Why PT Cannot Be Standardized

As a practicing orthopedic Physical Therapist for the past 6 years, injury presentations, on average, have become less mysterious and more straight forward. It’s important to note that when I say “straight forward”, it simply means I have come across many repeat injuries that have helped me build a track record of experience around identifying and treating them effectively. Beyond that, however, treating injuries always has been and always will be a multi-faceted experience that is uniquely curated for each client.

In this post, you’ll see some of the factors and questions that go into evaluating a client, and, in a future post, you’ll see some of the principles I work form when physically assessing him or her. In order to keep things simple, I listed some of the questions a client will receive from me on evaluation day.

When was the injury sustained?

Duration of time tells me how long something may take to improve

Was there a distinct mechanism of injury?

This will dictate how much focus I have on other parts of the history taking process as well as where my physical examination will go

What has the pain timeline looked like?

Are symptoms improving or getting worse? These answers impact the types of exercise prescription I will have to make

What is the pain experience?

Are they a “push through pain” person, or is the pain consuming every aspect of his or her life? This tells me where I’ll have to prioritize my energy. Will I need to dive into explaining physiology, or be firm about what this person should be cautious about?

What was the activity level prior to injury, and now, during the injury?

Was this person a marathon distance runner, or was this person newly active. This will set up my exercise prescription planning and indicate how much movement education someone might need.

What are the aggravating movements?

Is the pain when bench pressing 285lbs or is it when putting a dish away in the cabinet?

As you can probably gather, each response will be different for each person, making the injury management relationship and plan development unique to him or her. The evaluation session alone dictates the foundation of how I’ll communicate, how I’ll educate, where the starting point will be for that person, where the final goal is for them, how long the plan might take, how independent or supervised the plan will need to be, when to introduce new information, etc.

There are many factors that go into developing a robust, yet effective, plan of care for each person, which is why the evaluation session is the most important one, and is often why clinicians don’t typically offer this session for free. This is also why insurances require in-network Physical Therapists perform an evaluation before they can reimburse for any future sessions rendered. It’s an essential piece.

What I didn’t mention in the series of questions above, yet is important to address, is that in every evaluation or intake form, there is a portion where physical therapists ask the necessary questions to rule out red flags. This means they are trained to identify if something is not musculoskeletal in nature, and are able to refer an individual to the necessary medical professional as needed. Physical Therapists are often a first line of defense for many, as we spend more time, on average, with each client than most other medical professionals do.

To finish up, my goal in writing this post was to hopefully give a little insight into the importance and benefit of utilizing modern clinicians for managing musculoskeletal issues. While the internet and technology are great resources to have, there is still an under-appreciated benefit to working with a human resource that caters care to you.

Dr. Megan-Marie Delegas PT, DPT

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