Healing Hands
October is National Physical Therapy Month!
This month I am going to take this opportunity to tell you more about the field and highlight Physical Therapy treatment & specialities you may or may not be aware of. Over the years I have been extremely fortunate to work with (and learn from) some amazing Physical Therapists. First up: Manual Therapy!
Manual Therapy
Some are under the impression that PT treatment is only exercise based and while movement is a tool, manual therapy typically initiates the healing process. I was introduced to a number of manual therapy techniques when earning my Doctorate of Physical Therapy, but as Kristin mentions, manual skills are honed with post-graduate practice and continued education. I am Maitland trained which I tend to complement with other techniques. Generally, I believe in correcting any joint or soft tissue restrictions (if present) before implementing exercise. Otherwise you are reinforcing an already present “abnormal” movement pattern that has likely been provoking pain or dysfunction. With neurological diagnoses, I believe manual facilitation is key to train efficient movement patterns from an altered central nervous system.
As the restrictions and movement patterns improve, you are encouraged to MOVE and strengthen the muscles that have been identified as weak. This is where your dedication to recommendations and your home exercise program is crucial. This is what makes the intervention “stick” and provide long term management of a condition. Read on as one of my colleagues Dr. Hernandez tells you more about manual therapy and her extensive continued education that makes her an expert in the field.
Dr. Kristin Hernandez, DPT, FAAOMPT, Dip. Osteopractic, Cert DN, Cert SMT
Owner & Creator of Align Physical Therapy, PLLC
The term manual therapy originates from the Latin, manualis (meaning held in the hands). It refers to therapy performed by using the therapist’s hands on a person’s body for therapeutic purposes. It includes manipulation and mobilization of joints and soft tissue with an end goal of pain reduction, improving mobility, and encouraging the body’s natural ability to heal.
Manual therapists, like other physical therapists, are trained to assess a person’s mobility and limitations or movement compensation patterns. Once these patterns are assessed and understood by the therapist, a series of corrective exercises are instructed and prescribed and usually hands-on techniques are employed to address the limitations.
All physical therapists trained after the early 2000’s are trained at a doctorate level, meaning they go to school between 6 and 8 years. While all these therapists have the same basic training, the degree to which they are educated in manual therapy techniques varies greatly. Similar to physicians who are required to go through residency and sometimes continue through a fellowship, specialization through residency and fellowship is also an option for physical therapists.
When looking at options for additional training, there are a variety of programs one can choose. I opted for a program of study from the American Academy of Manipulative Therapy (AAMT) which is credentialed by the American Academy of Orthopedic Manual Physical Therapists (AAOMPT). The costs of enrolling in these courses of study include essentially volunteering your time to learn from the best therapists in the profession, traveling around the country to attend courses over 12-24 months, a high price tag of tuition, and spending most evenings and weekends studying and practicing your new skills. The benefits include taking your professional skills to the highest level and then bringing your knowledge home to your patients.
Because this course of study is so challenging, and because there is extensive written, oral, and hands-on examination to ensure you have mastered the program, only about 1% of all therapists in the country earn the professional title Fellow in the American Academy of Orthopedic Manual Physical Therapists, or FAAOMPT. Graduates from my particular program also earn the title “Osteopractic Physical Therapist” which includes mastery of skills such as dry needling (similar to acupuncture), spinal and extremity manipulation, instrument assisted soft tissue work, body tempering, joint mobilization, differential diagnosis, assessment and treatment. This is the most rigorous training we have in this country for manual therapists and it is truly an honor to be counted among the ranks of these physical therapists.
If you’re wondering how a typical session with a manual physical therapist would go, allow me to elaborate. A common pattern we see when assessing low back pain is lack of hip mobility and upper spine mobility, specifically at a region known as the thoracolumbar joint (TLJ). In this case, a manual therapist like me would use my hands and my body weight to mobilize the hip joint in the directions of the restrictions. In many cases I would manipulate the TLJ. I would use my hands or a tool such as dry needling to loosen the soft tissue around the hips. I would then re-assess the symptoms and check to see if my treatments had immediate impact on the patient’s limitations and pain. The patient’s homework would be specific exercises to reinforce my treatments for the day. My favorite exercise that I give nearly every patient is something called sidelying thoracic rotation. I give this exercise for nearly every diagnosis because thoracic mobility is key for so many pathologies we see, from neck pain, headaches and TMJ issues to low back pain, shoulder, elbow, hand, hip and even knee pain. It’s my powerhouse exercise and I recommend everyone, healthy or symptomatic perform regularly.
Your therapist should assess you, watch you, walk, squat, twist, sit, jump— move, regularly during a course of treatment. A good physical therapist is constantly assessing the nature of your symptoms and mobility, asking questions about your symptoms, your sleep, your nutrition and hydration. A very wise instructor of mine once said “if you listen long enough, your patient will tell you what’s wrong with them” meaning we glean important information from our patients’ history and symptom descriptions. Look for a therapist who will spend 1:1 time with you for your entire treatment, generally 45-60 minutes and actively listen as you explain your problem. Your therapist should mix assessment with treatment and give you an active role in making yourself healthier by giving you homework! Your therapist should assess your response to treatment and modify, correct, and sometimes abandon treatments that aren’t working for you. No two people are the same physically, and every patient we have gets a unique treatment.
When you spend time and money in a clinician’s office (from MD and DO to your local massage therapist), your clinician should be working on helping you attain great results, spend quality time with you, and make you feel as though you’re the only patient in their world. I tell my patients I have a thousand ways to treat your symptoms, and I need to find the most effective, most efficient methods. I will perform techniques that work and abandon those to which you don’t respond. You should see results. All therapists have an incredible amount of education, experience, a range of skills we can use for you, and we are the most well trained clinicians to help you with whatever physical symptoms you have been struggling with. If you have tried physical therapy in the past, without luck, try a different therapist. Ask your neighbors, your doctor, your friends for recommendations because there is likely a great PT in your area just waiting to help you get started on your healing journey!
