Lately, I have had a number of prospective physical therapy students contacting me about observing my practice. Since the newest requirements for application to graduate school requires these students to have a number of observational hours of various physical therapy practices this makes perfect sense. However, the students that have been observing me often continue to observe me after they have not only fulfilled these requirements but already submitted their applications. In other words, they just want to LEARN! I find myself very excited to share my insights with these future therapists and am very proud to know students who’s actions are indicative of wanting to really be the best even before they are accepted into school. I was also deeply humbled when one of them shared with me an essay he submitted with his Massachusetts General Hospital Institute for Health Professions application. I share it with you now.
There are a wide variety of techniques and modalities for a physical therapist, and the best therapists draw from evidence and experience to create their own style. Recently, I observed Barry, a self-employed outpatient physical therapist who fixes people’s orthopedic ailments. He is the most effective physical therapist that I have witnessed, and uses an uncommon style to give his patients immediate results.
First, Barry has few tools in his office. He uses only Bolster pillows, wedges, towels, and, occasionally, a theraband. I have seen many outpatient orthopedic physical therapists use thermal packs, ultrasound, and supervised patient exercise as their treatment modalities. However, Barry’s primary modality is manual therapy. He has a background in massage and incorporates a variety of techniques in his therapy, such as myofascial release, acupressure, applied kinesiology, orthopedic adjustment, and assisted stretching. A key benefit of manual therapy is that it gives the therapist tactile feedback, so he can feel the patient’s muscular tension or joint stiffness and draw on his experience to understand the cause of each patient’s dysfunction. Feeling the patient’s musculature gives an indication of how effective a treatment is or where to look for another possible source of dysfunction. This element adds a unique depth of care and attention to his practice.
Additionally, Barry uses simple tools for patient exercises rather than a gym. I have observed him using wedges and external thigh rotation to realign patients’ hips, and then demonstrating how wedges could be improvised with a towel-covered shoe so that the patients could perform the same movement at home. He prescribes movements that rely on little to no equipment, and avoids overwhelming the patient with complicated exercises. Keeping exercises simple helps with patient compliance and allows patients to take charge of their recovery by performing exercises at home.
During the course of his treatment, Barry is constantly performing functional tests on patients. Many physical therapists will perform muscle tests on the initial and final evaluations, but Barry performs tests throughout every session. He will test a muscle for weakness and administer treatment by mobilizing a joint or relaxing a muscle until the patient loses the weakness. The effectiveness of this technique is that the therapist can see whether therapy is working, and patients are also encouraged by the progress they see. Barry’s therapy leaves his patients feeling better even by the time they leave the office. Constant evaluation and testing of a patient’s pain, strength, and flexibility removes the need for patients to blindly trust in mystifying processes and, instead, allows them to see the results of experienced physical medicine in action.
Lastly, because he charges a flat rate and does not accept insurance, Barry can treat the whole patient, and not merely the chief complaint. I have observed that some physical therapists are unable to attend to patients as broadly because they were bound by the restrictions and hassles of dealing with insurance. The source of dysfunction and the source of complaint are not always the same, and there may be unnoticed symptoms related to the cause of dysfunction, or co-morbidities that also need attending to. All these considerations require an approach to treat the whole patient, not just relieve localized pain. Barry sees patients for a full hour, and sometimes longer, which allows more time for him to understand the patient’s entire condition and treat it rather than only treating the symptoms. Although many physical therapists find that they are consumed by administrative tasks or the cost of administrative employees, Barry keeps his practice simple so he can focus more on healing the patient.
Therapists who have extensive experience such as Barry learn to both make reasoned and intuitive assessments, and restore optimum functionality to their patients. Patients walk away from his office standing taller and feeling better. I hope to emulate this style of treatment, where I can attain technical mastery of manual therapy, understand and repair broken pieces of the body’s kinetic chain, and provide my patients with the best exercises to speed their healing and give them a strong role in improving their quality of life.