All the things you wanted to know about PT but were afraid to ask

Otherwise known as: a primer on physical therapy

We talk a lot about physical therapy and physical therapists on this page, and it’s possible we’re assuming a lot.  So, to start the New Year off right, let us share with you some of the “things you may not know” about us and our profession:

For instance, did you know that although many physical therapists practice in hospitals, more than 80 percent practice in other settings, including:

·Acute Care - In this setting, physical therapy is provided to individuals who are admitted to a hospital for short-term patient care for reasons such as illness, surgery, accident, or recovery from a trauma. The goal in this setting is to discharge the person as soon as he or she is medically stable and has a safe place to go, sometimes to:

Rehabilitation Hospital: In this setting, physical therapy is provided to individuals who are admitted to a facility or rehabilitation unit. The goal of this intensive therapy, typically 3 hours or more per day, is to improve the person's ability to care for himself or herself.

Sub-Acute Rehabilitation: In this setting, physical therapy is provided to individuals who are admitted to a special hospital that provides medical and/or rehabilitation care. The rehabilitation is less intense, typically less than 3 hours per day.

·Extended Care Facility /Nursing Home/Skilled Nursing Facility, where  physical therapy is provided to those who are admitted to a facility that typically cares for elderly patients and provides long-term nursing care, rehabilitation, and other services.

·Outpatient Clinic (also known as a Private Practice), where individuals visit a physical therapist in a clinic, office, or other health care facility primarily to address musculoskeletal (orthopedic) and neuromuscular injuries or impairments.

·School/Preschool, wherein physical therapy is provided within an educational environment, including preschool, elementary, or secondary education (high school and vocational) facilities.

·Wellness/Prevention/Sports/Fitness settings, where physical therapy is provided to individuals with a focus on wellness. This approach emphasizes preventing illness and injury and promoting a healthy lifestyle, as opposed to emphasizing treatment of diseases.

·Home Care, which provides physical therapy in a person’s place of residence. The majority of these persons are senior citizens, but there are also pediatric patients with developmental disabilities and other conditions, and people of all ages who need rehabilitation because of injury or other causes.

·Hospice: Physical therapy can be provided here to persons in the last phases of incurable disease so that they may manage pain and maintain functional abilities for as long as possible.

·Industrial, Workplace, or Other Occupational Environments:  In these settings, physical therapy is provided to primarily to help persons return to work or for the purpose of enhancing employee health, improving safety, and increasing productivity in the workplace.

·Local, State, and Federal Government agencies, where physical therapy is provided to civilians and military personnel. PTs are employed by federal agencies, including the Veteran's Health Administration (VHA), Department of Defense, and Indian Health Service (IHS).

·Research Centers, where physical therapists conduct research to improve patient/client care outcomes and support the body of knowledge in the field of physical therapy.

And did you know of the wide range of conditions that can be treated by physical therapists?  Some of them include arthritis, back pain, balance problems, burns, carpal tunnel syndrome, developmental delays, and Chronic Obstructive Pulmonary Disease (COPD). Others are dislocations, fractures, hand injuries, headaches, stroke, osteoporosis and other injuries.

Needless to say, we love what we do! Forbes ranked physical therapists as having 1 of "The Ten Happiest Jobs," according to articles published in 2013 and 2011. More than three-quarters of physical therapists polled reported to be "very satisfied" with their occupations, second only to clergy and the only health care professionals in the top 5.

We at Blue Sky Therapy are ready to assist your therapy – we’re the experts!

Blue Sky Therapy has a continued commitment to patient-driven quality, excellence, integrity and innovation in everything that we do. That’s why we are scrupulous about planning the treatment of each and every client, and carefully documenting the outcome!

This information is not intended to replace the advice of a doctor. Blue Sky disclaims any liability for the decisions you make based on this information.

Read more here


Yes, you can choose your own physical therapist -- and you don’t need a physician’s referral.

You may not be aware that you have the freedom to choose your own physical therapist, but it’s a fact: all 50 states and the District of Columbia allow direct access to physical therapist services without a physician's referral. There is a caution, however:  your insurance policy may require a visit to your primary care physician first or may limit your access to its “preferred providers” list.

Just be aware that you are the most important member of your own health care team, and you are entitled to choose the most appropriate health care professional to meet your goals. Your physician may refer you for physical therapy that is to be provided in his or her office, or to a facility in which he or she has a financial interest.  Or you may be a resident of a skilled nursing facility that offers in-house or contracted physical therapy – and that may be the most convenient choice for you.  Regardless, it is your right to choose your own physical therapist; you are not obligated to receive physical therapy in any specific facility.

Of course, if you “go it on your own,” you should insist that your physical therapy be provided by a licensed physical therapist. The American Physical Therapy Association (APTA) offers these guidelines for choosing a physical therapist for your care, and reminds you that physical therapists who are members of APTA are bound by the association's Code of Ethics and are committed to providing competent and compassionate care.

What does ‘licensed physical therapist’ mean? This phrase denotes a physical therapists who is licensed by the state in which he or she practices.  If your care is administered by a physical therapist assistant, check to make sure that he or she is licensed or certified as required by state law and that the care is being directed and supervised by a licensed physical therapist.

Be sure to ask if the clinic is accepted by your insurance company. If so, your financial responsibility for the service should be cushioned by your insurance.  However, if you need a physical therapist who has special skills related to your condition, or if the location or other aspects of the care or the facility meet your needs, this may be a good choice for you, regardless of the insurance participation.

The physical therapist's clinic you choose, may assume the task of submitting claims on your behalf to your insurance company. There may a copayment, which is your responsibility, and the amount may depend on whether the physical therapist is part of the insurer's provider network. You also will have to meet your deductible – that portion of medical costs you will need to pay before the insurance benefit begins. It is recommended you contact the insurance company before your treatment begins, verify out-of-pocket costs.

Don’t have any experience with physical therapists in your area? Use Find a PT to locate a physical therapist in your area. You can read information about the type of physical therapist that can help with your particular symptom or condition.

Your first visit should include an evaluation by the physical therapist who will perform an examination to identify current and potential problems. Based on the results, the therapist will design a plan of care and may provide instructions for care at home to facilitate your recovery.

Whether this is your first visit to a physical therapist or you've been treated in the past, there are things you can do to make your visit as successful as possible:

· When you call to make your appointment, ask whether you should wear or bring a certain type of clothing. You may be told to avoid tight or formal clothes, in case the therapist wants you to engage in activities during the first session.

· Make a list of any questions that you have, to make the best use of your time.

· Write down any symptoms you've been having and for how long. For example, is your pain or symptom:

Better or worse with certain activities or with certain positions, such as sitting or standing?

More noticeable at certain times of day?

Relieved or made worse by resting?

· Write down information about your medical history, even if it seems unrelated to the present condition. For example:

Make a list of prescription and over-the-counter medications, vitamins, and supplements that you are taking.

Make a note of any important personal information, including any recent stressful events, injuries, incidents, or environmental factors that you believe might have contributed to your condition.

Make a list of any medical conditions of your parents or siblings.

Consider taking a family member or trusted friend along to help you remember details from your own health history and to take notes about what is discussed during your visit.

Make sure you can see and hear as well as possible. If you wear glasses, take them with you. If you use a hearing aid, make certain that it is working well, and wear it. Tell your physical therapist and clinic staff if you have a hard time seeing      or hearing. If available, bring any lab, diagnostic, or medical reports from other health care professionals that may be related to your medical history.

  • Bring a list of the names of your physician and other health care professionals that you would like your physical therapist to contact regarding your treatment.

In our next column, we’ll talk about financial preparations and what to expect during your therapy sessions.


American Physical Therapy Association



Preventing Falls adds to length and quality of life.

“Help! I’ve fallen, and I can’t get up!”

It’s not funny when it happens to you or a loved one.

Especially among the elderly, falls are no laughing matter. Each year, one in three Americans 65 and older falls, and about 30 percent of those falls require medical treatment.
The Centers for Disease Control reports that more than $19 billion annually is spent on treating the elderly for the adverse effects of falls: $12 billion for hospitalization, $4 billion for emergency department visits, and $3 billion for outpatient care. Most of these expenses are paid for by the Centers for Medicare and Medicaid Services through Medicare. It is projected that direct treatment costs from elder falls will escalate to $43.8 billion annually by 2020.

That’s why The Falls Free™ Coalition, a group of national organizations and state coalitions working to reduce the growing number of falls and fall-related injuries among older adults, became the driving force to push the adoption of the federal Safety of Seniors Act in 2008.

The American Physical Therapy Association (APTA) was among the coalition of health and consumer groups that undertook to educate members of Congress and their staffs about the importance of falls prevention.  In an appearance in Washington, D.C., shortly after the enactment of the Safety of Seniors Act, APTA member and Falls Free Coalition representative Bonita Lynn Beattie, PT, MPT, MHA, told legislators that "falls and falls-related injuries are not normal consequences of growing old. There are evidence-based interventions that can help reduce older adults' risk of falling and can affect the rate of falls and falls-related injuries and death."

Beattie, who also represents the National Council on Aging (NCOA), urged Congress to fund efforts to increase the falls risk assessment and intervention skills of health care providers and promote collaboration with the aging services network.

“Physical therapists are taking an active role in educating consumers about how to safely prevent falls as well as treat those who have fallen and suffered injuries as a result, added then-APTA President R Scott Ward, PT, PhD. “This education will ultimately improve the health and quality of life of our nation's seniors."

The Safety of Seniors Act authorizes the secretary of Health and Human Services to oversee a national education campaign focusing on reducing falls among older adults and preventing repeat falls.  It awards grants, contracts, or cooperative agreements to design and carry out local education campaigns.

Meanwhile, a British study indicates that prevention exercises can help the elderly avoid falls, and may also reduce injuries when a fall occurs.

In a 2013 study published in the British Medical Journal, researchers reviewed results of 17 trials involving aged patients who received falls prevention exercises with those who did not, and included data on subsequent falls and the extent of injury sustained. Authors of the analysis then grouped the injuries according to standardized classifications and reviewed seriousness of injuries across the studies.

The research revealed that in addition to lessening the rate of falls, prevention exercises also reduced the severity of injury when falls do occur, with estimated reductions of 37% for all injurious falls, 43% for severe injurious falls, and 61% for falls that produced fractures.

 Authors of the study wrote that "it is…thought that exercise prevents injurious falls not only by improving balance and decreasing the risk of falling, but also by improving cognitive functioning, and the speed and effectiveness of protective reflexes (such as quickly extending an arm or grabbing nearby objects) or the energy absorbing capacity of soft tissues (such as muscles), thereby diminishing the force of impact on the body."

The Centers for Disease Control and Prevention's (CDC) new STEADI Tool Kit gives health care providers information and tools to assess and address their older patients' falls risk. The STEADI (Stopping Elderly Accidents, Deaths and Injuries) Tool Kit is based on a simple algorithm adapted from the American and British Geriatric Societies' Clinical Practice Guideline. It includes basic information about falls, case studies, conversation starters, and standardized gait and balance assessment tests (with instructional videos). In addition, there are educational handouts about falls prevention specifically designed for patients and their friends and family.

APTA members who are experts in falls prevention assisted CDC with the development of the toolkit, specifically with the evidence-based community falls prevention programs. A link to the toolkit also is available on APTA's Balance and Falls webpage under "Related Resources."

The American Physical Therapy Association ( is a national organization representing physical therapists, physical therapist assistants, and students nationwide. Its goal is to foster advancements in physical therapist education, practice, and research. Consumers can visit to find a physical therapist in their area, as well as for physical therapy news and information.

The American Physical Therapy Association

Centers for Disease Control and Prevention


Introducing PREHAB!

Whether you're preparing for an upcoming surgery or you're an athlete preparing for an upcoming season, Blue Sky Therapy's PREHAB treatment options are available to prepare you for the best possible outcome.

There are two approaches to Prehab- Pre-surgical and Pre-season prehabilitation - both intended to strengthen, promote healing and prevent injuries.


  • Poor pre-op strength in patients leads to increased post-op morbidity in elderly patients.
  • Studies show patients that receive Prehab, save an average of $1215 on post-op care.
  • Patients that receive Prehab have a decrease in hospital readmission.
  • Prehab is most beneficial to surgery involving:
    • Cardio
    • Chemotherapy
    • General
    • Orthopedic


  • Target Patients are athletes and student athletes, to assist with preventative exercises.
  • Individualized sport specific strengthening.
  • Coach and school screenings available for faulty movement patterns.
  • Prehab upon hire to prevent worker's comp cases with increased manual labor.

If you have questions regarding a Prehab program that is right for you, contact our team of experts today!


Prehabilitation before knee arthroplasty increases postsurgical function: a case study; Jaggers JR, Simpson CD, Frost KL, Quesada PM, Topp RV, Swank AM, Nyland JA J Strength Cond Res 2007; 21(2): 632-634

The effects of preoperative short-term intense physical therapy in lung cancer patients: a randomized controlled trial; Pehlivan E, Turna A, Gurses A, Gurses HN Ann Thorac Cardiovasc Surg 2011; 17(5): 461-468