Exercise Techniques

The past several blog posts have focused on the different types of physical therapy settings a physical therapist could work at. The purpose of the following blog post, however, is to describe some of the most common exercises seen at each setting. The ideal audience for this blog post would be undergraduate or graduate students pursuing physical therapy.

Being aware of the different types of exercises each setting uses can be extremely beneficial for assimilating into a professional therapy environment. Even if a student has no prior hands-on experience in a particular setting, having a background on the most common therapies can help them adapt and quickly becoming a contributing member of the therapy team.

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Physical Therapist: What It Takes to Be a DPT. 2012. Exercsie-science-guide, Austin, TX.

Out-patient physical therapy techniques were discussed briefly in a prior blog post because it is the most common therapy setting.  In out-patient physical therapy, oftentimes exercises machines, not unlike the ones seen at the gym, are utilized alongside body weight exercises, and manual manipulation of the injured area. Therapy exercise machines may not differ from the ones offered at the gym, such as the leg press or seated row machine. The benefit from exercising on these machines at the clinic rather than the gym is that the physical therapist is on location, observing the patients to critique technique and modify the therapy schedule. Body weight exercises often incorporate tools such as balance boards or exercise balls. Each clinic is unique in the types of exercises utilized, however it is common to see exercises on the balance board for strengthening lower extremity muscles. Most clinics also work in manual therapy, where the physical therapist uses their hand to manipulate the sore and injured muscles, and give passive range of motion to the patients.

Early-childhood intervention therapy can be extremely fun, with equipment including adapted gymnasiums and toys, such as twister. Allowing a child to play games during therapy can be extremely effective, because not only does it teach functional skills, but it helps socialize the children and create a fun learning environment. More information about pediatric physical therapy can be found here.  It is common to adapt toys and games for children with disabilities to play. For instance, adapting the popular sport volleyball can be as simple as lowering the net and utilizing a balloon. By lowering the net, children in wheelchairs can be accommodated, and the balloon allows for increased tracking and hand-eye coordination development. Since volleyball is a team sport, socialization is incorporated. There are several ways to adapt each game for children with disabilities, and students should be prepared with creative ideas before working at a clinic that focuses on children.

Geriatric facilities often focus on enhancing movements that contribute to performing activities of daily living, such as walking up a flight of stair or getting up out of a chair. The goal is fall prevention and increased mobility in geriatric physical therapy. Geriatric physical therapy was discussed in a previous blog post. Common exercises include chair-rise tests, and 6 meter walk tests, both of which assess the mobility of the patient. Increasing muscle power is critical for fall prevention, so oftentimes patients utilize therabands (resistance bands) instead of weights, because it is safer for older adults.

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Physical Therapy Bands. 2015. FlexActive Sports. Web.

In-patient facilities see the most injured patients, so the exercises seem fairly basic. Rather than basic, they are actually critical in restoring mobility for severely injured patients, sometimes the day after they received surgery. Since most of in-patient therapy occurs within a hospital, there are typically important guidelines depending on the type of injury the patient has. For joint replacements, the goal is to achieve full range of motion. Typically, the patient is in too much pain to actively move the joint, so the first day of therapy includes passive range of motion. Unlike replacements, where the joint is now replaced with hardware that works perfectly, joint repairs need more gentleness. Joint repairs allow the ligaments and bone to stay intact, however they are still fragile. Some doctors recommend exercising the surrounding supporting muscles, rather than the injured muscle itself for the first couple of weeks post-surgery.

Exercise Techniques

In-Patient Physical Therapy

As discussed in prior blog posts, there are several different populations physical therapists could work with. Previously discussed fields include early-childhood intervention, out-patient physical therapy, and geriatric physical therapy. The following post will discuss in-depth the advantages to working in an in-patient setting. This blog post would be ideal for undergraduate and graduate students pursing physical therapy, and those who want to know more details on a possible field.

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2014. TERRIO Physical Therapy & Fitness, California. MyTerrio.com. Web.

In-patient physical therapy differs from the other subsets of physical therapy mentioned prior. In the other subcategories of physical therapy, typically the physical therapists see a multitude of patients, all of whom travel to the physical therapist. Conversely, with in-patient physical therapy (also known as acute care therapy), the physical therapist works in a hospital or rehabilitation center, and they visit immobile patients. In-patient physical therapy is not for the faint; this field of physical therapy is typically the most traditionally medical, and this population of patients are usually the most severely injured. This population of patients cannot leave the hospital or rehabilitation center to visit an out-patient setting, so the physical therapists are localized in the hospital and visit each patient. Unlike out-patient physical therapy, where patients usually visit the clinic three times a week for an hour, in-patient physical therapy may occur for hours every day.

In-patient physical therapy could also be referred as an acute care field, because the goal is to see the patient for a short period of time, typically after a sudden or intense injury. As opposed to long-term or chronic care, the objective of acute care physical therapy is to treat the patient until they are mobile enough to visit a long-term clinic, such as out-patient therapy.

While intense, in-patient physical therapy could be extremely rewarding. A common location of in-patient physical therapy occurs in hospitals that service men and women in the armed forces. Nearby is Walter Reed National Military Medical Center, where men and women in the Army receive treatment. Physical therapists that work for Walter Reed may see Army personnel right after a war injury. Treatment may “start from scratch” and culminate with the patient gaining the mobility to leave the hospital. More information on volunteering can be found by following this link. Another website close to this area for students interested in volunteering in an acute care setting is the University of Maryland Rehabilitation & Orthopaedic Institute. This center sees a variety of patients, many of whom just underwent orthopaedic surgery. In most rehabilitation centers, the surgeries and therapies occur in the same location to assist the needs of patients with limited mobility.

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University of Maryland Rehabilitation & Orthopaedic Institute. 2012. Baltimore. Umms.org. Web.

In-patient physical therapists only constitute a small minority of physical therapists, approximately only 5 percent of all certified physical therapists work in an acute-care setting. While the amount of physical therapists in this setting are smaller than other fields, they typically make a little bit more money than the median salary. In-patient physical therapists make approximately $78,000 annually, while the median salary is $76,000. This demographic information can be found here.

In-Patient Physical Therapy

Geriatric Physical Therapy

As discussed in prior blog posts, there are several different populations in which physical therapists could spend their careers. The following post will discuss in-depth the advantages to working in a geriatric setting. This blog post would be ideal for undergraduate and graduate students pursing physical therapy, and those who want to know more details on a possible field, such as geriatric physical therapy.

Active senior couple walking with physical therapist.

Geriatric physical therapy is the subset of physical therapy that focuses primarily on older adults, usually older than 65 years of age. Oftentimes patients will be living in an assisted care or assisted living centers, and the physical therapist will be based out of these facilities. There are many challenges working in a geriatric setting. It is not uncommon for some therapists to describe this experience as too emotional or intense. Therapists typically see their geriatric patients several times a week for months to years, sometimes until the patient passes away. While geriatric therapy can be extremely rewarding, and the patients can be incredibly interesting, students should be warned of the possibility of potentially losing a patient due to old age. This is less likely to happen in other areas of physical therapy. Typical exercises in a geriatric setting include chair rising and walking tasks to improve mobility, and balloon tossing exercises to improve reflexes.

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With the population of older adults rising, geriatric physical therapy has seen a major increase in popularity and necessity. More information about this can be found by following this link. Approximately 18% of physical therapists work in an assisted living center, the more obvious work setting for geriatric therapy, and about 14% of physical therapists work in a home setting. While more therapists work in an assisted living center, geriatric therapists who work in a home setting, such as visiting different patients at their homes, make more money. Home health therapists make an average of $80,000, whereas assisted living therapists make an average of $73.000. This website has more information about salary.

Besides the universal Doctorate of Physical Therapy (DPT), those who wish to work in a geriatric setting should consider additional certifications. Physical therapists could become Geriatric Certified Specialists (GCS) or Certified Exercise Expert for Aging Adults (CEEAA) Helpful information about the CEEAA certification can be found here. Obtaining a GCS allows physical therapists to concentrate on geriatrics and gain new perspectives and experience in the field. Receiving a CEEAA would open a unique door for physical therapists; Not only could the therapists give treatment, CEEAA therapists could also focus on prevention. Exercise has been proven to slow the rate of aging and strengthen bones, so being qualified to manage an exercise program for older adults could seriously positively impact older individuals’ health.

Geriatric physical therapy is a unique and challenging field, with many interesting subdivisions. Students interested in pursuing geriatric physical therapy should consider volunteering at an adult day center or assisted living center. Many of these opportunities occur on-campus or close by and are welcoming to prospective students.

Geriatric Physical Therapy

Out-Patient Physical Therapy

As discussed in a prior blog post, there are several different populations physical therapists could work with. The following post will discuss in-depth the advantages to working in an out-patient setting. This blog post would be ideal for undergraduate and graduate students pursing physical therapy, and those who want to know more details on a possible field.

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Out-patient physical therapy is the setting most commonly thought of by the average, healthy person. This specific type of therapy is characterized by the patient visiting the clinic and the physical therapists. In this subset of physical therapy, the therapist could see patients of any age, with any injury. Common injury sites include the shoulder, back, and knee. Out-patient therapy would be a good option for those who enjoy meeting new people, because a physical therapist can often see around 4 patients an hour. Moreover, those who are creative may enjoy out-patient therapy, because physical therapists often make-up their own unique exercises. Out-patient physical therapists should also become comfortable with exercise machines, because oftentimes the patients utilize these machines for therapy. While a history in personal training is not necessary, many prior personal trainers feel comfortable in an out-patient clinic because of the experience with exercise equipment.

Other than the Doctorate of Physical Therapy (DPT), no other certification is required to work in an out-patient setting. Many therapists, however, decide to take certification courses in related field, such as dry-needling and trigger-point therapy to complement their initial education.   Dry Needling is similar to acupuncture, and is used in addition to manual therapy. Trigger Point therapy is a form of manual therapy that is used to loosen the extremely tight knots in muscles which cause severe pain. Trigger points can cause referred pain, so when the actual points are treated, most of the surrounding muscle pain is also weakened.   While both dry needling and trigger point therapy aim to target trigger points, each individual patient will respond to the therapies differently. Patients’ needs are unique, that is why many professional physical therapists recommend having a wide array of techniques within the professional toolbox.

DRY NEEDLING

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TRIGGER POINT

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Out-patient physical therapy is considered the most common setting, with one poll finding that 43% of physical therapists are in an out-patient setting. While out-patient therapy is not the most lucrative field within the industry, the average salary is still projected to be around $75,000. More information regarding salary can be found by following this link. A perk of out-patient physical therapy is the flexible hours; oftentimes therapists can make a schedule that works best for them, which often includes full week-days off. This field is appealing to those who hope to work multiple jobs, or want more time for family or personal matters.

For any University of Maryland students interested in pursuing an out-patient therapy setting, the University Health Center allows student volunteers and paid aide positions to work in the physical therapy clinic.

Out-Patient Physical Therapy

Types of Working Environments for Physical Therapists

As discussed in a prior blog post, there are several different populations physical therapists could work with. The following post will discuss in-depth the advantages to working in an early-childhood intervention setting. This blog post would be ideal for undergraduate and graduate students pursing physical therapy, and wants to know more detail on a possible field.

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Getting the opportunity to work with children with disabilities in an early-childhood intervention setting is a rewarding option many physical therapists choose to pursue as a career. This unique setting is perfect for young-spirited professionals, especially those with a lot of energy and patience. Oftentimes, therapy with young children involve playing games and modified sports, such as running obstacle courses or playing adapted baseball. Rather than being in a clinic all day, physical therapists who work with children with disabilities often spend their days in a gymnasium, or outside. While energy is crucial, so is patience. The types of disabilities seen in an early-childhood intervention setting could range from severe ADHD to progressive muscular dystrophy. Many patients may have a loss in functional use of their limbs, and several patients will require braces or wheelchairs. The therapist will have to be patient in modifying the games and explaining the exercises to the children, which is important because it is vital that the children receive their therapy. For University of Maryland students interested in this field, there is a clinic held on Saturday mornings that allows students to volunteer with certified professionals. This link has all of the information as well as a video which displays the field of early-childhood intervention therapy:

The initial certification needed for working with children with disabilities is the same for all practicing physical therapists, a doctorate of physical therapy (DPT), however having a background in the field would help applicants get their desired job. This could include volunteering at a location that cares for children with disabilities, or observing other physical therapists as they work with children with disabilities. Furthermore, getting a BACB Certification (Behavioral Analyst Certification Board) may be a smart choice.

Professionals with a BCBA (Board Certified Behavior Analyst) often work with children with disabilities to encourage desired behaviors, and eliminate undesirable behaviors. Having a dual certification in DPT and BCBA is common in the field, could improve applicants’ resume, as well as allow new techniques to be brought into the workplace.

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Practically, this particular field is very appealing as it allows the professional to maintain a flexible schedule. For instance, most physical therapists specialized in children with disabilities work at a school or day care center, which allows physical therapists who are parents to be on the same routine as their children. Moreover, while physical therapy in general is a lucrative and stable career choice,  specialists in pediatrics are some of the highest paid physical therapists .

For any aspiring physical therapists who loves staying active and working with children, try exploring early-childhood intervention therapy to see if it is the right fit.

Types of Working Environments for Physical Therapists

Classroom Guide for a Prospective Physical Therapist

With fall class registration approaching for University of Maryland students, the best audience for this blog post would be University of Maryland students interested in pursuing physical therapy as a career. The purpose of the following blog post is to highlight the recommended classes for pre-physical therapy students, as well as make suggestions on how pre-physical therapy students should utilize their summer to make it appealing for physical therapy school admissions.

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There are over 200 accredited physical therapy programs in the United States each with their own unique prerequisites. Luckily, this useful website, the Physical Therapist Centralized Application Service (PTCAS) lists out the prerequisites for each program. Being aware of the prerequisite classes required for physical therapy school is crucial even if you are just a freshman, because no single University of Maryland major encompasses all of the prerequisite courses. Most of the prerequisite courses will be achieved via elective credits, and your major classes will simply strengthen your application. Even the most basic programs require 8 credits of Anatomy and Physiology, with lab. At the University of Maryland, those classes are BSCI201 and BSCI202. Chemistry and physics are also required prerequisites at the majority of physical therapy school, with most programs requiring 8 credits. The most common chemistry and physics classes for pre-physical therapy students are CHEM131 with CHEM132 (lab) and CHEM231 with CHEM 232 (lab) and PHYS121 and PHYS122, respectively. All of these courses require laboratory sections, which are difficult and time-consuming. That is why it is critical that students as young as freshmen research the PTCAS website. Most schools also require some form of statistics (STAT100), introductory biology (BSCI105), and college English (ENGL100 or ENGL395). A helpful and color coated chart can be found on the PTCAS website, which list out every prerequisite needed for physical therapy school.

Since summer is approaching for University of Maryland students, it is critical that pre-physical therapy students make the most of their summer, both professionally and academically. The majority of physical therapy schools requires some form of professional observation. These observation hours must be confirmed by a physical therapist to be accepted for applications. A tip all advisors will recommend: double count your required observation with a summer internship “class”.  These summer internship classes are 3-credit courses that provides a grade for work done over the summer, and professional therapy observation is a confirmed accepted internship. By observing over the summer, pre-physical therapy applicants will achieve a necessary requirement for physical therapy school, and likely earn a high grade in a 3-credit course to boost their GPA. Another consideration for pre-physical therapy students is to take a prerequisite course over the summer. Many physical therapy schools require seemingly random prerequisite courses, such as abnormal psychology or medical terminology. If the course is not offered at the University of Maryland, summer is a great time to take a required course at a different college.

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Classroom Guide for a Prospective Physical Therapist

Roadmap to the Life of Physical Therapy

Physical therapy (PT) is a very competitive and demanding field.  However, many people find the work to be very rewarding, a main reason why the field is growing in popularity at universities across the world. The purpose of this blog post is to describe the background of physical therapists and discuss some of the potential career paths that are popular among physical therapists. The intended audience of this post is both undergraduate and graduate students thinking about a profession in physical therapy.

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Preparing for a career in physical therapy as an undergraduate typically entails majoring in anatomy, physiology or biology.  Although one’s major is not explicitly regulated, in order to gain acceptance into a graduate level physical therapy program, one must have completed many courses in these disciplines.  PT programs teach students the fundamental methods and tools needed to become a professional. More information about the requirements for different physical therapy programs can be found here. It is not uncommon for graduate students to cycle through many different internships, all in unique environments (as described in my previous blog post) in order to gain a deeper understanding of the field.

In the United States, physical therapy is strictly regulated. All those that complete a graduate program are required to be licensed. Each state has a unique licensing process, although there is a national examination that must be taken. After one receives their physical therapy license, they are still required to fulfill continuing education curricula, mandated by the state in which they practice. Information about the nature of this continuing education can be found by clicking this link.

It is very common for a physical therapist to land their first full time employment at a location in which they spent time as an intern.  Depending on personal preference and backgrounds, a PT will then choose in which segment of physical therapy they want to establish as their career. For example, a student who enjoys the business aspects of physical therapy my start their own private practice. This combines the fields of science and business. This is an example out-patient physical therapy, which is typically seen as the most lucrative career option. About 46% of all physical therapists work in an out-patient facility. Other similar statistics can be found on this website. Others may prefer to work at a hospital, where many feel their work is more rewarding.

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Due to the incredible amount of schooling to become a physical therapist, many students choose to be a physical therapist assistant (PTA). Physical therapists assistants work under the direct supervision of a physical therapist. The advantage of becoming a PTA is the reduced schooling and certification requirements. The continuing education program is less rigorous and there is overall less responsibility. However, as one may guess, the salaries are typically about half of that of a physical therapist.

The goal of this blog was to provide insight to prospective physical therapists on the road of becoming a physical therapist and some of the different career choices for physical therapists.

Roadmap to the Life of Physical Therapy