If you Google “Physical Therapy,” the first definition that will come up reads: “The treatment of disease, injury, or deformity by physical methods such as massage, heat treatment, and exercise rather than by drugs or surgery.” Most, if not all physical therapists, would argue that physical therapy is much more than just treating someone with massage, heat, and exercise. Treatment of musculoskeletal issues requires joint and soft tissue mobilization, neural glides, functional exercises, and modalities used in conjunction with evidence-based practice. However, none of these treatment techniques will return a patient to full function without addressing the psychology surrounding pain.

We have heard stories of soldiers being shot in war and reporting that pain was never felt. On the opposite spectrum, there are people who report that if you stroke their forearm it feels like a blowtorch even if there is no direct musculoskeletal injury. Why is there such a variable in the pain response? The answer lies in the brain and its perception of pain. Signals in your skin, muscle, ligament, tendon, capsule, and disc can all send messages to your spinal cord, and then to your brain, in order to report that something MAY be painful. But only your brain can interpret the signals and decide that the stimulus truly IS painful. People who have chronic pain (lasting over 3 months) can become hypersensitive to the signals that are transmitted to the brain. Now, a stimulus that other people would regard as just a hand brushing across a forearm feels more like a blowtorch.

A physical therapist trained in the understanding of chronic pain can recognize when a pain response is hypersensitive. Addressing this through education of what is ‘good pain’ versus ‘bad pain’ and the process of how pain is created by the brain, along with progressive desensitization techniques, is the best way to help patients begin to take control of the pain and increase their function. Knowledge is power, and in this case, knowledge means less pain.

Physical therapists earn a Doctorate degree after seven years of post high school education. Undergraduate work is four years focusing on anatomy, physiology, kinesiology, neuroscience, and biomechanics. Graduate work is three years of focused schooling on differential diagnoses of musculoskeletal disorders, effects of disease on all organ systems, pharmacology, and specialized care for patients with a variety of conditions. Physical therapists diagnose and manage movement dysfunction, restore and maintain function, and prevent the onset of symptoms and impairments [1].

Physical Therapists in most states are required to perform continuing education to maintain their licenses. Many therapists take this a step further and become credentialed in specialty areas of physical therapy. Specialist certifications can be in cardiovascular and pulmonary care, clinical electrophysiology, geriatrics, neurology, orthopedics, pediatrics, sports, and women’s health [2]. Even within those specialties, physical therapists can be credentialed in certain techniques to help improve their outcomes. However, in order to treat the growing number of Americans with musculoskeletal injuries, the physical therapist employs the use of physical therapy assistants and aides. It is important to identify what knowledge these healthcare workers have as well.

Physical therapy assistants (PTA) work together with physical therapists to provide patient care. The PTA program is a two-year program that is 75% classroom/lab study and 25% clinical education [3]. PTAs study anatomy and physiology, biomechanics, exercise physiology, and clinical pathology. Assistants cannot perform initial evaluations or progress reports, but they do provide exercises for patients, administer modalities, and perform some joint mobilizations under the direct supervision of a physical therapist. What a PTA can do specifically depends on the state in which they practice. There have been many physical therapists and PTAs alike who have expressed concern that a two-year program is not enough time for PTAs to be thoroughly trained in the increasing complex musculoskeletal disorders that are seen in clinics today. This year, the American Physical Therapy Association (APTA) is investigating the feasibility of changing the PTA program from a two-year associate’s degree to a four-year baccalaureate degree.

Physical therapy aides also work alongside physical therapy assistants and physical therapists. A physical therapy aide is not required to have a college degree and learns from on-the-job training. Aides are responsible for keeping therapy rooms clean and well organized, setting up and taking down equipment, performing clerical tasks, and assisting patients in and out of therapy areas [4]. Again, specific outlines concerning what an aide may, and may not do, are dependent on the state where the aide is employed.

In order to reduce healthcare costs and improve functional outcomes, physical therapy is being used more frequently as primary care for musculoskeletal disorders. More than one in every five primary care visits is for a musculoskeletal issue [5]. Physical therapy is more than just exercise, heat, and massage. Moreover, physical therapists cannot treat the growing number of patients coming into clinics alone. They rely on physical therapy assistants and aides in an effort to keep the quality of care as high as possible even when insurances are reimbursing less for services. If you have a musculoskeletal issue, contact a physical therapist to set up an appointment for an evaluation.

 

Works Cited

[1] American Physical Therapy Association. (2013, March 28). Role of a physical therapist assistant. Retrieved from http://www.apta.org/PTACareers/RoleofaPTA/
 
[2] ABPTS. (2013, February 28). Specialist certification. Retrieved from http://www.abpts.org/Certification/
[3] APTA. (2013, March 28). Physical therapist assistant (pta) education overview. Retrieved from http://www.apta.org/PTAEducation/Overview/
[4] Careers. How to become a physical therapy aide. Retrieved from http://www.innerbody.com/careers-in-health/how-to-become-a-physical-therapist-aide.html
[5] Power, J., Perruccio, A., Desmeules, M., Legace, C., & Badly, E. (2006). Ambulatory physician care for musculoskeletal disorders in Canada. Journal of Rheumatology, 33(1), 133-139.