Prevention - On Physical Therapists and Keeping Patients Moving

“Keep moving!”

Alistair Cooke, The Patient Has the Floor, Alfred A, Knopf, 1986

The late Alistair Cooke, the famed American-British journalist, in a talk to the Mayo Clinic, observed Brits outlive their American counterparts even though Brits consume more animal fats.

Cooke explained why in these words;

“Britain, I had noticed, maintains rights-of-way across fields and meadows and builds footpaths alongside highways and uses the phrase ‘Let go for a walk’ almost as an idiom. In America you cannot walk across field except in pursuit of a ball with a liquid center – and there are no footpaths once the town ends. The British walk, and cycle and walk, even in the rain. Let us face it, gentlemen, I said –‘They function!’ ”

So Much for the Opening Movement of This Essay

David Cella, senior editor for Jones and Bartlett, the publishing firm that is publishing my book Innovation-Driven Care: 34 Key Concepts in Transformation in late March, called the other day.

He recommended I speak to Dr. David Duvall, a PhD in physical therapy who heads up an organization called Sports Medicine of Atlanta (sportsmedicineofatlanta.com). Cella felt Dr. Duvall and I shared a mutual interest in innovative approaches to medical care.

I called Dr. Duvall. He quickly got to the point. He said his group – composed of physical therapists, physiologists, certified athletic trainers, nutritionists, sports and clinical psychologists, recreational therapists, registered nurses, and pastors - has created a new medical model of care.

Movement Science

The model is based on “movement science.” The model aims to keep patients moving. The model, collaboration between physician therapists and the medical establishment, bridges the gap between the traditional medical model, based on diagnosis and pathology, and the alternative practitioner model, dominated in Atlanta by chiropractors.

Duvall said his group, steeped in the discipline of neuromuscular science, evaluates movement impairment disabilities and enhances performance in athletes and non-athletes as well. Perhaps Duvall’s greatest passion is serving as one of nations’ eleven educational centers for physical therapists seeking a PhD. He says 25% of physical therapists now have PhDs, and the percentage of PhD candidates is growing rapidly.

A Movement Model

Sports Medicine of Atlanta is a direct access, multidisciplinary, specialty primary health care center. Most patients walk-in. The group provides access to unique and specialized neuromusculoskeletal care from a movement science perspective. The organization calls itself an Orthopedic-specialty center, although it has no orthopedic surgeons on its staff. Nevertheless, Duvall’s group regularly refers patients to orthopedists, and vice versa, and consider itself and orthopedic surgeons and other referring doctors as essential ingredients of the medical model.

Movement Integration

At Sports Medicine of Atlanta, state of the art diagnostics, interventions, preventative measures, performance enhancement, and wellness programs are integrated. The group has served Atlanta and Gwinnett County citizens since 1981. To identify the cause of movement-related problems, evaluations are performed and diagnoses established to direct the course of interventions.

Physical therapists, who regard themselves as clinical scientists, coordinate care to be received by each client to maximize his or her potential in recovery and/or enhancement of movement performance. They then design an intervention plan aimed at the treatment of movement impairments and their associated functional limitations and disabilities.

Physical and Manual Therapy

Sports Medicine of Atlanta's offers consumers physical and manual therapy based upon evidence-based approaches to patient management.

The group stresses examination and advanced clinical intervention. Its therapists are adept in achieving positive outcomes with difficult conditions. All physical therapy plans of care are designed or approved by an experienced, board-certified and fellowship trained doctor of physical therapy.

Alternative Practitioner Model

There’s another model out there as well. It’s called the alternative care model, or complementary practitioner model, and is based on the proposition that alternative practitioners, not MDs, can effectively treat patients too. I do not quibble with this assertion, except to point it is based on historical traditions and anecdotal evidence rather than on science and controlled studies. Nonetheless, alternative medicine is immensely popular among its followers.

Patients Seek Alternative Outside Traditional Medicine

Alternative medicine has been growing rapidly because patients want an alternative, outside of traditional medicine, free of third party intervention, focused on “natural remedies,” and devoid of potentially dangerous prescription drugs. Consumers are flocking to alternative practitioners outside the medical model – chiropractors, acupuncturists, homeopathic physicians, naturopathic physicians, message therapists, reflexologists, practitioners of herbal medicine.

Often consumers seek these practitioners out because they fail to find relief or satisfaction from traditional physicians. Many consumers suffer from neuromuscularskeletal disorders that manifest themselves as disabilities impairing movement and decreasing their physical performance. These disabilities include arthritis, neuromuscular diabilities, or mysterious ailments like fibromyalgia or fibrositis, or other causes of stiffness and muscle aches and pains that restrict movement.

Physical Therapists – A Logical Alternative

Physical therapists, as part of the medical model, offer a logical alternative to alternative practitioners. Physical therapist services are widely available. In 2004, there were an estimated 155,000 nationwide. Most work in hospitals, their own offices, or in the organizations like Health South, which has more than 1000 offices across the country.

I praise physical therapists for seeking advanced degrees. May the movement towards the advanced physical therapist movement continue.