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Physical Therapists and Imaging

Physical Therapists and Imaging

By Marian Williams, PT, DPT

Physical Therapists (PTs) are experts in the musculoskeletal system and typically use a patient's history and a thorough physical exam to help determine a diagnosis and treatment plan. PTs are increasingly utilizing the results from diagnostic imaging as they become the practitioner of choice for musculoskeletal injuries. Many PTs have access to diagnostic ultrasound right in the clinic. In some practice settings like the military and specific networks of health care providers (ACOs), therapists can order imaging like x-rays, CT scans, and MRIs.

Research indicates that PTs are effective in using their ability to order imaging when it exists. A study of 108 imaging orders by Physical Therapists providing primary musculoskeletal care in a direct-access sports physical therapy clinic found that advanced diagnostic imaging was ordered appropriately in over 80% of cases. 

A recent study demonstrated that PTs appropriately used diagnostic imaging in 91% of the imaging studies they ordered, and insurance reimbursement was obtained 100% of the time. (PTJournal Jan 2019)

"At Sutton Place Physical Therapy, our PT’s provide primary care to patients seeking direct access for musculoskeletal and neuromuscular conditions.".  "Doctor of Physical Therapy (DPT) programs provide rigorous training, including imaging studies, and competency standards are high. Often our patients come to us with their imaging results, confused about the terminology, and seeking more information. We help them understand what it all means, and it assists us in deciding on an appropriate PT plan of care."

To better understand how imaging improves PT treatment, let's look at a case study published in the July 2015 issue of the Journal of Manual & Manipulative Therapy. The patient was a very active dentist who had chronic mid and upper back pain. He had a known history of benign neural tissue tumors of his head and upper back region, but no specific diagnosis for his back pain had been provided. After examination, the PT decided to start treatment for the patient's back pain, but also order x-rays and an MRI of the symptomatic part of the patient's spine. An MRI showed a previously undiscovered meningioma, or benign tumor of the membrane that covers the spinal cord.

The benefit to this patient was that the PT could continue treatment without making referrals and waiting for someone else to order the images. Also, once the tumor was discovered, the PT could select exercises and manual techniques that would help the patient, but avoid putting stress on the area of the tumor. It also allowed the PT to educate the patient on fitness activities that would be safe and appropriate.

The quote from the case study sums up the benefits of imaging combined with Physical Therapy nicely: "Orthopaedic Physical Therapists have high levels of musculoskeletal expertise and extensive knowledge of typical patterns and behaviors of musculoskeletal conditions. These competencies and experiential knowledge enable them to appropriately recognize situations requiring additional diagnostic screening for non- musculoskeletal pathology. This case demonstrates how privileges to order musculoskeletal imaging studies assisted the physical therapist in providing optimal, patient-centered care. The physical therapist, in this case, was able to continue treatment without multiple referrals back to the medical provider to obtain imaging, and so provided more cost-efficient and convenient care."

Should you have any questions about imaging and your care, please be sure to ask me or any of my colleagues. We are here to help!

Reference article and case study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5046964/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4534847/