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  -Jane E. Brody

Physical Therapists, along with occupational therapists and visiting nurses, are the unsung heroes for millions of people trying to preserve or restore their mobility and maximize their ability to function. As the demand for physical therapy grows, the supply of qualified personnel is not keeping up, mainly because health insurers keep cutting back on reimbursements for their services, making it less and less profitable to pursue as a career.

As someone who has just spent more than four months in physical therapy after surgery to replace my worn-out knees, I can attest to the value of these services for a vast array of clients, from babies with birth defects to the elderly trying to stay active. The American Physical Therapy Association says, "Physical therapists are experts in the examination and treatment of musculoskeletal and neuromuscular problems that affect people's abilities to move the way they want and function as well as they want in their daily lives."

Physical Therapists work with people who have sustained injuries to muscles, nerves or joints, suffered strokes or heart attacks, or undergone neuromuscular or joint surgery. They also help people prevent injury and loss of mobility. Among people commonly treated are those with low back and neck pain, knee and hip replacements, problems with balance, mobility-limiting arthritis, sprains, muscle strains, hip fractures, pregnancy and postnatal movement problems and chronic respiratory problems.

A properly trained therapist has, in addition to a college degree, a master's degree (and sometimes a clinical doctorate) in physical therapy. Therapists must pass a national examination and be licensed by the state. Some receive additional training in specialties, like hand, sports or pediatric physical therapy.

Many people with injuries like badly sprained ankles or shoulder pain from too much swimming think it is best to tough it out. Too often, however, they suffer residual disabilities that are then much harder to treat. Getting physical therapy early on can result in faster recovery and prevent more costly treatment later. Patients who are not able to travel to physical therapy can often obtain services at home from therapists who make house calls.

Cost should not be an obstacle. Medicare and Medicaid cover needed physical therapy, federally qualified health maintenance organizations are required to offer physical therapy, and nearly all health insurers cover some physical therapy. But check with your insurer, because pre-certification is sometimes required. Your policy will define who is eligible for the therapy and the amount of care that is covered. Some policies limit sessions by the year, others by the condition being treated and still others by a strange designation called "per episode of care". One young man's ridiculous policy covers 30 sessions a year but only within a 30-day period. If you or your doctor believes you need more physical therapy than your policy will cover, you are entitled to appeal. Call the insurer's member services department to find out how to file an appeal.

As with any profession, there are good physical therapy practices and no-so-good ones. Boris Gilzon, a physical therapist in Brooklyn, outlined important criteria that patients should look for. First and foremost, the therapist must be licensed by the state and have a reputation among patients and local physicians for providing good service. The space in which therapy is provided should be adequate and the therapist should use a variety of techniques, not just gym equipment but perhaps also yoga, electrical stimulation, heat, and ultrasound.

The first visit should include an objective history and a look at the total person, not just an isolated body part that is the current complaint. The therapist should also discuss the patient's goals. Therapists who take a narrow view can limit a person's ability to achieve desired goals.

During prescribed exercises, both stretches and strengthening ones, the therapist should pay attention to details and carefully observe the patient's technique, because, as Gilzon said, "doing an exercise incorrectly doesn't do any good." Only after patients have mastered it should they be left to do it on their own.

Consider as well how much time the therapist spends with the patient. The therapist should not be constantly hopping from one patient to another, giving each a minute at a time. The purpose of each exercise should be explained, as well as what you should feel while doing it so you can tell whether you're doing it right when the therapist isn't looking.

Finally, the therapist should give patients exercises to do on their own, between treatments and after therapy is completed. You don't want to lose what you gained through all that hard work.

-Jane E. Brody © New York Times News Service -- Featured article in the San Diego Union Tribune

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