What really is Physical Therapy?

Most of us have had an orthopedic injury over the years, perhaps not ever requiring surgery, but enough to limit our activities. That episodic low back “going out” over the years, a chronic “stiff” shoulder, a knee that always “twinges” when we run. Many times we shrug it off as old age, bad knees, or just bad luck. Years of treating patients, be they professional athletes or 80+ year old arthritis patients, has shown me that surprisingly many people, even Medical Doctors, don’t really know how physical therapy can help them. Because they don’t understand what it is that our practice actually does.

Conventional Western medicine traditionally positions the practitioner as the educator, the gatekeeper of information, the patient as recipient. Many patients receive a diagnosis based upon their symptom or complaint, the area of pain, but no real explanation why they are having this issue, or where it could be stemming from. Many fail to realize that the symptom, may not be related to the actual source of their problems. When I sit down with a new patient it is only through a more holistic approach diagnosing the entire person, their history, and their movement impairments that I can get to the real issue that is causing the symptom in the first place.

This is where I think physical therapy is under appreciated and misunderstood by many. In  years past, physical therapy was based simply upon modalities  to mitigate pain- ice, heat, electrical stimulation, ultrasound. What has changed over the years? More research, advances in hands-on manual therapy, and a move towards “movement science” diagnosing the impairments in the whole chain, not just the point of pain. This is a more  multi-faceted approach including manual therapy, massage, pain relieving modalities, neuromuscular facilitation, myofascial work, and therapeutic exercises.

Many patients have asked me what schooling is required these days to become a physical therapist. Most are surprised to learn that I received my Doctorate in Physical Therapy. What once many years ago was simply a Bachelor’s degree in PT, has now become a research and evidence based Doctorate level allied health profession. In many states now a Physical Therapist has direct access meaning they can evaluate and treat a patient without a physician’s (Medical Doctor) referral. This is a huge step for increasing the legitimacy of our profession, and ameliorating the access to patients to receive faster and more appropriate care by a skilled healthcare professional.

In my typical day working in sports medicine in my outpatient clinic, I treat myriad injuries including knees, low back, neck, ankle, hip, surgical post operative patients, sports related, age related, work related, you name it.

The benefit of coming to physical therapy is the ability that we have to educate patients as well as provide therapeutic modalities. I often joke with patients my job is easy; the MD has to deal with serious life or death issues. In PT no one is usually dying, it is often really a quality of life issue, helping someone return to sport and activities of daily living. Patients usually start with a full evaluation, we discuss their history and symptoms, and then we get to work! Some of what I do is soft tissue massage, sports and athletic taping, cupping or myofascial decompression, assisted stretching, joint mobilizatons, and often dosing of therapeutic exercises. Given this large host of treatments, what I find most important is that I help patients understand the what, they why, the how of their injuries. How a previous ankle injury may be related to their current knee pain, or how a stiff mid back may be affecting their shoulder pain. Helping them understand the anatomy and physiology of their body and how we can create a plan to get them better.

That is what physical therapy does. It is rarely a quick fix, but most patients who follow a basic PT prescription get better, and are surprised to see those nagging injuries they have had for years – gone.

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