What Does a PT Do?

Today’s post is about everything a physical therapist does, both in front of the patient and behind the scenes. I will answer questions that have been asked of me over the years, as well as address misconceptions about my profession. By the end of this post you will probably have a greater understanding of what we do and why we do it.

Q: Is PT just about exercise? 

A: Definitely not! While exercise commonly makes up a large part of treatments, it is not the only modality we use. Hands-on work, such as Fascial Counterstrain, muscle scraping, and trigger point release are also used to encourage healing. In some clinics, therapeutic ultrasound and electrical stimulation (aka e-stim or TENS) are incorporated into sessions. Gait training is used to address how we move when walking, including our posture, arm swing, and trunk rotation during this process. Balance training is when we break down how and where we find our balance, allowing the load of gravity to be better distributed and limiting falls. Neuromuscular reeducation (commonly used for stroke rehab) uses various feedback techniques to rewire the brain, allowing for increased use of the muscles affected by an injury to the nerves/brain/spinal cord. Aquatic therapy, hippotherapy (use of horses in therapy), and cardiac rehab are other ways to reclaim and improve movement.

Q: What is the point of the exercise?

A: Ideally, exercise is used to support changes in movement achieved during sessions. I have found that pain and injury are rarely related to a lack of strength or range of motion. Instead, what I am finding is an imbalance in how muscles are being used, leading to a breakdown in movement and therefore pain/injury. During PT, these imbalances are discovered and then the body is retrained through various techniques as listed above. The exercises prescribed for home are to continue to reinforce those changes, allowing the body to recalibrate and integrate a more comfortable and healthy way of movement.

Q: Why is PT so often painful?

A: This can be for a number of reasons. I’ll first start with, I don’t agree with the “No pain, no gain” principle. If it’s really uncomfortable, something is being missed. There are ways to change movement patterns without it being all “pain and torture”. Some muscle soreness is common and appropriate, but outright pain is another thing entirely. Either it’s too challenging, the form is incorrect, or something was lost in translation along the way. I have known PTs to live by “No pain, no gain”, but this is a very outdated notion. Proper training for a marathon is not agonizing, and neither should your PT home exercises.

Q: What education and licensure is required to be a PT?

A: A doctorate is required to become a clinical physical therapist. Those who wish to do research or teach in a PT program must earn a PhD (or be grandfathered in if they’ve been teaching long enough). Like all other medical fields, our knowledge and reach is expanding, and with that comes more education. While some would argue this, we have to keep in mind that there is less on-the-job training happening, and so this is being made up for in the classroom. To specialize at all requires extended education; again this is being addressed in the classroom. 

To become licensed, potential PTs must take a national board exam after completing their coursework and clinicals. Once board-certified, a PT can apply for licensure in their state by presenting their board certificate and paying a fee. After that, PTs must take continuing education courses as required by their state. 

Q: What do PTs do in a hospital?

A: We work in all departments, from post-op to ER to ICU to oncology. Our goal is to get people up and moving to prevent deconditioning, pneumonia, and clots that could lead to blockages in the lungs/brain while also encouraging better healing. We also assess a patient’s ability to return home safely, and if that’s not possible, we recommend what kind of rehab they should go to. 

I loved my time working in hospitals. I got to see people get up for the first time since having a stroke, I collaborated with other healthcare professionals, and I used my internal medicine knowledge as a base for deciding whether it was safe for me to work with each patient. There are so many moving parts behind the scenes when working in a hospital, and the team atmosphere that comes from that is amazing.

Q: What else do PTs consider when working with a patient?

A: Many, many things! The first priority is to make sure it is safe and appropriate to work with a person throughout each and every session. Much of this is referring to internal medicine and how this affects a person’s ability to participate in physical therapy. I want to know if the person is about to pass out, if they have cancer, what their precautions are, do they have allergies, do they have PTSD, what meds do they take (and how do those affect our treatments), do they have a heart condition, and so much more. There is a constant monitoring process occurring for alertness and comprehension. Doing all of this allows me to pivot as needed to ensure safety. My bottom line is: no one dies or gets hurt. I may go home feeling like I did a poor job of educating my patients, but that doesn’t compare to a person’s safety. 

For me personally, I also like to cover all other aspects of health. I need to know if someone is having gut problems, mental health trouble, or a spiritual crisis so I can then refer them to the appropriate practitioners. If I know of something that can be useful in the meantime, I want to know so I can share that. Ignoring health outside of my scope of practice is just asking for failure. 

Safety is another factor. If the patient is in an abusive or dangerous situation, I need to know. While I am legally required to report to the state about abuse/neglect of those who are vulnerable (children, elderly, disabled), ethically speaking I am going to help anyone who walks through my door. Complete healing cannot occur when someone is under duress. They can make progress, but they will likely not see the full benefit of our time together if they are going home to a crap situation. Also, I just don’t believe anyone should have to continue living in fear.

A person’s day to day life is also examined. This often looks like setting the home up for greater accessibility and finding ways to make moving around in public safe. For school and work, programs can be provided and utilized to ensure a person’s needs are met. Accessibility is the key here. 

I feel that I could write many books about what physical therapists do. This post is just a snapshot of that, and I hope it has shed some light on this incredible profession.