Monday, November 27, 2006

Physical therapy arrives

Popularity surges for varied reasons
By Judy Foreman | November 27, 2006

So there I was, the quintessential battered athlete, standing in a silly little "johnnie" so physical therapist Susan Lattanzi could put me through my paces.

I had arrived on her doorstep at Mount Auburn Physical Therapy Associates in Watertown because my right shoulder was killing me. I had just joined a swim team and suddenly increased my weekly yardage substantially. By the time I saw Lattanzi, I couldn't swim 15 minutes without my shoulder screeching in protest.

She had me put my arm by my side, thumb facing forward, then lift it overhead alongside my ear. No problem. Then, another arm lift with my palm up and the arm raised to the side to shoulder level. Ouch!

My rotator cuff was damaged, but it felt better within weeks, after physical therapy with ultrasound to improve blood flow, deep friction massage to break up microscopic scarring, and home strengthening exercises. No surgery! Back to swimming!

No one keeps good track of visits to physical therapists, but there is so much demand that there are now more than 200 training programs in the United States, up from 140 just 10 years ago. Physical therapists are also better trained than ever before, with the number getting doctorates soaring.

Despite growing demand, in some ways it's easier than ever to see a physical therapist. Most states allow patients "direct access" without a doctor's referral, though in some cases, insurance companies will not pay for physical therapy without a referral.

"Physical therapy is booming. We can't get them out of school fast enough. Hospitals are crying out for physical therapists all over the country," said Dr. Jeffrey B. Palmer , director of physical medicine and rehabilitation at Johns Hopkins Medical Institutions.

Part of the growing demand is because the population is getting older and creakier. But much of it, particularly for problems like back pain, he said, "is the desire for conservative management."

Dr. Lyle Micheli , an orthopedic surgeon and director of sports medicine at Children's Hospital Boston, said he now sends 90 percent of patients "to physical therapy instead of surgery."

At the Spine Center at New England Baptist Hospital, Dr. Geno Martinez, who specializes in rehabilitation medicine, tells many patients that their back pain will improve if they get moving with the help of a physical therapist. Though some physicians still don't believe it, he said, "in reality, back pain, in general, is not a surgical condition."

Further driving the popularity of physical therapy is the fact that therapists can offer one-stop shopping, not just spinal manipulation or massaging muscles to get rid of tension. Physical therapists offer highly individualized programs of specific exercises and therapy to heal injuries, said Diane Maeda , a physical therapist supervisor at the UCLA Medical Center. By contrast, other physical therapists said, personal trainers in health clubs know how to build muscle but often do not have the lengthy medical training that physical therapists do.

There is also growing evidence of the efficacy of physical therapy for specific problems.

In the old days, physical therapists often stuck to a one-size-fits-all approach, using the same techniques -- massage, heat, stretching -- for everybody. Now they have a much better idea of which techniques work for which symptoms, especially with back pain.

Anthony Delitto , chairman of the department of physical therapy at the University of Pittsburgh, is one of the leaders in the emerging field of "evidence-based" physical therapy. Physical therapists, like others in medicine, are increasingly trying to base their treatments on research showing what works and what doesn't.

Delitto, for instance, has developed "prediction rules" for which patients with back pain will respond to which exercises.

But it's not just back pain that sends people to physical therapists. In addition to shoulder problems like mine, people go for help with neurological diseases such as multiple sclerosis, stroke, and even dizziness, among other things.

For those with multiple sclerosis, said Palmer of Hopkins, physical therapy doesn't change the course of the disease, but it can help them move better within their limits.

For stroke patients, there is "very good evidence that movement therapy can produce changes in the brain, or reprogramming," Palmer said. Brain scans show physical therapy can alter the brain so that a function, like moving an arm, that would normally be controlled by the damaged area of the brain can eventually be controlled by another area.

Anne Hartnett , 61, a Watertown health educator and artist, said physical therapy was tremendously helpful for her headaches and balance problems. Almost two years ago, Hartnett had a virus that attacked her inner ear -- which sends signals that help the brain perceive motion and the body's position in space.

She went to see Janet Callahan , a physical therapist at Massachusetts General Hospital, who taught her a series of exercises in which she keeps her eyes steady on a fixed target while moving her head. Over time, Callahan said, this teaches the brain to respond better to motion and orientation signals from what is remaining of Hartnett's inner ear function.

In the early months of therapy, Hartnett still could not stand and carry on a conversation without getting dizzy. She "lurched" around, she said, and felt that she had to explain to strangers that "I am not a drunk."

The physical therapy, Hartnett said, is slowly giving her back her life: "It is a godsend."

Judy Foreman is a freelance columnist who can be contacted at

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