A Complete Approach to Physical Therapy

According to the American Physical Therapy Association (APTA), physical therapy management has five elements: examination, evaluation, diagnosis, prognosis, and interventions. However, the most common problem with physical therapy is that it begins with a physical therapy prescription from a physician who already has a diagnosis assigned to the patient. Once applied to the patient's care, all findings are inherently biased by the diagnosis on the prescription. Furthermore, the physical therapist's treatment must follow the anatomical region denoted by the prescription. Traditional physical therapy typically follows this framework, and many practices forbid physical therapists from treating areas not listed on the prescription.

In my medical practice, physical therapy diagnosis and treatment are more integrated. Patient treatment involves discussion amongst multiple highly experienced medical professionals, a thorough review of patient medical history, imaging, bloodwork, lab work, and all prior testing. As a result, a complete physical therapy treatment plan is developed that follows the six principles of Naturopathic Medicine: The Healing Power of Nature, Identify and Treat the Causes, First Do No Harm, Doctor as Teacher, Treat the Whole Person, and Prevention.¹

The Healing of Nature recognizes the human body's unique ability to heal and recover from injury and illness. Regarding physical therapy, many diagnoses, such as tendinitis, bursitis, plantar fasciitis, tendinopathy, and neuropathy, are all related to the body's inability to heal or recover. Furthermore, delays in recovery from injuries or surgeries are also associated with difficulty in healing. Rather than minimize symptoms through medication, our approach is to determine a patient’s barriers to recovery and address those problems immediately. In this way, patients can heal and recover much faster than from traditional physical therapy, and they are less likely to have these difficulties again.

Identify and Treat the Causes emphasizes looking for the underlying source of a patient’s symptoms rather than simply minimizing or eliminating symptoms. A detailed examination and evaluation of a patient’s medical history allows our physical therapists to determine the specific origin of a patient’s symptoms as well as the root cause of those symptoms. According to the American College of Physicians, non-low back musculoskeletal injuries should be treated with topical non-steroidal anti-inflammatory drugs (NSAIDs), oral NSAIDs, oral acetaminophen, specific acupressure, or opioids, including tramadol.² However, none of these treatments address the source of a patient's symptoms. For example, a patient with a shoulder injury may be experiencing pain due to improper alignment of the shoulder or the adjacent cervical spine. The shoulder pain could also result from poor posture or repetitive movements with poor body mechanics. None of the above ACP treatments would address these musculoskeletal issues. On the other hand, physical therapy targeted to the specific source of the patient's shoulder pain effectively eliminates the pain and significantly reduces the likelihood of recurrence.

First, Do No Harm refers to using methods that minimize the risk of harmful effects and apply the most minor force required for diagnosis and treatment. This approach optimizes physical therapy treatment and outcomes because the less aggressive treatments avoid causing inflammation, resulting in a more accelerated recovery rate. Furthermore, because the interventions are less painful, patient satisfaction is also maximized. This approach offers a more comfortable recovery and often allows patients to avoid painful procedures such as injections or surgery.

Doctor as Teacher describes the importance of education in the patient-provider relationship. Patients learn how to achieve optimal physical health, which allows for a more rapid recovery from injury or illness. Improved physical health can also optimize physical performance and prevent injuries and illnesses. More importantly, patient education shows the patient how to control their health and wellness better. The psychosocial aspects of pain and chronic disease have been well documented, and providing patients with the means to manage their symptoms and accelerate recovery can be a potent tool.

Treat the Whole Person involves accounting for physical, mental, emotional, genetic, environmental, social, and other factors during a patient’s care. In this way, we address all contributing factors, and a patient can fully recover. For example, a patient suffering from neck pain may have additional factors impacting her neck. This patient may have a recent history of Lyme Disease, which is causing inflammation in the nerves/muscles around the neck, increased sympathetic nervous system activity due to a recent car accident, and strain on her neck and upper body because she is a single mother caring for a newborn. For the best possible patient outcome, all of these factors must be addressed, and she must be treated as a whole person, not just a patient with a neck pain diagnosis.

Prevention describes teaching patients how to avoid future injury by addressing contributing factors and promoting optimal physical health and wellness. This information will prevent the recurrence of the patient’s current problems and prevent future injuries or impairments. Most importantly, this aspect of treatment makes the patient better understand what caused their health and medical conditions. Rather than becoming dependent on medical providers, our approach empowers patients and teaches them how to better care for themselves.

Dr. Sean Altman, PT, DPT, CPT, Cert SMT. Cert DN practices physical therapy and functional medicine at Whole-Body Medicine in Fairfield, CT. He treats musculoskeletal and neurologic issues, including Lyme Disease, Fibromyalgia, Migraines, Concussions, Autoimmune disorders, orthopedic injuries, prenatal patients, spine disorders, chronic pain disorders, and TMJ.

References

1. Snider P, Zeff J. Unifying Principles of Naturopathic Medicine Origins and Definitions. Integr Med (Encinitas). 2019 Aug;18(4):36-39. PMID: 32549831; PMCID: PMC7219457.
2. Qaseem, Amir et al. “Nonpharmacologic and Pharmacologic Management of Acute Pain From Non-Low Back, Musculoskeletal Injuries in Adults: A Clinical Guideline From the American College of Physicians and American Academy of Family Physicians.” Annals of internal medicine vol. 173,9 (2020): 739-748. doi:10.7326/M19-3602.