When should I see a physical therapist?

Many of the patients I treat are extremely active, though few make their living playing sports professionally. They are passionate about their lifestyle and sport of choice, and take their health very seriously.  With many sports and hobbies, aches and pains are likely to occur.  Athletes quickly get used to sore muscles and minor injuries, often considering these a normal part of an active lifestyle.

But should these be treated more seriously?

Many of the patients with whom I work initially ignored what seemed to them to be minor injuries, yet have since become more frequent or more intense.

At what point should you visit a physical therapist?

Read more for quick tips to decide if what you’re feeling needs a closer look.

1. Immediately after a specific injury.

A number of recent studies have shown support for early physical therapy for lower back pain.  The studies show that physical therapy within 2-4 weeks of a lower back injury leads to a decreased risk of surgery and injections, fewer doctor visits, faster recovery, and fewer incidents of chronic pain.

Clinically, I have seen even earlier physical therapy provide excellent results. I am a strong advocate of patients developing a relationship with a physical therapist as a practitioner on their medical team.  I also believe that patients should have email access to their physical therapists in order to communicate updates and ask general questions.  Often, a patient will email or call our office within the first few days of an injury and we will schedule them that day.  Earlier this year, I worked with a triathlete who developed intense back pain after a weekend race.  We saw her the next day and within a week she reported an 80% decrease in her symptoms. The following week she reported a 95% improvement and was able to race again exactly one month later. The sooner we can see a patient post-injury, the faster their recovery from the painful, acute stage.  This allows us to move to more advanced stages of physical therapy earlier, in order to address the root cause of their injury.

2. If an old injury has reappeared or never disappeared!

As I was getting ready to graduate one of my runners from physical therapy the other day, she asked, “but…how will I know if I need to come back?”  It was a great question, yet one without a definitive answer.  Runners, especially, are subject to occasional minor aches and pains.  At what point should they take these more seriously and seek help?

In general, you should reconnect with your physical therapist when:

You feel pain during an activity that gets worse as you continue the activity.  This is a sign that something is not right.

Your pain changes the way you perform the activity.  If you are running down the street with foot pain and you have to limp to avoid it, go home and call your PT.  Remember, the faster the painful symptoms are addressed, the more likely the root cause will be identified and other related injuries are less likely to occur.

You feel pain during three consecutive workouts or activities Often pain will be present at the start of an activity, but will disappear within a few minutes.  Does that mean it should be ignored?  No.  If you are consistently feeling the same or similar symptoms, even if they go away during the activity, schedule an appointment.  Pain is a sign of tissue fatigue or too much stress on a particular part of the body, likely related to an underlying movement dysfunction.  In English?  You’re likely not moving as well as you could, an area of your body is doing more than its fair share of the work, and it needs some help.

3. For an annual check up.

Physical therapists can be, and should be, the medical practitioners of choice for a musculoskeletal wellness/fitness screen, an assessment with a physical therapist to identify risk factors for developing a particular injury.  Much like we visit the dentist on a regular basis, we believe that everyone should schedule an annual preventative visit to their physical therapist to identify and address areas of dysfunction (that tight neck you’ve been complaining about, poor posture, or the shoulder that occasionally hurts in your bootcamp class).  Left undetected, these will likely get worse over time.  We would much rather see you once a year to revise your exercise program and keep you healthy, than have you wind up in our office as our newest patient!

Remember, you shouldn’t try to tough it out or wait until an injury becomes more severe before visiting your physical therapist.  You will wind up suffering needlessly and make our jobs even harder!

If you’re still not sure you should come in for an assessment, feel free to email us:  hello@therapydiasf.com.

In your email, please provide the following:

-where is the location of pain?

-how did the injury occur?

-how long has have you had the pain?

-what makes it hurt?

-what makes it feel better?

We will review the information and advise you on the best option for your injury.  This may include advice for self-management, the need to schedule a physical therapy assessment, or a physician contact, if necessary.

Physical Therapists and Exercise

Why work with a physical therapist for fitness? 

PT’s are trained in movement:

We are healthcare professionals trained in optimal patterns of movement, posture, and form and will provide a safe and effective workout.

PT’s are experts in anatomy:

We will design a full body program to address strength, flexibility, cardiovascular health, and balance.

PT’s understand injury:

We will design a program that takes into consideration current and previous injuries, muscle imbalances, and current goals.

At TherapydiaSF, we offer a full selection of wellness services including:

  • Pilates
  • yoga
  • TRX training
  • general fitness training
  • small group classes
  • Fitness Screen: complete assessment of strength, flexibility, balance and independent program design.
  • RunRx: complete assessment of strength, flexibility, and video of running mechanics

What is Wellness?

Seems like everyone I know is a Wellness Coach these days.  Sounds great, but what exactly does it mean?  As much a buzzword in the health, fitness, and nutrition industry as local, organic, and artisanal are to the food and beverage industry, the term wellness may need a little more explanation.

On January 1, 2005 new legislation was passed to allow physical therapists in California to practice “wellness”.  What exactly did that permit us to do?  We could now see clients for “the promotion and maintenance of physical fitness to enhance the bodily movement related to health and wellness of individuals through the use of physical therapy interventions.” It is perplexing that physical therapists, healthcare professionals with extensive training in anatomy, physiology and pathology, had been previously relegated to treating only the injured.  There is no legislation to limit access to personal trainers and massage therapists.  Funny that it took a Senate Bill to allow CA PT’s to work preventatively with healthy adults.

I have always enjoyed my role as Wellness Provider (see definition above).   I believe that physical therapists are best poised to fill this role beyond formal rehabilitation.  Physical therapists have the training and formal education to help you before an injury occurs. You see your doctor and dentist on a regular basis.  Why not schedule an annual exam with an expert in neuromuscular health?

In addition to the Wellness Screen that many clients schedule annually, we offer a range of Wellness Services at TherapydiaSF.  Many clients have continued working with me following rehabilitation for a specific injury because of my training as physical therapist.  For those who wish to schedule Wellness sessions, we offer customized single and partner Pilates or TRX sessions as well as small group classes that are limited in size to provide attention to form. Injured or healthy runners benefit from RunRx, our program to evaluate run form and provide a custom, progressive training plan for improved performance and prevention of injury.


The label “Wellness Provider” is not exclusive to physical therapists.  Other professions use this term though it’s meaning may be different from industry to industry.   If you are interested in working with someone who calls him or herself a Health or Wellness Coach, ask them what it means.  Do they have specialized training in a particular skill beyond their primary occupation?  How are they unique compared to another massage therapist, personal trainer, nutritionist or life coach?

Don’t be fooled by labels.

Pain IS the perfect excuse…

…to call your physical therapist.  I get it.  I’m the one who cleans the apartment BEFORE the housekeeper comes. But waiting to schedule because you’re in too much pain is like telling your dentist, “my teeth are too dirty”, your personal trainer, “I need to lose weight before I start ” or your therapist, “I’m too down in the dumps to see you today.”  I can understand the fear that a PT may make you move, but being in pain is exactly why you should see a PT who will assess your movement and choose a treatment to alleviate your symptoms.  

Suspension Training 101

ImageYou’ve probably seen the black and yellow “straps” hanging in your gym or, if you live in San Francisco, you’re just as likely to have seen them anchored to a stop sign at a busy intersection.  Developed by former Navy Seal and Stanford graduate Randy Hetrick, TRX is a San Francisco-based company that is sweeping the nation with a new form of fitness training.  Used in the military and found worldwide in professional sports team training facilities, TRX Suspension Training is a tool that allows individuals to use their own body weight to develop strength, stability and flexibility.

TRX can be used to make exercises more challenging by adding instability to a movement, make exercises more manageable by assisting the movement, and allows participants to work multiple areas of the body in all planes of movement.   By simply adjusting your body position, you can change the resistance of an exercise, and control how challenging the workout is. But before you start thinking TRX is only for the elite athlete, read on…

I have been working as part of the TRX team for over two years, originally as a client.  I knew of the product and even had one in the clinic where I worked, but it wasn’t until a patient told me that his goal for physical therapy was to get back to using his TRX that I started to wonder how it might be beneficial for my clients.  A case of perfect timing, TRX was just releasing their Sports Medicine Suspension Training Course for healthcare practitioners and I was asked to become an instructor.   Over the past two years I have presented the one day course around the country and have had the opportunity to meet and engage with some of the best and brightest in the rehabilitation and fitness industries.

While TRX is not the only tool I use in my treatments, I can’t think of any client for whom it would be inappropriate. So why exactly do I use TRX in my practice?  TRX is a tool that allows me to:

  • Teach proper movement
  • Assist movement that a client might otherwise have difficulty performing
  • Unload healing bones, joints, ligaments, tendons, and muscles during the rehab process
  • Combine balance, stability and strength work into challenging full body exercises.
  • Provide a workout to the entire body during the rehab process
  • Save space and improve compliance due to easy set up and portability

If you would like to learn more about how TRX might be useful in your rehabilitation or are looking for a new form of exercise contact us today!



Join our Matrix Mashup class!

Led by physical therapist, Master Instructor for TRX and Pilates instructor Sydney James, this 6-week strength & conditioning circuit class incorporates a wide variety of exercises and equipment.  Experience a full-body workout to improve fitness and enhance your current exercise routine. With the class size limited to 10, participants can work at their own pace and will receive individual attention.

Join us Tuesday evenings 6-7 pm June 11-July 16.

Drop-in (based on availability) $35
6 week series: $150

Contact info@therapydiasf.com or call 415-765-1502 to sign up.

One size fits all? Part 2: What makes a good PT? Aren’t all therapists the same?

IMG_3930A good physical therapist…

…invests in continuing education- While the majority of states require continuing education credit for continued licensure, some therapists complete only the minimal requirements while others seem to spend every weekend taking courses!  It is reasonable for a patient to inquire about the therapist’s interest in educational topics.  Chances are the PT will be excited to talk about their latest course.

…considers the whole person.  An injury is very rarely limited to the specific joint or muscle that hurts.  A good therapist treats not only the symptoms, but looks for the cause of the injury and understands how dysfunction in one area of the body may contribute to symptoms in a different location.

…draws from a variety of sources and isn’t afraid to learn from others.  Therapists who are willing to collaborate with other practitioners can learn a lot! 

…is directly involved in your care.  Some tasks are acceptable to delegate to a physical therapy aide, but only a physical therapist (PT) or physical therapy assistant (PTA) can perform physical therapy.  If you only see your PT for a few minutes at the beginning or end of your appointment and spend most of your time doing exercises with an aide or independently, you are not receiving quality care.  The foundation of my training and education is my ability to observe dysfunctional patterns of movement and to relate those findings to the patient’s primary complaint.  It has taken me a long time to refine my observational skills and the longer I practice, the better I get.  Guiding a patient through their exercises provides yet another window of observation and completes my assessment of that person’s problem and is not something I’m willing to delegate to someone else.

…revises or progresses your treatment.  If you are not seeing changes in your condition, are doing the same exercises, or receiving the same treatment at every appointment from week one to week six, you need to consider finding a new therapist.