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It can be difficult to know where to go and who best can help you with the problems that you’re having.  I deal with a number of different types of clients with many different types of issues.  Have look at the categories below to get a better idea of what your next step should be.


When to make an appointment with your doctor

There are some standard hallmarks that warrant a visit to your doctor before beginning physical therapy.

1 – Constitutional signs and symptoms

These types of signs and symptoms are very non-specific, with a vast number of conditions as potential causes.  They require further evaluation by your physician.  Things such as unexplained weight loss, fever, fatigue, chills, night sweats, unremitting pain and global muscle aches, and “flu-like symptoms”.  These are things not treated in physical therapy.


2 – Resting Pain

This is the type of pain that wakes you up at night regardless of the position you’re in.  This is different than pain that you can alleviate by simply moving or repositioning yourself.  That type of pain is typically more mechanical in nature and is appropriate for your rehab provider to assess and treat.  If your pain cannot be mitigated by changing your movement or position, or by getting your weight off of or onto a particular body part, then that should be examined by your doctor before coming to physical therapy.


3 – Trauma

Acute trauma that presents with swelling, bruising, redness, increased temperature, or inability to bear weight should be evaluated first by your physician.  The decision to get imaging studies and/or prescribe medications will come from your doctor.  There are a number of clinical decision making rules that providers use to determine appropriateness of imaging and/or medications, so your doctor should be the first stop after any acute trauma.


4 – Neurological Signs & Symptoms

Severe or progressing neurological signs and symptoms should be evaluated by your doctor, who will often refer you out to a neurologist if needed.  Symptoms like numbness and tingling are commonplace in the physical therapy clinic and often can be treated.  But when numbness and tingling continue to progress and persist they need to be assessed by your physician.  There are a number of reasons why numbness and tingling can occur and those reasons need to be ruled out.  Physicians may order any number of tests for this – imaging, nerve conduction studies, blood work, etc.  If it’s progressing, get it checked out.

Weakness is another neurological sign.  Neurological weakness, or neurogenic weakness, is typically not painful.  It’s just weak.  If muscles and tendons are intact but not getting the power supply they need, they will not be able to perform.  The result is often a pain-free, but weak contraction of the muscle.  There are a number of clinical tests we use to determine this.  Your physician may also order any of the above-mentioned tests as well.  But sometimes there is pain associated with the weakness so that is not a hard-and-fast rule.  The take home point is, “If it’s weak, get it checked out by your doctor”.  In the state of California, physical therapists can not order imaging and lab studies, so you need to have your physician evaluate you.

As well, any sudden loss of strength on one side of your body, whether it’s your legs, arms, face, or trunk, needs an immediate evaluation by a physician.  This includes impairments in speech and swallowing.  Get to the Emergency Room or call 911.


5 – Cardiac Symptoms – Seek Immediate Medical Attention!

  • Discomfort, pressure, heaviness, or pain in the chest, arm, or below the breastbone.

  • Discomfort radiating to the back, jaw, throat, or arm.

  • Fullness, indigestion, or choking feeling (may feel like heartburn).

  • Sweating, nausea, or vomiting.


*If you are experiencing any of the above signs or symptoms, see your doctor before coming to see me.  If you come to me first and any of these things are present for you, I will call your physician and send you in to see them before treating you.

When to Make an Appointment with Me?

Neuromusculoskeletal Symptoms - Pain, Neurological Symptoms

When your symptoms are mechanical – that means they come and go. Maybe with certain positions or movements, or with certain lengths of time performing an activity. Mechanical symptoms change. They ebb and flow with your day, with your activity, with your position. Sometimes mechanical symptoms with resolve immediately when you get out of a certain position and sometimes they will linger even after you move or change positions.

Pain can mechanical. Nerve-type symptoms can be mechanical. The point is that they change. Mechanical pain is not constant and unremitting.

Some mechanical symptoms will require further consultation with your physician if imaging, medications, or a surgical consult are needed. I will let you know when to make an appointment with your doctor if those are needed. And I will be happy to speak with your doctor for you.


Functional Loss or Progressing to the Next Level of your Sport or Activity

If you are having an issue getting started with a new activity, progressing through a plateau with a current activity, or moving to the next level in your training, I can help you greatly in all those areas. My clients range in age from 3 to 101 years young. My clients range from formally sedentary folks trying to make some changes with their lifestyle to level 10 gymnasts and D1 athletes. Functional loss and biomechanical impairments are the forte of a good physical therapist.


Vertigo, Dizziness, Headache

This is another area of specialty for me. Vertigo (spinning sensations) can be a scary thing to experience and dizziness is one of the most common complaints patients have to their doctors. There are a number of conditions that can cause both of these symptoms and many can be treated with physical therapy. If you are experiencing spinning that comes and goes with certain movements or have dizziness that is related to body or head movements, those are typically things I can help you with. Usually the spinning, or vertigo, that comes with movement and lasts for less than a minute or so, can be treated in one session. Other types may take a couple follow up sessions.

Headaches are another area of symptoms that can often accompany dizziness and vertigo. Headaches are a broad category, so if you’re experiencing them and they do not fit into the mechanical type of symptoms described above, then make an appointment with your doctor before coming to see me. If I find non-mechanical reasons for your headaches I will often have you to make an appointment with your doctor to get other possible conditions ruled out. There are almost always mechanical components to a person’s headache, and sometimes they are strictly a mechanical problem. I can help you greatly with those.

Although headaches are typically experienced as pain, sometimes migraine-type headaches can produce vertigo instead of pain, or in addition to pain. I can very likely help you with that as well.

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