Your first physical therapy appointment: what happens in the hour and how to prepare

What a first visit should include

A first physical therapy appointment should include four things: a detailed conversation about your problem and your health history, a hands-on examination to find what is driving the pain, a plain explanation of the findings and the plan, and the first treatment, including exercises to start at home. Wear clothes you can move in that let the therapist reach the painful area, and bring a list of what you have tried and any imaging or physician reports. You should leave knowing what the therapist thinks is going on, what will be measured and what should change by when.

I am Dr. Brent Lockett, a Doctor of Physical Therapy, and I run Osteopractic Physical Therapy & Pain Relief in North Dallas. Every session in my practice is 60 minutes, one-on-one with me, so the first appointment has room to do all four properly. This guide walks through it in order, so nothing surprises you.

Before the appointment: the free discovery visit

In my practice, care starts before the first paid session with a free discovery visit. It is a short conversation, in the clinic or by video, usually 15 to 20 minutes. We talk about what the problem is in your words, how it started, what you have tried and what you want to get back to, and I do a brief physical screen if we are together in person.

The point is to answer one question honestly: is my approach likely to help this problem? If it is not, or if what you describe belongs with a physician, I will tell you, and that conversation costs you nothing. If it is, you will know roughly what a plan would involve before you book anything. No physician's prescription is needed to start, and I explain the Texas rules in seeing a physical therapist in Texas without a referral.

How to prepare in ten minutes

You do not need to research your condition. A little preparation, though, makes the hour far more useful, because your history is the fastest route to the cause. Jot down a few notes the day before:

If the visit is by telehealth, set up somewhere with room to move, put the camera far enough away that I can see your whole body, and have a chair and a clear patch of floor nearby. For an in-person visit, arriving a few minutes early gives you time to complete the paperwork without eating into the hour.

• When the problem started and what you were doing at the time
• What makes it better and what makes it worse, including time of day and positions
• Everything you have tried, such as medication, injections, massage or other therapy, and what each one did
• Your current medications and any health conditions, surgeries or past injuries
• Imaging or physician reports if you have them; the written reports are enough
• The specific activity you want back, such as running a half marathon, sleeping through the night or lifting your toddler

What to wear

Wear clothing you can move in that gives access to the area being treated. For a knee, hip or ankle, bring or wear shorts. For a shoulder, neck or back, a tank top or loose T-shirt works well. Avoid jeans and stiff fabrics that limit how far you can bend or squat, because I will ask you to move. Skip heavy lotion on the area that day if you can, since it makes hands-on work and taping harder.

If I see you at home, at your office or at your gym, the same applies, and you do not need to provide anything else. I bring the equipment with me. If you train in particular shoes, wear them; how you move in them can be part of the assessment.

The conversation and the safety screen

The first part of the hour is talking. I want to hear the story in your words and understand how the problem affects the things you actually do. Then come questions that may seem unrelated to your knee or neck: unexplained weight loss, fever, night pain, bowel and bladder function, a history of cancer, recent falls or accidents. These are the red-flag questions, and they exist to find the small number of problems that are not mechanical and belong with a physician. MedlinePlus, the National Library of Medicine's health site, lists several of them, such as back pain after a severe blow or fall, unexplained fever and loss of control over urine or stool, as reasons to contact a medical provider right away.

If you are being treated without a physician referral, Texas law also requires you to sign a short disclosure form. Section 453.301 of the Texas Occupations Code says the form states that physical therapy is not a substitute for a physician's medical diagnosis, is not based on radiological imaging, that a physical therapist cannot diagnose an illness or disease, and that your insurance may not cover the services. It takes a minute, and it is routine.

The examination, piece by piece

The examination is where the working idea from the conversation gets tested. It is thorough on purpose, because the spot that hurts is often not the spot causing the problem. In a full neuro-musculoskeletal examination, I typically look at:

• How you move in every direction, and which movement reproduces the symptom
• The joints above and below the painful area, such as the hips and mid-back for a low back problem
• Strength, compared side to side
• A neurological screen of reflexes, sensation and specific muscle strength if anything travels into an arm or a leg
• Tissue that refers pain elsewhere, such as trigger points in a muscle
• The task you came in to get back to, broken into its parts

Findings and a plan you understand

Next, I explain what I found in plain language: what I think is driving the pain, how sure I am, and what would change my mind. Then we agree on a plan around your goals. A good plan answers four questions, and if any clinician cannot answer them for you, it is fair to ask:

This is also the moment to raise anything that will affect the plan: an upcoming trip, a race date, a busy quarter at work, or a budget. A plan that fits your real life is the one that gets finished. If you are comparing clinicians, notice whether the explanation made sense to you and whether your questions were welcomed; both tell you a great deal about the care that follows.

• What do we think is driving the problem?
• What will we measure, and roughly when should it change?
• How often will you be seen, and how will that taper?
• What will you do on your own, and what happens if progress stalls?

Treatment starts the same day

A first visit should not be an intake-only appointment. In the same hour, treatment begins where the examination supports it. That can be spinal or extremity manipulation, which restores movement to a specific joint; dry needling into a trigger point that reproduces your pain; dry cupping; or instrument-assisted soft tissue work. Nothing happens without being explained first, and nothing happens that you have not agreed to. If you would rather avoid a technique, there is almost always another way to reach the same goal.

Hands-on work opens a window: the joint moves further and the guarding drops. The loaded movement that follows in the same session is what starts to make that change hold. If dry needling is part of your plan and you are curious about it, read what dry needling is and what it feels like.

Leaving with a home program, and the next 48 hours

You will leave with a short home program of exercises and self-mobilization techniques, short on purpose so you will actually do it. Most of the change happens in the days between visits, not in the hour itself, so this part matters.

Some soreness for a day or two after a first session is common, especially after manipulation or dry needling, and it usually feels like the day after an unfamiliar workout. The National Center for Complementary and Integrative Health notes that mild side effects after spinal manipulation, such as temporary soreness, stiffness or headache, usually go away within 24 hours. Light movement helps. If your symptoms change in a way that worries you, such as new numbness or weakness, contact me or your physician rather than waiting for the next appointment. Most clients are seen once or twice a week at the start; how that changes over time is covered in how many physical therapy sessions it takes.

Booking your first visit

You can call the practice or book online. Start with the free discovery visit if you are unsure whether physical therapy suits your problem, or tell me if you already know you want a full first session. Sessions take place at the clinic at 10670 North Central Expressway in Dallas, or at your home, office or gym, and telehealth is available when it fits the plan. My practice is out of network, and you receive a superbill after every session to file with your insurer.

Bring your notes, wear something you can move in, and come with your questions. By the end of the hour you should know what is going on, what we are going to do about it and how we will know it is working.

Questions people ask me