Frequently Asked Questions (FAQ)

During your first visit you can expect the following:

1. Arrive at your appointment with your paperwork completed (you can download it from our website - see the paperwork or forms link).
2. You will provide us with your prescription for physical therapy, unless you are coming as a Direct Access patient (ask us if you qualify if you don't have a prescription!).
3. We will copy your insurance card and license.
4. If appropriate, you will answer some questions on an ipad or a paper form to help us keep track of how you are progressing over the course of treatment.
5. You will be seen for the initial evaluation by a licensed Physical Therapist.
6. The Physical Therapist (P.T.) will discuss the following:
   • Your medical history.
   • Your current problems/complaints.
   • Pain intensity, what aggravates and eases the problem.
   • How this is impacting your daily activities or your functional limitations.
   • Your goals with physical therapy.
   • Medications, tests, and procedures related to your health.
7. The Physical Therapist will then perform the objective evaluation which may include some of the following:
   1. 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.
   2. Range of Motion (ROM) - the therapist will move the joint(s) to check for the quality of movement and any restrictions.
   3. 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.
   4. 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.
   5. Special Tests - the therapist may perform special tests to confirm/rule out the presence of additional problems.
   6. Posture Assessment - the positions of joints relative to ideal and each other may be assessed.

The Physical Therapist will then formulate a list of problems you are having, and a plan to treat those problems. This includes how many times you should see the Physical Therapist per week, how many weeks you will need therapy, home programs, patient education, short-term/long-term goals, and what is expected after discharge from therapy. This plan is created with input from you, your Physical Therapist, and your Physician.

Make sure you bring your physical therapy prescription (provided to you by your referring Physician). This is not needed if you qualify to be a Direct Access patient. Also, bring your payment information. If your insurance is covering the cost of physical therapy, bring your insurance card. If you are covered by Workers' Compensation, bring your claim number and your case manager's contact information. If you are covered by auto insurance or an attorney lien, make sure you bring pertinent information. Also, bring your preferred form of payment for your co-pay.

You should wear loose fitting clothing so you can expose the area that we will be evaluating and treating. For example, if you have a knee problem, it is best to wear shorts. For a shoulder problem, a tank top is a good choice. For low back problems, wear a loose fitting shirt and pants (shorts, if possible).

Treatment sessions typically last 30 to 60 minutes per visit. This timeframe may vary. Your Physical Therapist can give you the best estimate on the approximate time you will spend during follow up sessions after they complete your initial evaluation.

This is highly variable. You may need one visit or you may need months of care. It depends on your diagnosis, the severity and complexity of your impairments, how long you have had the problem we are treating, your medical history, etc. We frequently re-evaluate your progress and the need for continued care and discuss your plan for physical therapy treatment with you. When you have a follow-up visit with a referring Physician, we will provide you with a progress report and 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.

You have probably heard of the profession of physical therapy. Maybe you have had a conversation with a friend about how physical therapy helped get rid of his or her back pain, or you might know someone who needed physical therapy after an injury. You might even have been treated by a physical therapist yourself. But have you ever wondered about physical therapists--who they are and what they do? Many people are familiar with Physical Therapists' work helping patients with orthopedic problems, such as low back pain or knee surgeries, to reduce pain and regain function. Others may be aware of the treatment that physical therapists provide to assist patients recovering from a stroke (e.g., assisting them with recovering use of their limbs and walking again).

The ability to maintain an upright posture and to move your arms and legs to perform all sorts of tasks and activities is an important component of your health. Most of us can learn to live with the various medical conditions that we may develop, but only if we are able to continue at our jobs, take care of our families, and enjoy important occasions with family and friends. All of these activities require the ability to move without difficulty or pain.

Because Physical Therapists are experts in movement and function, they do not confine their talents to treating people who are ill. A large part of a Physical Therapist's program is directed at preventing injury, loss of movement, and even surgery. Physical Therapists work as consultants in industrial settings to improve the design of the workplace and reduce the risk of workers overusing certain muscles or developing low back pain. They also provide services to athletes at all levels to screen for potential problems and institute preventive exercise programs. With the boom in the golf and fitness industries, a number of Physical Therapists are engaged in consulting with recreational 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 comprehensive evaluation, hands-on care, customized and skilled therapeutic and rehabilitative exercise and functional training. Depending on the particular needs of a patient, Physical Therapists may "mobilize" a joint or joints or massage a muscle to promote improved movement and function. Physical Therapists are experts in re-training muscles to promote return to the best function/performance. In addition, Physical Therapists educate patients in self-treatment exercises and strategies. Physical Therapists also use methods such as ultrasound (which uses high frequency waves to produce heat), 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 (P.T.) or by Physical Therapist Assistants (PTA). Currently, Physical Therapists typically attend college for 4 or more years to complete all of their requirements to apply to Physical Therapy school, then complete 3 years of graduate work, always at an accredited Physical Therapy program. PTA's complete a 2-year education program and work only under the direction and supervision of Physical Therapists.

Reference: Some content from APTA

In most cases, health insurance will cover your physical Therapy treatment. Click on our insurance link for a summary of insurances we accept. Our payment options also include self-pay. We will verify your insurance benefits when you call to make your appointment. We also provide services at our office that are not physical therapy treatment and are therefore not covered by insurance. Dry needling and durable medical equipment is not covered by insurance, but we keep our prices competitive.

You will be evaluated by one of our licensed and highly trained Physical Therapists and, in most cases, he/she will also treat you during subsequent visits. We feel it is very important to develop a one-on-one relationship with you to maintain continuity of care. However, we also value collaborative care. If you are seeing one of our Physical Therapists and he/she thinks you would benefit from a specialized skill provided by another clinician, we will always recommend what we feel is best for you. Also, if you need to change to another clinician due to special needs in your schedule or for any reason, we will make the transition easy.

Yes! Below are areas of specialty that you will find in our practice:

• Orthopedic Physical Therapy - Probably the most common physical therapy specialist is the orthopedic specialist. These specialists care for post-surgical patients, arthritis, tendinitis/tendinosus, fracture rehabilitation, muscle sprains and strains, neck and back pain, hip and knee problems, shoulder, elbow, and wrist conditions. Some are board certified as Orthopedic Certified Specialists (OCS).
• Manual Therapy - Manual therapy is a broad term that describes a variety of hands-on treatment techniques that are applied to movement dysfunctions. Grade five mobilizations, Mulligan mobilizations with movement, Maitland and Kaltenborn techniques, functional technique, neural mobilization, joint mobilization, craniosacral therapy, strain/counter strain, myofascial release, etc. These are some of the more popular manual therapy techniques. Many manual therapists will take continuing education courses, obtain certifications in manual therapy, and will sit for board certification from the American Physical Therapy Association and other organizations. Most physical therapists incorporate manual therapy techniques as a part of a complete treatment plan.
• Geriatric Physical Therapy - Some therapists specialize in the rehabilitation of seniors. As the body ages, a variety of challenges arise. We stiffen, we lose strength, our balance skills decline, our bones become brittle (osteoporosis), our endurance decreases, and we take longer to recover from injuries. Balance and fall prevention are of paramount importance to the therapist who is working with seniors and some clinics are solely dedicated to caring for those with balance problems. Most physical therapists work with seniors/geriatric patients. Some have obtained additional education, have passed a board examination, and have earned the Geriatric Certified Specialist (GCS) title.
• Sports Rehabilitation - Experts in assisting with recovery after injury and surgery. Many sports specialists help with retraining the athlete utilizing running, throwing, jumping, and sport-specific programs to name a few. A therapist with the Sports Certified Specialist (SCS) title has passed a board certified test.
• Fitness and Wellness - Physical therapists are well trained to help with your fitness needs and wellness programs. If you need an exercise program, have trouble with your weight, are concerned about osteoporosis, have an issue with diabetes, or you would like to learn how to prevent falls, physical therapists can help. The previous examples are just a few of the many programs physical therapists offer.
• Women's Health - Some therapists specialize in women's issues such as pregnancy problems, pelvic pain, and incontinence. Special treatment is available for women who have these problems. Many that suffer from incontinence do so needlessly. A physical therapist may be able to help.
• Osteoporosis Rehabilitation and Prevention - Some practitioners specialize in the evaluation and treatment of osteoporosis patients. Working in concert with your medical doctor, the therapist will often design a specialized weight-bearing and resistance training program for those with this silent disease.

For many patients, one of the primary objectives is pain relief. This is frequently accomplished with hands-on techniques and education in strategies to decrease pain during your daily activities. Movement often provides pain relief as well. Your physical therapist will provide you with the appropriate exercises not only for pain relief but to recover range of motion, strength, and endurance. If indicated, modalities such as traction, heat, and/or cold therapy may be added to assist with pain relief.

In some cases, physical therapy techniques can be temporarily 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 use skilled manual therapy, modalities, and will modify your exercises to make your treatment as comfortable as possible. It is important to communicate with your physical therapist and let him/her know if treatment is increasing your pain.

First, we perform a comprehensive evaluation of your problem. Next, we use the best available research and clinical expertise to determine the combination of treatment techniques that we expect to give you the best possible results. Most importantly, we continually re-evaluate the effectiveness of our treatment plan and modify our approach as needed. In summary, it is not true that either more or less is always better, but important that the appropriate dose of the appropriate techniques are chosen for each individual case. Below are some of the treatments we use at our office:

• Education - a very important component of every patient's physical therapy program. We believe knowledge is power. We help each patient understand their problem and provide strategies for modifications in daily activities to speed recovery.
• 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.
• Trigger Point Dry Needling (TDN) - also known as intramuscular stimulation (IMS) and dry needling, is called such because the needles used in this treatment method are "dry", solid filament needles, versus hypodermic needles that can inject medication or draw fluids through them. It is used for the assessment and treatment of myofascial pain syndromes and dysfunction due to myofascial trigger points / tension areas / muscle spasm / increased tonicity (the direct and palpable source of patient pain).
• Joint Mobilization - hands-on therapeutic procedures intended to increase joint mobility. Mobilization is usually prescribed to increase mobility and/or to relieve pain. There are many types of mobilization techniques.
• Muscle Energy Technique - hands-on therapeutic procedures utilizing positioning of the spine or limbs combined with contraction and relaxation of specific muscle groups to promote improvement in muscle length, joint mobility or to retrain the body to move with greater comfort and efficiency.
• Visceral Mobilization - therapeutic movement of various organs as they interface with other tissues. This type of treatment can be very effective for some pain complaints. Sometimes it is important that other diagnostic tests rule out certain medical conditions before this technique is pursued as a component of your treatment.
• 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.
• Proprioceptive Neuromuscular Facilitation (PNF) - active and resisted exercises performed in diagonal patterns that mimic functional movements. PNF was initially used in developmentally and neurologically impaired patients but now is used as a very effective tool in the rehabilitation of orthopedic patients and athletes. Multiple skilled techniques, including manual resistance, verbal and visual cues are provided by the physical therapist to create the best physical performance.
• 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. We use a variety of patterns of movement and therapeutic tools to get the best results with AROM exercises.
• Active Assistive Range of Motion (AAROM) - therapist-assisted or patient-assisted active range of motion in therapeutic patterns of movement. This is usually prescribed for gentle stretching or strengthening for a very weak or painful body part.
• Seated Stationary Bicycle - with or without resistance. This is usually prescribed for improving the strength and/or range of motion of the joints of the legs and/or for cardiovascular endurance.
• Upper Body Ergometer (UBE) - with or without resistance. This is essentially a bike for the arms and is typically used to improve range of motion and/or strength of the joints of the upper back and arms. We also use the UBE in standing to challenge balance and/or the core muscles of the spine, pelvis, and hips.
• Gait or Walking Training - the analysis of walking problems by visually examining the interaction of the shoulders, spine, pelvis, hips, knees, ankles 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).
• Isotonics- muscle(s) contracting through motion with resistance. This is usually prescribed for strengthening.
• Stabilization Exercises - focus on strengthening of the muscles which provide dynamic stability for joints.
• 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.
• Plyometrics - exercises where muscles are worked in short intervals of maximal explosive force with the goal of increasing both speed and power. Plyometrics can be an important component of physical therapy for return to athletics.
• Proprioception Exercises - exercises which improve the body's ability to appropriately react to sudden changes in its environment. Proprioception is the ability to know where a body part is without having to look. For example: Proprioception allows you to walk or run on uneven surfaces without having to look at the surface. Proprioceptive exercises are important when recovering from an injury or surgery, when trying to decrease fall risk in senior citizens and when decreasing injury risk in athletes.
• STOTT® PILATES - a repertoire of hundreds of exercises that has been developed over decades by a team of physical therapists, sports medicine and fitness professionals. Key to the approach is correction of muscle imbalances and the ability to modify exercises as needed, allowing the physical therapist to facilitate improved performance while making specific modifications that are appropriate for the patient's injury. Progress Physical Therapy has a full line of Pilates fitness equipment to take full advantage of the benefits of this exercise approach and has 4 STOTT PILATES® certified instructors on staff.
• Yoga - is strategically used in customized exercise programs prescribed by physical therapists to work on specific deficits.
• Unloaded Exercise - exercise performed in a way where there is less gravity or load on a joint or a body region. We have special weight machines where we can unload joints as needed and also have a treadmill where we can unload the spine and legs during walking, running forward or in 360 degrees of motion! With our strategies for unloading, we can often progress patients to higher levels of activity much more quickly and comfortably
• Orthotics - inserts used in shoes to improve painfree mechanics of the lower body. Orthotics influence much more than just the feet and are often used do decrease abnormal stresses on the knees, hip, and spine. We carry a variety of orthotics for a variety of problems. We find and supply orthotics that are very effective and affordable.
• Taping - can be used to improve the mechanics of a joint, protect an injured joint or tissue or support an area that has insufficient support due to weak muscles or injured ligaments. Usually, taping is used as a temporary measure while developing strength and improving biomechanics to decrease abnormal stresses on joints during activities.
• Bracing - is used in similar situations as taping.
• 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.
• Vasopneumatic Compression - a form of cryotherapy that combines cold with intermittent (on and off) compression around a swollen and/or painful area. We find this to be even more effective than cryotherapy alone.
• 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. This can be an effective component of treatment in those who are "load sensitive".
• 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.
• 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.
• 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.

Physical Therapists are trained in a variety of techniques to speed your recovery, including massage (or soft tissue mobilization). Massage is typically used for three reasons:

1. To help to move swelling out of an area into the venous system,
2. To relax a tight muscle and
3. To relieve pain.

When massage is used in physical therapy treatment, it is usually only one component of a comprehensive treatment program. For example, when a muscle is chronically tight, there are often stiff joints in the region that also need to be treated with skilled joint mobilization and very specific exercises. Also, when a muscle is in spasm, it is often reacting to protect a joint nearby that has been enduring too much stress and strain. In this case, physical therapy treatment will include instructions and exercises to protect the irritated joint. In summary, massage is an important treatment tool, but using massage alone is rarely the answer for the best long-term results.

Yes! You always have the right to choose where you receive physical therapy treatment.

In Virginia, patients can arrange an appointment directly with a Direct Access Certified Physical Therapist without a prescription. At Progress Physical Therapy, LLC, all of our Physical Therapists are Direct Access Certified.

This means you can come directly to Progress Physical Therapy, LLC without being required to see a Physician first. Seeing a Physical Therapist first is safe and could save you hundreds or even thousands of dollars. Click here for details.

If you present with signs and symptoms that are beyond our scope of practice, we will immediately contact your Physician to discuss our concerns and arrange for referral to the appropriate specialist.

There are some restrictions related to Direct Access. For example, Medicare and a few other insurance carriers currently require a prescription from a Physician in order to cover physical therapy treatment. When you call our office at 270-7754 to make your appointment, we can let you know if you qualify to receive physical therapy by Direct Access.

Click here for more info on Direct Access at Progress Physical Therapy, LLC.

Billing for physical therapy services is similar to what happens at your doctor's office. When you are seen for treatment, the following occurs:

1. The physical therapist bills your insurance company, Workers' Comp, or charges you based on Common Procedure Terminology (CPT) codes.
2. Those codes are transferred to a billing form that is either mailed or electronically communicated to the payer.
3. The payer processes this information and makes payments according to an agreed upon fee schedule.
4. An Explanation of Benefits (EOB) is generated and sent to the patient and the physical therapy clinic with a check for payment and a balance due by the patient.
5. The patient is expected to make the payment on the balance if any.

It is important to understand that there are many small steps (beyond the outline provided above) within the process. Exceptions are common to the above example as well. At any time along the way, information may be missing, miscommunicated, or misunderstood. This can delay the payment process. While it is common for the payment process to be completed in 60 days or less, it is not uncommon for the physical therapy clinic to receive payment as long as six months after the treatment date.

Some patients will need to continue with a customized list of home exercises that we prescribe. Some may choose to continue with a gym exercise program - we will instruct you in modifications that that we recommend for your program at the gym. Others will complete their rehabilitation and return to normal daily activities. Giving you the tools for the best long-term outcome from physical therapy is an important part of our treatment philosophy!

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

These are some things you may consider when seeking a physical therapy clinic:

• The Physical Therapists (P.T.'s) should be licensed in the state.
• The first visit should include a discussion of the details of your complaints, a medical history and a thorough physical examination before any treatment is rendered.
• Your goals should be discussed during the first visit.
• Care should include a variety of techniques which might include hands-on techniques, soft tissue work, a customized therapeutic exercise program based on your clinical presentation and a thorough education about your problem as well as strategies to use at work, home and during physical activity to achieve the best progress.
• Location: If sitting or driving aggravate your problem or if you will need to be treated for several visits, you may want to look for the best Physical Therapy clinic that is conveniently located to work or home. However, a P.T. clinic with a great reputation is more important than choosing an office by convenience alone.
• What are the hours of operation?
• Choose a physical therapy clinic which schedules one-on-one time with a specific Physical Therapist. If you are not scheduled with a specific P.T. and are scheduled to arrive in 'waves' with other patients arriving at the same time for the same P.T. that is not a good sign. Occasionally, patient treatments can be appropriate in a 15 minute appointment time, but usually require more time. If the P.T. clinic is routinely scheduling 1 or more patients every 15 minutes, find another P.T. clinic!
• Ask your family and friends who they would recommend!

YOUR RIGHT TO A "GOOD FAITH ESTIMATE"

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
• Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call our number on our website for more information.