Physical therapists and physicians have worked alongside each other on the healthcare team since the inception of the physical therapy profession. However, 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, As a result, all CAPTE accredited physical therapy education programs making the full transition by 2017.
Physical therapy education programs take 3 years to complete. They 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. Some classes, like anatomy, pathology, and diagnostic imaging, are often taken alongside other medical professional students. A physical therapist’s clinical education requires a minimum of 30 weeks of full-time clinical experience. Most programs spread 35-40 weeks throughout the three years of schooling, with the majority of the clinical experiences at the end of the program.
PTs are primary care
In most states, including Minnesota, patients have direct access to physical therapy services. This means that they can see a physical therapist without a physician’s referral. Studies indicate that patients with orthopedic injuries experience better patient-reported outcomes related to pain, disability, and health-related quality of life when initially seen by a physical therapist versus a physician general practitioner.
Concerned about quality and accuracy of a physical therapist’s exam? Don’t be! Studies prove that there is no difference in the clinical diagnostic accuracy of musculoskeletal conditions between physical therapists and orthopedic surgeons. In addition, both physical therapists and orthopedic surgeons are more accurate at diagnosing musculoskeletal conditions than primary care physicians. Furthermore, a PT’s doctoral level training allows them to screen for medical issues masquerading as a musculoskeletal problem. If something seems fishy, they can catch it and refer to a physician.
We treat the source of the pain
The 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 underlying cause.
Injections and medications also come with a slew of dangerous side effects, ranging from infection and withdrawal to addiction and overdose.
Physical therapy treatments can improve inflammation, soft tissue and joint mobility, neuromuscular control, strength, and movement patterns. Not only does this correct the mechanical fault causing the pain, it also prevents it from recurring. Physical therapists also educate the patient on the source of the pain, home exercise, and lifestyle modifications.
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 factories, fitness centers to schools, private clinics to the patient’s home. Additionally, some specialize in specific patient populations, like sports medicine or pediatrics, 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 outcomes, and enjoy their physical therapy experience if they are working with a physical therapist who is an expert 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! 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, and decreased fall risk.
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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