People everywhere are experiencing the transformative effect physical therapy can have on their daily lives. In fact, as experts in the way the body moves, physical therapists can help people of all ages and abilities reduce pain, improve or restore mobility, and stay active and fit throughout their life. Many people with Marfan syndrome, Ehlers Danlos syndrome, and other connective tissue disorders have benefited from physical therapy, but many are reticent to try it due to common misconceptions.
The American Physical Therapy Association (APTA) conducted a survey and separated myths from facts. Here is what the APTA found, along with my own insights from my physical therapy practice, where I treat many patients with connective tissue disorders.
Myth: I need a referral to see a physical therapist.
Fact: The APTA found 70% of people think a referral (or prescription) is required for evaluation by a physical therapist. However, a physician’s referral is not required in order to be evaluated by a physical therapist in all 50 states including the District of Columbia (DC). All 50 states and the District of Columbia (DC) allow for some form of treatment or intervention without a physician’s referral or prescription; however, some states have restrictions about the treatment a physical therapist can provide without a physician’s referral or prescription. You can check with your local health department or your local physical therapist to see what those restrictions are in your state.
In Rhode Island (where I practice), we have direct access, which means we can practice without a physician’s referral or prescription; however, many of the insurance companies will not reimburse us without the physician’s referral or prescription. In addition, any physical therapist with less than one year clinical experience is not allowed to start treatment without a physician’s referral or prescription. We must also disclose to the patient in writing the scope and limitations of the practice of physical therapy and we must obtain their consent in writing. Finally, we must refer the patient to a physician (MD, DO, DDS, DMD, Podiatrist, NP, or DC) if we are treating the patient past 90 days for a referral or prescription. Once the referral or prescription is received, we are allowed to continue with treatment.
Myth: Physical therapy is painful.
Fact: Physical therapists seek to minimize your pain and discomfort; including acute, subacute, chronic, or long-term pain. They work within your pain threshold to help you heal and restore movement and function. The APTA survey found that, although 71% of people who have never visited a physical therapist think physical therapy is painful, that number significantly decreases among patients who have seen a physical therapist in the past year.
As physical therapists, we want our patients with chronic pain and/or chronic connective tissue disorders to understand that we want to decrease their pain as we help them increase their physical and functional abilities. It is a reality and perceptional issue because patients with chronic connective tissue disorders, such as, Ehlers-Danlos Syndrome, especially Hypermobility Type, and Marfan syndrome, have pain due to their weakened connective tissue. The weak connective tissue causes joint subluxations and or dislocations which, in turn, cause bone on bone pain and muscle spasms on a daily basis. We (as physical therapist) may not be able to eliminate your chronic pain completely, but if we can decrease your pain from say a constant number 6 or 7 out of 10; where 10 is unbearable pain to a constant number 2 or 3 out of 10 while, at the same time, increasing your physical, cardiovascular, and functional abilities.
Physical therapy does not adhere to the “no pain, no gain” motto, especially with patients with chronic connective tissue disorders. The therapy performed, whether it is manual therapy and/or therapeutic exercise, must be done with care and preservation of your connective tissue and your joints, including your spine. Starting an exercise program at 10 reps. X 3 sets may not be appropriate. The physical therapist must take your connective tissue issues and biomechanical deficits into consideration while he or she is setting up your treatment program. If they don’t, then you will have increased pain and you will think all physical therapy is painful when this is not the case.
One of the primary goals of physical therapy for individuals with connective tissue disorders is to get you to control your pain so you are in control of what you do; not the pain. Our objective at Healy Physical Therapy & Sports Medicine, Inc. is to keep you in the game of life through appropriate manual physical therapy and therapeutic postural re-education, stretching, stabilization, strengthening, toning, and cardiovascular exercises to your individual tolerance.
Myth: Physical therapy is only for injuries and accidents.
Fact: Physical therapists do a lot more than just stretch or strengthen weak muscles after an injury or surgery. They are skilled at evaluating and diagnosing potential problems before they lead to more serious injuries or disabling conditions – such as chronic headaches; neck and back pain; spinal, rib, and joint hypermobility; subluxations; and dislocations.
As, physical therapists we are experts in the way the body moves and it is our job to help people of all ages and abilities reduce pain, improve or restore mobility, and stay active and fit throughout life. So, we must take care when we are treating patients with chronic connective tissue disorders not to put those patients in with our non-connective tissue patient population. Patients with chronic connective tissue disorders do not heal or respond as quickly as do non-connective tissue patients. Chronic connective tissue disorders patients tend to heal slower, bruise easier, and have more episodic flare-ups of their symptoms. Care must be taken to progress the patient at his or her tolerance to prevent setbacks and patient frustration or disappointment.
Those who are not cared for properly usually stop physical therapy and believe that they cannot be helped, leading them to feel hopeless. However, if they were receiving the correct form of physical therapy, it will keep them in the game of life.
Myth: Any healthcare professional can perform physical therapy.
Fact: Although 42% of consumers know that physical therapy can only be performed by a licensed physical therapist, 37% still believe other healthcare professionals can also administer physical therapy. The truth is that physical therapy can only be performed by a licensed physical therapist or a licensed physical therapy assistant who is under the supervision of a physical therapist.
Today, graduating physical therapists are doctors of physical therapy. Physical therapists’ college or university education is 6 to 7 years. Many go on to earn board certification in specific areas such as neurology, orthopedics, sports, women’s health, and/or manual therapy. Physical therapy assistants’ college education is 3 years. Once a physical therapist and a physical therapy assistant graduate from an accredited college or university, then they have to pass their state’s licensing exam. If they do not pass this licensing exam, they cannot practice physical therapy. If you are receiving physical therapy from anyone other than a licensed physical therapist or a licensed physical therapy assistant, you are risking significant to your body. Plus, according to the law in every state, only physical therapists and physical therapy assistants can practice physical therapy.
Myth: Physical therapy isn’t covered by insurance.
Fact: Most insurance policies cover some form of physical therapy. In fact, most insurance companies have a list of physical therapy providers that are in their network. I would recommend checking with your insurance company to find out if physical therapy service is covered and, if it is, ask about the deductible, co-payment, number of approved visits, the need for preauthorization. Keep a record of all that you were told, as well as, the date and the name of the person at the insurance company who provided the information. It is important to know what your financial responsibilities are before you begin treatment.
Myth: Surgery is my only option.
Fact: In many cases, physical therapy has been shown to be as effective as surgery in treating a wide range of conditions; orthopedically speaking, from rotator cuff tears, degenerative disc disease, to meniscal tears, spinal and joint hypermobility, as well as some forms of knee osteoarthritis. Those who have recently seen a physical therapist know this to be true, with 79% believing physical therapy can provide an alternative to surgery. However, with this said not all physical therapist and physical therapy assistants are created equally.
If you have a chronic connective tissue disorder, you do not want to be treated by a physical therapist who does not understand your disorder or by a physical therapist who does not want to learn about your disorder. This is a prescription for immediate failure. Instead, find a physical therapist who understands your disorder or is willing to learn about it and who understands manual therapy and therapeutic functional exercise. Not all physical therapists practice this combination of treatment. When it comes to orthopedic issues, it is in my professional opinion that one should exhaust all options prior to having surgery unless it is a life-threatening situation. Even if you eventually require surgery, the physical therapy you went through gives you a better chance at a positive outcome because you will have better controlled mobility of your spine and joints, improved cardiovascular conditioning, and improved joint and spinal stability going into that surgery. I call this a win-win situation.
Myth: I can do physical therapy myself.
Fact: Your participation is key to a successful treatment plan, but every patient still needs the expert care and guidance of a licensed physical therapist. Your therapist will leverage his or her specialized education, clinical expertise, and the latest available evidence to evaluate your needs and make a physical therapy diagnosis before creating an individualized plan of care. Again, all connective tissue disorder individuals need to be treated by a physical therapist who understands their individual connective tissue disorder and knows that your progression is going to be slower, with peak and valleys throughout the treatment. Having this skilled physical therapist will limit the number of flare-ups that you have; therefore, decreasing the chance of re-injury or injuring yourself further which in turn will keep you in the game of life which should be the goal of all therapy.
Michael P. Healy, PT, DPT DOMTP (Canada), IOMT, CSN, CPT, TPI GFI, MBA, is the president and CEO of Healy Physical Therapy & Sports Medicine, Inc., in Rhode Island.
- Acknowledgements: Joseph Brence, PT, DPT, FAAOMPT, COMT, DAC.
- Flynn, T Fritz, Whitman J, et al. A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with spinal manipulation. Spine
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- Cook CE, Showalter C, Kabbaz V. O’Halloran B. Can a within/between session change in pain during reassessment predict outcome using a manual therapy intervention in patients with mechanical low back pain? Man Ther. 2012; 17(4): 325-329.
- Kaczynski JJ, Schwieterman B, Columber K, Knupp D, Shaub L, Cook CE. Effectiveness of physical therapy administered spinal manipulation for the treatment of low back pain: a systematic review of the literature. Int J Sports PhysTher. 2012; 7(6): 647-662.
- apta.org. 08/16/2017.
- Rules and Regulations for Licensing Physical Therapists and Physical Therapy Assistants in The State of Rhode Island and Providence Plantations [R5-40-PT/PTA].
Michael P. Healy, PT, DPT DOMTP (Canada), IOMT, CSN, CPT, TPI GFI, MBA, is the president and CEO of Healy Physical Therapy & Sports Medicine, Inc., in Rhode Island.