The Nature of Physical Therapy

The other day a client of mine told me a story. Her housekeeper had fallen in the home of one of the people she works for. She fell on her right side, shoulder and arm. She didn’t think she had been hurt because she was able to finish all her work and continued to work for the rest of the week, but in increasing discomfort. When her pain level was too difficult to manage, she went to Bellevue Hospital and saw an orthopedist who took x-rays and pronounced no bones broken but probably a lot of muscle bruising and tendonitis. He injected her shoulder with cortisone. It did not help her. She then went to a chiropractor she had been told about who took more x-rays and told her that no bones were broken and to get a shoulder splint and wear it. She did but the pain increased. She then went to another chiropractor who sent her to a different hospital where the physician told her to take off the splint and to get some physical therapy because it was necessary for her to move her arm with proper instruction as how not to harm herself further.

This is a story repeated over and over in my office. There is a tendency in modern countries for injured people to believe that only an MD can treat an injury. It is my opinion that if physical therapy were sought as a first resort, many injuries would have less recovery time.

I applaud the work of dedicated physicians to their specialties. But the truth is that doctors receive no training in physical therapy. Nowadays, there is some training in medical schools in alternative methods of healing, but as far as I have been able to determine, no training or credit hours in physical therapy per se. Following Medical School, doctors spend at least four additional years in hands on training in their specialties, but that training still does not include the art of physical therapy.

Many people do not realize how well trained physical therapists are in diagnosing and treating all kinds of injuries. Of course they refer to physicians when they suspect there is something more at hand than the injury described by the patient. But too often physicians prescribe rest or injections for an injury when the more advantageous treatment would be gentle and then greater manipulation along with proper exercises designed to strengthen and heal.

The Education and Training of Physical Therapists

The education and training of physical therapists is lengthy. (See the United States Department of Labor’s website)  It includes science courses such as biology, anatomy physiology, cellular histology, exercise physiology, neuroscience, biomechanics, pharmacology, pathology, radiology/imaging, as well as behavioral science courses, such as evidence-based practice and clinical reasoning. In addition to classroom and laboratory instruction, students receive a great deal of clinical experience. Their training nearly equals the number of years it takes doctors to gain proficiency in their particular fields of interest.

Before entering an accredited Physical Therapy program many students have already completed an undergraduate degree. They can then study for a Master’s Degree or DPT (Doctor of Physical Therapy.) All graduates must pass the National Physical Therapy Examination and fulfill State requirements to obtain licensure, after which they are able to practice in hospitals, outpatient clinics and/or private offices. Most full time physical therapists work a 40 hour week.

Many States require continuing education as a condition of maintaining licensure. However, all physical therapists are expected to continue their professional development by participating in continuing education courses and workshops.

Physical therapists also carry personal liability insurance as do other health care professionals.

How to Find the Proper Physical Therapist

But knowing all of this, there still remains the problem of finding the proper physical therapist for you. A recommendation from a trusted friend can be helpful, but I will give you some guidelines for finding the help you need.

  1. The physical therapist should have a minimum of 10 years of experience in private, solo practice and should spend a minimum of 30-40 minutes, hands on, with you.
  2. Don’t be impressed with the look of the office or the convenience of the location.  What is important is the therapist’s knowledge of how to work with your body. The best physical therapist talks less, explains less and asks the minimum. His expertise is in finding in your body what you are not aware of and trying to fix it.
  3. The physical therapist should know all about various modalities and manual techniques such as laser, ultrasound, short wave diathermy, non invasive electrical stimulation and also Alexander, Trager and Feldenkreis. Not necessarily to use all of them, but to choose the right ones for you condition. Then he must teach you how to behave with your body to minimize the damage you may be doing with every day activities.
  4. Most important of all is how you feel. Ask yourself: “Do I like this touch?” Some pain that you may experience is not necessarily bad, but you must decide: “Is this right for me? Do I feel better?” If your answers are no, then you must find another therapist. However, give yourself at least 4-6 sessions with the therapist before deciding whether to continue or not. If all your answers are yes, and you are satisfied, then you are in the hands of a professional who has the training and ability to make your life a happier one, hopefully free of pain, with increased mobility and a more positive outlook on life.

Every health practitioner wants to help you. But nobody knows everything. You need to feel in your body that your choices are leading you to the shortest way to recover from discomfort, pain and tension in your body. For today and tomorrow.