One size fits all? Part 2: What makes a good PT? Aren’t all therapists the same?

IMG_3930A good physical therapist…

…invests in continuing education- While the majority of states require continuing education credit for continued licensure, some therapists complete only the minimal requirements while others seem to spend every weekend taking courses!  It is reasonable for a patient to inquire about the therapist’s interest in educational topics.  Chances are the PT will be excited to talk about their latest course.

…considers the whole person.  An injury is very rarely limited to the specific joint or muscle that hurts.  A good therapist treats not only the symptoms, but looks for the cause of the injury and understands how dysfunction in one area of the body may contribute to symptoms in a different location.

…draws from a variety of sources and isn’t afraid to learn from others.  Therapists who are willing to collaborate with other practitioners can learn a lot!  See this post for further comments on this topic: Lessons Learned

…is directly involved in your care.  Some tasks are acceptable to delegate to a physical therapy aide, but only a physical therapist (PT) or physical therapy assistant (PTA) can perform physical therapy.  If you only see your PT for a few minutes at the beginning or end of your appointment and spend most of your time doing exercises with an aide or independently, you are not receiving quality care.  The foundation of my training and education is my ability to observe dysfunctional patterns of movement and to relate those findings to the patient’s primary complaint.  It has taken me a long time to refine my observational skills and the longer I practice, the better I get.  Guiding a patient through their exercises provides yet another window of observation and completes my assessment of that person’s problem and is not something I’m willing to delegate to someone else.

…revises or progresses your treatment.  If you are not seeing changes in your condition, are doing the same exercises, or receiving the same treatment at every appointment from week one to week six, you need to consider finding a new therapist.

One size fits all? Part 1: How to choose the best PT for you

I’ll never forget talking with a good friend who was looking for a physical therapist a few years ago.  His doctor had given him a few local names but he wasn’t sure how to choose.  So, he picked up the phone and started calling.  But, he wasn’t calling to schedule an appointment…he was calling to interview the therapists!   At the time, I remember laughing and him and his surprise when I told him pre-interviewing a physical therapist wasn’t a common practice, however I now understand why he felt the need.

So…

How do you choose a physical therapist?

Is the list your doctor hands you the best guide?

Is Yelp the place to go to find the right fit for you?

1. Trust the testimonials of family, friends, coworkers, and other healthcare practitioners.  Ask for their recommendation of whom they would visit should they or a loved one need physical therapy.  Many people have had a previous experience with a physical therapist.  Some remain loyal patrons of one practitioner, while others have been treated at multiple clinics, by several different therapists.   Read review sites with an open mind.  Many times, negative reviews focus on billing misunderstandings or office policies

2. Understand a PT’s credentials.  Most consumers have no idea what the letters behind the therapist’s name mean.  I address this in an earlier post found here: Alphabet Soup  Don’t be fooled by the number of certifications and credentials listed after your therapist’s name—they often little to do with the quality of the therapist.

3. Establish a rapport. You’re going to be spending a quite a bit of time with your therapist, so it’s helpful to get along, while maintaining a professional relationship of mutual respect.  You should feel that your PT is listening to your concerns and involves you in the goal setting process.  It is great to find a PT who has similar interests as you, but if they don’t, they should at least be willing to understand the demands of the activities that you enjoy.  Although I’m a runner, swimmer, and cyclist, I have treated fencers, ballet dancers, surfers, and hockey players.  If you don’t connect with your therapist after the first couple of visits, it’s reasonable to consider involving another in your treatment.

So now you’ve chosen your therapist and begun treatment.  When you’re ready to compose a testimonial, what will you write?

Stay tuned for steps to determine if you chose wisely in: One size fits all?  Part 2: What makes a good PT?  Aren’t all therapists the same?

Alphabet Soup

Image

Are more letters better?

The question brings to mind the popular AT&T commercial currently airing which features a guy in his 30s sitting around a table in a classroom with a group of four kids.  He asks similar questions, “Is bigger better?”, “Would you rather be faster or slower?”, “Would you rather have more or less?” while the cameras roll, catching the excited answers of the kids and his deadpan responses.  I bet if he asked those kids (or a group of adults, for that matter) if more letters behind a name were better than fewer letters, they would all agree that more is better.  But is that really the case?  Are the number of letters after a therapist’s name  related to their skill as a physical therapist?

No other profession knows their alphabet better than healthcare.  Only in healthcare do you find such a mix of letters designating specific licenses, degrees, and certifications extending beyond a practitioners name, often coming close to Twitter’s 140 character count limit.  Sitting around the table at the Sports Physical Therapy Section conference in Las Vegas one year, several of my colleagues and I began quizzing one another on just what all of those letters meant.  One physical therapist even had a running list he kept on his iPhone where he wrote down every combination of letters he came across after someone’s name.  We stumped each other with a few, which made me wonder if consumers were just as confused by all of those letters.

In this month’s edition of Today in PT, writer Terese McUsic describes several different certifications and states, “PTs are increasingly finding that adding specialty designations can increase their patient base and enable them to explore cutting-edge therapies.”  John Lowman, PT, PhD, CCS, chairman of the American Board of Physical Therapy Specialties claims that certification can increase credibility in the eyes of referral sources though, from my experience, referral sources rarely know what even the most common physical therapy credentials stand for.

A statement I hear with increasing frequency is, “He’s a DPT.”  No, he’s a PT.  The fact is, most consumers believe that a physical therapist with a DPT is more skilled than one who earned their Masters of Science or even Bachelor’s Degree in Physical Therapy.  I would argue that the difference in degree is more a reflection of how long the therapist has been practicing, since the DPT degree was far less common as little as 10 years ago.  However, this is not an article meant to discuss the value of a DPT, but rather to point out that referral sources and patients alike need to be informed about the various credentials after your name, and how those certifications may not only differentiate you as a therapist, but also influence your treatment philosophy and style.

Credential List (special thanks to Bryce Taylor, PT, MS for helping out with this list):

PT-physical therapist (not personal trainer)

MS-Masters of Science

DPT-Doctor of Physical Therapy

DPTSc-Doctor of Physical Therapy Science

DHSc- Doctor of Health Sciences

DHS-Doctor of Health Sciences

CCS – Cardiovascular and Pulmonary Certified Specialist

ECS – Clinical Electrophysiologic Certified Specialist

GCS – Geriatric Certified Specialist

NCS – Neurologic Certified Specialist

OCS – Orthopaedic Certified Specialist

PCS – Pediatric Certified Specialist

SCS – Sports Certified Specialist

WCS – Women’s Health Certified Specialist

FAAOMPT-Fellow of the American Academy of Orthopedic Manual Physical Therapists

FAPTA- Fellows of the American Physical Therapy Association

DMT-Doctor of Manual Therapy

MOMT- Master of Orthopedic Manual Therapy

CSMT- Certified Spinal Manual Therapist

GDMT- Graduate Diploma in Manipulative Therapy

MCSP- Member of the Chartered Society of Physiotherapy

CFMT-Certified Functional Manual Therapist

COMT- Certified Orthopedic Manual Therapist

OMT-Orthopedic Manual Therapist

MDT- Mechanical Diagnosis and Therapy

CMP-Certified Mulligan Practitioner

ATC-Athletic Trainer

CSCS-Certified Strength and Conditioning Specialist

CLT- Certified Lymphedema Specialist (not to be confused with Certified Lab Technician)

CPE- Certified Professional Ergonomist

CVT- Canine Physical Therapist (yes, our best friend needs PT too!)

CERP-Certified Equine Rehabilitation Practitioner

CDMS- Certified Disability Management Specialist

LMBT- Licensed Massage and Bodywork Therapist

MMT- Master Massage Therapist

LMT-Licensed Massage Therapist

RYT-Registered Yoga Teacher

CPI-Certified Pilates Instructor (though there is no one Pilates Certification Board)

PES- Performance Enhancement Specialist

HFS-Health Fitness Specialist

ART-Active Release Technique

CKTP- Certified Kinesiotape Practitioner

CGFI-1- Certified Golf Fitness Instructor Level I

Unable to find these:

MTC

GCPT

MMPT

CBI

M&MAI

Ah-ha moments

I had an ah-ha moment the other day.  Ah-ha moments are interesting—I can’t predict when they’ll surface or how powerful they’ll be.  The one thing I can always count on, is that they will teach me something I hadn’t considered before.

This particular moment came as I was instructing a patient in a breathing and core muscle activation technique.  He and I have worked together, on and off, for the past 5 years for rehab, to wellness, then back to rehab.

As he concentrated on my cues and tried to do as I instructed, he suddenly stopped.

“You know Sydney, this is really frustrating,” he said.

“I know.  It takes practice but you’re getting it,” I replied.

Then the ah-ha moment.

“I think you think it’s really great that you’re always learning new things, but for a patient, it’s really frustrating.”

And then I understood.

I had never considered that my excitement about having a greater understanding of the assessment and treatment techniques we employ could be a source of frustration for my patients.  What I was teaching 5 years ago, may, in fact, be very different that what I am teaching today.  There isn’t a one size fits all treatment approach for a given condition and every day we’re learning more and more.

I do think it’s great that we haven’t figured everything out and we understand more about the human body every day.  How dull would it be if we knew all there is to know and that was all there is?  Over the course of my 10 years as a physical therapist, I have grown and changed my treatment strategy.  While my core philosophy remains the same, my techniques and understanding have evolved as I’ve continued to learn from research, from experience, and, let’s face it, from trial and error.  I will continue to learn and quite possibly change how I do things from time to time, in the hopes that I’m creating an ah-ha moment for someone else.

Lessons Learned

This post has been a long time coming, and I’m not particularly sure why.  Perhaps I was worried I might ruffle some feathers, but when I read the recent editorial by Jas Randhawa, DC and DPT student Kyle Balzer, I was ready to write.  If you haven’t yet read the post, you should:

http://www.jrsportperformance.com/uncategorized/pts-vs-chiros/

PT’s in California are facing a fight in Sacramento that threatens to take away our ability to perform techniques that we have been practicing for years.  SB 381 would prohibit physical therapists in California from performing joint manipulation, reserving the right to this technique to licensed chiropractors, physician/surgeons or osteopathic physician/surgeons.  I don’t know about you, but I don’t know many physicians trained to do joint manipulation.  However, HVLAT techniques are a part of physical therapy school curriculum.  See this editorial for more on the history and training of the two professions:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2565606/

But…I digress.  The intent of this post isn’t to discuss SB 381, it is to share a lesson I’ve learned over the past couple of years.

The interaction between chiropractors and physical therapists has often been contentious, but over the past several years, I’ve asked myself if it really needs to be that way.  PT’s and Chiropractors (we may as well throw Athletic Trainers into the mix) get so hung up on territory and competition and scope of practice, but the way I see it, it’s not only a waste of time and energy but leads to many missed opportunities for learning.

Some of my closest friends in the rehab world are not PT’s.  Some of the people I respect most as clinicians in the rehab world are not PT’s.  Some of my mentors are not PT’s.  The one thing we have in common is that we’re not afraid to learn from practitioners outside of our discipline.  As a result, I’ve been exposed to continuing education courses, have learned techniques that fall outside of the world of traditional PT courses and have become a better clinician because of it.  I’ve been fortunate to have conversations with other rehab specialists, been able to discuss complicated cases approached from different perspectives and am a better clinician because of that.

Rather than staking claim to certain techniques or being worried that someone will take business away, we should spend our time and energy learning from one another to improve the health and optimize the function of our patients. Let’s face it, there will always be plenty of people who need our help.

On the Run

I can’t escape it.  My work follows me wherever I go.  Everyone always talks about how PT’s get to leave their work at the clinic.  Once we’re done with the daily documentation there really shouldn’t be anything that has to be done at home.  The one thing no one talks about is how hard it is to take off your PT hat to see the world through different eyes.

It used to be fun.  In graduate school we’d be given assignments to go out in a public space to observe people walking and completing daily activities.  Now I watch people wherever I am, evaluating their every move.   It’s so normal for me that I don’t even realize I’m doing it, much of the time.  It’s not until T and I are on one of our epic urban hikes and I’m performing running analyses on every poor runner who happens to bound by, gleefully unaware that I’m scrutinizing their every step and he tells me, in his kind way, that he’s heard enough.  It’s even gotten to the point where he calls out mechanics he doesn’t like in runners passing by and sometimes I have to tell him, in my kind way, that I’ve heard enough.  Ever the entrepreneur, he recently, and only half-jokingly, suggested I set up a booth on The Embarcadero and offer my services to the scores of runners passing by.

I have, however, begun to see this “problem” as more of a blessing than a curse. I do believe it’s made me a better PT by exposing me to all types of running styles.  I didn’t need to read a running magazine a few years ago to forecast the growing popularity of the minimalist shoe. In the past few years, I have seen a noticeable increase in the number of people running without shoes or in minimal shoes, and with that, a rise in the number of runners who come to me with an injury related to running because they haven’t transitioned correctly or may not be appropriate for minimalist footwear.  I also now see more runners landing on their toes than I have in the past, independent of shoe type, and while some runners look so natural moving down the road, the effort is palpable in many others.

I feel fortunate to work in a city where running is so popular, a job that involves the rehabilitation and prevention of running injuries, and in an era when research on running mechanics, styles, and trends is constantly emerging.  I look forward to sharing what I see and learn…just as soon as I get back from my run.

“My Physical Therapist”

Month–wonder if anyone knows that besides the physical therapists?  It always amazes me when I ask a new patient if they have ever had physical therapy and their answer is, “no.”  Many of the people I know in San Francisco have a team of practitioners: my doctor, my dentist, my chiropractor, my acupuncturist, my nutritionist, my personal trainer, the list goes on and on.  I look forward to the day when physical therapists consistently make the list of healthcare practitioners that patients seek out if they have a musculoskeletal injury.

A couple of years ago, my friend was diagnosed with an L5-S1 spondylolisthesis.  He was anxious about the diagnosis and asked for my advice.  I assured him that this was a common condition that PT’s treat and encouraged him to seek treatment.  A few weeks later he told me about his experience choosing a physical therapist.

He explained that he called the clinic and asked to speak to the therapist in order to interview her before starting treatment.  I laughed at the time–he wanted to interview her??  I told him that isn’t the way it works–generally patients just schedule the appointment and go for the initial evaluation where they meet the therapist for the first time.  Of course, I’ve given many clinic tours and talked to plenty of patients at the front desk to answer questions before their first session.  In the past, I always did so with a little (hopefully well-hidden) annoyance feeling irritated that they had doubts that we could help them.  Well, maybe my friend and those patients are on to something.  I’m not suggesting we all spend hours of our already packed days being interviewed by prospective patients, but perhaps a few minutes spent answering an email or talking with a potential patient could go a long way in developing rapport and ensuring that the patient become an active participant in their rehab.

That’s what we all want, isn’t it?

And then, just like that, you’ve become, “my physical therapist.”

Why PT?

physical_therapy_san_francisco

I wasn’t one of those kids who knew exactly what they wanted to be when they grew up.  Problem was, I wanted to grow up and do lots of different things.  This affliction followed me to high school where I sang in choirs, wrote for the school newspaper, played sports, and was surprised to discover my love for the human body in Mr. Larson’s anatomy class.  College rolled around and I had to apply to a specific major.  I knew I loved teaching, but there were just so. many. things. I wanted to learn and do.  I used to say I wished I had 9 lives so I could have 9 different careers.  Fast forward to my last year of college.  I was on track, ready to graduate and start a teacher credential program when I found it–a profession that encompassed just about everything I was looking for that allowed me to educate, stay active,engage with interesting people, promote healthy lifestyles, and help people heal.  Physical therapy was something I knew absolutely nothing about until a minor running injury landed me on the table in our local clinic.  I didn’t go to many sessions and remember little about what we did there, but the experience opened my eyes to a new opportunity.  Much to my parents dismay, I forged a new purposeful path and spent the next 3 years pursuing this new goal.  Even upon graduation from PT school, I had no idea how my career would evolve beyond the walls of a clinic.  I now have a job that lets me do just about all of the things that I enjoy–teach continuing education courses, promote health and the prevention of injury to community groups, evaluate runners for injury prevention, and write articles for various physical therapy magazines.  I save the cooking for home and the singing for my weekly get together with The Loose Interpretations (more on that to come…).