Wednesday 29 June 2016

I Asked A Physiotherapist How She And I Compare

Athletic Therapists are consistently compared to Physiotherapists, and we're constantly asked to describe the differences between us. I won't lie; I see a problem with asking one person alone to describe the gap. An AT will likely come off as prickly to try and measure up to the PT. A PT might view us as inexperienced clinicians of a young profession. So, in that case, I took the diplomatic approach and interviewed my friend Lisette, a Physiotherapist in Vancouver. Between an AT and PT, we broke it down.


Me: Athletic Therapy is officially defined by Canadian Athletic Therapist's Association as follows:

"Certified Athletic Therapists are best known for their quick-thinking on-field emergency care of professional and elite athletes. The first to respond when someone gets hurt, they are experts at injury assessment and rehabilitation. It’s that same mix of on-site care and active rehabilitation skills that makes Athletic Therapists so effective in treating the musculoskeletal (muscles, bones, and joints) injuries of all Canadians, whether on the field or in the clinic.

Athletic therapists adhere to the Sports Medicine Model of care. They treat a wide range of patients, from kids with concussions to seniors recovering from hip replacement surgery, using various manual therapies, modalities, exercise prescription and even bracing and taping. The treatment varies but the objective doesn’t: an Athletic Therapist's goal is to help clients return to their usual activities, whether that means playing competitive sports or walking to the mailbox and back.

The five practice domains are as follows:
  1. Prevention
  2. Assessment
  3. Intervention
  4. Practice Management
  5. Professional Responsibility"

Can you please define your field of physiotherapy for me?

Lisette: To put it simply, Physiotherapy is a healthcare profession dedicated to working with people to identify and maximize their ability to move and function throughout their lifespan.

From our association websites, PABC and CPA, you can find more information:

Me: The education process for Athletic Therapy is to complete a four-year Bachelor's Degree in Athletic Therapy (at which there are seven schools in Canada), which consists of extensive practical and hands-on instruction. We are then required to complete 1200 hours of practicum, and then attempt the national board exam to finally certify.

Could you  tell me about the education process of Physiotherapy? Please mention if there's any comparisons or contrasts you'd like to make.

Lisette: The education process within Canada is to complete a 2-year Masters degree in Physical Therapy, with most schools requiring slightly different admission criteria on top of an undergraduate degree. While it varies from school to school, most are looking at GPA of the last 2 years of your undergraduate degree that are 300- and 400- level courses, prerequisite courses, volunteer hours and professional references. Most have the McMaster University adapted “MMI”, or Multiple Mini Interview format, similar to that of medical school. The programs consist of theoretical and clinical components and we have separate national board written and clinical exams to pass in order to fully practice with no restrictions.

When it comes down to it, can you describe the differences between the two fields, firstly in the specific scope of practice, and secondly in terms of experience and focus of work.

Lisette: It is actually quite difficult to describe the differences between the two fields, at least from my perspective. The scope of physiotherapy is quite broad and encompasses several different and varied practice areas. I think the biggest overlap of a PT and an ATs scope of practice is with sport and orthopaedics, which a large portion of PTs work in, sometimes within the same clinics as ATs. As from our association website, physiotherapists are employed in multiple settings, not just in private clinics that many people are accustomed to:

Back pain
Cardiovascular Conditions (including post heart attack, 
Chronic Obstructive Pulmonary Disease (COPD), and pneumonia)
Cerebral palsy
Chronic Pain
Critical Care
Developmental Delay & An Array of Paediatric Conditions
Falls & Fractures
High Blood Pressure
Multiple Sclerosis
Neck Pain
Neurological Conditions (stroke, concussions, spinal injury, Parkinson’s disease),
Occupational Health
Oncology-Related Conditions (including lymphedema)
Pregnancy-related Incontinence
Vestibular Disorders (dizziness)

Just to name a few. :)

Taken from CPAs website, our scope of practice is as follows: The ‘foundation practice acts’ are in all provincial legislations and include assessment of neuro-musculoskeletal and cardio
respiratory systems, therapeutic exercise, electrotherapy, hydrotherapy, soft tissue techniques, manual therapy, wound management, and tracheal suctioning. The knowledge and skills required to perform these acts are taught in the entry-level physiotherapy curricula in all Canadian university programs and are included in the blueprint for the Physiotherapy Competency
Examination administered by the Canadian Alliance of Physiotherapy Regulators.
Other acts, such as spinal manipulation or dry needling (acupuncture) are within the profession’s authorized scope of practice but are not considered entry-level. They require additional education and training following graduation.

Me: Definitely, a physiotherapist’s scope of practice extends across a much more broad range than an AT’s, but as you said, there is a lot of overlap in our skillset when it comes to orthopedics, musculoskeletal rehab, and sport. If I were to just pull from your same list, my list would, of course, be shorter, but still encompass quite a range itself.

Back pain
Chronic Pain
Critical Care
Falls & Fractures
Neck Pain
Neurological Conditions (stroke, concussions, spinal injury, Parkinson’s disease)
Occupational Health

We also have the addition of being the on-field specialists, as you said. On sports fields - and in labour fields and factories as well, in fact - we are trained professionals in quick on-site assessments, shorter-term injury care, and first responders in the events of emergency.

As well, if I dare to make a slight side-step, many AT’s receive full training as Exercise Physiologists as well. While we’re not all necessarily certified as such, and while the exact scope of our skills are different, we are known to be adept with chronic diseases such as high blood pressure, diabetes, and osteoporosis ourselves.

Also like a PT, ATs will further-specialize in specific sub-fields; simply within a smaller pool, but no-less skilled in them. We do have a wide-array of entry-level skills and techniques, but, like I’m sure is the case for you as well, the continued-education is endless if we so choose.

Can you provide an example or two of a type of client or situation that you would refer away to an AT?

As a physio, I firmly believe in client-centred care. To me, that means if a patient is better-served by a different practitioner, whether it be within the same profession or not, that is the most important thing. As I mentioned previously, I think that the scope of an AT falls within that of a physical therapist’s. From what I understand, the majority of an AT’s focus in school is sport and rehabilitation, as well as on-field assessment. When we graduate from physio school, we are entry-level PTs that are considered generalists. I would say that the majority of my classmates have gone on to orthopaedics, and some have started to specialize in sport rehabilitation. I think this is where the lines get quite blurry, because of the overlap in scope. I don’t think one or the other would be better or worse for a patient to be treated by, just as within the domain of physio there are different treatment styles, techniques and theories which seem to have all had success and have better success with some patients than others. Let’s put it this way: if I have a patient who is a basketball player and after trying some things, the patient did not seem to improve, I would consider referring him to either another PT that I knew could potentially be more successful, or another rehabilitation expert, such as an AT.

I often feel like, as an AT, I’m almost akin to a physio that fast-tracked a speciality. While I don’t receive any training when it comes to MS, cerebral palsy, or cancer, I graduated school with speciality-level skills in the orthopedic field immediately. I think a lot of people view us as less competent due to our fewer years of education than a Physio or Chiro, but it’s important to remember that there’s a tradeoff. Fewer years with a narrower, but more specialized scope of practice versus a longer program with a broader, but more general knowledge-base.

That isn’t to say that that, by default, makes me more qualified than a Physiotherapist when it comes to musculoskeletal conditions. If I know of a Physio with more experience with certain types of injuries than myself and I think that my client is better off with them, then of course, they’re referred on. On that note, while AT’s can safely treat orthopedic conditions of clients who also have other chronic diseases (MS, cancer, etc.), if those diseases are complicated to the point that they would start directly affecting my treatment process, then there isn’t a question of if I send them on or not.


A quick interview for sure, but thanks so much, Lisette, for answering my questions. I hope that this sheds some light on the comparisons and contrasts between these two professions. My goal is to see Athletic Therapy as a well-known and widespread option available to everyone in the coming years. It helps if I can show people that we're more than just soccer team-tapers or a baby-profession that hasn't found its legs yet. At the same time, we're not here to replace Physiotherapists or discredit the amazing work that they do.

If nothing else, I also hope that this post triggers questions to be asked of Athletic Therapists. If you have one, please do not hesitate with it.

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