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How Should We Represent Ourselves as a Profession

10/13/2015

5 Comments

 
Ever since the beginning of physical therapy as a profession, physical therapists have been viewed as an ancillary service or extension of the doctor. In years past, this was absolutely true. The training of a physical therapist was far inferior to that of a medical doctor. More recently, the education requirements of physical therapists have increased, leading to a push for access as primary care. Physical therapists are clamoring to be viewed on or near the same level as the medical doctor. Should this be the case?

Whether or not physical therapists are prepared for this is debatable. In general, one of the requirements in switching to the doctoral degree was to improve the differential diagnosis skills as a physical therapist. While this has without a doubt improved, the consistency of being able to recognize non-musculoskeletal disorders may not be as great as desired. This can be improved with residency training. Ideally all PT's would go through residency training; however, not nearly enough residencies are available. Maybe there can be some alternative step after PT school that could simulate what doctors go through in their residency training, but be more accessible to PT's.

If we want to be viewed on the same level as medical doctors, I believe there is a bigger issue that needs to be addressed - how we treat pain. Much of the recent research regarding pain science has consistently showed a lack of correlation between anatomical "pathology" and pain. There have been numerous studies showing asymptomatic individuals with pathological findings in their spine and other joints. I bring this up, because many doctors (not just orthopaedic surgeons) continue to attribute pain to the pathoanatomical theory. The relationship between pain and the nervous system is inconsistently understood. Many practitioners misinterpret that pain is a sensation (via "pain fibers") and not realize that it is actually a perception. The studies showing inconsistencies in imaging findings are taken but then interpreted that the findings are only significant if they match the patient's pain complaints. While this is a step in the right direction, it continues to have a pathoanatomical basis. If this were completely true, a patient with L-sided radicular pain would not have complete resolution with repeated loading on the involved side! The pain patients experience is more associated with a hypersensitization of the nervous system and can be managed by finding a way to down-regulate it.

Why do I bring up the pain issue? Because the AMA holds a monopoly on the development of health care policy, it is more so the medical profession that must be convinced of physical therapy's ability to increase their direct access. Before we can convince others organizations, we need to have consistency amongst our profession. Many of the "top physical therapists"  build their therapeutic model off the pathoanatomical theory as well, leading to professional organizations promoting these ideas. Even as research regularly is coming out that should push us away from that model, many PT's cling to it. There is success with treating via the biomechanical approach, but is it the most effective? In trying to increase the relevance of physical therapy as a profession in primary care, we need to promote the same ideas and philosophies if we expect to be the provider of choice for musculoskeletal pathology.

-Chris

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You may have seen some posts earlier on our site about OPTIM Physical Therapy. Several months ago, Chris and Jim joined OPTIM Physical Therapy to create a COMT program based out of Scottsdale, AZ. The mission of the program is to create a residency-like experience for those who are unable to make the financial and location commitment. The program consists of 6 weekend-long courses on-site, in addition to Medbridge courses and online mentoring between classes. Throughout the year, the class as a whole will improve their clinical skills and reasoning while working as a team. Check out www.optimfellowship.com for more information. Only a few spots remain for the year's cohort!

Like this post? Then check out the Insider Access Page for advanced content! And check out similar posts below!
Consider Pursuit of OCS
OCS Preparation
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5 Comments
J.A.
10/13/2015 12:14:49 pm

Great post, couldn't agree more! I have found some very eye opening articles involving MDT assessment/treatment vs pathoanatomical diagnoses. Would you mind providing some article titles/search terms to additional research? I would love to find some more research to back dialogue with colleagues. Thanks!

Reply
AK
10/14/2015 07:12:37 am

I'm a current student, and love the site.

Any recommendations for texts/literature regarding pain science? I have read Explain Pain before I began PT school, but should definitely check it out again.

Reply
Chris link
10/14/2015 08:24:16 am

Hi AK,

While Explain Pain is an excellent resource for patients, the book Therapeutic Neuroscience Education is what I recommend for learning how to best explain pain science. It also goes a little more in-depth into the actual physiology behind it. Hope that helps!

-Chris

Reply
Glenn
10/14/2015 10:05:30 am

Why do we need a doctorate degree? Maybe some patients will experience greater improvements with the underdog PT relative to all of the medical doctors and specialists who have initially failed to treat their chronic pain. It's more about your personality and how well you communicate with your patient, rather then the status and skills of the profession.

Reply
Colin
10/14/2015 10:29:14 pm

I agree 100% with the rationale that PT professions needs unifying standards of treatment diagnoses and we need to get away from the pathos atomically model and do what we do best, assess the human kinesthetic system and relate it back to function. I actually think most PTs follow this model whether they know it or not.....and we didn't need to acquire doctorate degrees to get there.

As far as being viewed on "the same level as medical doctors," follow the money with AMA and big pharma, we don't write Rxs or perform surgery....that's the monopoly, not how we treat pain as PTs. Let us not forget that treating pain is also an art, your personality and the placebo effect goes a long way in improving outcomes both physically and psychologically.

Reply



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  • Home
  • About Us
  • TSPT Academy
  • Resources
    • Newsletter
    • Orthopedic Blog
    • Featured Articles
    • Research Articles
    • Residency Corner
  • Special Tests
    • Cervical Spine >
      • Alar Ligament Test
      • Bakody's Sign
      • Cervical Distraction Test
      • Cervical Rotation Lateral Flexion Test
      • Craniocervical Flexion Test (CCFT)
      • Deep Neck Flexor Endurance Test
      • Posterior-Anterior Segmental Mobility
      • Segmental Mobility
      • Sharp-Purser Test
      • Spurling's Maneuver
      • Transverse Ligament Test
      • ULNT - Median
      • ULNT - Radial
      • ULNT - Ulnar
      • Vertebral Artery Test
    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Leg Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test