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Jay Segal, PT, agrees that patients benefit when physicians and therapists work together.

In a city that's home to some of the nation's top sports orthopedists and one of the nation's largest providers of rehabilitative healthcare services, physical therapy and rehabilitation probably enjoy a higher profile than in Birmingham than in many cities. But at the same time, those factors could obscure the fact that therapy offers benefits for many different patients and conditions, not just athletes and joint replacement patients. We spoke to several local therapists for some thoughts on how patients could benefit from a visit to a physical therapist.

Emmett Parker, PT, ATC, owner of Accelerated Physical Therapy in Trussville, explains how therapy differs from the practice of medicine. "If someone breaks their arm, we don't treat a fractured humerus," he says. "We treat the loss of motion, the loss of strength, the loss of function [that results from that fracture]."

For instance, Parker says, take a common injury such as a sprained ankle with some torn ligaments. "It will begin to feel better, and it will heal, and the patient will walk around and feel much better over time, even without physical therapy," he says. "However, if you took them into a biomechanics lab and had them do different activities, you would see they had a loss of proprioception, a component of your balance system. They would be favoring that leg almost assuredly. They would be weaker on that side. With that loss of proprioception, loss of strength and stability, you're predisposed to another injury." In addition, if a patient walks around favoring one leg, they're potentially causing problems in other parts of their body, such as the hip and back.

"We like to emphasize early intervention with therapy," says Bill Huber, administrative director for rehab at Medical Center East. "A lot of times a doctor may see a patient and not think about physical therapy at first. He may want to get them to rest a little bit, take some medicine, then come back in a couple weeks. If we could encourage doctors to think about therapy as a first choice, that early intervention will help people get back on their feet and functioning much faster."

Sometimes, all it takes is a visit or two for a patient to benefit from therapy. For instance, Huber says, therapists can teach a patient with a sprained ankle about ice, compression and elevation and some simple exercises to do at home.

Donna Goodwin, MS, PT, MOMT, co-owner of Physical Therapy Solutions in Vestavia, recalls a young patient whose range of motion was poor following arthroscopic knee surgery. "They held that knee still with a pillow under it for three weeks," she says. It took weeks of therapy to get that range of motion back, she says, but just a few visits following the surgery could have prevented the problem.

"A therapist explains very carefully about walking up and down stairs, how far they can bend that knee, how much pain they should take," Goodwin says. "Most patients don't realize that getting it straight out is just as important as bending it. I wish more doctors would send them to therapy, just for a day or so, to clear up some of those things."

Therapists also would like to see more recognition that physical therapy and rehab programs aren't just for joint problems. "It's important for doctors and patients as well to know that participating in cardiac rehab has been shown to lead to improvements in strength, faster return to work, faster return to being themselves, as well as a decreasing chance of them having another heart event," says Jana Williams, cardiac rehab coordinator at Medical Center East.

"I'd like physicians to know that there's more to physical therapy than ultrasound and exercise," says Jay Segal, PT, Human Performance and Rehabilitation Center (HPRC) in Vestavia. He and some other therapists are trained in techniques such as functional manual therapy that can provide relief from severe headaches, lower back pain, and other problems for which physical therapy might not immediately come to mind.

"Most headaches have a muscular/soft tissue component that could respond to therapy," Segal says. "Another thing is a lot of ear pain, some head pains and some neck pains actually come from a problem within the jaw, the temporomandibular joint." He also has seen a number of patients diagnosed with carpal tunnel syndrome that found relief when he was able to release a trapped nerve higher up in the arm through manual therapy.

Different physical therapists may have different specialties, experience and treatment styles. For instance, some therapists, such as Segal, have additional schooling in manual therapy. There are board-certified specialties such as cardiovascular/pulmonary, geriatric, neurologic, orthopaedic, pediatric and sports.

It's a good idea to develop a relationship with several therapists; you may find one therapist especially good for one type of diagnosis, another one excellent at a different type of problem.

"It's not fair to ask a doctor to keep up with everything going on in their world and domain and also be able to keep up with everything going on in ours," Parker says, with new techniques, new technology, the latest research. "It's extremely rare to get a referral to a physical therapist that's inappropriate. [The problem is] the people that don't get referred to therapy that might have benefited because [the physician] might not have realized it was indicated. It's imperative that physicians and therapists continue to work together to be on the same page."

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