What is a Physical Therapist?

In all of my long career spanning 8 months as a licensed physical therapist I have quickly come to the realization that there is a huge portion of the population who have no clue what a physical therapist is, what we do, how we are educated, how we can help you achieve your goals, where we work, etc. Having just spent the previous 7 years of my life laboriously taking thousands of hours of anatomy, physiology, psychology, physics, biomechanics, pharmacology, clinical hours, etc to become a physical therapist and help people on their journey to improve function, heighten performance, decrease pain, and elevate quality of life it is a defeating feeling to know that a huge proportion of the general public does not know what I do and how I can help them.

We have a serious branding issue within our profession, and we have no one to blame but ourselves. If you ask anyone off of the street what a chiropractor is that will undoubtedly give you an immediate answer along the lines of “who I go to when my back hurts or feels stiff” or “the guys who crack(“adjust”) your neck/back”. If you ask what a cardiologist is they will without hesitation say a heart doctor, neurologist is a nerve doctor, and dermatologist is a skin doctor. However, if you ask 100 people what a physical therapist is you will get a very broad range of answers. Some of my personal favorites that I’ve received are “you’re like a personal trainer right?”, “you guys give lots of massages right?”, “those are the guys who you have to see after you have a surgery”, or WORST OF ALL “you’re the guys who use that electric stuff, ultrasound, and hot packs on my back when it hurts!”.

I wanted to take the opportunity with this blog to delve into educating anyone who will read what and who we as PTs are.

According to the American Physical Therapy Association (APTA) a physical therapist is:

· Physical therapists (PTs) are highly-educated, licensed health care professionals who can help patients reduce pain and improve or restore mobility - in many cases without expensive surgery and often reducing the need for long-term use of prescription medications and their side effects.(1)

· Physical therapists can teach patients how to prevent or manage their condition so that they will achieve long-term health benefits. PTs examine each individual and develop a plan, using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. In addition, PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness- and wellness-oriented programs for healthier and more active lifestyles.(1)

· Physical therapists provide care for people in a variety of settings, including hospitals, private practices, outpatient clinics, home health agencies, schools, sports and fitness facilities, work settings, and nursing homes. State licensure is required in each state in which a physical therapist practices.(1)

In my opinion this is a great definition, but I think that we can go so much further with educating and explaining who we are.

· Yes, all of us that come out of school now have a Doctorate in Physical Therapy. Per the APTA “the length of professional DPT programs is typically 3 years. Primary content areas in the curriculum may include, but are not limited to, biology/anatomy, cellular histology, physiology, exercise physiology, biomechanics, kinesiology, neuroscience, pharmacology, pathology, behavioral sciences, communication, ethics/values, management sciences, finance, sociology, clinical reasoning, evidence-based practice, cardiovascular and pulmonary, endocrine and metabolic, and musculoskeletal. Eighty percent (80%) of the DPT curriculum comprises classroom (didactic) and lab study and the remaining 20 percent (20%) is dedicated to clinical education.”

· Yes, in all states you can come to us for at least an evaluation before needing a prescription from a physician. In many states, in the military and other countries we can treat you as well.

· Yes, we can help you with so many other issues than just after you have had a surgery. Some examples are injury prevention efforts, back pain, knee pain, elbow pain, shoulder pain, neck pain, muscle strains, joint sprains, poor balance, gait problems, pain while running, vestibular dysfunction, headaches, urinary incontinence/pelvic floor dysfunction, neurological conditions such as MS/Parkinsons/spinal cord injuries/concussions/and many more in addition to taking you back to your pre-injury or pre-surgical level of function and quality of life.

· No, we are not just personal trainers. Some of us were before physical therapy school, and some of us may continue to do performance training on the side in combination with advanced education on safety/biomechanics/injury prevention (common for PTs to also be certified strength and conditioning specialists or “CSCS”). What is someone who is a CSCS? Link here.

· Yes, we can “crack joints”. To be more correct with terminology, a large proportion of us are well trained in the usage of high velocity low amplitude thrust (HVLAT) techniques to perform joint manipulation.

· Yes, depending on which state you live, we can use thin monofilament needles in a practice called dry needling to treat pain and dysfunction to the neuromusculoskeletal system. Well verbalized by the Arizona Physical Therapy Association ““dry needling" means a skilled intervention performed by a physical therapist that uses a thin filiform needle to penetrate the skin and stimulate underlying neural, muscular and connective tissues for the evaluation and management of neuromusculoskeletal conditions, pain and movement impairments”(6)

· No, we are not massage therapists.

· Yes, we know very well how to do many massage techniques to address soft tissues, but it is just one of many effective tools we use in a well-rounded approach to treating dysfunction.

· No, we are not going to just put you on a table with e-stim, hot packs, ultrasound, and do some pressy-guessy rubbing on your back. We are going to guide you through a process of rehabilitation and self-healing with active strategies focusing on exercise, but not limited to manipulation (popping joints), soft tissue work, dry needling, taping, bracing, and EDUCATING about how you should manage your condition on your own.

· The odds are, and yes this has actually been explored and proven by research, that we know much more about your neuro-musculo-skeletal issue than your primary care physician…or any physician other than orthopedic surgeons.

· Additionally, a good proportion of PTs are very well educated on the experience of pain. In fact the leading pain researchers in the world are physical therapists. We can educate/council you through your chronic pain, and teach you the truth about pain that you most likely have never heard or understood before.

Again, I repeat that this lack of understanding is all of our own doing. We have not appropriately educated the general population, patients, and very often physicians about what we can truly provide. Some of this may be because we were late to the game and haven’t been a profession for that long in the grand scheme of things (since 1921 officially)(1). Other non-physician doctorate level professions such as chiropractors have been an official profession since 1895(2), optometrists in 1898(3), dentists in about 1841(4), and podiatrists in 1912(5). Other reasons I won’t spend time delving into have quite a bit to do with politics, money, and power. However, I wanted to take the opportunity to write an educational piece that most physical therapists would love for everyone in the nation to read.