How to get what you need from physical therapy.

As a runner, two things are nearly certain: first, your sport is a very important part your life--not running is nearly inconceivable; and second, sooner or later you are likely to get laid up with an injury. Biomechanical "errors" that your body forgives you for with light activity can cause problems as you age, or as the miles add up.

If you've been injured and need rehabilitation, what should you look for in a physical therapist? How can you judge the quality of the care you receive? A good physical rehabilitation service should take into consideration the big picture--not just the injured joint or muscle. A physical therapist should take a broad view, including biomechanics, lifestyle, posture, work setting, and training schedule. Don't settle for assembly line care.

You'll know you are getting the care you need to return to your active life and sport as soon as possible and reduce the likelihood of re-injury if you expect the following guidelines to be met by your physical therapist.

* Independent evaluation: A physical therapist should provide a thorough exam, an appraisal of the dysfunction, and a summary of treatment on a regularly scheduled basis.

* Close supervision with hands-on care: Every visit should involve direct treatment and reassessment by a physical therapist. Your therapist should personally oversee all aspects of the treatment program.

* Goal-oriented treatments: All types of interventions prescribed should be specifically designed to enhance strength, flexibility or endurance. The reasoning for each treatment should be explained to you.

* Individualized program: Your occupation, lifestyle and personal habits should all play major roles in treatment and education programs. Since no two people are exactly alike, your program should be unique to your circumstances.

* Active patient involvement: You should receive exercises and lifestyle-modification advice that extends the recuperation process beyond office visits and to the home and gym. Physical therapy includes postural training for routine sitting, standing, and lifting; education regarding injury prevention in daily life; and lifestyle improvements like stress management.

* Discharge planning: The program should include ongoing exercise and lifestyle recommendations to follow after treatments end and to minimize the possibility of a recurring dysfunction.

Overall, your care from a physical therapist should be personal, thorough, and active. You are more than "a torn meniscus" or "a herniated disk." You are a whole person who has suffered an injury in the context of your life and sport. Physical therapy should provide not only rehabilitation for your specific injury but approaches for you to extend to your training and lifestyle as well.

RELATED ARTICLE: Extending the Care

Rarely will insurance provide an open-ended policy for physical therapy that extends until your injury is healed and you're back on the road. Instead, most insurance companies allow only a certain number of visits to a physical therapist for a given injury. But, by using your rehab visits for assessment, treatments, and an exercise prescription, you can extend your benefits. Once you are past the acute stage and are ready to return to activity, ask your physical therapist to give you exercises that can be done on the equipment you have at home or at your gym. Then, return to your physical therapist every couple of weeks to adjust your prescription and to evaluate your progress. Using insurance Paid visits to sit on an exercise bike can waste money and time--both yours and the therapist's.

(Susan Kalish, AR&FA Executive Director)

(Bruce R. Wilk, P.T, O.C.S., is a board certified orthopedic physical therapist and director of Orthopedic Rehabilitation Specialists in Miami, FL.)