There are more than just actors behind the curtain at your favorite Broadway musical. It's also standard practice for these big-time shows to have a physical therapist stage-side. They ensure that the singers and dancers don't actually break a leg. New York's Karen Litzy did just that for The Lion King, where she worked on sudden -- and strange -- injuries. "Not everybody is running across the stage in a hyena suit with hydraulics on their head; not everyone has to walk on hands and feet or on stilts because they’re a playing a giraffe," Litzy, who specializes in chronic pain as well as post rehabilitation strength-training and visits her patients in their New York City homes, told ValuePenguin. "You have to get pretty creative with your treatment techniques and ideas and evaluative procedures, because it’s a completely different population." We asked Litzy, who is also a spokeswoman for the American Physical Therapy Association, about her work with the general public as well as her path into the profession.
How do people generally react when you tell them that you are a physical therapist?
It’s always positive. Normally the next question is, “I have this thing with my back,” or “I have this thing with my foot… what do you think is going on?” That’s usually the main reaction that I get.
People also tend to ask, “What do you do when you’re with your patients?” I think a lot of people have the misconception that you go to a physical therapy office and they give you modalities -- like hot packs or cold packs -- and then kind of give you exercises, and then you leave. That couldn’t be further from the truth these days. Physical therapists are experts in the musculoskeletal system, and we’re now a doctoring profession. We do have the ability to evaluate, come up with a physical therapy diagnosis and treat that diagnosis as we see fit, according to best practices and best evidence. A lot of people are surprised when I tell them that I don’t use an ultrasound machine, and I don’t use an e-stim machine and that I do a lot of hands-on, manual therapy work coupled with patient education and exercise. That is the biggest misconception: that we just do hot packs and exercise.
Before we clear that up, tell us about your path into the profession...
When I was in high school, the physical therapist in my town wanted to do some evaluative tests on me -- I had been a gymnast as a kid -- and wanted to do strength and flexibility tests. I would hang around the clinic, and I liked what I saw. I knew I wanted to do something in the medical field and wasn’t sure if I wanted to go the route of a physician. So I went to physical therapy school straight out of high school. When I went, it was a five-year master’s program, so I graduated at 22 with my master’s in physical therapy. Once I went on to my physical therapy clinical affiliations or residencies -- after my fourth year of school, when I went out on a clinical rotation and got to actually work as a physical therapy student alongside a licensed physical therapist -- I realized that I definitely wanted to do physical therapy, and I definitely did not want to be a doctor. I wanted to spend the time with the patient, and really being able to be a big part of their care and their recovery.
Does this five-year program option still exist for students today?
No, it doesn’t. Now it is, you do your four years of undergraduate work, and then you apply to PT school. There are some different models of physical therapy school coming out now, but for the most part, it’s a two-to-three year program to get your doctorate in physical therapy.
Did you go back to school to get doctoral-level degree?
If you have a bachelor’s or a master’s degree in physical therapy, you’re not required to go back to get your doctorate of physical therapy, but I did go back and get my doctorate of physical therapy and graduated in December of 2014. I decided to go back for a number of reasons. One, I truly like learning, and I like going to school. And I actually had patients here in New York City who would ask if I had my doctorate, which I found very interesting. I think it’s because, nowadays, with some of the options for your care, the health care customer is much savvier.
Mine was a two-year program, online and in-person, at Misericordia University. The doctoral study was a lot of digging through research and writing papers and doing research articles, and things like that.
After earning your master’s degree, passing the national board exams and gaining your state license, how was your first professional experience in the field?
My first job was in an acute care hospital in Scranton, Penn. I’m really happy that that was my first job, because it exposed me to a lot of different kinds of patients: very, very sick patients to orthopedic patients and neurological patients. And you’re also working in a really great team environment when you’re in a hospital: You have a lot of people to bounce ideas off of; you have a lot of mentors to help you through. So I quite enjoyed that.
Because literally 100% of the population, at some point in their life, may need physical therapy, finding a physical therapy job is not that difficult. That being said, just like with anything else, finding your dream job might take some time. But that’s with any job.
Early into your career, did you ever question whether you were in the right spot?
Well, when I was in school, I thought I was definitely going to go into pediatrics and work with children. And then I did a rotation in school. Your rotations are so that you can go out, and you can figure out what you like, and what you don’t like. And maybe what you think you like, you might not like. So I did a clinical in pediatrics, which I enjoyed, but I also did a clinical in an outpatient sports medicine clinic, and I liked that more.
Your tastes change, and even as you age and mature through the profession, I think people’s preferences change. That’s the beauty of physical therapy, because you can go down so many different avenues. You can work with sports medicine, you can work with spinal cord patients, pediatrics, geriatrics; you can be an administrator or researcher. So there’s a wide range of choices, which I think is a good thing, because not a lot of careers can say that.
Was your second physical therapy-related job in sports medicine?
I actually moved to New York City without a jon lined up and ended up working at a gym, Reebok Sports Club. I knew about this gym before I moved, and it was a really great decision because I was amongst peers who were all like-minded and around the same age, which is great when you move to a big city like New York. Working in that gym is where I got the idea of seeing patients in their homes. Because I saw all of these personal trainers seeing their clients in their homes, as well as seeing them in the gym. And I thought, “If they can do it, I can do it.” And that’s how I started doing the home thing.
After I left the gym, I did work at two outpatient clinics in a full-time capacity, and then once my home business started really picking up steam, I worked part-time for a couple friends who had started a clinic. I went from 20 hours a week, to 16, to 12, to 8 at this clinic, and then finally left the clinic and went out completely on my own.
What is a day in your work life like now?
I see anywhere from five to eight patients a day. Part of my day is spent on subways and busses and walking to patients’ homes. Usually I will go to see a patient, we will sit and chat for a couple of minutes. We talk about how they’re feeling, where they feel they are with their goals and their values. Then I’ll do a quick re-evaluation based on what I saw last time I saw them.
A treatment might be anything from some hands-on manual work, to patient education, whether it be on neuroscience, or what’s happening as a result of my doing manual therapy from a physiological standpoint. And then I’ll again re-evaluate -- did what I just do with the patient work? And if it didn’t work, then I’ll try something else and then re-evaluate and see if that works.
It's part of a "PDFA" cycle: You plan, you do, you study, and then you act. So I make my plan, I do my plan, I study it, I see how that plan unfolded for the patient, and then I act appropriately. And then I always follow up some manual work with exercise, some sort of movement or exercise. Because you need to bookend that manual work with good solid education and good solid exercise. Research has shown that when all three of those happen at the same time, the patient has pretty good outcomes. That’s probably what I do with every single patient. Granted, each patient is different, each diagnosis is different, but the approach is usually the same.
Any success stories come to mind?
I had a patient a couple of years ago who fell while skiing at a high velocity, and basically had the same injury as Lindsey Vonn, with her knee. It was a fractured tibia, which is a bone in the lower leg, a torn ACL, which is a ligament in the knee, and a torn meniscus, which is connective tissue, plus other torn ligaments. She had surgery in Utah, came back to New York and was referred to me by a physician who was overseeing her care here. There was a lot of hard work, lots of physical therapy. We had a really great partnership between myself, the physician and the patient. She was motivated and on-board. Long story short, by the next ski season, she sent me a video of her skiing down the mountain in Utah again. Once we got her to the point where I was seeing her once a week, or once every other week, I then hooked her up with a personal trainer that I work with. Now it’s me, the trainer, the doctor, the patient. Having that great teamwork approach, she was a huge success. This could have gone really bad; it could have gone south, given the severity of her injury. And she was able to get back out on the slopes the next season. And she is also a mom, and she was able to lift her kids up out of the crib, which is something she couldn’t do before. She was able to walk down the streets with her kids. So forget about skiing; she was able to get back to really doing the things she liked to do.
Speaking of referrals and working with physicians, is that how you typically find new patients?
A lot of my patients come via word of mouth, which is great. I do work with a couple of doctors here in New York City. In New York state, we have what’s called “direct access." A patient can come to you without a physician referral for 10 visits. Someone, maybe a word-of-mouth referral from a past patient, can come to me directly, and I can evaluate them to rule out any red flags, and then I decide if I can provide treatment or if more investigation is necessary. So I’m lucky to have relationships with doctors here in the city, that I can say, “You know, this is what I think is going on, but I would feel comfortable if you went to the doctor, and we can see how to proceed.” And then, to other patients, I say, “You know, we can handle this. It’s not a problem.”
It just happened a couple of weeks ago that a patient of mine wanted me to look at her husband. I evaluated him, and he had some things going on with his arm. I said, “I’m going to evaluate you. I don’t think right now physical therapy is appropriate; I think you need to see a neurologist. But I’m going to evaluate you, so then I can send all my notes to the neurologist, or get on the phone with the neurologist, and say, ‘This is what I’m seeing; does he need a referral?'” So, I was able to do that with the neurologist. He came back with, “This is who he needs to go to; if you have any problems, I’ll make the referral.” So PTs refer to physicians; physicians refer to the PTs. When you have good working relationships with physicians, and they trust you, and they’re happy, because their patients are happy, it’s a really great relationship.
How has new technology eased this part -- and other parts -- of your job?
Now almost everyone is using EMRs, which is electronic medical records. Which does make life a lot easier, because now you don’t have to have locked file cabinets full of files. Everything is internet-based EMRs, so I can log on anywhere, go in with my password, and write up my patient notes. I use an EMR called WebPT, but there are tons of them out there now. And there are a lot of great apps out there right now. For example, when you go in and are doing evaluative procedures with patients, there are a lot of different special tests that you can use, and now there are apps that have a list of all the special tests that you can use. There are aps that are measuring devices, like goniometers, we call them — it’s how you measure range of motion — now in an app. You can measure gait speed in an ap, or walking speed. So you don’t have to bring all this cumbersome equipment with you anymore. You can just bring your phone, which is kind of awesome.
Also, for patients' home exercise program, instead of photocopying all this stuff for them, I’ll take their camera, their phone, and videotape them doing their exercises. So then if they want to refer back to them, it’s on their own phone,which is pretty cool.
Anything more broad excite or concern you about the future of your field?
The rise of telehealth could be a really good thing. It’s a nice way to reach people who may not have the ability or the means to get to a PT clinic as much as they would like; like people in more rural areas. So I see that as a real big expansion for physical therapy in the future.
I also find that new graduates coming out of PT school are just so motivated and innovative. I think that gives a lot of hope for the profession, and medicine in general. They’re the ones really developing a lot of these new web-based applications, or phone apps, as far as technology is concerned -- there’s a startup in Brooklyn called Vinitial, for example, that’s developed a HIPAA-compliant, patient-to-doctor text messaging system. New grads have an enthusiasm and love for the profession is really refreshing and exciting.
What advice do you give to these aspiring physical therapists?
If you’re a PT student and you’re getting ready to graduate, is to really be clear on the population that you want to work with and the setting that you want to be in. And that’s, again, what your clinical affiliations are for: to help you get clear on that. Once you graduate, you want to be in an environment that makes you happy, that every day you get up and you can’t wait to get to work. It turns you on, you’re excited, and you’re enthusiastic about going to work. If you’re not in that situation — and I think this goes with any profession — burn-out can come pretty quick. And so you want to make sure that you’re really clear on where you want to be, who you want to be with, and why you want to do what you want to do. I think if you can be really clear on those statements, then you’re going to have a really great first experience as a physical therapist. There’s nothing worse than to graduate and have a crappy experience, and say, “Forget it, I made a mistake; and, oh by the way, I’m six figures in debt.”
Besides thinking things through, what is innate in all good physical therapists?
Having a real sense of empathy, being an empathetic provider. A lot of people who go into physical therapy probably have that as an innate skill. When you have that sense of empathy for your patients, it goes such a long way. They pick up on that; they know it — and then that patient is more likely to be on board with you and your plan, and more likely to follow your instructions, and be part of the team.
And having people skills; not being a jerk. Again, this is not a job where you’re going and sitting in front of a computer all day. This is a job where you’re in front of people, you’re working with people, and you need to be on your game all day long. You can’t nap in the middle of a treatment.
Karen Litzy's Reading List:
The Life-Changing Magic of Tidying Up, by Marie Kondo -- "I know this book was all the rage, but I listened to it last year -- I’m on Audible all the time, because I’m in and out of people’s homes, so I’m always listening to books. I know the title sounds crazy, but when you think about it, everyone who wants to start their own business should read that book: It teaches you to tidy up your life, your personal life. If you can come home each day to a tidy apartment or home, and have a system for your personal life, it allows you to focus more on your business. Because if you’re coming home to chaos every day, odds are you don’t have the energy to put into your business. If you’re coming home to a tidy apartment, where everything has its place, it’s so much easier for you to then focus on your business. It sounds crazy, but it makes sense." The Power of Habit, by Charles Duhigg -- "This is another book that I tell people to read, which I just love — and it’s a little bit more physical therapy focused, because it’s more of a neurology-based book. It tells people why we do the thing we do, in life and in business. As a physical therapist, it can maybe give you a little insight into why your patients do the things that they do, and how, as a PT, you can help them change those habits." Explain Pain, by David Butler and G. Lorimer Moseley -- "There are books that every physical therapist should read as well. Even if you’re not going to have your own practice, there are a couple of books that every PT should read. Actually, every person should read Explain Pain because, just as the title suggests, it gives a good sort of neurological basis for why you have pain." Aches and Pains, by Louis Gifford Therapeutic Neuroscience Education, by Adriaan Louw and Emilio Puentedura Start with Why, by Simon Sinek Ask, by Ryan Levesque Give and Take, by Adam Grant Simple: Conquering the Crisis of Complexity, by Alan Siegel and Irene Etzkorn