By Mike Dee, P.T., SCS, (APTA: Board Certified Sports Certified Specialist)
Why should I go to physical therapy? Why did my Nurse Practitioner, Physician Assistant or Doctor send me to Physical Therapy?
That is a fair set of questions and one I hear often. I think the real question is,’ What does a physical therapist do? And ‘How will they help me’?
The American Physical Therapy Association (APTA) defines physical therapists as:
‘Physical therapists are movement experts who improve quality of life through prescribed exercise, hands-on care, and patient education. … A Physical therapist examines each person and then develops a treatment plan to improve their ability to move, reduce or manage pain, restore function, and prevent disability. ‘
The physical therapy education is like that of an M.D. in our anatomy, physiology, and pathophysiology. However, we stop short of the complexity of all illnesses and medications. We understand them however don’t necessarily deal with all of them or prescribe medications.
Human Movement is our wheelhouse and boy do we thrive on it. Nobody considers the entire person and their movement dysfunction like a good P.T. While teaching the Doctor of Physical Therapy Students at the University of Vermont today, I reflected to them that they had observed and measured so much of their fellow student and knew so much about their movement system while never having to do anything invasive or take an x-ray.
Patients often come to physical therapy because of a basic problem with moving. We need to know all the body’s systems that contribute to our ability to move: the nervous system, the musculoskeletal system, the cardiopulmonary and integumentary systems, how one creates energy, how one sees and hears and how one reacts to the physical space around and underneath them.
Our approach to an injured athlete is the same for an octogenarian with a total knee replacement or the sixty-year-old with Parkinson’s Disease. How is this person moving? Where are they on a timeline of onset, tissue repair and remodeling or the progression of the disease process. We evaluate to find out: Is there a stiffness or mobility issue or is there a weakness and stability issue? What is the status of the nervous system on this patient’s movement problem? As we assess these questions and observe basic human movement, we consider our intervention. But first we must get to know our client. And know them we must.
All healthcare providers must listen and qualify what their patients are saying. It is not about us, but them. Physical Therapists are asking patients what their movement goal is. We need to know that first. Is it less pain? Climb stairs? Walk with a friend? Compete in a sport? Stand, sit or sleep with less discomfort? Play with grandchildren?
With that information we conduct our examination and determine what the limiting factors are and what can be done about those. We ask patients to take time out of their day, perform therapeutic exercises and /or change the way they move related to a functional task. We don’t prescribe a pill to take two times a day, rather our prescription is a very specific task or set of exercises that requires time and effort. Patients need to understand this, and we need to understand them. It goes both ways and works best when we are allied. Patient engagement and education are pillars of our care.
The Physical Therapy ‘Connection’
No limb or joint in the human movement system operates independent of its neighbors. Often a runner with insidious knee pain has a limitation in their ankle or hip. A good P.T. uses the science to evaluate the entire lower extremity and to design a therapeutic intervention to address the ankle or hip problem, while addressing the local knee problem. And sometimes this knee pain will have a remote relationship to weak abdominals. The research bears that out.
Our patient with Parkinson’s Disease has a progressive condition. The P.T. knows this and considers how that patient is functioning at present and how they can optimize their current status. Balance and stability exercises work wonders as we recruit core muscular strength thereby allowing a better level of movement for the arms and legs. A P.T. even considers ankle stiffness from an old ankle fracture in the same client. This is what makes physical therapy work so well. We connect all aspects of the entire movement system.
‘A Good P.T. ‘
The APTA uses this moniker in our promotional literature. The science and scientific literature for physical therapy has arrived and is growing. You want a P.T. that uses the latest scientific evidence, not the newest method or disproven interventions.
A ‘good’ p.t. can explain complex anatomical things to you in terms you can understand and use. You should ask for articles and or links to references on the therapeutic intervention. Are they listening to you and engaging you in the therapeutic path taken? Are you getting a simple set of home exercises? That is our ‘jar of pills’ and it should be that simple.
The APTA has Clinical Practice Guidelines (CPG) that are available online. These guidelines are comprehensive scientific literature reviews that weigh the efficacy of certain movement problems and our interventions. They serve as an excellent starting point for our intervention.
In Vermont you can access a p.t. directly, however some insurance carriers require a physician’s referral. Check with your p.t. or your insurance carrier. The physical therapy intervention and its positive outcomes is now required before an MRI is considered in some cases. If physical therapy is performed the way we teach it, you will see some benefit.
APTA is a good resource and consider a group with board certified physical therapists.
Choose p.t. and choose to move. . . a little better.
Mike Dee is co-owner and practices at DEEPT in Chittenden County which is The Clinical Faculty Practice in support of the UVM Doctorate of Physical Therapy program. He lives in Charlotte with his wife Justine.