NATIONAL PHYSICAL THERAPY MONTH: YOUR TOP QUESTIONS FOR A PHYSICAL THERAPIST

Who Are Licensed Physical Therapists (PT)?

Physical Therapists (PT’s) are healthcare providers with a minimum of 7 years of medical education/training, passing their State Education licensing exam, to practice in the profession of physical therapy.  PT’s examine and treat a wide range of diagnoses that includes: neck/back pain; sports injuries; arthritis; burns; heart disease; post op surgery of shoulders/hips/knees; sciatica;  stroke; trauma; gait and balance difficulties; TMJ, headaches, pre/post pregnancy musculoskeletal injury; breathing problems; pelvic floor dysfunction and more.

Educational requirements for the three year (very competitive) PT education programs includes a bachelor’s degree (above 3.3GPA) from an accredited four year university with a degree in biology, psychology, kinesiology, or other fields related to human science.  Most PT programs offer a clinical doctorate in physical therapy (DPT).

What is the difference between a Licensed PT and Personal Trainer?

Personal trainers do not have the 7 years of educational requirements, scope of medical knowledge, and months of “hands on” clinical internships in hospitals, rehab centers, private practices, nor do personal trainers receive a license from the State Education Department.  Most personal trainers receive a certificate after passing a written test given by the company/organization offering such programs. One organization offered 75 hours of study and direct contact education (which is great, but very rare). Many certificate programs are self-study online courses with no direct contact training. One online program offered a self-study personal training certification for $69.95. Some fitness centers require their personal trainers to attend their in-house training programs to better their skills.  Personal trainers help healthy clients attain improved fitness and should refer any injured client to a PT for guidance and treatment.

PT’s refer their discharged patients to gyms/personal trainers once their patients are fully rehabilitated.

What is the Education of a PT?

The student PT studies human anatomy and movement sciences, which includes dissecting a human cadaver to appreciate alignment and position of nerves, muscles and bones.

Anatomical knowledge is the framework upon which PT’s understand physiological processes, evaluate pathology and trauma, and design the best intervention strategies for optimum recovery and function.

Studies also include basic medical sciences, biomechanics, neuroanatomy, pathology, mechanics of injury, and theory / practice of physical therapy.  Objective tests and measurements for multiple diagnoses are instructed and practiced. Tests are used as benchmarks to report improvement during physical therapy and to help motivate patients to continue with therapy, if needed and perform their home exercises.  Rehabilitative procedures such as manual therapies, therapeutic exercises, use of modalities, sports training, balance and coordination are taught.  Along with didactic study, the PT student receives hands-on experience through a number of 8 week clinical internships.

What Does a  Licensed PTs Do?

Physical therapists examine, evaluate and treat pain syndromes, movement dysfunctions, muscle/joint restrictions, scar tissue adhesions, strength deficits and balance and coordination issues. Therapeutic techniques such as myofascial release, trigger point therapy, joint mobilization, nerve mobilization, visceral mobilization, core stabilization, strengthening exercise, posture and body mechanics, instruction in a tailored home exercise program are utilized to return patients to optimum function.  PT’s are trained to restore, maintain and promote overall health, wellness and fitness.  Many fitness centers utilize equipment/training techniques, for example, physioball classes, therabands;  body blade and agility skills that were originally designed by physical therapists. PT work in hospitals, rehab centers, schools, in patient homes, have outpatient private practices.  They also work with all levels of high school, collegiate and professional sports teams and are the “go to” rehab specialists of the Olympics.

What Can I Expect During a PT Evaluation?                                                                                                                                                              

The PT will take a detailed history and then examine the patient’s symptoms or diagnosis For example, if a patient has neck pain, the PT may ask the patient to rate the pain on scale of 0 to 10; when does the pain occur and where is the pain is located; does pain travels towards the head or down the arm; what movements/positions makes neck pain worse/ better; is sleep is affected; what postures do the patient assume at work/home?

Following a history, the PT observes and measures the patient’s ability to actively move their cervical/shoulder and scapula joints followed by the PT passively moving these joints (with patient resting comfortably) to see if the same pain or restrictions are reproduced.

Palpation is next – the PT gently lifts the skin/connective tissue to note pain and mobility followed by palpation of muscles of the neck, shoulder/scapula to assess for restrictions, adhesions, trigger points. Neural mobilization techniques are performed to test if a nerve is compressed and/or symptomatic. Strength testing is done to note whether weakness of stabilizing muscles are causing overwork of neck muscles.  The overall movement patterns of the neck/shoulder and scapula are observed for imbalances, poor muscle firing and faulty patterning.

Depending on time scheduled for an Evaluation, the patient with neck pain may be instructed to modify their office desk arrangement, be taught a gentle neck stretching exercise and a general posture awareness technique.  The patient leave the PT practice with a good understanding of their condition, what kinds of therapy will be provided and feel hopeful that their neck pain will abolish with physical therapy.

Does the PT communicate with my Doctor?                                                                                                                                                        

Following an Evaluation, the PT sends a detailed report to the referring MD.  As treatment continues, physical therapists document progress, conduct periodic examinations, identify areas requiring more or less attention, and modify treatments.  Documentation is required by Medicare and health insurance companies. As part of the profession, PT’s are required to justify the reason for each physical therapy treatment session. Documentation is used to track the patient’s progress and helps motivate the patient as they see the changes.

Do I Need a Doctor’s Referral for PT?                                                                                                                                                                      

Under New York State Law, and in many other states, patients may directly seek and receive evaluation and treatment from a licensed PT without a physician’s referral for up to 10 visits or 30 days, whichever occurs first.  If permitted by their insurance company, patients can be evaluated and treated without having to first obtain a referral.

PT’s are well trained to refer to a MD if improvements are not being made in a timely manner or if any red flags are raised regarding a patient’s medical condition.. We are on the doctor’s team.

 What are “Red Flags” when physical therapy cannot help me?

1)  Fevers chills or night sweats –  this may be a systemic disorder such as an infection

2)  Recent unexplained weight changes – weight gain could be due to congestive heart failure, hypothyroidism or cancer; weight loss could be due to a GI disorder, hyperthyroidism, cancer or diabetes,

3)  Malaise – may be a systemic disorder

4)  Quadrilateral paresthesias (nerve symptom in both arms/legs) – CNS involvement

5) Shortness of breath – can indicate a myriad of conditions ranging from anxiety and asthma to serious cardiac or pulmonary dysfunction.

Can I find a Good Quality PT in an “In-Network” vs “Out of Network” practice?                                                                                       

The term “Good Quality PT” can be hard to define, as many PT’s with their seven years of education, may have to treat 4 to 5 patients/ hour due to the set up of the organization they are employed.

Most PT practices that accept “in-network” insurances receive very low reimbursement payment per patient (sometimes as low as $25.00 a visit).  In order to keep in business, these PT practices have a large open gym-like settings, no private rooms, where a licensed PT oversees a number of patients simultaneously being treated by either aides(non trained) or by trained personnel (Physical Therapy Assistants, Certified Athletic Trainers).  This fast paced environment combined with minimal direct patient contact by licensed PT’s does not result in consistent effective outcomes in patient care.  Many patients and PT’s are very frustrated with this practice model.

The PT practice setting that has licensed PT’s directly treating one patient at a time, for eg, every 30 or 40 minutes, is a much better choice. These practices are typically “out of network” that may accept “out of network” insurance payments, accept private pay fees and may be certified Medicare providers (accepting the Medicare fee payments).

Sometimes paying extra for this value added service can result in an overall lower cost with better outcome of care vs spending time and money in a busy “in-network” practice where multiple patients are co treated with potentially poor outcomes, resulting in more MD visits, more procedures, new medications and frustration.

How do I find a PT practice?                                                                                                                                                                                              

Go to the American Physical Therapy Association  (APTA) website, www.apta.org and look up your region for a list of members.  The organization also has a subsection, SOWH Section of Women’s Health to find providers who specialize in pelvic floor physical therapy for men, women and children.

You will need to do some sleuthing, by calling the individual practices and asking some questions:

  • How much individual time does your licensed PT directly spend with each patient at each treatment session?
  • Does your licensed PT co treat other patients during my treatment session and if so, how many are co treated simultaneously?
  • Will I receive treatment by a “PT aide” ( person with no formal PT education, usually trained on site by employer) or PT Assistant (person with education & licensed as a PT Assistant)  during my session?

Go online. Many PT practices have websites that outline the services they offer, their hours and location, and what to expect during your therapy session. These websites often have links to copies of the required paperwork to be completed prior to your visit so you can have them ready on the day of your evaluation.  Contact the practices you are interested in to ask the above questions as practice models may change without being updated on their websites

Who Needs a PT?                                                                                                                                                                                                                    

PT’s are becoming the first line of defense when an sports/orthopedic/work injury, sprain, strain, fall and pain occurs. Everyone should have a “good PT practice” on their mobile device, or speed dial on their home phone for immediate consultation and treatment.  In NYC, contact EMH Physical Therapy (212) 288-2242.   If needed, a PT will refer to a MD for further consultation.

 

What is your greatest success story?

As a licensed PT for over 25 years, I have thousands of success stories.

From the thirteen year old soccer star who dislocated her knee cap and thought she could not be a top player again; after 10 sessions of physical therapy, she was back in full playing mode with her teammates.

The postnatal woman with a 3 month old child who couldn’t lift her baby and couldn’t sit comfortably to feed her baby because of excruciating back pain, sacroiliac  joint malalignment and sciatica; after 2 months of physical therapy she is fully painfree and fully able to care for her baby (plus take care of husband, older child, work colleagues, you know how that goes!).

The male college student with history of sexual abuse experiencing constant “knife-like” pain in his pelvic floor region, could not sit for long periods for his classes, did not engage in sport due to pain and experienced constipation even after taking fiber rich foods and laxatives; after 4 months of PT, his symptoms have decreased markedly. He still needs to do his daily stretches and pelvic floor exercises, is able to sit and study without pain, is not constipated and is considering playing a sport.

The world traveling, bridge playing NYC senior who had a bad fall resulting in a hip fracture and is now fearful of walking down a city street thinking she will lose her balance and fall again.  She withdrew from social events and stayed home, getting more depressed.  After 3 months of physical therapy, she regained her strength and balance, resumed weekly bridge games and traveled to Paris.

Anyone, at any age who has experienced relief, return to pain free function, improved their strength and endurance, and returned to an active social life is a PT’s greatest success story.

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