Health & Wellness

Orthopedic Physical Therapy

5 Important Questions To Ask Your Physical Therapist Before Starting Treatment

Physical Therapy Questions To Ask Before Starting Treatment

If you are starting physical therapy for the first time or someone returning for another round of treatment but trying a different clinic, ask these five crucial questions before you begin treatment. These questions will help you make more educated decisions about your health while avoiding setbacks, wasting time, and insurance benefits. Ask these questions over the phone before your first appointment or during the initial evaluation to ensure your treatment plan is clear and in line with your goals and expectations.


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Question 1: What specialized training do you have to treat my particular condition?

Each physical therapy practice specializes in different types of rehabilitation, and each therapist that works at the practice also has their own specific education and certifications. Make sure to ask your therapist if they treat your condition or symptoms regularly and what credentials they have that will benefit you during recovery. 

The American Board of Physical Therapy Specialties list ten specialties, which is always great to identify to start:

  • Orthopedics
  • Cardiovascular and Pulmonary
  • Clinical Electrophysiology
  • Geriatrics
  • Neurology
  • Oncology
  • Pediatrics
  • Sports
  • Women’s Health
  • Wound Management

On top of that, there are individual certifications and continued education for therapists, such as:

  • DPT– Doctor of Physical Therapy
  • OCS- Orthopedic Certified Specialist
  • MLD- Manual Therapy Certified
  • ATC- Athletic Trainer Certified
  • PAS- Postural Alignment Specialist
  • COMT- Certified Orthopedic Manual Therapist
  • BRM- Barbell Rehab Method
  • BFR- Blood Flow Restriction Training
  • IASTM– Instrument Assisted Soft Tissue Manipulation

And many more.

Question 2: Who will I be working with for each visit? Will it be the same person each time?

Many people run into this problem in as little as a couple of appointments. They have an initial evaluation with a Doctor of Physical Therapy (DPT) and return to their second appointment to find out they will be working with a physical therapy assistant or a physical therapy technician.

Technically, this is ok as long as a licensed DPT is present in the clinic area, but it could lead to some problems with the quality of treatment moving forward. A PTA or PT Tech does not attend the same amount of schooling or have the same experience as a DPT.

If you or someone from your family is a fall risk, has new questions at each appointment, or requires special attention, it may be best to find who you will be working with each time. 

At Balanced Physical Therapy, all of our patients get treated by a licensed and certified Doctor of Physical Therapy. We believe this is the best way to provide the safest, most effective care for everyone. Patients experience different symptoms and feel better or worse daily. With Dr. Robert Litzenburg and Dr. Tori Gasperoni working individually with each patient for all appointments, they can adjust treatments quickly, provide timely and accurate education, and notify primary care doctors when necessary.

Mt. Clemens Physical Therapy

Question 3: How much time will I get with my physical therapist? How much time will I spend with an assistant, tech, or aid?

A great follow-up question to question number two is to find out the specific details of how much time you spend with each person. Confirm exactly what your treatment will look like if you are getting treatment from a physical therapy clinic that splits up your treatment time between a doctor, the assistant, and/or aid.

Sometimes certain therapy places will have the DPT or PTA perform manual skills at the beginning or end of treatment and exercises under the supervision of a tech/aid/or assistant.

Question 4: How long will each physical therapy appointment be? And how long will I be attending physical therapy?

These two questions for your physical therapist will give you a better idea of how long your recovery process will take. While an exact time may be difficult for any healthcare professional to provide for new patients, you can still gain valuable insight, even if it’s a general estimate.

Appointment times vary from clinic to clinic and typically range from 30 minutes to 45 minutes, up to an hour. At Balanced Physical Therapy, we always say time is valuable and something to consider seriously (which is why we treat every patient for 1 hour). From the surface, patients can flat out get more done in an hour than they can in 30 minutes, allowing them to progress better and/or more quickly. Other patients recover a little slower and can’t rush through an entire treatment program like others, which is another reason more time should be allowed.

Question 5: What will I do at each appointment with my therapist?

Each patient is different and requires specific treatments more than others. Knowing what you will be doing at a physical therapy session for the first week, month, and months after is crucial.

Pain management, strength, flexibility, mobility, biomechanics, and sports-specific exercises are a few possible things to work on during an appointment. Ask this question to make sure what you are doing is safe, will contribute to better outcomes, and help you achieve your long-term goals.

Stress Awareness and Management

Stress Awareness and Management: 3 Natural Ways To Start Feeling Better

A special guest blog post from The Kee Institute in West Bloomfield focusing on mental health, stress awareness, and management.

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Stress Levels Are At Record Highs

If you’re currently feeling stressed, know that it’s normal and you are not alone. Stress and worry during the Coronavirus have increased in most adults by 30%, and there is still so much uncertainty in the world. When will things ever feel normal again? Will I have to go back into an office? When will it be safe to fly? The more unanswered questions we have, the more stressed we become. So what is stress anyway? 

What Is Stress? 

When we were hunter-gatherers, stress was our brain’s natural defense mechanism in response to danger. It would flood the body with hormones that prepare us to flee or fight whatever the threat might be. Today, while we’re less likely to run into a bear, a job interview, multiple work deadlines, or even driving in traffic can still trigger our brain with a fight or flight response. 

What Are The Symptoms of Stress? 

It can be challenging to manage stress as it doesn’t always manifest itself in the most obvious ways. Here are some of the more commonly associated behaviors and physical effects of stress: 

Common Symptoms 

● Difficulty sleeping or sleeping too much 

● Jaw clenching 

● Trouble staying on task 

● Lack of motivation 

Tension and muscle pain 

● Restlessness 

● Moodiness and irritability 

● Low energy 

● Aches, pains, and headaches 

Symptoms of Stress

Impulsive Stress Behaviors 

● Binge eating or skipping meals 

● Compulsive online shopping 

● Excessive drinking 

● Shutting yourself off from friends and family 

● A decline in self-care and personal hygiene 

You might spend every Monday feeling exhausted and moody, thinking that it’s just a “classic case of the Mondays,” without even realizing that you’re feeling stressed. A new week can be overwhelming, and Monday mornings will often greet us with a not-so-pleasant inbox. Your brain can perceive Monday as a threat because of how you’ve felt on Mondays in the past. So much so that you might start feeling anxious and restless on Sunday night. 

How You Can Manage Your Stress: 

While it’s nearly impossible to prevent altogether, there are some simple methods you can try next time you’re feeling stressed. 

Schedule Time For Yourself 

Life can be chaotic sometimes, and stress management isn’t always top of mind. We often forget to schedule a time to check in with ourselves with so much on our daily calendar. Put some relaxing “me time” on your calendar once a day. Whether that’s listening to a podcast, reading a book, taking a bath, a quick walk, or cooking yourself a nice meal, try to spend 15-30 minutes each day enjoying something that makes you happy and put the to-do lists out of mind. Make time for yourself and fit it into your schedule so, at the end of the day, you took that time to relax and breathe. 

Move Your Body 

One of the most effective ways to calm your mind is to move your body. If you’re mindlessly scrolling through your phone or struggling to get out of bed, your mind has plenty of time to run through your mental checklist of to-dos and other life triggers. When you exercise, your mind must focus on the movement, mainly so you don’t trip over your own feet. It’s difficult for your mind to wander when following a workout video, listening to a podcast on a walk, or playing a sport with friends.

Not only is exercise a great distraction, but it can increase the production of the brain’s feel-good chemical called endorphins, which can naturally improve your mood. You don’t need to go wild and take up CrossFit to feel the benefits. A simple 15-minute walk with a friend can make a world of difference. 

How to manage stress

Be Kind To Yourself 

Be kind to yourself. It might feel like it’s easier said than done but try your best to listen to your inner cheerleader and ignore your inner critic. The time you spend telling yourself that you can’t complete your tasks in time, that you won’t answer the interview questions right, that there’s no way you’ll make your flight will never positively impact the outcome. While stress is normal, you’ll have difficulty remembering a situation when worrying about something repeatedly made the outcome any different. 

It’s important to note that your feelings are valid no matter what is stressing you out. You, along with your fellow humans, have just endured one of the most challenging years in the last century. Identifying stress is the first step to effective management. While these tips are helpful, it is always beneficial to seek professional help before your stress levels get out of control.

Balance Training For Seniors and Older Adults

Balance Training: A Better Way To Prevent Falls

A balance training guide for seniors, older adults, and their family members. Learn what conditions affect balance and coordination, ways to identify a fall risk, and how physical therapy can improve everything from stability to sensory orientation.

Improve Balance and Coordination At Physical Therapy


Balance and coordination tend to decline as a person ages. Luckily there are things you can do to improve balance, reduce fall risks, and improve the overall quality of life. Being physically active is always a great first step when it comes to improving your overall health. It can also be necessary to seek specialized care for a custom balance training program as health declines.

Balanced Physical Therapy helps senior and older adult patients improve balance, control and coordination. Patients are less likely to fall and suffer from injuries when they have

  • Increased Overall Independence
  • Reduce Fear of Falling
  • Improved Coordination
  • Faster reaction Time
  • Stronger Bones
  • Increase Walking Speed
  • Improved Muscular Function
  • Improved Cognitive Function

Seniors and older adults often experience a decline in motor and cognitive functions. Balance is strongly affected and daily activities such as cleaning, exercising, and getting dressed can become more difficult in a short time.

Knee Stability Exercise

What conditions affect balance in seniors and older adults?


The American Family Physician attributes gait and balance disorders to seven different types of medical conditions including:

Affective Disorder and Psychiatric Conditions

    • Depression
    • Fear of Falling
    • Sleep Disorders
    • Substance Abuse

Cardiovascular Disease

    • Orthostatic Hypotension
    • Coronary Artery Disease
    • Congestive Heart Failure
    • Arrhythmias

Infectious and Metabolic Diseases

    • Diabetes Mellitus 
    • Obesity
    • Hyper and Hypothyroidism
    • HIV-associated neuropathy
    • Vitamin B12 deficiency

Musculoskeletal Disorders

    • Gout
    • Lumbar Spinal Stenosis
    • Osteoarthritis
    • Osteoporosis
    • Muscle Weakness and Atrophy
    • Podiatric Conditions
    • Cervical Spondylosis

Neurological Disorders

    • Dementia
    • Parkinson Disease
    • Stroke
    • Vestibular Disorders
    • Multiple Sclerosis 
    • Myelopathy

Sensory Abnormalities

    • Hearing Impairment
    • Peripheral Neuropathy 
    • Visual Impairment


    • Other Acute Medical Conditions
    • Recent Hospitalization
    • Recent Surgery

How To Know If Someone Is a Fall Risk


A person who is a fall risk can often show signs and symptoms before having an accident. The best way to keep track of age-related balance issues is to be consistent and active when going for yearly checkups. It is extremely important to always report falls and near falls to your physician. Your primary care physician can help monitor your overall health and identify fall risks as they present themselves.

In addition to seeing your primary care physician on a regularly, it can be useful to know and watch out for some common signs of a balance deficit among friends and family. These include

  • A person having a difficult time getting up from a chair. This can indicate a weakness in the glutes, quadriceps, hamstrings, or hips.
  • A person who has a difficult time walking. Someone who tends to reach out for support on furniture or walls.
  • Near falls or someone who would have fallen if they had not caught themselves.
  • Someone taking pain medication or sleep aids. Some medications can cause dizziness, drowsiness, and balance issues.
  • Dizziness when standing up from a sitting or laying position.
  • Foot, knee, or hip pain that leads to an abnormal or shuffling type of walk.

Why Balance Training Is Important


People that fall once, have double the chance to fall again. Studies show that one out of five falls causes seniors injuries such as broken bones or head injuries. These falls can lead to long periods of pain, lower quality of life, disability, or even death. 

Balance training under the supervision of a physical therapist is a way to promote better overall health in a safe environment. A physical therapist can help improve balance and decrease your risk of falling by implementing a training program specific to your needs.
Patients can reverse the effects of physical inactivity and overcome the fear of falling. Patients can also benefit from additional education as well as emotional support from a healthcare professional.

Physical Therapy Program for Balance and Coordination


Patients who are unsure if they require specialized balance training should consult with their primary care physician. Your doctor can prescribe physical therapy to help improve balance and coordination. 

Once prescribed, your physical therapy program will always begin with an evaluation. A physical therapist will conduct a fall-risk assessment to better understand risk factors such as vision, mobility, transfers, daily activities, environment, and nutrition. Patients can also ask questions, discuss their goals, and express any concerns during the assessment.

Based on your current health your therapist will create a balance training program that is fit for your needs. Our therapists are experienced in modifying most therapy techniques to best suit your condition and to properly challenge you on a day-to-day basis.

Exercises For Balance Training


Physical Therapy exercises can be targeted to a specific physiological system or combine multiple systems to better simulate real-life activities. Certain parts of the balance training program will be geared towards motor function while other parts will focus more on cognitive improvements. Examples of these include

  • Increase stability limits
  • Improve anticipatory postural adjustments
  • Improve postural responses
  • Improve sensory orientation
  • Improve stability in gait

Yoga Ball Balance Exercise

Therapy sessions normally last about an hour and begin with a warm-up such as riding a bike, marching in place, or stretching. After warming up patients often train using therapy balls, uneven surfaces, body weight, and resistance training. A therapy session will conclude with stretching, massage, and a cool-down period. Not every appointment will be the same, in fact, they often differ to properly progress while keeping things interesting and fun.

At Balanced Physical Therapy, we pride ourselves on providing every patient with the expertise they deserve. Each patient is treated by a DPT for their entire session, avoiding any issues that may arise when working with assistants or techs. Your therapist will always be by your side and we encourage all our patients to ask questions and issue any concerns whenever at any point of your appointment.

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Improve Post-Op Recovery with Prehabilitation

What is Prehabilitation?

Prehabilitation, or “Pre-hab”, is a proactive measure for patients scheduled for orthopedic surgeries. A surgeon or primary care physician will often prescribe patients “prehab” to help prepare them for physical and lifestyle changes associated with surgeries.

Studies show that patients who move better, feel better, and feel stronger tend to do better. This article can be useful for patients considering or expecting orthopedic surgery. You can also find some specific tips at the end of each section about some common spine, knee, shoulder, and foot surgeries.


What are the benefits of prehabilitation?

‍Patients who attend physical therapy before surgery can improve physiological, mental, nutritional, and lifestyle health. Orthopedic surgery can be thought of as a marathon, meaning the preparation put before actually running the race will ultimately help your overall performance during and after it.

Physical Therapy Before Surgery

Tip #1: Timing, Type, Setting, and Costs

When considering a prehab program prior to surgery, important things to consider are timing, type, setting, and costs.  

The U.S Department of Health and Human Services published a study related to patient outcomes of major joint replacement surgeries (Total Knee Arthroplasty (TKA) and Total Hip Arthroplasty (THA). The evidence showed that when your rehabilitation occurs (timing), what the training consists of (type), where your rehab occurs (setting), and out-of-pocket or insurance costs are the most important things to consider for patients, surgeons, and therapists.

Physiological benefits of prehabilitation

If your surgeon has prescribed physical therapy prior to surgery, you can improve the function, strength, and conditioning of your body many weeks ahead.  A physical therapist can evaluate you and come up with a treatment plan that includes aerobic exercise, strengthening, and stretching, and pain management.

Improve Recovery After Knee Replacement

Studies show aerobic exercises such as low-impact cycling or walking as an effective nonpharmacological option for patients undergoing total joint replacements. Patients can often expect a decrease in pain symptoms, joint tenderness, and better overall function for daily activities.

Tip #2: Getting Prehab

The best way to get started with prehab is to work individually with a physical therapist.

If you are dealing with insurance issues and the number of appointments available, we recommend talking with your doctor, surgeon, or local physical therapy clinic. They may be able to direct you to some free prehab education classes or come up with a treatment plan that can be done at home.

Mental benefits of prehabilitation

‍Mental health is one of the most important and often overlooked aspects of orthopedic surgery. It is natural for patients to feel stressed and anxious before surgery. Attending physical therapy can be extremely useful to help get you prepared mentally and feel confident.

Tip #3: Make use of downtime

It is common for patients to wait multiple weeks before entering the operating room, this time can be used to get acquainted with your physical therapy clinic, your therapist, and surgical procedure. Learning how to modify daily activities, transferring positions, and using crutches or walkers can help reduce your hospital stay and home care costs.

Nutritional support from prehabilitation

Nutrition plays an important role when recovering from orthopedic surgery. Physical Therapists can assist you with fine-tuning your diet to improve blood circulation, manage glucose uptake and insulin resistance while reducing oxidative damage to blood vessels.

Daily Nutrition For Orthopedic Surgery

Tip #4: Avoid high-fat meals

Adults expecting an orthopedic surgery of any kind diets should limit fat intake to less than 35% of their daily calory intake. A high-fat meal close to surgery can increase the risk of blood clots and inflammation at the surgical site.


Lifestyle support from prehabilitation

Physical therapy can help patients adjust to various lifestyle changes associated with surgery recovery. Helping you prevent fall-related injuries, work from home tasks, and things like sleeping or showering.

Tip #5: Home Preparation For Knee and Hip Surgery

Move things you use frequently above waist level, prepare food ahead of time, and make sure your bed, armchair, car, and toilet seat are at safe levels before you leaving the hospital.

Question about Prehabilitation?

Balanced Physical Therapy is dedicated to providing everyone an equal opportunity for a full recovery. Contact us with any questions you have about insurance, treatments, and the rehabilitation process.