, industrial rehabilitation specialists will evaluate your ability to perform certain job tasks with a Functional Capacity Evaluation (FCE).

Pediatric Physical Therapy - Pediatric therapists specialize in the rehabilitation of children. They may assist with kids who suffer from cerebral palsy, developmental disorders, neurological disorders, and/or orthopedic problems. A Pediatric Certified Specialist (PCS) is a board certification that some may obtain from the American Physical Therapy Association.

Aquatic Physical Therapy - Aquatic therapy takes advantage of the physical properties of water to assist with the rehabilitative process. Buoyancy, turbulence, hydrostatic pressure, and thermal properties of water can assist with the rehabilitation of a patient. Those suffering from chronic pain, osteoarthritis, fibromyalgia, rheumatoid arthritis, lumbar fusion surgery, or with a limited weight-bearing status are just a few of the many different patient populations that can benefit from aquatic therapy.

Cardiac and Pulmonary Rehabilitation - A small percentage of physical therapists practice in this discipline. Those that pass the board certification have the title of Cardiovascular and Pulmonary Certified Specialist (CCS) work with patients who have had heart attacks, bypass surgeries, angioplasty, breathing problems, emphysema, and other heart/lung related conditions. Physical therapists are well equipped to work with these types of patients because many of them have orthopedic ailments that limit their ability to function. In other words, a physical therapist can address the heart and lung problems as well as the muscle problems that are concurrently present.

Neurological, Spinal Cord Injury, and Traumatic Brain Injury Rehab - A large portion of physical therapists work with patients who suffer from these conditions. Functional retraining including, walking, wheelchair use, getting in and out of bed or chairs (transfer training), moving in bed (bed mobility), and retraining patients to use their shoulders, arms, and hands are just some of the services these therapists provide to those with neurological involvement. A certified specialist holds a Neurologic Certified Specialist title (NCS).

Balance, Dizziness, and Vertigo Rehabilitation - Many suffer from dizziness or BPPV (benign paroxysmal positional vertigo). Some clinics specialize in the rehabilitation of patients with vertigo. Patient education, strengthening, safety awareness, posture and balance exercise, walking exercise, and special techniques that affect sensory and balance centers of the brain and limbs are all important components of a rehabilitation program.

Amputee Rehabilitation - many physical therapists specialize in the rehabilitation of amputees. Caring for the injured limb, functional and walking training, training in the use of assistive devices (crutches, canes, prosthetic limbs, etc.) are all provided by a therapist who specializes in care for amputees.

Wound Care - Some therapists specialize in the treatment and care of wounds. This is accomplished by the removal of unviable tissue (debridement), the application of special dressings and prescription drugs/ointments, and the use of ultrasound, electrical stimulation, and aquatic modalities to promote healing. Exercise and patient education are also routine components of a wound care program.

ECS (Clinical Electrophysiologic Certified Specialist) - A physical therapist who is board certified to perform electroneurophysiology examinations such as nerve conduction studies and electromyography.

Lymphedema Rehabilitation - We take it for granted but a special component of the circulatory system, the lymph system, helps filter and drain fluid from our arms and legs. When this drainage system is damaged, painful swelling can result. Some therapists specialize in the treatment of lymphedema as it is called. Special positioning, massage and bandaging techniques are utilized by the lymphedema specialist.

Osteoporosis Rehabilitation and Prevention - Some practitioners specialize in the evaluation and treatment of osteoporosis patients. Working in concert with your medical doctor, the therapist will often design a specialized weight-bearing and resistance training program for those with this silent disease.

Q?

Why is physical therapy a good choice?

A.

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 root cause.

Physical therapists are experts at treating movement and neuro-musculoskeletal disorders. Pain often is an indicator, a symptom, of a movement disorder. Physical therapists are movement experts and can help correct the disorder and relieve the pain.

Q?

Who pays for treatment?

A.

In most cases, health insurance will cover a portion of your treatment, sometimes most of it. When you contact us to schedule your first visit, we will collect your insurance information and call them to get your benefits, so you will know as much as they will tell us about what they will cover. 

Q?

Why should I choose a private practice physical therapist?

A.

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.

Q?

Is physical therapy painful?

A.

For many patients, one of the primary objectives is pain relief. This is frequently accomplished with hands-on techniques, ice and/or education. 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.

In some cases, physical therapy techniques can be painful. But this is not true for most patients in most treatment plans. For example, recovering knee range of motion after total knee replacement or shoulder range of motion after shoulder surgery may be somewhat painful. It is critical that you communicate what you feel with your physical therapist, including the intensity, frequency, and duration of any pain or discomfort, as they cannot feel for you. Your physical therapist does not wish you to experience any unnecessary pain. Without this information, it is difficult for the therapist to adjust their techniques and your treatment plan.

Q?

Why do people seek and why are they referred to physical therapy?

A.

Individuals may be referred to physical therapy because of a movement dysfunction and associated pain. 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. People who are having difficulty getting out of a chair, can't participate in their preferred sport, or who have trouble walking, for example, may seek out a physical therapist. Physical therapists treat these movement dysfunctions and their associated pain and restore your body's ability to move in a normal manner.

Q?

What will I have to do after physical therapy?

A.

It may be recommended that you continue with home exercises or a gym program. While we always advocate regular exercise to stay healthy, sometimes it is not necessary for people to continue specific physical therapy exercises to return to normal daily activities.

What is best for you will largely depend on your goals. This is about you and for your benefit, after all. 

Q?

What happens if my problem or pain returns?

A.

Sometimes symptoms recur. One of our primary goals is that you don't re-injure yourself.  

Occasionally an old injury is irritated, what we often refer to as a "flare up". If you have a flare up (exacerbation), give us a call. We may suggest you come back to see us, return to your doctor, or simply modify your daily activities or exercise routine. But we will only know after talking with you. 

Q?

What is your privacy policy?

A.

Our privacy policy can be read here: Notice of Privacy Practices

Q?

What do physical therapists do?

A.

Physical therapists are experts in human movement. The profession has evolved rapidly, and where 20 years ago it was not uncommon to encounter a practicing physical therapist who had earned their bachelors degree or certificate in order to qualify for a physical therapy license in their state, the professional entry-level education standard is now a Doctorate degree in Physical Therapy, or DPT. For a number of years in the 90s and 2000s, a Masters in Physical Therapy was the standard. Now all 14 programs in California and over 99% of programs nationwide are Doctoral programs in physical therapy.

Learn more about physical therapists and physical therapy:

Physical Therapy Programs in California

Notable Physical Therapy Programs outside California