Physical therapy is a valuable and often highly effective treatment option for a wide range of musculoskeletal and mobility issues. But what if physical therapy doesn’t work?
If physical therapy doesn’t work, there can be a number of reasons why, including unrealistic expectations, a poor fit between the therapist and patient, not keeping consistent appointments, failure to complete a home exercise program, or even misdiagnosis.
Over the last 30 years, we’ve seen thousands of patients recover from musculoskeletal issues; physical therapy works for most people. However, if it turns out that physical therapy just doesn’t work for you, we hope to provide some insightful guidance into the next steps to take.
Understanding the limits of physical therapy
We often say that it’s important for people to realize that physical therapy’s greatest strength can sometimes be its downfall. Physical therapy is, by its nature, non-invasive and inexpensive compared to other treatment options.
However, physical therapy is a science-based approach that aims to optimize physical function and reduce pain through exercises, manual therapy techniques, hands-on care, and education. If a patient truly requires surgery instead of physical therapy, then physical therapy can augment, but not replace that approach.
Additionally, physical therapy is a healing process, not a quick fix. It requires commitment and work on behalf of both the physical therapist and the patient, over the course of weeks or months.
For more details on time frames, see our guide on how long it takes to repair damaged tissue and recover from injuries.
The top 5 reasons why physical therapy doesn’t work
Before you draw the conclusion that physical therapy didn’t work, take a glance through these common reasons we see for a lack of progress on your journey to reducing your acute or chronic pain.
1. Unrealistic expectations
As mentioned above, physical therapy works slowly over time, as we build strength in muscles, connective tissue, and bone structures. If a patient expects to get better within one or two appointments, they will typically be disappointed.
Rather than focusing on the short term, we often encourage to watch for various signs that physical therapy is working.
We often say in physical therapy that things will get worse before they get better. While this isn’t true in a literal sense (you’re actually healing the entire time), aggravating an unused joint can sometimes cause a patient to experience more discomfort in the beginning.
Typically, when patients stick with physical therapy for 2-3 months in a row, they a marked decrease in pain while also getting improvements in flexibility, mobility, strength, and function. This leads directly into our next point:
2. Inconsistent physical therapy appointments
Though physical therapy isn’t the same as working out in a gym, there are clear parallels:
Imagine “Patient A” going to the gym three times one week, once the next week, skipping a week entirely, and then going to the gym three times the following week.
Now, imagine “Patient B”, who goes to the gym three times per week for four weeks in a row.
Who will get better results? The answer should be obvious – the patient who was consistent! Keeping a regular appointment schedule is a core component of how physical therapy works.
Physical therapy treatment sessions work the same way: consistency is naturally rewarded with better progress since each physical therapy appointment should be building on the progress of our last appointment.
Additionally, moving appointments around can compromise your physical therapy rest and recovery days. Of course, we understand that things come up. However, regularly missing or moving physical therapy appointments is a surefire way to see lackluster results.
3. Not completing a home exercise program
Every physical therapy treatment plan you’ll find involves some type of home exercise program. Often, the physical therapist will supply the patient with the equipment they need, and some printouts detailing their exercises so that the patient can refer back to them later.
This point dovetails directly into our section on consistency earlier – if a home exercise is not completed properly, then a subpar healing process can be expected.
4. Poor fit between patient and therapist
Sometimes, a patient and a therapist just don’t get along with each other, or they consistently miscommunicate. While most physical therapists work hard to maintain open communication with their patients, sometimes the relationship just isn’t working out.
This is a two-way street: both the patient and the therapist need to work towards open communication.
Most physical therapy practices have multiple physical therapists. If you’re struggling with the communication style of your physical therapist, this can often be remedied simply by asking to work with another therapist.
5. Misdiagnosis or inaccurate assessment
The last point we’d like to make is that physical therapy can only work if the diagnosis made by the physician is appropriate and accurate. While physical therapists are trained to look for underlying issues that may have been missed by a physician, sometimes
If you believe this is the case, discuss it with your physician or therapist. Perhaps, ordering more diagnostic work, like an MRI before continuing physical therapy can help adjust the treatment plan to more accurately target the source of your discomfort and pain.
What to do if physical therapy doesn’t work
1. Reevaluate your treatment plan
If you find that physical therapy isn’t delivering the expected results, discuss this concern with your physical therapist! Often, your therapist can help you either adjust your treatment plan, add or remove exercises, or even help you manage your own expectations to get back on track.
What’s essential to note here is that your physical therapist can’t help you unless you’re open with them about your concerns.
2. Seek a second opinion
None of us will be offended if you seek an outside opinion. Sometimes a fresh set of eyes is just what a condition needs to get back on the road to recovery.
Discussing your concerns with your physician can be a good place to start, but even asking another physical therapist can go a long way.
Remember that every therapist has their own unique set of skills and experiences, and what works for one person may not work for another.
3. Explore complementary therapies
If physical therapy alone isn’t producing the desired results, consider exploring complementary therapies that can work alongside your current treatment plan. These might include basic interventions like deep tissue massage or acupuncture, or it may require something more involved like a surgical intervention.
4. Embrace lifestyle changes
While undergoing physical therapy, consider making positive lifestyle changes that can support your recovery. This includes developing or maintaining a healthy diet, developing good sleep hygeine, managing stress, and avoiding activities or habits that worsen your condition.
Many of these lifestyle changes are known for their ability to reduce chronic pain regardless of any outside treatment type chosen. Things like getting good sleep to recover for physical therapy appointments, or taking rest days between appointments can go a long way.
If you’d like some pointers on these “lifestyle” topics, simply talk with your therapist, or ask for a referral to someone who could help you. In our case, we often work with nutritionists or other outside sources if patients ask for it.
Next steps
In the recovery process, it’s important to recognize that traditional physical therapy is not a one-size-fits-all solution. While it can be highly effective for many individuals, there are cases where it may not work as expected.
If you find yourself in this situation, don’t lose hope. Instead, communicate with your therapist, explore alternative treatments, and consider seeking a second opinion.
The path to becoming pain-free may require patience and a willingness to adapt your approach, but with the right guidance and determination, you can still achieve your health and mobility goals. Remember that your well-being is a priority, and there are many avenues to explore on your road to recovery.
