What Happens During a Physical Therapy Appointment? Here's What to Expect at Your First Physical Therapy Appointment

You finished reading Part I in this series, reasons to see a physical therapist during pregnancy, and now you're thinking about taking the plunge and making a physical therapy appointment. But what will that first appointment be like? (keep reading) Does physical therapy hurt? (keep reading!) How long should you expect to be there? (maybe an hour or so) Does insurance cover it? (usually, yes! Of course, check your policy for details)

what-to-expect-physical-therapy-appointment

Here's what a typical first visit to a physical therapist can entail:

  • Ask about any specific issues you are having
  • Check your posture and silhouette
  • Check your range of motion
  • Check your diastasis recti muscle (vertical muscle that runs down the center of your abdomen)
  • Check for rib flaring (your ribs pushing forward)
  • Test the strength and tone of a variety of muscles including transverse abdominus and exterior muscles
  • If you are not pregnant, a quick internal exam (similar to your yearly exam with your OB, but without the speculum) might be done to check muscle tone
  • Asking some questions about any pain, urinary leakage, or urgency (needing to pee less than every 2 hours)

When she's checking on your muscles, the PT is paying attention to four things:

muscle tone

Is a particular muscle very toned, or very under-toned, or just right? Muscles often work in pairs, so where one muscle is overly toned, its "pair muscle" is often very under-toned.

Additionally, when one muscle is extra weak, it often causes other muscle groups to have to "step in" and do the work that weak muscle should be doing. This can cause you more pain because it's not the job those new muscles are supposed to do. You can also have pain from your super weak muscle when it does finally engage, because it's so weak and not used to being called into action. 

trigger points

Trigger points are extremely sensitive, teeny tiny knots in your muscles. There is a whole branch of massage therapy devoted to trigger points, but the way I imagine them is akin to a regular sore muscle - you know when you massage a certain spot and it "hurts so good"? That tenderness hurts to touch, but once you've massaged it, the pain goes away. A trigger point is like that, except extremely small, and if they exist, it's always in a specific spot along a muscle. 

After the physical therapist (PT) has determined which of your muscles are too weak or too toned, she is able to make an educated guess about where trigger points will exist in your body.

The PT has learned where these spots should be and can easily feel them. When she touches one, you might feel a zap of energy or brief pain, which is another hint that she found one!

Working out trigger points helps the muscles fully relax. Typically this involves putting pressure directly on the trigger point for at least 90 seconds.

Once the muscles are nice and relaxed, they can be taught how to properly re-engage with various exercises or stretches that your PT will teach you. 

trigger-point-in-the-trees

recruitment

If your physical therapist pushes on a muscle and asks you to tense back that same muscle in response, can you do it? That's recruitment - "recruiting" your muscles to engage. 

Your muscles' ability to recruit (or not) gives the PT more clues about which muscles need to be focused on. The physical therapist will also be able to give you exercises that will help you recruit the correct muscles for certain activities.

For example, some of my SPD symptoms were caused by lack of strength in my lower abdominal muscles. When testing recruitment of those ab muscles, I could barely even tell which muscles my PT wanted me to use - that's how weak and used they were! She showed me a couple of super easy exercises to do at home, and the SPD pain disappeared after just a couple days of practice. 

sensation

Sensation is exactly what it sounds like - how does the muscle feel, and can you feel what she is doing? 

All of this information lets your physical therapist know which muscles are most likely the cause of your issue.  In turn, the PT is able to provide customized exercises, stretches, or manipulation that will alleviate (or even completely eliminate!) your pain and other symptoms. 

After my first PT session with Amy, my back was more relaxed than it has ever been, even moreso than right after an hour long deep-tissue massage. My husband also noticed an immediate difference, saying I looked more relaxed and balanced. At a later session with Amy, she showed my husband how to do some of the physical manipulations at home. 

I am SO HAPPY to report that throughout almost 40 weeks of pregnancy #4, I experienced only an occasional, fleeting dull ache in my pelvis. Absolutely NOTHING like the prior pregnancies, and I am confident that if I had visited Amy more or was more diligent at home about doing the exercises, even those occasional aches would disappear. 

Does physical therapy hurt? 

Generally speaking, no. When the physical therapist finds trigger points, you might feel a zap of discomfort, but nothing you can't breathe through (and what great practice for labor!) Additionally, the PT should be checking in with you throughout the session, making sure you are comfortable, and letting up if anything gets too intense.

The exercises themselves are also very low-impact. Nothing that Amy asked me to do at home ever caused pain - unless you count a sore muscle that finally started getting some use after years of being inactive! :)  

Did I miss anything? What else do you want to know about physical therapy?

Make sure you don't miss my next post, about how physical therapy can help with symphysis pubis dysfunction specifically - subscribe to the blog!