Tuesday, August 7, 2007

What Ails You: Role of physical therapist more complicated than some understand

By Jackie Randa

It was a very nice lady who, when she overheard me talking one day, came up and excitedly told me that her granddaughter, who had recently graduated from high school, was now doing physical therapy.

“Is that so? Where?” I asked trying hard not to knit my brow too tightly at her. Her granddaughter, it turns out, had gone to work in a chiropractor’s office. The “physical therapy” she was doing was applying various hot packs and electrical modalities to patients before or after the chiropractor performed his adjustments.

There is often confusion between chiropractic and physical therapy. Chiropractic treatment is a philosophy of health that asserts pain and dysfunction, regardless of where it presents itself, stems from misalignment of the spine; therefore, chiropractic treatment must include manipulation. You may receive other modalities during your treatment with the chiropractor, but the massage, heat and electrotherapy are only adjuncts to the chiropractic manipulation.

Physical therapists, by way of contrast, believe that a vast majority of pain and dysfunction results from problems in the soft tissues (muscles, ligaments, tendons, nerves, etc.). Apart from the philosophical differences, from my experience, the biggest difference between chiropractic and physical therapy is in the effort to guide you to a point when you will become independent of the physical therapist. Especially early in your treatment, I may do treatments to you, but by the time we are nearly done, you will be independent in various movements and practices which will allow you to manage your condition on your own.

Just as I, a physical therapist, cannot advertise chiropractic services, a chiropractor may not say or advertise that he offers physical therapy unless he either is dually licensed or employs a physical therapist who would then perform physical therapy for his clients. A chiropractor may use any of the modalities to help relieve your symptoms. The modalities — which include ultrasound, heat, ice and electrotherapy — can be used by a variety of health professionals and others. They are not tightly regulated and are not, in and of themselves, considered physical therapy. Your dentist may have ultrasound and electrotherapy available. When you go to a spa, they may have the same machines available to use as an adjunct to your massage.

While hot packs and electrotherapy can be a soothing adjunct to any treatment, they should never constitute the treatment in entirety. If that is the only service you are receiving, you need to have a lengthy discussion with your healthcare professional.

Massage, in and of itself, is not physical therapy. If the professional care you are receiving — whether chiropractic or physical therapy — only includes the modalities and massage by an unlicensed aide, you are being shortchanged. Massage is a wonderful way to maintain your health, reduce your stress, care for and nurture your self. It is not, however, an effective treatment for most of the conditions you would seek professional help with.

Physical therapists perform soft tissue mobilization, which is sometimes confused with massage by those who have not had their soft tissue mobilized. Massage may include scented oils, fragrant candles and soothing music while a massage technician smoothes and soothes your muscles. It may be a gross understatement to say that soft tissue mobilization can be uncomfortable. A physical therapist performing soft tissue mobilization is actually reorganizing the tissues so that, once you recover from the treatment, you will find that your pain and dysfunction is greatly reduced. Soft tissue mobilization must be performed by a licensed therapist; either a physical therapist or physical therapist assistant.

Some of our friends and neighbors are being required by their doctor to go to the doctor’s office for physical therapy. “Surely,” you think, “the doctor can perform physical therapy.” Actually? No. physical therapy is performed solely by physical therapists. Your physician may employ a physical therapist who will treat you, but you would have to ask yourself why the doctor is requiring you to travel such long distances to receive your therapy when there are qualified therapists here in your home town. Your doctor is obligated to tell you that he profits from your treatment through the physical therapist he employs.

Personally, I have concerns about physical therapists working for other professionals. It is not that I expect all physical therapists to be self-employed like I am. That is a hard road; a path not for the timid. When a physical therapist works for a doctor or for a chiropractor, I believe — and research on the topic supports my conviction — the patient suffers. Research shows that when the physician profits from the patient’s referral to therapy, treatment is less effective and includes significantly more visits than when the patient is seen by an independent physical therapist.

If you are being treated in a physician-owned physical therapy clinic, be sure you are, in fact, being treated by a physical therapist. A physician cannot direct the activity of a physical therapist assistant. Although assistants are licensed, they must be directly supervised by a physical therapist. When your physician bills your insurance for physical medicine (what physicians sometimes call physical therapy), the doctor must perform the treatment himself. He cannot relegate your care to an unlicensed aide.

A physical therapist has a graduate degree and may even have board certification in their area of expertise. Those diplomas and licenses should be proudly displayed. When you are receiving physical therapy, you should be receiving the focused attention and skills of a licensed professional and not, with all due respect to my friend’s granddaughter, a high school graduate working her first real job. You come to us with pain and dysfunction and we help you through various means to regain as much movement and function as possible. When some restriction persists or when the condition you have is chronic, we help you learn to manage that condition and maximize your abilities in spite of it. A physical therapist helps you reclaim your life from the enemy: pain and immobility.