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What to expect from physical therapists
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Kamakshi posted:
I read the WebMD article on types of physical therapy. Can a physical therapist diagnose whether a muscle or joint is weak, unstable or vulnerable after mobilizing the muscle or joint? It is possible that the mobilization doesn't have an immediate effect on the muscle or joint. I may need to use the muscle/joint in a rigorous exercise like jazz dance after my therapy session.
Also, in physical evaluation, can he identify other points of vulnerability that can affect my full recovery? For example, if my main problem is strain in my SI joint (S1 vertebra), can he check if its supporting structures or weakness in the lumbar back muscles/discs (L1 to L5 vertebra) are vulnerable and may need to be treated too?
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lorigibs40734 responded:
Hi! I don't know where you live, but here in Ky, the physical therapist does not diagnose anyone. He gets the diagnoses from the doctor who referred you.

They may be able to spot other things, like an increase in pain when touching other areas, that the doctor might not be aware of and can recommend the doctor do more tests, X rays, MRI's, CT scans whatever.

I wish you the best of luck and keep us posted!!

Lori
 
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Kamakshi replied to lorigibs40734's response:
Hi! I am from India.
I understand that a physical therapist cannot replace an orthopaedic specialist. But they can help you with recovery from pain by applying various manual therapy techniques like mobilization. They should also be able to define a treatment or exercise plan to aid better range of motion in joints, rest or modification in activities to aid recovery from pain. They should be able to determine whether or not a joint or muscle is ready for vigorous exercise soon after manual therapy. I referred to a physical therapist's role recently in a publication "Today's Physical Therapist" from the American Physical Therapy Association (http://www.apta.org/uploadedFiles/APTAorg/Practice_and_Patient_Care/PR_and_Marketing/Market_to_Professionals/TodaysPhysicalTherapist.pdf ).
It seems to confirm my understanding.

My concern is that some physical therapists are either not skilled enough to perform their job completely and prevent further injuries in the patient, or do not educate the patient properly. I have suffered at the hands of a physical therapist who neglected to do this and ended up with anterior displacement of my lumbar spine disc. I had continued my dance and exercise alongside my manual therapy sessions. It is possible my joint was weak or unstable after the therapy session and could not withstand the stress of my dance/exercise.

I now urge everyone in this forum to be very careful when they go to any physical therapist. Ensure that the therapist has practical experience. Ask a lot of questions to understand your treatment , why it is best suited to you, what precautions you need to take, what exercises you can/cannot do, the state of your joint/muscle being treated etc.
 
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annette030 replied to Kamakshi's response:
Well said. I have also been injured by a physical therapist (years ago).

Take care, Annette
 
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Kamakshi replied to annette030's response:
Sorry to learn that Annette! What was the injury and how did you recover?
I might get some direction to correct my problem also, based on your experience.
 
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lorigibs40734 replied to Kamakshi's response:
Oh I agree!! I've had four, well three because I didn't stick with the fourth, bouts of PT. One for my carpal and cubital tunnel of right had, and two for my back.

I loved the therapist I went to for my back. He also treated my arm as well even though the referral letter specified lower back and neck area only. I went for 80 visits twice for my back and neck area. I still do the stretches he taught me and some very LIGHT exercise.

Here in Kentucky, they have what they call a "Pill Mill" bill, known as House Bill 1. *insert eye roll here*
They want to see that Pain Management doctors are doing other things to help patients manage pain other than writing prescriptions. So I take the steroid shots again, I had them before, they don't help, the doctor knows they don't help, but I have to take them anyway. And he recommended PT.

My GP, who is an APRN, made me the appointment in there other office as they have "physical therapy" there. I went one time. The "Therapist" was the girl who did the triage (took patients bp, weight, etc and then took the patient to the room).
I stretched for about 10 minutes. I did a stretching exercise that my previous therapist taught me by using a corner in the room, to stretch out my shoulders. She said she had never seen that before! THEN she told me to get on the bike and ride that for ten minutes. ~sighs~ That was the extent of my pt for the day. Needless to say, I didn't go back.

She never showed me anything new to do, and I can do my stretches at home for free. It was pitiful to say the least.

And yes I agree, Physical therapist should be more educated on how to treat patients. Not every patient is the same, and not every patient shares the same pain. The pt techs should also be more informed on how to help patients better.

Best of luck to you!
Lori
 
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Peter Abaci, MD responded:
In my own practice, I work very closely with a number of physical therapists. Some of whom I actually work with directly at my center and others who are in my community that I refer patients to because I value what they can offer. I think the best way to view the patient-doctor-physical therapist relationship is one that should be synergistic and one of those things where the whole is greater than the sum of the parts. What that means is that both the physical therapist and the physician can gain from the perspective of the other to provide better care to the patient. Certainly, there are aspects of a patient's physical condition that a physical therapist can pick up on that a physician may not be in tune with and visa versa. What is important is that the two communicate and work together for the benefit of the patient.

One of the challenges that physical therapy training programs need to address is that they spend very little time teaching new physical therapists about chronic pain. There is a lot of emphasis given to acute injuries and sports injuries, but not nearly as much to working with the body that is struggling with chronic pain. As a result, not all physical therapists offer the same benefit, just like not all doctors are the same. Finding the right physical therapist who can best help you with your particular problem may be a challenge in some cases but worthwhile in the end.
 
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Kamakshi replied to Peter Abaci, MD's response:
Thanks for clarifying Dr. Abaci. The synergy between the physician and therapist is important, and unfortunately, missing at the therapy center I was going to in India. This center's therapy is being overseen by "experts" from The Institute of Physical Art, Colorado, USA.
 
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annette030 replied to Kamakshi's response:
I had cervical spine issues, and pain down my right arm. Right after he treated me, I developed neck pain, which I had never had before. I reported him and time, heat and ice, and cervical traction, at home fixed things for me. But, I did have to go see my doctor of course.

About 4 years ago, I began belly dancing along with a DVD at home for about an hour a day. It is great, I love it, and have lost over fifty pounds without changing my diet at all. Very slowly, of course. This is the right way to lose weight though. I am 62 years old, it is a very private thing, no one watches! My doctor knows of course.

Take care, Annette
 
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annette030 replied to Kamakshi's response:
I don't know what the demands of the profession are elsewhere, but in the three states on the West Coast that I have lived in, (CA, NEV, and OR) it was required that a physical therapist have a Master's Degree, however the PT aides only needed a certificate from a community college. Talk to your PT, ask what level of education they have.

Don't be shy, ask your doctor when he refers you to someone what education they have, what he expects from therapy, etc.

Take care, Annette


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