“Try PT First” is a tagline we all live by. As PTs, we know that many conditions can be improved with our skill set. Sometimes, though, we see patients whose structure is so significantly impaired that we can make only a negligible change. Total joint replacement is one example. Fortunately, these are highly successful surgeries, and PTs see patients regain a significant amount of mobility afterward.

The Case for Prehab

We often hear the word prehab, in the literature and in conversations with patients. The idea behind any prehab program is to improve the patient’s range of motion and strength before surgery, with the goal of improving post-operative outcomes. It makes sense to any healthcare professional and patient: the better you go in, the better you come out, right?

As a treatment, prehab is safe, with little to no harm. The patient gets a head start on rehabilitation, gets to know their therapist and learns what to expect after surgery. Interventions may also overlap before and after surgery, which suggests patients may adapt more easily post-op. Sounds good to me, but is there evidence to support it?

What the Updated Guideline Says

An update to the clinical practice guideline for PT management of total knee replacement was recently published in Physical Therapy (PTJ). In its section on prehabilitation, the authors found strong evidence that prehab has a positive short-term effect after surgery on strength, function and pain, though they noted the evidence was not completely definitive.

There was little evidence on whether prehab affects hospital stay, readmission or revision rates. The prehab programs studied also varied widely in amount of exercise, length and exercise selection.

Image spot (optional): therapist measuring knee range of motion

Weighing Benefit and Harm

When benefit and harm are weighed, prehab comes out on top in my mind. There is little risk to the patient when PTs take objective measures, actively listen to their patients and set appropriate exercise doses. Most prehab patients come in for only a few visits before surgery, and in the current insurance landscape, visits are valuable, so economic factors must be weighed as well.

Closing Thoughts

Prehab is safe and can be effective in the short term. As always, we must consider patient factors, especially current physical status, access to PT and insurance limitations.

As physical therapists, exercise is a vital part of our practice. We are the movement experts! With that in mind, dosing the intensity of our exercise interventions effectively should be a priority.

Why We Prescribe Isometrics

Isometrics are a widely prescribed type of muscle contraction, with several benefits described in the literature:

• Safely loading tissue, such as in post-operative patients
• Preserving muscle tissue and avoiding atrophy
• A proposed analgesic effect, leading to less pain while still loading tissue

One downside of isometric contractions can be patient specific. Explaining isometric contractions and having patients perform them effectively can be a challenge. I’ve often seen patients use compensatory motions, or push so hard I fear they’ll put a hole in the wall.

What the Research Found

A recent article in Orthopaedic Physical Therapy Practice (OPTP) explored how accurately people can estimate their maximal voluntary isometric contraction percentage (%MVIC). Sixty-seven subjects performed isometric shoulder abduction at different %MVIC levels, and the actual force produced was measured with a handheld dynamometer.

The findings generally showed that subjects undershot or overshot the target %MVIC. Speaking from experience, this is no surprise.

Image spot (optional): isometric shoulder exercise against resistance

What This Looks Like in the Clinic

In my experience, isometric contractions performed by patients tend to be “failed” concentric contractions. In other words, patients try to perform a motion and fail, creating an isometric contraction. This often leads them to overshoot the target %MVIC.

Patients can also undershoot. One example I see often is shoulder external rotation after a rotator cuff repair. Patients often use compensatory motions such as supination or abduction to complete the movement, producing less than the desired %MVIC.

So What Do We Do?

With this information, what should we do as PTs? Stop prescribing isometrics? Change our cues? Use handheld dynamometers to be accurate?

Osteoarthritis (OA), a wearing down of the joints, can be debilitating. The pain and stiffness that come with OA can limit everyday activities such as walking, going up and down stairs, squatting, doing housework and playing sports. OA can follow a previous surgery or injury, but it is often a result of aging.

What Can Be Done for Osteoarthritis?

The good news is there are several treatment options. Today we’ll look at exercise.

People with OA commonly have weakness in the muscles around the affected joint. With knee OA, for example, the muscles in the front and back of the thigh often become weak. A large body of research shows that targeted exercise for these muscles can reduce pain and stiffness and make daily activities easier.

Why Dosing Matters

It may seem counterintuitive to exercise a joint that is painful and stiff. The key is a physical therapist who knows how to dose exercise properly. Exercise works a lot like medication: too little won’t help, and too much can do harm. The dose has to be right to get the best effect.

Image spot (optional): therapist adjusting resistance on a leg exercise

What the Research Says

A recent review looked at how the intensity of knee exercise affects knee OA. It concluded that moderate-intensity exercise is the best choice for people with knee OA.

There are other factors you and your physical therapist will consider, such as whether the joint is currently inflamed, your previous activity level and how severe your symptoms are. A thorough history tells your therapist where to start, with the goal of progressing to moderate-intensity exercise.

This article is for general education and isn’t a diagnosis or a substitute for care from a licensed provider. If your symptoms last or get worse, see a physical therapist or your doctor.

Before becoming a physical therapist, buying sneakers was simple: go into the store, see a pair you like, maybe try a few on to make sure they fit, and buy them. After PT school, the way we look at human motion changes completely, and footwear choices become much more complex.

Footwear types, flat feet versus high arches, and which brands are best could each be their own discussion. Today we’ll keep it simple: does the wrong size shoe affect the way we walk?

What the Research Found

In a study from Japan, 30 healthy adults were given shoes anywhere from 1 to 3 cm longer than their measured foot length. Researchers measured how fast participants walked and how much the joints in their legs (hip, knee and ankle) moved.

The longer the shoe compared to the foot, the more participants’ joints had to move. It also took participants longer to walk the same distance in longer shoes than in correctly fitted shoes. In other words, the longer the shoes, the more their movement changed and the slower they became.

Image spot (optional): person walking, side view

The Takeaway

Shoe size can affect how we move. Shoes that don’t fit properly can make walking harder, so fit is worth checking the next time you buy a pair.

This article is for general education and isn’t a diagnosis or a substitute for care from a licensed provider. If your symptoms last or get worse, see a physical therapist or your doctor.

Low back pain is a common and often debilitating problem. The pain is often short-lived, and in some cases it resolves on its own, but many people need treatment to find relief. Physical therapy can be an effective, practical solution that helps people avoid surgery or long-term use of medication.

Physical therapists follow research-backed treatment guidelines and make treatment decisions together with their patients. Current research suggests that a combination of exercise, manual therapy and patient education is the preferred way to treat low back pain, particularly when the pain keeps coming back (1, 2).

How Can Physical Therapists Help?

Devise an Exercise Plan

A physical therapist can recommend the exercises that are safest and most effective for the type of pain you’re having. Exercises can be done during physical therapy appointments and as part of a home exercise program. For pain that has lasted less than 3 months, exercises that target the back or abdominal muscles may be most helpful. These exercises isolate the muscles that control and stabilize the spine.

Image spot (optional): core stabilization exercise

When pain lasts longer than 3 months, general exercise such as strength training, aerobic exercise and aquatic exercise often helps relieve low back pain.

• Strength training uses weights to improve how specific muscles perform.
• Aerobic exercise uses large muscle groups and gets your heart rate up, such as running, walking or cycling.
• Aquatic exercise takes place in a pool. It is a highly effective, low-impact alternative to traditional exercise that reduces pressure on bones and joints, while the water’s natural resistance still strengthens muscles.

Pilates-based physical therapy has grown in popularity in recent years. Pilates-trained physical therapists combine the targeted and general exercises that define Pilates with their knowledge of low back pain. This combination can help people with both acute (recent) and chronic (long-term) low back pain.

Manual Therapy

Physical therapists use manual therapy techniques such as massage and joint or soft tissue mobilization. Manual therapy helps reduce pain, which lets patients exercise with fewer restrictions and makes daily activities easier.

Soft tissue mobilization includes massage techniques and myofascial release. Fascia is a layer of tissue over the muscles that can become stiff, restricting movement and adding to pain. Myofascial release addresses the stiffness that commonly comes with low back pain.

Joint mobilization is a technique in which a therapist moves a joint by hand. It can improve joint mobility and reduce pain. Physical therapists tailor these mobilizations to each patient, and they can be directed at the vertebrae to help relieve back pain.

Image spot (optional): therapist performing hands-on manual therapy

Provide Patient Education

An important part of a physical therapist’s role in managing low back pain is helping patients understand pain itself. Pain science has evolved in recent years, and studies show that physical therapy combined with pain science education can be especially helpful for chronic low back pain. Teaching patients good posture and positioning, such as how to sit at a desk or lift an object from the floor, can help ease pain or keep it from coming back.

This article is for general education and isn’t a diagnosis or a substitute for care from a licensed provider. If your symptoms last or get worse, see a physical therapist or your doctor.

Hamstring injuries are fairly common in our more active patients. The hamstrings are vital for sprinting, much more so than for regular walking. Sports with explosive movements, such as baseball, football and soccer (and of course sprinting!), can lead to hamstring injuries.

There is plenty of research on hamstring strains: the mechanics behind the injury, what to examine and how to treat it. Today we’ll look at a recent article from the September 2026 issue of JOSPT, “Timing and Dose Matter: Late High-Speed Exposure and Higher High-Intensity Acceleration Volumes Reduce Hamstring Reinjury Risk in Elite Male Football (Soccer).”

Return to Play Is Individual

With any injury, there are several factors to consider for return to play, such as level of play, training history and injury history. Talking with the coaching staff is also vital for the best transition back to play. It allows for the right dose of activity to support recovery rather than cause a reinjury.

Image spot (optional): athlete doing a hamstring strengthening exercise

What the Research Found

The article concluded that introducing higher-speed running, sprinting and high-intensity accelerations later in the rehabilitation program was associated with a lower risk of reinjury. A gradual build-up of higher-intensity exercise also led to a lower reinjury rate.

The Takeaway

When considering any patient’s return to sport or previous level of function, we must compare their individual physical demands with their current status. Rushing back to any activity without building adequate strength, and without a gradual progression of exercise tied to their movement goals, often leads to incomplete recovery or reinjury.

I’ll never forget one patient from my first year of practice. She came in with an MRI report in hand, halfway to tears. She didn’t have an appointment. She had come right off the streets of Manhattan, fresh from her visit with her orthopedist, and asked to speak to a PT for some clarity on her imaging results.

A patient had canceled, so reception called me to the front. I gave my standard line, that I was a PT and not a radiologist, but that I would take a look at her report. It said she had multiple severe disc herniations and stenosis throughout her lumbar spine.

Treat the Person, Not the Image

As I read, I noticed something. She was shifting from side to side, pacing and moving with a lot of frantic energy, which is how most of us would react to news we thought was terrible. I stopped reading and asked how she felt right now. She started jumping and squatting to show me how well she was moving. She said she had pain at times but was able to keep up her daily routine.

I reassured her that evidence shows many of us past a certain age will have findings on a lumbar MRI, and that research at the time supported treating the person, not the image. I told her about PT, and she came in for an evaluation with a colleague. By their report, she was a straightforward case! I firmly believe imaging is a powerful tool that helps countless patients, but research shows it shouldn’t fully guide our treatment.

Image spot (optional): patient moving freely during an exercise session

What the Research Found

A recent article in Physical Therapy (PTJ) explored how the severity of structural lumbar spinal stenosis relates to response to exercise-based PT. The study compared improvements in pain, disability, strength, medication use and function after PT-led exercise interventions, with patients grouped by the severity of their stenosis.

The authors concluded that patients improved by the same magnitude across all structural severities of spinal stenosis. I immediately remembered my patient, how terrified she was of her MRI and how mobile and functional she was.

How many patients avoid being active because of the harm they believe their imaging findings mean? How many never see a PT who could improve their mobility or quality of life, because they’ve been told their spine is too far gone?

What We Can Do

We can keep educating our patients, and those around us, on the importance of focused, purposeful exercise to improve their function, and help them avoid putting everything into their imaging results.