In recent times the profession of physical therapy has been labeled as the "career for the future" due to the increasing average age in the world. However many do not know what physical therapy is or why someone will need it. A physical therapist will evaluate and treat mechanical dysfunction of the human body and also treat the consequences of disease. They are a key member of the health care system and can work with a variety of diagnoses in many different clinical settings.

The role of a physical therapist is to improve the functional activities of life. If someone has difficulty reaching the top shelf in the kitchen, it may be for different reasons. A physical therapist will focus on improving the patient's function, whether it is through treating the joints, nerves, muscles, or just changing the way the movement is performed. Due to the variety of reasons for limitations in tasks, physical therapists have to be movement scientists to breakdown simple or complex activities into components to find out the cause of the problem. However, in order to determine a course of treatment, an evaluation is necessary.

The physical therapy evaluation is broken down into three sections. The first is when a skilled interview is given to gather information about the history and details of the patient's condition. The next section is a more active part, with the therapist and patient going through movement, strength, sensation, and functional tests to determine where the limitation is originating. Goals must now be set to compare patient function between visits to measure progress. It is important for the therapist and patient to set goals together to make sure they are reasonable and what the patient desires. The therapist will then develop and perform a specific treatment plan. The last part is to educate the patient in the condition and give a home exercise and management program until the follow up visit usually a few days later. Patient education is the key to successful physical therapy because the patient must know how and why the condition occurred to avoid a relapse in the future.

The human body undergoes many changes over the course of a lifetime. Some of these changes are due to age and degeneration, trauma, or disease. Physical therapy will play a role in all of these categories. Depending upon the clinical setting, a therapist may see only one type of ailment or a variety in one day. Orthopaedic problems are very common due to arthritis, fractures, sprains, tendonitis, low back or neck disorders, rehabilitation after surgery, and even deconditioning. Neurological patients may be treated for stroke, brain injury, spinal cord injury, or diseases like Parkinson's and Multiple Sclerosis to name a few. There are other groups as in cardiac rehabilitation after heart attack or surgery, burn and wound care, as well as urinary incontinence. With all these conditions, it can be seen that a physical therapist needs to be well rounded to treat effectively.

The process in which a physical therapist sees a patient is part of the medical model. Usually a patient will go to a physician with a problem. It is here that an evaluation is performed and any "red flags" or signs of major illness or disease (i.e. cancer) are ruled out. If there is an identified musculoskeletal condition that needs to be addressed, the patient will be referred to the service of physical therapy. The therapist will then perform another evaluation to determine functional limitation or impairment and develop the treatment plan, while staying in touch with the physician via progress notes. Many times physical therapists may work within a healthcare team along the side of physicians, social workers, occupational and speech therapists to better treat the "whole" patient for complicated cases.

The arsenal of treatments a physical therapist can use is fairly extensive. Many therapists treat differently depending upon biases from experience, education, clinical setting, or a variety of other factors. Manual therapy tends to be one of the techniques used for working on specific regions of the body. Joint mobilization or manipulation plus soft tissue mobilization are very important to decrease restrictions in joints or muscles. Therapeutic exercises are very important to stretch, strengthen, work on balance, or any number of tasks to improve function. Modalities were the first form physical therapy many decades ago when ice, heat, ultrasound, and electrical stimulation were used frequently. There is also whirlpool treatment mainly used for wounds and burns when debridement (tissue removal) needs to be performed by the physical therapist. Of course certain treatments are used for specific conditions, but ultimately, knowing how and when to use them all makes for an outstanding clinician.

As described before, there are many different clinical settings in which a physical therapist can practice. Many choose to work within a hospital, where inpatient and outpatient facilities offer the widest variety in patient population. Private practice clinics for the most part function autonomously and are a good business for those who want to be their own boss. Physical therapists can also be found in schools, communities, fitness centers, or on the athletic field as or working with athletic trainers in sports injury rehabilitation.

The road to becoming a physical therapist is somewhat of a long one. At this time there are clinical degrees at the bachelor, master, or doctoral levels. There are also separate degrees after this to become a professor or a high level administrator in the healthcare system. The average time table is four years undergraduate followed by two to three years of graduate school. There is then a state board examination to pass to earn a license to practice.

The life of a physical therapist is a rewarding one. Helping people reach a satisfactory quality of life and educating them in maintaining that level is a real sense of accomplishment for both the therapist and patient. It is this unique teamwork approach that makes the positive change.

For further information in the field of physical therapy, locate the American Physical Therapy Association (APTA) Internet address at www.apta.org.

Daniel J. Kirages, D.P.T. works with outpatient orthopaedic, neurological, and urological disorders for Kaiser Permanente Los Angeles Medical Center in the Physical Therapy Department. He earned a Bachelor of Science degree in the field of Exercise Science, as well as a Doctor of Physical Therapy (DPT) degree at the University of Southern California School of Biokinesiology and Physical Therapy. He can be reached at dkirages@pacbell.net.