What Physical Therapy Is

Dr. Beauchamp is going to start featuring guest bloggers here at www.whatphysicaltherapyis.com.  As the owner of Spine & Sport, he is fortunate to have a staff of talented clinicians to pull from. We hope that you will find the information they share, relevant and useful. Whether you are seeking answers to pain you are experiencing or you are a physical therapist looking for an exchange of ideas.

Nathan Johnson PT, OCS

Our first guest blogger will be Nathan Johnson, the Director of Rehab at our new clinic in Jacksonville, Florida. He graduated from Bradley University in 2004 with his masters in Physical Therapy. He is a board certified orthopedic physical therapist that specializes in spinal rehabilitation. He completed his clinical certification through the Ola Grimsby Institute where he learned advanced manual therapy skills and scientific therapeutic exercise progression. Nathan is an active member in the orthopedic section of the APTA and the American Academy of Orthopedic Manual Physical Therapists.

Easy answer to the first part of the above question – YES!  Yes, except if you live in the State of Arkansas??  (See #1 below)

Let me start by defining some words we are using:

Mobilization or manual therapy means a group of techniques comprising a continuum of skilled passive movements to the joints or related soft tissues, or both, throughout the normal physiological range of motion that are applied at varying speeds and amplitudes, without limitation.

Manipulation utilizes a high velocity, low amplitude thrust technique whereby the joint is moved beyond its normal physiological range of motion.

Adjustment  “refers to a wide variety of manual and mechanical interventions that may be high or low velocity; short or long lever; high or low amplitude; with or without recoil. Procedures are usually directed at specific joints or anatomic regions. An adjustment may or may not involve the cavitation or gapping of a joint (opening of a joint within its paraphysiologic zone usually producing a characteristic audible “click” or “pop”). The common denominator for the various adjustive interventions is the concept of removing structural dysfunctions of joints and muscles that are associated with neurologic alterations. The chiropractic profession refers to this concept as a “subluxation.” This use of the word subluxation should not be confused with the term’s precise anatomic usage, which considers only the anatomical relationships.” (2)

Now, back to the topic! The manipulation technique has been added to most curriculums throughout the USA. (Interesting topic found link #3 below)  The manipulation technique has been taught by most physical therapy curriculums external of the US for a long time.  Some physical therapists use this technique frequently; others, not so much.  Every Physical Therapist is different, but it is my opinion that a manipulation technique can be very beneficial when used with the correctly identified patient.

A question I often get from the public when discussing this topic is, “What is manipulation as compared to an adjustment that is traditionally performed by Chiropractors.  Here’s the skinny:

The easy answer is that both techniques usually involve the technique culminating with an audible “pop”.  The pop is referred to as a cavitation in the physical therapy world and is the result of the release of nitrogen gas within the joint.  This is where the similarity between the two end.  Once again, I’m not a Chiropractor so I will not speak for them.  (Read link #4 and #5 to see what a Chiropractor has to say on this topic.)  As for the field of Physical Therapy, the cavitation itself is not the purpose of the technique, just a byproduct of it.  The primary reason why a Physical Therapist uses this technique is to create mobility in an otherwise tightened joint. 

This is a brief overview on this topic, but hopefully it gives you some insight.  If you have any questions, please ask!!

1-  http://physical-therapy.advanceweb.com/editorial/content/editorial.aspx?cc=61582&CP=4

2-  http://www.chirobase.org/05RB/AHCPR/08.html

3-  http://www.chirobase.org/17QA/ptschool.html

4-  http://www.chirobase.org/01General/chirosub.html

5-  http://www.chirobase.org/01General/01General/placebo.html

The following is a continuation of my conversation and recommendations to a patient dealing with runner’s knee. This installment also covers my thoughts on the use of supplements and contains a link to our website where you can get more information on Amerisciences, the supplement line we carry at Spine & Sport. Enjoy, and as always, please feel free to send me any questions you may have.

 LJ: So would you weight train one day and run the next and just keep the rotation up? Do I just keep on weight training or is this just something that I need to do initially? I’m just wondering if this is something that you have to keep on doing for maintenance or not. I will definitely add this to my workouts though.

Thanks for the advice and happy running.

P.S. What do you think about using a glucosamine supplement to help with joints? I am curious if these are worth my time to help lubricate the joints. They are an expensive supplement so I am curious if you think there is a benefit. I have taken the product Osteo Bi-Flex in the past and wonder if you endorse something like this.

 Dr. Beauchamp: You could add the weight training in your routine when it is convenient for you.  I do some of mine when/during/after running ie lunges squats calf raises and the rest in a gym.  I would recommend lifting throughout.  In about 8 weeks you could decrease sessions per week to 2 and that will maintain.

I agree with the use of a glucosamine product as some of my patients have had success with using it.  The fact of the matter is the source of the glucosamine is where the problem is.  The majority of people taking supplements do not understand that what is in the pill can be significantly different from manufacturer to manufacturer.  The pills you find on the shelf at a discount rate at a local large distributor may or may not contain what it states it does contain - as there is minimal to no oversight of that industry (supplementation businesses).  The company that I promote and use is Amerisciences.  It uses better-than pharmaceutical grade measures that insure quality products.  The product I promote for joint pain is Joint Ease; it is the best product on the market for that particular problem.  Here’s a link on our website: http://www.spinesport.org/home.cfm/page/products/category/0/product/36_Joint_Ease_(1_Bottle).html

A relatively new trend in the field of physical therapy in the US is Residency.  It models that of other doctorate-degreed professions in that it is training that occurs after the individual has graduated from physical therapy school and has attained a license to practice.  Usually the residency-site is geared towards a specific field of specialty, orthopedics, neurology, pediatrics, etc.  The physical therapist applies for acceptance into the program and upon acceptance goes through a pre-determined, rigorous training program that includes written, demonstration, working with an expert trained clinician along with a few other tasks usually while working as a physical therapist in the clinic. 

Yes!  Quite demanding, however quite rewarding if the PT is looking to improve his/her skills!  The residency can last anywhere from 6-24 months depending on how the program is structured.  Upon graduating residency, the PT is then able to market him/herself differently than other therapists as the knowledge and skills acquired on the residency path lead to significant knowledge in that area as compared to his/her peers that are not residency trained. 

Obviously, experience is also important and this writer is not inferring that a person with 10+ years experience is less of a therapist than one who is residency trained.  However, I am saying that a residency-trained therapist comes to the table with knowledge and skills that some experienced therapists do not have.

Another form of training that a PT can do after graduating is Fellowship training.  I will discuss that in my next blog!