Careers in Physical Therapy Sports Medicine

CAREERS IN PHYSICAL THERAPY SPORTS MEDICINE

Institute Research Number 109 O*Net SOC Code 29-1123.00 ISBN 1-58511-109-0 DOT Number 076.121-014 CAREERS IN PHYSICAL THERAPY SPORTS MEDICINE WHAT DO A STROKE VICTIM, A STAR ATHLETE, A YOUNG MOTHER WITH MULTIPLE sclerosis, an injured fireman, and a premature baby born with birth defects have in common? They all need a physical therapist to help them overcome pain, restore mobility, and lead independent lives. Physical therapists help more than one million people every day, from every age group and background you can think of. Physical therapists treat any part of the body that isn’t functioning properly due to injury, disease, or other causes. They are trained to stretch, strengthen, test balance and coordination, massage, and enhance mobility. In addition to these hands-on skills, they employ a 2

wide variety of mechanical means such as special exercises, extreme temperatures, infrared light, ultrasound, and electricity. The goal for physical therapists is to help people help themselves. The primary purpose of physical therapy is to help people use their own bodies to function as best they can and to lead more active lives. For an athlete, that could mean training to set a new record. For someone with a debilitating disease, that could be as basic as getting out of bed and dressing without help. Because injury and disease can affect anyone, physical therapists can work in a general practice or specialize in a number of areas: Pediatrics Geriatrics Occupational therapy Women’s health Acute care Wound care Orthopedics Performing arts Neurology Cardiopulmonary rehabilitation Sports medicine A physical therapist is a valued member of a healthcare team. Patients are usually referred by attending physicians for diagnosis and treatment. After developing a treatment plan, the physical therapist coordinates treatment and reports on progress to doctors, nurses, psychologists, coaches, and social workers just to name a few. PTs work in many settings: Hospitals Outpatient clinics Fitness centers Schools Sports facilities Nursing homes Workplaces Patient homes 3

CAREER WITH A GOOD FUTURE PHYSICAL THERAPY IS A MULTIFACETED AND CARING PROFESSION OFFERING MANY opportunities today with great prospects for the future. The need for physical therapy is growing rapidly. People over 50 aren’t retiring to sit in rockers on the porch. They are becoming increasingly active, traveling, working out, and getting involved in sports. Every day millions of Baby Boomers join this generation of active seniors and every day many fall victim to accidents, injuries, strains, sprains, and various age related maladies. They want to do whatever they can to keep up their normal activities and a good way to do that is to get help from a physical therapist. With a good education, certification, and the desire to help people, you can expect excellent prospects for a growing career. Sports Medicine – Hot Career Choice Do you enjoy sports? Are you physically active yourself? Then sports medicine is a specialty to consider. Sports medicine has been traditionally defined as the diagnosis, treatment, and rehabilitation of athletic injuries. Today it’s considered a hot specialty because it’s not just for professional players anymore. Sports medicine focuses on the effects of any form of exercise or physical activity. Often it’s as much about preventing or enhancing physical performance as helping injured people recover. It’s good news that more and more people are working out. With so many getting involved in fitness activities, the role of the sports physical therapist is becoming increasingly important. In order to help people achieve optimal health and peak performance, the sports physical therapist is often called upon to develop exercise programs for schools and health clubs, teach people how to prevent injury, and design special conditioning programs for athletes. It’s the physical therapist who provides athletes and other active people with the knowledge and skills to become stronger, faster, and have more endurance. 4

STEPS YOU CAN TAKE NOW DO YOU ENJOY SPORTS AND HELPING PEOPLE? A POSITIVE ANSWER WOULD be a good start toward assessing whether you might enjoy working as a physical therapist. To learn more about this career and whether it’s the right choice for you, you should talk to people who are actually working in physical therapy and sports medicine. Ask your guidance counselor to invite professionals to speak at your school on career days. If you can, talk to college professors about what you can expect during your college years and after graduation. Prepare for college entrance requirements early in your high school years. You’ll need four years of English and four years of natural sciences. Physics and biology are a must. Any other classes involving health, wellness, and nutrition will be beneficial. In your career as a physical therapist, you’ll be working with patients with many different cultural backgrounds. Learning a foreign language and taking psychology courses will help you relate to patients and their families. The physical therapy program in college will be demanding. In high school, develop good study habits and keep your grades up. Admission officers will expect to see a GPA of at least 3.0. Look for a part-time job in the physical therapy field. Ask your guidance counselor, parents, and relatives for possible leads. Ideally, you would find work as a physical therapy aide. Aides work closely with physical therapists doing much of the same work. Although it is not a stepping stone to employment as a physical therapist, it’s a great way to learn the ins and outs of the job. If you can’t find a job, you can always volunteer. Talk to your school’s coaches and physical education teachers about working with any of the teams. You could conduct warm-ups and also observe and record injuries and responses to treatments throughout the season. Volunteer experience and letters of recommendation from science and physical education teachers, PT professionals, and coaches will enhance your chances of being accepted to the school of your choice. This is a field that is growing and changing fast. Keep up with the latest developments and new techniques by reading health and fitness magazines. 5

HISTORY OF THE PROFESSION AS A PROFESSION, PHYSICAL THERAPY IS A RELATIVE NEWCOMER, STARTING during World War I. But the same methods and restorative aids used today have been around since the days of the caveman. In fact, physical therapy may well be the oldest method of medical treatment. Physical therapy utilizes basic elements such as heat, cold, running water, and manual manipulation to restore body movements. Heat is one of the oldest forms of therapy, used originally in the form of exposure to the sun. The sun was worshiped for its healing powers in ancient times throughout Egypt, India, Persia, Peru, Rome, and Greece. In Germany, people not only worshiped the sun, they set up special healing fields, where the sick went to lie in the sun and recuperate. Later, heat was applied in different ways. The Greeks promoted fever therapy, and the Romans applied hot wax to relieve pain. The Romans rolled around on heated sheep hides to ease aching muscles. In 19th century France, bakeries were used after hours for heat therapy. Doctors prescribed “stoving” for arthritic patients. After the bread had been baked for the day, patients were laid in the hot ovens to soak up the lingering heat. As primitive as that treatment may seem, it was only a few decades ago that modern physical therapists used fever cabinets in much the same way. The basic principle of heat therapy is sound and in common use today. It is now known as hypertherapy and is applied in various ways from simple heating pads to ultrasound. The application of cold, now known as cryotherapy, is another popular treatment used for the past few centuries. The use of ice packs didn’t catch on until around 1750, when it could be artificially manufactured. Until then, cold therapy was common only in countries that had plentiful supplies of snow and ice. In Russia, for instance, ice packs were used extensively to reduce fevers, treat the pain of arthritis, control infections, and treat diseases like meningitis and gout. Russian surgeons on the battlefield were the first to discover that frozen legs were easier to amputate. Hydrotherapy, the use of water in medical treatment, began in primitive times when people stood in running streams to bathe their wounds. In some cultures, the healing power of water was elevated to sacred status. For thousands of years, Hindus and Egyptians have traveled great distances to bathe in the sacred waters of the Ganges River and the Nile. 6

Sports medicine began when the ancient Greeks used water to treat the wounds of injured athletes. In addition to soaking in water and bathing wounds, water therapy was applied through sweat baths, first by the Romans and then by Native American tribes. Today, many famous European spas and American health resorts are built on natural hot springs. Electrotherapy has been around for a long time. Although the light bulb wasn’t invented until the late 1800s, electricity for therapy started in ancient times when people used electric eels to heal arthritic joints. Fortunately, patients no longer have to catch a fish in order to get some pain relief. Massage and exercise are the hallmarks of modern physical therapy. Almost every major world culture has used this combination of treatment throughout history. Kong-Fu, a Chinese practitioner, wrote the first book on the subject in 3000 BC. At the same time, the Japanese also treated patients with massage and the Hindus developed the seven forms of Yoga, which has gained popularity over the centuries and is now more popular than ever. Therapeutic exercise and massage spread throughout Europe during the Dark and Middle Ages. Now, a prescription of exercise and massage is the basis for almost all physical therapy regimens. Physical Therapy as a Profession It was in Britain in the late 19th century that modern physical therapy was established. It started as a subspecialty of orthopedics. British orthopedic doctors knew of the beneficial affects of heat, massage, and exercise. Using these techniques was time-consuming and those with busy practices recruited young women to help ease the workload. The women were trained to treat pain with heat, relax muscle spasms with massage, stretch tight joints and muscles, and oversee exercises to strengthen weak muscles. The practice of training women as physical therapists crossed the Atlantic and quickly spread among American orthopedic surgeons. Hundreds of therapists were pressed into service when a polio epidemic swept the United States from 1915 to 1917. The Surgeon General’s office formed a new department called the Women’s Auxiliary Aides, under the Division of Orthopedic Surgery. Shortly thereafter, the first school of physical therapy was established at Walter Reed Army Hospital in the nation’s capital. After the outbreak of World War I, 14 additional schools were established and about 800 therapists were trained and utilized in military service. 7

In 1921, the first professional association was formed, called the American Women’s Physical Therapeutic Association. Eventually men were allowed to join and in the late 1940s, the name was changed to the American Physical Therapy Association. During the 1940s and 1950s, America was hit hard by the worst polio epidemic in history. There were about 15,000 reported cases and schools scrambled to train enough physical therapists to meet the demand. The 1940s was probably the most important decade for the advancement of physical therapy. Polio, casualties of World War II, and increasing industrial accidents created the need for new treatment procedures. Millions of dollars were poured into research and scholarship funds. Many new treatment procedures were developed and physical therapy became a mature and respected field in its own right. After World War II, physical therapy became widely accepted by the public. Treatments developed for polio victims and wounded soldiers were soon applied to athletes, handicapped children, and patients with chronic disabilities. Today, biomechanical engineers and other physiology researchers are developing new types of braces, prosthetics, pain relief methods, and equipment. There are currently more than 130,000 licensed physical therapists in the US, working in a wide variety of practice settings and specialties. As our population becomes more diverse, active, and older, the role of the physical therapist becomes increasingly important. There are now more than 200 accredited programs available through colleges and universities where future physical therapists can train to meet the needs of all groups. 8

WHERE YOU WILL WORK AS YOU MIGHT EXPECT, MANY PHYSICAL THERAPISTS WORK IN HOSPITALS. BUT there are many different settings for this work. About 70 percent of physical therapists work in one of these private practice settings: Outpatient clinics Doctors’ offices Rehabilitation centers Long-term care facilities Nursing homes Hospices Schools Employee health centers Community health centers Research centers Other employers include schools and organizations for the handicapped, government health agencies, and home health agencies. Sports physical therapists also work in hospitals and clinics. But most work in private sports medicine clinics, consulting groups, fitness centers, sports facilities, and schools, including high schools and colleges. Some physical therapists work as salaried full-time employees, but many are technically self-employed even though they work in much the same way and in the same settings. They may be in private practice by themselves or they might be one of the owners in a partnership or group practice. Their earnings are based directly on fees from patients. 9

Working Conditions Regardless of where they perform their duties, physical therapists work as members of a healthcare team. The team almost always includes at least one physician, but can also include nurses, other types of therapists, dentists, psychologists, and social workers. This is typically full-time employment with workweeks of 40 to 50 hours. Only one in four physical therapists works part time. Work hours often include evenings and weekends, especially for those specializing in sports medicine. There are actually more physical therapy positions than there are physical therapists to fill them, so many work in more than one job at a time. Make no mistake, this is hard work. Physical therapists stress their own bodies when they stoop, kneel, squat, and spend hours at a time on their feet. There is a lot of lifting, too. Primarily, that involves lifting patients or holding them upright while they go through their therapeutic exercises. Working in a larger facility can be a little less physically demanding. There are assistants and aides available to do a lot of the heavy chores while the therapist provides close supervision. Most physical therapists provide direct patient care, but some move into other areas such as consultation, supervision, teaching, administration, and research. 10

THE WORK YOU WILL DO A TRUCK DRIVER INJURES HIS BACK UNLOADING HEAVY BOXES. A MIDDLE-AGED executive has a stroke. A six-year-old child has cerebral palsy. An adolescent skateboarder suffers a head injury. An elderly woman has hip replacement surgery. These are all very different people with different problems dealing with varying degrees of disability and pain. And for help, they all come to you, the physical therapist. As a physical therapist, you’re a cheerleader, a taskmaster, the one they’ll hate for months, and the one they’ll thank for a lifetime. It’s your job to help victims of injuries and disabling diseases involving muscles, joints, nerves, and bones. Through a variety of physical stimulation and focused exercise, you’ll help them attain normal bodily function and movement. It’s often hard and frustrating work. But the satisfaction of restoring someone’s quality of life and independence is immeasurable. This is very personal work. You’ll be working closely with people, often for long periods of time – months, or maybe even years. Some people have experienced severe trauma; others are health-conscious and want your help to increase their overall fitness level. Every patient has a different goal, whether it’s to walk without a cane, relearn how to get dressed without help, or return to a sport stronger and more confident than ever. You’ll need first to identify what that goal is, then come up with the best plan of action, and follow through with hard work and commitment until that goal is accomplished. Not all of a physical therapist’s work is hands-on. Once a treatment plan is written, it must be explained to the patient and the family. They need to know how to correctly perform self-care at home and what to expect as the healing process progresses. In a way, physical therapists are teachers. Part of the job is to help people maintain overall fitness and prevent injury. This is especially true when dealing with athletes or anyone involved in sports or fitness activities. If you’re employed by a health club, for instance, you would show people how to properly perform their exercise routines without doing more harm than good to their bodies. Working with athletes, you might prescribe and supervise individualized conditioning programs designed to increase optimal physical performance. Although you’ll be working one-on-one with patients, you’ll often be acting as a member of a team. Chances are, physical therapy has 11

been prescribed by another healthcare professional such as a surgeon or a dentist. Depending on the situation, you will often consult and practice with a variety of other professionals, such as nurses, educators, social workers, occupational therapists, speech-language pathologists, and audiologists. What does a typical day in the life of a physical therapist look like? If you are working in a general practice, you might see 20 patients with diverse injuries. You’ll evaluate new patients, check the progress of existing ones, and discuss treatments with physicians and case managers. You’ll apply treatments, help patients do their prescribed exercises, and discuss how they’re feeling. Throughout the day, there’s paperwork to be done. You’ll document everything you’ve said and done, along with everything your patient has said and done, and make sure that information is passed along to the rest of the healthcare team. Diagnosis and Evaluation Before you start treating a patient, there are several preliminary steps: Examine medical history Assess problem Design treatment plan Educate patient and patient’s family Report findings to referring physician With each new patient, a physical therapist starts with a complete evaluation, documenting the history of the problem and performing tests to accurately measure the problem. Which tests you perform will depend on the individual situation. You might test muscle strength, joint motion, sensory and neurological responses, balance and coordination, posture, range of motion, respiration and palpitation, flexibility, or other specific bodily functions. Basic functional activity testing is always done to determine how well a person can perform the necessary tasks of caring for themselves. During the evaluation process, the therapist must have an open and honest discussion with the patient to determine what he or she wants and expects. The success of any treatment plan is dependent on the therapist and patient working together toward a common goal. If a patient’s expectations are unrealistic, trust in the therapist will eventually break down. Tell it like it really is from the start and you won’t run the risk of derailing your patient’s treatment. 12

Once the physical therapist and patient both understand what needs to be accomplished, it’s time to develop a treatment plan. The plan will lay out a specific strategy, describe its intended purpose, and prospects for a successful outcome. It will include methods to deal with the existing problem and also steps for preventing a recurrence in the future. The plan is explained in detail not only to the patient, but also to family members even if they are not directly involved with the treatment. Types of Treatment Physical therapy procedures are diverse. A variety of methods and techniques will be combined to decrease pain and increase movement and function. In general, a treatment plan will include: Lifestyle modification Therapeutic exercise External stimulation Assistive devices Lifestyle modification involves relearning basic mobility skills and improving function so that patients can regain independence and return to activities of daily living. They may need to learn how to get in and out of bed, get in and out of a wheelchair, walk with crutches, use lifting devices on stairs, bathe themselves, eat a meal, or get dressed. Some modifications will probably be necessary to make any of these activities possible. Someone with arthritis, for example, might be instructed to replace buttons with velcro fasteners. Someone with a back injury will need to learn how to maneuver from a prone position to a chair without causing pain or reinjury. Therapeutic exercise is at the heart of any physical therapy regimen. The exact exercise will depend on the problem involved, but in general, these exercises are intended to restore strength and endurance, increase range of movement, and improve balance and coordination. In the past, injuries were automatically treated with immobilization and extended periods of inactivity. This was especially true for athletic injuries caused by overuse of muscles. Now we know this is a bad idea. Failure to use the muscles surrounding an injury can lead to permanent weakness. For some areas of the body, such as shoulders, continuing movement is vital to recovery. A shoulder that has been injured or even just strained can become “frozen” if it isn’t kept moving. The longer it stays immobile, the more difficult it 13

becomes to move it without severe pain. Someone with a frozen shoulder will eventually find it impossible to lift the arm high enough to eat or comb hair. The treatment? Keep moving. Properly prescribed exercise is now accepted as the most effective method for healing sports injuries. Patients who have been immobilized by necessity will need to counteract the effects of atrophy by using their own muscles – often to the point of exhaustion. Once muscle strength and flexibility have increased, more advanced exercises are employed to improve coordination, endurance, and functionality. Sometimes it is necessary for the physical therapist to provide hands-on help in the form of joint mobilizing techniques or deep-tissue massage to improve soft tissue flexibility. Exercises are performed under the supervision of the therapist who makes sure they are being done right. But, of course, exercising during office visits alone isn’t enough. A physical therapist teaches patients how to exercise at home so they can recover as quickly as possible. Therapeutic exercise is often combined with external stimulation such as: Heat Cold Water Ultrasound Electricity Infrared or ultraviolet light Traction Massage Each of these stimuli can be produced in a variety of ways. For instance, heat can be applied with heating pads, whirlpools, melted paraffin wax, lamps, ultrasonic waves, and diathermy (electrical current). Each method delivers heat to a specific area such as body tissue, or internally for the purpose of relieving pain or reducing swelling. Assistive devices include canes, crutches, walkers, braces, prosthetic limbs, and wheelchairs. In some cases, the physical therapist teaches patients how to use an assistive device to conduct normal 14

activities in their daily lives. Anyone who’s ever tried walking on crutches knows it’s not as easy as it looks. Imagine learning to walk with an artificial leg! When an assistive device is used during treatment exercises, it is called gait training. After a spinal injury, for example, a patient might be instructed to walk on a treadmill while being supported by a harness. Throughout the treatment plan, a physical therapist must periodically evaluate and document progress. It is not uncommon to adjust treatments from time to time, as special problem areas become apparent. Monitoring patients’ progress and keeping the rest of the healthcare team informed are part of the job. Specialties A physical therapist can work in a general practice, treating a wide range of afflictions and types of people. There are also many areas of specialization to choose from. Some of the most common are: Cardiopulmonary rehabilitation Helping those who are recovering from heart disease Biomechanics The science of body movement Pediatrics Working with children Geriatrics Working with the elderly Orthopedics Correction of skeletal deformities and recovery from broken bones Neurology Dealing with maladies of the nervous system such as stroke or cerebral palsy Sports medicine Treatment of anyone involved in physical exercise Sports Medicine The fastest growing specialty area in physical therapy is sports medicine. The term sports medicine is a little misleading because it sounds like it means treating athletes for sporting injuries. Certainly the image of helping an injured football player get back in shape for the next big game is a glamorous one. But it’s usually not that high profile. Sports medicine is correctly defined as healthcare for anyone who performs exercise and plays sports. These days, athletes are only one segment of a much bigger population of people who are physically active and need specific care. 15

Sports physical therapy includes injury prevention, performance enhancement through training, management of medical problems caused by exercise, treatment of chronic disease with exercise, treatment and rehabilitation after injury, and specific exercise needs of demographic groups such as children or women. Injury prevention is a primary focus in sports medicine. Helping people stay fit and safe makes a lot more sense than waiting for an injury to occur, then spending months in recovery. A big part of the sports physical therapist’s job is to teach people how to exercise properly, how to avoid serious injury, and what kind of exercises to do to prepare for specific sports. It’s common knowledge that most injuries occur when an athlete is fatigued. Exercises that enhance overall physical fitness and build endurance are an important part of the prevention regimen. The other primary focus of sports medicine is the diagnosis and treatment of injuries that occur during sports or exercise. There are two different types of injury: acute and chronic. Acute injuries are those that occur suddenly and can usually be healed completely in less than six months. The most common acute injuries are broken bones, torn ligaments and tendons, sprains, and muscle strains. The causes are usually twisting or sustaining a blow such as being kicked. Knees and ankles tend to be the most vulnerable spots. Sometimes severe accidents occur resulting in head or spinal cord injuries. In these cases, recovery will likely take much more than six months. Chronic injuries are those that develop over time and resist quick treatments. Tendinitis and stress fractures (hairline fractures) are the most common. You don’t have to be a hardcore athlete to suffer chronic injuries. Anyone who consistently overuses muscles for extended periods of time is vulnerable. For example, stress fractures can happen to any long-distance runner. And anyone who plays tennis regularly knows about tennis elbow, one of the most common types of tendinitis. The best way to avoid chronic injuries is to prevent them with proper conditioning exercises and training management. That’s part of the sports physical therapist’s job. 16

THE PROFESSIONALS SPEAK I Work in a Health Club “I always wanted to be in a healthcare profession, mostly because I like to help people. I chose physical therapy because the job availability was so good. I’ve been a physical therapist for 20 years now, and I think the opportunities are even better now than when I started. Like most physical therapists, my first job was in a hospital, but with outpatient services. I gained a lot of valuable experience there, but being an independent sort I eventually went into private practice. I specialize in orthopedic and sports therapy so it made sense to move my practice into a health club. Being able to help such a wide variety of people is one of the best things about this work. Even though I work in a sports and fitness environment, I get all kinds of people with all kinds of problems. Most of my patients come by medical referral, so a lot of them come from outside the gym. Of course, I do get a lot of sports related cases because of where I am. People will often ask me to take a look at their workouts and see if I can suggest how to improve their routines. Sometimes just walking through the gym, I’ll notice that someone is not using the correct form on a machine and I’ll stop and give some advice. No one seems to mind if I butt in like that. If I don’t, they’re going to be in my office for treatment sooner or later. The problems I treat are predominantly spine related, meaning neck and back injuries and strains. I also get a lot of shoulder injuries, postoperative knees, and a mixed bag of sports injuries like messed up ankles and tennis elbows. There’s no question that this is hard work. You really have to love it. The hours can be long, especially for someone like me – a solo operation. My day starts with setting up schedules and getting all my paperwork caught up. I have to make sure every detail is documented and that referring doctors know what’s going on. And I have to deal with billing insurance companies. That can be a real pain. 17

Then I start treatments. I might see as many as 18 people on a busy day. I set them up every half-hour, so you can see why the days can be long. The work itself is physically demanding, too. Because I do primarily orthopedic manual therapy, there is a lot of hands-on work involved. Imagine you’ve got a football lineman who weighs 300+ pounds and you have to lift his leg. His leg alone could weigh as much as a small woman. Then while you’re holding it, you have to stretch out these huge muscles that are fighting you every inch of the way. It’s exhausting! And I love every minute of it.” I Work With Stroke Victims “Suffering a stroke is one of the most devastating things that can happen to a person. It’s so frightening for a person to suddenly lose their ability to do the things they’ve always taken for granted. Imagine waking up in a hospital and not being able to form simple words, to get dressed, or to stand up without falling over. Sometimes their memory is affected and they can’t remember their own family members. I work for a hospital, specializing in neurology and geriatrics. That almost always means my patients are stroke victims. I treat patients here in the hospital, but I also make regular home visits after the patients have been released. Recovery is a long-term process. Depending on the severity, it can take up to a year of regular therapy sessions, plus periodic follow-ups long after that. My treatment includes exercises that help patients regain muscle strength and endurance, but especially balance. Balance is the tricky thing. It depends on the type of sensory information that the brain may not be processing correctly. For example, if your vision has been affected in your right eye, your depth perception might be off so you don’t know how far down to put your foot when you take a step. That makes it hard to walk without falling. Another major aspect of my job is to help people relearn how to perform everyday functions like dressing, brushing their teeth, and eating. When they return home, I make an inspection and evaluate the safety issues. Things like throw rugs and bathtub bars 18

that aren’t sturdy enough to bear weight are hazards that need to be taken care of. In my work, I’m as much a cheerleader as anything. Depression is a very common side affect of stroke. It comes from the feeling of helplessness and the frustration from trying to make your body do things that it just won’t. It’s as if your body has betrayed you. I get frustrated right along with my patients because I want so badly for them to succeed. But I can’t show it. I have to remain cheerful and keep a smile on my face no matter how hard it gets. I guess you’d say I’m a people person. All I want to do is help my patients feel better and get better. If you don’t possess a high level of empathy, this isn’t the career for you.” I Treat Professional Athletes “I wasn’t one of those people who dreamed of working with professional sports teams. Actually, I concentrated on geriatrics in school. It was timing and circumstances that led me to sports medicine. One of my first jobs as a physical therapist was in a city clinic during a time when fitness was becoming the rage. I began to see more and more people coming in with injuries mostly because they were out of shape during the week and overdoing it on the weekend. It wasn’t very challenging to figure out what was going on and what to do about it. But it did give me a lot of good experience in learning how the body reacts to action-related stress. Eventually, I joined a hospital rehabilitation center that specialized in orthopedics. It was there that I started to see athletes, both professional and amateur. Changing my specialty to sports medicine wasn’t something I did intentionally, it just happened. I’ve worked with athletes in all kinds of sports — hockey, football, baseball, rugby, you name it. It’s my job to get an injured athlete back out on the field. But it’s important that they return not just able to play, but able to play better than ever. That’s the difference between sports therapy and other kinds of physical therapy. Basic rehabilitation isn’t enough. Athletes need to 19

strengthen the area of injury in a way that will avoid the risk of re-injury. If they don’t, they might as well start looking for another career. So there’s a lot riding on how well I do my job. Logically, you’d think that the way to handle an injury is to immobilize it and do whatever you can to keep from stressing it. The opposite is true. The injury occurred because there was a weakness somewhere. I find that weakness and design a conditioning program that will build it up. That usually means building up all the supporting muscles in the area. We need to get to the point that under the exact same conditions in which the injury occurred, it won’t re-occur. The athlete returns to work stronger, faster, and better than before. I like working with athletes, especially professional athletes, because they are so focused and dedicated. They trust me to give them the right prescription for recovery and they’re not afraid to push themselves despite a lot of pain. They’re under tremendous pressure. I admire them and they appreciate me. For me, there’s nothing more satisfying than watching someone return from an injury to break another record on the field.” I Help People Avoid Osteoporosis “I’ve been in practice for over 30 years. My specialty in school was geriatrics. About 15 years ago, my mother died from complications after breaking her hip in a fall. Since then, I have narrowed my focus to the prevention and treatment of osteoporosis. At that time, not a lot was being done about this disease. It was considered a normal part of the aging process. Thankfully, we’ve come a long way since then. Over 10 million people in America have osteoporosis, a disease that causes the bones to become so thin they break easily. Millions more are at risk because their bone density is decreasing or is already dangerously low. This is not just a disease that affects women, but about four times as many women are affected than men. And although it most often occurs in people over the age of 50, there are increasing numbers of young people at risk. Eating disorders, crash dieting, and some medications can cause osteoporosis in anyone. 20

What people need to know is that osteoporosis is not inevitable. There is plenty you can do to prevent it or even regain bone mass that has already been lost. Making sure you get sufficient calcium in your diet is a good start. But one of the most effective ways to increase bone mass is through weight bearing exercise. That’s where I come in. A lot of the people I treat have never done any kind of exercise program. I treat each person individually, making sure that the routine matches their level and they can do it safely. The last thing I want is for someone to get hurt from trying something they’re not ready for. Making sure the exercises are easy enough for them in the beginning is important for building their motivation and making sure they stick with it long enough to see progress. My patients are always surprised by how quickly they start to feel stronger. The routines I put together are designed to accomplish several goals. Building stronger bones with weight bearing exercise is only part of the program. There are exercises to strengthen the body core (the abdomen and back) and improve balance. If your posture is good and you’re not wobbly, you’re less likely to fall and break something. I also teach the basics of body mechanics as they relate to ordinary activities. Believe it or not, you can hurt yourself just getting dressed if you don’t realize which movements are potentially harmful and how to do them correctly. I also treat patients with broken bones, for pain relief, rehabilitation of the affected areas, and prevention of recurrence of the injuries. This is very satisfying work. It requires a lot of patience on my part. It can take up to two years of daily work for a person to get their bone density up to a safe level. But I gently remind my patients that it’s worth it. It’s not just about avoiding a painful injury. It could be life saving.” 21

PERSONAL QUALIFICATIONS WHEN YOU SAY “HOW ARE YOU?” ARE YOU JUST BEING POLITE OR DO YOU REALLY want to know? If you genuinely care about people and want to help them feel better, you have the nurturing nature needed for this kind of work. There are many other traits that are advantageous for a practicing physical therapist to possess. The two most important are patience and a high energy level. Your patients will typically be faced with long, tedious, and often painful therapy regimens. Many will want to give up. Don’t be surprised when they take their frustrations out on you. You need to have more patience than they do, to be able to remain calm and continually offer motivation and reassurance. This can take its toll on you emotionally, so learning how to handle stress is important. It will help if you develop interpersonal skills, good communication, empathy, and a healthy sense of humor. This can be physically demanding work. You will need to maintain a high degree of physical fitness both in terms of strength and endurance. Your hours could be long and there will be times when you’re doing most of the work for your patients. The best way to handle the demands is to keep up your own exercise routine. Figuring out the best therapy prescription for patients isn’t always that obvious. Often, you’ll have to apply your own ingenuity and adapt techniques to suit the person’s particular needs and circumstances. The most successful physical therapists have a unique combination of critical thinking ability and manual skills. It is very important that you be a people person. You’ll be dealing with all kinds of people from all age groups and social backgrounds. You’ll need to be able to relate not only to them, but also to their family members and the other professionals on their healthcare team. Other important characteristics to have are integrity, a strong work ethic, dedication, adaptability, and creative thinking. You should also have a strong interest in physical fitness, kinesiology, exercise, health and wellness, and nutrition. Naturally, if you intend to specialize in sports medicine you’ll be very interested in sports. 22

ATTRACTIVE FEATURES ARE YOU LOOKING FORWARD TO A SECURE FUTURE IN AN INTERESTING CAREER loaded with opportunites? Do you want a career in a healthcare profession without the rigors of medical school? Are you willing to invest in a college education if there’s a reasonable expectation of a payoff upon graduation? If the answer to these questions is yes, then physical therapy could be the career for you. Job prospects for the field of physical therapy are excellent and the potential is constantly growing. Industry and government surveys predict that physical therapy will continue to be among the fastest growing careers for the foreseeable future. This is one career that you can count on to provide plenty of job opportunities. Earnings prospects are excellent. Over the past decade, salaries have doubled and even tripled in some areas. It’s a matter of supply and demand. Because the demand far exceeds the supply of qualified physical therapists, employers must compete to fill openings. As a general rule, jobs pay better in big cities than in small towns. That is not necessarily the case with physical therapy. This is one of the few careers that can actually pay more in a small population area. That’s an ideal situation for someone who doesn’t want to be forced to relocate to pursue career goals. Physical therapists are rarely bored. You get to work with all kinds of people in a wide variety of settings. You can choose to work in a general practice and treat different kinds of patients each day. Not knowing who’s going to come through the door next and what the problem will be can certainly keep you on your toes and challenge your ingenuity. If you find that you are especially interested in a particular type of patient or treatment, you can specialize. Do you like working with kids? Specialize in pediatrics. Do you get a kick out of helping an athlete reach new levels of performance? Specialize in sports medicine. You can also choose how and where you work. You can set up your own private practice and work for yourself, go into a partnership in a group practice, or work for someone else on salary. You can work in a school, an industrial work site, a sports arena, a nursing home, a private office, or a hospital or clinic. Wherever and however you choose to practice physical therapy, you will enjoy the prestige of working in a valued healthcare profession. You’ll be respected by fellow professionals, the many patients you help throughout your career, and the public. If you’re looking for job satisfaction, you’re likely to find it in this career. 23

UNATTRACTIVE FEATURES EVERY CAREER HAS ITS DOWNSIDE, AND PHYSICAL THERAPY IS NO EXCEPTION. While it is interesting, challenging, and rife with opportunity, it is also a lot of hard work. The upside to choosing a career where you are in great demand is the security of knowing you’ll always be able to find a job. The downside is long hours and heavy workloads. Hospitals and clinics are often short-staffed. Sometimes that’s due to budgetary constraints, but often it’s simply because they can’t find additional recruits. Patients aren’t going to be turned away, so you may have to work overtime and handle more cases than is comfortable. The work itself can be physically, mentally, and emotionally exhausting. Treatments can be physically demanding. You will be lifting patients who cannot move or holding up limbs while you manually manipulate muscles and tendons that resist movement. On rare occasions, the job can even be dangerous. Patients who aren’t in control of their body mechanics can catch you by surprise with an unexpected and sudden motion. While performing a routine treatment, you could suffer an injury in the line of duty that requires a brace, traction, surgery, or – you guessed it – physical therapy. The emotional stress is far more fatiguing than the physical labor. People don’t come to you because things are going well for them. They’re in a life-altering situation, often desperate for relief and some sign of normal body function. Empathy is a primary trait required to do this job, yet caring about your patients and wanting to help them can be emotionally draining. You will be dealing with people who are in pain over a long period of time. It’s your job to constantly encourage and reassure them in the most positive terms possible and never scold or criticize. Internalizing your fear and frustration can take its toll on your health and well being unless you learn to deal with the stress. Sports medicine can be one of the most exciting specialties within physical therapy. Working in an outpatient clinic or at a health club, you’ll be stable and secure. Focusing on team sports might be more glamorous, but it’s also seasonal by nature. Except at the highest levels, team sports therapists often find they have to work another full-time job that provides a year-round income and consider the team position as a second job. During the season, this can add considerable pressure on the physical therapist’s time and workload. 24

EDUCATION AND TRAINING There are three basic requirements for practicing as a professional physical therapist: a bachelor’s degree from an accredited four-year undergraduate college or university, a post-baccalaureate graduate degree in physical therapy, and certification. Undergraduate Education College admission officers will be looking for a solid high school education and evidence that you have seriously committed to physical therapy as a future career path. You will need the usual college prep courses, with four years of natural sciences including physics. Your chances of being accepted will definitely increase if you do any volunteer work as a physical therapy aide. Be sure and get as many letters of recommendation from physical therapists or science teachers as you can. A grade point average of 3.0 or higher will also be expected. As a physical therapist, a big part of your job will involve educating patients and their families about their treatments. Because you’ll be working closely with all kinds of people from different backgrounds and cultures, a broad liberal arts program is recommended for your undergraduate work. You’ll need courses that help you develop good skills in communication (both written and oral), critical thinking, interpersonal exchanges, and mathematical problem solving. In addition, extensive course work in the natural sciences will be necessary to lay the groundwork for graduate study. Physical Therapy Program Physical therapy programs are offered at two degree levels: doctoral (DPT) and master’s (MPT, MSPT, MS). To be eligible for certification, you will be required to have at least a master’s degree. A doctoral degree is not required; however, students are increasingly choosing this degree program. According to The American Physical Therapy Association (APTA), the majority of practicing physical therapists will possess a DPT degree by the year 2020. A typical physical therapy program will be heavily slanted toward medical sciences, starting with basic courses in biology, chemistry, physics, statistics, anatomy and physiology, and psychology. Your education will progress towards more specialized studies such as research methodologies, abnormal psychology, kinesiology, biomechanics, neuroanatomy, human physical development, manifestations of disease, examination techniques, clinical procedures, and therapeutic modalities. 25

Not all your education will take place in the classroom. A heavy emphasis is placed on applying what you’ve learned in theory to real clinical situations. Sometimes you’ll be an observer; other times you’ll be allowed to work hands-on under supervision. You will be spending a lot of time observing professional therapists working in a variety of practice settings. This is a valuable learning experience. It will also help you determine the particular area of practice to pursue upon graduation. As in most healthcare careers, a physical therapist’s education never stops. To keep up with new treatment techniques and clinical developments, expect to participate in many continuing education courses and workshops throughout your career. Certification After graduation, you’ll be eligible to sit for the national physical therapy exam administered through the American Physical Therapy Association (APTA). Before you will be allowed to practice, you will need to successfully pass this exam. This is a requirement of all states and Puerto Rico. Some states have additional requirements, such as state licensure and/or continuing education to maintain licensure. EARNINGS BECAUSE OF THE GROWING MARKET DEMAND, SALARIES FOR LICENSED PHYSICAL therapists have increased in recent years. Overall, you can expect a career in physical therapy to earn you a good living since the median salary is about $60,000. There is, however, considerable variation in salaries from entry level to the top of the profession. How much you will earn depends mostly on your level of experience, where you live, and where you work. Starting out, your first job will probably pay somewhere between $25,000 and $35,000 depending on where you are. Sports physical therapists are generally paid at the lower end of the scale, but those who choose this specialty insist that the stimulating work environment makes it worth the small sacrifice in pay. With experience comes more money and after a few years, you could double your income. With a combination of experience, the right geographic area, and a good practice setting, top salaries can go as high as $100,000. The best way to determine what you can expect to earn is to talk to practicing therapists in your area. 26

OPPORTUNITIES THE EDUCATIONAL REQUIREMENTS FOR THIS CAREER ARE DEMANDING, REQUIRING a minimum of four years of serious academic study. So naturally, you’re wondering if there’s going to be a job waiting for you when you’re finished. The definite answer is yes. This is one of the hottest careers of the decade. Forecasts for future job growth are excellent. Physical therapists enjoy one of the lowest unemployment rates of any career. The demand for services is high and is expected to rise continually for the foreseeable future. Why is there such a need for physical therapy? There are several reasons. One is the rapidly growing population over age 50. The aging process brings with it increased incidence of chronic and debilitating conditions. Even the healthiest individuals become more vulnerable to unexpected disabilities and limited functions. As millions of Baby Boomers join the ranks of the elderly, they face the prospect of heart attacks, strokes, fragile bones, and stressed joints. Baby Boomers tend to be active people, determined to stay healthy and fit as long as possible. Walk into any health club and you’ll find that a large percentage of members belong to this generation. Ironically, this obsession with staying young and active is another reason sports physical therapists will continue to thrive. As exercise and participation in sports increases, so do stressed bodies and sports injuries. At the other end of the age spectrum, more and more babies will require therapy. Technology is allowing many children to be born who would not have survived in the past. Unfortunately, this translates into a greater number of birth defects, some severe. Likewise, as technology saves more lives, survivors of traumatic accidents and disabling conditions will need rehabilitative therapy. More and more physical therapists are being employed to prevent injuries, rather than treat them. Loss in productivity due to ill health and injuries costs a lot more than developing programs to keep employees fit. Employers use physical therapists to make sure workers are performing their jobs safely and to promote overall health by designing exercise programs. 27

Most physical therapists work for hospitals or physical therapy centers. Others are employed by home health agencies, outpatient rehabilitation services, doctors’ offices, and long-term care facilities such as nursing homes. Some are self-employed, contracting their services to the same types of facilities but also seeing individual patients. It’s common to see a sports physical therapist operate a private practice out of a health club or a multidiscipline healthcare group. Upward career mobility isn’t a big draw in this career, but there are some opportunities to advance if that’s important to you. If you work for a hospital or a large healthcare agency, you could move into a management or administrative position. Another way to increase your potential earnings is to open your own practice or clinic. If you have an advanced degree, you could teach at the college level or possibly do research. Patients of every background, age, race, ethnicity, and religion need physical therapy. This creates a tremendous opportunity for multilingual therapists. Cultural diversity is continuing to grow in the US and with it the need for physical therapists who can relate to a wide variety of patients and their families. GETTING STARTED ONCE YOU’VE GRADUATED WITH A DEGREE IN PHYSICAL THERAPY AND HAVE successfully taken the certification test, you’re a duly licensed physical therapist ready for your first job. But don’t make the mistake of waiting until this point to get started looking into the employment possibilities. You should be laying the groundwork throughout your college years. A big part of your education will involve working in clinical settings under the supervision of licensed professionals. This is unpaid work, but it is abundant with opportunity. Take the time to talk to the people who work there. Ask questions, let them know you’re excited about your career choice, and let them see you in action doing your best to learn what it takes to do the job and take on responsibilities. This is a great time to start networking. The contacts you make could last a lifetime. 28

Any time you have the chance, volunteer to work or observe in physical therapy or sports medicine settings. Community service organizations, clubs, and other nonprofit groups are always looking for volunteers. Every bit of experience you get will not only help you perform your job better when you get one, it also looks great on your résumé, which can look a little sparse when you are just starting out. Remember, experience listed on a résumé does not have to be paid experience; volunteer work counts. Ask your guidance counselor to help you find an internship. There are many internship programs available through hospitals, clinics, and nursing homes. If you are in a big city, you might even be able to choose the particular area of therapy that interests you most. But be willing to try different settings. That is a good way to investigate different specialties. Aside from networking, there are several good ways to find your first job. Your school will have listings of job openings. So will the state employment office and the classified section of your local paper. There are employment agencies, both on the Internet and off, that specialize in health related jobs. And there are industry associations just for physical therapists that post jobs from all over the country. You’ll find some of them listed at the end of this report. You can also go straight to the source. Apply directly to hospitals, clinics, health clubs, sports teams, schools, and any place where physical therapists work. In conducting your job search, you’ll need to have a good résumé, a cover letter, and references from teachers and professionals you’ve worked with. But always keep in mind that your greatest asset will be your enthusiasm and your genuine desire to help people. 29

ASSOCIATIONS n American Physical Therapy Association http://www.apta.org n American College of Sports Medicine http://www.acsm.org n The National Academy of Sports Medicine http://www.nasm.org n Health Occupation Students of America http://www.hosa.org SCHOOLS n Armstrong Atlantic State University http://www.pt.armstrong.edu/ n Creighton University http://pt.creighton.edu/ n George Washington University http://www.gwumc.edu/healthsci/pt.htm n Lorma College http://www.lorma.org/pt/ n Medical College of Georgia http://www.mcg.edu/SAH/PT/Index.html n Medical College of Virginia http://www.pmr.vcu.edu/ n Northeastern University http://www.ptd.neu.edu/ n Nova Southeastern University http://www.nova.edu/cwis/centers/hpd/allied-health/ n Slippery Rock University http://www.sru.edu/depts/pt/ n South West Texas State University http://www.health.swt.edu/PT/pt.html 30

n University of Delaware http://www.udel.edu/PT/ n University of Tennessee http://www.utmem.edu/physther/gpintro.html n University of Washington http://www.utmem.edu/physther/gpintro.html PERIODICAL n The Physician and Sports Medicine Journal http://www.physsportsmed.com/journal.htm WEBSITES n Rehab Options Placement Service http://www.RehabOptions.com n PhysicalTherapist.com job site http://physicaltherapist.com n PTjobs.com job site http://www.ptjobs.com n Sports Medicine Jobs http://sportsmedicinejobs.com n Sports Medicine on the Web http://www.sportsmedicine.com n Federation of State Boards of Physical Therapy http://www.fsbpt.org COYRIGHT 2007 Institute For Career Research CHICAGO CAREERS INTERNET DATABASE www.careers-internet.org 31