So You’re Hurt, What Should You Do?

As people who lift weights and are generally physically active, every now and then we are going to experience some sort of ache, pain, or injury. The question is, when this happens, what should we do?

Traditionally, people would go to see their primary care provider, or a specialist like an orthopedic surgeon, as their first line of management. Quite often, when we go to see professionals such as these, we will likely be told to take some time off of training and see if the injury resolves, or we may even be told that surgery is our best option. We are told things like these because many healthcare providers, no matter how good they may be at their profession, don’t have significant experience with lifting and training, and therefore don’t necessarily know how to help us continue to train while dealing with injuries.

Further, when we go see healthcare providers such as these, we will often have increased costs and increased use of medical imaging, such as x-rays and MRIs, performed much more often than we otherwise would have. While this may not seem like a big deal, it does have some potential downsides.

But what if there was another way to go about seeking help when we have an injury that we’re dealing with? Well luckily there is, and it has to do with physical therapists. It is now being advocated that physical therapists should be the first healthcare provider that people consult with when dealing with a musculoskeletal injury (things like strains, sprains, overuse injuries, low back pain etc). In fact, there are many benefits to seeing a physical therapist first when dealing with issues like these.

First, seeing a physical therapist as the first line of care for an injury or pain can save you time and money. In fact, it has been shown that seeing a physical therapist first saves a person approximately $2,700 on average in medical expenses. This is because people who choose this route undergo less unnecessary medical imaging, costly procedures such as injections, and referrals to other healthcare providers. It has also been shown that people who choose physical therapy first miss less days of work due to injury, and require surgery a smaller percentage of the time.

Another important aspect of seeing a physical therapist first is its effect on the opioid crisis. While opioids are certainly appropriate in some cases, it cannot be denied that they have been over-prescribed far too often, and for far too long. Opioid addiction is a devastating potential consequence of improper opioid prescription, and can cause tremendous harm. It’s been shown that seeing a physical therapist first for an injury or pain reduces the odds of opioid prescription by 85%, and the odds of long-term opioid use by 73%.

Now I know what you may be thinking, “there seem to be a number of benefits to seeing a physical therapist first, but can they actually figure out what’s going on just as well as other healthcare providers?” To be honest, that’s a perfectly reasonable question to ask. Many people don’t really know what physical therapists do, or what type of education they have.

Currently, all PT programs in the United States are doctoral level programs, with graduates earning their Doctorate of Physical Therapy. This requires rigorous education in areas such as anatomy and physiology, kinesiology, pathophysiology, neuroanatomy, differential diagnosis, and many other areas. In fact, it’s been shown that physical therapists are able to diagnose injuries better than non-orthopedic healthcare providers such as family care, internal medicine, and emergency room physicians. Physical therapists have also been shown to be able to diagnose injuries on par with orthopedic surgeons.

So we’ve established that seeing a physical therapist for an injury or pain is probably a good idea. The next question you may have is “can I see a physical therapist first without having to see my regular doctor?”

Luckily, in all 50 states there is some form of direct access to physical therapists. What this means is that you can legally see a physical therapist without having to see another healthcare provider first. It should be noted that if you are going to see a physical therapist through your insurance, they may have their own separate rules, and may require a referral to a physical therapist. This will differ state-to-state, and between different insurance providers.

However, there is always the option to go out-of-network to a physical therapist who doesn’t go through insurance. In these instances, you pay the physical therapist directly, and they often provide “superbills” that you can send to your insurance provider to potentially get reimbursed for part, or all, of what you spend with the physical therapist.

At the end of the day, you need to choose the right healthcare provider to help you manage your injury. In the case of musculoskeletal pain and injury, that would often be a physical therapist. Just remember that not all physical therapy is the same, and you should strive to find a therapist who understands your lifestyle and training, and can help you continue doing the things you love while going through the rehab process!

References

1) Ojha, H. A., et al. “Direct Access Compared With Referred Physical Therapy Episodes of Care: A Systematic Review.” Physical Therapy, vol. 94, no. 1, 12 Sept. 2013, pp. 14–30, 10.2522/ptj.20130096.

2) Moore, Josef H., et al. “Clinical Diagnostic Accuracy and Magnetic Resonance Imaging of Patients Referred by Physical Therapists, Orthopaedic Surgeons, and Nonorthopaedic Providers.” Journal of Orthopaedic & Sports Physical Therapy, vol. 35, no. 2, Feb. 2005,pp. 67–71, 10.2519/jospt.2005.35.2.67.

3) Pendergast, Jane, et al. “A Comparison of Health Care Use for Physician-Referred and Self-Referred Episodes of Outpatient Physical Therapy.” Health Services Research, vol. 47, no. 2, 23 Sept. 2011, pp. 633–654,www.ncbi.nlm.nih.gov/pmc/articles/PMC3419881/, 10.1111/j.1475-6773.2011.01324.x.

4) Fritz, Julie M., et al. “Primary Care Referral of Patients With Low Back Pain to PhysicalTherapy.” Spine, vol. 37, no. 25, Dec. 2012, pp. 2114–2121, 10.1097/brs.0b013e31825d32f5.

5) Kazis E. L. et al. “of initial healthcare provider for new-onset low back pain with early and long-term opioid use. BMJ, 2019 Sep 20;9(9):e028633. doi: 10.1136/bmjopen-2018-028633