What Exactly Is Direct Access?

By Kateri Kane, PT, DPT

October is Physical Therapy Month, so we thought we would use this opportunity to provide some good information you might not know about the field of physical therapy.  Have you ever heard the terminology direct access in relation to physical therapy?  If not, here’s the run down.  Direct access is an individual’s freedom to acquire physical therapy treatment WITHOUT a referral from a physician.  Say for example, you twisted your ankle or started having back pain and needed physical therapy to recover.  Through direct access you are able to bypass going to a doctor’s appointment in order to get a referral for PT.

Direct access not only saves you the hassle of visiting your doctor, it can also save you money.  According to a study by Jean M. Mitchell and Gregory de Lissovoy, when comparing physician referral episodes of physical therapy. Direct Access episodes, total paid claims were 2.2 times higher for physician referral episodes.  Direct access episodes also encompassed fewer visits and thus less cost in this study. Even though your insurance may cover the majority of your physician and PT visit costs, you still have to pay your copay every visit.  These costs can add up, especially as the rates of copays increase; so the idea that you MAY have fewer PT visits and no doctor visit to pay for could be financially helpful.

Unfortunately, not EVERY state has direct access, but the majority of states do.  According to the APTA, 47 states and the District of Columbia have direct access.  Michigan, Indiana, and Oklahoma are the only states that DO NOT.  Michigan and Oklahoma allow for a PT evaluation but no treatment without a referral, while Indiana does not allow for either of these without a referral.  Despite the fact that a majority of states have direct access, each state has different rules and possible restrictions that can be viewed here.

So how exactly does direct access work?  In Pennsylvania, you are permitted to see a physical therapist that has a Direct Access certification for up to 30 days without a prescription from a physician.  If you require treatment for longer than this amount of time, then your physician will need to be contacted and sign off on a plan of care to continue with treatment.  If a therapist determines that you need further testing or that you are not an appropriate candidate for PT at the time of evaluation, he/she will refer you to your physician or a specialist.

Even though state law may allow you to see a PT through direct access, your insurance may not pay for it.  Medicare in particular allows for an initial evaluation through direct access, but will not cover any treatment without a referral from a physician.  It is important for you to be familiar with your insurance plan in order to know what is covered.  If you are unsure of your plan benefits, you may want to ask the physical therapist’s office to check into your coverage before you begin therapy.

We hope this information helps give you a better idea of what PT benefits are out there for you.  Once again if you have any comments, questions, or suggestions for future topics let us know.  Thank you and stay active.



APTA Overview

APTA Direct Access

APTA Direct Access by State


Backpacks Can REALLY Be a Pain in the Neck

By Kateri Kane, PT, DPT

Most kids just want to fit in with the crowd and keep up with whatever is in style. Middle school and high school can especially be tough both socially and academically. So much is expected from both peers and adults. So what does this have to do with backpacks? Well, believe it or not, I was a student once. Every day I witnessed how kids were wearing their backpacks. Typically, they were slung on one shoulder with loose straps and a ridiculous amount of books in them. If I wanted to fit in, I knew that I had to do the same. Had I known then what I know now, I never would have worn my bag the way I did.

What are the risks of improperly wearing a backpack? Neck, back, and shoulder pain can all result from excessive backpack weight as well as carrying the bag on one shoulder or with the straps too loose. 

No, structural scoliosis does not occur from wearing your backpack on one shoulder, but functional scoliosis is a possibility. Functional scoliosis is not a permanent change in the joint structures; instead, it is caused by muscle shortening due to prolonged time periods in an abnormal position (being side bent in this case). Even though structural scoliosis may not be caused by backpacks, if your child has already been diagnosed with structural scoliosis, it can be aggravated by a heavy backpack that is held incorrectly.

The long term effects of carrying a backpack improperly may include: excessive compression on the spine resulting in dysfunction at the joints, hip and knee pain from the impact of walking while carrying an increased weight, and the formation of poor postural habits. Postural habits can be especially difficult to break and will worsen back problems as children grow older.

What is the proper way to wear a backpack? According to the American Physical Therapy Association (APTA) and the American Academy of Orthopedic Surgeons (AAOS), backpacks should be worn as follows:

  • Always use both shoulder straps
  • Tighten the straps so that the bag rests over the strongest mid-back muscles
  • Pack lightly(no greater than 15% of body weight)
  • Organize your backpack(heaviest items closest to your body)
  • Remove unnecessary items
  • Lift your bag properly (use your legs, not your back)
  • Build muscle strength

As a parent, you may have to take action. Back in high school, I didn’t have time to go to my locker and switch books between certain classes. I ended up carrying almost all of my books with me, which was a huge strain on my neck and back. If your child ends up in a similar situation, you may have to talk to the school about lightening the load, increasing the opportunity for students to stop at their lockers, or even having a set of classroom books so that the students don’t have to carry as much. The APTA created a video which is a good summary of everything listed here.

Share this material with your kids.  Keep them informed so that they can be the ones to set a trend that will help their bodies in the future, annot harm them. HAPPY BACKPACK AWARENESS DAY! Feel free to leave any comments or suggestions. Our next entry will discuss your ability to have direct access to physical therapy.Thank you and stay active.


Move Forward PT

Ortho Info

Tucson Weekly

How Can You Prevent Falls?

By Kateri Kane, PT, DPT

Every year one out of three adults 65 and older experience a fall, according to the CDC. Of these individuals, 20-30% suffer moderate to severe injuries. The CDC also states that the risk of falling and being seriously injured in a fall increase with age, with 82% of deaths related to falls having occurred in people 65 and older in 2008. The question is, what can you do to avoid becoming one of these statistics?

Balance is one of the most important components of fall prevention. It can include both static (stationary sitting, standing) and dynamic (walking, turning) activities. Your body utilizes three systems in order to maintain balance: the visual, somatosensory, and vestibular systems. We could write an entire article on what these systems entail, but when it comes to your balance, these are the essentials. Vision lets you see where you’re going, the somatosensory systems lets you feel what’s under your feet (flat surface, uneven, etc.), and the vestibular system lets your brain know that you’re moving. A disruption in any of these systems can cause major balance deficits whether it is from an incorrect eyeglass prescription, peripheral neuropathy related to diabetes, vertigo, etc.

In addition to deficits in these systems, any nervous system or musculoskeletal system pathology can affect your balance. Conditions such as a stroke, traumatic brain injury, Parkinson’s disease, a hip fracture, or muscle weakness can lead to falls. So, how do you prevent this? You may not be able to prevent all the conditions mentioned previously, but being aware of your deficits and doing things to counter them is your best strategy to prevent a future fall.

Step 1: Find out what deficits are present. Certain problems may be obvious to you. For example, you may notice that you repeatedly trip over the throw rugs in your home or you stumble around in the middle of the night if you have to get up and use the restroom. Simply removing your throw rugs and placing a red nightlight in your room are quick fixes to these problems. Other problems may not be as obvious. No two people are the same so,if you have a specialist assess you, that person will be able to tell you where your individual deficits lie.

Step 2: Utilize specific exercises and balance activities to train yourself.The brain has a certain degree of plasticity, which means that it can learn new things as long as it is trained to do so. Practice and challenging your balance are the best ways to improve stability.This should always be done in a SAFE environment which is why seeing a specialist is so important when you suspect any problems with your balance.

A general guideline for those both with and without balance deficits is regular exercise and continued activity, especially weight bearing activities like walking or Tai Chi. These are good ways to maintain musculoskeletal health.

In order to continue to raise awareness about the risk of falls as well as offer an important service to the community, Advanced Physical Therapy and Fitness will be providing FREE balance screenings on Thursday, September 20, 2012 from 10am to noon. We encourage everyone to come down and be screened. Once again feel free to leave any comments or suggestions for future posts. Our next entry will be related to backpack safety as the school year gets underway. Thank you and stay active.



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  Disclaimer:  The information in this medical library is intended for informational and educational purposes only and in no way should be taken to be the provision or practice of physical therapy, medical, or professional healthcare advice or services. The information should not be considered complete or exhaustive and should not be used for diagnostic or treatment purposes without first consulting with your physical therapist, physician or other healthcare provider. The owners of this website accept no responsibility for the misuse of information contained within this website.