A ROLE BEYOND REHAB;
EVEN THE INJURY-FREE MAY GAIN FROM ADDING A PHYSICAL THERAPIST TO THEIR FITNESS PROGRAM
NADINE EPSTEIN
SPECIAL TO THE WASHINGTON POST
Tuesday, March 20, 2001 ; Page T08
When my doctor referred me to a physical therapist for treatment of an injury a few years back, I gained far more than I expected. As the therapist treated me, she taught me things I never knew about my body's musculoskeletal structure, unraveling mysteries that had long troubled me.
I learned why I had been an uncoordinated child, the kind who never could do a cartwheel, always one of the last to be chosen for a team. I discovered why my hip joints had always hurt when I walked, worked out or rode my bike. No gym teacher, personal trainer or physician had ever provided me with this information.
The first and most obvious culprits were my hip flexors -- my iliopsoas muscles -- which attach the lumbar spine to the upper thigh, threading through the pelvis along the way. They were so busy trying to stabilize my lower back that they were falling down on their primary job -- movement. Since they weren't made to stabilize spines, they weren't doing a good job of it and had grown far too tight and powerful.
As it turns out, my domineering hip flexors were compensating for a series of other weaknesses. My lower back was too mobile while my upper back wasn't flexible enough. What it came down to was this: I was propelling myself through life with my hips instead of my trunk. The tail was wagging the dog. No wonder I had never mastered a cartwheel.
My experience, it turns out, reflects a trend that is redefining the relationship between physical therapy and fitness. Although most physical therapists still focus on helping people recover from injuries, a growing number are switching over to prevention, according to Nancy White, vice president of the orthopedic section of the American Physical Therapy Association, who teaches physical therapy at Howard and Marymount universities.
"Increasingly," she says, "we are working with people who don't necessarily have a problem. This has come about as people have become more interested in healthy lifestyles, exercising and taking care of themselves than ever before."
Could a physical therapist help you?
Could be, especially if you have been injured previously, have a chronic musculoskeletal problem such as a bad back, knee or other joint, or are simply curious about your body's structure.
In these cases, a physical therapist -- who has a bachelor's or master's degree in a medical-model academic program and has passed a state licensure exam -- can assess problems and weaknesses, and design a detailed program to meet your specific needs. Otherwise you may do just as well to see a personal trainer. Personal trainers teach you to do exercises properly in a general way, check your technique and keep you motivated, says Laurent Amzallag, a Bethesda personal trainer and fitness consultant. But they don't usually provide as much detailed information about your musculoskeletal system as a physical therapist. "Most personal trainers check for muscle strength, cardio-endurance, overall fitness and some nutrition," he says. "The rest is beyond our scope."
Unless, that is, you're at a facility like the new Beyond Fitness in Rockville, where all the trainers are physical therapists. Combining the two disciplines, says president and founder Steve Daisey, "is a heck of a lot safer and more effective. We could look at your shoulder and tell if there's a minor rotator cuff tear or see if you have problems with your spine, stuff that could turn out to be problematic if you exercise the wrong way."
Daisey makes no bones about the fact that his is a hostile invasion of once-foreign turf; many traditional trainers, he charges, lack the knowledge to conduct safe exercise programs.
But all trainers and therapists don't necessarily view one another as competition; they often work in tandem. Amzallag approves when clients check in first with a physical therapist. "The more knowledge that a client can provide a personal trainer, the less likely an avoidable injury will occur," he says. "If a client has one shorter leg, I need to know that. Otherwise when I put her on the treadmill, her back will hurt."
Tom Papke is one of many physical therapists who fled from a corporate contractor with managed care providers to focus on wellness within a fitness environment. Papke now leases space for his Capitol Metro Physical Therapy at Sport and Health Clubs in Old Town Alexandria and Ballston. In addition to offering rehab services, he works closely with health club fitness staff and offers free screenings for members. "In a health club setting, we're set up for wellness," he says. "Physical therapy adds an understanding of pathology and movement."
In Arlington, physical therapist Jennifer Gamboa and staff offer a variety of fitness reeducation and preventive programs at Gamboa's studio, called Body Dynamics. Some classes cater to dancers and ice skaters; others feature Pilates and movement. They also do personal training with clients, most of whom have suffered previous injuries.
Papke and Gamboa both start with a basic musculoskeletal fitness screening, in which they assess posture, muscle strength, flexibility, joint and spine motion, core stability, balance and proper integration of the musculoskeletal system. The session costs around $75. "We identify how everything is working together and change the body's strategy," says Gamboa.
After the screening, the therapist develops a plan that can include home exercises, gym pointers, suggestions for a personal trainer or classes. Some people choose to continue working one-on-one with a physical therapist; the cost generally ranges from $60 to $100 an hour. Clients typically visit once or twice a week. Expect to pay for visits out-of-pocket, unless you've been injured. Most insurance policies don't cover preventive medicine.
My physical therapist was like a detective who uncovered -- clue by clue -- why my hip flexors were overworked and what was preventing my musculoskeletal system from working as it should.
Over a series of sessions, she got my joints moving, suggested adjustments and gave me exercises to do at home. Then she relaxed my hip flexors with soft-tissue massage. While studying my lower back and pelvis, she noticed that my left leg was a fraction of an inch shorter than the right. This mismatch was an invitation for lower back problems, she said. I was given a lift for my shoe.
Next came a new fitness plan. I stopped doing leg lifts and other exercises that strengthened or tightened my hip flexors. Instead I learned to strengthen my trunk by using my abdominal muscles in all movements. I felt better, moved more comfortably and began to grow stronger.
Others have had similar experiences.
Tracy Steiner, a 32-year-old Silver Spring lawyer in her eighth month of pregnancy, receives one-on-one Pilates training from a Body Dynamics physical therapist. The goal both here and in her regular workouts with Amzallag is to strengthen her back and core support muscles. To accommodate her curvature of the spine and two herniated discs, her therapist has helped her modify exercise positions and everyday activities to reduce stress on her lower back.
"Some exercises that other people can do standing, I have to do seated or on an incline," she says. "I also have to alter grips for certain machines and be very careful about posture and form while exercising."
Steiner says she likes what the sessions have done for her. "I feel more in control. I now have a much better appreciation of the mechanics of my body."
In my case, the visits to a physical therapist were well worth the time and expense. A properly functioning musculoskeletal system transformed my physical approach to the world. Strengthened, stretched and armed with new knowledge, I have changed how I walk, sit, stand, sleep, exercise and think about my body. One of these days, if I'm lucky, I may even learn how to do a cartwheel. Nadine Epstein is a Washington writer, artist and late-start exercise enthusiast.
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