Specialties and Practice Settings as a Physical Therapist

What is physical therapy?
Chances are, you’ve heard of physical therapy (PT). Perhaps you have even attended physical therapy as a patient. Maybe a friend or family member has had physical therapy in the past. But if pressed, you might not know how to describe or define physical therapy. That’s no surprise; physical therapy is such a large profession, with so many practice options and settings, that it can be tough to describe what PT truly is at its core!
Simply put, physical therapy is the education, guidance, training, and physical interventions provided by physical therapists (PTs) to help people regain their functional abilities and maximize their independence. PTs help patients achieve their functional mobility goals, by assessing and treating their pain and physical limitations. Once these limitations are identified, PTs provide corrective exercises and training, manual (hands on) therapy to relieve pain and correct physical imbalances, and family/caregiver education to ensure patients are as independent as possible.
Physical therapy is considered a conservative intervention, meaning that it is less taxing on the body than harsh medications and surgeries. For this reason, physical therapy is often the “first line of defense” for orthopedic and neurological disorders. In fact, physical therapy can sometimes help patients avoid surgery altogether, or at least better prepare their bodies for the rigors of an operation. Physical therapy is also frequently provided after surgical procedures, or after medical events that compromise people’s ability to move around and care for themselves, such as strokes, brain injuries, or traumatic accidents.
Who are physical therapists?
Physical therapists are highly educated, licensed healthcare professionals. PTs are required to pass a national board examination in order to obtain the board-certified title of “PT,” and they also must pass a state board examination, in order to obtain a license to practice physical therapy in a particular state. For many years, physical therapists were educated at an associate’s or bachelor’s degree level, then even a master’s degree, but over the last 15 years or so, nearly all physical therapy educational programs have transitioned to doctoral level degrees. For physical therapists who were licensed before the transition to doctoral level programs, there are special “transitional doctor of physical therapy (tDPT)” programs available.
Physical therapy over the years:
The physical therapy (PT) profession in the United States has evolved quite a bit over the years. PT had its humble beginnings in the U.S. over 100 years ago, and it was a female-dominated profession, with women providing services like joint range of motion, stretching, and assistance with walking to injured soldiers from World War I. In fact, PT was so overwhelmingly populated by women, its first professional association was formed in 1921, and called “The American Women’s Physical Therapeutic Association.” While men were allowed to join the association almost immediately, PT was still primarily considered a women’s field for many years after its inception.
Physical therapy really grew as a profession during the Polio epidemic of the 1940s and 1950s, and the number of schools nearly tripled during this short period of time. Since then, the PT field has expanded far beyond the early days of hydrotherapy (using water for healing) and basic joint mobility (limb movement exercises), and become a widely respected doctoral-level profession, attracting some of the best and brightest students across the globe.
Physical therapy today:
The last 20 years or so have seen an incredible evolution of the field. Today, physical therapists work in multiple settings, with various patient populations (from children to adults, and from highly athletic to extremely physically debilitated), and can specialize in a wide variety of practice types.
There are currently over 200,000 physical therapists working in the United States today, and there are currently over 225 physical therapy schools, with more opening on a regular basis.
Physical Therapy Specialties: 
The American Board of Physical Therapy Specialties (ABPTS) endorses 8 specialties (or areas of advanced practice), which can be obtained either via clinical experience (years on the job) and passing an exam, or by completion of a residency program and passing said exam. Several of the specialties require additional tasks or projects in order to earn the specialty status, and all require periodic re-examination to maintain credentialing.
Pediatrics (PCS) – Working with children, including those with autism, cerebral palsy, and other limiting disorders, as well as otherwise healthy children with musculoskeletal injuries (meaning a sprained ankle or dislocated finger).
Geriatrics (GCS) – Working with older adults, with a focused understanding of their unique medical, physical, and emotional needs.
Cardiovascular and Pulmonary (CCS) – Working with patients who have heart or lung disorders or operations.
Clinical Electrophysiology (ECS) – Using electrotherapy and other physical agents to promote healing and recovery.
Sports (SCS) – Working with athletes of all ages, from children all the way through older adults.
Neurology (NCS) – Working with patients with neurological conditions, such as strokes, multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), and more.
Orthopaedics (OCS) – Working with patients with orthopedic conditions, such as abnormal bone growth, rotator cuff tears, osteoarthritis, and post-surgical pain and stiffness.
Women’s Health (WCS) – Working with women who have difficulty with urination, post-pregnancy complications, post-operative pain, and pelvic floor pain, tightness, or weakness.
While the above board-certified specialties are the only ones endorsed by the ABPTS, there are many other emerging areas of advanced practice, which, in time, will likely lead to additional specialty certifications. Just a few of these include: animal rehabilitation, men’s health, pre-partum and post-partum care, wound care, intensive care unit (ICU) therapy, oncology therapy (patients who have/have had cancer), and aquatic therapy. Some of these additional career paths within the physical therapy profession are considered “off the beaten path” from normal PTs’ career trajectories, but they can be quite rewarding.
Beyond the specialties, many physical therapists opt to take additional training to become certified in very focused areas of physical therapy. For example, PTs can take coursework in types of manual therapy and movement assessments and earn additional titles, such as “Manual Therapy Certified (MTC)” and “Fellow of Applied Functional Science (FAFS)” Some physical therapists argue that the options to add titles and qualifiers after “PT” have become so extensive that PTs have a bit of “alphabet soup” following many of their names.
Luckily, PTs don’t always need to pay for such certifications to take coursework and grow their skillsets. In fact, with the advent of online continuing education, physical therapists are able to taste various practice focuses, without investing money in full weekend courses. In addition, many large organizations and hospitals offer on the job training for physical therapists to learn wound care and other forms of advanced practice, without requiring PTs to make the upfront investment of additional training.
Traditional physical therapy settings:
While physical therapists can work in almost any setting, there are several primary settings where the vast majority of physical therapists do work.
Outpatient physical therapy clinics – Outpatient means that patients visit the clinic for short visits, coming from their own homes. These patients are typically more independent and need less intensive care than patients in other settings. Many physical therapists work in private outpatient clinics, or for large chains of physical therapy clinics, while others work in hospital-based outpatient physical therapy clinics. Outpatient physical therapy clinics typically serve adults and/or children, and they can treat very general conditions, or they can be extremely specialized (such as only serving elite athletes with orthopedic conditions or only working with autistic children). Sometimes, these clinics are affiliated with physicians’ offices or hospitals, and other times, they are independently owned by physical therapists or other medical professionals.
Hospitals – Quite a few physical therapists work in hospital settings. Within the hospital, there are quite a few departments where you might find a physical therapist.
Acute care – Acute care physical therapists are typically the first ones to get patients out of bed and moving after medical emergencies, prolonged illnesses, and traumatic or neurological events. Physical therapists who work in acute care often work alongside nurses and other therapists, working as an interdisciplinary team to maximize patients’ mobility. These PTs often assess patients’ mobility, determining whether they need more physical therapy or intensive rehab before returning home from the hospital.
Inpatient rehab – Inpatient rehab physical therapists usually work with patients for 1-4 weeks after acute neurological illnesses or orthopedic trauma. The patients stay within a hospital setting, but they receive intensive physical, occupational, and speech (if needed) therapy. This is generally provided for 3 hours a day on average! Only certain patients qualify for this type of therapy, and it is the type of PT you will think of when you think of a relatively young post-stroke patient learning to walk again (though post-stroke PT can be provided in many different settings).
Outpatient – As noted above, some hospitals boast their own outpatient physical therapy departments.
Patients’ homes – Many physical therapists work in home health physical therapy (HHPT), and they travel to patients’ homes to provide care. PTs who work in HHPT will visit patients in their homes following hospitalizations for illness, injury, or simple deconditioning. Because these patients are unable to drive or independently attend outpatient physical therapy, they are treated in their own homes. Home health physical therapists will provide exercises and manual therapy, as well as make equipment adjustments and recommendations, and assess patients’ homes for mobility hazards such as rumpled throw rugs, poor lighting, and unsafe bathroom setups.
Skilled Nursing Facilities – In some cases, patients need ongoing nursing care, and they are unable to safely or financially receive such care in their own homes. Such patients will either spend time, or reside in permanently, in skilled nursing facilities (sometimes called “nursing homes”). Physical therapists who work in nursing homes will primarily work with geriatric patients, but will frequently see younger patients who simply need longer-term inpatient rehabilitation. Examples include spinal cord injury patients who cannot tolerate intensive inpatient rehab, or traumatic brain injury patients who require much longer than 4 weeks to recover to their fullest-possible function.
Schools – Physical therapists who work in schools are primarily responsible for ensuring that students are as functional and independent as possible within an educational setting. School physical therapists will make recommendations about students’ seating arrangements, fitness plans, and overall accommodations to best facilitate learning and independence in a classroom setting.
Less conventional physical therapy settings: 
Integrated health clinics – Recently, a number of integrated health clinics have sprung up. They have arisen out of necessity, as many patients have felt that they have fallen between the cracks in the medical system. For patients who seek physical therapy, chiropractic, nutritional guidance, nursing/medical care, acupuncture, personal training, massage and other wellness services, integrated clinics are a wonderful solution, as the team frequently will have “grand rounds” and truly look at the patient as a whole person, rather than an injury or diagnosis.
Prisons – Believe it or not, physical therapists work in prisons! While less conventional than other settings, prisons provide the ability to work with a fairly athletic population in a very unique environment. Considered one of the higher-paying settings, strong and brave physical therapists can really enjoy working in this setting.
Veterinarian clinics –Animal physical therapy is an emerging type of PT practice. Some animal physical therapists own their own businesses, but others work in the offices of veterinarians. These physical therapists work with dogs, cats, rabbits, and even turtles, ensuring that they remain as mobile as possible for their adoring owners’ pleasure.
Corporate clinics – Larger companies, such as Google, Qualcomm, and others have decided to add on-site wellness and health clinics. In many cases, physical therapists are part of those clinics. Corporate physical therapists have the opportunity to provide ergonomic training and setups, treatment for repetitive stress injuries from desk jobs, and even treat non-work-related injuries.
Gyms – There are several types of gyms and athletic facilities that employ physical therapists. Some are traditional gyms, and others are called “neuro gyms,” which serve patients with neurological conditions. There are even “autism gyms” that cater exclusively to autistic children and adults.
Sports teams or performing arts groups – Always wanted to work with the Cirque du Soleil, but have two left feet? Fear not; physical therapists travel with performing arts groups. They also travel with professional sports teams! While these jobs are few and far between, they’re definitely attainable.
Military – Quite a few physical therapists opt to become military physical therapists. These PTs can travel and work on overseas military bases, or they can remain in the US, treating injured soldiers.
With so many settings and areas of treatment focus, a typical day in the life of a physical therapist will vary widely. One PT might work in an acute care setting, helping post-stroke patients take their first steps and determine the best type of ongoing rehabilitation to maximize their function. Whereas, an animal rehabilitation PT might help an injured cat or dog gain mobility after surgeries, injuries, or after they lose function from painful arthritic conditions. A sports-certified physical therapist might spend her days working with a professional sports team, ensuring that injured athletes are able to safely return to sport without lasting negative impact.
One thing that all types of physical therapy have in common is that they all involve people; even animal rehab involves working with animals’ owners. You will rarely find a physical therapist spending most days behind a desk. However, even this could change very soon. The American Physical Therapy Association has recently endorsed the PT profession’s use of telehealth (remote delivery of healthcare services), to improve care of patients who are unable, or unwilling, to attend PT in person.
In addition, now that almost all physical therapy schools offer doctoral level education for physical therapists, savvy PTs are leveraging their degrees in unique ways. Some PTs have opted to use their education to move into sales, consulting, higher education, marketing, information technology, and healthcare leadership roles. You might find a physical therapist working alongside a team of copywriters and graphic designers at a medical tech company, performing utilization review (reviews of PT services) audits for an insurance company, or even leading a team of sales reps for medical devices. And don’t forget: the physical therapy professors at PT school are almost certainly physical therapists, themselves!
Summary:
As the physical therapy profession continues to grow, the practice options will follow suit. Regardless of whether a person is introverted or extroverted, enjoys a busy day or a mellow day, or gravitates toward children or adults, he or she can find a place in the physical therapy profession.
References:
American Board of Physical Therapy Specialties – ABPTS
APTA History
Telehealth
http://aptaapps.apta.org/accreditedschoolsdirectory/AllPrograms.aspx?UniqueKey=
Physical Therapists
“The History of Physical Therapy Practice in the United States” by Moffat, Marilyn – Journal of Physical Therapy Education, Vol. 17, Issue 3, Winter 2003 | Online Research Library: Questia
What is physical therapy | World Confederation for Physical Therapy
About the Author
“Meredith Castin, PT, DPT earned her doctorate in physical therapy from University of St. Augustine in 2010. Since then, she has worked in multiple physical therapy settings, including acute care, outpatient orthopedics, sports, inpatient rehab, and home health. After spending 5 years “in the trenches” as a clinician, she realized that her true passion was writing, and she switched gears to focus on doing what she loves. In 2015, Meredith teamed up with a colleague to launch NewGradPhysicalTherapy.com, a website devoted to promoting the successful transition of student physical therapists to professional physical therapists Launching the website has enabled Meredith to create a niche career that blends her formal physical therapy education with her passions of education, writing, and helping others succeed.”