Physical Therapy Has Evolved

November 2, 2021

Physical therapists are movement experts who improve quality of life through hands-on care, patient education, and prescribed movement. Physical therapists treat people of all ages and abilities and empower patients to take an active part in their care. Every October is National Physical Therapy Month, an annual opportunity to raise awareness about the benefits of physical therapy. For an update on the latest trends in physical therapy, we talked to Pam Toler, PT, long-time physical therapist with Visiting Nurse Home Care & Hospice of Carroll County (VNHCH).

Pam has worked as a physical therapist for VNHCH for eight years, after spending 24 years at Memorial Hospital as an inpatient and outpatient physical therapist. After decades of serving the PT needs of the community, she has seen a lot of change over the years. She recalls when VNHCH needed only one physical therapist for 20 hours a week to meet the need. Today, VNHCH has five PT professionals on staff. The growth has been fueled by population growth, an aging demographic in the region, and a growing understanding of the importance of physical therapy as a treatment for many conditions and diseases.

As varied as the conditions they treat, so do the approaches to care these professionals offer. Pam explained, “One of the things people may not know is the different settings we work in – acute hospitals to skilled care to nursing homes to outpatient facilities. Some work with sports teams, or in home care. We work with different specialties – sports medicine, pediatrics, or acute rehab. Some PTs love manual therapy – joint mobilization and joint tissue work. Some PTs incorporate tai chi or yoga. Each school teaches differently so people come out with different backgrounds. It’s what we call our tool kit – the education and what we learn along the way. If one technique doesn’t work with a patient, we can try something else. You can have the same diagnosis with two people – one responds to treatment and one doesn’t. We offer different treatments and modalities to treat a condition.”

When asked to name what the average person might not know about PT, Pam shared that today, they often use physical therapy to treat chronic illnesses. This includes conditions like MS, Parkinson’s, ALS, neurological diseases, COPD, or heart failure.

These physical therapists are also seeing firsthand the longer-term impacts of COVID-19. “We are seeing post-COVID patients with weakness and shortness of breath. They are starting to return to the community. We are seeing patients with long Covid, still suffering from side effects or deconditioned from it. We’re starting to see what these long-term effects are. People can’t walk up a flight of stairs. Our job is to get them stronger. They have respiratory issues. We monitor their oxygen rate – watch them closely and tax them only as much as they are able. It’s a slow strengthening process.”

More and more patients are turning to physical therapy for the treatment of chronic pain. According to the American Physical Therapy Association, the cause of chronic pain can be from medical conditions like diabetes, fibromyalgia, cancer, and arthritis. Physical therapists work together with chronic pain patients to lessen their pain and restore their activity to the highest possible levels. With treatment, the adverse effects of chronic pain can be reduced.

Pam added, “Physical therapists can teach something as simple as controlling breathing and ways to cope when pain hits. Patients can be shown how to try alternatives – ice, heat, stretching, gaining strength in an area that is injured. We’ve learned how to deal with pain and inflammation rather than relying on opioids.”

Another “what’s new” in physical therapy is the prevalence of same-day hip and knee replacements. VNHCH’s physical therapists see these post-surgical patients in their homes. “It’s a lot of education. In the past, they’d get education during a 2-3 day hospital stay. We teach them about pain control, obtaining range of motion, getting up from a chair. You have to go right to the basics. It’s a big challenge in home care now. We are pulling drains, taking dressings off – some nursing type duties. More acute care formerly provided at the hospital is now shifting to home care and to physical therapists. This trend started well before Covid but there are more and more surgeons are now doing it. From Boston to Portland to Dartmouth to Portsmouth, they are doing same-day joint replacement surgeries.”

Overall, home care is delivering more acute care. Pam continued, “Patients in rehab are coming home needing high-level therapies. Rehab facilities are letting them home sooner than they did in the past. When I started 40 years ago, my first job in acute rehab – we kept people up to a year sometimes! Now it’s 2-3 weeks then they are home. People are more acute and have more needs.”

Despite how much has changed in physical therapy over the years, one thing remains the same. The patient is the center of care, and their goals are paramount in developing a treatment plan. Pam explained, “I listen to the patient’s goals. It could be getting in and out of the car to go to the hairdresser. They won’t feel good unless they get there! What’s their focus, what’s important to them. They’ll participate then. I’ll explain, ‘You need to strengthen your quads to go up and down stairs, out of the house and into the car.’ In home care, you have to explain things. You have to spell out how you have to focus on muscle groups to handle the stairs. I try to figure out what’s important and gearing the exercise so they participate. That’s where I get the most success if you explain exercise towards a functional goal they may have.”

VNHCH offers physical therapy in the home for patients in Carroll County and Western Maine. For more information on physical therapy, contact them at 603-356-7006 or online at