Sixty minutes
What happens in the first hour
Mostly questions, then an examination aimed at reproducing your problem rather than cataloguing your body, then a plan with a number of visits attached to it.
The half you were not expecting
The first appointment is mostly talking, and people are frequently surprised by how much of it. What you cannot currently do, when it started, what makes it worse, what makes it better, what you have already tried, for how long, and what happened when you stopped.
That is not preamble. The examination that follows is only as good as the questions before it, because the point of the examination is to test a small number of specific ideas rather than to measure everything about you. A clinician who examines without a hypothesis finds a great deal of irrelevant stiffness.
Some of the questions will seem to have nothing to do with your knee. Weight, night pain, fever, bladder and bowel changes, previous cancer. That is the screening, it takes two minutes, and it is the part of direct access that the law's three-year experience requirement exists to protect.
The examination
Aimed at reproducing your problem. If we can make it hurt in a way you recognise, and then make it better, we know a great deal more than we did — so you will be warned that this is coming rather than surprised by it.
Then measurements. Not a pain score out of ten: the actual tasks. How far you can reach, how many times you can stand up in thirty seconds, how far you can walk before it starts, whether you can get your socks on. Those get written down, and they are what we repeat at visit four.
What you leave with
An explanation of what we think it is, in words rather than in jargon. An estimate of how many visits it should take and what would change that. Three or four exercises with the sets, the load and the days written down. And a clear statement of what would make us stop and send you to a physician instead.
In order
From booking to discharge
You book a slot, or you telephone
Sixty minutes, with a named clinician, at a time on the calendar that is genuinely free — the booking page shows each therapist's own diary rather than a generic grid. You do not need a doctor's referral to start, unless the claim is Workers' Compensation, No-Fault or Medicare, in which case you do from the first visit. If you are not sure which of those you are, telephone and we will work it out with you before you book.
The first visit is mostly questions
What you cannot do, when it started, what makes it worse, what you have already tried and what happened. Then an examination aimed at reproducing your problem rather than at cataloguing your body. You will leave the first appointment knowing what we think it is, what we think the course looks like, and what would make us change our mind.
You get a number of visits, at the start
An estimate, in writing, of how many appointments this should take and what it means if it has not moved by then. Every condition page on this site publishes that range too, before you contact anybody. An estimate can be wrong and we will tell you when ours is; what it cannot be is absent, because an open -ended course is how a plan of care becomes a subscription.
Most of the work happens when you are not here
Three or four exercises, written down, with the sets, the load and the days. This is the part that actually changes tissue, and clinic time exists to make it possible and to check it is being done correctly. A programme of eleven exercises is a programme nobody completes, which is why you will not be given one.
We reassess at visit four, not at visit ten
The same measurements taken at the first visit, repeated. If they have moved, we carry on and progress the load. If they have not, we change the plan or we send you back to a physician — and we say which, plainly, rather than booking another block and hoping. Direct access here also runs out at ten visits or thirty days, so this conversation happens well before the law forces it.
You are discharged, on purpose
With the programme that got you here and the version that keeps you there. We do not schedule maintenance appointments for people who no longer need treatment, and we do not sell blocks of visits in advance — the sentence “you are better, stop coming” has to be free to say.
Bring these
What to bring, and what not to bother with
Clothes you can move in
Shorts for a knee or hip, a vest or loose t-shirt for a shoulder or neck. There is somewhere to change.
Your insurance card
Though we will have verified the benefit before you arrive and told you the copay.
Imaging reports
The written report. Not the discs — we read reports and do not formally interpret images.
A referral, if one of the three
Workers' Compensation, No-Fault or Medicare. All three need one from the first visit.
Your medicines
A list is fine. What you take affects what we recommend and occasionally what we screen for.
A list of what you cannot do
The actual tasks. This is what the hour is mostly about and it is worth five minutes' thought beforehand.
Asked most often
The first visit — frequently asked
How long is the first appointment?
Sixty minutes, like every appointment here. Most of it is history and examination rather than treatment, though you will normally leave having been treated and with something to do at home.
What should I wear?
Something you can move in, that gives access to the part that hurts. Shorts for a knee or a hip, a vest or a loose t-shirt for a shoulder or a neck. If you are coming straight from work we have somewhere to change.
Will I be given exercises on the first day?
Almost always, and there will be three or four of them rather than eleven. A programme nobody completes does nothing, and eleven items is how you get one. They will be written down with the sets, the load and the days.
Will it hurt?
The examination may reproduce your symptoms, deliberately, because that is how we find out what is producing them — and we will tell you before rather than after. Treatment itself is uncomfortable in the first fortnight for a fair number of conditions, particularly tendon problems, and you will be told that in advance along with the rule for what would be too much.
Do I need to bring my scans?
Bring the written report if you have one. We do not need the discs and we do not formally interpret images — we read the report, examine you, and tell you honestly whether the two tell the same story. Frequently they do not, and that is a useful conversation rather than a disappointing one.
What will I know by the end of it?
What we think it is, what we think the course looks like in number of visits, what would make us change our mind, and what to do between now and the next appointment. If we think physical therapy is not the right treatment, you will know that too, and we will not bill you for the visit.
When to stop and see a physician the same day. Some things are not ours to treat, and the useful skill is recognising them quickly. Unexplained weight loss, night pain that does not change with position, fever with back pain, a sudden change in bladder or bowel control, progressive weakness, a history of cancer with new bone pain, or trauma with a suspected fracture all mean we stop and send you to a physician the same day. We would far rather make that call ten times unnecessarily than miss it once.
How a visit turns into units on a bill. Physical therapy is billed in fifteen-minute units of hands-on time, and Medicare's eight-minute rule decides how many: add the timed minutes, divide by fifteen, and add one more unit if eight or more minutes are left over. That rule is why the difference between a busy hour and a padded one is visible on the bill if you know where to look. Ask us for the codes on any visit and you will get them, along with what was actually done in each unit.
Sixty minutes, one to one, with the therapist you chose
Book an appointment
The booking page shows each therapist's own diary rather than a generic grid, so a slot you can see is a slot that is genuinely free. Most people do not need a doctor's referral to start — New York's direct access law runs to ten visits or thirty days — though Workers' Compensation, No-Fault and Medicare each need one from the first visit. If you are not sure which of those you are, telephone and we will work it out before you book.