General PT Information – Physical Therapy Education Solutions

Is the American Physical Therapy Association failing us?

Jon Waxham, PT — Mon, 01 Feb 2021 18:06:31 +0000

As a physical therapist who is a 25-year member of the APTA and someone who cares deeply about the future of our profession, I ponder this question more each year. After the challenges our profession faced in 2020 and a lot of reflection, I decided it was time to try and answer that question. The conclusion I reached is that the APTA is no longer an effective leader for the physical therapy profession. I feel they have spread themselves too thin and lost their focus on their main mission, to support the members and to help the physical therapy profession thrive. I’ll present my case below and let you decide on your own.

Before I dive into specifics, I feel it is important to say that the APTA has done a lot of good for our profession, especially in the early days and through the mid-to-late twentieth century. There are a lot of genuinely good people that serve and work there. Having said that, the Association has failed to keep up with changing times. Most of you know the famous saying that insanity is doing the same thing over and over and expecting different results. That describes how we have approached the last 30 to 40 years in physical therapy. Expenses continue to rise, and reimbursement continues to fall. If we don’t commit to taking a hard, honest look in the mirror, we may not last much longer as a viable profession.

Reimbursement

Off all the issues that should be a priority for our national association, reimbursement should top the list. In this area I feel the APTA has been completely ineffective and continues to be reactive instead of proactive. Our profession is headed towards death by a thousand cuts. If you don’t know by now, The Centers for Medicare and Medicaid Services (a.k.a. CMS, or in other words Medicare) is the trend setter when it comes to payment policies for physical therapy. The private payers tend to follow CMS’s lead. Let’s look at policies affecting Medicare reimbursement that CMS has implemented in the last 25 years and let me know how many of these you would chalk up as wins.

1997: The Balanced Budget Act and the therapy cap

Under the BBA, two annual $1,500 caps were established, one for occupational therapy and one for physical therapy and speech therapy combined. While the cap was repealed (kind of, we still have a soft threshold), the administrative reporting implemented with the cap is still a requirement and moving past the $3,000 mark may trigger a targeted review by Medicare. The long and short of it is that for complex patients there is a chance we will not get reimbursed for services.

2007: The Physician Quality Reporting System (PQRS)

The PQRS (which started as Physician Quality Reporting Initiative, PQRI) was designed to track outcomes related to a series of outcome measures throughout the healthcare industry. Early participation was voluntary and was rewarded (if you met their threshold) with a modest 0.5% bonus of allowable, covered charges for the reporting period. By 2014 and beyond those not reporting data were penalized initially 1.5% increased to 2.0%. In true CMS fashion, the measures PT ended up reporting on had very little to do with providing data on patient outcomes and created an unreasonable administrative burden on outpatient PT providers.

2011: Multiple Procedure Payment Reduction (MPPR)

CMS decided that they were going cut the amount paid when more than one related procedure was done on the same treatment day. The APTA estimated that reimbursement will drop on average 6% to 7% because of this CMS policy. There were so many private insurers that also implemented the MPPR that the APTA use to provide a reference list of all of them, but that is no longer available. Not a legacy that the APTA would want to advertise. The APTA continues still today to assert that MPPS is a flawed policy but it remains in effect.

2018: Merit-based Incentive Payment System (MIPS)

The PQRS was discontinued and it’s reporting measures incorporated as part of the Merit-based Incentive Payment System. Basically, all but small practices (billing under $90,000 in part B charges, treating less than 200 Part B patients) must report on quality measures and improvement activities. The carrot on the end of the stick is a possible bonus from CMS. For 2021 the maximum possible incentive is 7.0% and the maximum penalty is -7.0%. Because the MIPS program must be budget neutral, the ACTUAL maximum incentive is 1.79%, but the penalty for a poor score is -7.0% (source: www.MDinteractive.com). Again, we are left with minimal to no incentive, large potential penalties, and are burdened with more administrative responsibilities that take away from actual patient care.

2021: “The Cut”

Most of you are well aware of the approximate 9% reduction in reimbursement facing physical therapy in 2021. Due to the Covid-19 pandemic and Congressional Relief legislation that cut is estimated to be about 3.6% (APTA, 12/22/20). We have a temporary stay of execution, but don’t have any illusions that the rest of the cut won’t get implemented. Despite efforts by the APTA over many months, CMS decided to go ahead with the cut. While I applaud the response and advocacy of the membership, the only reason we didn’t get completely crushed is because of the pandemic, not any successful lobbying attempts by the APTA.

2022: PTA Reimbursement Reduction

Starting in 2022, if a PTA provides more than 10% of a service then the fee for that service will be reduced by 15%. Again, despite any efforts on the part of the APTA, CMS is pushing ahead with this reduction.

In addition, there have been numerous adverse Correct Coding Initiative (CCI) editing decisions by CMS that have affected our ability to get reimbursed for specific code pairs provided during the same visit. While there may have been a 1% gain mixed in on an occasional year from Medicare, I believe the list above represents a pattern of significant losses, despite the advocacy efforts from the APTA.

According to John LaRosa at Market Research.com, the average net profit margin for an out-patient PT clinic is 14.6%. The CMS cuts above have certainly come close or exceeded the profit margin for treating Medicare patients. The next cut might be the final nail in our proverbial coffin.

My biggest question remains why they continue to use the same losing strategy year after year without trying something else.

Marketing and Brand Recognition

If reimbursement is priority 1, then marketing is priority 1A. All of us physical therapists, physical therapist assistants, physical therapy administrators and support personnel know the value we provide for our patients. BUT DOES ANYONE ELSE?

We have done a very poor job of explaining what we do and how it benefits our patients, to other healthcare providers and more importantly the public at large. I want to try a little experiment, have you ever heard of either of these phrases: “Got Milk?”, or “Beef, it’s what’s for dinner”? I will bet almost all of you will say yes to at least one of those. What do they have in common? They were marketing campaigns created for national boards/associations (California Milk Processor Board and National Cattlemen’s Beef Association respectively).

What is the great marketing campaign for our profession, www.choosePT.com. They describe the site as the official consumer information website of the APTA. I wanted to gauge how easy it is to find this consumer information website, so I conducted a brief experiment.

I went on the three popular search engines and did two simple searches that our potential future patients might ask. I documented the ranking position for any content hit for the APTA main website and for the ChoosePT website. The results can be seen below.

According to internet marketing company imFORZA, 75% of search engine users never scroll past the first page of search results (https://www.imforza.com/blog/8-seo-stats-that-are-hard-to-ignore/). How many searchers do you think ever make it to the ChoosePT website? Well, the APTA must not have time to focus on search engine optimization because of the employees and dollars focused on the print, radio, and television marketing campaigns. As Sheldon on the Big Bang Theory often asked, “that’s sarcasm, right?” In my over 25 years working in physical therapy, I have no recollection of any national marketing done for the PT profession.

We could learn a lesson that the pharmaceutical industry learned a long time ago, if you want to improve your business you need to cut out the middleman (the physicians) and take your message directly to the consumers. Every other commercial these days (for those of us still watching broadcast TV) is for a prescription medication. You see, they figured out that instead of their reps trying to convince MD’s to recommend their products, they would sell the benefit of their medication straight to the consumers. Then, the patients would go into the doctor’s office already informed and ask to try a specific medication. If I had a dollar for every time I heard, “Ask your doctor if … is right for you”, I’d be a rich man!

This is a strategy we could easily adopt with a national marketing campaign. Just imagine if a patient had seen about the benefits of physical therapy in an ad or commercial and went into their general practitioner’s office and told their doctor that they wanted to try PT.

I wanted to find out the importance the APTA currently puts into marketing and was pleased to see one of their four strategic goals is to: “Maximize Stakeholder Awareness of the Value of Physical Therapy”. One of the ways they intend to do this is to “Leverage the #ChoosePT campaign and ChoosePT.com to inform the public about the benefits of physical therapy”. If this is a prime strategy (see ranking chart above) the PT profession is poised to wither away in obscurity.

According to their 2019 annual report, the APTA spent 6.7 million dollars on Public Affairs. It would be helpful to have more transparency on how that money is being spent, especially with a continued lack of public awareness about what we do and how we can help.

If the APTA chooses to continue to follow the current marketing strategy (if there is one), then at least more collaboration with the medical professionals we rely on for referrals might boost business. I checked the APTA website to see who was listed as APTA Partners. There are a few good organizations such as The American College of Sports Medicine, The Arthritis Foundation, and the U.S. Department of Veterans Affairs, but no association with the American Medical Association or American Academy of Family Physicians, you know, the kind of partners needed to grow our business and our brand.

Participation in the Association

For an association to claim it represents the profession it would logically follow that a significant portion of the profession should support it and be involved. Unfortunately, with the APTA this is not the case. Let’s look at some of the numbers. There are over 100,000 members however, about one third of those are students required to join or having their dues paid by grants. The following chart shows the number of PTs and PTAs working in the U.S. and the number for each that are APTA members. As you can see, as of 2019 the APTA represents about 26% of all PTs and a little over 7% of all PTAs.

Despite the growing number of licensed PTs and PTAs, as of 2019 the participation rate is declining. A couple of observations, with only 21% of the profession represented, when it comes time for advocacy we are speaking with a very small voice and in the eyes of our elected representatives we are an insignificant portion of their constituency and not worthy of listening to. There are two things lawmakers respond to, money and votes. We either need to spend more, or speak with a larger voice. It is unlikely that we can spend as much as the insurance industry, but if we can increase our participation, we might improve (?) the chance lawmakers listen.

What have they done to increase participation?

While the APTA has tried to argue that it has increased its value to its members through modified services, a growing number of those in our profession think that membership just isn’t worth the cost. Annual membership dues are among the highest in the country for medical professionals. The chart below lists the APTA and a few other associations and their cost for membership.

For a little frame of reference here is the annual salary for each of the professional groups listed above and the annual cost of association membership as a percentage of their annual income.

It may be hard for the APTA to argue that they provide twice the value over the AOTA or the AMA for their members, and the argument they currently provide enough value for the cost of a membership seems to be a losing one. It’s logical to me that if you want to be the voice of the profession then you would want the highest level of participation, so your organization carries more weight. The APTA has never tried recruiting more members by lowering their annual dues. If the APTA cut their dues in half they might double (or more) the number of people willing to support our association. One way to lower the cost is to reconsider the requirement to subsidize the state chapters, it seems like an unnecessary cost. Especially considering that the other medical associations listed in our chart can function with no state membership requirement. The APTA could generate equal or increased revenue from memberships and have a stronger voice, but I guess we will never know if that strategy would work since they seem unwilling to explore it.

Mission & Governance

There are three major factors about how the APTA chooses to function that for the life of me I can’t understand.

First, The Mission Statement for the APTA is “Building a community that advances the profession of physical therapy to improve the health of society”. I don’t see any mention of the membership or their interests in that mission statement. How can you expect an association to make decisions in the best interest of its members if you don’t make it part of your mission to serve the members? For the sake of argument, let’s assume (you know how that usually ends up) that the needs of the members are hidden within the mission statement. We in physical therapy are taught to rely on data when making decisions about progress and changes to our plan, yet our association makes decisions about the best interest of their members without the benefit of data about member satisfaction. Based on my physical therapy education, I would say that is NOT the right way to measure progress and modify goals.

At least in the past we could provide some feedback through comments on the APTA website. It was interesting to note that when they rebranded and rebuilt their website, they turned off the comments section for any posts. I guess those comments were deemed unnecessary.

I will say after 25 years, in November 2020, I finally received an invitation to provide my opinion to the APTA through a survey. I expressed many of the same concerns to them that I bring up here. I don’t know how they plan to use that data or if they will make the results public, but at least they finally asked.

Second, the organizational structure and the procedures used to conduct association business are based on a model of governance that is over 230 years old! This is one of those instances when the APTA has failed to keep up with the times. We live in a digital age where facilitating comment and votes from all of the membership is an easy task. Why we continue to rely on State Delegates being elected, convening in a House of Delegates meeting where motions are brought to the floor and voted on seems like an arduous and archaic process.

In today’s physical therapy world, things occur and change on a month-to-month or even week-to-week basis. The current structure of the APTA doesn’t allow for the rapid response to constantly evolving circumstances. I believe the Association’s response to guidance during the Covid-19 pandemic is a perfect example. In the early days physical therapy professionals were crying out for some type of guidance regarding changes to procedures, whether to stay open or close, and how best to respond. The best advice the APTA could offer is use your best professional judgment.

Here is an excerpt from a statement from the APTA Board of Directors posted on March 17, 2020:

“As actions are taken across the country to reduce the spread of COVID-19, a virus that spreads easily from close contact, APTA encourages physical therapists to use their professional judgment to determine when, where, and how to provide care, with the understanding this is not the optimal environment for care, for anyone involved.”

And an excerpt from a letter posted by the APTA President on March 20, 2020:

“This is a challenging time to be in health care. I commend all those who are putting their own health at risk to treat their patients and clients who have immediate health needs. I also applaud those who are selflessly closing the doors to their practices because they have determined the risk of spreading COVID-19 outweighs the benefits of providing care that is not urgent. Both actions are heroic.”

Can you tell the best course of action from their advice? Not quite the kind of guidance you might expect from an organization that claims to be leading our profession. They did eventually provide guidance but only after watching how the profession and other health related agencies reacted and then forming an opinion. It was a case of closing the barn door after the horse got out.

Third, I have heard from my early days of PT school how important it is that we use evidence-based practice (EBP) and incorporate the latest research into our clinical decision making. I agree with this philosophy 100%, however every journal publishing PT research guards that information like it is a State secret. I understand there are costs to operating a journal, but the over-monetization of research results only serves to hinder one of the APTA’s strategic plan objectives: “Translate the latest research into tools and resources for practice”. Remember only 21% of our profession belong to the APTA which means only 1/5^th of our profession has access to the research in our primary professional resource, PT Journal. You then must be a member of each special section to gain further access to the research available through their specific journals, leading to even further restricted access to research.

I don’t understand why all the research done through the APTA and their Special Sections isn’t available to the entire profession, regardless of membership or not. The APTA’s document on Core Values for PTs and PTAs identifies altruism and collaboration as key values. Although it might cost a small amount of revenue, wouldn’t altruism dictate that making research accessible to everyone in our profession outweighs any monetary gain from selling it? Especially since EBP has been one of the highest priorities for our profession over the last few decades.

Pursuing Policies That Have Little Return On Investment

The APTA has chosen to expend time and resources on policies that don’t appear to provide the expected return on investment, such as the Doctor of Physical Therapy degree and adoption of the movement system.

There was a big rush to transition quickly from the Master’s level degree to a Doctoral level degree to usher in the new era of autonomous practice and primary care physical therapy. However, the APTA didn’t consider the practicality of the transition. With the transition came increased school costs, so now new PTs are coming out of school with crushing amounts of debt. A blog post entitled “Is a DPT degree worth it?” (from fifthwheelpt.com) examines the cost of becoming a physical therapist and a physical therapist assistant. Based on the amount of school and the associated cost, it will take a PT about 20 years to catch up to the PTA in career net earnings. Considering the high rate of burnout (see Burning and churning: Why PTs are leaving patient care, EIM Blog, July 2019), I would be surprised if a PT makes it 20 years to recoup the cost of that Doctoral degree. In addition, having some therapists call themselves doctor while many others don’t (out of choice or because they have a Bachelor’s or Master’s) just confuses people further. Maybe 20 years from now it won’t be an issue, but its hard to argue that more student loan debt and public confusion are helpful.

To pile onto the confusion, we have decided to try to associate ourselves with a body system that doesn’t actually exist. This transition has been a focus of the profession for 40+ years and I ask to what benefit? In 2013 the APTA officially adopted the Movement System as the foundation for physical therapist practice, education, and research. The goals included elevating the public’s perception of our profession by associating with the movement system, as well as to enhance the quality of care and promote the development of more meaningful diagnostic labels for physical therapy. From 1921 to 2013 we encountered significant challenges in educating the public in what we did using terminology they might understand, muscles, nerves, and bones. I can’t see how introducing the movement system will make things clearer for Mr. and Mrs. John Q. Public OR fellow medical professionals. Additionally, we have trouble getting reimbursed when we use currently recognized and accepted ICD-10 diagnosis codes. How do you think the AMA (who administers the code set) and insurance companies will react when we show up with a whole new code set specific to movement system diagnoses?

As a matter of philosophical point of view, pursuing these goals might be worthwhile pursuits but we are struggling to get by in the real world today. Like we always emphasize to PT and PTA students, you have to master the basics before moving on to more advanced concepts and techniques. As a profession, we have not mastered the basics of communicating who we are and what we do, so do we really need to go muddying the water further with more complex questions of identity?

As I stated in my opening, I feel there are several good people involved with the APTA. My beef is not with the people, but with the organization, the mission and the decisions being made. In my opinion the APTA suffers from two major flaws:

They have branched out into so many areas that they have undermined their own ability to be effective at any one of them. Our leadership should be focused on three priorities, reimbursement, marketing, and growing our knowledge base.
The APTA suffers from a concept known as paralysis by analysis. In other words, too much time thinking and studying and being reactive. When it comes to the health of our profession, we don’t need another study group or position statement. We need our leaders to be pro-active about today’s most important issues.

I think the KISS (Keep It Simple Stupid) principle can and should be the primary guiding principle for our profession until we have started to show some progress. Let’s get the word out about what we do, let’s develop and use effective research to prove what we do is effective, and let’s fight to get reimbursed appropriately for what we do. When we are winning those battles, we can pursue more lofty professional goals.

I didn’t choose to write this just to complain. My goal is to determine if others feel the way I do and to hopefully be an agent of change to help PT thrive again. If the APTA is unwilling or unable to reassess and make changes, then perhaps the time has come for our profession to consider other alternatives for leadership and representation. I would love to see your thoughts either way, so please participate in our poll and/or leave a comment if you feel motivated to do so.

Note: There is a poll embedded within this post, please visit the site to participate in this post's poll.

Thank you for taking the time to read, provide your opinion, and for caring about the future of our great profession.

Considering a career change: How about Physical Therapist Assistant?

Jon Waxham, PT — Tue, 15 Dec 2020 20:26:22 +0000

The top four reasons people consider a career change are because they are unhappy, they want more money, or they desire greater flexibility or increased job satisfaction. A career as a physical therapist assistant (PTA) can satisfy many, if not all those desires. Careers in physical therapy routinely rank in the top twenty for job satisfaction, flexibility, and job growth.

Why do people change careers?

Despite the general perception, people don’t just change careers on a whim. In my case I chose physical therapy as a second career because I couldn’t find a job after college graduation. It takes some forethought and planning before you can make that jump. According to Indeed.com, a person will think about a career change for an average of 11 months before acting and the top 5 reasons people consider a change include:

Unhappiness in current job/profession
Desire for greater flexibility
A chance to earn more money
Not challenged or satisfied
Looking for more opportunities for advancement

Deciding to make a change is a big first step, but once you have decided to change what do you do? Choosing a new career has a lot to do with the reason(s) you considered a change in the first place. You need to identify what your current job/career is lacking and then try to find a choice that will get you what you need.

What makes physical therapist assistant a good career choice?

If a majority of people make career changes for the reasons listed above then working a physical therapist assistant is worthy of serious consideration as a new career. Physical therapist assistants are licensed healthcare workers that work under the supervision of a physical therapist. They provide physical therapy treatment to persons across all age groups and in all healthcare settings (hospitals, out-patient clinics, nursing homes, etc.). For more specific information about physical therapy, you can check out our blog: What is Physical Therapy?

Annual Salary

According to the Bureau of Labor Statistics, the average annual salary is $58,520 with an average hourly wage of $28.14. Annual salaries are impacted significantly by the healthcare setting where the physical therapist assistant works, with skilled nursing facilities and home health settings paying the best. Geographical location can also have a large impact on compensation. More specific salary data can be found at: https://www.bls.gov/oes/current/oes312021.htm

Job satisfaction

Working in physical therapy provides a high degree of job satisfaction. I can’t count the number of patients who told me that physical therapy changed their lives. The treatment that PTs and PTAs perform can provide pain relief and restore the quality of life for patient’s that had little hope before seeking out our services. Making that kind of difference in people’s lives is what being a physical therapist assistant is all about.

Flexibility

The variety of job openings and work settings available provide the physical therapist assistant with a flexibility that is not always available in other careers. Much of the day-to-day routine of a PTA is determined by the type of patients they encounter and the healthcare setting where physical therapy treatment is provided. If you choose to work as a PTA, you will have the choice to work full-time, part-time or on an as needed basis based on your career goals and financial needs. In addition, providing physical therapy treatment in an acute hospital is a completely different work experience than treating patients in a sports medicine clinic. Therefore, if things get a little stale you completely change your daily experience without having to start a new career.

Advancement

As a physical therapist assistant, you can choose to focus on just providing patient care, however opportunities exist for PTAs to advance into management positions and even into ownership. I have had physical therapist assistant students that graduated and within 5 years had accepted clinic director positions. No matter what your level of ambition is, you can be sure to find it as a physical therapist assistant.blog

What attributes make a good PTA?

If you want to become a physical therapist assistant, you will need these 5 attributes:

The ability to work well with people. This applies not only to being able to interact with patients but also to work as part of the physical therapy and the larger healthcare team.
Compassion and energy. When people come to see PTs and PTAs they are usually hurting and not at their best, so it is up to us to empathize and support them until they get back up to speed.
A passion for learning. To be an effective PTA you need to have a strong foundation in human anatomy and physiology and in physical therapy procedures.
Critical thinker. Even though PTAs work under the direction of the PT, they are expected to make daily decisions to ensure that treatment they provide is both safe and effective.
Physical stamina. Providing PT treatment can be a physically demanding task, so you want to make sure you are up to the challenge before starting on your new career path.

What does it take to become a PTA?

You need to complete the following steps to begin working as a physical therapist assistant. First you must graduate from an accredited PTA program which requires two years at a community college or university. Then you must pass the national licensing exam for physical therapist assistants. Finally, you must apply for licensure in the state where you intend to work. Once you have been awarded your state license you can work as a PTA.

Worried about going back to school?

During my time as a physical therapist assistant program director the students that entered our program ranged in age from 17 to 58 with an average age of 28 years old. About 45% of students in our program were changing from a previous job/career into physical therapist assisting. I had multiple students who had retired from one career and were looking for something new to do. The demographics for my program were consistent with trends seen throughout PTA programs, so if you have any concerns about being the only older student you needn’t worry!

Are there physical therapist assistant jobs?

It is natural to have concerns when you start preparing for a change in careers that there won’t be a job for you when you finally get there. That won’t be the case if you choose to become a physical therapist assistant. The Bureau of Labor Statistics estimates the need for PTAs will grow by 33% between 2019 and 2029. That gives you plenty of time to complete your training and be sure there will be a job waiting for you.

There are many reasons you might be considering changing careers. A career as a physical therapist assistant just might provide you the income, satisfaction and flexibility that is lacking in your current job. Remember,

“The only way to do great work is to love what you do. If you haven’t found it yet, keep looking. Don’t settle.” – Steve Jobs –

References:

31-2021 Physical Therapist Assistants. (2020, July 06). Retrieved December 15, 2020, from https://www.bls.gov/oes/current/oes312021.htm
Career Change Report: An Inside Look at Why Workers Shift Gears. (2019). Retrieved December 15, 2020, from https://www.indeed.com/lead/career-change

Do Physical Therapy Exercises Help?

Jon Waxham, PT — Mon, 30 Nov 2020 17:47:34 +0000

Why do people go to physical therapy? Typically they have pain or impaired movement. Physical therapy exercises are chosen specifically because they will help reduce your pain or improve your ability to move and function, so they can have an immediate impact on your quality of life. General exercise is non-specific with a goal of improving overall fitness, which can take weeks or months.

The purpose of general exercise.

General exercise doesn’t have a specific purpose but is intended to improve overall health. How many times has your doctor told you that you need to exercise more? If you are like me, you hear it every time you go to the doctor. They tell you how important it is but don’t give you many specific suggestions. General exercise usually has one of three purposes. First, you can exercise to improve heart and lung function (cardiovascular exercise). This is what most doctors mean when they say you should exercise more. If your heart isn’t up to speed, then the rest of your body isn’t either. Second, you can exercise to improve strength (resistance exercise). As we age, we lose muscle mass (termed sarcopenia) which leads to weakness and some loss of function. Think about the old commercial, I’ve fallen and I can’t get up. The most common reason is insufficient strength in the legs and core to get off the floor. The third reason we exercise is to improve mobility (flexibility exercise). Advancing age and the postures we adapt all day (like sitting) lead to increased tightness and less motion. Stretching is a good way to minimize or reverse poor mobility.

Physical therapy exercise is targeted to your specific needs.

Unlike general exercise, physical therapy exercises are chosen for you with a very specific purpose in mind. Physical therapists and physical therapist assistants spend a lot of time in school learning how the human body functions and how to fix it when something isn’t working the way it should. During the physical therapist’s examination, they identify individual muscles, joints or nerves that are not functioning optimally. Those affected structures result in your pain or inability to perform your daily tasks.

Based on the results of their examination they select specific exercises to resolve your specific impairments, to reduce pain and to restore your ability to do the things you need or want to. This is referred to as an exercise prescription. Once your pain has gone away and your ability to function is restored then the exercises are no longer needed.

What is an exercise prescription?

When you think of a prescription you think of a particular medicine that you doctor has prescribed you to help with a current illness. You take your prescription until the symptoms or illness has gone away. Well, an exercise prescription is basically the same thing. Much like your doctor, your physical therapist conducts an examination and identifies a diagnosis and treatment plan. Your treatment plan may include an exercise prescription. These are exercises designed to resolve your specific physical impairment or to reduce your pain. You are to perform these exercises until your symptoms resolve or your function improves. Once that has occurred you can stop the exercise prescription.

Physical therapists may also provide exercises to prevent future problems.

A big component of physical therapy treatment is educating our patients about how their body works and how to prevent injury. In addition to an exercise prescription your physical therapist may also suggest maintenance exercises to keep your body functioning well and/or to prevent your injury from reoccurring. Many patients that seek out physical therapy care are not sure how or why they started having problems. It might be something they are doing in their daily routine or might be the result of some age-related changes like decreased mobility or strength. In both cases a physical therapist can work with you to identify factors that contributed to your diagnosis or that put you at an increased risk for future injury, and suggest exercises or modifications to your daily tasks to minimize your risk for injury. Unlike an exercise prescription, these types of exercises are designed to be done long term.

So physical therapy exercises are provided with a specific purpose based on individual needs with a goal of restoring optimal function, getting rid of pain, or preventing future injury. General exercise tends to be just that, with an overall goal of improving cardiovascular health, strength, or mobility.

What is Physical Therapy?

Jon Waxham, PT — Mon, 26 Oct 2020 18:28:31 +0000

What is Physical Therapy?

When I tell people what I do for a living the most asked question is what is physical therapy? Physical therapy is the branch of medicine that focuses on reducing pain and improving/restoring your ability to move so you can participate in the specific activities that make your life meaningful. Physical therapists accomplish this by reviewing your medical history, completing a physical examination, and developing a treatment plan that addresses your specific injury/disease, and functional limitations.

Who provides physical therapy?

Physical therapy is provided by physical therapists and physical therapist assistants.

- Physical therapists are medically trained experts that study how the human body works and learn methods to restore function for a wide variety of diseases and injuries. It takes 7 years of college including a 4-year Bachelor’s degree and 3 years of graduate training in physical therapy to become a physical therapist. Once a physical therapist has completed their education, they must apply for a license to practice in their state and pass a national licensing exam. As the name implies, physical therapist assistants work under the direction of the physical therapist to provide the treatments to the patient that the physical therapist has chosen.
- Physical therapist assistants get their training from approved 2-year college programs. They earn an Associate’s degree, must also apply for licensure with their state, and must pass a national licensing exam specific to the role of the physical therapist assistant.

What treatments are done in physical therapy?

There are a large variety of treatment choices a physical therapist may choose to treat your particular case. The type of treatments you receive in physical therapy are specifically chosen based on your level of function, your injury or diagnosis, where you are in the healing process, and the goals that you and your physical therapist have identified.

If you have just suffered an injury, have pain and are in the early stages of the healing process treatment will focus on reducing inflammation and protecting the healing tissue while making sure you don’t continue to lose function. Physical therapists use equipment such as ultrasound, electrical stimulation, compression, hands-on treatments, and cold therapy to reduce pain and swelling.

For injuries or diagnoses that are more chronic or long term, treatment will focus on improving strength and mobility and restoring your ability to function. Treatment choices may include massage, joint stretching, muscle strengthening, therapeutic exercises, and functional movement re-training.

For both acute (recent) and chronic (long-term) problems, patient education plays a key role in recovery and is one of the many treatment strategies used in physical therapy. Many people that come to physical therapy have no idea why they started having pain. Part of the physical therapy examination is to identify movements and behaviors that may have contributed to your pain and/or loss of function and to educate you in strategies to prevent future injuries. Patient education also includes things you can do at home to help the help aid in your own recovery. This may include the use of ice or heat, modifications to specific activities, or exercises that can be done to speed the healing process.

What kinds of injuries do physical therapists treat?

Regardless of the reason, if you are in pain and/or have lost some level of physical function then you are a candidate for physical therapy. Most patients referred to physical therapy are those that have some injury or disease that affects the nervous, muscular, or skeletal systems. Some of the most commonly treated diagnoses include:

Arthritis and joint replacements
Muscle strains
Neck and back pain
Tendonitis/bursitis
Joint sprains/ligament tears
Fractures
Plantar fasciitis/bone spurs
Degenerative disc disease
Sciatica

Stroke
Rheumatoid Arthritis
Parkinson’s Disease
Cerebral Palsy
Multiple Sclerosis
Coronary Artery Disease
Fibromyalgia
Complex Regional Pain Syndrome
Chronic Obstructive Pulmonary Disorder

Where do physical therapists work?

One of the benefits of working in physical therapy is that we can choose to work in medical facilities, patients’ homes, schools, private practices or in corporate businesses. Most physical therapists and physical therapist assistants’ practice in acute care hospitals, rehabilitation hospitals or private out-patient practices. According to the Bureau of Labor Statistics (BLS), in 2019 the most popular work locations for physical therapists were:

- Private out-patient practices 33%
- Hospitals 26%
- Home healthcare 11%
- Self-employed 8%
- Nursing and assisted living 6%

An evaluation by a physical therapist is a given for any patient staying in the hospital. Physical therapy helps to minimize the impact to overall health that hospitalization can have and makes sure that the patient has the mobility and strength to care for themselves before being discharged. The majority of patients with pain or functional limitations don’t require hospitalization so private physical therapy offices employ the most physical therapists and physical therapist assistants.

Can physical therapy help me?

If the answer to either of these two questions is yes, then physical therapy may be able to help you:

1. Do I have pain that gets worse or better with activity?
2. Is there some physical activity I can’t currently do that I would like to be able to do again?

Those are the two biggest reasons people come to see a physical therapist. While physical therapy can reduce your pain and improve your function most of the time, it is important to understand that there might be reasons you have pain or have lost function that require the expertise of another type of medical professional. Part of being a physical therapist is to recognize when patients should be referred to another type of doctor and to make sure that they get to the right medical professional. We are trained to be able to determine if a patient is a candidate for physical therapy treatment or when we need to refer them to a specialist. So you can feel confident that if we can help we will, and if we cannot that we will make sure you get referred to the right type of provider to help you with your problem.

REFERENCES:

Physical Therapists : Occupational Outlook Handbook. (2020, September 01). Retrieved October 26, 2020, from https://www.bls.gov/ooh/healthcare/physical-therapists.htm