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Raising the Bar in Rehab

Direct Access

Published May 3, 2012 3:39 PM by Lisa Mueller

Usually about once or twice a year, I break down and make an appointment for a massage. As all the hours add up of providing manual therapy for my patients, as well as my moderately rigorous exercise routine, I feel like I need some relief to start fresh again. It's one of the best gifts I give myself. I am a new person after those massages. My body feels more relaxed and my mind appreciates the hour of total silence. Actually, as I write this, I realize it's about time for my semi-annual massage. I should make an appointment soon.

A good friend of mine used to see a personal trainer. Two or three times a week, she would set up an appointment to increase her weight training, cardio and balance skills and was really happy with the results. After a month of seeing the trainer, she could not believe the results. She dropped a few pounds, fit into her clothes better and her self-esteem was the best I had seen in years.

My father-in-law occasionally sees a chiropractor. Every once in a while he will "tweak" his back and need an "adjustment" to relieve the pain. After a handful of sessions, he feels normal again and no longer needs the services of the chiropractor. (As a side note, I have offered many times to educate my dad-in-law about exercises and stretches he could do to maintain a healthy back, but so far no luck in persuading him to change his routine!).

I have friend who has been trying to conceive a child for many years. This year, she started trying other methods to reproduce, including seeing an acupuncturist to improve her fertility. After a few treatments (as well as other treatments and medications), she is now the happy (and tired) mom to a beautiful baby girl.

So, what do a massage therapist, personal trainer, chiropractor and acupuncturist all have in common? They all have direct access. Anyone can make an appointment and walk right into the offices of these practitioners without a note from their doctor. Why doesn't physical therapy fall under those same standards? PTs have more education than most massage therapists. PTs work alongside chiropractors, often treating the same patients. What needs to change so that if patients need physical therapy, they can make an appointment with their therapist directly and bypass the step (and extra time required) of seeing their physician?

I know not all PTs are on the direct-access boat. Some PTs like the way things are. I can understand that side of the argument. But given that so many other clinicians in the health care field practice without physician referrals, it makes sense that physical therapists should be included in that group.

What do you think? Why are the rules so different between PTs and the professions I listed above? Is there less risk to see a personal trainer than a PT?


I think you need to look at insurance as being one reason. As a Massage Therapist and CSCS,medicare isnt going to pay for any massage or personal training sessions I provide. However, I am also an LPTA and with a Dr. order medicare will cover the physical therapy services I help provide. I think younger PTs will embrace it more , especially those with the DPT. Older PT professionals, at least the ones I know, are very used to the guidance from the physician.

Brian , Physical therapy - PTA,LMT,CSCS May 8, 2012 7:26 AM

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