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PHYSICAL THERAPY: Growing by leaps and bounds Active lifestyles, aging population increase the demand for services


Spring is a heavy season for physical therapists. Walk into any physical therapy facility at any time of day, and you'll see evidence of it.

In the morning there's the retiree getting friction massage on his tennis arm for the tendinitis that flared up after a recent match. In the afternoon, you'll see the high school lacrosse player soaking his sprained ankle in an ice bath. Late in the day, the sedentary office worker will arrive for heat treatments after wrenching her back turning over the garden on the first sunny weekend of the season.

Even baby boomers, who grew up in the Kennedy years when lifelong physical fitness was touted as a national goal, are now making demands on physical therapists.

Warm weather brings out the weekend warrior, and all that activity leads inevitably to injury. But health professionals are quick to point out that injuries during outdoor activity only aggravate an already swelling demand for physical therapy. Everyone, it seems, from chronic neck pain sufferers to accident victims to recovering cancer patients is discovering that life can be improved with a few weeks or months of physical therapy.

Whirlpools, swimming pools, hot packs, cold packs, electrical stimulation, ultrasound, traction, hands-on therapy, and rooms full of exercise equipment that would make a health club pale in comparison are among the treatments therapists -- both private and hospital-affiliated -- make use of.

Therapists agree that a combination of factors are involved in the rather recent increase in demand for physical therapy. They note an aging population, improved medical and surgical techniques that allow us to survive devastating illness, an overall shift from in-patient to out-patient hospital care, a preoccupation with physical fitness that can lead to injury, and some all-American impatience.

Indeed, in our fast-paced society, people are no longer willing to wait for nature to take its course, says Neil McDonald, director of the Sports Medicine Center at Union Memorial Hospital.

"It was not unusual years ago to have a knee or hip replacement and hear the doctor say, 'Go home and walk a little and wait for it to heal.' But nowadays people aren't comfortable with taking months to recover," he says.

"We want fast food and instant results, and that's true in our health care, too."

In addition, Mr. McDonald notes, medical advancements in the last decade have shifted the emphasis in treatment from in-patient to out-patient care.

"Look at knee surgery to repair a torn cartilage," he notes. "It used to be done on an in-patient basis under general anesthesia with two or three days in the hospital. Now it's done as an out-patient, with local anesthesia and you go home right away."

The first health professional such a patient sees after his release is often a physical therapist to help speed his recovery, says Mr. McDonald. Union Memorial recorded more than 25,000 out-patient visits to its physical therapy centers last year, including its hand, spine, sports medicine and general out-patient facilities.

The fact that the population in general isn't getting any younger only exacerbates the need. The older people are, the more bones they break, the more illnesses they suffer and the more need they have for post-surgery assistance.

And those baby boomers, with their emphasis on physical fitness, are more frequently subject to injury.

"That's a segment of the population that was educated that fitness is important, and exercise has become an important component of their lives," Mr. McDonald notes. "They want to stay active, but they're older now and not quite as flexible. They're starting to suffer from overuse."

In fact, "people who work out on weekends only are our biggest customers" says Mr. McDonald, a licensed physical therapist who is also certified as an athletic trainer.

The American Physical Therapy Association says about 350,000 people are treated daily by physical therapists. It estimates that while there are about 75,000 physical therapists practicing in the United States, the need for therapists is growing so rapidly that a shortage is expected to continue well into the next century.

"Traditionally, you think of a physical therapist in a hospital setting," says APTA spokeswoman Alexis Waters. "But today they are practicing in a large variety of places, including nursing homes, industry and public schools. In fact, the trend is toward private practice."

She notes that while therapists used to concentrate on treating spinal and neurological problems, today their services are being demanded for a variety of reasons that reflect the times. A typical patient today could have carpal tunnel syndrome (an industry-related condition involving repetitive hand movement), or need to regain her strength after breast cancer surgery or a joint replacement, or be recovering from a sports-related injury.

"Our lifestyles have changed," says Constance Mech, a physical therapist in private practice in Catonsville. "We're doing risky things like leaping out of airplanes and skiing. And a more adventurous lifestyle means more injuries.

"Skiing alone keeps us in knee injuries," she adds, noting that one of her patients refuses to give up the wintertime sport even after two operations.

Ms. Mech spent 13 years as a physical therapist at Kernan Hospital in northwest Baltimore before opening her own practice more than six years ago. While she still treats some pediatric patients and an occasional stroke victim, she concentrates on orthopedic problems -- bone, muscle and joint conditions -- one of the fastest-growing areas in therapy.

Among her patients is Sue Metz, a Catonsville medical assistant who had reconstructive surgery on her ankle in January for a torn tendon. She has been visiting Ms. Mech a couple of times a week since her cast and brace were removed two months ago.

Mrs. Metz, 50, says her problems began the day she sprained an ankle while playing tennis some 12 years ago. She says her ankle never completely healed and that she just "learned to live with it."

"I would wrap it and just put up with a chronically bad ankle," she says, noting that she continued to play tennis, using an air cast for ankle support when necessary.

"Finally the pain got so bad in my ankle and foot that I couldn't walk on it," she says, and she consented to surgery. With therapy, she has been able to resume her work schedule and return to a regular regimen of walking. She hopes to be back on the tennis court in a couple of months.

"We're talking about quality of life here," says Ms. Mech. "Instead of living with that bum knee or bad back, people are saying lets do something about it."

Even though Maryland is one of 23 states in which you do not need to see a physician before being treated by a physical therapist, it is generally believed that health insurance companies are more likely to reimburse the patient if therapy is done on a physician's recommendation.

The cost of therapy varies widely, depending on the treatment. The patient is usually charged for each "modality" or form of treatment, such as traction, ultrasound, massage, electrotherapy, exercise, etc. A single session could range from $45 to $125, depending on the number and kind of modalities used, says Ms. Mech.

She says people are attracted to physical therapy because of its "conservative" image.

Therapists do not diagnose illness, nor do they administer lab tests, order X-rays or dispense medications. Rather, they prefer to say they "evaluate" patients in a lengthy physical exam that scrutinizes a person's motions, sensations and strengths.

Based on the evaluation, they recommend a treatment plan specifically for the individual. It may include everything from simple hands-on treatment to the use of high-tech equipment like the Cybex, a machine designed to exercise a muscle and test its strength.

Despite the recent technical advances, in many cases patients say it is the educational aspect of therapy that makes the greatest impression.

"It's not only a physical feeling," says Mrs. Metz. "There's a lot of encouragement here. For someone to explain to you exactly what you are feeling and why and to reassure you that it will get better is very important."

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