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.


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.


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.


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.


6 thoughts on “Physical Therapy

  1. Hi, Socks: First of all, what a marvelous career choice, but when did you get a daughter old enough to think about these things? (They grow up so darned fast even though WE don’t get any older!). I love your explanation and agree completely about the worth of physical and occupational therapists. While not all states will let you just consult with a therapist (see my blog post on open access:, I believe any physician treating an RA patient would be willing to prescribe therapeutic sessions. You must be very proud of your daughter!

    • I hear you! My kids are older than me now 🙂 It’s funny, people started saying my oldest would be an engineer when he was about 4 years old. He just thinks that way. Now he’s in engineering school. Since she was about 3, I’ve thought my 1st daughter would be a nurse; she is studying health science in college and wants to be a paramedic (I was close). My 2nd daughter just turned 17 and last fall told me she thought she wanted to be a PT. We started looking into what’s involved and discovered the observation requirement, so she’s been spending mornings at PT clinics and afternoons on schoolwork, and is now positive that she wants to be a PT. WA is not an open access state. PT’s are working to get reclassified as primary care so that anyone anywhere can make appointments without referrals, and insurance won’t be able to limit the number of visits you can have.

  2. Thanks for the information, WS. PT is good for everybody, just not very affordable for most people. The new PTD’s will have to be creative with their business strategies. Fewer of my patients are willing to get a full course of PT since they have the $3000 to $6000 deductible health insurance. Short courses of PT or alternative practitioners have more appeal. Massage therapists and dry “needlers” are getting more business. Interesting times, but fraught with opportunity for creativity in health care. Your kids will be challenged in health care.

    • PT is definitely expensive! We have already hit my daughter’s annual deductible, but it’s helped so much that we believe it was a good investment.

      I understand the dilemma of thinking $350 per week is unaffordable, yet needing to do something in order to feel better. My daughter couldn’t walk or participate in any activities. She sat in her recliner and the rest of us waited on her for months. After a switch in meds and a few months of PT, now she’s feeling so good that she’s able to be on her feet five hours a day, plus teach horse lessons once a week. It’s expensive, but this is one of those things we couldn’t afford NOT to do.

  3. I am just finishing up 3 months of ot. I had to have hand surgery and I went to a small practice afterwards. I’m certain the care I received was a better quality than a large franchise practice would have been. This is simply because of the extra time the therapist spent with me. There was no time clock and I often was there well past the hour prescribed. I went to her because my insurance wasn’t accepted by the larger practices. Now, I feel lucky they didn’t. I have almost full use of my hand and anticipate it will continue to improve. Expensive oh yes but if you can swing it well worth the money.

    Good luck to your daughter. What a wonderfully fulfilling career choice.

  4. Socks, I’m currently seeing a certified hand therapist (CHT) who a trained OT. You’re right, PT and OT schools are going doctoral level. All the schools in Washington are now DPT. That’s exciting your daughter is considering this as a profession!

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