HEALTHY YOU

Physical Therapy: What You Need to Know

by Dr. Tom Walters, PT, DPT

I am often asked, “would physical therapy work for me?” or “what would a physical therapist do for this problem?”  With so many healthcare choices available, it can often be difficult to choose the most appropriate provider, and thus, many people go on living with pain and dysfunction that could be resolved.  Physical therapy in particular, has undergone significant changes throughout its development, which has left the healthcare consumer confused on issues; such as what it means to be a physical therapist and what conditions the PT (physical therapist) can treat.  It is my goal to provide some clarity in order to help guide those experiencing musculoskeletal dysfunction in the most appropriate direction.  

Educational Requirements

Much of the public today is unaware of the extensive level of training that is now required to become a licensed physical therapist.  In order to become a physical therapist, one must complete a bachelor’s degree that includes classes such as anatomy and physiology, biomechanics, exercise physiology, psychology, physics and statistics before being accepted to graduate school.  Physical therapy school then consists of an intensive three year curriculum that prepares the graduate to adequately manage a variety of neuromusculoskeletal conditions ranging from cerebral palsy in the pediatric population, to spinal stenosis and shoulder impingement in the orthopedic realm, to spinal cord injuries and stroke in the neurologic setting.  According to the American Physical Therapy Association, as of July 2008, there are now 210 physical therapy programs throughout the US with 192 of those programs training individuals at the doctoral level1. The remaining 18 programs are providing masters degrees with the plan to switch to the doctorate of physical therapy (DPT) within the next several years.   Upon finishing graduate school, the student must then pass the national physical therapy exam and any other state issued requirements before becoming licensed.  Another interesting fact that many people do not know, is that many physical therapists go on to complete residencies and fellowships, and work to become board certified in their area of expertise.  Board certification can be attained in such areas as orthopaedics (OCS), geriatrics (GCS), neurology (NCS), pediatrics (PCS), sports medicine (SCS), cardiopulmonary medicine (CCS) and electrophysiology (ECS).  

When to See a Physical Therapist

As stated earlier, physical therapists see patients in a variety of settings, but I will focus on orthopedics, which is pertinent to the fitness community.  Many people do not realize the scope of conditions that are often treated by the therapist, and what a typical treatment involves.  A large percentage of the public already knows that physical therapists often treat those that have undergone surgical operations, such as rotator cuff repairs, ACL reconstructions, total knee and hip replacements and low back surgery, just to name a few.  In addiction to post-surgical cases, orthopaedic therapists treat conditions such as spinal stenosis, disc herniations, sciatica, shoulder impingement, frozen shoulder, muscle tears, joint dislocations, ankle sprains, nerve pain and numerous other musculoskeletal problems that may cause pain, weakness, diminished range of motion and ultimately limited function in one’s daily life. Upon visiting the PT’s office, the patient will undergo an extensive evaluation in which range motion, strength, nerve mobility and functional movements are assessed based on an individual’s complaints before initiating a treatment program.  The treatment plan usually involves a combination of manual therapy, therapeutic exercise and modalities such as ice, heat, electrical stimulation and mechanical spinal traction to achieve the patient’s goals and get them back to an optimal level of function.  Manual therapy is a term commonly used in physical therapy and describes the process of using one’s hands to move the patient’s body with the goal of improving mobility and decreasing pain.  Examples of manual therapy include joint, soft tissue and nerve mobilizations in which the therapist uses very specific techniques to increase joint mobility, stretch and loosen muscles and decrease nerve irritation such as seen in carpal tunnel syndrome, sciatica, and any other musculoskeletal condition that may cause numbness and tingling in the arms or legs.  Along with manual therapy, therapeutic exercise is often implemented in order to strengthen muscles and tendons, increase range of motion and provide additional joint stability.  Unlike generalized exercise programs, therapeutic exercise is specifically tailored to the patient by the physical therapist to correct muscle imbalances and improve joint mechanics based on the person’s particular problem.  Lastly, modalities may be used by your physical therapist to help decrease inflammation, pain and swelling and are usually used at the end of the therapy session. This section only provides a brief summary of when and for what reasons one might see a physical therapist.  In general a person’s best option is to contact their local physical therapist if they are unsure if physical therapy is appropriate for a particular problem.  

A Final Note

Under current California legislation, an individual can see a physical therapist directly without a physician’s referral for an evaluation and treatment if they are being seen for a previously diagnosed condition, or for minor aches and pains that would fall under the heading of “wellness”.  However, if one is experiencing moderate to severe symptoms, they may visit a physical therapist for an evaluation, but must see a medical doctor before proceeding with physical therapy intervention.  This issue can be confusing and frustrating when one is experiencing musculoskeletal pain and must spend extra time and money before receiving treatment.  As a physical therapist in California, I ask that the readers of SB Fitness Magazine support AB 1444, which would allow patients to have direct access to physical therapy services.  Now that physical therapists are trained at the doctoral level, we have the ability to screen individuals as to their appropriateness for receiving physical therapy and whether or not they would be better suited seeing another healthcare practitioner for a particular problem.  Numerous studies have documented the benefits of direct access, which 42 states have some form of, including the military, which has held direct access capabilities for years.  For more information on this issue please visit the American Physical Therapy Association at www.apta.org and search direct access.

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