Custom Care Physical Therapy

Physical therapy is a profession which uses an array of noninvasive interventions to decrease pain and increase function in people dealing with injury, disability, or disease.  Physical therapy not only effectively treats existing conditions, but helps prevent their recurrence.

The tools of physical therapy take a wide variety of forms, from therapeutic exercise and movement analysis, to manual therapy and manipulation, not to mention modalities like ultrasound and electrical stimulation.

More important than the tools used by physical therapists is their unique appreciation for, and observation of the human body.

  During your first visit you can expect the following:

• Arrive 10-15 minutes early to complete paperwork
• Provide us with your prescription for physical therapy, if you are coming with a physician referral.  (Not required in Oregon. Custom Care PT is “Direct Access” certified.)
• We will copy your insurance card, if you would like us to submit it for reimbursement.
• You will be seen for the initial evaluation by Aaron Frye, MSPT.
• We will discuss the following:
1. Your medical history.
2. Your current problems/complaints.
3. Pain intensity, what aggravates and eases the problem.
4. How this is impacting your daily activities or your functional limitations.
5. Your goals with physical therapy.
6. Medications, tests, and procedures related to your health.
• We will then perform the objective evaluation which may include some of the following:
1. Palpation - touching around the area of the pain/problem. This is done to check for the presence of tenderness, swelling, soft tissue integrity, tissue temperature, inflammation, etc.
2. Range of Motion (ROM) - the therapist will move the joint(s) to check for the quality of movement and any restrictions.
3. Muscle Testing - the therapist is checking for strength and the quality of the muscle contraction. Pain and weakness may be noted. Often the muscle strength is graded. This is also part of a neurological screening.
4. Neurological Screening - the therapist may check to see how the nerves are communicating with the muscles, sensing touch, pain, vibration, or temperature. Reflexes may be assessed as well.
5. Special Tests - the therapist may perform special tests to confirm/rule out the presence of additional problems.
6. Posture Assessment - the positions of joints relative to ideal and each other may be assessed.

We will then formulate a list of problems you are having, and how to treat those problems. A plan is subsequently developed with the patient's input. This includes how many times you should have PT per week, how many weeks you will need therapy, home programs, patient education, short-term/long-term goals, and what is expected after discharge from therapy. This plan is created from input from you, us, and your doctor.

Make sure you bring your physical therapy referral (if provided to you by a doctor) and your payment information. If your insurance is covering the cost of physical therapy, bring your insurance card. If you are covered by Workers' Compensation, bring your claim number and your case manager's contact information. If you are covered by auto insurance or an attorney lien, make sure you bring this information.

You should wear loose fitting clothing so you can expose the area that we will be evaluating and treating. For example, if you have a knee problem, it is best to wear shorts. For a shoulder problem, a tank top is a good choice, and for low back problems, wear a loose fitting shirt and pants, again so we can perform a thorough examination. Don't worry if you aren't sure what to wear. We have shorts, shirts, and gowns available if they are needed, and we can advise you what to wear for future appointments.

Treatment sessions typically last 45 minutes per visit, but this can be varied to help fit your schedule if need be.

This is highly variable. You may need one visit or you may need months of care. It depends on your diagnosis, the severity of your impairments, your past medical history, etc. You will be re-evaluated frequently and when you are to visit your doctor, we will provide you with a progress report with our recommendations.

More than half of all Americans are suffering from pain. Whether it is a recent episode or chronic, an ABC News/Stanford study revealed that pain in America is a serious problem. However, many do not even know that physical therapists are well equipped to not only treat pain but also its source.

Physical therapists are experts at treating movement and neuro-musculoskeletal disorders. Pain often accompanies a movement disorder, and physical therapists can help correct the disorder and relieve the pain.

For many patients, one of the primary objectives is pain relief. Movement often provides pain relief once we have determined the proper corrective motion(s) for you. Pain relief is also possible with hands-on techniques, modalities such as ultrasound, electrical stimulation, and/or heat or cold therapy.  We will provide you with the appropriate exercises not only for pain relief but to recover range of motion, strength, and endurance.

In some cases, physical therapy techniques can be painful. For example, recovering knee range of motion after total knee replacement or shoulder range of motion after shoulder surgery may be painful. We will utilize a variety of techniques to help maximize your treatment goals and cause you a little discomfort as possible. It is important that you communicate the intensity, frequency, and duration of pain to us. Without this information, it is difficult for us to adjust your treatment plan.

There are dozens of different types of treatment interventions. A more detailed list of our most commonly used treatments and modalities can be found on our Techniques page. Here is a list of possible treatment interventions:

Active Range of Motion (AROM) - the patient lifts or moves a body part through range of motion against gravity. AROM is usually one of the first modalities prescribed for arthritis.

Active Assistive Range of Motion (AAROM) - therapist-assisted active range of motion. This is usually prescribed for gentle stretching or strengthening for a very weak body part.

Stationary Bicycle - with or without resistance. This is usually prescribed for improving the strength and/or range of motion of the back or lower extremities as well as cardio-vascular endurance.

Gait or Walking Training - the analysis of walking problems by visually examining the interaction of the low back and the joints of the thighs, legs, and feet during the various stages of walking, including initial contact, loading response, mid stance, terminal stance, pre swing, mid swing, and terminal swing. Many back, thigh, leg, ankle, and foot problems may be caused by or manifest themselves in subtle gait abnormalities.

Isometrics - muscle contraction without joint movement. This is usually prescribed for strengthening without stressing or damaging the joint (e.g., arthritis, or exercises to be performed in a cast, or right after surgery if recommended by the therapist/doctor).

Isotonics- muscle(s) contracting through the ROM with resistance. This is usually prescribed for strengthening.

Soft Tissue Mobilization - therapeutic massage of body tissue, performed with the hands. Soft tissue mobilization may be used for muscle relaxation, to decrease swelling, to decrease scar tissue adhesions, and for pain relief.

Mobilization - hands-on therapeutic procedures intended to increase soft tissue or joint mobility. Mobilization is usually prescribed to increase mobility, delaying progressive stiffness, and to relieve pain. There are many types of mobilization techniques including Maitland, Kaltenborn, Isometric Mobilizations, etc.

Proprioceptive Neuromuscular Facilitation (PNF) - a system of manually resisted exercises performed in diagonal patterns that mimic functional movements. PNF was initially used in developmentally and neurologically impaired patients but now is used in almost every aspect of neuromuscular retraining from athletes in sports facilities to the very weak in hospitals and nursing homes.

Posture Training - instruction in the correct biomechanical alignment of the body to reduce undue strain on muscles, joints, ligaments, discs, and other soft tissues. There is an ideal posture but most do not have ideal posture. Therapists educate patients about the importance of improving posture with daily activities. Stretching and strengthening exercises may be prescribed to facilitate postural improvement and to prevent further disability and future recurrences of problems.

Progressive Resistive Exercises (PRE) - exercises that gradually increase in resistance (weights) and in repetitions. PRE is usually prescribed for reeducation of muscles and strengthening. Weights, rubber bands, and body weight can be used as resistance.

Passive Range of Motion (PROM) - the patient or therapist moves the body part through a range of motion without the use of the muscles that "actively" move the joint(s).

Stretching/Flexibility Exercise - exercise designed to lengthen muscle(s) or soft tissue. Stretching exercises are usually prescribed to improve the flexibility of muscles that have tightened due to disuse or in compensation to pain, spasm or immobilization.

Cryotherapy or Cold Therapy - used to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but also an effective pain reliever for even the most chronic pain. Not commonly used as a standalone treatment, we may include an icepack during E-Stim based on your personal preference.

Electrical Stimulation (E-Stim) - tiny electrical impulses can be used to decrease pain and swelling and to relieve muscle spasm. While we do not consider E-Stim to be necessary to treat all patients or conditions it can help us breakup a pain cycle that hinders more restorative forms of treatment.

Neck Traction - a gentle longitudinal/axial pull on the neck, either manual or mechanical, intermittent or continuous for relief of neck pain, to decrease muscle spasm, and facilitate unloading of the spine.

Heat - heat is recommended to decrease chronic pain, relax muscles, and for pain relief. It should not be used with an acute or "new" injury. Not commonly used as a standalone treatment, we may include an icepack during E-Stim based on your personal preference.

Iontophoresis - medications are propelled through the skin by an electrical charge. This modality works on the physical concept that like charges repel each other, therefore, a positively charged medication will be repelled through the skin to the underlying tissues by the positively charged pad of an iontophoresis machine. Iontophoresis is usually prescribed for injuries such as shoulder or elbow bursitis.

Transcutaneous Electrical Nerve Stimulation (TENS) - a relatively low voltage applied over painful areas through small self-adhesive electrodes. The electrical stimulation "disguises" or "overrides" the sensation of pain. It is a small, portable unit, used in intervals, to control pain and reduce dependence on drugs. It is usually prescribed for relief of pain. If we find that E-Stim during your treatments is helping you make it through your day we can set you up with a home-unit to take with you wherever you go.

Ultrasound - ultrasound uses a high frequency sound wave emitted from the sound head when electricity is passed through a quartz crystal. The sound waves cause the vibration of water molecules deep within tissue causing a heating effect. When the sound waves are pulsed, they cause a vibration of the tissue rather than heating. The stream of sound waves helps with nutrition exchange at the cellular level and healing. Studies have shown that ultrasound is helpful for ligament healing and clinically, for carpal tunnel syndrome, and muscle spasm.

Massage may be part of your treatment. Rehabilitation specialists are trained in a variety of techniques that may help with your recovery. Deep tissue techniques may be part of the rehabilitative process. Massage is used for three reasons typically - to facilitate venous return from a swollen area, to relax a tight muscle, or to relieve pain.

A full service massage therapist is also available within the Forest Grove Health & Fitness Clinic. Call or ask us about that as a treatment option.

Physical therapists are important members of your medical team. Custom Care PT is licensed to help patients who have not first visited a physician.  (Forty-three states have some form of direct access, and Oregon is one of them.  The State of Oregon’s certificate of authorization is issued only to licensed physical therapists practicing physical therapy.) If you do not get better within 30 days, we will discuss with you the most relevant physician referral for your condition.

Billing for physical therapy services is similar to what happens at your doctor's office. When you are seen for treatment the following occurs:

1. The physical therapist bills your insurance company, Workers' Comp, or charges you based on CPT (Common Procedure Terminology) codes.
2. Those codes are transferred to a billing form that is either mailed or electronically communicated to the payer.
3. The payer processes this information and makes payments according to an agreed upon fee schedule.
4. An EOB (Explanation of Benefits) is generated and sent to the patient and the physical therapy clinic with a check for payment and a balance due by the patient.
5. The patient is expected to make the payment on the balance if any.

If you are uninsured or would prefer to pay out of pocket at the time of your appointment we offer a 20% Time of Service (TOS) discount. This only applies if you pay by cash, credit, or check at the conclusion of each appointment. 

Some patients will need to continue with home exercises. Some may choose to continue with a gym exercise program. Others will complete their rehabilitation and return to normal daily activities. It is important that you communicate your goals to us, so we can develop a custom program for you.

Yes, Aaron maintains his license to practice physical therapy in Oregon. Physical therapists (PT's) and physical therapist assistants (PTA's) are licensed by their respective states. Current licenses should be prominently displayed within the clinic space, or available immediately upon request.

• Do you feel comfortable with, and do you trust, your physical therapist? These questions should be answered upon your first visit.
• The therapist should be licensed in the state.
• The first visit should include a thorough medical history and physical examination before any treatment is rendered.
• The patient goals should be discussed in detail during the first visit.
• Care should include a variety of techniques which might include hands-on techniques, soft tissue work, therapeutic exercises and in some cases heat, cold, electrical stimulation or ultrasound.
• Do they have a service that can address your problem?
• Do they take your insurance or are they willing to work with you if they are not a preferred provider?
• They should be conveniently located. Since sitting and driving often aggravate orthopedic problems, there should be a very good reason for you to drive a long distance for rehabilitation.
• The therapist should provide the treatment.
• Ask your family and friends who they would recommend.