As John Mitchell lifted his bicycle, he felt a sharp pain in his back and thought that he pulled a
muscle. Later that evening, he couldn't feel his right leg. Mitchell, a 51-year-old Dallas police
officer, was in good health and prior to his injury had not missed a day of work in eight years.
However, after being diagnosed with ruptured/bulging discs, Mitchell has been unable to work
for the last two years.
"I couldn't sit, I couldn't stand, and I couldn't lie down," he says. "I was miserable."
After a series of cortisone shots and a discogram (a test that involves injecting a dye into discs
in the vertebrae to measure structural integrity), Mitchell opted for back-fusion surgery to repair
Following the surgery, Mitchell began intensive physical therapy (PT) to build his strength back
up and begin the healing process.
"Physical therapy has gotten me on my feet again," Mitchell says. "Without Southwest
(Center Physical Therapy and Rehabilitation) Clinic, I would be out of commission for sure."
Mitchell, like most injured patients, began the process of rehabilitation soon after his injury and
subsequent surgery, but the process is not as simple as it sounds. Rehabilitating an injury
takes dedication from the patient, as well as the help and hard work of a host of medical
"The ultimate goal of physical medicine and rehabilitation (PM&R) is increasing the patient's
functionality," says Dr. Tracey Adams, a private practice PM&R doctor in Dallas. "Physical
medicine is a team approach. I work hand in hand with the physical therapists and receive
progress notes on my patients."
Ideally, an injured patient will first see a doctor of PM&R for a physical exam to determine what
treatment options are available. In some cases, an injury will require surgery to repair the
damage. But surgery or no, most patients with a serious structural injury will be referred to
physical therapy to ensure there are no lasting effects from the injury.
WHAT TO EXPECT
Physical therapy will help you regain flexibility, restore function and strength, improve mobility,
reduce pain, and prevent future injury. But it is going to take a commitment on your part to stick
to the schedule and do the exercises properly and to the best of your ability.
It's not all blood, sweat, and tears, though. The first stage of physical therapy involves using
the muscles associated with your injury to increase range of motion. Once your flexibility
increases, the therapist begins to focus on strengthening the weakened area, which improves
your stability and balance, while adding power to the weakened muscles.
Once those hurdles are cleared, you will begin exercises meant to maintain function and
recovery. These exercises, depending on the extent of the injury, will be continued at home for
a period as you finish your treatment. It is this time, when you're away from the watchful eye
and encouraging words of your therapist, that is critical to your full recovery.
Not completing physical therapy on even the most minor injuries can have severe
consequences. Even innocuous injuries can affect other areas of the body, lengthening the
recovery period and making it more painful.
"I have never seen a patient who kept up with their home program return to therapy," says
James Brady, M.S., P.T. "Maintenance is integral to the success of a therapy program: Keep it
up, or you will likely be back in therapy."
Brady, owner and physical therapist at Southwest Center Physical Therapy and
Rehabilitation located in Dallas, sends his patients home with paperwork and pictures detailing
their exercise routine, hoping patients will continue their program on their own.
"I give people the tools to get over their problem, " says Brady. "My job is to get a patient out
of my office, not coming back. In my opinion, if you are seeing a PT and you are not exercising,
then you are missing 50 percent of the picture. Exercise is the key component to successful
There are as many treatment choices available as there are injuries - surgery with
post-surgery physical therapy, physical therapy without surgery, aquatic therapy, cortisone
shots to relieve inflammation, and just plain anti-inflammatory medications and rest, just to name
a few. But don't think you can just ignore the problem. Massages, cold compresses, and heat
applications may augment different forms of therapy, but they usually only relieve pain and do
not have lasting results.
Choosing a therapist and physical therapy clinic can be overwhelming. Most doctors will refer
you to someone that they have experience using and trust, but you do not have to work with the
therapist your doctor recommends; the choice is up to you. Beyond the actual therapist, you
can choose to rehab in a PT-owned or hospital-based clinic, depending on your preference.
Whichever type of clinic you choose, you will still want find out a few things about a potential
therapist. All qualified physical therapists should have a master's or doctoral degree and must
pass a state licensure exam before they are allowed to practice. Some states require that
therapists participate in continuing education courses to maintain their license, as well. You can
visit the American Physical Therapy Association web site (www.apta.org) for more information.
It is also a good idea to ask your therapist how long she has been practicing. A therapist
should always be willing to give you referrals. Be sure to ask for and then follow up with some of
her previous clients. When you call, ask how they felt about the therapist. Were the treatments
helpful? Was she professional and accommodating? Did they fully recover from the
experience, and would they change anything about the treatment?
A well-rounded clinic will also have a psychologist, an occupational therapist, and possibly a
nutritionist on staff to improve your overall health and guide you to recovery.
If you find that you are not connecting with your physical therapist, feel free to move to a new
clinic. It is your health after all, and making a full recovery from your injury is too important to
allow anything or anyone to jeopardize your progress.
Mitchell knows that he found a good physical therapist, one who cares and wants him to
"I can't say enough good things about James [Brady]," says Mitchell. "Thank God for him;
otherwise I wouldn't be able to walk."
Which is all any good physical therapist wants to hear.