Non-physicians performing "dry needling"

[pmrmd]

I rest my case after the Five's response. Apparently you prescribe exercises without trying to tie imaging into the program and don't understand the elementary biomechanical ramifications a leg length inequality has on the spine. You can find that in any literature search my boy. You are exactly the kind of P.T. that I have experienced--you know, the ones that make me shake my head and wonder how they can be at the same time clueless yet demand they be called doctor.

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[ampaphb]

So let's stipulate that some PTs are above average, and some docs are below average. Some docs are arrogant a$$holes, and some PTs are ignorant *****s. No big surprise there; you could pretty much say that about any large group of folks.

PTs want to change the status quo. So it is incumbent upon y'all to explain why the current system needs to be changed.

Rather than ensuring that we all get further entrenched in our original positions by entertaining us with yet another vitriolic screed, please explain, using literature if it is available, why a PT expanding his or her scope of practice to include invasive procedures like dry needling will benefit patients. Clearly, physicians can already provide trigger point injections. Why do PTs need to duplicate a service other health care providers already offer?

 

[Fiveoboy11]

I consider all factors in designing an exercise program. I'm just not obsessed with imaging as you appear to be. If there is clinical coorelation between imaging and symptoms then yes it should be a factor. If there are findings that make certain movements or exercises contraindicated then yes it should be a factor.
I would disagree strongly that any physician could design a better exercise program for a patient than a PT considering all the factors. This is based on my experience with the feeble minded "scripts" that constantly demonstrate no clue with regard to rehab or physical therapy. This is based on the fact that this is the PT's job and expertese as we actually have training to do this and do it every day, all day long. Arrogant physician's with no clue should not be prescribing exercise, especially in light of double standardizations they use (perceived less training equals out of scope vs physician's can do anything and everything any time they want). I truly feel sorry for the patient's.
Also, Leg lenth inequality. I used to measure this, and on occassion recommend heel lifts for symmetry, but not anymore. I'm fairly certain the evidence says that LLD does not predict or cause NMSK conditions and "correction" of LLD does not alleviate NMSK conditions. It does not even predict what way someone would curve if the tried to walk straight with eyes closed! Much the same as how the idea that other alignments are particularly important, this is not the case. Everyone is malaligned, with LLD's, it's normal. Are each side of the brain or organs symmetrical? Is everyone dominant in strenth/function equally on the right and left sides of the body.

 

[Fiveoboy11]

So let's stipulate that some PTs are above average, and some docs are below average. Some docs are arrogant a$$holes, and some PTs are ignorant *****s. No big surprise there; you could pretty much say that about any large group of folks.

And the vast majority of physician's are ignorant *****s with regard to rehab and physicial therapy. Please provide me with evidence of physician competence in physical therapy.
[/QUOTE] you want to change the status quo. So it is incumbent upon y'all to explain why the current system needs to be changed. [/QUOTE]
If you knew anything about physical therapy, anything at all (realistic), especially literature regarding safety and improved outcomes and less cost with direct access to physical therapists, you wouldn't have asked that question. Perhaps one should actually face facts and read the literature and use some common sense before making stuff up in there head.
[/QUOTE] Rather than ensuring that we all get further entrenched in our original positions by entertaining us with yet another vitriolic screed, please explain, using literature if it is available, why a PT expanding his or her scope of practice to include invasive procedures like dry needling will benefit patients. Clearly, physicians can already provide trigger point injections. Why do PTs need to duplicate a service other health care providers already offer?[/QUOTE]
I was really waiting for some evidence based justification for your guys postings, behaviors and in response to my postings. A PT doing dry needling is for one not exceeding scope. It is reasonable that a PT, seeing as the type of patient's he/she sees all day long, would have dry needling as an option to offer a patient when it is indicated and since it is very safe. Safer in fact than pronably any single OTC medication. Read a few paragraphs about physical therapy from a descent source, and get more than 1 hour of observation time of a PT, then we'll go from there.

 

[Fiveoboy11]

Not long are we back from being banned?

Any data to suggest benefit from PT? For axial low back pain.

I was banned? Are you joking with regard to evidence in support of PT for axial LBP? Did you look up a "study" in JAMA or something. Did you unilaterally look for studies which question PT for axial LBP? Someone has to review the rules of evidence! Someone has to look up bias in the dictionary.

Here's some documents I use in treating LBP, that are rationalistc and evidence based.

http://www.orthopt.org/uploads/cont...Clinical_Practice_Guidelines___JOSPT_2012.pdf

Maybe consider the above for your "scripts" and worthless checkmarks for particular interventions. You know since it is based on over 300 peer reviewed studies of low back pain.

And: http://www.amazon.com/gp/aw/d/1416047492/ref=mp_s_a_1_1?qid=1401034436&sr=8-1

Great book "manual physical therapy of the spine" which I've read cover to cover (which intelligent/scientific PT texts have you read?). It goes into detail regarding examination and treatment of lumbopelvic spine disorders.

 

[pmrmd]

Five: Measuring leg length inequality is notoriously inaccurate with tape measuring. Radiology is the only way to do it. You can stop a back ache by correcting for a 3/8 or 1/2 inch leg length inequality with simple correction of the weight bearing, no exercise (or injections!) needed. Feel free to look it up at your leisure. Also, everyone is not malaligned. I have the imaging to prove it. Do you? No. Next, please do not conflate a prescription from an internist with a prescription from a physiatrist regarding physical therapy. You should be able to correlate history, symptoms, and radiology for every patient and a specific exercise program prescribed. If someone has a curvature convex left and another convex right, you should be having them do different exercises. If you don't have the imaging, you can't service your patients (not patient's).

 

[Fiveoboy11]

Five: Measuring leg length inequality is notoriously inaccurate with tape measuring. Radiology is the only way to do it. You can stop a back ache by correcting for a 3/8 or 1/2 inch leg length inequality with simple correction of the weight bearing, no exercise (or injections!) needed. Feel free to look it up at your leisure. Also, everyone is not malaligned. I have the imaging to prove it. Do you? No. Next, please do not conflate a prescription from an internist with a prescription from a physiatrist regarding physical therapy. You should be able to correlate history, symptoms, and radiology for every patient and a specific exercise program prescribed. If someone has a curvature convex left and another convex right, you should be having them do different exercises. If you don't have the imaging, you can't service your patients (not patient's).

I surely hope you are not imaging all your patients (I tend to think grammar comes distantly second from critical reasoning). Also, can you show me guidelines or research that supports the weighting of imaging and aligning as you suggest it should? It has it's place of course, but what you're describing quite frankly sounds a lot like chiropractic.

Further, you do not prescribe physical therapy, only a physical therapist does that. And it surely is nice when a physician knows enough to include imaging reports with a physical therapy referral (rare) so the PT can utilize it as appropriate. I take imaging into consideration in all cases. I take scripts or orders into consideration in zero cases. Physiatrist vs otherwise = no difference with regard to physical therapy.

 

[ampaphb]

So sadly, despite my request for literature citation, you seem to be incapable of civil discourse. I believe you have proved my point.

 

[pmrmd]

So, to my fellow physiatrists, the DPT thinks you do not know anything about exercises, that it is seemingly out of your scope of practice to give therapeutic exercises and oversee modalities, and he considers any prescription other than eval and treat to be blasphemous. It is in the scope of the DPT though to use needles. You mentioned arrogance? Tell you what pal, you keep following your guidelines and handing out your generic exercises and I'll keep pointing out to my patients why physical therapy outcomes are, at best, average. Bye.

 

[emd123]

Does anyone here regularly see dramatic results from PT, in general? By the time most of my patients get to me, they're so far gone, PT is uncommonly life changing. In my experience it does allow small progress for some people, and plays a role, but rarely an earth shattering one.

 

[Fiveoboy11]

So, to my fellow physiatrists, the DPT thinks you do not know anything about exercises, that it is seemingly out of your scope of practice to give therapeutic exercises and oversee modalities, and he considers any prescription other than eval and treat to be blasphemous. It is in the scope of the DPT though to use needles. You mentioned arrogance? Tell you what pal, you keep following your guidelines and handing out your generic exercises and I'll keep pointing out to my patients why physical therapy outcomes are, at best, average. Bye.

I don't give out generic exercises to anyone. The exercises given depend on the assessment and all other circumstances.

 

[Fiveoboy11]

So sadly, despite my request for literature citation, you seem to be incapable of civil discourse. I believe you have proved my point.

Yeah I have a big problem with someone calling PT's paraprofessionals and clinically considering us techs.

I've asked many times for citations as well.. Where are they? There is evidence for PT's doing dry needling and its safety and effectiveness, not hard to find so look it up yourself. You ask why should PT's do dry needling when physiatrists already do something similar? Because there's overlap in healthcare, PT's are more likely to provide it early on, it's likely far cheaper by PT's and can be done in conjunction with other things.

Why a change in the status quo? Who wants to "work with" physician's voluntarily given the way they behave? Who wants to waste money and time on the wrong healthcare professional? Who wants to be "under the thumb" of someone who is ignorant and incompetent with respect to what you do? Also, there's strong evidence as to the safety and effectiveness of direct access to PT's, and cheaper then when referred. Plus it is a patient right to dictate the care they get. The evidence for PT direct access and importance of getting PT ASAP is not difficult to find either, so look it up yourself.

 

[ampaphb]

I hope you arent as lazy in your practice as you clearly are intellectually.

Not surprising. I have always been struck by the lack of appreciation of PTs of the important role that a physicians play in ruling out other medical conditions that could be the source of the pain, before referring the patient for physical therapy treatments. Perhaps if your licensure requirements included testing for entry-level competence in the areas of examination and evaluation, diagnosis, prognosis, treatment intervention, prevention, and consultation skills, direct access might be a reasonable option.

December 2004 report from the Medicare Payment Advisory Commission concluded that the physician referral and plan certification requirements were in place to ensure the proper patient diagnosis and treatment. The commission also concluded the requirements did not appear to inhibit beneficiary access to services.

In one study, direct access episodes were shorter, encompassed fewer numbers of services, and were less costly than those classified as physician referral episodes. Unfortunately, one of the potential reasons why the authors felt this might be the case is that PTs started treatment on patients with lower severity of injury.

 

[Fiveoboy11]

Working 50-60 hrs/wk is lazy? Honestly I'm using an iPhone to type all this and the information is available for you to see if you would take the time to look. Once again I've asked you for many citations, you have given none, so does that make you lazy? Stop making stuff up in your head. PT school does encompass the things you listed. Do you think it's 3 years of learning about the muscles? What knowledge do you have of PT education/training? Look on capteonline.com to see requirements of PT education. Medicare is run by incompetents including physician's so the findings of that report do not influence me. It is constantly trying to find ways to nickel and dime, but they've most certainly got it all figured out? No evidentiary or patient centered basis. The direct access study you talked about makes a good point, patients get seen faster, therefore more acute, easier to treat and get better faster. Imagine that.

 

[ampaphb]

I have always been struck by the lack of appreciation of PTs of the important role that a physicians play in ruling out other medical conditions that could be the source of the pain, before referring the patient for physical therapy treatments. Perhaps if your licensure requirements included testing for entry-level competence in the areas of examination and evaluation, diagnosis, prognosis, treatment intervention, prevention, and consultation skills, direct access might be a reasonable option.

Actually, I was paraphrasing from the American Academy of Orthopaedic Surgeons in their opposition to direct access IN CALIFORNIA! To show you how FOS you are, the California PT Association objected to this new testing requirement on the grounds that the Physical Therapy Board would be testing physical therapists on areas outside of their scope of practice. California Orthopaedic Association argued that such testing was unnecessary, would detract from required physical therapy training, and would later let physical therapists claim that their education and training qualified them to make a medical diagnosis.

 

[Fiveoboy11]

I have always been struck by the lack of appreciation of PTs of the important role that a physicians play in ruling out other medical conditions that could be the source of the pain, before referring the patient for physical therapy treatments. Perhaps if your licensure requirements included testing for entry-level competence in the areas of examination and evaluation, diagnosis, prognosis, treatment intervention, prevention, and consultation skills, direct access might be a reasonable option.

Actually, I was paraphrasing from the American Academy of Orthopaedic Surgeons in their opposition to direct access IN CALIFORNIA! To show you how FOS you are, the California PT Association objected to this new testing requirement on the grounds that the Physical Therapy Board would be testing physical therapists on areas outside of their scope of practice. California Orthopaedic Association argued that such testing was unnecessary, would detract from required physical therapy training, and would later let physical therapists claim that their education and training qualified them to make a medical diagnosis.

PT school accreditation requires differential diagnosis (screening for referral), PT diagnosis, examination/evaluation, POC development, prognosis. The NPTE (national physical therapy examination) tests on this as well.

But if you could could you post where the CPTA says what you say they said? I followed that battle and do not recall that.

Here's the curriculum from my PT school:

http://www.atsu.edu/ashs/programs/physical_therapy/documents/DPTCurriculumOverview_2013.pdf

Here's accreditation requirements as far as curriculum for all PT schools, start at page 45.

http://www.capteonline.org/uploaded...reditation_Handbook/EvaluativeCriteria_PT.pdf

Here's a content outline for the national PT exam:
https://www.fsbpt.org/Portals/0/documents/free-resources/ContentOutline_2013PTT_201212.pdf

 

[Fiveoboy11]

And how come I have these books regarding imaging, pathology, primary care, diagnosis and differential diagnosis? And why are they made for physical therapists? How come many have MD's as co authors? How come I was taught classes in PT school by MD's?

http://www.amazon.com/gp/aw/d/1416031189/ref=mp_s_a_1_1?qid=1401076364&sr=8-1

http://www.amazon.com/gp/aw/d/0803615280/ref=mp_s_a_1_1?qid=1401076445&sr=8-1

http://www.amazon.com/gp/aw/d/1416061053/ref=mp_s_a_1_1?qid=1401076494&sr=8-1

http://www.amazon.com/gp/aw/s/ref=i...ical+therapists&sprefix=Diagnostic+imaging+fo

http://www.amazon.com/gp/aw/d/1437725430/ref=mp_s_a_1_1?qid=1401076618&sr=8-1

 

[ampaphb]

So three books on imagining, even though 5 says it isn't important, and we don't need to look at no stinkin' images. Pathology text authored by a PT. Differential text authored by an RN and a PT. Nothing on Nephology. Nothing on Diabetes. Nothing on Hematology/Oncology. Nothing on Immunology. Nothing on the Gastrointestinal System. Nothing on Endocrinology. Nothing on Urology, or OB/GYN. Nothing on Psychiatry. One section on the test over a three year curriculum that takes care of the cardiopulmonary system (boy, THAT must be thorough). Yup, you cover exactly the same curriculum allopathic and osteopathic physicians do.

 

[lobelsteve]

A doctor in PT knows as much about medicine as a a DFA.
http://wikiality.wikia.com/Cheating_Death_with_Dr._Stephen_T._Colbert,_D.F.A.

Glad this guy is in AZ, where he cannot harm my patients. I have had 2 recent reviews involving PT's injuring patients. One was post-lami and the PT pulled the screws out. The other was osteoporosis with a McKenzie "q" certified where they flexed the little old lady into 2 fractures. Wait, on second thought, they are good for business. I think they are fine to have first try at patients, its gets the low hanging fruit that did not need medical care. It also ticks the box for those who do.

 

[Fiveoboy11]

So three books on imagining, even though 5 says it isn't important, and we don't need to look at no stinkin' images. Pathology text authored by a PT. Differential text authored by an RN and a PT. Nothing on Nephology. Nothing on Diabetes. Nothing on Hematology/Oncology. Nothing on Immunology. Nothing on the Gastrointestinal System. Nothing on Endocrinology. Nothing on Urology, or OB/GYN. Nothing on Psychiatry. One section on the test over a three year curriculum that takes care of the cardiopulmonary system (boy, THAT must be thorough). Yup, you cover exactly the same curriculum allopathic and osteopathic physicians do.

I never said it was as thorough as MD/DO school. The idea is to recognize a patient has S/S out of scope for a PT, not to make a medical diagnosis, and to refer out. You guys on the other hand think you "order up some PT" like it is some procedure and think we do nothing but "work on" the patient. Stupify and abuse my profession some more why don't you. The books I have do cover the areas you say they do not, maybe one doesn't have everything to satisfy you but as a whole they do. The pathology book is co authored by a MD as is one other, and it's 1700 pages long. And please show me curriculum, texts and testing you guys have on physical therapy period, let alone to the level a PT learns. Dr. Steve Lobel, MD, PT's know a hell of a lot more about medicine than physicians know about PT or rehab.

 

[ampaphb]

Dr. Lobel is boarded in Physical Medicine and REHABILITATION.

So when you perform the thorough evaluation, as listed on page 47, section CC-5.30 of the CAPTE Evaluative Criteria for PT programs

(Examine patients/clients by selecting and administering culturally appropriate and age-related tests and measures. Tests and measures include, but are not limited to, those that assess):
a. Aerobic Capacity/Endurance
b. Anthropometric Characteristics
c. Arousal, Attention, and Cognition
d. Assistive and Adaptive Devices
e. Circulation (Arterial, Venous, Lymphatic)
f. Cranial and Peripheral Nerve Integrity
g. Environmental, Home, and Work (Job/School/Play) Barriers
h. Ergonomics and Body Mechanics
i. Gait, Locomotion, and Balance
j. Integumentary Integrity
k. Joint Integrity and Mobility
l. Motor Function (Motor Control and Motor Learning)
m. Muscle Performance (including Strength, Power, and Endurance)
n. Neuromotor Development and Sensory Integration
o. Orthotic, Protective, and Supportive Devices
p. Pain
q. Posture
r. Prosthetic Requirements
s. Range of Motion (including Muscle Length)
t. Reflex Integrity
u. Self-Care and Home Management (including activities of daily living [ADL] and instrumental activities of daily living [IADL])
v. Sensory Integrity
w. Ventilation and Respiration/Gas Exchange
PT Evaluative Criteria
Revised January 2014
34
x. Work (Job/School/Play), Community, and Leisure Integration or Reintegration (including IADL)​

Please point out for me which of those covers Nephology? Diabetes? Hematology/Oncology? Immunology? The GI tract? Endocrinology? Urology, or OB/GYN? Psychiatry?

 

[lobelsteve]

I never said it was as thorough as MD/DO school. The idea is to recognize a patient has S/S out of scope for a PT, not to make a medical diagnosis, and to refer out. You guys on the other hand think you "order up some PT" like it is some procedure and think we do nothing but "work on" the patient. Stupify and abuse my profession some more why don't you. The books I have do cover the areas you say they do not, maybe one doesn't have everything to satisfy you but as a whole they do. The pathology book is co authored by a MD as is one other, and it's 1700 pages long. And please show me curriculum, texts and testing you guys have on physical therapy period, let alone to the level a PT learns. Dr. Steve Lobel, MD, PT's know a hell of a lot more about medicine than physicians know about PT or rehab.

I know all about PT and medicine as an MD, Physiatrist. PT plays a crucial role in the lives of many of my patients. But you sir, are a piece of dung. Your attitude towards this forum is unappreciated, and your lack of uneducated ranting is annoying. Please go back under your rock, or back to a PT forum and talk about how bad us docs are. Just go away as you fail to contribute anything meaningful, and it appears your only intent is to post barbs and insults. If it helps you go away, I'll say you are always correct in all prior posts.

 

[Apollyon]

One was post-lami and the PT pulled the screws out.

No kidding - the person stripped the hole? Wow...I thought that that was just me, working on my house!

 

[Fiveoboy11]

Dr. Lobel is boarded in Physical Medicine and REHABILITATION.

So when you perform the thorough evaluation, as listed on page 47, section CC-5.30 of the CAPTE Evaluative Criteria for PT programs

(Examine patients/clients by selecting and administering culturally appropriate and age-related tests and measures. Tests and measures include, but are not limited to, those that assess):
a. Aerobic Capacity/Endurance
b. Anthropometric Characteristics
c. Arousal, Attention, and Cognition
d. Assistive and Adaptive Devices
e. Circulation (Arterial, Venous, Lymphatic)
f. Cranial and Peripheral Nerve Integrity
g. Environmental, Home, and Work (Job/School/Play) Barriers
h. Ergonomics and Body Mechanics
i. Gait, Locomotion, and Balance
j. Integumentary Integrity
k. Joint Integrity and Mobility
l. Motor Function (Motor Control and Motor Learning)
m. Muscle Performance (including Strength, Power, and Endurance)
n. Neuromotor Development and Sensory Integration
o. Orthotic, Protective, and Supportive Devices
p. Pain
q. Posture
r. Prosthetic Requirements
s. Range of Motion (including Muscle Length)
t. Reflex Integrity
u. Self-Care and Home Management (including activities of daily living [ADL] and instrumental activities of daily living [IADL])
v. Sensory Integrity
w. Ventilation and Respiration/Gas Exchange
PT Evaluative Criteria
Revised January 2014
34
x. Work (Job/School/Play), Community, and Leisure Integration or Reintegration (including IADL)​

Please point out for me which of those covers Nephology? Diabetes? Hematology/Oncology? Immunology? The GI tract? Endocrinology? Urology, or OB/GYN? Psychiatry?

Patient/Client Management Expectation: Screening
CC-5.27 Determine when patients/clients need further examination or consultation by a physical therapist or referral to another health care professional.

It's about screening for referral, not making a medical diagnosis.

 

[Fiveoboy11]

I know all about PT and medicine as an MD, Physiatrist. PT plays a crucial role in the lives of many of my patients. But you sir, are a piece of dung. Your attitude towards this forum is unappreciated, and your lack of uneducated ranting is annoying. Please go back under your rock, or back to a PT forum and talk about how bad us docs are. Just go away as you fail to contribute anything meaningful, and it appears your only intent is to post barbs and insults. If it helps you go away, I'll say you are always correct in all prior posts.

You know all about rehabilitation, not physical therapy. They're not one in the same. Just as dry needling is not physiatry. It's impossible to know all about something you have no training in. Perhaps you "know PT" as chiropractors claim they do, in other words you have your own training that may be similar in some respects but overall doesn't come close. You're not a PT and do not practice remotely like one but you "know PT"?

 

[ampaphb]

Patient/Client Management Expectation: Screening
CC-5.27 Determine when patients/clients need further examination or consultation by a physical therapist or referral to another health care professional.

It's about screening for referral, not making a medical diagnosis.

And how do you make an appropriate referral when you don't perform a complete physical exam? (to be clear, what you do is a very thorough, focused MSK exam). When you don't take vitals. When you don't review films. When you don't know what you don't know about Nephology? Diabetes? Hematology/Oncology? Immunology? The GI tract? Endocrinology? Urology, or OB/GYN? Psychiatry?

 

[Fiveoboy11]

How do physician's make an appropriate referral to a PT when they don't know what they don't know about PT and with zero PT examination/evaluation? Yet another double standard.

I take vitals on many patients. And it has to do with the interview of the patient and assessment. If there is any suspicion of being outside of scope then it warrants referral. If the patient does not respond in a reasonable timeframe then it warrants referral. We do this with or without referral. We do not just " do some therapies." What do you think the assessment is for? Answer: to assess whether and how likely a patient complaint is amenable to physical therapy, screen for referral, develop the POC, etc. Let's not forget that physical therapy is designed for people who are ill, diseased, post surgical, etc.

And let's be honest and regognize that the average physician obsesses about films (which can be very harmful as guidelines recommend avoidance of detailed pathoanatomical discussion with the patient with regard to LBP). Not to mention strong evidence of waste, association with worthless surgery/interventions. And there are guidelines for when to do imaging, if a patient meets criteria they get referred out. Also, physicians do not always do a complete physical/exam.

 

[lobelsteve]

How do physician's make an appropriate referral to a PT when they don't know what they don't know about PT and with zero PT examination/evaluation? Yet another double standard.

I take vitals on many patients. And it has to do with the interview of the patient and assessment. If there is any suspicion of being outside of scope then it warrants referral. If the patient does not respond in a reasonable timeframe then it warrants referral. We do this with or without referral. We do not just " do some therapies." What do you think the assessment is for? Answer: to assess whether and how likely a patient complaint is amenable to physical therapy, screen for referral, develop the POC, etc. Let's not forget that physical therapy is designed for people who are ill, diseased, post surgical, etc.

And let's be honest and regognize that the average physician obsesses about films (which can be very harmful as guidelines recommend avoidance of detailed pathoanatomical discussion with the patient with regard to LBP). Not to mention strong evidence of waste, association with worthless surgery/interventions. And there are guidelines for when to do imaging, if a patient meets criteria they get referred out. Also, physicians do not always do a complete physical/exam.

You are the world's greatest PT. We have no data to refute that. Please teach us oh mighty doctor (not a real doctor, but doctor of PT)! How do we examine patients? We have so little time, so much to do....
:troll:

 

[pmrmd]

.

 

[SSdoc33]

After reading more thoroughly through these posts I must say too that I couldn't care less what a physician writes on a "script" or what they say not to do. The PT POC is set by the PT and nobody else. Take note of the physician above "prescribing" aquatics. At least one physician subsequently noted the PT actually knew what to do. Heel lift? For what? Exercises based on imaging alone? Yikes. Surely PMRMD doesn't really think he knows a better PT POC than the actual PT? PT's are experts in the muscular system but nothing else? Wrong, PT's are experts in rehabilitation, function and pain as it pertains to disease. PT's don't "work with the muscles" and "get people stronger." Yet more proof of physician ignorance and incompetence with regard to physical therapy and physical therapists. But keep thinking we're personal trainers.

Sorry guys but we're not your tech, get over it and do your own job.

physicians are arrogant. agreed. most PCPs will write for PT with an eval/treat and dx: of LBP. this is not the greatest care.

however, as is said with so many other "paraprofessionals", you dont know what you dont know. therein lies the danger. you are not trained, nor equipped to diagnose disease. you are trained to provide physical treatments.

you might be able to differentiate between frozen shoulder and a RTC tear better than a family doc, but i constantly see therapists misdiagnosing and misleading patients. you might think this is your role. you might want it to be... but it is not.

 

[nvrsumr]

I work only with PTs I have careful selected but everyday. In the past I had write directed PT scrips so money ***** direct access PTs wouldn't just do US, hot packs and needling 3x a week to infinity.

The good ones I use now seem to appreciate my "hints"- piriformis, eccentric, Mckenzie. I treat them as professionals and appreciate their input. If a PT calls me and suggests a tx modification I have likely never said no. If one ignores my scripts they lose my biz.

5boys hubris is dangerous and many times more so in physicians. He really knows so little of what a physician knows it is hard to comprehend his arguments. Next he will be telling us that he knows more about orthotics and prosthetics or occupational therapy or social work or wound care, psychiatry, radiology and pharmacy as previous mentioned. Mastery of these fields of which physical therapy is only a small part in the grand rehabilitation of a patient is essential knowledge for any journeyman physiatrist.

 

[clubdeac]

Trigger points are low risk and personally I don't get too worked up by PTs doing them. Chiro's do them all the time and most are quacks. However, pneumo's happen as can infection. It's a slipperly slope. Soon you'll start injecting lidocaine which brings a whole new can of worms. I knew a pain doc who was anesthetizing the track with a 1 1/2" 25g needle and went too deep entering the canal giving the guy a high spinal. Fortunately he was an anesthesiologist and knew how to bag and then tube the patient. What happens if you guys get a tension PTX from a simple thoracic trigger point? Sorry but your 3 years of PT school don't touch 4 yrs of med school and then at least another 4 of residency working 80+ hrs a week in the ICU, ER, trauma, surgery etc. Complications with trigger points are few and far between but it's a slippery slope and when calamity strikes, good luck!

 

[lonelobo]

You guys should be more respectful of Five, he is a "Doctor" of PT after all.