Most of us know someone who has experienced physical therapy, whether for recovery from a car accident or a fall, rehabilitation from a surgery or as treatment for something ongoing like back pain or balance difficulties. For me, the beauty of physical therapy lies in the breadth of what it can address to help people get back to moving in safe and efficient ways.
I first found physical therapy as a patient in 2009, after a major illness and period of disability. I received intensive medical treatment, regular massage and acupuncture, ate a healthy diet and did everything possible to support my recovery. Daily physical therapy was the one part of my journey over which I had direct agency. It was how I could help myself. It was empowering to improve my health and mobility—and I was the only one who could do it.
Physical therapists are an integral part of the medical team. We aren’t the first provider you see, but often we are the one you see the most. Our job is to guide you and support you in regaining your physical abilities so you can move in your life with safety and comfort. Physical therapists “improve the way you move,” and we consider you as a whole person. Before prescribing exercises, it is important to me to know what is important to you. What do you want and need to be able to do physically? What has changed over time that prevents you from performing those activities? What logistical or psycho-emotional blocks do you face? How can we create a plan that will set you up for success?
Exercise is central to physical therapy and is prescribed with specific parameters of intensity (think speed or amount of weight), duration (length of time or number of repetitions), and frequency (how often). These factors are identified with the intent to reach and overload an individual’s threshold, meaning a current physical limit. When a physical threshold is met and exceeded slightly, a new threshold is established. This equates to tangible gains like walking for a longer distance, holding proper posture for a greater period of time, lifting and carrying more weight, having greater range of motion, and so on. Movement is also inherently analgesic.
The role of exercise in our daily mobility and safety, longevity and mental health cannot be overstated. I address four main components when prescribing exercise: strength for activities like stairs, lifting, and carrying; flexibility to have adequate range of motion for daily functional activities like gardening and physical pursuits like sports and martial arts; cardiovascular or aerobic exercise through activities like hiking, biking, and dancing; and balance to keep the body upright and stable, whether sitting, standing or doing more dynamic activities.
Exercise is not all a physical therapist has to offer. Manual therapy includes soft tissue mobilization, which can be thought of as massage with a specific intent to affect the tone and mobility of tissues, and joint mobilization, which include the application of force at specific locations and angles to increase movement at a joint. Skillful touch has healing and therapeutic qualities in and of itself. I also teach people how to perform daily tasks in ways that protect joints, including the back. This encompasses assessing and altering daily activities like lifting and carrying items safely, setting up a computer workstation to sit with a neutral spine and neck, and identifying safe and comfortable sleeping positions. I advise patients on matters concerning the use of heat versus ice, when a splint or brace is appropriate, how and when to use a cane or a walker, sustainable weight loss and more.
In addition to standard equipment I keep in my office, I recently added a beautiful piece of Pilates equipment (a reformer with extra features) that can be used by patients. Pilates is a method of exercise that can be done on a mat or with equipment that is fully adjustable and utilizes springs for resistance. Exercises can be done lying down, kneeling, sitting or standing. Pilates emphasizes alignment and neutral posture, coordination, balance and moving from what we refer to as the core—the back and abdominal muscles, which provide the stable foundation for effective movement of the limbs. Pilates is a fun (yes, fun!) and exceptionally safe way to exercise, and I’m very happy to offer it as a standalone method or as part of physical therapy rehabilitation.
I am fortunate to own West Marin Physical Therapy, the only phyiscal therapy office in West Marin. I have the autonomy to make decisions with you so that together we can determine the frequency and focus of visits rather than being limited by a corporate health care structure. I observe you doing exercises as opposed to having an aide take over, as often happens in other offices. I am not tied to a computer, so I can engage with you more fully when we are together rather than staring at a screen. My goal is for you to feel in control of your health, to have all necessary information and to feel as physically good as possible. Providing quality care and fostering caring, professional relationships is something I strive for as I serve my community. I welcome new and returning patients and clients in my office and look forward to working with you.
Freda Weitzer of West Marin Physical Therapy was raised and lives in Bolinas.