You probably did not get too little physical therapy. Most people who arrive here after a course that failed had two or three visits a week for six weeks — plenty of therapy. What was missing was what happened inside those visits.
Followed closely by “they never really listened to what my problem was.” Almost everyone who comes here after a failed course of physical therapy says one of those two things, usually in the first five minutes.
They are not describing a clinic that saw them too few times. They are describing a room where the therapy happened near them rather than to them.
A patient came in not long ago after a total shoulder replacement. At his previous insurance-based clinic, he told me, there had been no stretching, no passive range of motion and no manual therapy at all. He never worked with the physical therapist. He was handed a sheet of paper and told to do the exercises, with nobody correcting him.
He knew he was compensating. He could feel himself moving badly, and nobody was watching closely enough to tell him so.
Then the clinic lost track of his insurance authorization. When he called to ask whether he had been approved to keep going, nobody could tell him. That is the point at which he started looking for somebody — anybody — who would actually help him.
Significant mobility deficits through the shoulder capsule, and a scapula that was barely moving. Neither had been addressed. For a post-operative shoulder these are not advanced findings — they are the things you look for first.
We have been working together four to five weeks now: specific joint mobilisations, hands-on manual therapy, and exercises that actually progress. His range of motion is improving and he tolerates more load. It took about a month before we saw real change — and the functional, back-to-normal-life part will take longer than that. I told him so at the start.
In a high-volume model a therapist may be responsible for several patients at once, and much of the hands-on time falls to an aide. That is what the staffing model requires, not misconduct by anyone in the room — but an experienced clinician’s hands and eyes are the treatment for a great deal of what walks in.
Some presentations genuinely need joint mobilisation, soft tissue work and passive range of motion. A stiff post-surgical shoulder is the clearest example. If that never happened, exercise alone was being asked to solve something it cannot reach.
The biggest one, and the least visible. Progressive loading is what changes tissue capacity, and it needs a background in strength and conditioning plus a clear return-to-sport or return-to-work target. Without that, exercise plateaus at bands and body weight — enough to ease pain, nowhere near enough to make it hold.
A printout is not a program. Doing the right exercise badly for six weeks builds the compensation instead of fixing it — and the patient often knows it is happening with no way to say so.
These are not exotic findings. They are basic impairments, and they turn up again and again in people who have already completed a full course of care.
Running through nearly all of them: not properly loaded, and moving with poor form nobody corrected.
Nobody benefits from a number that is not true.
You will see clinics advertise relief in three or four visits. Sometimes that is achievable. Often it is not — and the harder thing, the thing that does not market well, is telling a patient honestly that this will take longer and here is what has to improve along the way. I would rather say that at the evaluation than have you find out at visit four.
Sometimes there is more going on than the tissue. Stress and other biopsychosocial factors genuinely affect the pain experience, and where that is a significant driver it is worth involving your primary care physician and, where appropriate, a behavioural health specialist. That is not a dismissal and it is not a hand-off — physical therapy can still be very much indicated at the same time.
And sometimes the previous clinic did nothing wrong. Not every patient gets better, and not every failure is a failure of care. Often what was missing was the explanation — nobody made clear what was being worked toward, how long it would take, or what would have to change along the way.
A word on home programs, since people arrive expecting to be told off about them. A home program only works if it is short, specific and actually yours. I give three or four things — a couple for mobility, a couple for strength, depending on the person — and I change it every week as you progress. If your last program was a long printout you never understood, not doing it was a reasonable response.
Most people who arrive after a failed course of care believe they cannot — that this is age, or a bad back, or just how they are now. In most cases that is not true. It is what happens when someone has had a lot of therapy that was not specific to them.
The other belief worth dismantling: many patients have been told that doing more will make it worse, and have built their lives around avoiding movement. Usually the opposite is true. What is needed is gradual, progressive, properly coached loading — and being afraid of it is itself something to treat.
High-volume care is built to see as many people as possible. What gets squeezed out of it is the art of treating someone — the hands on the joint, the eye on the movement, the week-by-week judgement about what to change. Not the intent. The craft.
A full hour, one-on-one with a doctor of physical therapy, every visit. No aide, no second patient in the room, no fifteen minutes split three ways. That is not a luxury feature — it is the minimum required to put hands on a stiff joint, watch how you actually move, load you correctly and progress it, and change your program every week rather than at discharge.
An evaluation is $150 and every price is published. In Texas you can be seen for 30 consecutive calendar days without a physician referral.
In most cases the problem was not the number of visits. People who arrive at Solas PT after a failed course of care have usually had two or three visits a week for six weeks. What was missing was the content of those visits — hands-on manual therapy where it was indicated, loading that actually progressed week to week, and someone watching and correcting how they moved rather than handing over a printout.
A course of care can be high in volume and still never address the thing that is wrong. The most common gaps are basic and specific: a shoulder capsule that was never mobilised, a scapula that does not move well, hip abductor weakness driving knee pain, or a low back that was never built up to tolerate load. Volume does not substitute for a targeted approach.
In a high-volume clinic a therapist may be responsible for several patients at once, and much of the hands-on time falls to an aide or technician. That is what the staffing model requires rather than misconduct by anyone in the room. But an experienced clinician's hands and eyes are the treatment for a great deal of what walks in, and there is a floor below which that substitution stops producing change.
It is common, and it is not the same as a program. Doing the right exercise with poor form for six weeks reinforces the compensation instead of correcting it, and patients often know it is happening without being able to say so. A home program should be short, specific to you, and adjusted as you progress.
Progressive loading is what changes tissue capacity, and it requires a background in strength and conditioning plus a clear idea of what you are returning to. If the hardest thing you did in your last course of care was a resistance band or body weight, the loading stage very likely never started. That is enough to reduce pain and not nearly enough to make the result hold.
It depends on the problem. Acute injuries can improve within a few days to a few weeks. Subacute problems typically take six to seven weeks. Chronic conditions take longer, because there are movement dysfunctions to address on top of the original injury. Clinics that advertise relief in three or four visits are sometimes right and often not.
Usually, yes. Most people who arrive after a failed course believe they cannot get better, and in most cases that is not true — it is what happens after a lot of therapy that was not specific to them. A thorough evaluation identifies what was missed, and treatment is built around that rather than around a generic protocol.
That is worth knowing, and it is usually not laziness. A home program only works if it is short, specific and genuinely yours. Dr. Cisneros gives three or four things — a couple for mobility, a couple for strength, depending on the person — and changes them every week as you progress. A long printout nobody explained is a reasonable thing not to have done.
Usually the opposite is true. Many patients have been told to avoid movement and have built their lives around that, which is itself something to treat. What is needed is gradual, progressive, properly coached loading. Fear of movement under load is common after a course of care that never progressed, and it responds to being coached rather than avoided.
Not always. Stress and other biopsychosocial factors genuinely affect the pain experience, and where they are a significant driver it is worth involving your primary care physician and, where appropriate, a behavioural health specialist. That is not a dismissal, and physical therapy can still be very much indicated at the same time.
No. Texas direct access allows a physical therapist to evaluate and treat you for 30 consecutive calendar days without a physician referral. If care needs to continue past that window, a referral is required, and Solas PT will tell you before you get there.
A full 60-minute evaluation is $150, one-on-one with Dr. Andrew Cisneros, PT, DPT, MS. Every price is published on the pricing page. Solas PT does not bill insurance, and a superbill is available on request for out-of-network reimbursement.
Book an evaluation and you will get a straight answer about what your last course of care did not address — and an honest one if the answer is that you need something other than physical therapy.