Do I need to see a ‘specialist’ PT?

You’re hurting and you’ve heard that PT can help. A doctor, friend, co-worker, chiropractor, etc may have recommended you see one. OK – now it’s time to choose. Who should you see? Let’s face it – there are literally thousands of physical therapists. In the US, you have about a quarter-million therapists to choose from, although only a small percentage of those are fully trained in pelvic care. How will you know you’ve got the right one?

There are a few questions to answer here…

First of all, do you go in-network versus out-of-network? Should you stick with the general in-network PT you found on the insurance website? You’ve heard good things about seeing a therapist with the out-of-network option, but is it really worth it? Cost of therapy can vary greatly, as can the quality of therapy you’ll receive. I’m not saying the most expensive is always the best. However, insurance restrictions make it very difficult for even the best PT to provide really good care, much less great care. 

Secondly, do you need an expert or specialist pelvic PT? Since cost is THE number one barrier to people seeking the help they need from a specialist PT, knowing what you will get for your money is so important. 

So what is the difference? What makes a PT a specialist or expert level? Here are a few ways to narrow it down.

Board Certification Credentials

There are a few methods for PT’s to achieve credentials of specialization in pelvic therapy. Board certification is achieved through the American Physical Therapy Association and governed by the American Board of Physical Therapy Specialists. It defines a specialist as having “….greater depth of knowledge and skills…exceeding that of the physical therapist at entry to the profession.” 

As of June 2019, out of 248,000 PT’s nation-wide, only 489 have their WCS (women’s specialty certification) and only 10 of those are located in Georgia. Another designation of specialization is the PRPC (Pelvic Rehab Practitioner Certification), which is overseen by an entity outside of the American Physical Therapy Association It is inclusive of all genders and more specifically geared toward pelvic conditions (versus all of women’s health).

Skills and Techniques

Having a board certification is helpful in knowing your provider is well-trained. However, board certification isn’t everything – let me explain why. The credentials are earned through examination of broad knowledge base and demonstration of critical thinking skills (usually through case study). Manual skills and clinical techniques are generally not assessed though. Clinical skills (including hands-on, neuromotor training, exercise prescription, etc) are different from the book-knowledge component. 

For example, imagine trying to do yoga, learn a new dance or play baseball by only reading instructions. The information is important, but actually doing the movements sure helps in developing those skills. The same applies to physical therapy! Also, the same technique doesn’t work with everyone. If a therapist is highly skilled in one technique, that’s great. It will really help that specific set of people who need exactly that thing. However, a truly skilled therapist, IMHO, has trained in a variety of skills to meet each person where they are. 

Experience

Both skills and knowledge develop over time and with exposure to many clients, situations and conditions. Has your therapist treated people with your particular issues before, and if so, how often? Do they feel comfortable in helping you define not only what is going on, but also the options for moving forward? Experience with a complicated issue may allow for more efficient treatment and/or collaboration with other health care providers to get you where you need to be faster.

Let me be very clear about one thing: Some therapists are top notch early on in their careers. I can honestly say I’ve met some therapists a year or so out of PT school who have blown me away with their insight, innovation, and scope of knowledge. And conversely, some are sorely lacking despite literally years of treating. So how do we really define an ‘expert’? 

This question was addressed in a 2000 article by Jensen, et al (here is the article):

They defined four components you should see in an expert therapist:

  • Multidimensional Knowledge Base – extensive and defined in terms of each individual client; incorporating various realms of information including experience, research, medical, interpersonal
  • Clinical Reasoning – contextual collaboration with the client; specific medical diagnosis not as central in management as how current condition is affecting that client; innovation in approaches to treatment
  • Movement Analysis/Scripts – hands-on and listening skills for evaluation and treatment; more automatic programming for skills application and analysis of movement patterns
  • Virtues – high standards for themselves and staying current on evidence; client-centric

Another important factor they identified as common among all of the experts was that people / clients were not judged. The expert clinician (as I’d argue all clinicians should) assumes responsibility for trying to solve “complex clinical cases” versus labeling clients as “noncompliant or malingering”, and subsequently dismissing them.

The truth is, physical therapists go through rigorous training in graduate school, residency and through extensive, ongoing post-graduate education. They are all highly trained and dedicated health care professionals. So given all of that, really, how do you know who you need to see? 

What may be helpful in deciding is for you to answer the following:

Why would I NOT need to see a specialist?

  • If your symptoms are from a known, more recent injury.
  • If your MD did not specify the therapist for you to see.
  • If your symptoms seem more ‘straight-forward’.

What are some signs I SHOULD see a specialist / expert-level pelvic therapist?

  • If you’ve seen multiple providers – chiropractors, PT’s, MD’s, etc – without needed improvement. An expert may have more experience with your more complicated issues.
  • If you have a few (or several) issues involved, not just one symptom.
  • If you have had a previous complicated intervention – ie, complicated surgery or injury.
  • If you have many other medical conditions that need to be managed along with your PT-related issue.
  • If your MD has specified that particular expert clinician.

Either way, please know that PT can be a game-changer for you. Physical therapy is a front line treatment approach for so many conditions and can save time, money and frustration in terms of testing, medications, doctor visits and time away from the things you love.  

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