Physical Therapy as Primary Care

This post was written by Patricia Fasciotti and Maurice Dumit, physical therapists at INVIVO Wellness.

Patricia recently had dinner with a friend, and it came up in conversation that he is not running anymore. He was clearly frustrated and admitted to having some knee pain. He went to an Orthopedic doctor, had Xrays and was told nothing is wrong and that he just shouldn’t run anymore.

As a Physical Therapist and as an avid runner, Patricia felt that this particular doctor’s advice was not only detrimental to her friends’ long-term health and quality of life, but his diagnosis was uneducated. How do we dare say the doctor is uneducated?

Allow us to explain.

How many hours of orthopedic education do you think medical schools require? In one study we reviewed, primary care physicians are reported to get an average of 2.37 weeks of clinical clerkships in physical medicine and rehabilitation. 47% of medical schools (from another study published in 2003) had no required instruction in musculoskeletal medicine! It’s an elective for most. In yet another study, physicians in 417 internal medicine departments were given a basic musculoskeletal competency exam. 78% of the physicians Failed!

We think it is reasonable to conclude that medical school preparation for musculoskeletal medicine is inadequate. And yet 13-28% of people going to primary care clinics present with complaints of musculoskeletal problems!

Conversely, Doctors (and Masters) of Physical Therapy receive a highly concentrated curriculum of courses focused on neuromusculoskeletal problems. These courses include Gross Anatomy, Applied Physiology, Rehabilitative Neuroscience, Pathophysiology, Medical Imaging, Clinical Medicine and Pharmacology. And that is only one semester! Physical Therapists specializing in Orthopedics will continue to take advanced courses in specialized techniques ranging from advance joint and spinal manipulation to dry needling, and myofascial release techniques.

Physical Therapy interventions have been shown to be cost-effective and provide good alternative results. A recently published study demonstrated that Physical Therapy is just as effective as decompression surgery for relieving symptoms and improving function in patients with lumbar spinal stenosis (Annals of Internal Medicine, 2015). Also physical therapy for patients with new episodes of low back pain resulted in less than half the cost of imaging and generated lower costs associated with use of health care resources over time (March 2014, Health Services Research).

Further evidence that Physical Therapy should be used as a primary intervention is supported by State legislation. As of January 1, 2015, all 50 states, the District of Columbia, and the US Virgin Islands allow patients to seek some level of treatment from a licensed physical therapist without a prescription or referral from a physician.

In multiple studies comparing clinical exam skills, Physical Therapists were shown to have equal abilities to diagnose musculoskeletal conditions. True we cannot order MRI’s or Xrays, but these imaging studies are often not necessary or truly indicative of the pain generator.

We do believe that collaborative care with physicians can provide good results but the truth is (and studies are supporting this more and more) that for chronic and many acute Orthopedic issues, Physical Therapy should be your drug of choice!

INVIVO’s award-winning Physical Therapy program helps hundreds of patients each year reclaim their bodies and discover a more balanced way of living. If you are experiencing pain, Physical Therapy is a good place to start. INVIVO Physical Therapy is also a preferred provider for all major insurance and Medicare. Call (414) 265-5606 or click here to schedule an evaluation or free injury screening.


Patricia Fasciotti is Physical Therapist and yoga instructor at INVIVO Wellness in Milwaukee, WI. Patricia holds a Masters of Physical Therapy from UW-LaCrosse and then went on to complete her Doctorate in Physical Therapy (DPT) and Certification in Sports Therapy (STC) through the North American Sports Medicine Institute in partnership with the University of St. Augustine. Patricia lives in Brookfield with her husband and two children. She enjoys running, yoga, pilates and exploring all this great city has to offer!

Maurice Dumit is owner and Physical Therapist at INVIVO Wellness in Milwaukee, WI. Maurice holds a Masters of Physical Therapy degree from Marquette University and a bachelor of science in Kinesiology from the University of Wisconsin-Milwaukee. He is an avid runner of half-marathons and marathons, a dedicated golfer and student of yoga.