What is a Physical Therapist?

Physical therapy is defined as the treatment or management of physical disabilities, malfunction, or pain by exercises, massage, hydrotherapy, etc., without the use of medicines, surgery or radiation.  The APTA further defines physical therapists as experts on how the musculoskeletal and neuromuscular systems function, and that physical therapist services are cost-effective in that early physical therapy intervention prevents more costly treatment later and can result in faster recovery which reduces costs associated with lost time from work. 

A physical therapist (PT) is a highly-educated, licensed health care professional who can help patients reduce pain and improve or restore mobility, in many cases, without expensive surgery and often reducing the need for long-term use of prescription medications and their side effects.  Physical therapists teach their patients how to prevent or manage their condition in order to achieve long-term benefits without surgery or medication. A physical therapist evaluates, diagnoses, and treats patients with disorders that limit their abilities to move or function “normally” throughout their daily lives. 

PTs examine each individual and develop a plan using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability.  Fitness and wellness-oriented programs allow the patient to maintain mobility and prevent loss of mobility, which allows for a healthier, more active lifestyle.  A physical therapist may work at a hospital, private practice, outpatient clinic, home health agency, schools, sports and fitness facilities, work-settings, and nursing homes. 

Physical Therapist Assistant

A physical therapist assistant works under the direction and supervision of the licensed physical therapist.  The assistant will have duties that include implementing selected components of patient/client interventions; obtaining outcomes data related to the interventions provided; modifying interventions either to progress the patient/client as directed by the physical therapist or to ensure patient/client safety and comfort; educating and interacting with other health care providers, students aides/technicians, volunteers, and patients/clients and their families and caregivers; and responding to patient/client and environmental emergency situations. 

Physical therapists and PT assistants are part of a health care team that includes physicians, nurses, occupational therapists, speech language pathologists, and other ancillary services.  A physical therapist is typically seen by a patient after they receive a referral from their primary care physician.  In some states, this referral is not necessary and the patient can bypass the primary care physician and directly seek the assistance of a physical therapist.  Physical therapists specifically evaluation patients and, along with PT assistants, provide treatment to individuals that primarily focuses on movement, reduction of pain, restoration of function, and prevention of disability. 

Patients tend to pay less when they have direct access to physical therapy services.  The important caveat to direct access is that under managed care, services may be terminated prematurely.  Many patients with direct access to physical therapy services had fewer episodes of care and services were ultimately less costly.  As health care professionals, physical therapists most often are paid for their services by all insurers who cover physical medicine and rehabilitation services.  Insurers may be government, private, or related to workman’s compensation.  In some cases, the patient may pay the physical therapist directly for their services.

According to the Bureau of Labor Statistics, there is a high demand for licensed physical therapists, with the field expected to grow by 36 percent from 2012 to 2022, which is must faster than the average for all occupations.  The demand for physical therapy is expected to grow, although it does vary by geographical region and area of practice.  Elderly patient care and rural locations are expected to be the areas with highest growth expectations.  The growth expected is due to an aging population and its need for rehabilitative services to manage illness or injury and recuperate from surgery.  Additional information from the Bureau of Labor Statistics can be found below.

Source:  Bureau of Labor Statistics

A physical therapist may provide treatment for the following conditions:  back pain, knee problems, shoulder/arm conditions, neck problems, muscle sprains and strains, ankle/foot pain, carpal tunnel, stroke rehabilitation, problems with balance, burn rehabilitation, postsurgical rehabilitation, hip fracture, and many others. 

What Does a Physical Therapist Do?

From teaching someone to walk again to relieving the pain of severe arthritis, a day in the life a physical therapist can be challenging, but immensely rewarding.  Someone licensed in this profession may treat a wide range of patient with a wide range of physical problems, or they may specialize in a specific area of focus, such as stroke patients or sports injuries.  In many cases, physical therapists develop long-term relationships with their patients and observe first-hand the benefits of their treatment.  This job involves a deep understanding of the human body as well as a compassionate nature since many patients may be struggling with negative emotions related to their injury or disease. 

As a physical therapist, you will consult with a patient to discuss their symptoms and collaboratively develop a rehabilitation plan and schedule.  The patient is then treated by teaching then different exercises intended to strengthen or stretch muscles as well as alleviate pain.  It is important to note that encouragement and support are just as important as the physical treatment a physical therapist provides.

The everyday work life of a physical therapist may consist of the following:

• Consulting with patients to learn about their physical condition and symptoms
• Developing a treatment plan
• Teaching patients how to properly use exercise techniques
• Providing stimulation or massage
• Use equipment and devices to assist patients
• Maintain patient’s records, keeping track of goals and progress
• Advise patient and family about in-home treatment options and exercises

Occupational therapy is similar to physical therapy, however occupational therapists focus on ways to help patients with everyday activities.  While most of the treatments and exercises are the same, an occupational therapist provides evaluations for workspaces and identifies adjustments for patients with temporary or permanent disabilities. 

There are many different career paths a physical therapist may follow.  General physical therapy or specialization may be chosen, in addition to practicing in a hospital or private practice.  Some of the following options may be considered by a future or practicing physical therapist:

• Health practitioner offices: Physical therapists work with patients on a regular basis until their condition improves.
• Hospitals: Patients in a hospital typically have life-altering injuries or need to regain body function.
• Home health care services: A physical therapist will travel to a patient’s home where they conduct the same types of diagnosis and treatment as they might in a medical setting.
• Nursing and residential care facilities: The physical therapist in this case will focus on improving a patient’s overall body function with exercises and equipment.

The History of Physical Therapy

World War I

Physical therapy practices can be dated back several centuries.  Exercise, massage and mobilization of tissues, heat, cold, water and electricity dates back to Greek culture and Hippocrates’ influence as the Father of Western Medicine.  Europeans used exercise to treat muscle and bone disorders and disabilities in the 1500s, 1600s and 1700s, which eventually progressed to exercise and muscle re-education used for a variety of orthopedic diseases and injuries in the 1800s.    

The profession of physical therapy in the United States developed during World War I between 1914 and 1917, when the need to treat soldier’s war injuries arose.  The Army Medical Department, Division of Special Hospitals and Physical Reconstruction developed training programs to respond to the need for medical workers with expertise in rehabilitation.  Walter Reed and Reed College Hospitals graduated a class of the first physical therapists known as “reconstruction aides” at the time.  Although their degrees varied, they all underwent additional training in order to perform physical therapy services.  Reconstruction aides were assistants to a physician. 

Poliomyelitis was an acute viral disease, usually affecting children and young adults, caused by any of three polioviruses, characterized by inflammation of the moto neurons of the brain stem and spinal cord, and resulting in motor paralysis, followed by muscular atrophy and often permanent deformities.  Physical therapists primarily treated patients with poliomyelitis, which ravaged the United States between 1920 and 1930.  In 1921, this original group of physical therapists or reconstruction aides formed the American Women’s Physical Therapeutic Association, naming Mary McMillan as their first president. 

World War II

The polio virus continued to epidemic proportions in the 1930s. World War II began around 1939 and it led to an increase in the need for practicing physical therapists due to advances in medicine – more soldiers with injuries survived, and physical therapists were needed to treat those with war disabilities.  Wounded veterans who returned home with amputations, burns, cold injuries, wounds, fractures, and nerve and spinal cord injuries required attention of physical therapists in the first half of the 1940s, with World War II at its peak. 

As physical therapy gravitated more toward war injuries and less toward polio-related injuries, the profession began to reflect that transition within their own education and training programs.  The American Women’s Physical Therapeutic Association changed its name to the American Physiotherapy Association during the late 1930s.  In 1946, Congress passed the Hospital Survey and Construction Act (also known as the Hill Burton Act) to build hospitals across the country and increase public access to hospitals and health care facilities. 

This legislation led to an increase in hospital-based physical therapy practices and an increased demand for physical therapy services.  Again, in the late 1940s, the professional physical therapy organization changed its name from the American Physiotherapy Association to the American Physical Therapy Association, which is still its name today.  The APTA focused on education for post-war needs and created a Schools Section of the organization that made recommendations on curricula, education, and administration of physical therapy programs, encouraging medical schools to expand existing programs, create new programs, and create graduate level educational opportunities. 

Physical therapy continued to evolve and develop as more soldiers survived previously fatal injuries.  The Korean War began in 1950.  The Korean war presented even more soldiers with war disabilities who required treatment in addition to polio patients.  In the early 1960s, the Salk vaccine for polio was introduced, so physical therapists gradually moved their focus from polio-related injuries to soldier injuries.  Polio was eradicated in the early 1960s, although those with the disease continued to need treatment. 

The 1950s decade was a critical time for the profession in terms of gaining independence, autonomy, and professionalism.  During this time, the APTA formed a Self-Employed Section which allowed for expansion of private practices, and the Physical Therapy Fund was created to foster science through research and education within the profession.  State regulation also became part of the APTA’s recommendations, with 45 states offering regulations and certification by 1959. 

1960s – Today

During the 1960s, most states had physical therapist licensure laws.  Medical advances such as open-heart surgery and total joint replacements were becoming more commonly practiced.  This led to an increase in the need for post-surgery rehabilitation. Significant neuromuscular research by Margaret Rood, Margaret Knott, Dorothy Voss, Signe Brunnstrom, and Berth and Karl Bobath developed techniques for adults with stroke, cerebral palsy, and other disorders of the central nervous system (CNS) which advanced the field of physical therapy. 

This time period saw the gradual transition from exercise, massage, functional training, water (hot and cold), heat (heat lamps, paraffin baths, diathermy), simple electrotherapeutic modalities, and assistive devices and equipment (wheelchairs, splints/braces, ambulatory aids) to address patient needs to new testing methodologies with more objective outcome measures and expansion of the diseases and conditions a physical therapist could positively influence. 

One of the greatest hallmarks in the physical therapy profession came in 1967 when amendments to the Social Security Act added definitions for outpatient physical therapy services.  With the implementation of this legislation, physical therapists were officially deemed as health care providers, and their services would now be eligible for health care reimbursements.  Once the profession of physical therapy was established and validated by the Social Security Act, the field began to expand and areas of specialization began to develop.  Areas of physical therapy specialization include acute care, federal, geriatrics, hand, health policy and administration, neurology, oncology, pediatric, sports physical therapy, and women’s health. 

Significant changes in the health care delivery system in the country required major association focus in the 1990s, influencing the practice of physical therapy in ways that continue today.  The role and benefit of physical therapists was highly challenged in the 1990s with passing of the Balanced Budget Act of 1997, the Medicare Prospective Payment System (PPS), and the Medicare cap on physical therapy services adopted in 1997 and implemented in 1999.  This legislation led to the development of the Guide to Physical Therapist Practice in 1995.  It clearly describes the role of the physical therapist in the examination, evaluation, diagnosis, prognosis, intervention, re-examination, and assessment of outcomes in the management of patients and clients.

Modern day physical therapy has evolved to treat not only multiple types of diverse injuries, but also to prevent the dehabilitation associated with a multitude of disease processes.  Many physical therapists work with little instruction from the physician.  They evaluate and treat patients based on their own knowledge, judgement and discretion.  Because of the growth and responsibility in patient care, the APTA now encourages risk management for any physical therapist. 

Physical therapy is one of the few health care professions that is integrated into a majority of the federal programs that provide health care services to United States veterans, members of the armed services, individuals with disabilities who have been harmed by natural disasters and public health threats, and Native Americans.  The APTA has developed a vision statement that by the year 2020, among other things, physical therapists will practice in every state without the necessity of a physician’s referral (direct access) and will practice without the necessity of physician consultation, known as autonomous practice. 

The US military has an extensive community of physical therapy specialists as well.  The profession of physical therapy started as reconstruction aides to physicians began due to the polio epidemic and for the delivery of treatment to soldiers injured as a result of multiple world wars.  Educational requirements have progressed from a baccalaureate to master’s to now most physical therapy programs are at the doctoral level.  Very few programs remain at the bachelor’s or master’s level. 

How to Become a Physical Therapist

A future physical therapist must earn a bachelor’s degree.  Although the major is not specified, science prerequisites are typically required for a PT graduate program, so a student may major in chemistry, biology, pre-medical, or another science focus.  The student should also consider obtaining experience in physical therapy through volunteering, observing, or interning.  Physical therapists must earn a master’s or graduate degree from an accredited academic program in physical therapy.  Typically, the student then goes on to a doctoral program for three years in order to earn their doctoral degree. 

Subjects included in a physical therapy graduate program include human anatomy, biomechanics, musculoskeletal system, pathology, and neurological dysfunction management.  In addition, clinical internships and other hands-on training in patient care, screening, assessment, treatment, and intervention are required for training purposes.

Each state has its own licensing body and requirements for physical therapists.  Most states require the candidate to have a graduate degree in physical therapy from an accredited program in addition to passing the National Physical Therapy Examination (NPTE).  Some states require jurisprudence exams and/or continuing educations requirements for maintaining a physical therapy license.  A state license must be obtained before a physical therapist can practice in that respective state.

The American Board of Physical Therapy Specialties (ABPTS) offers certification to physical therapists, although this certification is voluntary.  The ABPTS certification allows for physical therapists to have opportunities in specialized areas such as cardiovascular and pulmonary, clinical electrophysiology, and geriatrics.  There are a total of nine specialized areas, and in order to become certified, a PT must have 2,000 hours of clinical practice and pass an examination proctored by the ABPTS. 

The American Physical Therapy Association (APTA) is a professional organization for physical therapists that offers continuing education opportunities.  National conferences, live classes, and online lessons are available through APTA for all practicing physical therapists. 

Physical therapy is a demanding occupation that may be physically, mentally, and emotionally exhausting.  Despite these demands, it can also be a very rewarding career that offers the benefits of long-term patient relationships and observing patient recovery and improving their quality of life. 

Who Should See a Physical Therapist?

As mentioned previously, there are a variety of specialization fields for physical therapists.  Whether it be orthopedics, sports or neurology, you will want to find a physical therapist that has experience with other patients with your specific health problem.  Other specialized areas include back and neck pain, cardiac rehabilitation, wound care, cancer-related problems, or treatment of children or older adults. 

Some may see a physical therapist to recover from surgery; others may need treatment after a vehicle accident or a sports injury.  The physical therapist will first try to reduce any pain or swelling. Manual therapy, education, and other techniques may also be incorporated depending on the needs of the client and the severity of the injury.  Exercise may be used, including stretching, core exercises, weight lifting, and walking.  In some cases, the patient will be asked to do exercises on their own in order to better benefit their recovery. 

References

The Evolution of Physical therapy. Jones and Bartlett Publishers.  Chapter One. Retrieved September 5, 2017 from:http://www.jblearning.com/samples/0763740691/40691_CH01_FINAL.pdf

American Physical Therapy Association (APTA).  Today’s Physical Therapist: A Comprehensive Review of a 21st-Century Health Care Profession.  January, 2011.

Study.com.  Physical Therapy, 2017.  Retrieved September 5, 2017 from: http://study.com/articles/Physical_Therapy_Required_Education_to_Be_a_Physical_Therapist.html

Allied Health Schools.  Physical Therapist Job Descriptoin and Duties.  Retrieved September 5, 2017 from: http://www.allalliedhealthschools.com/physical-therapy/physical-therapy-career/