Physical Therapy

PT & OT. What’s the difference?  Does it matter?

Even physical therapists and occupational therapists can have a hard time explaining the distinction between the two fields because there is significant overlap.  When asked, professionals who have been able to formulate any sort of response have explained:

  • PT tends to work on large joints (knees, hips, shoulders); OT tends to work on small joints (hands & wrists)
  • PTs tend to prescribe formal exercises; OTs are more likely to learn about your daily life and find things you can fit into your normal routine to exercise the joints involved (an OT will tell you that knitting and piano playing are excellent hand exercises).

However, PTs can work on the hands.  In fact, they can earn extra “hand” certification.  I discovered this (and many other interesting things) because my daughter has decided that her career goal is to become a physical therapist.  She has been learning what hoops she’ll need to jump through to make that happen, and one requirement is a certain number of observation hours in a variety of PT settings.  Two local PT offices have graciously allowed my daughter to observe in their clinics, so she has been able to compare not just different therapists in a single location, but the differences between how two different clinics are run.

One of the PT clinics where she’s observing is a large chain.  An advantage to large chains is that they employ floaters who act like a substitute teacher, travelling from one clinic to another to cover for those who call in sick.  Patients can set up a therapy schedule and be confident that they won’t be cancelled if their therapist becomes ill.  One disadvantage is that the PTs there are extremely clock-conscious, and ignore the patient part of the time because they’re doing documentation.  In case you haven’t discovered it yet, ignoring patients to do documentation means that the therapist doesn’t notice when patients are doing their exercises wrong.

The other place is a small, privately owned clinic.  They do not watch the clock as strictly, and tend to be more focused on accomplishing specific goals for each patient each day.  If that requires an extra ten minutes, it isn’t a problem.  On the down side, if someone is out sick, either another therapist has to pick up extra patients all day, or patients have to be rescheduled.

Schooling

In the past, PT was an undergrad degree.  That has changed, however, and new physical therapists enter the field with a doctorate in physical therapy.1  DPT school is every bit as competitive to enter as medical school, and has stringent entrance requirements:  at least one year each of college level biology, human anatomy & physiology, chemistry, physics, and psychology, with a number of other “strongly recommended” courses, as well.

Benefits

Anyone with RA (or another type of autoimmune arthritis) can benefit from consulting a physical therapist.  PTs can test to determine which muscles need to be strengthened, and can then teach the least painful way to strengthen muscles so that joints work as efficiently as possible.  The more I learn, I believe there is value in shopping for a PT like we shop for a physician.

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1Occupational therapists enter the field with a masters degree, which honestly makes no sense to me, since it takes about the amount of time to earn as a DPT.

Exercise Resolution

With a 5-lb potato bag in each hand, extend arms straight out from sides & hold.  Soon you’ll find you can hold this for a bit longer.  Try to reach a full minute.  Then move up to 10-lb bags, then 50-lb bags & eventually get to where you can lift a 100-lb potato bag in each hand & hold your arms straight for more than a minute.  (I’m at this level)  Once you feel confident at that level, put a potato in each bag.

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It’s that time of year when people make New Years resolutions, and variations on exercise/get in shape/be healthier are common.  Despite my wish to be in good shape, wishing won’t make it happen.  I need concrete goals (I’ve previously written about goals here):

My resolution/goals are:

  1. Develop and follow an exercise routine
  2. Write weekly menus for my family and prepare those well-balanced, nutritious meals
  3. Carefully keep track of everything I eat

I’ve already been working on the first one.  My family joined the YMCA, and part of the membership fee included an appointment with a personal trainer to customize an exercise program.  This was a huge waste of time.  Fortunately, I also saw a new physical therapist.  The contrast was remarkable.  My physical therapist has been working with me to find stretches and exercises that start with where I am now and will protect my joints while getting me into good physical condition.  I’m already seeing progress.

I also bought a home gym.  Do not pay full price if you decide to do this.  Craigslist is a great place to find exercise equipment.  Things tend to be more expensive when everyone is making New Years resolutions, but many people give up on their resolutions after eating tons of Valentines chocolate, and prices go back down.  Here’s what I got:

The reason I chose this model is that it includes a rowing machine, which is fantastic low-impact cardio.  I still have my elliptical, so now I have two cardio options.

One entire PT session was spent going through the exercise book that came with my home gym, with the physical therapist marking which exercises I should do and which ones should be avoided.  It was pretty interesting to see the therapist’s eyes grow big as saucers as she exclaimed, time and again, “Oh, my!  Don’t do this!  It would be terrible for your ____.”

I love having my exercise routine designed by someone who knows what she’s talking about.  Now I just have to put it into practice.

Any resolutions you wish to share?

Rotator Cuff Tears

Found an interesting bit at MedPage Today.

There are several effective approaches for treating a rotator cuff tear, but none stands above the rest, a systematic review showed.  A literature review revealed that both operative and nonoperative approaches work for improving function and relieving pain, Jennifer Seida, MPH, of the Alberta Research Center for Health Evidence at the University of Alberta in Edmonton, and colleagues reported online July 5 in the Annals of Internal Medicine.

But evidence comparing different techniques was limited and weak, “which precludes firm conclusions for a single approach or the optimal overall management of this condition,” the researchers wrote.

Complication rates across studies were low.

“Because of the low event rates, the benefit of receiving treatment for rotator cuff tears seems to outweigh the risk for associated harms,” Seida and her colleagues concluded from their review, which was prepared for the Agency for Healthcare Research and Quality.

Really?  Getting treatment for a tear is a good idea?  They spent money to figure this out?

Without treatment:  can’t get things out of the cupboard, can’t use a computer’s mouse, can’t wash own hair, can’t dress without assistance, can’t reach overhead, difficult to lift things, can’t play guitar (or violin or piano), can’t help put up hay…

With treatment:  function restored (at least enough to do most routine activities)

It’s really not as obvious as some of the studies Dr. Grumpy reads.  There are risks associated with treatment (even though the article doesn’t say what those risks are).  It’s like taking medicine:  you only want to do it if the potential benefits outweigh the risks.  What they wanted to know is which treatment is best (comparative effectiveness at work?).  The answer is that we just don’t know.  It’s worth reading the entire article:  No Clear Favorite for Rotator Cuff Repair 

With any luck, some poor student in need of a study topic will follow-up and figure out which treatment is most effective.  Not just PT versus surgery, either.  If the answer is PT, I want to know which PT exercises would be best.

I tore my rotator cuff last July.  That’s right – a full year ago.  First I did exercises at home that had previously been prescribed for tendonitis.  They didn’t work.  Eventually I spent hours travelling for treatment only to pay a physical therapist to tell me to do the exact same thing I was already doing.

Since all that work/time/money didn’t help, I wasn’t too optimistic when I was sent back for yet another round of PT.  This time, though, I’ve been given different exercises.  This time it’s working.  I don’t have full use, but enough to do most things.  So why didn’t we start with these exercises instead of spending two months (and blowing my insurance company’s PT allotment) on something that was useless.  It would have been really nice to start with the exercises that work.

I guess that’s the point of the study.  Treatment helps, but it would be nice to know which treatments would be best for a specific tear.