FAQs

At your first visit to Rancho Del Mar Physical Therapy you can expect the following:

Please arrive at your appointment with your paperwork completed (you can download them here).
We will need your prescription for physical therapy.
We will copy your insurance card.
A therapist will see you for your initial evaluation.

The therapist will ask about the following:

Your medical history.
Your current problems/complaints.
How intense your pain is, what aggravates it, and what eases the pain.
How is it impacting your daily activities and is it limiting your functions.
Your goals with physical therapy.
Medications, tests, and procedures related to your health.

The therapist will then perform the objective evaluation, including but not limited to 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.

Once the therapist is done, they will create a list of problems and how to treat them. A plan will then be developed with your input, including how many times a week and how many weeks you will need therapy. You will discuss home programs, short-term/long-term goals, and what to expect after therapy.

Your physical therapy referral from your doctor as well as your payment information. If your insurance provider is covering the cost, bring your insurance card.

Loose-fitting clothes so that you can expose the area that we will be treating. If, for example you have a knee problem, wear shorts. For a back problem, a loose fitting shirt would be best so that the therapist can perform an examination.

Sessions usually last 60 minutes.

This all depends on your injury and the amount of care needed. You may need one visit or multiple. The severity of your injury, your medical history, your diagnosis, all of these are factors in determining how many visits are needed. You will be re-evaluated on a monthly basis and we will provide your doctor with a progress report with our recommendations.

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.

Physical therapists are experts in movement and function, but they do not only treat people who are ill. A large part of a physical therapist’s program is directed at preventing injury, loss of movement, and even surgery. They also provide services to athletes at all levels to screen for potential problems and institute preventive exercise programs. Physical therapists are also engaged in consulting with 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

Movement dysfunctions associated with pain are the most common reasons for people to be referred to physical therapy. If you have difficulty moving part(s) of your body it probably limits your daily activities. 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.

Most of the time, health insurance will cover your treatment. Visit our Patient Center for a summary of insurances we accept. And please talk to our receptionist if you have any questions.

One of our highly trained, licensed physical therapists will see you and will be your therapist on subsequent visits.

Most people see a physical therapist for pain relief, which can be accomplished with hands-on techniques, ultrasound, electrical stimulation, and/or heat or cold therapy. Your therapist will show you the appropriate exercises for your injury, which may also include movements. In some cases, physical therapy techniques can be painful. For example, recovering knee range of motion after total knee replacement or shoulder range of motion after shoulder surgery may be painful. 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.

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.

Heat – heat is recommended to decrease chronic pain, relax muscles, and for pain relief. It should not be used with an acute or “new” injury.

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.

Transcutaneous Electrical Nerve Stimulation (TENS) – a relatively low voltage applied over painful areas through small self-adhesive electrodes. The electrical stimulation “disguises” or “overrides” the sensation of pain. It is a small, portable unit, used in intervals, to control pain and reduce dependence on drugs. It is usually prescribed for relief of pain.

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.

It is a possibility. Rehabilitation specialists are trained in a variety of techniques that may help with your recovery, so deep tissue massage may be part of your rehabilitation. There are three reasons that massage is typically used, to facilitate venous return from a swollen area, to relax a tight muscle, or to relieve pain.

Injuries can be exacerbated and flare ups are not uncommon. Give us a call if this happens. We may ask you to follow up with your doctor, modify your daily routine, or come back to see us.

You have the right to choose any physical therapy clinic and our practice is a provider for many different insurance plans. You can see them here.

If you have questions, please give us a call and we will do our best to answer them.

All states have some type of direct access. And in most cases, if you are not improving in 30 days, your therapist will refer you to a physician, or back to your physician if you came in from a referral.

Your medical doctor will be the one to provide you with a medical diagnosis. In most states, physical therapists cannot do this.

Physical therapy billing is similar to what happens in your regular doctor’s office.

1. Our physical therapist will bill your insurance company, Workers’ Comp, or charge you based on Common Procedure Terminology (CPT) codes.
2. Then these codes are transferred to a billing form that is either mailed or electronically communicated to the payer.
3. The payer then processes this form and pays according to an agreed upon fee schedule.
4. Finally, an Explanation of Benefits (EOB) is generated and sent to you as well as the physical therapy clinic with a check for payment and a balance due by you. You will be expected to make the payment on the balance if there is any.

There are exceptions are to the above and at any time along the way, information may be missing or miscommunicated. This can obviously delay the payment process. The typical payment process is completed within 60 days but it can take as long as six months for the clinic to receive payment.

This depends on your treatment within the clinic and your injury. Some patients will continue with home exercises, others can continue with an exercise program at a gym. Other patients can return to their normal daily activities after rehabilitation. One of the most important things you can do is communicate your goals to your therapist, so that together you can develop a custom program.

Physical therapists (PTs) and physical therapist assistants (PTAs) are licensed by their respective states.

Some things you might want to consider when seeking a physical therapy clinic:

• The therapist should be licensed in the state.
• Your first visit should include a thorough medical history and physical examination before any treatment is rendered.
• Your goals should be discussed in detail during the first visit.
• Care should include a variety of techniques which might include hands-on techniques, soft tissue work, therapeutic exercises and in some cases heat, cold, electrical stimulation or ultrasound.
• If they do not take your insurance, are they willing to work with you?
• You should find a clinic that is close to you. Most injuries can be aggravated by sitting and driving, so unless there is a very good reason to drive a long distance, the clinic should be convenient to you.
• What are their hours?
• Ask family and friends who have experience with physical therapy who they would recommend.

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