A Personal Perspective on Physical Therapy
by Karen Kinsey

Practicing as a licensed physical therapist for numerous years, it surprises me that many patients and people in general are not familiar with physical therapy. People seem unaware of our function in the medical community. Our field has changed a great deal in the past 20 years; however it seems that the general public is still unaware of exactly what we do. I have put together the following list of questions and answers to hopefully clarify the situation.

What should a person expect from physical therapy?

A person starting physical therapy should expect a thorough evaluation of the neuromuscular system in order to find the cause of the problem. Based on this evaluation, a comprehensive plan of care should be initiated to address these issues.

Treatment options may include joint mobilization, traditional stretching, neuromuscular treatment strategies and or modalities. Treatment should be active with the involvement and movement of the patient. Physical Therapy is not just passive with the use of modalities (Hot Pack, Ultrasound, and Massage) only.

A patient should expect to see improvements. A good Physical Therapist will reassess progress and make adjustments to treatment plans based on new findings. Also, therapy is generally a limited number of visits with the ultimate goal being discharge and return to function. It is not based on principles which dictate a need to return on a habitual basis for an infinite amount of time. We foster patient independence, and discharge patients with home exercise programs so they continue their progress on their own.

In addition, if after the initial evaluation the therapist decides that this is not an appropriate referral which fits a mechanical model; the Physical Therapist should speak to the physician and offer their findings.

What is a physical therapist?

According to the APTA (American Physical Therapy Association), the definition of a physical therapist is an individual, licensed by the State Board of Physical Therapy Examiners, who practices physical therapy and who has passed the national physical therapy licensing examination. ⁽¹⁾

What is the level of education involved in physical therapy?

Currently students complete a post baccalaureate (Bachelors Level) program. Most cases this is a Masters Level Program, however, there are professional or (Doctorate) programs in physical therapy. These programs are approximately 3 years in length.

To apply to Physical Therapy School, one must possess a bachelor’s degree with a strong emphasis in the sciences. It is recommended that you carry a 3.0 GPA or higher for acceptance into the program.

The profession is transitioning into Doctoral programs of education however currently most programs continue to be Master’s Level.

What is physical therapy?

The Maryland State Physical Therapy Practice Act defines physical therapy as the health specialty concerned with: the prevention of disability in individuals, and the physical rehabilitation of individuals with a congenital or acquired disability.

Practicing physical therapy includes

• Performing evaluations for the physical therapy needs of individuals;
• Performing and interpreting tests and measurements of neuromuscular and musculoskeletal functions to aid in treatment;
• Planning treatment programs that are based on test findings
• Administering treatment with,
  • Therapeutic exercise
  • Therapeutic massage
  • Mechanical devices
  • Or therapeutic agents that use the physical, chemical, or other properties of air, water, electricity, sound or radiant energy. ⁽²⁾

It does NOT include using X-rays, radioactive substances, or electricity for cauterization or surgery. ⁽²⁾

What does a physical therapist do?

Put simply, physical therapists are movement specialists. Our job is to determine causational relationships using biomechanical means. (For example, we may evaluate your foot function to see how this affects the forces at your knee). We assess the patient (both statically and dynamically), and then develop treatment strategies to correct the deficits and normalize joint function. Normal joint function depends on

• Joint stability,
• Freedom of movement (full range)
• Proper load distribution through the joint

Our job is to get joints moving, not to treat joints passively only through the use of modalities. (Hot Packs, Ultrasound, Massage, Electrical Stimulation), although modalities (physical agents such as heat, ultrasound, or electrical stimulation) are used in conjunction with treatment, physical therapy is much more than that.

Put more simply, physical therapists increase stability through strengthening and neuromuscular treatment, increase movement through stretching and mobilization, and retraining the joints to function normally;

What are the general principles involved in physical therapy?

The general principles involved in physical therapy are

• Myokinematics,
• Osteokinematics,
• Arthrokinematics
• Kinetics.

Put more simply, Physical Therapist must understand the proper movements of the muscles, bones, joints, and how they function together to properly treat patients. ^{(3, 4, 5)}

What are the different types of physical therapy?

There are many divisions associated with physical therapy. Some include

• Acute care
• Aquatics
• Cardiovascular and pulmonary
• Geriatrics
• Oncology
• Neurology
• Orthopedics
• Pediatrics
• Sports physical therapy
• Women’s health

How did Physical Therapy Start?

Physical Therapists have been around since the beginning of the twentieth century, however, they gained more recognition during the 1940’s and 1950’s during the polio epidemics.

During the 1960’s an increase in the number of educational facilities emerged and course work became more challenging.

During the past two decades, the profession has made great strides to incorporate biomechanical principles in order to help patients achieve and restore optimal functional capacity, minimize impairments, functional limitation and disabilities related to congenital and acquired conditions.

What has changed in physical therapy?

Over the years, physical therapy has progressed into a more exact practice.

Education has changed from Bachelor Level to a Masters and/or Doctorate level.

Clinical skills are specific. Treatments are designed to influence a specific problem to help change biomechanical causes which create symptoms.

As the population ages and changes, physical therapy demands increase to ensure better mobility and function, which translates into better quality of life.

I hope that this has cleared many questions that you may have had. If you would like to discuss it further please contact us at Hereford Physical Therapy and Sports Medicine (410) 229-0055

⁽¹⁾ Foundation of State Boards of Physical Therapy, Model Practice Act for Physical Therapy, - 3rd Edition, 9/01

⁽²⁾ Maryland State Physical Therapy Practice Act , Definitions 1 – 3

⁽³⁾ LeVeau, B and Bernhardt, D, Developmental Biomechanics, Effects of Forces on the Growth, Development and Maintenance of the Human Body, Physical Therapy, Vol 64, No 12, 1874-1882, 1984

⁽⁴⁾ Bullough, P, Osteoarthritis : Pathogenesis and Etiology, British Journal of Rheumatology, Vol 23, No 3, 166-169

⁽⁵⁾ Gofton, JP, Studies in Osteoarthritis of the Hip, Part IV, Biomechanics and Clinical Consideration, Canadian Medical Association Journal, Vol, 104, No 11, 1007-1011, 1971

Please call Hereford Physical Therapy & Sports Medicine for assistance or consultation with your physical therapy needs.

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