In West Virginia, we can go to a physical therapist without a referral, but it will hurt in the pocket book. Medicare and other insurers require a prescription for coverage.
The physical therapists have a collection of evaluation techniques for assessing problems, ranging from difficulties with balance, weaker bones, decreased joint flexibility, osteoarthritis, even pain related to various conditions. Once they have determined the nature of the difficulties, they design a program tailored to the individual.
Just as important, they know what to avoid.
"For example, it is known that strengthening exercises are good for loading bone and preventing worsening of osteoporosis," Mancinelli wrote.
Yet some gym equipment can "promote the slouched position of osteoporosis and create the wrong types of load that can cause further fracture and pain," she wrote.
That's just one of the conditions many of us encounter as we age.
Mancinelli's areas of clinical expertise includes falls and balance of the elderly.
"It is not 'normal' to fall or be fearful of falling as you age," she wrote. "It is not 'normal' to lose the ability to stand from a seated position, lose balance while turning, trip regularly and so on."
Instability can decline for a variety of reasons including loss of muscle mass, flexibility and vision, stroke, and spinal problems, medications or even inner ear dysfunction, she wrote.
The physical therapist has a bag of tricks for assessing stability and fall risk, and some are relatively simple, with no high-cost medical screening equipment.
The Berg Balance test, for example, requires the physical therapist to evaluate 14 common tasks that include picking a shoe up from the floor, turning to look over each shoulder and standing on one leg at a time, Mancinelli said.
"There are many other tests the physical therapist can use to determine baseline values of physical function and safety. Interventions can then be designed to address deficits."
It's worth keeping in mind.