Physical Therapy & Direct Access

Most people understand what it’s like to experience physical discomfort. Aches and pains of all varieties are quite common, whether it’s in the neck and shoulder area, lower back, knees, or feet. Many people suffer quietly without doing anything to address their pain, until one day it gets to be too much. The question is, what do they do then?

Some may go to a chiropractor, hoping for a quick fix. Others may go to their primary care provider, such as a doctor or nurse practitioner. The latter may result in a referral to physical therapy for treatment. No matter the route they take, ideally, they will receive treatment that addresses the core problem. Physical therapy and chiropractic care are healthcare disciplines that focus on improving musculoskeletal health. Though they are both effective, they differ in their approaches and treatment methods.

Most problems involving pain or limited function that are musculoskeletal in nature respond very well to conservative management, treatment defined by the avoidance of invasive measures such as surgery. These problems include osteoarthritis, bulging spinal discs, sciatica, plantar fasciitis, and tennis elbow. The list goes on and on. It’s important to recognize that, with or without a formal diagnosis, pain or limited function that is mechanical in nature can also be treated successfully with physical therapy. Physical therapy involves a thorough evaluation of all body systems involved, and a treatment plan is developed that is specific to each patient. Physical therapists use a variety of treatment interventions, including patient education, therapeutic exercise, manual therapy techniques (joint mobilization and soft tissue mobilization), neuromuscular re-education that could include balance retraining, functional dry needling, vertigo treatment, among others. The scope of what physical therapists do is broad and always directly involves the patient in self-management, empowering them to restore and maintain normal, pain-free function.

As individuals consider their options for addressing musculoskeletal issues, understanding the qualifications of healthcare professionals becomes crucial. Physical therapy educational training is now, and has been for some time, a Doctoral Degree in Physical Therapy (DPT), which is three years of school beyond a bachelor's degree. This includes clinical internships in a variety of settings, along with a rigorous didactic program involving extensive anatomy and physiology training. A physical therapist’s knowledge of anatomy, especially of the musculoskeletal and nervous systems, is on par with the highest level of expertise in the healthcare field. Physical therapists also continue to advance their skills and understanding of new interventions and treatment approaches through continuing education seminars.

One of the most important points to be made here is that in many states, including Iowa, a patient does not need to have a doctor’s referral to see a physical therapist. This is called direct access. This is also where the conversation of physical therapy vs. chiropractic care becomes more relevant. Most are aware that a referral to see a chiropractor is not required. Many people choose this option first, believing that a conservative and holistic approach makes sense. Physical therapy also offers a conservative and holistic approach to the treatment of pain and loss of function, and perhaps, with a higher level of integration within the health system. They work hand in hand with other healthcare professionals to provide the most optimal care.

Direct access enables individuals to promptly access physical therapy services, speeding up evaluation, diagnosis, and treatment. This approach has several advantages, including quicker access to care, potential cost savings by bypassing unnecessary visits to other healthcare providers, and timely intervention for musculoskeletal issues or injuries. Moreover, it empowers patients to take a proactive role in their healthcare by directly engaging with a physical therapist who can offer personalized assessments, exercises, and rehabilitation strategies tailored to their specific needs. This is critical not only to fully resolve a given musculoskeletal problem, but to help prevent future recurrence. Physical therapists teach patients how to treat themselves.

Additionally, in an era of rising healthcare costs, physical therapy has been shown to have a net economic benefit for many conditions. In an analysis by the American Physical Therapy Association (APTA), eight common conditions were studied: knee osteoarthritis, carpal tunnel syndrome, low back pain, stress urinary incontinence, tennis elbow, vascular claudication, falls prevention, and cancer rehabilitation. In every case, the use of physical therapy was associated with a net economic benefit to the health system, compared to alternative types of care. The range in average net benefit per episode of care was between $2,144 for falls prevention to $39,533 for carpal tunnel syndrome.

In summary, physical therapy should be always considered as the first line of treatment for musculoskeletal problems, due to its non-invasive nature, focus on functional improvement, and evidence-based approach. Additionally, the collaborative and patient-centered nature of physical therapy encourages active participation in one's healthcare. If you experience aches and pains, limited mobility, or have difficulty doing the things you like to do, physical therapists can help.

Brian Poirier, PT
Physical Therapy Department
Medical Associates Clinic

Physical Therapy Department