- The Washington Times - Monday, September 15, 2003

Somewhere among chiropractor, osteopath, occupational therapist, massage therapist and physiatrist is the practitioner of physical therapy.

People who are understandably confused by these terms should know that a chiropractor is concerned primarily with the spine and the nervous system; an osteopath works with bones and muscles; an occupational therapist uses practical activities to treat physical or mental disabilities; a massage therapist works on skin and underlying tissues to promote patients’ general well-being; and the physiatrist is a doctor who deals exclusively with rehabilitation medicine. All work to improve a client’s sense of well-being.

The physical therapist is a little bit of all of these since, in the dictionary definition, he or she helps treat or manage a patient’s physical disability, malfunction or pain by exercise, massage, hydrotherapy and other means. The difference is that he does so without the use of medicines, surgery or radiation.

Granted, such definitions are limiting; most such professions have shifting goals and use varied approaches. It is a given, however, that a physical therapist will deal with the body as a whole and as a moving structure.

Training programs for physical therapists are exhaustive and include a great deal of anatomical and psychological know-how. While few physical therapists attempt definitive diagnoses of physical injury, they usually are called upon to determine the best way to cure or alleviate a problem.

In many cases, a physician determines by examination and X-ray or another imaging method whether a major break has occurred that would require immediate surgical intervention. If not, he might turn to a physical therapist to evaluate what is wrong as well as provide the necessary care.

“We don’t do X-ray, but we use machines such as therapeutic ultrasound, which is different from a sonogram ultrasound,” says Gloria Rogers, acting director of the physical therapy program at George Washington University. Colleagues also use electrotherapy — electricity to facilitate muscle contractions — and infrared machines, she explains. The main difference between physical and massage therapy, she adds, is that physical therapy employs massage to bring about a change of structure or physiology at the tissue level.

“I’m a little biased in my belief that physical therapists feel they can cure a patient more often than a chiropractor,” says Evan Paprocki, 24, of Bowie, who is training to be a physical therapist at George Washington University. “The joke is that a chiropractor will crack your back for a temporary fix, but you have to come back [to us] to be cured. The physical therapy focus is more on strengthening and more into preventive exercises.”

A second-year student in the university’s 2-year master of science program, Mr. Paprocki has begun his third semester of academic work. In October, he is scheduled to do a full-time unpaid internship at Children’s Hospital that will continue until his graduation next May with a master of science in health sciences. Currently, only post-graduate degree programs are available for people entering the physical therapy field. A total of 202 such programs — 126 master’s programs and 76 doctoral programs — are offered nationally, 10 of them in the District, Maryland and Virginia.

(The Web site of the American Physical Therapy Association — www.apta.org — contains much useful information about the profession that Jody Gandy, the association’s director of education, calls a profession in transition due to an upgrade in entry requirements in recent years. See especially “A Future in Physical Therapy” under the Consumer and Education sections.)

Students in GW’s program come from a mix of backgrounds, says Ms. Rogers, with many of them entering a second career. For example, a lawyer is among the entering class this fall.

Dr. Richard Pollin, an assistant professor in the program, says one of their best students had been an advertising executive. Dr. Pollin was a practicing veterinarian for 10 years before he switched, with additional study, to physical therapy, and Dr. Pollin says he likes it for its combination of intellectual and sensory challenges.

“I use my sense of touch as well as my analytical ability,” he says. “It’s a cliche that a person needs body strength. There are some physical therapists with handicaps and at least one who is blind.”

Mr. Paprocki, who majored in psychology at the University of Maryland, was introduced to the field as a senior in high school while working under a mentor on a strengthening program for elderly residents at a nursing home. “I didn’t know what physical therapy was about, but I liked what she did and got interested in it,” he says. He appreciates that he can combine hands-on work with a science-oriented approach.

“Maybe 50 percent of people going into physical therapy school are athletic,” Ms. Rogers says. “Some have been athletes who have been injured and had physical therapy and were impressed by how they were treated. Some decided they wanted a medical field and thought physical therapy was for them because — like those previously in the computer world — they wanted more one-on-one contact with people.”

GW’s faculty, with five full-time members, graduated its first class just two years ago. Howard University’s program goes back 20 years. Marymount University in Arlington also has a graduate degree program and sends students to the GW hospital for some course work. Requirements for entering such programs include undergraduate classes in biology, chemistry, physics, anatomy and physiology.

May Kessler, 48, is a physical therapist in private practice and founder of the Center for Physical and Massage Therapy at 5225 Wisconsin Ave. NW.

“Generally, the person always is interested in the body to begin with,” she says. “Being an active healer means you are a catalyst. You learn about someone when you place your hands on them.”

The calling is an art form, she believes. She tests candidates in job interviews by having them do work on her personally.

“If they can feel what is going on with me, I can tell whether they have talent or not. I interviewed someone with 15 years’ experience on a day when I was in pain. I showed him where a patient was hurting, and he still couldn’t find the trigger points: tightness and restrictions in mobility. You can take all the courses in the world, but you won’t [necessarily] get the art of it.”

Ms. Kessler says there is a big demand for therapists, especially those with experience working in a clinical setting. Nearly all practicing therapists are optimistic about the future of their profession based on figures predicting that the size of the aging population — especially those 85 years and older — will increase dramatically. Seniors are more prone to heart attacks and stroke and need physical therapy for follow-up recovery.

By 2010, Ms. Rogers says, there will be an estimated 33 percent increase in the need for therapists and other health professionals. Apart from the growing market, another incentive for entering the field is that beginning salaries are between $45,000 and $52,000 for staff positions and possibly more in small towns or rural areas desperate to attract a qualified professional.

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