Drawing Distinctions: The Differences Between Physical Therapy and Personal Training

Recently, 1HP asked what you thought of when you see the abbreviation “PT”, and whether or not the roles of physical therapists and personal trainers are, at least in esports, significantly different from each other.

For the most part, people thought that physical therapists are able to offer more to a team than personal trainers are, but a good deal of people thought there wasn’t much difference in what the two disciplines can do for a team. So let’s break down a bit what it takes to be a physical therapist vs a personal trainer, what they’re legally allowed to do, and what they can do for esports in particular.

LICENSING

For personal trainers, there isn’t just one path to certification. I’m going to use the requirements of the five best personal training certifications (in terms of education, knowledge base, and general industry recognition). For reference, those are the certifications obtained through the American Council on Exercise, the American College of Sports Medicine, the International Sports Sciences Association, the National Academy of Sports Medicine, and the National Strength and Conditioning Association.

Only two of these require a high school diploma or equivalent; none require education beyond high school. All five require CPR/AED certification. All five require a passing score on a certifying exam and continuing education for recertification every 2-3 years.

For physical therapy, the path to practice in the United States is a clinical doctorate program. Any physical therapist graduating in the United States will have a Doctorate of Physical Therapy. This requires a Bachelor’s degree with certain prerequisite courses (anatomy and physiology, kinesiology, biology, chemistry) followed by the graduate clinical doctorate program. Generally, this is a 7 year process. At the end of all that education, graduates are Doctors of Physical Therapy, but not yet physical therapists. The title of physical therapist is only granted after you pass a state licensing exam and, in some states, a jurisprudence exam that indicates you know the limitations on scope of practice in that state. While certain regulations differ from state to state, the general requirements to become a practicing physical therapist in the United States are:

1. Bachelor’s Degree with required courses related to physical therapy (anatomy, physiology, kinesiology, biology, chemistry, etc.) (4 years)
2. Doctorate of Physical Therapy from an accredited university program (2.5-3 years)
3. Passing score on state licensure exam
4. CPR/AED/First Aid certification
5. 30-40 hours of continuing education per recertification period (usually 2 years)

SCOPE OF PRACTICE

So now that we’ve established what physical therapists and personal trainers are, let’s talk about what they do.

Personal trainers have clients. They assess clients and determine short- and long-term fitness goals, and develop an exercise plan to meet those goals. They adjust plans over time in order to meet those goals (or new ones, as goals my change). Some personal trainers are also registered dieticians or certified nutritionists, and are then able to incorporate nutritional advice into an exercise plan as well.

An important difference between physical therapists and personal trainers is that while personal trainers are able to take a client’s injury history into account, they cannot diagnose or treat an injury.

Physical therapists work with patients in two timeframes: preventively and reactively. Preventively, they work to avoid injury, pain, and loss of mobility by developing fitness/wellness programs that incorporate exercise, nutrition, and lifestyle changes. Reactively, they evaluate patients for pain, lack of mobility, weaknesses, imbalances, and functional deficits. After that evaluation, they develop an individualized plan of care that may involve exercises; therapeutic massage; modalities such as ice, heat, electrical stimulation, and cold laser; or some combination of all of those interventions. In both cases, they reassess both the plan and the patient over time and make changes that fit a patient’s needs.

There is some amount of variation in what physical therapists are allowed to do from state to state, mostly centered around two very particular treatments: dry needling (similar to acupuncture, but with an anatomical basis rather than a chi-related one) and grade V manipulations (“cracking a joint”, the way a chiropractor might also do for your back).

ROLE IN ESPORTS

There’s definitely a degree of overlap in what physical therapists and personal trainers can offer an esports organization. Physical therapists, especially those specializing in orthopedics and/or sports physical therapy, and personal trainers can provide general exercise routines to promote overall health and meet fitness goals. Both disciplines can help structure practice on a micro (taking appropriate breaks, incorporating time for activity and exercise) and a macro (applying the concepts of training cycles to gaming practice) level. It is important to note that the types of exercises provided from each practice will likely differ for the exercise programs/routines. Programs designed by Physical Therapists are likely to be more specific with dosages (frequency, volume, load, type, etc.) based upon deep understanding of physiological, anatomical and movement relationships. For example, incorporating specific stretches for the shoulder as shoulder mouse movers are likely to have posterior capsule stiffness leading to increased risk of injuries during functional overhead movements or even with large flicks during play. This is not to say that Personal Trainers do not have a deep understanding of these same relationships and are unable to prescribe with the same level of specificity. Personal trainers can seek advanced education to supplement their knowledge of exercise prescription (often times seeking a degree in Physical Therapy) and their understanding of the movement science, however Physical Therapists are required to have this level of knowledge from their degree. 

There’s also a degree of overlap in what they can’t do. Neither discipline can prescribe medications or order medical imaging. The most significant difference between personal trainers and physical therapists, though, is that personal trainers cannot diagnose or treat injuries.

Evaluation, diagnosis, and treatment of injuries are all within the purview of physical therapists but not personal trainers. Exercises prescribed by physical therapists incorporate the concept that movement is medicine; that is, that with the right exercises, in the right amounts (dosages), at the right intensities, and with the right frequency and rest, we can prevent injuries that gaming and personal injury history predispose us to, can treat injuries that arise in the process, and manage the specific stresses and strains of each individual competitor over time.