A Needed Paradigm Shift for the Physical Therapy Profession
Physical therapy is a profession that is largely misunderstood by the general population. In this article, I want to clarify what physical therapy is, and why a shift in the current mode of thinking is necessary to improve human health.
The birth of physical therapy
The devastating effects of World War I led to the widespread need for rehabilitation services for injured soldiers. Physical therapy began to emerge as a profession during this time, with trained therapists providing rehabilitation to wounded soldiers. The polio epidemics of the early 20th century further highlighted the importance of physical therapy in helping individuals regain mobility and function.
There was a clear relationship between poor neuromuscular functioning and movement impairment at the time. The treatment was relatively simple and involved stretching, maintaining range of motion, and bracing.
What physical therapy is today
Now, physical therapy focuses on treating the movement system. The American Physical Therapy Association defines the movement system as “The integration of body systems that generate and maintain movement at all levels of bodily function. Human movement is a complex behavior within a specific context, influenced by social, environmental, and personal factors.” It comprises the musculoskeletal, neurologic, cardiopulmonary, and metabolic systems.
Merriam-Webster states that “physical therapy is used to preserve, enhance, or restore movement and physical function impaired or threatened by disease, injury, or disability and that utilizes therapeutic exercise, physical modalities (such as massage and electrotherapy), assistive devices, and patient education and training.”
This definition says nothing about prevention, it only focuses on treating symptoms once there is a disease or injury. Treating symptoms only once they arise is not unique to physical therapy. It encompasses the entire healthcare field that spends trillions of dollars on treatments and little of that money goes into preventing diseases and injuries in the first place.
Social media and physical therapy
Social media has become an increasingly influential platform in the field of physical therapy, offering unique opportunities for communication, education, networking, and patient engagement. It appears to be heading in a perilous direction though. It is discouraging when PTs post content like “Cure your knee pain with this exercise” or “Do this stretch to fix your back.”
Any “expert” who claims that a specific exercise will cure your pain is flat-out lying. Pain is a complex experience that involves biological, psychological, and social factors that no single exercise can fix independently.
There are, however, numerous physical therapists on social media that post educational content, validated by the literature, and have your best interest in mind. But you should be skeptical and question someone selling a program or document claiming that it will “fix” your body. Exercise is a vital aspect of the rehabilitation process, but not the only thing.
A good physical therapist is able to identify what structure is generating the pain. If PTs aren’t able to determine the structure at fault, then we’re just throwing things at the wall and seeing what sticks.
Educational content online and social media can help you identify where you’re moving improperly. However, identifying the pain-generating tissue and faulty movement pattern typically requires a movement expert (aka a good physical therapist).
The use of PTs as injury prevention providers
It’s recommended that we see a dentist 1-2 times per year to prevent gum disease and cavity formation. We get our car’s oil changed every 5,000 miles or so to keep the engine running properly. So why don’t we do the same maintenance work for our bodies?
Physical therapists are movement specialists who can identify areas of compensation and weakness in people—even those who aren’t in pain.
Next time you see a toddler, watch how they move their bodies. They typically have beautiful mechanics with foundational movements like squatting and deadlifting. But as we age, we are forced to sit at desks for most of our adolescent lives and come out of high school with less-than-ideal movement patterns.
If people came to see a PT every 6 months or so for a movement screening, we could get ahead of many injuries before they occur. Unfortunately, the current medical model isn’t designed for preventive care and these sessions likely won’t be covered by insurance.
This is where physical therapy and the healthcare field need to go. Rather than fighting against the current, we need to go upstream and stop the problems before they flow down.
Shifting to preventive care is not going to happen overnight, and may not even happen fully in my lifetime, but we can start to shift our mindsets when it comes to taking care of our bodies, learning foundational movements, and getting ahead of injuries before they happen.
