Let’s say you’ve been going to therapy for a while now. It could be Physical Therapy (PT) or Occupational Therapy (OT). You’ve been receiving treatment for a few months now, and you feel like you’re not making progress.

Should you continue?

This can be a very real dilemma many may encounter throughout their rehab journey.

If you’ve been very diligent about your therapy attendance and practice your home program, but are not making any progress, should you keep going to therapy?

Let’s consider some possible reasons as to why therapy may not be working and how to approach things if they get to this point.

Possible Reasons Why Therapy May Not be Working

There are a multitude of reasons why you may not be responding to your PT or OT sessions.

One of the first things you have to look at is if you’re being an A+ student.

• Are you practicing your home program the way your therapist prescribed it to you?

• Are you over-doing things outside of therapy?

• Are you allowing yourself to push into pain with everything you do?

• Is there enough of a recovery period between rehab sessions?

These are some excellent questions to first ask yourself if you feel like you’re not making progress with your therapy.

If you know, without a doubt, that you’re doing everything you’ve been told to do, and are still not seeing results, then the next question would be: Does your therapist need to switch things up?

Sometimes in the rehab process, your therapist may start off with a specific plan, but based on your progress (or lack of), may need to change things as you go.

For example, if you started out with a relatively low pain level, but a lot of limitations with your mobility, they may have started with a more active approach to work on these mobility issues. This could have included specific exercises to work on the stability, flexibility and strength of the area being treated. While this may have started out working well, one day you come in with more pain than normal.

Should your therapist keep doing the same thing?

Not necessarily. Your symptoms are presenting differently, so this usually calls for a different approach. Your therapist may decide you require more hands-on work that day, such as with massage or myofascial release. You may also need some additional tools and modalities, such as electrical stimulation, heat or ice.

If changing things up works, then great! If not, then there may be more to the story.

If a patient is not responding to therapy within a relatively specific time frame, then the therapist may question if there is something else going on. This could be a different diagnosis or medical condition than what the patient was referred for, or maybe the referring diagnosis is accurate, but of a greater severity than what was originally anticipated.

In a case like this, your therapist may decide to refer you back to the referring provider to re-evaluate what is going on or to have some additional imaging taken (e.g., MRI, CT scan, etc.)

These are some common possibilities as to why you may not be responding to therapy the way you anticipated you would.

Communicating with your Therapist

If you are going to have a positive response to therapy, how long should it take? At what point should you question your progress if you’re not seeing results?

While there is no exact cookie-cutter timeline that works for everyone, there are some general guidelines to consider.

Once you begin therapy, you should start seeing some kind of positive results within the first couple of weeks. This may be in the form of your pain intensity and/or frequency improving, noticing better tolerance for your day-to-day tasks, or even having a better tolerance for your therapy sessions themselves. This type of progress, of course, involves full compliance with your PT appointments and home program.

After about a month of treatment, you should definitely be noticing some type of positive improvements, similar to what was just stated above. You may not have all of your pain and mobility issues resolved by this time, but you can tell you’re on the right track.

If anywhere from a couple to a few weeks goes by and you’re not noticing any results, tell your therapist sooner than later!

Typically, at each therapy session, your therapist will ask you how you feel with regards to your symptoms and progress. Be honest with them! Don’t try to sugar coat things.

If you don’t feel like you’re progressing, or feel some aspects of therapy are working better than others, communicate this with your therapist. This gives them an opportunity to re-examine your symptoms, what is being done during treatments, and where they would expect your progress to be at that time. If they see some potential changes that could make things better, your communication gives them the opportunity to make those changes.

Even more important, if you’re describing a response to therapy that is not what would be expected, or maybe even completely opposite of what should be occurring, your therapist needs to know. This is so they can make an informed decision and determine if you need to be referred back to your medical provider.

With this approach, you and your therapist can work as a team to determine if continuing therapy is the right choice for you.

Moving Forward

To recap, here are a few things to consider moving forward with your rehab journey:

• In order to best assess your response to treatment, make sure you are fully compliant with attending therapy and doing your homework.

• If something feels more painful or uncomfortable during therapy or at home, let your therapist know immediately.

• If you feel something in particular is helping your symptoms, communicate this to your therapist.

• If you feel like, at any point, you’re not progressing as you had hoped to, tell your therapist.

Moral of the story, keep an open line of communication with your PT or OT!

They can’t help you if they don’t know what’s going on. While yes, they can assess your progress with standard objective measurements, your subjective reports regarding your progress, or lack of, are equally important.

Your therapist should always be kept in the loop. So, if at any point you are reconsidering your participation in therapy, make sure to discuss things with them so that you both are on the same page and can make an informed decision together.

In the end, make sure to talk it out!