Physical Therapy

As physical therapists, you can think of patient discharge in two different ways:

1. A celebration!  A time to praise for hard work, to reminiscence about how bad patients were when arrived but much better now, and a time to check off long term goals.

2. Termination!  An ending of care, a hug to say we hope not to see you again (joking of course), a way to close out the account.  Abolishing the ease for a patient to return to us if needed.

In all reality, we know that symptom reoccurrence is high.  Up to 70% in most spinal conditions.  Why do physical therapists make it harder for patients to return to us by discharging them?  We all realize that coming to us first for spinal conditions reduces costs, improves out of work days and overall is more effective treatment of choice.

In this day and age, patients are still limited in how they can access a physical therapist.  Some states do not have Direct Access and others are very restrained.  In the state of VA, if I have seen a patient who was referred to me 90 days ago for, say back pain, then I cannot see them again without a referral.  The patient knows the physical therapist is who they need to see, but is restricted in getting back in for relief and improved function.

So, the question comes to mind in that who can our duration of care be?   I think this is a gray area, but why not put ‘4 weeks initially and then as needed’?  We don’t need to discharge our patients, but have an open chart for them to return if the same condition arises again.  You don’t see primary care physicians, chiropractors, or even massage therapists filling out discharge papers.  Why do we?

Some food for thought.  I would like to hear your feedback. 



  1. My chiro colleague called it “releasing from active care” meaning regularly schedule (frequent) visits, but not ruling out maintenance. Some patients want maintenance, which we charge private pay, others want to get the heck out. Around the end of their care (2-3 visits to go) I always plant it in their head to call ASAP as acute conditions are more easily treated and that it can be the same or a completely different area. I also say all the local insurances no longer require a prescription and patients are happy to hear that. I know it’s different for you, hopefully that will change.

    1. Hey E.,
      Yeh I would say we can learn from our chiro friends concerning this topic. Now I don’t necessarily think everyone needs maintenance or sign up for a year contract as some Chiros do, but their is a place to have quick access to a healthcare provider when pain arises, and I agree with you; when it is acute! We can try to keep people active and to perform HEP when symptoms arise, but we all know we need help sometimes.

  2. I frequently write on the plan, especially for postoperative later phase patients to progress to HEP, but have a follow up check in a month or sooner if needed, and give patients the option to call and cancel as it gets closer if they are doing well, don’t have any questions it concerns. It has worked really well and I think gives patients some reassurance that they’re not totally let go and can still see you in needed or want to ensure they’re continuo bing to progress or Dan make any modifications if needed. It’s worked great for all of us 🙂

    1. Hey Jenny! Thanks for the feedback. I will definitely keep mentioning that to my patients. Hope you and the family are doing well!


  3. Hey Harrison,

    Do you think that Danielle would mind being our subject/model for our study. We need to take some pictures demonstrating the mammillary process HVLAT for the IRB. We could take the pictures after work on Thursday or Friday. Probably will look a lot like the pictures in Dunning’s course manual. Then we need to write up the technique for the IRB. I have a camera, but your camera is probably nicer than my camera.

    Sent from my iPad.

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