One of the most common questions I get regarding my practice is “How does what you do differ from physical therapy?” It’s actually a more complicated question than may be apparent. First , know that my primary credentials are as a certified massage therapist (CMT) and personal trainer, not a physical therapist. The primary difference between this and physical therapy is regarding scope of practice. Physical therapists have a more expansive scope than CMT’s or personal trainers. There are certain techniques licensed PT’s can employ that CMT’s and trainers cannot. These include: ultrasound, electrical stimulation, EMG and wound care. However, in California, CMT’s have a fairly broad scope of practice. We can employ most any technique that isn’t the specific purview of a higher license, such as PT’s, MD’s or osteopaths. This leaves a lot of open territory. This includes most every manner of soft tissue work, joint mobilization, movement re-education, and most forms of evaluation and assessment. I can even assign corrective exercises to complement treatments (this is where my training and corrective exercise credentials and background come into play).
Limitation Placed on Physical Therapists by Insurance Companies
Physical therapists are highly educated and highly skilled individuals. That said, one of my most common types of client is the one who’s already been through PT and didn’t get the results they were looking for. While there and good and bad practitioners of EVERY stripe in the health and wellness field, this fact doesn’t reflect a failure of the SCIENCE of physical therapy as much as it does the BUSINESS of physical therapy. Physical therapists’ effectiveness can often be limited by how much time they get with patients and other limitations placed on them by insurance companies, such as how many visits they get with their patients and what sorts of interventions they will actually get reimbursed for. These are not limitations that affect my practice.
First and foremost, I don’t take insurance. While some will see this as a negative, it’s actually incredibly liberating. It frees me to spend as much time with a client as I feel necessary and to utilize any technique I see fit, provided it falls within my training and scope, both of which are vast. I also have no limitations placed on me regarding the number of visits I can have with a client. This gives me the latitude I may need to get them 100%, not just good enough that they can walk out the door.
Physical therapists have specific guidelines for when they cut a patient loose and consider their therapy complete. Unfortunately, these don’t always equate with a fully functional patient. “Good enough” is often the name of the game. Again, I don’t hold the PT’s themselves responsible for this shortcoming but rather the system they operate within. It’s long been known that the most sure-fire predictor of future injury is PREVIOUS INJURY. Preventing future injury requires a more comprehensive approach to treatment and evaluation than time and other factors often allow. With a sprained ankle, for instance, PT’s are generally excellent at getting the ankle back to full strength and mobility. Unfortunately, this doesn’t necessarily tell the whole story. This doesn’t address the full restoration of proper motor control to the ankle, nor does it address the issues that may have led to the sprain or the issues that may have arisen secondary to the sprain in areas remote to the original injury. For example, post ankle rehab, patients are still at far higher risk of ACL injuries for instance. I’ve heard figures as high as a 300% greater risk.
I don’t want to in any way give the impression of impugning physical therapy or physical therapists. I’m a fan of what they do. Nor do I ever discourage clients from pursuing their services, especially if their insurance will cover it. The more information you have as a patient, the better. However, limitations placed on PT’s create an opportunity for individuals like myself to pick up where they leave off and really make a difference. Massage therapy is a rapidly expanding field and there has been an explosion in recent decades of incredible new techniques for both evaluation and treatment (many of which are used by the best physical therapists out there) that fall squarely under the scope of practice of CMT’s and fitness trainers. My favorite comment I routinely receive from clients is that they wish they had come to see me first. Considering all the amazing health and wellness professionals out there, PT’s included, that really is the highest praise possible.