When a new patient sits down with Dr. Elbaridi and he asks whether they have tried physical therapy, the answer he hears more than any other is this: it didn’t work for me. He follows up with one simple request. Show me one or two exercises your therapist taught you.
Most patients can’t. And that tells him almost everything. If you can still demonstrate one exercise two years after you finished therapy, you had good therapy. If you can’t remember any of it, the therapy never left an imprint, and the problem was rarely the therapy itself.
Dr. Elbaridi practiced as a licensed physical therapist before he became a physician. He has seen the profession from both sides, and he is a strong advocate for it. That is the starting point for Episode 8 of Inside the Loop, where he sat down with two members of the ATI Physical Therapy team to talk about what physical therapy actually is, how it fits alongside pain management, and what Chicago patients can do on their own without waiting for a referral.
Why “Physical Therapy Didn’t Work for Me” Usually Means Something Else
Physical therapy is not something that is done to you. It is something you learn and carry forward.
The most common failure point is what happens after discharge. A patient leaves with a long home exercise program. Compliance is high in the first week, drops over the next month, and is close to zero a year later. When the pain comes back, the patient concludes that therapy failed.
Matt Tucker, a physical therapist with ATI, said he actually welcomes the “it didn’t work” patient, because he treats it as a challenge to earn their buy-in. He starts by asking what they did last time. Then he asks what their goal is now, and builds everything backward from that goal. A patient who wants to get back to Pilates, or carry groceries up three flights of stairs, will stay with a plan that is clearly connected to that outcome.
For Dr. Elbaridi, the active patient is the foundation of everything he does. Patients who want to be passively treated, whether with medication or with procedures alone, rarely get the outcome they are hoping for. Patients who stay involved in their own recovery do.
What Physical Therapy Actually Involves
Physical therapy is a three-year doctoral-level discipline, and it is not passive. Matt estimated that more than 80 percent of a typical treatment plan is some form of exercise. That does not always mean lifting weights. It means movement that is matched to where the patient is today.
At ATI, a first visit is a thorough evaluation of at least an hour. The therapist tests:
- Strength
- Range of motion and mobility
- Functional ability, such as getting in and out of bed, standing up from a chair, and going up and down stairs
From that evaluation, the therapist builds a plan that the patient can actually do on day one. As Matt put it, if a patient cannot stand up from a chair, asking them to do 15 squats is a mismatch, and that patient is not coming back.
This matters for the patients Dr. Elbaridi sees most often. Pain from age-related changes, from obesity, from diabetes, or from years of accumulated small injuries almost always comes back to one thing: mobility. If you cannot move, you are stuck. Physical therapy is how you get unstuck in a way that lasts.
A Real Case: Partial ACL Tear and Bone Bruise From Pilates
Dr. Elbaridi brought a real case to the conversation. A 25-year-old woman was injured during a Pilates class when the reformer struck her knee. She came away with a bone bruise and a partial ACL tear. Her MRI showed significant inflammation, and she was not a surgical candidate at that point. Until the tissue calmed down, there was nothing to repair.
He referred her to physical therapy with one specific goal: protect her knee extension and prevent a flexion contracture, where the knee loses the ability to fully straighten.
Matt walked through how he would approach it:
- Goals first. On day one, find out what she wants to get back to, whether that is Pilates, running, or another sport.
- Range of motion before anything else. Full knee extension is the single most important factor with any ACL injury, partial or complete. Without it, the quadriceps cannot fully activate.
- Quadriceps activation. Once extension is back, rebuild the quad with quad sets, short arc quads, and straight leg raises.
- Progressive loading. Move to closed-chain, functional exercises and gradually build tolerance for her normal activities.
The important point is that this plan does not change much based on whether she eventually has surgery. Whether she stays non-operative or goes on to reconstruction, she needs full extension and strong quads. Starting therapy early protects both paths.
If you have a knee or sports injury and have been told to wait until the swelling goes down, ask whether you should be in therapy during that window. Often the answer is yes.
Do You Need a Referral for Physical Therapy in Illinois?
In most cases, no. Illinois has allowed direct access to physical therapy since August 2018. That means you can call or walk into a physical therapy clinic, be evaluated, and begin treatment without first seeing a physician.
A few things to know:
- Your doctor still stays in the loop. Under Illinois law, a therapist treating you without a referral must notify your treating health care provider within five business days. ATI typically asks for your primary care physician and any specialists within the first week of treatment.
- Your insurance may have its own rules. The law permits direct access, but health plans decide whether they will pay for it. Some plans, including some Medicare and Medicaid plans, still require a physician referral or a signed plan of care. Call your insurer or ask the clinic to verify before your first visit.
- Direct access is still underused. Steve from ATI noted that in states where direct access has existed longer, a much higher share of patients come in on their own. Many Chicago patients still assume they need a doctor’s order first.
You can reach ATI by calling a clinic, using their main number, email, their app, or simply walking in.
Physical Therapy Before Surgery: Why Prehab Matters
One of the most overlooked uses of physical therapy is before a procedure.
Say it is September and you have a knee replacement scheduled for December. To many patients, starting therapy now seems backwards. It is not. Going into surgery stronger, with better range of motion and better function, makes recovery afterward faster and more predictable.
With direct access, you can walk into a clinic and say: I am having a procedure in two months. Should I be exercising, and what should I be doing? A good outpatient therapist will evaluate whether you are fit for exercise and will coordinate with your primary care provider if you need clearance or testing that a therapist does not perform, such as an EKG.
The same logic applies before spine procedures and other interventional treatments. The stronger and more mobile you are going in, the more you get out of the procedure.
When You Need Imaging and When You Don’t
Imaging came up from both directions in this episode.
On the physician side, Dr. Elbaridi described a frustration every interventional specialist knows. A patient has a clear case of leg pain from lumbar radiculopathy, a pinched nerve in the lower spine. An MRI is the right test. The insurance company denies it and asks whether an X-ray was done first. The delay does nothing for the patient.
On the therapy side, Matt raised the opposite problem. Patients often arrive fixated on what their X-ray or MRI shows. For physical therapy, imaging is helpful, but not required. A therapist builds a treatment plan from the physical exam. Imaging matters much more when an interventional procedure is being considered, which is where diagnostic imaging at Loop Medical Center comes in.
The practical takeaway: an MRI finding is not the whole story, and the absence of an MRI is not a reason to delay starting therapy.
How Communication Between Your Doctor and Therapist Affects Your Recovery
Both guests agreed that the biggest obstacle in their work is not the patient and is usually not the physician. It is the system.
Insurance authorizations come in smaller increments than requested, so therapists spend time writing progress notes to justify continued care. Reaching a physician inside a large health system can mean days of navigating answering services. Steve’s role at ATI is largely to do that legwork, so therapists can stay focused on patients.
What works, they said, is the care team: the physician assistants, nurse practitioners, medical assistants, and practice managers who answer the phone and move information between providers. And what physical therapists most want to know from a pain physician is simple:
- What procedure was done and what was the goal?
- Are there any restrictions, and for how long?
- Should anything in the therapy plan change because of it?
Dr. Elbaridi noted that ATI’s documentation gives him exactly what he needs to decide on the next step of care when a patient comes back to him. That kind of consistent communication is what turns two separate treatments into one coordinated recovery.
Inside the Loop Episode 8: Physical Therapy, Direct Access, and the Full Recovery Picture
Episode 8 of Inside the Loop features Dr. Nidal Elbaridi in conversation with two members of the ATI Physical Therapy team.
The full episode covers:
- Why “physical therapy didn’t work for me” is usually a compliance problem, and the one-exercise test Dr. Elbaridi uses
- What a thorough PT evaluation looks like and how therapists match a plan to a patient’s current function
- A real partial ACL tear case and how a therapist would progress it
- Direct access to physical therapy in Illinois and how to start without a referral
- Prehab: why starting therapy before a knee replacement or other procedure improves recovery
- Insurance pre-authorization, imaging, and communication breakdowns in the health care system
- ATI’s 13-month sports residency, including sideline training at Chicago Public Schools events, where ATI provides the athletic trainers
- How the relationship between orthopedic surgeons and physical therapists has changed over the past generation
Watch the full episode:
About our guests
Matt Tucker, PT, DPT, OCS, is a physical therapist with about 13 years of clinical experience and the Residency Site Coordinator for ATI Physical Therapy’s Sports Physical Therapy Residency in Chicago. He splits his time between treating patients and mentoring residents.
Steven Domke has been with ATI for about 11 years on the business development side, coordinating communication between ATI clinicians and referring physicians.
ATI Physical Therapy was founded in the southwest suburbs of Chicago in 1996 and celebrated its 30th anniversary this year. It now has outpatient clinics across 24 states, with roughly 140 in Illinois, including locations in the South Loop and throughout Chicago.
When to See Dr. Elbaridi
Physical therapy is the right first step for many conditions. Dr. Elbaridi works alongside therapists when pain is limiting progress or when the source of the pain needs a more precise diagnosis.
Consider scheduling an evaluation if:
- You have done physical therapy before and the pain came back
- Pain is preventing you from participating fully in therapy
- You have leg pain, numbness, or weakness that suggests a pinched nerve (see how long sciatica lasts)
- You have an upcoming procedure and want a plan for before and after
- You were injured at work, in an accident, or during sports and need both treatment and documentation (see Workers’ Comp and Personal Injury)
Most insurance accepted, including Medicare, Medicare Advantage, PPO and HMO plans. Coverage depends on medical necessity — we verify before your visit. We also treat Workers’ Compensation and Personal Injury cases. Same-week appointments are available at both Chicago locations, in the South Loop and Streeterville.
Frequently Asked Questions
Do I need a doctor’s referral for physical therapy in Illinois?
No, not under state law. Since August 2018, Illinois has allowed patients to see a licensed physical therapist for evaluation and treatment without a physician referral. The therapist must notify your treating provider within five business days. However, your insurance plan may still require a referral or a physician-signed plan of care for coverage, so verify with your insurer or the clinic before your first visit.
Why didn’t physical therapy work for me?
The most common reason is that the exercises did not continue after discharge. Physical therapy builds strength and mobility over time, and those gains fade if the home program stops. Other reasons include a plan that did not match your starting level, an undiagnosed source of pain that therapy alone could not address, or therapy that was too passive. A good test: if you cannot recall one exercise from your last course of therapy, it is worth trying again with a plan built around a specific goal.
Should I do physical therapy before knee replacement surgery?
In most cases, yes. Prehabilitation, or physical therapy before surgery, improves strength, range of motion, and function going into the procedure, which generally supports a smoother recovery afterward. Talk to your surgeon or primary care provider to confirm you are cleared for exercise, then start with a physical therapy evaluation several weeks before your surgery date.
Can a partial ACL tear heal with physical therapy?
Many partial ACL tears are managed without surgery, and physical therapy is central to that approach. The first priority is restoring full knee extension, followed by rebuilding quadriceps strength and then progressing to functional and sport-specific exercise. Whether surgery is eventually needed depends on the degree of the tear, knee stability, and your activity goals. Starting therapy early benefits you either way.
Do I need an MRI before starting physical therapy?
Usually not. Physical therapists build a treatment plan from a hands-on exam of your strength, mobility, and function. Imaging becomes more important when an interventional procedure or surgery is being considered, or when symptoms such as progressive weakness or numbness suggest nerve involvement.
How does physical therapy work with pain management?
They address different parts of the same problem. Interventional pain management identifies and treats the specific structure causing pain, such as an irritated nerve root or an inflamed joint. Physical therapy restores the strength and movement that keep that pain from coming back. When pain is too severe to participate in therapy, a targeted procedure can create the window in which therapy becomes effective.
Ready to Get Moving Again?
If you have tried physical therapy and the pain keeps coming back, or if pain is keeping you from doing the work recovery requires, the right next step is a conversation with Dr. Elbaridi.
He will review your history, examine what is actually happening, and tell you honestly what is driving the pain and how physical therapy and targeted treatment can work together for your recovery.