Direct Access and Medical Screening in Physical Therapy

Many people visit a physical therapist after seeing a physician and being given a prescription to start physical therapy.  However, this is not the only scenario a patient can be seen by a physical therapist. In New Jersey, as well as all the other states in the country, there is “direct access.” This allows a patient to be treated by a physical therapist without a physician referral.

What is direct access and how does it work?

The American Physical Therapy Association defines direct access as, “the legal right to seek and receive the examination, evaluation, and intervention of a physical therapist without the referral from another health care provider.” This means you don’t have to wait a couple of weeks to get an appointment with a physician. This can be a big help when someone is in pain or just unsure of what to do when they are having difficulty doing activities in their everyday life. The next question becomes: how do physical therapists know what to do without a physician referral?

The profession of physical therapy has gone through many changes in the past 20 years, which is as long as I have been practicing. In the past, it was at a bachelors’ level, and then a master’s level, which I got in 2000. Since then the profession has evolved into a doctoring profession.  Older more experienced therapists were given the opportunity to go back to school and get their doctorate in physical therapy, which I did in 2011.  All this advancement in the education levels of our profession has made physical therapists more than capable to see patients without a physician referral.

What’s different about an evaluation using direct access?

Virginia Mason

When a physical therapist sees someone via direct access the first question that we look to answer is if a patient is appropriate to be at physical therapy.  Your physical therapist will direct your care in the right direction.  He or she will also provide you with whatever type of education you need. This is helpful because waiting to see a physician will only create a longer period of time before relief can occur.

How do physical therapists determine if physical therapy is appropriate?

Physical therapists have many movement-based tests and questionnaires we use to aid in the decision-making process.  This allows us to determine your appropriateness for physical therapy.  Some of the screening tests look at how you move on your feet and isolate different body parts. Others use research-based questionnaires to screen for certain problems or rule out various diagnoses. Physical therapists also do a standard examination looking at your range of motion, strength, and joint motion.  This allows us to isolate the areas that are problematic. We take all this information and determine what is best to help you achieve your goals.

Conclusion

In summary, physical therapists are able to see patients without a physician referral. This is something that doctors of physical therapy have been trained in.  At BSR, most of our therapists have gone on to become board-certified specialists in either orthopedic or sports physical therapy.  These advanced certifications make us even more capable and confident in providing the best possible care.  Direct access can be a very useful tool to allow patients to get care quickly and safely.  When physical therapy is not appropriate, you will be referred to the proper health care provider. Give us a call and see if direct access is right for you.

 

Ankle Sprains: Diagnosis, Treatment and Return to Sport

What are Ankle Sprains?

Ankle sprains are one of the most common injuries that people experience.  These injuries account for one million physician visits each year.  Lateral ankle sprains, also known as inversion sprains, are the most common.  They are particularly common in sports.  Forty percent of all traumatic ankle sprains occur during sports.  However, only 50% seek medical attention. The lack of medical care results in an increased risk for developing chronic ankle stability.  There are 3 different grades of ankle sprains, which progressively worsen with each grade.  Healing times vary from a couple of days to up to 6 months depending on severity.

Grades of lateral ankle sprain

What are Lateral Ankle Sprains?

Lateral ankle sprains occur when the outside of the ankle is stressed .  This usually occurs when the ankle is forcefully turned inward. This can happen when stepping on an uneven surface or landing awkwardly after jumping. The lateral ankle sprain typically occurs with stress to 1 of the 3 ligaments that stabilize the outside of the ankle. Depending on whether the foot is up (dorsiflexed), neutral, or down (plantarflexed) different parts of lateral ankle ligaments can be injured.

Lateral ankle sprains

How does a Physical Therapist Diagnose a Lateral Ankle Sprain?

A physical therapist can use tests and measures to diagnose ankle sprains. Typically this will involve checking ROM (range of motion) and strength of the ankle and lower leg.   Additionally, special tests and joint mobilization testing  can bias the ligaments to determine which are involved.  Movement analysis such as the FMS (functional movement screen), hop testing, and running/agility tests can also be used to help determine some of the impairments that may have contributed to the ankle sprain.  If you are seeing a physical therapist with direct access (seeing a PT first without going to a physician) they will perform other tests and screening procedures to make sure physical therapy is appropriate.  If your physical therapist feels you need different services, he or she will direct you to the best healthcare provider.

How are Ankle Sprains Treated?

Depending where you are at in the recovery phase and your goals, a physical therapist will approach your care differently. Early in treatment crutches or a boot may be used and a physical therapist will focus more on pain, swelling and maintaining motion and strength.   As your recovery progresses, your treatment will progress to more active treatments.  This will include manual therapy to improve ankle motion,  proprioceptive training, training for return to activity and strengthening exercises targeting areas that the therapist has found to be weak.

How do you Know you are Ready to Return to Sports?

Physical therapists have a great deal of experience in determining if you are ready to return to sports, work, and other activities.   A few of the tests a physical therapist can use to determine if you are ready to go back to your sport are the FMS, Y-Balance test, hop testing, tuck jump assessment, and the Landing Error Scoring System.  A physical therapist can also give you recommendations on footwear and proper training tips to help avoid ankle sprains in the future.  Contact your physical therapist to learn more about managing ankles sprains.

References

  1. Vuurberg G, Hoorntje A, Wink L, van der Doelen B,van den Bekerom M, Dekker R, van Dijk C, Krips, R, Loogman, M, Ridderikhok M, Smithuis F, Stufkens S, Verhagen E, de Bie R, Kerkhoffs G. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline.British Journal of Sports Medicine 2018;52:956
  2. Doherty C, Delahunt E, Caulfield B, et al. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Med 2014;44:123–40
  3. Verhagen EA,van Mechelen W,de Vente W. The effect of preventive measures on the incidence of ankle sprains. Clin J Sport Med 2000;10:291–6
  4. McGuine TA,Keene JS. The effect of a balance training program on the risk of ankle sprains in high school athletes. Am J Sports Med 2006;34:1103–11
  5. Kobayashi T,Tanaka M,Shida M. Intrinsic Risk Factors of Lateral Ankle Sprain: A Systematic Review and Meta-analysis. Sports Health 2016;8:190–3
  6. Ivins, D. Acute ankle Sprain: An update. American Family Physician. 2006:741714-1720
  7. Wolfe M, Uhl T, Mattacola C, McCluskey L. Management of Ankle Sprains. Management of Ankle Sprains. 2001,63:93-1004
  8. EIM 2018 Sports Physical Therapy Competencies 2018 Lab Manual

Power Training in Seniors

Typically training for power is thought of as something that is more for the younger, athletic population. However, today older adults are trying to stay more active with activities such as tennis, golf, hiking, or dancing.  All these activities require some component of power.  Are older adults performing any power-based exercise to help with these activities?

What is Power?

First of all, what is power? Power is simply adding speed to a movement.   Power is a combination of strength and speed.   When exercising, we typically encourage slow and controlled movement, but when you are able to control during the exercise, what’s next? We can add resistance to the movement, or sometimes we can add speed. Why would we add speed? Say you are playing tennis and have to move across the court for a drop shot, how do you move to get the ball? Is it slow and controlled or quick? Does it make sense to only strengthen with slow and controlled motions? Or should we think about adding some speed to the movement you are training?

Muscles change with age and they also change with the demands we put on them. As we get older and stop doing fast movements is it fair to expect the body to continue to move quickly to react to a drop shot, field and ground ball, or even jump to catch a ball when playing with grandchildren?

Adding Power Training to an Exercise Program

Adding power to an exercise routine is simple, and can be fun.  You can simply do a movement or exercise that you can do properly and add some speed to it. Another idea can be bouncing a medicine ball or any ball that can bounce onto the ground or a wall. Mini jump hops are also another way to add speed and dynamic movement.

In Closing

Seniors are continuing to stay active in sports and similar to any athlete, they need to train to play the sport they want to do. A lot of the sports and activities seniors do on a daily basis are not slow and controlled. Power is something to think about with a regular workout routine as we age.  If you are not sure how; give your physical therapist a call.