To MD or to DPT, that is the question
The Western medical model has been set up where your first line of contact for an injury is your Primary Care Doctor who then will likely refer you to the Orthopedic doc or specialist (MD). The doctor is likely to examine the problem area and decide if you need imaging (x ray or MRI). If through clinical tests they decide it is minor, they will likely prescribe a medication to help with pain or inflammation and then maybe refer you to physical therapy.
Now with different laws around direct access for physical therapists, it allows you as the consumer to decide if you want to go straight to the doctor of physical therapy (DPT) first. In that case, you skip two (maybe unnecessary) appointments. The physical therapist will evaluate the area in question and then decide if you are a good candidate for PT or if you need to be seen by an MD for an issue that is something we will not address-- fracture, dislocation, infection, tumor, etc.
So when deciding which professional to see first (MD vs DPT), ask yourself these questions:
Was it traumatic? If there was an accident, like a fall skiing or you fell off your bike and landed on your shoulder, there is a roll for both. If you go to a doc, they will go straight to imaging which may be necessary! If you go to a DPT, they can perform clinical tests to let you know if they are the right person to see or not. Your decision here might rely on relationships with the professional, ease of scheduling, time frame, etc.
Was it gradual? If it has been hurting for 1 week+ or heck maybe 6 months, then I’d suggest a DPT. It is unlikely to be some urgent problem if it has continued thus far. Again, DPTs can screen the shoulder and if they see something concerning that warrants a trip to the MD, THEY WILL TELL YOU! So that shoulder pain you have been ignoring for months then finally decide to go check it out. Don’t rush to the MRI machine. It might take some time and work on your part, but you can address these chronic issues conservatively!
Can you bear weight? You’re playing basketball with the kids and you twist your ankle. MD or DPT? The first thing we will both ask is, “can you walk?” Inability to walk, massive amounts of swelling and bruising warrant a trip to the MD to rule out a fracture.
Do you have a movement/fitness goal in mind? DPTs are the movement experts. We are able to modify movements and training plans to keep you as active as possible while addressing dysfunction and pain. MDs are here to keep us alive, decrease pain through medication and perform surgeries. They usually do not have the resources to spend 1 hour with you to chat about your marathon training plan and how we can tweak it to decrease your foot pain. If that’s what you want- DPT all the way.
Is your bone the correct shape? If your hand or foot are facing the wrong direction, don’t go to a DPT. That’s an ER trip.
Does it have to do with your “insides”? Gastrointestinal problems, chest pain, urinary tract infection, puking, etc are MD territory. There are caveats for some of these (pelvic floor DPTs can help address some GI issues) but that will be decided after an MD clears you.
This is by no means an exhaustive list nor is it medical advice. Rather a quick overview of some decision making to decide where to start. Of course, any medical provider that evaluates you and feels that you need someone else’s care should be referring you directly there. As always, if you are skeptical, get a second opinion.
DPTs can be more helpful than some folks realize. We aren’t all treating elderly people with therabands and stretching your hamstrings. Find a DPT that understands the principles of strength & conditioning. Find a DPT that does what you do, or at least understand the needs and lingo! Not all DPTs are made equal but there are some darned good ones out there!
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TLDR
The medical model used to be set up so that you visited primary care doc then specialist and then maybe physical therapy.
With some form of direct access in many states, you have the power to decide who to see first.
If there was an acute trauma, you can’t walk, had a head injury, a limb in facing the other way or you are puking-- see an MD.
If your nagging shoulder pain finally becomes enough to cause you to reach out for help-- see a DPT.
Have questions about how to address your nagging pain and want to work with a DPT who can keep you active? Send an email to info@SpectrumPerformance.fit and let’s schedule some time to chat about your goals!
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Thanks for reading!
Dr. Jackie, DPT
