What is Physical Therapy? Understanding Treatment, Benefits & Expert Care
- Dr. David Didlake, DPT
- Sep 14, 2023
- 8 min read
Updated: Apr 5
Have you ever been referred to PT, only to realize it isn't someone named "Pete-ee"! Physical therapy or physiotherapy, abbreviated PT, has many misnomers and misconceptions. In fact, did you know that you don't need a physician referral for physical therapy in all 50 states*? Did you also know that according to the Physical Therapist Centralized Application Service (PTCAS), acceptance rates into most Physical Therapy programs is around 10%, while average GPAs for accepted applicants is 3.57? And if that didn't impress you, most PT programs are intensive 3 year doctoral programs that confer doctoral degrees - so as a profession, I'd say we're an intelligent bunch!
*Specific provisions and limitations differ by state
So let's elevate our thinking, stimulate that frontal lobe, and learn more about what physical therapy is, what Physical Therapists do, and why seeing a Physical Therapist should be a regular part of your life in maintaining and achieving optimal health and wellness.
What is Physical Therapy?
Physical therapy is an often misunderstood profession. I know this because of what people say or ask when I tell them I'm a Physical Therapist:
"Did you have to go to school for that?"
"Don't you just do exercise?"
"Oh, so you're like a personal trainer"
Yes, I had to go to school to be a Physical Therapist (undergraduate degree in Kinesiology from California State University, Fullerton, and a graduate degree in Physical Therapy from Chapman University), no I don't just "do" exercise, and while I think personal trainers are great, Physical Therapists have a more rigorous and medical based background that allow them, as licensed professionals, to do things that personal trainers cannot do, like perform dry needling, manipulate joints, or perform wound care (yes, I've done all of those things!).
As I alluded to above, physical therapy encompasses a broad field of practice in which PTs can work in a variety of settings, such as outpatient orthopedic clinics, hospitals, home health practices, schools, and inpatient rehabilitation facilities (just to name a few!). So if your only exposure to PT was in one of these main settings, such as home health PT, you might generalize your understanding of physical therapy to that particular setting, and erroneously think that home health physical therapy typifies all of physical therapy. Which of course it doesn't!
The Diverse Nature of Physical Therapy Practice
In addition, the practice of physical therapy can vary widely within each setting. As an example, some outpatient orthopedic clinics may focus on women's health, while others may focus on individuals with neurologic conditions, and others still may focus on wound care. In each of these examples, treatment and intervention practices would vary widely even though they are all outpatient physical therapy clinics. So while some of you might have thought that physical therapy is all about exercise, which hopefully by now you see that it isn't all about exercise, these three examples showcase that exercise can be a part of, but does not completely define, physical therapy.
At one point in my career I worked in a wound care setting as a Physical Therapist, and believe me when I tell you that I was not prescribing much exercise! Instead I was educating patients on proper nutritional intake, positioning of limbs, and maintaining appropriate hydration, along with performing sharp debridement (removing dead tissue) while applying dressings and bandages to assist with wound bed healing. Like I said, not much exercise prescription going on!
So, while different settings may involve different types of treatments and approaches to helping individuals, one of the key elements that I believe constitutes physical therapy is the examining, evaluating and testing of the patient or client in order to determine a diagnosis, prognosis, and plan of treatment.
This is what separates Physical Therapists from other professionals, including personal trainers. And let me be clear, I have no qualms with personal trainers! As part of my study and learning process, I acquired a certification in strength and conditioning by the National Strength and Conditioning Association. So I have great respect for personal trainers and strength coaches, but physical therapy is not personal training.
The Core Definition of Physical Therapy
Another key element that I believe constitutes physical therapy is a simple foundational principle that physical therapy helps people live healthy and active lives.
It's really that straight forward and is worth repeating: Physical therapy is the practice of helping people live healthy and active lives.
This broad yet simple definition of physical therapy makes intuitive sense, and supports the American Physical Therapy Association's (APTAs) definition of Physical Therapists as "health care professionals who diagnose and treat individuals who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives."
So while physical therapy is the practice of helping people live healthy and active lives, Physical Therapists treat people who have limitations with movement and function.
What Exactly Do Physical Therapists Do?
If PTs treat people who have limitations with movement and function, what exactly do they do? And what do their treatments or interventions look like? These are good questions, and while I cannot comment on what other Physical Therapists do or don't do, I will attempt to explain what I do, as an outpatient orthopedic based PT.
Let's say you come into my clinic complaining of back pain and you tell me you can't play a round of golf because of your pain. My goal would be to find out the cause and the source of your pain. This same principle would apply to anyone who came into my clinic, regardless of where their pain was, or what their clinical presentation looked like.
Usually the cause and source of pain are in different areas of the body, but not always. In a straight forward scenario a client's source of pain may originate in the low back and be caused by something in the low back, like an irritated or herniated disc.
The Comprehensive Osteopractic Approach of Physical Therapy
Most scenarios involve multiple pain sources (i.e. muscle, fascia, nerve, tendon, capsule, etc.) and multiple pain causes (i.e. limited mobility, ischemia, muscle weakness, inflammation, trauma, etc.), which requires a more detailed and comprehensive examination.
Therefore, only after performing a comprehensive examination (which might include neurological integrity testing, assessment of functional movement, range of motion, passive accessory movement and joint play, soft tissue and fascial mobility, neural mobility, musculoskeletal integrity, and the use of diagnostic ultrasound) can most, if not all, of the causes of musculoskeletal pain be identified.
Once the pain causing tissues are identified, treatment can be appropriately prescribed. Sometimes it takes multiple sessions to uncover the complex layers of dysfunction and pain, especially if someone has been dealing with their pain for years. The following is a list of treatment options I offer in my clinic for those suffering from acute or chronic pain, or some type of neuromusculoskeletal dysfunction (listed in alphabetical order):
Cupping
Electric stimulation
Ice massage
Interval training
Mobilization of the spine and/or extremities
Motor control and motor learning
Neural flossing
Nutrition assessment
Resistance training
Scraping - instrument assisted soft tissue massage
Soft tissue massage
Stretching
Therapeutic exercise
Traction
Ultrasound
Look out for future posts on these treatments in isolation, and let me know if there is one you would like to know more about!
The Physical Therapy Treatment Process
So if you came in with back pain that was soft tissue related (i.e. your fascia was restricted, or your iliocostalis lumborum was ischemic from muscle spasm), I would focus on improving your soft tissue mobility with interventions such as cupping, scraping, electric dry needling, manipulation, or body tempering. After performing one or more of these interventions, I would retest your function or mobility to ensure that you are showing signs of improvement. As you progress with your treatment, I would add different interventions to promote further tissue healing while taking away others that are no longer needed. This process is repeated until you reach your goal(s) and achieve what you initially came in to accomplish.
When you reach this point in your recovery you may be just beginning your wellness journey.
To some that might seem strange that an individual would be just beginning their journey. However, when my clients are finally pain free and able to move with correct motor patterns, they are ready to begin taking on greater loads and resistance. These higher loads and resistance levels are needed for optimizing musculoskeletal strength, power, and balance, which can both reduce future injury risk as well as optimize overall health and wellness!
Why Should I See an Osteopractic Physical Therapist?
I might be a bit biased in answering this question, but having 15 years of clinical experience, plus my additional training in orthopedics, golf specialization, strength and conditioning, dry needling, manipulation, and diagnostic ultrasound, makes me a clinical expert. Period.
I am an expert because:
I know how to correctly diagnose and treat movement dysfunction.
I know about the various healing phases of tissue injury, and how to best incorporate load in order to optimize tissue growth.
I know about nutritional deficiencies and how they can hamper healing.
I understand the interplay of various tissues (muscle, tendon, ligament, nerve, fascia, and bone) throughout the body, and how they are all interdependent upon one another for achieving proper ratios of mobility and stability.
I know about motor control and how correct movement patterns are created in order to override faulty movement patterns.
I know about posture, force production, power transfer, and acceleration needed for safe and effective lifting.
I understand the cellular mechanisms of pain relief, and how certain interventions are best for certain types of pain, and for specific musculoskeletal conditions.
I know how to screen for underlying serious pathologies, and will refer clients out to the appropriate medical professional when necessary.
So, having said all that, I hope you can see how I AM a clinical expert and how most individuals are not suited to properly care for their injuries, nor do they have the tools needed for applying the correct treatment; but Osteopractic Physical Therapists, like me, do!
The reality is, most people want a quick fix to solve their medical problems. I'm here to tell you that in most circumstances, there isn't a magic pill or a quick gimmick that will make everything right overnight. Physical therapy provides a sustainable, evidence-based approach to healing and maintaining optimal movement for life.
So if you are suffering from pain or dysfunction, or want to live a healthier, more active lifestyle, don’t procrastinate any longer! Contact us to start feeling better.
Here’s to your health!
Dr. David Didlake, DPT
PT, Cert. SMT/DN, CSCS, Cert. TPI Medical Level 3, Dip. Osteopractic, FAAOMPT
Owner, Integrative Therapeutics "Home of the Saint Louis Golf Doc"
Follow me @theintegrativeclinic @thestlgolfdoc
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Physical Therapy FAQ
Do I need a doctor's referral to see a physical therapist?
No, all 50 states have some form of direct access to physical therapy services, though specific regulations vary by state.
How long does physical therapy treatment typically take?
Treatment duration varies depending on your condition, but most patients see significant improvement within a few sessions.
Does insurance cover physical therapy?
Most health insurance plans cover physical therapy, though coverage details and copays vary by provider.
What's the difference between an osteopractic physical therapist and a chiropractor?
While both treat musculoskeletal issues, osteopractic physical therapists focus on movement restoration through a variety of techniques and modalities, including spinal manipulation, while chiropractors primarily focus on spinal manipulation.
Can physical therapy help prevent injuries?
Absolutely! Physical therapists can identify movement deficiencies before they cause pain and develop preventative strategies tailored to your activities.
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