I worked as a physical therapist for 40 years.
There are times when our patient can no longer benefit from therapy. The caregivers/patient think that more therapy equals more improvement. Or the facility demands therapy because they can get renumeration. Sadly, there are also times when therapy is clearly indicated but there is no money to pay for it .I never found a facility that would allow me treat with out renumeration
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As an Orthopedic Technician I have seen the doctors orders for CPM or cold compression therapy be undermind by PT's down the line whose opinions may be valid but isn't this a discussion that should be between the doctor and the therapists . Not the therapist and the patient because the majority of patients getting CPM benefit from getting the active motion for many hours a day when not in therapy. The therapist opinion should not over ride the learned choices of treatment that a doctor feels would the most beneficial to their patients specific needs. And upon this order, the therapist job should be to encourage the patient to maximize their success using what the doctor feels is best. CPM's are a great benefit to flexion extension of any post op knee .
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I'm going to be starting physical therapy soon, and I want to know what to expect. I trust that whoever I go to will know what not to have me do, but it's good to know. It's my knees that are the worst of it, the older I get, the worse they seem to get. Thanks for all the great information!
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Thanks for sharing these insights! Some of these seem like a no-brainer - like stopping whirlpool treatment for open wounds. Getting out of bed to prevent blood clots seems to have caught on within the medical community but perhaps not as fast within the physical therapy community. Getting out of bed to build strength post-joint replacement has caught on if my mother's experience is any indicator.

But what is posted are really just general guidelines. A professional therapist must do an evaluation and make a determination as to the best approach for his or her client. This often means balancing different concerns. For an otherwise healthy senior, pushing further with strength training may be a good idea. But what if the senior has a heart condition or other underlying condition that limits his or her ability to exert him or herself? That would have been my FIL. He would have done anything the therapist told him to do, if he could. But his body could only go so far. Therapists must keep this in mind...and those of us in the caregiver role need to do so as well.

Ice and heat for short term only....again, that's a balance that needs to be struck between the overall condition of the patient, the actual problem which needs the heat or ice, and the long term effectiveness of any physical therapy program. Yes, physical therapy can do a lot of good. It's not a cure-all. For instance, physical therapy did reduce and occassionally eliminate the pain in my arthritic knee. It also had a tendency to aggrevate my knee. I stopped after about six months of therapy. Meanwhile, there are only so many different solutions to knee pain. When all other options are considered, that bag of frozen peas is one of the least invasive, has very few if any medical side effects, and is relatively inexpensive in comparison with what else is out there. The take away from this item is that if heat and/or ice don't fix it, try PT. If PT doesn't fix it, you probably need to take it up a notch with the doctor. But all things considered, if heat/ice helps, fits your budget, and keeps you going...stick with the peas.
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