You may be asking yourself, “How long do I need to see a physical therapist?” And that is a great question to ask. In fact, I encourage every patient that comes into our clinic to ask that question during the first appointment. You should know upfront, how much time, energy, and effort are required to help you overcome your pain, improve your performance, and/or get you back to doing the things you want to do. 

Have you recently injured your shoulder?

Or maybe you’ve got some low back pain giving you a hard time?

Or, like many people across the country, your primary care doctor or surgeon recommended that you see a physical therapist…

Now, you want to know how long you need to see a physical or occupational therapist before you’re pain-free or ready to be “discharged” from care.

Unfortunately, to answer that question, you need to first understand the reasoning behind the treatment you’ll be receiving at your physical therapy appointments. I like to call this the philosophy of care or even a treatment framework.

An Example: Our Philosophy of Care & Rehabilitation Phases

We know from the literature and available research, conditions that require the treatment of physical or occupational therapy rarely resolve with infrequent visits or carryover in home programs. For example, the minimum dose to protect older adults from falls is 50 hours [1]. This likely requires more than a single visit, or even higher frequency than 1 visit every other week or once per week. 

In fact, research also suggests that patients experiencing musculoskeletal pain, including chronic pain, show greater improvement and adherence to home programs by following 8 weeks of supervised physical therapy exercises, twice per week [2]. So the research supports seeing a physical or occupational therapist for more than just a visit or two. The research also suggests, however, that you don’t need (or want) to see a therapist several times a week for months on end. What you want is a plan of care with measurable goals & objectives and a defined time period. 

That being said, at ProActive Rehabilitation & Wellness, we take a 4-Phase approach to rehabilitation Programs 

4-Phase Physical Rehab Programs at ProActive (Our Framework Behind How Long to See a Physical Therapist)

ProActive Rehabilitation & Wellness uses a 4-phase rehabilitation approach to treatment. These four phases may overlap and may not necessarily be distinct, but it helps to think about a course of care as having 4 phases. 

Below are the 4 phases of ProActive’s rehab program development, specifically for musculoskeletal pain (MSK) and orthopedic conditions:

• Phase I: Pain Relief
• Phase II: Retraining & Return to Normal Movement 
• Phase III: Functional Performance and Targeted Improvement (Strengthening) 
• Phase IV: Self-Management & Discharge with Independence 

Now, this may vary a bit depending on the specific treatment you’re receiving (for example aquatic therapy or pelvic floor therapy may work a bit differently) . But, for the most part, when answering “how long do I need to see a physical therapist for …”, the answer typically takes into account the 4 phases outlined above.

Below, let’s break down each of the 4 phases in this framework. After that, we’ll dive into putting some potential timeframes around how long a typical course of treatment in occupational or physical therapy typically lasts.

Phase I: Pain Relief Phase 

Initially, your clinician addresses issues related to the main complaint. For example, many people seek a referral to PT/OT because of a complaint like “shoulder pain”. Treatment in this initial phase involves addressing the symptoms of pain, edema/swelling, tissue tension, etc. while preparing the body for the corrective or repairing stage of treatment. 

This may include modalities, hands-on manual therapy, exercises, and activities specific to your condition or situation. Home programs are also issued in this phase with the aim of reinforcing the key components of treatment in the clinic. 

Phase II: Retraining & Return to Normal Movement 

As your affected body part or region begins to heal from acute or subacute symptoms and the injury or the flare-up begins to resolve, your clinician then turns the focus of treatment to retraining your body into normal movement patterns. 

Joint or soft tissue injuries throw a monkey wrench in movement patterns, which result in compensatory motor patterns. These compensatory patterns open you up to the risk of injuring or overworking other joints and muscles in the body. An example here would be a person who sustains a hip injury and then experiences back pain as a result of compensatory motor patterns. 

In this phase, you learn exercises and techniques you need to enhance specific motions or movement patterns that activate the entire kinetic chain appropriately. This opens the door to functional training and functional movement activities. 

Phase III: Functional Performance and Targeted Improvement (Strengthening)

After your pain is gone and normal movement becomes more normalized, the next step in the process involves reinforcing and strengthening those motor patterns and functional movements. Strengthening generally takes time. Repetitions, frequency of exercises, etc. all impact how quickly strengthening happens. 

In phase, your clinician helps you strengthen the entire kinetic chain, and even the entire body, to facilitate normalized movement patterns [3]. Formal therapy sessions may be reduced in frequency as the you are able to perform exercises at least 3 times per week independently. This means you may taper down from seeing your therapist a couple of times a week to maybe once a week or even once every other week. 

Phase IV: Self-Management & Discharge with Independence 

Consider this the “graduation” phase of your rehabilitation course of care here at ProActive Rehabilitation & Wellness. To reach this phase of a rehab program you have 1) overcome the pain and symptoms or limitations resulting from your main complaint or original injury 2) you’ve relearned appropriate motor patterns and reinforced them through functional activities & exercises and 3) you’ve increased strength in the entire kinetic chain of that movement or injured area. You have also demonstrated increased independence, compliance, and ability to progress your home program.  

At that point in time, you no longer need to see a physical or occupational therapist anymore because you have the ability and resources to manage the rest of recovery on your own.

How often should you see a physical or occupational therapist?

The next quest we get asked a lot revolves around how often you should see a physical or occupational therapist. While it may sound self-serving to say “as often as possible”…we follow what the research suggests. Now, it just so happens that the clinical research would indicate that, at least at the beginning of a treatment plan, more frequent visits help increase the odds of success.

In fact, the research supports increased frequency in physical & occupational therapy treatments, over a set & defined course of treatment as a way to improve clinical outcomes and functional improvement [4]. Research also suggests that the optimal frequency for PT/OT treatment plans for orthopedic & musculoskeletal pain/dysfunction approaches 2-3 visits per week [4], at least at the beginning of the plan of care. 

Look at the image below.

As you can see, simply increasing the number of weekly PT/OT visits from 1/wk to 2/wk results a 95.5% increase in successful discharge from physical therapy [4]. In this study, “successful discharge” was defined as the patient meeting their goals, becoming pain-free, and returning to their normal activity. 

Now, the key here involves a set and defined course of treatment. You shouldn’t sign on to see a physical therapist 2 times per week for an unknown time period. It needs to fit in with a treatment framework designed to help you meet specific goals in a specific time period (like our 4-phase approach outlined above). 

Answering “How long do I need to see a physical therapist?”

Our goal at ProActive Rehabilitation & Wellness is to empower our patients to overcome their limitations and return to the activities and roles which they value the most, and to do it in the most effective & efficient way possible. That means we take these findings into consideration when establishing plans of care with patients. So we generally recommend a “tapered” approach to care. It may look something like this:

• Phase I: 2 times per week for 1-2 weeks
• Phase II: 2 times per week for 1-2 weeks
• Phase III: 1-2 times per week for 2-4 weeks
• Phase IV: 1 time per week for 1-2 weeks, then discharge

If you do the math, that comes out to about 8-10 weeks of therapy in total. However, depending on what exactly you’ve got going on, you may get to phase III and then skip all the way to phase IV in 1 week.

Also, it’s important to note that this framework is for injuries or muscle/joint pain. If you have surgery, then you likely have to follow the rehabilitation protocol that your surgeon prescribes. This may include upwards of 12+ weeks of formal therapy.

Summary

Ultimately, answering “how long do I need to see a physical therapist?” requires knowing some specifics about your situation and circumstances. Some people who experience an acute running injury, are already exercising regularly, and only need a bit of guidance in recovering and returning to normal running, may only require a few visits. Other people may require a longer course of care if they’ve been experiencing their pain for a longer time.

That being said, I like to answer this question by pointing people to our 4-phase treatment framework. It helps provide a benchmark for where you should be on your road to recover, and it also helps you figure out about how long you’ll need to see your physical or occupational therapist. The important thing is to ask your therapist on the first appointment about your situation, the plan you’re both creating, and the timeline associated with it.

And, if you’re experiencing pain and want to learn more about seeing us for a 4-phase rehab program, book an appointment here!

References

[1] Shubert, Tiffany E. MPT, PhD. Evidence-Based Exercise Prescription for Balance and Falls Prevention: A Current Review of the Literature. Journal of Geriatric Physical Therapy 34(3):p 100-108, July/September 2011. | DOI: 10.1519/JPT.0b013e31822938ac

[2] Matarán-Peñarrocha GA, Lara Palomo IC, Antequera Soler E, et al. Comparison of efficacy of a supervised versus non-supervised physical therapy exercise program on the pain, functionality and quality of life of patients with non-specific chronic low-back pain: a randomized controlled trial. Clinical Rehabilitation. 2020;34(7):948-959. doi:10.1177/0269215520927076

[3] Sarto, F., Franchi, M.V., Rigon, P.A. et al. Muscle activation during leg-press exercise with or without eccentric overload. Eur J Appl Physiol 120, 1651–1656 (2020). https://doi.org/10.1007/s00421-020-04394-6

[4] Bastan, M., Toher, R.,Nula, M., Harvey,J. Association Among Select Clinical Data and Successful Completion of a Treatment Plan in an Outpatient Orthopaedic Physical Therapy Setting. Orthopedic Practice. 2017;29(4): 200-202. Accessed here: https://www.orthopt.org/uploads/OPTP_Vol29_No4_FINAL_WEB.pdf