Sports Med Physician Vs Physiotherapist

[Justin Vanderleest]

On 4/30/2013 at 1:55 PM, ralk said:

 

PTs receive a ton of training and have MSK knowledge undoubtedly beyond that of an average physician who does not work directly in the field, but they are not allowed to give diagnoses in many jurisdictions. That is not a statement on the typical physiotherapist's knowledge or abilities, but on the legal framework of the medical system in Canada.

 

Now, this is changing. I will stand corrected in that I was too absolute in my first statement; in Ontario, they have been given the right to communicate a diagnosis, but this is a relatively new development (not even two years old). Not all jurisdictions have this in place. They still cannot order tests, though this is coming. Further, the scope in which they are allowed to diagnose conditions is limited.

The ability to communicate a diagnosis was written into legislation in Ontario in about 2011, I believe. I graduated in Saskatchewan in 2005, and physiotherapists were trained to communicate a diagnosis, there, at that time. In most jurisdictions, physiotherapists are considered primary practitioners and patients can go straight to the physiotherapist, who can make a diagnosis. PTs are expected to be able to recognize sinister pathology, or at least pathology outside their scope of practice, and refer to the doctor as indicated.

[Justin Vanderleest]

On 4/30/2013 at 12:40 PM, goleafsgochris said:

 

I was just gonna say the same thing lol. If youre aiming for PT and think this is what youre getting into, seriously consider shadowing a physio 1st. I have worked with them A LOT. Docs perscribe PT, PT does exercises. Atleast in a practical sense, they dont diagnose, or even treat except what docs have perscribed

Doctors don’t prescribe PT, they refer to PT. Semantics perhaps. But, you prescribe something that you yourself can dose specifically. If you are engaging another person for a consultation based on their expertise, that’s a referral. The doctor prescribes a brace or a medication. The physiotherapist prescribes exercise and other forms of therapy.

Also, physiotherapists do diagnose in most jurisdications. According to Aicken and McColl 2009, physiotherapists diagnose on par with orthopaedic surgeons and much better than GPs. However, physiotherapists provide more treatment recommendations than surgeons as they tend to do an assessment that looks for more impairments and dysfunction. It results in a more detailed analysis of the causative factors at play. That makes sense when you think that the typical physiotherapy assessment is 40-90min long, compared to the much shorter typical consult with a physician that may last 5-15min.

[hummingbird88]

As a primary care sports medicine physician in Canada, I'm not particularly debating any points above but this is my perspective.

Sports Medicine can include everything within musculoskeletal and neurological medicine (but also so much more, read below).  The diseases we see sometimes overlap with Ortho, Neuro, NeuroSx, and Physiatry, but sometimes do not.  We have far more training than family physicians in the diagnosis of MSK/neurological issues.  Even when physical therapy is the main solution - "sending them to PT" isn't good enough - we can also diagnose what's going wrong with treatment based on alignment/loading/type of activity/other comorbidities.  We provide detail prescriptions for exercise and rehab.  Sports Physicians also treat with medications, injections, manual therapies, acupuncture, etc.  

It goes beyond being able to order images - we don't treat MRIs, we treat patients.  It takes skill to know what is the pain generator when multiple findings (or NO findings) show up on an image.

There are also many nutritional/metabolic diseases which can relate to the highly active (even if not competing at an elite level), such as: Fe deficiency (athletes have higher Fe requirements), RED-S and eating disorders.  There's exercise-induced migraines, diarrhea/GI symptoms, asthma and migraines. There are concussions - acute and chronic issues and how to return to work/play/school safely.  

There are several paediatric sports medicine injuries that family physicians don't know what to do with!  Never mind they can still get many injuries we see in adult populations.  We end up seeing tons of these patients, most of which do not need surgery but all of which require good child/parental/coach counselling and a detailed follow-up plan.  

There is a whole field of sports psychology, and several physicians train specifically in counselling for these issues.

Team physicians need to know everything a family doc does AND sports med.

Physiotherapists/kinesiologists are the experts for biomechanics and technically they do spend more time with each patient.  Not all sports med docs will take the time to care - I understand that.  But it's the same variability within any family practice/primary care subspecialist/specialist.  There are plenty of patients I see who cannot afford a physiotherapist - without sports medicine specialists, they often fall between the cracks when GPs just tell them the diagnosis or give them a handout.  I often demonstrate rehab exercises.  But I would not say that my scope is that of a physiotherapist.  We also don't learn a ton about taping/bracing etc, and we often work closely with ATs as well, especially when providing team coverage.

TL;DR: Sports Medicine is comprehensive MSK, neurological, nutritional, and psychological care relating to injuries in people of ALL ages and activity levels.  Any medical student/resident/PT student who has ever done any sports medicine electives will agree - our field is highly specialized and is not just physiotherapy plus.