Board-certified orthopedic clinical specialist Dr. Courtney Mears joins WIRED to answer the internet's burning questions about physical therapy. What's the relationship between physical therapy, physiotherapy, and sports medicine? How long does physical therapy last? Is it supposed to hurt the way it does? Does VR physical therapy exist? Is preventative physical therapy effective, or only after an injury? How do physical therapists help treat patients with pneumonia? How does yoga assist in physical therapy? Answers to these questions and more await on Physical Therapy Support.
Director: Jackie Phillips
Director of Photography: AJ Young
Editor: Richard Trammell
Expert: Courtney Mears
Line Producer: Joseph Buscemi
Associate Producer: Paul Gulyas
Production Manager: Peter Brunette
Production Coordinator: Rhyan Lark
Casting Producer: Nick Sawyer
Camera Operator: Seth Craven
Sound Mixer: Gray Thomas-Sowers
Production Assistant: Doug Archibald
Post Production Supervisor: Christian Olguin
Supervising Editor: Erica DeLeo
Additional Editor: Samantha DiVito
Assistant Editor: Andy Morell
Director: Jackie Phillips
Director of Photography: AJ Young
Editor: Richard Trammell
Expert: Courtney Mears
Line Producer: Joseph Buscemi
Associate Producer: Paul Gulyas
Production Manager: Peter Brunette
Production Coordinator: Rhyan Lark
Casting Producer: Nick Sawyer
Camera Operator: Seth Craven
Sound Mixer: Gray Thomas-Sowers
Production Assistant: Doug Archibald
Post Production Supervisor: Christian Olguin
Supervising Editor: Erica DeLeo
Additional Editor: Samantha DiVito
Assistant Editor: Andy Morell
Category
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TechTranscript
00:00Hi, I'm Courtney Mears, and I am a doctor of physical therapy and a board-certified
00:04orthopedic clinical specialist. Let's answer some questions from the internet. This is
00:09physical therapy support.
00:15At Schminxer asks, how long does physical therapy last? This is a really broad question. My patients,
00:21I typically see them around six to eight weeks, give or take. The fix after physical therapy,
00:26it really depends on how good you are about your home exercise program, how long you typically
00:32decide to stick with it. And again, just depends on what's injured, what are you trying to get back to,
00:38and what your functional goals are. At Fully Loaded asks, I'm going to ask my PT tomorrow,
00:43but are physical therapy and rehabilitation exercises supposed to make your body parts ache?
00:48Every time I do them, it hurts more. Typically, whenever you're given something new, it might
00:53hurt a little bit, or you might be a little achy here or there, but all of that's very normal.
00:57Just like if you did a little workout that you've never done, sometimes you're a little sore,
01:02maybe for like a day or two, but then it should get better over time. A lot of PTs use that zero
01:06to 10 scale, so you'll see zero means, I'm in no pain, 10 means, oh my gosh, I have to go to the
01:12emergency room. And so you could typically be around like a two or a three, and then we're good to go.
01:16At Kurt2Dope asks, why does physical therapy include so many science classes? That's because
01:22what we do is science. A lot of what we're doing involves a lot of physics. We have to understand
01:28different pharmacological interventions, which involves a lot of chemistry classes. A lot of us
01:33have to, you know, think about the research side of things, so you have to be able to analyze and
01:38understand a lot of that information. And everyone now coming out of a physical therapy school is
01:43earning a doctorate. So they're just taking you to the next level to make sure you have a really
01:46wide understanding of what you're doing with patients. At Jay's Your Drug asks, does physical
01:51therapy really help with having a bad back? So if we look at this, there's a lot going on with the
01:57back. I don't ever tell people they have a bad back. Everyone looks a little bit different. When you
02:02go to PT, they can tell you, is it actually your back? Or is it your hips? Or is it something
02:07completely different? I think physical therapy helps with pain and with function. But again, I don't
02:13think anyone really has a bad back. This thing is so cute. I love her.
02:17At Starkiller KOF asks, so how does physical therapy work? Do I go somewhere to do it? Or is it a thing
02:25that you do by yourself at home? Nowadays, it could actually be both just because we have so many more
02:31options out there with the use of telehealth. But I would say you have two different ways to go about
02:35it. You're going to be able to go into your standard clinic and be one-on-one in person with your PT,
02:40or you might be through the screen and going through them with exercises or what can you do
02:46in your home environment. But in both situations, you're going to be with somebody, not just by
02:51yourself. You'll always get homework, I think. You'll always have something to do. You're obviously
02:55going to a PT because you're looking for help. But in order to make it last, you're going to have
03:00to put in the work by yourself too at home. At Physiot 06546448 asks, what is aquatic therapy?
03:08This is really PT in the water. So you're in the pool. Typically, a rehab pool is heated. So it's a
03:15little bit different than your community pool. The water gives you some type of compression, but the
03:19water also gives you a lot of support. So for some people, you want to be unweighted. So it loads you a
03:24little bit less and it makes you just a little bit more comfortable to move. But even if you're in
03:28the water, we're typically asking people to then do everything you learn there on land because we're
03:35not fish and we have to be able to do things on land anyways. This might be my chronic pain patient
03:40or my older patient. So maybe they have a lot of arthritis in one of their joints and they just need
03:46to unload that joint a little bit. And so this just allows them to be more comfortable, but get the
03:50movement that we're trying to achieve. At Companion Rag asks, I think I need physical
03:54therapy for my jaw or something. The pain is getting consistent and unbearable. TMJ tips,
03:59welcome. Most people don't realize that PTs can treat jaw pain. The jaw is a joint just like any
04:05other part of your body. You have muscles that are around it just like any other part of your body.
04:10Typically for a lot of my patients, I prescribe them some soft tissue work. So we'll be working like
04:15a little bit of massage through these big muscles here. If you can find out how to relax your jaw,
04:20that's going to be the number one. So what I tell people is tongue on the roof of your mouth,
04:25teeth slightly apart, lips closed, and see if these can relax a little bit. And if you can get that
04:31throughout your day, you're going to be golden. If I was going to be doing a self-massage at home,
04:35I typically try to find this really high bone up here at my cheek. And then I find my jawbone here
04:42at the bottom. And this is where I'm going to be doing my soft tissue work. If you're clenching down,
04:48it's not going to work because you're just going to be fighting yourself. So again,
04:51you want to be relaxed and you're just going to kind of push and pull, push and pull.
04:57At youdon'tneedtoknowy asked, how the hell does physical therapy fix a pinched nerve?
05:03A pinched nerve really just means that there's some type of pressure on the nerve. A lot of the times,
05:08what I see is posture related. So if people are really hunched over or moving a little bit different,
05:15it can put pressure on different parts of the spine and those spinal nerves. Strengthening if
05:21they're really, really weak, either through their back muscles or maybe their core muscles. But it
05:27doesn't fix the pinched nerve. It just helps give you support all around it. Nerve symptoms present as
05:33numbness, tingling, burning, but it could also just present as pain. When we look here at the spine,
05:40all of these little yellow lines are nerves that are coming out. For some people, these spaces that
05:47these nerves come out of are a little bit smaller, whether that be from arthritis or if they've had
05:54a disc herniation. And physical therapists are there not only to help treat this, but to help you
06:00compensate if we need it. Because we don't fix what your bone does, but we might be able to help you
06:05move better so that you don't make that nerve angrier. At Neha Patel DC asked, did you know that
06:12physical therapy isn't only for the injured? Physical therapy sessions can also help athletes
06:17become stronger and more injury resistant, thus allowing them to perform better than they normally
06:22do. Absolutely true. I think where physical therapy is going isn't just for people who are coming in for
06:28injuries, but really trying to prevent an injury. Every population, every age group, everybody could use a
06:34little TLC to their muscles or their mobility just to make sure you're living the best life you can.
06:39At Eye Administrative 197 asks, MCL grade three tears. How long did your MCL take to heal? MCL,
06:47if we're talking about the knee, it's your medial collateral ligament. It gives you some stability
06:52around the middle part of your knee to prevent it from, you know, feeling unstable. Depending on the
06:58grade of tearing, MCLs don't heal on their own. Grade one is just a little bit of stretch. Grade three,
07:06now we're seeing a little bit more tearing, a lot of stretching, and it just means that our process in
07:12PT might take a little bit longer. If you have a sprain where it's stretched out, maybe you can get
07:17some support around your joint to make it feel better, but it doesn't necessarily mean that the tissue
07:24itself is healed back to a hundred percent. Might have a little bit of scar tissue now. You might
07:29have a little bit more of an odd movement pattern, but this is where, you know, if you can go to a PT
07:34as soon as you can so we can fix those things, it just puts you on the track to success a lot faster.
07:40At Seven Spring Days asks, I need someone to explain the difference between occupational and physical
07:45therapy to me like I'm a five-year-old. Our professions are very similar, but occupational therapy,
07:51when you're at point A and point B, they'll help you do those activities at those points. And then
07:58if I'm working with a PT, they're going to help me get from point A to point B. If you weren't a
08:04five-year-old, I'd say a PT really helps with the gross motor skills, strength, mobility, flexibility,
08:11and OTs might be working with you on more fine motor tasks, but both are going to be helping you back
08:16to your activities of daily living. At Gadd Center asks, physical therapy versus gym personal training.
08:22Both of us do exercises with people. Both of us correct how movement is being done, but I like
08:28when people see a PT first because then they can really get down to the nitty gritty. Like what
08:33should I really be doing to get back to this goal? Or how can I do X, Y, Z safely by myself? And then
08:40maybe you go to the gym. You know exactly what you're doing so that you prevent the injury from
08:44happening. That way you don't have to end up at the PT anyway. At Memento Quest asks,
08:50did you know physical therapy strengthens your muscles, but what about your brain? Anytime you
08:55do any type of movement, you're creating these new pathways in your brain. This is what we call
09:00neuroplasticity. And when you learn a new motion or how to correct something, you're getting all
09:07those pathways going and you're just enhancing the way you think. So you're really aren't just
09:12strengthening your muscles. You are strengthening your brain, all of your cognitive abilities. And
09:17there's also other portions to PT where maybe that's all they focus on. One of them is neurologic
09:22specialty in physical therapy. And they're really working with the nervous system. So some people
09:28have changes in their brain. Maybe they've had a stroke. Maybe they have a neurologic disorder
09:34like Parkinson's. And so what PTs in that specialty do, they're really working on rewiring the brain
09:40to help with their balance, to help them with their motor function, to get them back to what
09:45they want to do too. At YRS asks, does VR physical therapy exist? Definitely. A lot of people are now
09:51using this and we see it being used to help people with their balance. So they're putting them in a
09:57different environment with one of those really big headsets. And they're trying to get them to reenact
10:02how they would be walking down the street. Or if someone came up right in front of them and they have
10:08to react to move. But other specialties are also using this to help people relax and help calm their
10:14nervous system down. A lot of our chronic pain patients are using this nowadays. And a lot of
10:19great research is coming out about it. At MRCNNS1 asks, do you recommend blood flow restriction training?
10:26First, the person has to qualify for this. So if you had something like a blood clot, you're not
10:33appropriate for this. Definitely not. But a lot of patients do benefit from this. And what blood
10:39flow restriction training is, so we take one of the limbs, whether it's the upper body or the lower
10:44body, we put a really big blood pressure cuff around it. We pump it up and it restricts blood
10:49flow. What that does is it creates this environment for muscles to grow faster, what we call hypertrophy.
10:57And you're also able to do more with less. And so this is really nice for people who don't tolerate
11:03really large loads, but you still want to get more muscle growth, better endurance, and again,
11:09better outcomes. A Reddit user asked, to what extent can psychological anxiety lead to chronic
11:15physical symptoms? So there's a center in your brain that processes what pain is to you. And this
11:21little center, if everything is very heightened, like for those who experience anxiety, might light
11:27up a lot more than for your typical person. When everything's heightened, something like a loud
11:34sound can feel a lot different to that person. While I see a lot of these people, it's usually a
11:40multidisciplinary approach. So they might be seeing somebody like a psychologist or a mental health
11:46consultant, just to make sure that we're both addressing their needs. But it's really this like
11:51balance of how we address it. It's definitely not just in your head. At Mitch Liu asks, how do
11:57physical therapists always know when you aren't doing the stretches at home? Hashtag called out. When I
12:03have my patients, I'm always testing them right when they come into the clinic. I'm asking, well, show me
12:08what you did last time. And if one, they don't remember, I definitely know they didn't do it. But two, if
12:13we aren't getting where we're supposed to be, I know something's going on. And it just has to be
12:18called out. We do catch everybody.
12:22At Pdig917 asks, ice or heat? Big question in physical therapy. I would tell people if they're
12:29immediately post-op, so they just had a surgery, ice is probably a better option because they probably
12:35have a lot of swelling, a lot of inflammation. And we're really trying to get things to calm down.
12:40But if you're someone who feels really tight all the time, or like your muscles are just stiffening up
12:46and your joints are stiffening up, and you've been experiencing that for years, heat might be a
12:51better option for you. At the end of the day, it's really what you prefer. So if it's the winter for
12:57me, I'm usually not choosing ice and I'm going heat. At Power Arm asks, PT perspective on cortisone
13:03shots. Cortisone is an anti-inflammatory. So if you have a lot of inflammation in a specific joint,
13:10and if you can't move because there's not a lot of space, you're probably going to be in some
13:14amount of pain or dysfunction. So when you get the cortisone injection, it just again helps
13:20everything calm down so that we can get you moving a little bit better. A lot of what we do in PT is
13:26really helping that person load a specific tissue. But if that tissue isn't ready to be loaded, then
13:32we're just going to be at the standstill. At DH Dunkson asks, what is the difference between physical
13:38therapy, physiotherapy, and sports medicine? Physical therapy and physiotherapy, same thing.
13:45It just depends on what country you're in and who's talking to you about it. But the difference
13:49between physical therapy slash physiotherapy and sports medicine is the broadness of what you're
13:56able to practice. Sports medicine deals with athletes and a more active population. So it could be your
14:03high school athlete who's playing recreational soccer on the weekends, but it could also be your
14:08professional athlete who's in the NHL. Physical therapy has a much wider range on what we do and
14:15who we treat. At Risk Everything asks, how much of physiotherapy is pseudoscience? So I think in any
14:21profession, there is some type of pseudoscience, but for what I do and how I practice, I'm always going
14:28back to the research. I'm never just, you know, shooting from the hip here. Whatever I'm putting into
14:33practice with patients, I'm making sure that it's been tested and it's tried and true and that ultimately
14:39it works because there's a lot out there now in our profession that we know about in relation to
14:45stretching, strengthening, manual therapy techniques. And we know what the best intervention is for the
14:53right person in diagnosis. At Alicia Gexie 92206 asks, how do you stop peeing yourself every time you
15:01sneeze, cough after giving birth? Asking for a friend. So you have muscles within your pelvis. It's your
15:07pelvic floor. Those muscles, just like any other muscle in your body, need to be trained. After giving
15:13birth, a lot of these muscles are getting relaxed because of a different hormone that you're producing
15:20to get ready for birth and open up your birth canal. After birth too, sometimes you have different
15:25structures in your spine that are also a little bit more relaxed or they're just being used a little
15:31bit differently. So if you feel like you're a little incontinent, definitely head up a physical
15:36therapist to get seen and to get treated for it because it's not something that you have to live
15:40with. At Amir Exists asks, why are physical therapy stretches so much harder than lifting weights?
15:47Great question. It's probably because your PT's isolating the exact muscle. And when you're at
15:54the gym lifting your weights, your body's taking the path of least resistance. So it's always good
15:59to see a PT just to make sure that you're hitting the exact right spots. At Eric Robertson asks,
16:04how is cupping therapy actually part of physical therapy? Why not herbs? Why not magnets? And why does
16:11cupping escape scientific scrutiny? I don't think it escapes scientific scrutiny because even I'm a
16:17little bit hesitant to use this with people. This is a therapy that we might use because it's readily
16:23accessible for a lot of people. You can buy a set on Amazon for 20 bucks. So instead of going to PT,
16:30maybe this is something you can do in between. Typically you're right. It's like a bandaid on what
16:35we're trying to complete, but if it makes you feel better, why not? At Joey Giggles asks,
16:40how does mirror therapy work? Mirror therapy is really trying to almost retrain your brain
16:46to not be in pain. Typically what we're doing is we're putting a mirror near a limb or body part
16:53that that person is interpreting with their brain as normal. And we're trying to make that connection
16:59in their brain that the other side is also okay. At Poo Poo Sandwich asks, who invented physical
17:06therapy? Some guy was just like, hey, let's move his arm the complete opposite way and see what
17:11happens. So there's a couple different theories out there for who started physical therapy and how he
17:17became to be. During the polio pandemic, someone was like, hey, I want to get people back to moving
17:24who are really weak. And what she did was actually aquatic physical therapy. So that's how our
17:29profession got going. And once we realized that people who move do better, we just kept growing
17:35and growing. And now we do it all. At Eleanor 95670977 asks, how do physical therapists help treat
17:44patients with pneumonia? It's not my specialty, so I don't typically treat this, but there is chest
17:49physical therapy. So they use different percussive techniques and typically their hands are like this,
17:56creating little cups and they're pushing and pressing on little parts of the lobes of your chest
18:02to help all those secretions that might be coming from pneumonia dislodge so that you can be able to
18:08cough them out. At L Growing Bones asks, how does yoga assist in physical therapy? So I think yoga has a
18:14lot of great qualities. A lot of people are doing yoga to be stronger, to gain more flexibility. And this can
18:22be really useful in PT because we're working on a lot of the same activities. Yoga is usually the
18:27activity, though, that I'm helping people get back to. So I'm working things maybe in more isolation
18:33to help them get back to their goal of a certain yoga pose or to be able to tolerate a single leg
18:39stand while they're completing a tree pose. But if you're stretching that much and not strengthening,
18:44you're going to be unbalanced and your body is going to be a little bit dysfunctional.
18:49At Joel Martinez asks, well, that was a new experience in physical therapy. They use this
18:54thing that looks like a dull knife to break up some scar tissue and fascia. Let's see how this
18:59feels later today. Some physical therapists use metal tools or plastic tools and they really are
19:05scraping the tissue. The research behind this is a little spotty, but the idea is, is that you're
19:11creating a type of microtrauma to that tissue, which increases blood flow. And when you increase blood
19:18flow to an area, that helps heal tissue and get nutrients to it so that it heals faster.
19:24At KittyPlays as, anyone have experience with a TENS machine? Got my first one today and so far
19:30it's working to relieve my pain. Awesome. Would love to know any tips and tricks on how to use it.
19:35A TENS machine is a transcutaneous electrical nerve stimulation machine. There's little sticky pads
19:41that you'll put on different parts of your body and the machine sends an electrical current to that pad,
19:48which stimulates muscle contraction or nerve stimulation where you might feel a slight buzz
19:54or just a different sensation. Essentially what we're trying to do is modulate pain. So when you feel
20:01that buzzing or that twitching, it's sending that signal up to your brain and it's telling your brain,
20:07think about this, and it beats the pain signal. So when you're using it, I'm glad you're getting
20:13relief in your pain because that's exactly what it should do. At Personalized Milk asks,
20:17who wants to hit me with the Epley Maneuver before I throw up? So the Epley Maneuver is used for people
20:22who are experiencing dizziness, specifically those who are experiencing dizziness due to benign
20:28paroxysmal positional vertigo. Most people just call it vertigo, but that's the long name for it.
20:34There's crystals in your ear and sometimes those crystals get dislodged, which is what's causing
20:39people's dizziness. So what this maneuver is trying to do is put that crystal back into place, thus
20:45leaving you dizzy free. At SN1 asks, lol, over 40 and your back hurts from just lying down too long.
20:52It's like your body goes, oh, we're getting up. Yo, I thought you were dead and I'm not going to lie,
20:57I just stopped working. Hold on, I'll fire back up. As we get older, we get a little stiffer.
21:02We become a little less flexible. So when you don't move, there's no joint fluid that's lubricating
21:09a lot of your joints. And when that happens, things feel a little creaky. So then when you get back up,
21:15you get that joint fluid, you're lubricating all the joints that you have, and then you're feeling
21:19good as new. If you're feeling a little stiff when you wake up in the morning and you're in bed,
21:24just move your knees back and forth just to get things again lubricated a little bit.
21:28Or if you're sitting and you're really hunched over, just try sitting up nice and tall. And maybe
21:34you're doing a couple shoulder blade squeezes to lubricate those joints back there and just
21:38correcting your posture in general. At MB Rose asks, I wonder when people are going to start wearing
21:44kinesio tape just to look cool in sports. Kinesio tape is the stuff. It's a flexible tape that we've
21:50probably seen a lot of athletes wear. It kind of stretches. The idea behind it is that it's lifting
21:56some of the tissue to increase blood flow to an area, but some people also use it to feel a little
22:01bit more support when they're completing an activity. Typically, I don't use this too often,
22:06but you do see it a lot out in the public. There's different prints out there. Some have a camo print,
22:12some have different stars or hearts on it, but it all does the same thing.
22:15At P Coleman 84 asks, can physical therapy help with scoliosis patients or is surgery the only tool?
22:22Surgery is definitely not the only tool. Some people have scoliotic curves in their spine
22:27and they have no pain. And some people have really large scoliotic curves that we have to help
22:34different muscles stretch out or different joints kind of loosen up, but we can definitely help with
22:40this and surgery is definitely not your only option. At Brayden Weiss PT asks, did you know that
22:46physical therapists can treat pain in limbs that have been amputated? Physical therapists have
22:51developed many techniques for treating phantom pain. So some people, when they have a limb amputated,
22:58their brain still thinks it's there. Because your brain is interpreting that the limb is there,
23:03it's sending signals and creating pain in something that is no longer. So what mirror therapy does
23:09is it's having you look at the limb that still exists and it's retraining your brain to thinking that
23:16the limb that doesn't exist anymore is absolutely okay. So you can think of this as kind of like
23:23a brain game retraining. Okay, that's all the questions for today. Thanks for watching. PT support.