I have noted Direct Access in the past through prior posts and a high supporter of the move to autonomous practice.  I feel this is the right direction for the profession not only for an acceptance as qualified clinicians by the medical field, but predominantly for the patients; whom, I feel, benefit significantly from our services that are currently limited.

This can be a long discussion and can veer down many paths, but I do want to hear from others mainly concerning the success of Direct Access (or even treatment as a whole) without imaging.  Even though I, you and many others (here and here) know that imaging is over-utilized, it is limiting us as a profession due to everyone wanting to get either an x-ray or MRI.

I recently wrote a post on the loss of the clinical exam here with a high number of responses so I know this is a hot topic.

Is it a type of subconscious way of feeling better inside for the individual or is this the way it has always been and will it change?

If our profession wants to advance further with autonomous practice, is getting the ability to order imaging (other than PTs in the military whom have this capability) needed to stay with the pack?

Are you comfortable treating without imaging?  How much of a mechanical response to our treatment is enough to be cleared?

What are you saying to your patients if you see them under Direct Access or even referral from a physician but have not had any imaging?  Or, how long do you treat under Direct Access until you decide that you, yourself, needs imaging to cover anything missed?


  1. Although I work in a direct access state, I have not actually seen very many direct access patients. My current caseload consists of largely orthopedic cases, about 50% of which are referred by PCP’s, 40% by orthopedists, and the remainder from a variety of sources. I have rarely found knowing the results of imaging to be necessary when treating a patient. Such knowledge certainly cannot replace a thorough clinical exam. On the contrary, quite often the patient has had some imaging, the results of which were discussed briefly with the patient by their physician, but not included with their referral to PT. The patient then comes to PT with some erroneous or incomplete understanding of their condition, which adds to the difficulty of getting an accurate history.

    Obviously, there are times when knowledge of imaging results is helpful. I certainly prefer to know how well a fracture is healing; however, I feel that too many patients put too much stock in their X-ray or MRI results. As I tell all of my non-surgical patients, I will treat them on the basis of the findings of my physical therapy examination.

    I do not feel that having access to imaging is the answer for PT’s. I feel that one of the strengths of our profession has always been in educating our patients. This may include educating them to the limitations of diagnostic imaging and the advantages of a thorough examination.

    1. Thanks for the comments Holly. I agree with what you wrote and especially the last sentence concerning the limitations of diagnostic imaging. For the layman, it seems to be the current thinking that imaging is the only answer for pain or dysfunction. Since we are one of few professions now that do not order imaging, especially with the recent growth of our field; it shows that this is not the answer.

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