Tricia Ligon, DPT | Professionals' Collective
Meet Tricia Ligon.
One of my short-term goals has been writing more about my experiences among different populations as a way of informal continued education. Both colleagues and idols have narratives I wanted to learn more about. So this led me to create The Professionals’ Collective and invite my friend Tricia to speak more about her role as a physical therapist. She pivoted from vying for a career in medicine to establishing a career in physical therapy after an untimely tennis injury led her to realize her passion.
This project will host conversations with professionals I admire about their experiences over the past few years and how they have developed their skills and craft as leaders in their fields. We also discuss the state of their industry and what they think the future landscape will look like.
I presented each participant in the Professionals’ Collective with an open-ended series of questions—a little like the following I presented to Tricia:
If I were to ask a very broad question, say,
"What trends have been impacting you as a provider before covid-19 and/or how do you think the industry will shift to best serve different populations going forward?"
.....what thoughts immediately come to mind? And what ideas from prior deep thought come out of that?"
Here is what Tricia had to say…
I would say in terms of my focus area as a physical therapist, it would definitely be outpatient orthopedics. I am working towards getting my Orthopedic Certified Specialist certification next Spring. My favorite groups to treat are adult athletes and runners, but I see anything from chronic pain to post op to athletes to amputees to chronic stroke to general deconditioning.
While there are benefits to specializing in a niche group, I’ve found by continuing to see a variety of types of patients, it’s helped me to grow as a therapist and made me realize how much carryover there can be in terms of how you treat different populations.
I love treating direct access and wish more people used us as a first line of defense rather than seeing a PCP or ortho MD first. Ortho MDs are great at what they do, but they can often bias patients, where intentional or unintentional, that surgery and/or injections are going to be the primary way to “fix” the involved tissue. Sometimes I feel like ortho MDs use PTs as a “last result” before surgery which automatically sets the patient up to think that PT won’t help. I feel like some Ortho MDs aren’t even fully aware of what we can do as PTs, which is probably partially on us and how we market/brand ourselves, but it can be frustrating, nonetheless.
I try not to be too focused on any one specific trend. I think we see a lot of trends that start from the sports world that make their way to the general population that gain a lot of popularity quickly, and then the research comes out afterwards, showing minimal to no actual benefit (i.e., KT tape, cryotherapy). I think in general, I try to follow the evidence based model as much as I can in treatment, relying not only on current research/practice guidelines but clinical experience and patient preferences. So if a patient really thinks that pulling on his earlobes helps with his back pain, I might do that, but then will follow it up with interventions that both the evidence and my experience tells me will be helpful. And then I will slowly educate them to tell shift their current beliefs on how to manage their symptoms.
I’ve found if you come out the gate too strong on education that differs from someone’s belief system, they are hesitant to listen to you/believe you.
I hope that over the next several years, our profession progresses to becoming more comfortable with the doctorate title. Most programs switched to a DPT in the mid 2000s, so a lot of senior therapists do not have their doctorate degree. I think as a whole, this has made our profession not utilize the title of “Dr.” Some people say it’s so we don’t offend our senior therapists without the title. Some, unfortunately, seem to think we’re not deserving of it, and some think that using the term Dr. would alienate us from our patients. However, if we want to elevate ourselves as a profession, I think it’s important that our patients and medical peers know that we earned a doctorate level education to really trust that we are quite knowledgeable on the musculoskeletal system.
One thing that I’d like to see physical therapists take more seriously is exercise/exercise prescription. I think while we’ve gotten so good as techniques such as manipulation and dry needling to help with immediate pain, as a whole, I’ve seen a lot of therapists be lazy in terms of the actual exercise portion of a treatment.
A couple of things that really helped me in this area are 1) utilizing RPE instead of reps and 2) making sure people actually feel the right muscles working when doing an exercise. Our eyes can only see so much, so even if someone’s form/tempo look good, they may not always be getting the most out of an exercise. So many times I’ve seen people do a bridge exercise and their form looks fine, but when I ask them “where do you feel this working” they’ll say quads or back or abs, because they’re focusing more on the stabilizing muscles rather than the ones doing the action/movement. So a simple cue of “dig your heels in/act like you’re pulling your heels to your butt” can automatically shift their focus to their glutes/hamstrings.
Or say someone is doing a pistol squat and even if their knee isn’t moving into valgus, they only report feeling their quad working. Not only can you cue them to use their glutes more (push through the heel, slightly tuck your pelvis) but it could also cue you into the fact that maybe their back hurts because their glutes are being lazy with functional movement. I also thinking proper cueing can help you better recruit a muscle to get them to a target RPE more efficiently rather than making them do 30 reps of an exercise without much fatigue.
I personally believe that poor movement patterns are at the root of most (non-accident) musculoskeletal pathology, and that correcting bad mechanics and improving functional mobility can correct most pain, where it be disc related, nerve related, joint related or muscle related. The key is catching it quickly and not letting it develop into something chronic. There are of course exceptions to that, such as RA, advanced OA, severe nerve compression or other advanced pathologies, but my point is that, just because your MRI shows a disc bulge, it doesn’t mean that your spine is weak or that you’re broken.
I think so much language that other medical professionals or even friends/peers use can make a patient fearful of movement, when really it’s about correcting poor movement patterns.