Do I need a prescription to start physical therapy? What's Direct Access?

"Oh, I want to start physical therapy, but don't I need to get a prescription first?" This is a common question that we receive from patients. The quick answer is....mostly no.

In nearly 40 states, Direct Access legislation has been passed, allowing doctors of physical therapy varying degrees of autonomy. For example, in the state of New Jersey, physical therapists are permitted to evaluate and treat patients without an MD prescription for most commercial insurance plans (BC/BS, United Healthcare, etc). However, Medicare, workers' compensation, and no-fault patients do require a prescription.

The advantage to you as the consumer is that your musculoskeletal pain (neck, back, shoulder, knee, etc) can be addressed far more quickly instead of the weeks of waiting that can occur when trying to see a physician. Also, while family/primary care physicians, and internists are adept in utilizing their knowledge of medicine and systemic diseases, physical therapists are trained in evaluating and treating musculoskeletal injuries and can usually arrive at a movement impairment diagnosis without the use of diagnostic studies such as MRI, X-ray. Physical therapists are also educated on medical screening and will send patients to the appropriate physician when a medical yellow or red flag may be present.

Don't I need to get an MRI or xray before I see a physical therapist?

Seeing is not always believing-

I will venture out and say that 95% of the cases I've treated- whether it be neck, low back, shoulder, knee, or ankle pain have not required a diagnostic study (MRI, X-ray) for a patient to be treated successfully. Any orthopedist, neurologist, or physical therapist will tell you that most of the time, musculoskeletal and neurological pain follow specific pain patterns and with a good history taken and thorough clinical neuromusculoskeletal examination, a diagnosis can be determined without a diagnostic study.

Case in point- We have had a number of patients who have had a "torn meniscus" show up on their MRI study only to have surgeons go into the knee arthroscopically and finding no tear.

Another case in point- MRIs demonstrate a 30% FALSE positive in determining the presence of a disc herniation. What does that mean? 30% of the time the MRI study will read that a disc herniation is present when in fact, a herniation is not even there. AND, even if a disc herniation is present, unless the patient reports very specific kinds of pain patterns (worse with sitting or bending forward, and sciatic pain down the back of the thigh, e.g), the disc herniation is probably NOT the cause of the patient's back pain.

When pain does not follow the typical pain patterns or if pain is constant, if there's night pain, or if conservative care does not bring about significant change in a few weeks, then a diagnostic study may be ordered by your physician.