Physical therapists and physicians have worked alongside each other on the healthcare team since the inception of the physical therapy profession, but many physicians do not understand or utilize a physical therapist’s education and skills to their full extent. Over the years, physical therapy education has evolved to a doctorate level, allowing for greater depth and breadth of evaluation and treatment skills. Here are 5 things physicians need to know about physical therapists.
We are doctors:
Entry level physical therapy education is now at the doctoral level. The transition to the entry-level doctorate program began in the early 2000s, with all CAPTE accredited physical therapy education programs making the full transition by 2017.
Physical therapy education programs take 3 years to complete, and include both didactic and clinical education experiences. The didactic portion of a physical therapist’s education includes hard sciences, physical therapy specific skills courses, and research-based courses. The hard science and research portions are very similar to that of medical, dental, and pharmacy students, and some classes, like anatomy and physiology, pathology, diagnostic imaging, neuroscience, etc, may be taken alongside other professional students. The clinical portion of a physical therapist’s education must comprise of a minimum of 30 weeks of full-time clinical experience. Most programs disperse 35-40 weeks throughout the three years of schooling, with the majority of the clinical experiences at the end of the program education.
We are primary care:
In most states, including Minnesota, patients have direct access to physical therapy services. That means that they can see a physical therapist without a physician’s referral. A recent study indicated that patients with orthopedic injuries experience better patient-reported outcomes related to pain, disability, and health-related quality of life when initially triaged by a physical therapist versus a physician general practitioner.
Another study proved that there is no difference in the clinical diagnostic accuracy of musculoskeletal conditions between physical therapists and orthopedic surgeons. Both physical therapists and orthopedic surgeons were significantly more accurate at diagnosing musculoskeletal conditions than their primary care physician counterparts. Our doctoral level training allows us to screen for medical issues that may be masquerading as a musculoskeletal condition and make an appropriate and timely referral.
We treat the source of the pain:
The vast majority of the time, the root cause of musculoskeletal pain is a mechanical problem at the tissue level. Unfortunately, many common pain treatments, like medication and injections, provide a chemical-based treatment.
A chemical treatment may mask pain for a while, but it doesn’t correct the mechanical issue.
Injections and medications also come with a slew of dangerous side effects, ranging from infection and withdrawal to addiction, overdose and death.
Physical therapy treatments can reduce inflammation, improve mobility at the soft tissue and joint level, improve neuromuscular control and strength through a full range of motion, and improve movement efficiency to correct the mechanical fault causing the pain and prevent it from recurring. Physical therapists can also provide extensive patient education on the source of the pain, home exercise, and lifestyle modifications to improve the patient’s quality of life.
Not all physical therapists are the same:
Just as physicians have evolved into a variety of specialists, so too have physical therapists. Physical therapists can work in a variety of settings, from hospitals to industrial settings, fitness centers to schools, private clinics to the patient’s home. They also specialize in specific patient populations, like sports medicine, pediatrics, or neurological patients, or specialize in specific body areas, like spine or shoulder.
A generic referral isn’t always the best referral! A patient is more likely to be adherent to their treatment program, have better pain and function based outcomes, and enjoy their physical therapy experience if they are working with a physical therapist who is knowledgeable in their particular injury/condition. A little research can insure that you aren’t sending your college baseball pitcher to stroke rehab!
We know that physical therapy works, as we see our patients leaving us with decreased pain, improved functional mobility, greater knowledge of their body and condition, and overall improvement in their quality of life on a daily basis. The “side effects” of physical therapy include improved range of motion, strength, and endurance, decreased fall risk, and event improvements in mood and body composition.
As doctoral level providers and scientists, we also appreciate high quality evidence. A quick search of pubmed, or even google scholar, will reveal article after article comparing physical therapy to more invasive treatments, like surgery. There is overwhelming evidence that physical therapy is just as good as surgery for most patients, and much safer! Below are a few examples:
Degenerative knee disease (arthritis, meniscal tears): Treatment guidelines strongly recommend conservative treatment, including physical therapy, and strongly recommend against knee arthroscopy. There is no difference in outcomes between physical therapy and knee arthroscopy, but knee arthroscopy carries a much higher risk of complications (more frequent and severe).
Lumbar stenosis: There is no difference in outcomes between PT and surgery, and there are fewer and less severe complications associated with PT.
Rotator cuff impingement: Surgery has not been proven to be superior to physical therapy, and is associated with more frequent and severe complications. In addition, subacromial decompression surgery has been proven to have the same outcomes as a placebo surgery.
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