The Best of Both Worlds

Alternative and traditional approaches can be incorporated into a physical therapy career

From inside his clinic in New York City’s Carnegie Hall, Lithuanian native Shmuel Tatz, PT, works his wonders on the likes of renowned composer Andrew Lloyd Weber, ABC news anchor Peter Jennings, violinist Isaac Stern and prima ballerina Susan Jaffe, as well as a full roster of “regular” folk.

They come seeking relief from performance-related injuries: pianist and writers appear with neck and shoulder strains; dancers with hip, knee and back pain. But more than half of Tatz’s clients have more standard ailments, such as arthritis, slipped disks and Parkinson’s disease.

Patients Willing to Pay

What makes them so eager to pay Tatz $190 for the first treatment (including coffee, Tatz said with a laugh), and $150 for subsequent visits? It’s because Tatz, who has the temperament of a maestro, offers what he calls “body tuning,” a unique blend of conventional Western physical therapy combined with techniques from yoga, osteopathy, acupuncture, massage, Tai Chi and reflex therapy.

“We have a clientele who think that buying physical therapy is not like buying aspirin,” said Tatz, who once trained as a dancer. “PT is an art.”

A growing number of patients accept the use of so called alternative, or holistic therapy such as those used by Tatz and others, although many health care providers remain skeptical. According to the March/April 1998 issue of Natural Health magazine, 70 percent of patients use so-called alternative, or holistic therapies but do not tell their health care provider because of the anticipated reaction: scorn.

The reaction on the pert of providers is due in large part to a lack of education about holistic therapies, some PTs believe. Brian Miller, PT, OCS, a therapist with Community Physical Therapy in Marquette, MI, integrates movement therapies, such as Feldenkrais®, Rolfing and the Alexander technique and the Trager® method, with traditional therapy.

Returning to Hands-On Care

“These [alternative] therapies increase my sense of touch and my ability to perceive changes and nuances in movement,” he explained.

Miller said he spent years and thousands of dollars of his own money learning about holistic therapies, something many Pts don’t have time or money to do. “With cutbacks in continuing education, this is a big-time money and time commitment that comes out of the therapist’s own pocket,” Miller explained.

Tatz assigns some blame to the way physical therapists are trained. “When you go to school, you only get the A-B-Cs of physical therapy, and this is all we need to know to get licensed,” he said. “No one really teaches us how to treat a disease or heal injury. Then, when people get out of school, they immediately feel the pressure of the dollar and forget why we got into this business in the first place.”

Therapists using holistic methods are quick to caution against practitioners whose methods have no scientific basis. “If you wave your hands over someone’s body to dispel an aura, that’s quackery,” Miller stated. But those who have been trained to use more proven methods, such as Feldendrais, see its potential for helping patients both physically and emotionally as reaching far beyond the bounds of traditional therapy.

“Using alternative therapy is like being a Van Cliburn conducting a symphony, although that doesn’t mean we don’t have a need for conventional therapists, who are like people who play ‘Happy Birthday’ at a party,” Tatz said. “It’s my job to feel the bones, the muscles, the ligaments and the tendons with my hands and to evaluate what is wrong in each area. When I feel what the problem is, I do adjustments and manipulations on patients, and I try to re-educate their body to move as it should – as it used to. But the first step is for me to feel the problem.”

Incorporating Holistic Themes

Rivi Har-el, MS, PT, a doctoral candidate in physical therapy at New York University, uses conventional exercise, along with dance movement therapy and guided imagery for patients with chronic pain because of movement disorders. “The goal of movement therapy is to enhance patients’ capacity for emotional release and to heighten awareness of how they move,” she said. “Often, chronic pain relates to depression and stress and tension. I look at the entire picture of a patient’s condition.”

She encourages patients to bring in their favorite music to listen to while they sit, stand or lie doing rotations and other movements. Trained in guided imagery, Har-el asks clients to describe what images come to their mind while they move.

“One lady said she felt like she had a rope around her neck and was being choked,” Har-el said. “I asked her to analyze why. I ask people about both their physical and emotional pain, which forces them to be more aware of where all of this is coming from.”

Har-el is conducting a study on how traditional exercise and alternative therapies affect patients with chronic neck pain. As part of that, she is seeking people between the ages of 18 and 55 who have had pain for more that three months but have no neurological problems.

Despite the long-standing skepticism of Western practitioners, alternative methods are slowly being accepted as part of standard treatment. Natural Health magazine reports, for example, that the National Institutes of Health recently approved acupuncture as “an effective therapy for certain medical conditions,” although consumers must first seek a Western medical doctor who practices acupuncture before turning to a nonmedically trained acupuncturist.

If the NIH is willing to give a qualified blessing to one form of holistic medicine, can it be long before insurance companies agree to pay for alternative therapies? Clinicians say they already are being reimbursed because holistic therapies are not done in isolation. They are part of a complete treatment that combines traditional exercises with holistic techniques, and that total treatment is reimbursed.

Standard Treatment

“Everyone I know who does this incorporates standard therapy so there is no problem with billing,” Miller said. “If you can justify your therapy with scientific principles and it makes sense it’s OK with your state practice law, then you can bill for it.”

Miller also said he is with in the law when he provides patients with books on nutrition, including vitamin supplements and holistic therapies, then advises them to discuss the information with their doctor. “There is nothing wrong with recommending principles when they meet acceptable standards,” he said.

Susan Morrill Ramsey, MA, PT, owner of Holistic Therapy Services in Merion and Rosemont, PA, wrote in her ADVANCE column, “Holistic PT,” that if the holistic therapy can be identified under a billable code and it is included in the state’s practice act, the it is a reimbursable service. However, if a therapist was using Tai Chi to work on a patient’s balance, for example, the activity would have to be broken down into parts and each part would have to be explained, along with its functional outcome.

“The components of the technique must be broken down into specific activities and have clear, functional outcomes in order to receive reimbursement by insurance companies,” Ramsey wrote.

Tatz side-steps the problem of reimbursement by accepting only cash. “I don’t need approval from someone 300 miles away from my office, or from some physician who has studied PT for zero hours,” he said. “I am proud to be in this country for 10 years and not have signed with an HMO.”

Miller said therapists interested in using alternative techniques first need to read about the method, then get intensive training so the treatments are done properly. As they work with patients, therapists need to carefully evaluate whether they are getting positive results. And they must be wary to techniques that are not based in sound, scientific principles. “If it sounds strange and it looks strange and smells strange, stay away from it,” Miller said.

Advance for Physical Therapists & PT Assistants

Pamela Rohland is a free-lance writer and the owner of Rohland Communications in Bernville, PA. She is a frequent contributor to ADVANCE.