I receive many emails and calls from young people who want my advice as to how to become a good physical therapist. So, I’ve decided to put down a few of my thoughts on what I believe it takes to become a successful practitioner, to enjoy it and to make a good living.
A Creative And Artistic Profession
To become a better physical therapist, just like becoming a better pianist, you have to practice. Physical therapy is a creative and artistic profession. In medicine there are perhaps ten different drugs for a particular condition, and several surgical techniques that could aid the patient. In physical therapy, there are therapeutic modalities and active and passive movements the physical therapist can use. In the use of manual therapy, learning to touch and move a patient’s body, there are a hundred different possibilities for each condition. This means that physical therapists need to have more experience and knowledge of movement.
Studying Physical Activities
In the area of movement, which is a large part of the practice of physical therapy, the study of physical activity is necessary. You need to learn to study Western sports activities and Eastern physical education, like Tai Chi, Kung Fu and Yoga, plus modalities, like cupping and shiatsu. In sports like tennis, for example, it is better to study the movements of table tennis where you have slow and then quick movements. Racquet sports require control of both racquet and ball which teaches coordination. But the physical therapist needs to have a feeling for all sports in order to be able to do better manual therapy.
Modalities
In the use of various modalities, we learn that different patients react differently to the same modality…electricity, light, mechanical vibrations. There are no explanations for why different people have different reactions to them, but they do. Every human sensation is different. Some patients dislike grade five manipulation but have a good response to grade one. So the physical therapist needs to be attuned to the patient’s comfort and to find alternate modalities for increased healing. When you are in training to become a physical therapist, you can only practice modalities on yourself and friends. But this is the best time to experiment with them. It is not necessary to have tendonitis to understand how the tendon works and to experiment with what you can do with a healthy tendon and how various modalities feel.
My Personal Experience
Ten years ago I woke up and my knee was swollen. I was in a lot of pain. I tried to do different modalities but the inflammation did not disappear. After two weeks there was no improvement, so I visited an orthopedist. He had me take an MRI which showed that I had a torn cartilage and arthritis. He offered me surgery. Like many other patients, I wanted another opinion. I ended up seeing several other knee specialists. Three suggested surgery, but I declined. Instead, I asked for anti-inflammatory medication. I took it and four days later the swelling went down. I then saw two chiropractors to find out what they recommended for my condition. One said I had a pinched nerve in my back. I didn’t believe it. I then saw an acupuncturist who talked about my kidneys. I was not in sympathy. After that, I saw four or 5 physical therapists. One said he had the same problem I had and had surgery. I asked why and he said because the orthopedist had referred a lot of patients to him and he was afraid that if he didn’t have the surgery done he would lose his business.
After half a year of physical therapy, I was fine. Now, 10 years later, I hardly remember what happened to my knee. I have had no symptoms since. I’ve seen patients who had arthroscopic surgery for the same problem and the price they paid years later. They were in discomfort, and finally needed a total knee replacement. My recommendation to patients stems from my own experience: Find a good physical therapist. Work for a minimum of 2 or 3 months to get results, and remember that in some cases, full recovery can take 6-8 months. My personal insight, following not only my own experience but what I have seen and heard from patients who have gone to orthopedists, chiropractors and physicians, is that we in physical therapy have the best possibilities, the best modalities to make it possible for patients to avoid unnecessary procedures.
Physicians, Chiropractors, Occupational Therapists, Massage Therapists, Athletic Trainers
Once upon a time, before physicians became pain management specialists, they referred their patients to physical therapists. Now they are likely to give injections and medications rather than refer to other health practitioners. Chiropractors used to do only spinal adjustments. Today they are using the same modalities as physical therapists. Before, occupational therapists were working mostly on the effects of neurological conditions, like stroke. Now people with upper body injuries are most likely to be referred by their physicians to occupational therapists rather than physical therapists. Five to ten years ago, it was considered laughable if massage therapy was mentioned as an adjunct to healing. Today massage therapy is recognized by insurance companies. So patients can go directly to massage therapists for help rather than to see a physical therapist. Today, even athletic trainers use the same modalities as physical therapists. So to succeed in private practice physical therapy, you need to be not just good: you need to be outstanding.
Training
Physical therapists have the best training to use the necessary modalities to work with the various conditions patients bring to us. But, we need to have better practical experience. Pain management physicians work hard in hospitals. It’s difficult to become a pain management specialist. Before licensing, physicians are scrutinized on both their theoretical and practical experience with how they treat patients. Chiropractors have both theoretical and practical experience. But not physical therapists. To obtain a license you don’t have to do a practical test. Physical therapists go to school mostly for theoretical knowledge. Thirty years ago there was a practical test for physical therapy licensing. Now the concentration is on theoretical knowledge to obtain a license.
In music, even if they become a recognized musicians, most go to listen to other great performers. This can give them ideas on how to become a better performer. How soon you, as a physical therapist can get personal treatment from a senior physical therapist, the better it is for you to learn the sensations of touch, the intensity of it, and the changes it brings in your own body. Also, as you move on in your training and become more accomplished, it is a good idea to seek out everyone close to you, family and friends and ask them to let you work on them. That will enable you to learn how their reactions to your work.
No one physical body is perfect. Physical therapy is performed on newborns and people in comas, on people who run marathons and people with breathing difficulties. Age differences, physical conditions and disabilities offer the physical therapist a wide range of therapeutic possibilities. And you must be prepared to handle them. If you have learned about your own body by doing a lot of physical activity, you have developed instincts about how your body reacts. Later, when working hands-on with patients you will train your hands to become your eyes and ears and develop your own instincts about the body you are treating. If you ask a great pianist how they do what they do, they cannot tell you. When you ask a physical therapist, many cannot explain what they do, but they can do. Some can explain but can’t do very well. In society there are ‘healers’ who can’t explain how they do what they do, but they succeed in healing. In rare cases, the physical therapist can explain and can do. In any case in a good physical therapist, instinct plays a large part in how to deal with a patient’s physical problems.
Learning Beyond Training
In a concert hall there are not many people who can truly tell the difference between good and mediocre playing. Unfortunately, the same thing is true for physical therapy. Patients may continue going to a physical therapist even though they are not pleased with the results they are getting. They need to be encouraged to pay attention to what is happening in their bodies. Do they like the therapist’s touch or not? Are they feeling better? Are they in less pain? If not, they need to find another physical therapist. If you wish to be the best physical therapist you can be, think of it as if you wished to become the best and most creative chef. You can apprentice at McDonald’s or you can work with a great French chef. You need to learn the basics, the well known methods, like Maitland or McKenzie, and many therapeutic modalities. A great pianist starts out with scales and arpeggios and then gradually learns Bach, Chopin, Schubert, and much more so that he/she will a choice of repertoire which can be called upon at any time for any audience. Accordingly, physical therapists need to learn traditional techniques and modalities, and then develop their ‘repertoire’ in order to be creative with each patient who comes with a different physical problem.
The secret to becoming a successful physical therapist is to study hard in school and later: practice, practice, practice!