Physical Therapy and the City: An Insiders Guide to the Good, The Bad and The Ugly

Russ S

I've been a physical therapist (PT) in NYC for the past 15 years. Due to a schedule that included going for a second Masters degree in acupuncture, as well as living abroad a few years, I've jumped around and experienced about a dozen different outpatient PT settings. These included offices within orthopedic doctors' and physiatrists' practices, corporate gyms, chiropractors, and private PT-owned clinics.

Considering the vast array of options in NYC when seeking the services of a PT for your running injuries, you would be wise to become an educated consumer. The first question most people have is "does my insurance cover the treatment?" Many PT offices are going out of network, which maximizes their reimbursement. Even if you have out of network benefits, you will often have to meet a deductible. If you will need more than a few sessions of treatment, then this may balance out in the end since you should not be paying a copay after the deductible is met.  

I think the most important question to ask is how much time will be spent with the PT during the initial session, and any subsequent sessions. A PT's office may indicate that a session is 1 hour, when in reality your actual time with the PT is only 15 minutes. The rest of the time you may find yourself doing "supervised" exercises or getting hooked up to electric stimulation. The supervision of an exercise routine is very important but comes at different levels depending on the office. 

Physical Therapy Hotel-Visit/In-Call
Yuki Kawauchi, Invited Japanese Runner, Pre-NYC Marathon 2013.

Some practices will maximize their number of appointments so that either a PT or an aide is left "supervising" several people at a time. No matter what ailment you're having treated, you want a PT who has experience with manual therapy, and that should be an integral part of your session together. You shouldn't settle for anything less than 30 minutes of direct contact, one on one with your PT. This may include manual therapy techniques, stretching, feedback for proper form during new exercises, and correcting improper gait or movement patterns. 

A hot or cold pack application, electric stimulation, or riding a bicycle, etc., should not be included in your 30 minutes, but could be extra time you spend in the visit. Ascertaining what the treatment regimen will entail may require you to make a bunch of phone calls, and the office may be reluctant to give you the information. Site visits before you commit may be another option to see the flow of the office.  

If money is not an option and you will pay anything, regardless of insurance, you may be tempted to go to a fancy office with high tech equipment. However, the best tools at a PT office are the PT's educated hands and a few low tech gadgets. In fact you can probably bet that the fancier the office, the more patients they are seeing, the more they are getting paid by insurance and the more rushed or crowded you will feel. 

If you absolutely have to try the anti-gravity treadmill, just find one and pay for it separately. Offices will rent them in packages of small time intervals. (Incidentally, my college track coach just made us jog in the water when we were injured.)

Before you were deciding where to go for PT, you or your doctor identified a running injury requiring intervention. So besides physical therapy for post-surgical rehabilitation, what complaints respond best to PT? 

In my experience, the most typical running injuries include patella tendonitis, ITB syndrome (causing lateral knee pain), shin splints, plantar fasciitis and muscle strains or sprains (hip flexor, hamstrings and calf the most common). Out of all the above, plantar fasciitis is the most stubborn and difficult to treat. Often improper footwear or bad arch supports is a confounding factor.  Most of the other complaints should respond well in 6-10 weeks, more or less, depending on the severity and length of injury pre-treatment.  

On a personal note, there are an increasing number of physical therapy offices adding complementary services such as massage or acupuncture.  Since I already incorporate PT principles into my training routine, I seek out acupuncture and massage when an old injury comes back or while I am ramping up my training for a race.  Receiving a combination of PT, massage and acupuncture (which is starting to get reimbursed by insurance here in the US) is what I've seen many elite runners do in Japan when I was living there. This is starting to catch on here in the U.S. as an orthopedic intervention, not just a gimmick for weight loss or smoking cessation.  

- Russell Stram PT, LAc.

Blogmaster's note:  If you have any specific questions about your physical therapy program or have interest in other supportive treatments and would like to contact Russ, you can best reach him at Runnerclinic@gmail.com.  And to view his website, you can click HERE.