T Nation

Any Physical Therapists?

Any Pt’s out there, I’m just looking to get a leg up on everyone else. I’m enrolling in college this fall and I plan on majoring in movement science and going pre-PT. I was just wondering if there’s any good books specifically on physical therapy or movement science-related material to read so I can get a headstart going into it.

I’m not one yet, but I will be in about 3 years… I’m going to start school shortly. A friend of mine is further along in the process. He recommends just knowing muscles and bones pretty well going into PT school.

I’ve been studying “Anatomy of Movement” by Blandine Calais-Germain. I like it a lot because its helping me brush up on anatomy and it explains kinesiology in a way that I can understand it… If I studied a more advanced kinesiology book I think I’d have a bunch of questions and I won’t have time to get through the entire thing before school starts. You will not be an expert on kinesiology by the time you finsh the book but you’ll have a pretty strong foundation to build off of. I’m confident just knowing the muscles/bones their approximate insertions/origins and a general idea of what they do will give me a lot of confidence once I get to school. I’m sure someone else here is already a PT or at least has started school and can give you some more advice. Its not an easy field of study, so plan to study a ton once you get to grad school

I’m not a PT but I like to read alot of the books the contributors reccomend. Along those lines I’d read Stu McGill’s Ultimate Back Fitness and Performance and Sahrmann’s Diagnosis and Treatment of Movement Impairment Syndrome, reccomended by Eric Cresses among others. Theory and Practice of Strength Training by Zatsiorski is a good general read. B

iochemistry Primer for Exercise Science by Mike Houston as reccomended by Dave Barr is a good introductory text, as I’m sure you’ll have to take an exercise physiology class. Jack Nolte’s The Brain is a great neuroscience book reccomended by Chad Waterbury, and is more then you’ll ever be expected to know as an undergrad.

Hope that helps. Hope some other people chime in, because I’m a sucker for book lists.

I was a kinesiology major (pre-PT). If you’re just starting out then you still have to spend your first two years doing the general ed shit.

In addition to that you’ll have to do the year long Anatomy & Physiology, General Chemistry, and Physics sequences as “major prep”.

THEN you start the upper division kinesiology stuff. After this you graduate with your BS degree which is almost useless unless you go to PT school or some other grad school.

THEN you try to get yourself into PT school. Here you’ll spend two years finally doing what it is you wanted to do all along; learn how to fix people.

THEN do your internship and start your successfull career!

Good luck! You’ll need it!

[quote]Soldierslim wrote:
I was a kinesiology major (pre-PT). If you’re just starting out then you still have to spend your first two years doing the general ed shit.

In addition to that you’ll have to do the year long Anatomy & Physiology, General Chemistry, and Physics sequences as “major prep”.

THEN you start the upper division kinesiology stuff. After this you graduate with your BS degree which is almost useless unless you go to PT school or some other grad school.

THEN you try to get yourself into PT school. Here you’ll spend two years finally doing what it is you wanted to do all along; learn how to fix people.

THEN do your internship and start your successfull career!

Good luck! You’ll need it![/quote]

A lot of people have what it takes. Its not really that hard to get through 4 years of undergrad and apply to grad school. You do raise a point that I think others would agree with me on. I wouldn’t major in Kinesiology/Pre-PT or whatever your school calls it. I’d major in Biology. You can take the same courses and it’ll open WAY more doors for you if you decide you don’t want to become a PT.

[quote]lucky_swami wrote:

A lot of people have what it takes. Its not really that hard to get through 4 years of undergrad and apply to grad school. You do raise a point that I think others would agree with me on. I wouldn’t major in Kinesiology/Pre-PT or whatever your school calls it. I’d major in Biology. You can take the same courses and it’ll open WAY more doors for you if you decide you don’t want to become a PT. [/quote]

Well, one thing’s for sure; the full year of A&P, Chem, and Physics was as un-cool as it gets. But that’s just me.

If you follow it through to the end though it’s a great field to get into.

If there are any physical therapist on the boards, I have several questions myself? I have been out of school for about nine years, but am now getting ready to head back to pursue my interest in physical therapy. I have also entertained the thought of med school and then going into physical medicine and rehabilitation (physiatrist).

My undergrad was in business, and I have looked at the courses I will need in order to apply. There are some chemisty, physics, a&p, and a few math courses, but I’m concerned with the lack of biomechanics courses which I think would be essential in physical therapy. I looked at the curriculum at one pt school and none of it mentioned biomechanics. I would also like to know if any PTs out there are certified as orthopedic manual therapists and how does your rehab protocols differ from just a regular PT without that particular certification? Are there any PTs out there that practice in a state with direct access in which no referral is needed from a primay healthcare provider? Do any PTs work with a physiatrist? If you happen to work with one, what exactly is the role of the PT within that team since physiatrists are rehab specialists as well? I noticed there was mention of someone reading Stuart McGill’s works which I really believe are instrumental in learning about lower back disorders. I have Low Back Disorders Evidence-Based Prevention and Rehabilitation by Stuart McGill and its a tough but awesome read. I’m not sure if anyone responding to the thread has experience dealing with rehab specialists, but if you do, how do you feel about the field? I have been to many chiropractors, several physical therapists, and of course have had the visit to the orthopedic. I have learned new things from some and have not learned squat from others, so just curious about each person’s experiences?

Wow…you are ambitious. Getting ready to start undergrad and you are already looking for resources to prep you for grad school. I think you must already be ahead of most of your peers.

As far as texts are concerned, stick with those to help you develop your knowledge in the areas of anatomy, physiology, and biomechanics. I have a few foundational texts that I still go back to on a regular basis. You’ll likely get and general anatomy/physiology texts for your anatomy/physiology courses, but good anatomy atlas is invaluable in helping you develop a spatial and relational understanding of human form and function (Atlas of Human Anatomy by Netter). Anatomy flash cards are even nice when getting started. If nothing else, becoming familiar with the bones and joints of the skeleton as well as the origins, insertions, actions, innervations, and blood supplies for the skeletal muscles.

Physiology gets very involved very quickly. I am sure you will be taking basic physiology and exercise physiology courses. “Exercise Physiology” by McCardle, Katch, and Katch is a widely used and easily digestible book once you have some of your basic sciences out of the way. If you get the chance, you may also want to look into taking specific muscle physiology, neuroscience, and/or pathology courses as you go through undergrad work.

A good text for biomechanics by PTs for PTs is “Joint Structure and Function” by Norkin and Levangie. It is very straight forward with some clinical applications tied in, but you’ll need some understanding of anatomy and physics before it becomse relevant.

Also, exposure to medical terminology and research methods through courses or texts could also help.

A couple things about the movement science major…

Depending on what area of PT you think you might ultimately like to be involved in, you might want to consider a few other options. If you are thinking about orthopedics/sports medicine, blending the movement science with an athletic training degree would allow you to have clinical experience and even some professional credentials prior to PT school. With most PT programs going to doctoral level degrees, you might also want to consider a more “traditional” science degree like biology while throwing some movement science electives in the mix.

Probably most important of all, though, is to observe PTs in different settings while you are going through your undergrad work. Look for a mentor. You may even look for a job as a PT aide in a clinic, hospital, nursing home, etc. Simply seeing what a patient is like following an injury, surgery, stroke, etc. can greatly aid knowledge and confidence.

Sorry if I droned on and on, but your question made me ask myself, “What would I like to have known back then?”

Hope this helps…

This is a generalization and certainly does not apply to all physical therapists, but, IMO, most people in the profession are quite poor at what they do. It is clear that PT school is deficient in many areas, particularly the administration of exercises. I can’t even count the number of times I’ve been to a PT only to recieve exercises that were either totally unchallenging with little or no resistance, or outright irrelevant and unnecessary. They’ll charge you $20 per worthless exercise and often won’t even supervise you. I’ve been to about five different PTs in my life and found them all to operate similarly.

Hopefully, someone with a strength training backgorund will be better suited for the job than most.

[quote]belligerent wrote:
This is a generalization and certainly does not apply to all physical therapists, but, IMO, most people in the profession are quite poor at what they do. It is clear that PT school is deficient in many areas, particularly the administration of exercises. I can’t even count the number of times I’ve been to a PT only to recieve exercises that were either totally unchallenging with little or no resistance, or outright irrelevant and unnecessary. They’ll charge you $20 per worthless exercise and often won’t even supervise you. I’ve been to about five different PTs in my life and found them all to operate similarly.

Hopefully, someone with a strength training backgorund will be better suited for the job than most. [/quote]

Unforunately, this happens to often. It really frustrates me as a PT. In a lot of clinics, they just use “protocols” which are specific exercises for general diagnoses; i.e. back pain, etc. If you do a search for some of my other posts, you will see that I always recommend a manual physical therapist. I personally prefer someone who uses an Australian or Maitland approach, but there are others out there.

As far as exercises go, they will need to be “easy” initially because you are rehabbing something. However, sometimes the exercises every patient thinks is easy, is only easy because they are doing it incorrectly. This is especially true of some of the core stabilization exercises. For example, most people/patients can not properly perform quadruped alternate arm and leg lifts. They can raise their arm and leg without much problem. However, their back arches and wobbles throughout. It is much harder to perform when you keep your back level (think of having two boards on your back, one sideways and the other up down your back) throughout and do not arch. If you do the exercise correctly, the boards should not move.

[quote]rnav30 wrote:
If there are any physical therapist on the boards, I have several questions myself? I have been out of school for about nine years, but am now getting ready to head back to pursue my interest in physical therapy. I have also entertained the thought of med school and then going into physical medicine and rehabilitation (physiatrist).

My undergrad was in business, and I have looked at the courses I will need in order to apply. There are some chemisty, physics, a&p, and a few math courses, but I’m concerned with the lack of biomechanics courses which I think would be essential in physical therapy. I looked at the curriculum at one pt school and none of it mentioned biomechanics. I would also like to know if any PTs out there are certified as orthopedic manual therapists and how does your rehab protocols differ from just a regular PT without that particular certification? Are there any PTs out there that practice in a state with direct access in which no referral is needed from a primay healthcare provider? Do any PTs work with a physiatrist? If you happen to work with one, what exactly is the role of the PT within that team since physiatrists are rehab specialists as well? I noticed there was mention of someone reading Stuart McGill’s works which I really believe are instrumental in learning about lower back disorders. I have Low Back Disorders Evidence-Based Prevention and Rehabilitation by Stuart McGill and its a tough but awesome read. I’m not sure if anyone responding to the thread has experience dealing with rehab specialists, but if you do, how do you feel about the field? I have been to many chiropractors, several physical therapists, and of course have had the visit to the orthopedic. I have learned new things from some and have not learned squat from others, so just curious about each person’s experiences?[/quote]

I will try to answer all of your questions. If I miss anything, just ask again.

As far as PT vs. Physiatry, you will obviously make more money with physiatry but the time commitment is much longer. The focus between the two is different as well. As a physiatrist, you will primarily be prescribing medicine, doing diagnostic tests (x-rays, MRIs, etc.), etc. If you want to see a pt. more than every couple of weeks and spend longer with each patient, then I would pick PT. As you know, these are just general observations and recommendations because both professions cover a broad feild.

For biomechanics, you probably will not take a course that focuses on biomechanics solely. It will be covered in some of your other classes. (My was called Musculoskeletal I, II and III.) You will cover arthrokinematics, etc. which looks at how the joints move. You will also have a course on Gait (mine was in Musculoskeletal II I think) that will cover normal walking and what occurs at each phase. One thing I would like to mention about biomechanics is that I think it is overrated in respect to joint movement. The reason for this is that biomechanists do not agree on what occurs. For example, everyone seems to agree that there is a coupling of motion that occurs on the joint level for the spine in regards to rotation. They say as the joint rotates there is also some side bending that occurs. However, they do not agree on which way the joint side bends. Some say to the same side as the rotation, others to the opposite side. Bear in mind, there is published research that states each of the above. But, if you tailor your treatment plan to fit your patient, it doesn’t truly matter what the biomechanists say.

I believe that manual therapy is the way to go. I am not certified, but I have a few friends who are. Our treatments do not differ in theory. I say in theory because application is always dictated by the patient. Treatment will most likely differ greatly from someone who does not perform manual therapy. This person will most likely not do any joint mobilitizations, etc. They will tend to focus on the exercise aspect of rehab. I worked in outpatient clinics performing manual therapy for about 4 years. I have since switched to home health, but continue to perform manual treatments as indicated. Typical treatment sessions are as follows:
Assess the patient/determine the
cause of their ailment (stiff joint,
weakness, spasm, etc.)

Perform treatment (PA mobilization
at L5 for 3 sets of 20 sec)

Reassess patient to see if things
are better, worse or the same. Use
the same movements that created
problems or pain during the first
assessment and patient’s subjective
report.

Repeat as needed.

Most treatments consist of some joint work, soft tissue work, and strengthening work. Most of the strengthening work is used to target specific muscles and is not like most typical gym workouts. Squats, etc. were used some times, but again it all depends on what the pt. needs. Hopefully, after this long winded response to manual therapy you see that you want to stay away from protocols (i.e. for back pain do x, for shoulders do y).

Most states have direct access and I live in one of them. There are some pts. who come in without a doctor’s order, but most still see the MD first. I believe PT as a profession should do more to educate the public at large about this. There is normally some backlash against PTs when a state gets direct access. For example, PT as a profession was taken to court by the chiropractic association. They stated we were not qualified to treat the spine. As far as I know, PT’s treatment of the spine was not called into question before this (but I may be wrong).

I worked with a group of physiatrists. Experiences will vary depending on the doctors personalities, specialty, as well and th PT involved. In general for outpatient treatment, the physiatrist will see the pt. and determine if they need PT. The doctor will prescribe any meds that are needed and do any testing (x-rays, MRIs, etc.) The PT will do their own evaluation to determine the pts. needs and treat accordingly. I worked in a group that dealt with chronic pain. It was not uncommon for me and my colleagues to go to the physiatrist and tell them that the pt. needed a facet block at a certain level or trigger point injections, etc. The doctor would normally schedule the pt. for that procedure and then send them back to PT. We also would have meetings about the pts. every 1-2 weeks. In a rehab/transitional care unit, I think things would be pretty similar, but you probably would not have much need of trigger point injections, facet blocks or the like.

I think that you will be better equipped to diagnose and treat low back disorders with manual therapy. McGill has some great advice, but there is always more to learn. Also, pts. normally don’t present like you read about in text books. I have only had 1 patient in 5+yrs of practice who presented with the textbook description of disc pain. Again, the key is to do an accurate and detailed evaluation to determine the s&s of the patient as well as the cause of the s&s. Then you should have enough tools in your toolbag to treat those issues that you find.

Sorry for the very long post. Let me know if you have any further questions.

I agree with Climbon. If you are going to see a physical therapist for treatment, manual therapy is the way to go. Even if you don’t make much progress with treatment, the fact that the therapist cares enough to put his/her hands on you to try to fix you gives you the feeling that they really put every effort into your treatment plan.

As far as PT programs themselves go, I graduated from UF in 2001. It was primarily a neuro school so I learned a lot about strokes, brain and spinal cord injuries, etc. We only had a few classes in anything biomechanically related but what the program lacked in quantity, it made up for in quality. The professors were excellent. With internships, I lucked out and my neuro rotation turned into another ortho rotation, which is what i do now. My clinical instructors were all very good with ortho treatment so today i still use a lot of what they taught me as well as some things ive picked up along the way.

I also have my CSCS and am working on my Mckenzie certification so there’s always something to learn. Like climbon said, its upsetting to hear that the public just thinks PTs give them exercises in the clinic and leaves them to it. I am the general manager at a rehab clinic and we actually work one on one with our PT patients. Its so much better b/c not only do you pay attention to one person at a time, you also get to know the person and establish a relationship with them.

PT is definitely a job where you can meet new people, use your exercise and anatomical knowledge and get results with patients. I love every minute of it.

oh yeah, as far as books go, norkin and levangie joint structure and function is a great biomechanics book. anatomy by netter and anything by robin mckenzie is fantastic for spine treatment. his books have a simple philosophy for treatment that you can easily explain to all your patients.

[quote]speaden wrote:
I agree with Climbon. If you are going to see a physical therapist for treatment, manual therapy is the way to go. Even if you don’t make much progress with treatment, the fact that the therapist cares enough to put his/her hands on you to try to fix you gives you the feeling that they really put every effort into your treatment plan.

As far as PT programs themselves go, I graduated from UF in 2001. It was primarily a neuro school so I learned a lot about strokes, brain and spinal cord injuries, etc. We only had a few classes in anything biomechanically related but what the program lacked in quantity, it made up for in quality. The professors were excellent. With internships, I lucked out and my neuro rotation turned into another ortho rotation, which is what i do now. My clinical instructors were all very good with ortho treatment so today i still use a lot of what they taught me as well as some things ive picked up along the way.

I also have my CSCS and am working on my Mckenzie certification so there’s always something to learn. Like climbon said, its upsetting to hear that the public just thinks PTs give them exercises in the clinic and leaves them to it. I am the general manager at a rehab clinic and we actually work one on one with our PT patients. Its so much better b/c not only do you pay attention to one person at a time, you also get to know the person and establish a relationship with them.

PT is definitely a job where you can meet new people, use your exercise and anatomical knowledge and get results with patients. I love every minute of it. [/quote]

Whats Mckenzie certification?

Whats the deal with PT’s only averaging $60,000 a year? PT is in the mainstream health care field, you now need a masters and many schools are switching to a DPT… Physicians Assistants make an average of about 15,000 more a year than PT’s. My uncle is a nurse and makes more than I will as a PT. I can definately live off of 60,000, but it almost seems as if PTs should make more considering the education that is required

Robin Mckenzie is a new zealand physical therapist who is known for his mechanical diagnosis and treatment of the spine. its one treatment philosphy just like maitland, Kaltenborn, etc. It uses gradual repetitive movements in conjunction with manual therapy to reduce spinal dysfunction. it also focuses on empowering the patient by teaching them easy treatment techniques to perform them at home.

As far as $60000 goes, I dont know the national average but you have to look at all the diverse areas where PT are: home health, nursing homes, outpatient rehab, hospitals, and so on. I know a home health PT who makes $100000 per year. he busts his ass but thats what he wants to do.

As far as PAs go, i cant speak for them obviously but i wouldnt want to be on the hook for as much as they are (liability). i know its not as much as the physician but the liability is so much more than a PT. they are also the ones with the beeper at 3am when a patient needs them at the hospital and the doctor doesn’t have to go. again, im just going on what ive heard and seen from PAs that i know.

I’m a kinesiology grad, studying in a therapeutic exercises concentration, and planning on being a PT in 2-3 years.

If you want a good boost in biomecanics, than I recommend Brunnstrom’s Clinical Kinesiology and McGinnis’ Biomecanics of sports and exercises. Both are comprehensive, thorough and easy to understand. If you want the real deal on testing, buy Magee’s Orthopedic assessment, it’s a classic, and quite likely to be on your book list anyway. Another one likely to be there is Kendall’s muscle: testing and function. A quick reference guide that I like a lot for it’s pocket book format is Klaus Buckup’s Clinical Tests for the Musculoskeletal System. Here is the amazon.ca link:
http://www.amazon.ca/exec/obidos/ASIN/1588902412/sr=8-2/qid=1147027481/ref=sr_1_2/701-4602175-9169961?_encoding=UTF8&s=gateway&v=glance

Hope that helps.

[quote]speaden wrote:
Robin Mckenzie is a new zealand physical therapist who is known for his mechanical diagnosis and treatment of the spine. its one treatment philosphy just like maitland, Kaltenborn, etc. It uses gradual repetitive movements in conjunction with manual therapy to reduce spinal dysfunction. it also focuses on empowering the patient by teaching them easy treatment techniques to perform them at home.

As far as $60000 goes, I dont know the national average but you have to look at all the diverse areas where PT are: home health, nursing homes, outpatient rehab, hospitals, and so on. I know a home health PT who makes $100000 per year. he busts his ass but thats what he wants to do.

As far as PAs go, i cant speak for them obviously but i wouldnt want to be on the hook for as much as they are (liability). i know its not as much as the physician but the liability is so much more than a PT. they are also the ones with the beeper at 3am when a patient needs them at the hospital and the doctor doesn’t have to go. again, im just going on what ive heard and seen from PAs that i know.[/quote]

Ah, I didn’t realize PA’s get called in at all hours. I’m glad PT’s don’t have to worry about that.

As far as being liable, isn’t that what insurance is for?

I agree that all of the books mentioned are good. However, I think they are probably too specific for someone who is not in PT school yet. I would recommend focusing on anatomy and physiology in undergrad. You will have plenty of time to read books that are more related to PT. You will also learn more once you graduate.

As an aside, don’t try to fit each pt. into McKenzie’s treatment. Like everything else, it will work for some and not others. I have obtained better results by combining some of McKenzie’s ideas with joint mobilizations. I also highly recommend taking David Butler’s continuing education courses and buying his book The Sensitive Nervous System. This should be required for anyone who is treating pain.

your right about the books as well as avoiding putting all patients with one treatment method. Mckenzie, however, does use mobilization and even mobilization with movement like Brian Mulligan has written about. I have also been to a couple of Stanley Paris’ courses on spinal and extremity mobs. You have to have a big bag of tricks.

very interesting post