If you’re reading this newsletter, then you are already familiar with how a physical therapist can be an integral part of any individual’s team of medical providers We PTs are movement and activity experts – trained to identify problems with the musculoskeletal system that impair physical function and then to correct these problems with a combination of hands-on joint and soft-tissue treatments and movement-based therapy. If any part of the body moves too much, too little, with poor coordination, or with pain – we can help. Maintaining optimal function of your moving parts translates into better general health. It’s well-documented that efficient movement aids heart health, blood sugar management, sleep patterns, mood, energy level, and a whole host of other things.
A physical therapist is generally not the only medical practitioner that “belongs” on an individual’s health care team. Other specialists are also typically team members. Most people have a primary care physician (a family practice specialist of an internist, for example). Typically there is a dentist “on board.” Other medical specialists may participate from time to time – an ob/gyn, or a cardiologist, or an endocrinologist, or a podiatrist, to name a few. A collaborative effort between practitioners is in theory the most effective way to maintain, manage, and/or improve a person’s health. Each practitioner has an individual area of expertise, and ideally each compliments the others.
A recent patient story has prompted me to revisit in my mind the concept of “Team”.
This story involved a patient who has successfully been utilizing a physical therapist’s advice and treatment on an intermittent basis to gradually improve function over the course of several years after a significant traumatic injury and surgical repair of a fracture .This patient was told on an unrelated visit to a new health care practitioner (who had not been present during the course of care to date) that “the bone has long since healed, so physical therapy isn’t going to help.” On seeing the patient’s disappointed reaction to the comment, the practitioner then went on to say “…but if you want to see a physical therapist I won’t try to stand in your way.”
A physical therapist on a regular basis sees in practice that it is not at all uncommon that patients can benefit from therapy regardless of how long it has been since an injury or illness. In this case, while it is true that a bone will typically heal over the course of about 8 weeks after a fracture or repair, it should also be considered that it is generally not only the tissue healing at the site of an injury that determines whether or not a patient is able to function normally. In this case, the effects of the bone injury and subsequent surgery created significant ongoing movement limitations that led over the course of many months to muscle wasting in some areas and muscle overuse in other areas. All of this altered movement perpetuated a situation in which activity caused pain and a constant abnormal tissue stress in the injured area kept soft tissues near the injury and surgical site inflamed. Very gradually over the course of time in physical therapy, this patient was able to gain mobility and learn to utilize muscles better. Function returned. However, because of the nature of the original bone injury, the patient remains prone to movement dysfunction. Seeing a physical therapist intermittently helps this patient to recalibrate the movement available in the injured area when it becomes limited, so that the patient can again function fairly normally for a period of time. This patient also finds it useful to periodically seek treatment from other practitioners, including a chiropractor, a massage therapist, and an exercise physiologist.
In this case, as in many others, multiple medical specialists have played important roles. An Emergency Room physician stabilized the original injury. An orthopedic surgeon did the best repair that was possible for a complicated fracture. A physical therapist managed the initial recovery of movement and day to day physical capacity. And now, because for this patient unfortunately things aren’t “as good as new”, an ongoing health management strategy is appropriate. The patient observes that working with a physical therapist continues to be a useful part of this management, as treatment enables better movement and reduces pain on the job and during daily life. Intermittent clinical assessment by a physical therapist of this patient reveals musculoskeletal issues that are known to respond positively to physical therapy treatment. Why would there be any reason for anyone to “try to stand in the way”?
A physical therapist’s job in part is to recognize when a patient’s presentation makes them appropriate for medical evaluation by someone besides a physical therapist. For example, if a patient is demonstrating signs of a systemic illness, the physical therapist should refer them to their primary care provider for assessment. If a fracture is possible in an injured area, the patient should be sent to a physician who can order and then interpret imaging. In these cases, it is not the physical therapist’s role to guess whether or not the patient will respond well to another type of care. Instead, their role should be to expect the next specialist to provide their expert assessment and opinion regarding the case.
In many or even most cases, collaborative care between physical therapy and other health care providers is appropriate. There is often no single practitioner capable of optimally managing patient health. It is not uncommon for the physical therapists at Symmetry to consult or co-treat with one or more physicians during the course of a patient’s care, as well as with pharmacists and chiropractors and acupuncturists and personal trainers and massage therapists and nutritionists and counselors and coaches– not to mention spouses or parents or children. Open communication and respectful collaboration between all of these resources enables good health care.
Not to be forgotten would be that at the crux of all of the opinions of various health care providers is each individual patient’s experience. Only a patient can gauge the true personal value that they receive from their medical care. This story and circumstance reminds me that my role as a health care provider is to do my best to provide expertise and insight for each patient based on my medical training. Then it is ultimately my role to allow the patient to decide whether or not they would like to choose to allow me to participate with them during their care. It’s always exciting and gratifying to see the results of an effective collaborative treatment. It’s fun to have the opportunity to be part of a well-trained “Team”.