Choosing a physical therapist: the questions to ask and what a one-on-one hour changes

What to look for, in short

Choose a physical therapist who holds a current Texas license, examines you thoroughly before treating, explains the findings in words you can repeat, tells you what will be measured and when it should change, and spends most of each session with you personally. Ask how long sessions are and how much of that time is one-on-one with the licensed therapist, because that single answer explains much of the difference between practices. A full hour with one clinician lets examination, hands-on treatment and loading happen together, which tends to mean steadier progress and fewer total visits.

I am Dr. Brent Lockett, a Doctor of Physical Therapy with a post-doctorate Diploma in Osteopractic, and I run Osteopractic Physical Therapy & Pain Relief in North Dallas. Many of the people who come to me have already been through physical therapy somewhere else. Their problem was rarely the profession. It was usually the format. This guide is the checklist I would give a friend.

Check the license first

Physical therapists in Texas are licensed by the Texas Board of Physical Therapy Examiners, which shares a state agency, the Executive Council of Physical Therapy and Occupational Therapy Examiners, with the occupational therapy board. Its website has a Look up a License tool, which also leads to disciplinary actions, and a page for filing a complaint. Search for the person you will actually see, by name. You are confirming that the license is active and that nothing on the record needs a question.

While you are there, find out who will treat you. Some practices have several therapists and assistants, and the person who evaluates you may not be the person who treats you on later visits. In my practice, every session is with me, so there is only one name to check.

Online reviews are worth reading after the license check, but read them for specifics rather than stars. Look for mentions of how much time the therapist spent, whether the explanations made sense, whether people were taught what to do at home, and whether the problem stayed better. A review that describes the process tells you more than one that only says the staff were friendly.

Ask how the hour is actually spent

This is the question most people never think to ask, and it matters most. In many insurance-based settings, reimbursement rates mean a therapist sees more than one patient in the same hour. You might get a short stretch of hands-on time, then exercises supervised by an aide or done on your own while the therapist moves between patients. That is economics, not a lack of skill or care, and it suits some straightforward problems.

For problems that have lasted, keep coming back or involve several areas, the format often becomes the bottleneck. Ask any practice these questions and listen to the answers:

• How long is a session?
• How much of it is one-on-one with the licensed physical therapist?
• Will I see the same therapist every visit?
• Who supervises my exercises, and are other patients being treated at the same time?
• Is anything charged separately from the session?

What a full one-on-one hour changes

Every session in my practice is 60 minutes, one-on-one with me, never handed to an aide. That changes more than comfort. Hands-on treatment such as manipulation or dry needling opens a window: the joint moves further, the guarding drops. Loaded movement in the same hour uses that window, so the change has something to hold it. When the two are split across different staff or different days, the window often closes before it is used.

A full hour also means assessment never stops. I can see how you respond to a technique and change course within the session, rather than discovering at the next visit that something did not work. And continuity matters: the clinician who remembers exactly how your shoulder moved last week notices change, good or bad, sooner. Together, those are the main reasons a one-on-one model tends to reach the same result in fewer sessions, which I explain in how many physical therapy sessions it takes.

The examination should come before the plan

Nobody should hand you a plan before examining you. A good first visit includes a detailed history, screening questions for problems that belong with a physician, and a hands-on examination that looks beyond the painful spot: the joints above and below, strength side to side, and a neurological screen if anything travels into an arm or a leg.

Then you should hear the findings in plain language and agree on what will be measured. If you want to know exactly how I run that first hour, read what happens at a first physical therapy appointment. Notice, too, whether your questions are welcomed. A clinician who is comfortable being asked how they reached a conclusion is usually one who reached it carefully.

Ask, too, how often the plan is reassessed. The same measurements taken the same way every few visits turn progress into a comparison rather than a feeling. If nothing measurable has moved after a sensible period, a good therapist changes the plan or refers you on, and says so without being asked.

Training beyond the degree

Every licensed physical therapist has a professional degree; many now hold a Doctor of Physical Therapy. What varies is the post-professional training, and it is fair to ask about it, especially if a practice offers specific techniques. For dry needling, the American Physical Therapy Association notes that physical therapists complete additional post-professional education and hands-on training specific to the technique where state law allows it.

My own training: a Bachelor of Science in Biology from Baylor University, a Master of Physical Therapy from the University of Mary, a Doctor of Physical Therapy from Texas Woman's University, and post-doctorate residency training for a Diploma in Osteopractic, which covers spinal and extremity manipulation, dry needling, instrument-assisted therapies and differential diagnosis. I am certified in dry needling, spinal manipulation and blood flow restriction therapy. Credentials do not guarantee a good fit, but they tell you what tools are available.

Red flags worth noticing

Most physical therapists are conscientious. Still, a few patterns are worth slowing down for, whoever you are considering:

• A plan or package recommended before any examination
• Most of each session spent on exercises you could do alone, with little contact with the therapist
• A different clinician every visit, with no one who knows your history
• No clear answer about what is being measured or when it should change
• Passive treatment only, with no exercise or home program
• Promises of a cure or a guaranteed result
• No discussion of when you would be referred to a physician

Match the practice to the problem

Not every problem needs the same kind of practice. If you have strong in-network benefits and a straightforward problem, an in-network clinic may be a sensible choice, and I would tell you that at a discovery visit. If you need very frequent visits for months, such as after a major joint replacement, insurance coverage can make a large difference.

A one-on-one practice tends to suit people whose pain has outlasted standard care, who want manipulation, dry needling or blood flow restriction training as part of the plan, who value fewer, fuller sessions, or who need flexibility about where they are seen. If you are still deciding between a physical therapist, a chiropractor and a massage therapist, my guide on which one fits your back or neck pain may help.

Practical fit matters as much as clinical fit. A plan works only if you can get to the appointments, so think about location, parking, appointment times and whether the practice can see you at home, at the office or by video when a week gets busy. The best therapist on the wrong side of town at the wrong time of day is the one whose plan you abandon.

Cost, insurance and the honest comparison

When you compare prices, compare the whole episode of care, not one visit. A shorter visit with a small copay can still cost more in total if it takes many more visits, or if your deductible means you pay the full allowed amount anyway. My practice is out of network: you pay directly, receive a superbill after every session to file with your insurer for possible reimbursement, and can call for current pricing. I walk through deductibles, superbills and health savings accounts in what physical therapy costs in Dallas.

Whatever you choose, the right practice is the one whose plan you will finish. Ask about cost up front, and expect a plain answer before anything starts.

Meeting me before you decide

The easiest way to judge any physical therapist is to talk to them. With me, that starts with a free discovery visit, a short, no-obligation conversation in the clinic or by video about what is going on, what you have tried and whether my approach suits your problem. If it does not, I will say so and suggest where to go instead. No physician's prescription is needed.

If we go ahead, every session is 60 minutes with me, at the clinic on North Central Expressway or at your home, office or gym, with telehealth when it fits the plan. For recurring back or neck pain in particular, my guide to pain that keeps coming back explains how I approach it. Bring the questions from this guide; I would rather answer them than have you wonder.

Questions people ask me