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What happens during my first visit?
The first assessment can take approximately 1 hour. During this assessment, you can expect the following:
- Arrive at your appointment with your paperwork completed (you can download it from our website - see the Patient Forms link).
- You will provide us with your insurance card and doctor's referral for physiotherapy, if required by your insurance company.
- We will copy your insurance card or health card.
- If you are being treated under the Motor Vehicle Accident protocols, we will copy the information your insurer sent back to you outlining the benefits to which you are entitled and help you process the necessary paperwork for your claim.
- If you are a Workers' Compensation Board (WCB) patient, we will take down your claim number and case manager's contact information and help you with any necessary paperwork for your claim.
- You will be seen for the initial assessment by the therapist.
- The therapist will discuss the following:
- Your medical history.
- Your current problems/complaints.
- Pain intensity, what aggravates and eases the problem.
- How this is impacting your daily activities or your functional limitations.
- Your goals with physiotherapy.
- Medications, tests, and procedures related to your health.
- The therapist will then perform the objective assessment which may include some of the following:
- Palpation - touching around the area of the pain/problem. This is done to check for the presence of tenderness, swelling, soft tissue integrity, tissue temperature, inflammation, etc.
- Range of Motion (ROM) - the therapist will move the joint(s) to check for the quality of movement and any restrictions.
- Muscle Testing - the therapist may check for strength and the quality of the muscle contraction. Pain and weakness may be noted. Often the muscle strength is graded. This is also part of a neurological screening.
- Neurological Screening - the therapist may check to see how the nerves are communicating with the muscles, sensing touch, pain, vibration, or temperature. Reflexes may be assessed as well.
- Special Tests - the therapist may perform special tests to confirm/rule out the presence of additional problems.
- Posture Assessment - the positions of joints relative to ideal and each other may be assessed.
The therapist will then formulate a list of problems you are having, and how to treat those problems. A plan is subsequently developed with the patient's input. This includes how many times you should see the therapist per week, how many weeks you will need therapy, home programs, patient education, short-term/long-term goals, and what is expected after discharge from therapy. This plan is created with input from you, your therapist, and your doctor.
What do I need to bring with me?
Bring your payment information. If your insurance is covering the cost of physiotherapy, bring your extended insurance card. Alberta Health Care patients, bring your health card. If your insurance company requires a doctor referral for physiotherapy, be sure that your physician or physiotherapist with a practitioner ID has already faxed that to our office prior to setting up an appointment with us. If you are covered by a Workers' Compensation Board (WCB) claim, bring your claim number and your case manager's contact information.
If you were in an auto accident and decide to be treated under the Motor Vehicle Accident (MVA) protocols:
- Complete a Notice of Loss and Proof of Claim Form. Retain a copy for your records and send the original signed form(s) to the insurance company within 10 days or as soon as possible from the date of your accident.
- You will be contacted about the benefits you are entitled to receive after the insurance company reviews your completed form. If your insurance company needs any additional information in order to process your application, they will contact you. Please visit Alberta Finance for more information on what to do after an auto accident.
- Bring the information from your insurance company to us so we help you complete your insurance claim forms.
How should I dress?
You should wear loose fitting clothing so you can expose the area that we will be evaluating and treating. For example, if you have a knee problem, it is best to wear shorts. For a shoulder problem, a tank top is a good choice, and for low back problems, wear a loose fitting shirt and pants, again so we can perform a thorough examination. Gowns will be provided if necessary and for female patients, female staff presence during assessment or treatment can be arranged upon request.
How long will each treatment last?
The first assessment can take approximately 1 hour. Subsequent treatment sessions typically last 30 to 60 minutes per visit.
How many visits will I need?
This is highly variable. You may need one visit or you may need months of care. It depends on your diagnosis, the severity of your impairments, your past medical history, etc. You will be re-evaluated on a monthly basis and when you see your doctor, we will provide you with a progress report with our recommendations.
Who will see me?
You will be evaluated by one of our licensed and highly trained physiotherapists and he/she will also treat you during subsequent visits. Unlike some clinics, where you see someone different each visit, we feel it is very important to develop a one-on-one relationship with you to maintain continuity of care. Since only one physiotherapist knows your problems best, he/she is the one that will be working closely with you to speed your recovery.
Who pays for the treatment?
How does the billing process work?
Billing for physiotherapy services is similar to what happens at your doctor's office. When you are seen for treatment, the following occurs:
- The physiotherapist bills your insurance company, Workers' Comp, or charges you based on Common Procedures Terminology (CPT) codes.
- Those codes are transferred to a billing form that is either mailed or electronically communicated to the payer.
- The payer processes this information and makes payments according to an agreed upon fee schedule.
- An Explanation of Benefits (EOB) is generated and sent to the patient and the physiotherapy clinic with a check for payment and a balance due by the patient.
- The patient is expected to make the payment on the balance if any.
It is important to understand that there are many small steps (beyond the outline provided above) within the process. Exceptions are common to the above example as well. At any time along the way, information may be missing, miscommunicated, or misunderstood. This can delay the payment process. While it is common for the payment process to be completed in 60 days or less, it is not uncommon for the physiotherapy clinic to receive payment as long as six months after the treatment date.
Why are people referred to physiotherapy?
Why is physiotherapy a good choice?
More than half of all Canadians are suffering from pain. Whether it is a recent episode or chronic, pain in Canada is a serious problem. However, many do not even know that physiotherapists are well equipped to not only treat pain but also its source.
Physiotherapists are experts at treating movement and neuro-musculoskeletal disorders. Pain often accompanies a movement disorder, and physiotherapists can help correct the disorder and relieve the pain.
How do I choose a physiotherapy clinic?
These are some things you may consider when seeking a physiotherapy clinic:
- The therapist must be registered in the province or territory in which they work. It's the law.
- The first visit should include a thorough medical history and physical examination before any treatment is rendered.
- The patient goals should be discussed in detail during the first visit.
- Care should include a variety of techniques which might include hands-on techniques, soft tissue work, therapeutic exercises and in some cases heat, cold, electrical stimulation or ultrasound.
- Do they have a service that can address your problem?
- Do they take your insurance or are they willing to work with you if they are not a preferred provider?
- They should be conveniently located. Since sitting and driving often aggravate orthopedic problems, there should be a very good reason for you to drive a long distance for rehabilitation.
- What are the hours of operation?
- Can they provide satisfaction survey results?
- The therapist should provide the treatment.
- Can you briefly interview the therapist before the first visit?
- Ask your family and friends who they would recommend.
Can I go directly to my physiotherapist?
Physiotherapists have been considered Primary Health Professionals since 1995. So, you can go directly to your physiotherapist without a doctor's referral, unless your health insurance requires one in order to pay for the cost of your treatment. Then, you will need a doctor's referral.
What do physiotherapists do?
You probably have probably heard of the physiotherapy profession. Maybe you have had a conversation with a friend about how physiotherapy helped get rid of his or her back pain, or you might know someone who needed physiotherapy after an injury. You might even have been treated by a physiotherapist yourself. But have you ever wondered about physiotherapists--who they are and what they do? Many people are familiar with physiotherapists' work helping patients with orthopedic problems, such as low back pain or knee surgeries, to reduce pain and regain function. Others may be aware of the treatment that physiotherapists provide to assist patients recovering from a stroke (e.g., assisting them with recovering use of their limbs and walking again).
The ability to maintain an upright posture and to move your arms and legs to perform all sorts of tasks and activities is an important component of your health. Most of us can learn to live with the various medical conditions that we may develop, but only if we are able to continue at our jobs, take care of our families, and enjoy important occasions with family and friends. All of these activities require the ability to move without difficulty or pain.
Because physiotherapists are experts in movement and function, they do not confine their talents to treating people who are ill. A large part of a physiotherapist's program is directed at preventing injury, loss of movement, and even surgery. Physiotherapists work as consultants in industrial settings to improve the design of the workplace and reduce the risk of workers overusing certain muscles or developing low back pain. They also provide services to athletes at all levels to screen for potential problems and institute preventive exercise programs. With the boom in the golf and fitness industries, a number of physiotherapists are engaged in consulting with recreational golfers and fitness clubs to develop workouts that are safe and effective, especially for people who already know that they have a problem with their joints or their backs.
The cornerstones of physiotherapy treatment are therapeutic exercise and functional training. In addition to "hands-on" care, physiotherapists also educate patients to take care of themselves and to perform certain exercises on their own. Depending on the particular needs of a patient, physiotherapists may also "mobilize" a joint (that is, perform certain types of movements at the end of your range of motion) or massage a muscle to promote proper movement and function. Physiotherapists also use methods such as ultrasound (which uses high frequency waves to produce heat), hot packs, and ice. Although other kinds of practitioners will offer some of these treatments as "physiotherapy," it's important for you to know that physiotherapy can only be provided by qualified physiotherapists or by physiotherapist assistants, who must complete a 2-year education program and who work only under the direction and supervision of physiotherapists.
Most forms of physiotherapy treatment are covered by your insurance, but the coverage will vary with each plan. Canada does not legally require patients to see their physicians before seeing a physiotherapist. Most of the time all you have to do is ask your doctor if physiotherapy is right for you. However, your insurance may require a physician referral before seeing a physiotherapist. So, it's best to check with your insurance carrier before making your first appointment and have your physician or physiotherapist with a practitioner ID fax the referral to us before setting up an appointment.
What kind of training do physiotherapist require?
- Physiotherapists must have a Bachelor or Master's degree in Physiotherapy from an accredited university.
- They must have passed the national Physiotherapy Competency Examination (PCE).
- They must be registered with the regulatory body in the province or territory where they work. Physiotherapists (PTs) in Alberta are registered with Physiotherapy Alberta College and Association.
Is my therapist licensed?
In Canada, physiotherapy is a regulated profession. Each therapist must register with the regulatory body in the province or territory where they work. Physiotherapists (PTs) in Alberta are registered with Physiotherapy Alberta College and Association.
Click here to see if your therapist is registered with Physiotherapy Alberta.
Can my therapist provide me with a diagnosis?
Physiotherapists cannot make a medical diagnosis. This is something that your medical doctor will provide for you. But, your physiotherapist can provide a physiotherapy diagnosis.
Are there physiotherapy specialists?
Orthopedic Physiotherapy - Probably the most common physiotherapy specialist is the orthopedic specialist. These specialists care for post-surgical patients, arthritis, tendinitis/tendinosus, fracture rehabilitation, muscle sprains and strains, neck and back pain, hip and knee problems, shoulder, elbow, and wrist conditions. Some are board certified as Orthopedic Certified Specialists (OCS).
Manual Therapy - Manual therapy is a broad term that describes a variety of hands-on treatment techniques that are applied to movement dysfunctions. Grade five mobilizations, Mulligan mobilizations with movement, Maitland and Kaltenborn techniques, functional technique, neural mobilization, joint mobilization, craniosacral therapy, strain/counter strain, myofascial release, etc. These are some of the more popular manual therapy techniques. Many manual therapists will take continuing education courses, obtain certifications in manual therapy, and will sit for board certification from the Physiotherapy Alberta College and Association and other organizations. Most physiotherapists incorporate manual therapy techniques as a part of a complete treatment plan.
Geriatric physiotherapy - Some therapists specialize in the rehabilitation of seniors. As the body ages, a variety of challenges arise. We stiffen, we lose strength, our balance skills decline, our bones become brittle (osteoporosis), our endurance decreases, and we take longer to recover from injuries. Balance and fall prevention are of paramount importance to the therapist who is working with seniors and some clinics are solely dedicated to caring for those with balance problems. Most physiotherapists work with seniors/geriatric patients. Some have obtained additional education, have passed a board examination, and have earned the Geriatric Certified Specialist (GCS) title.
Sports Rehabilitation - Experts in assisting with recovery after injury and surgery. Many sports specialists help with retraining the athlete utilizing running, throwing, jumping, and sport-specific programs to name a few. A therapist with the Sports Certified Specialist (SCS) title has passed a board certified test.
Fitness and Wellness - physiotherapists are well trained to help with your fitness needs and wellness programs. If you need an exercise program, have trouble with your weight, are concerned about osteoporosis, have an issue with diabetes, or you would like to learn how to prevent falls, physiotherapists can help. The previous examples are just a few of the many programs physiotherapists offer.
Hand Therapy - Most physiotherapists are well trained to treat hand and wrist conditions. Some therapists have taken additional courses and training and have passed a hand therapy certification examination. These therapists are called Certified Hand Therapists (CHTs).
Women's Health - Some therapists specialize in women's issues such as pregnancy problems, pelvic pain, and incontinence. Special treatment is available for women who have these problems. Many that suffer from incontinence do so needlessly. A physiotherapist may be able to help.
Industrial Rehabilitation - Specialists in industrial rehabilitation help with those that have suffered on-the-job injuries. Moreover, they will evaluate work tasks, fabricate assistive devices, evaluate your ergonomic situation, and help redesign work flow/tasks to decrease the incidence of injury. Often, industrial rehabilitation specialists will evaluate your ability to perform certain job tasks with a Functional Capacity Evaluation (FCE).
Pediatric Physiotherapy - Pediatric therapists specialize in the rehabilitation of children. They may assist with kids who suffer from cerebral palsy, developmental disorders, neurological disorders, and/or orthopedic problems.
Aquatic Physiotherapy - Aquatic therapy takes advantage of the physical properties of water to assist with the rehabilitative process. Buoyancy, turbulence, hydrostatic pressure, and thermal properties of water can assist with the rehabilitation of a patient. Those suffering from chronic pain, osteoarthritis, fibromyalgia, rheumatoid arthritis, lumbar fusion surgery, or with a limited weight-bearing status are just a few of the many different patient populations that can benefit from aquatic therapy.
Cardiac and Pulmonary Rehabilitation - A small percentage of physiotherapists practice in this discipline. Physiotherapists are well equipped to work with these types of patients because many of them have orthopedic ailments that limit their ability to function. In other words, a physiotherapist can address the heart and lung problems as well as the muscle problems that are concurrently present.
Neurological, Spinal Cord Injury, and Traumatic Brain Injury Rehab - A large portion of physiotherapists work with patients who suffer from these conditions. Functional retraining including, walking, wheelchair use, getting in and out of bed or chairs (transfer training), moving in bed (bed mobility), and retraining patients to use their shoulders, arms, and hands are just some of the services these therapists provide to those with neurological involvement.
Balance, Dizziness, and Vertigo Rehabilitation - Many suffer from dizziness or BPPV (benign paroxysmal positional vertigo). Some clinics specialize in the rehabilitation of patients with vertigo. Patient education, strengthening, safety awareness, posture and balance exercise, walking exercise, and special techniques that affect sensory and balance centers of the brain and limbs are all important components of a rehabilitation program.
Amputee Rehabilitation - many physiotherapists specialize in the rehabilitation of amputees. Caring for the injured limb, functional and walking training, training in the use of assistive devices (crutches, canes, prosthetic limbs, etc.) are all provided by a therapist who specializes in care for amputees.
Wound Care - Some therapists specialize in the treatment and care of wounds. This is accomplished by the removal of unviable tissue (debridement), the application of special dressings and prescription drugs/ointments, and the use of ultrasound, electrical stimulation, and aquatic modalities to promote healing. Exercise and patient education are also routine components of a wound care program.
Clinical Electrophysiologic Certified Specialist (ECS) - A physiotherapist who is board certified to perform electroneurophysiology examinations such as nerve conduction studies and electromyography.
Lymphedema Rehabilitation - We take it for granted but a special component of the circulatory system, the lymph system, helps filter and drain fluid from our arms and legs. When this drainage system is damaged, painful swelling can result. Some therapists specialize in the treatment of lymphedema as it is called. Special positioning, massage and bandaging techniques are utilized by the lymphedema specialist.
Osteoporosis Rehabilitation and Prevention - Some practitioners specialize in the evaluation and treatment of osteoporosis patients. Working in concert with your medical doctor, the therapist will often design a specialized weight-bearing and resistance training program for those with this silent disease.
Is physiotherapy painful?
For many patients, one of the primary objectives is pain relief. This is frequently accomplished with hands-on techniques, modalities such as ultrasound, electrical stimulation, and/or heat or cold therapy. Movement often provides pain relief as well. Your physiotherapist will provide you with the appropriate exercises not only for pain relief but to recover range of motion, strength, and endurance.
In some cases, physiotherapy techniques can be painful. For example, recovering knee range of motion after total knee replacement or shoulder range of motion after shoulder surgery may be painful. Your physiotherapist will utilize a variety of techniques to help maximize your treatment goals. It is important that you communicate the intensity, frequency, and duration of pain to your therapist. Without this information, it is difficult for the therapist to adjust your treatment plan.
What types of treatments will I receive?
There are dozens of different types of treatment interventions. Here is a list of treatment interventions:
Active Range of Motion (AROM) - the patient lifts or moves a body part through range of motion against gravity. AROM is usually one of the first modalities prescribed for arthritis.
Active Assistive Range of Motion (AAROM) - therapist-assisted active range of motion. This is usually prescribed for gentle stretching or strengthening for a very weak body part.
Stationary Bicycle - with or without resistance. This is usually prescribed for improving the strength and/or range of motion of the back or lower extremities as well as cardiovascular endurance.
Gait or Walking Training - the analysis of walking problems by visually examining the interaction of the low back and the joints of the thighs, legs, and feet during the various stages of walking, including initial contact, loading response, mid stance, terminal stance, pre swing, mid swing, and terminal swing. Many back, thigh, leg, ankle, and foot problems may be caused by or manifest themselves in subtle gait abnormalities.
Isometrics - muscle contraction without joint movement. This is usually prescribed for strengthening without stressing or damaging the joint (e.g., arthritis, or exercises to be performed in a cast, or right after surgery if recommended by the therapist/doctor).
Isotonics - muscle(s) contracting through the ROM with resistance. This is usually prescribed for strengthening.
Soft Tissue Mobilization - therapeutic massage of body tissue performed with the hands. Soft tissue mobilization may be used for muscle relaxation, to decrease swelling, to decrease scar tissue adhesions, and for pain relief.
Mobilization - hands-on therapeutic procedures intended to increase soft tissue or joint mobility. Mobilization is usually prescribed to increase mobility, delaying progressive stiffness, and to relieve pain. There are many types of mobilization techniques including Maitland, Kaltenborn, Isometric Mobilizations, etc.
Proprioceptive Neuromuscular Facilitation (PNF) - a system of manually resisted exercises performed in diagonal patterns that mimic functional movements. PNF was initially used in developmentally and neurologically impaired patients but now is used in almost every aspect of neuromuscular retraining from athletes in sports facilities to the very weak in hospitals and nursing homes.
Posture Training - instruction in the correct biomechanical alignment of the body to reduce undue strain on muscles, joints, ligaments, discs, and other soft tissues. There is an ideal posture, but most people do not have ideal posture. Therapists educate patients about the importance of improving posture with daily activities. Stretching and strengthening exercises may be prescribed to facilitate postural improvement and to prevent further disability and future recurrences of problems.
Progressive Resistive Exercises (PRE) - exercises that gradually increase in resistance (weights) and in repetitions. PRE is usually prescribed for reeducation of muscles and strengthening. Weights, rubber bands, and body weight can be used as resistance.
Passive Range of Motion (PROM) - the patient or therapist moves the body part through a range of motion without the use of the muscles that "actively" move the joint(s).
Stretching/Flexibility Exercise - exercise designed to lengthen muscle(s) or soft tissue. Stretching exercises are usually prescribed to improve the flexibility of muscles that have tightened due to disuse or in compensation to pain, spasm or immobilization.
Cryotherapy or Cold Therapy - used to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but also an effective pain reliever for even the most chronic pain.
Neuromuscular Electrical Stimulation (NMES) - the application of electrical stimulation to aid in improving strength (e.g., the quadriceps muscle after knee surgery or injury). NMES is also used to decrease pain and swelling and to relieve muscle spasm.
Neck Traction - a gentle longitudinal/axial pull on the neck, either manual or mechanical, intermittent or continuous for relief of neck pain, to decrease muscle spasm and facilitate unloading of the spine.
Heat - heat is recommended to decrease chronic pain, relax muscles, and for pain relief. It should not be used with an acute or "new" injury.
Pelvic Traction - the longitudinal/axial pull on the lumbar spine, either manual or mechanical, intermittent or continuous. Pelvic traction may be helpful for the relief of low back pain and muscle spasm.
Transcutaneous Electrical Nerve Stimulation (TENS) - a relatively low voltage applied over painful areas through small self-adhesive electrodes. The electrical stimulation "disguises" or "overrides" the sensation of pain. It is a small, portable unit, used in intervals, to control pain and reduce dependence on drugs. It is usually prescribed for relief of pain.
Ultrasound - ultrasound uses a high frequency sound wave emitted from the sound head when electricity is passed through a quartz crystal. The sound waves cause the vibration of water molecules deep within tissue causing a heating effect. When the sound waves are pulsed, they cause a vibration of the tissue rather than heating. The stream of sound waves helps with nutrition exchange at the cellular level and healing. Studies have shown that ultrasound is helpful for ligament healing and clinically, for carpal tunnel syndrome, and muscle spasm.
What will I have to do after physiotherapy?
Some patients will need to continue with home exercises. Some may choose to continue with a gym exercise program. Others will complete their rehabilitation and return to normal daily activities. It is important that you communicate your goals to your therapist, so he/she can develop a custom program for you.
What happens if my problem or pain returns?
Flare ups are not uncommon. If you have a flare up (exacerbation), give us a call. We may suggest you come back to see us, return to your doctor, or simply modify your daily activities or exercise routine.