Getting Fit Without PainBy Kevin Helliker,
Wall Street Journal Athletes over 50 usually hire a physical therapist after a problem, often an injury if not 
surgery. But more older people are starting to hire physical therapists before they get hurt to fill the role of personal trainer.
Before he began training for a marathon, 62-year-old veteran runner Joseph Goldberg consulted with a physical therapist about the shin splints that had developed whenever he'd run more than eight miles at a stretch. She diagnosed an imbalanced gait, ordered custom orthotics for him to wear in his shoes and prescribed exercises to strengthen his hips, a corrective proven to reduce leg-related ailments. "I finished the marathon without injury," says Mr. Goldberg, a Virginia attorney.
By fitness-training standards, physical therapists who specialize in sports medicine are extraordinarily highly educated in the science of preserving, restoring and improving human function. Most have master's degrees, and the profession is pushing its members to obtain doctorates as a matter of course by 2020. But while physical therapists have become fixtures on the sidelines of professional and college sports, their health-preserving skills are little known among recreational athletes. "We're the best-kept secret in sports medicine," says James Glinn, a physical therapist who runs a set of clinics called Movement for Life, bases in San Luis Obispo, Calif.
Word is getting out, as Jane Esparza can attest. The owner of a speakers bureau, Ms. Esparza encountered intensifying levels of knee pain as she entered her 50s. Her doctor told her that losing weight and getting fit would help.But the trainers she interviewed paid less attention to her knee pain than to her excess weight. All of them, she says in an email, responded with some variation of "We'll whip you into shape."
Then see learned about a fitness clinic near her Virginia home called Body Dynamics, run by Jennifer Gamboa, who holds a doctorate in physical therapy. Following a thorough study of Ms. Esparza's needs and limitations, a Body Dynamics physical therapist worked one-on-one with her for eight weeks, leading her through exercise routines that improved fitness and built confidence without straining her knees. Then she was handed over to a Body Dynamics personal trainer, who continued the regimen that the physical therapist had crafted, with an easy-does-it emphasis.
After 18 months, "I've lost weight," Ms. Esparza says. "My blood pressure has gone down. My cholesterol has improved. I breathe better. My strength and balance are improved. And the pain I lived with daily in my knees has greatly improved. Some days I'm almost pain free."
"What physical therapists are very good at is identifying barriers to exercise - knee injuries, chronic ankle pain - and building a program around them that creates incremental improvements," Dr. Gamboa says. Half of people who start an exercise program drop out within six months, partly because of "fear, discomfort and lack of confidence," she says.
Physical therapists often charge far more than $100 an hour, well above the cost of a personal trainer. Insurance companies tend not to cover the cost of physical therapy without a physician's referral; referrals are often limited to patients recovering from injuries, accidents or surgery. After receiving a fitness program from a physical therapist, many patients will, like Ms. Esparza, hire a personal trainer to implement it. But prevention is where many physical therapists say their profession could make the most difference.
A large percentage of aging athletes eventually suffer sprains, strains, overuse injuries and joint pain, and as part of their recovery they go to a physical therapist who focuses on resolving inflammation, restoring flexibility and developing a more-efficient and balanced program.
A proactive visit to a physical therapist can reveal the muscle imbalances and inefficient movement patterns that cause injury. The therapist can provide a regiment that corrects those problems while enhancing endurance, balance, strength and weight control.
The American College of Sports Medicine says that it has certified hundreds of physical therapists and that it has no official position on whether injured athletes should help first from a physician or physical therapist.
Even so, fitness trainers shouldn't attempt to treat, and certainly shouldn't ignore, sports injuries, says Diana Buchta, spokeswoman for IDEA, a trainer organization. "We must refer those clients to a physician," she adds. Of course, many personal trainers specialize in treating the aging population. But the credentials of personal trainers can range from doctorate-level academic degrees to little or no certification at all. To address that problem, officials at IDEA recently established FitnessConnect, an online directory of more than 100,000 trainers with verified credentials.
Physical therapy "is largely built on sciences of anatomy, biomechanics, exercise science and movement analysis," Carl DeRosa, a doctor of physical therapy at Northern Arizona University. That combination, he says, provides " a comprehensive and efficient 'start-to-finish' service to recreational athletes."
In five states, a physician's referral is required for patient visits to a physical therapist. Elsewhere such restrictions have been eliminated, and physical therapists are allowed to diagnose and treat conditions involving impaired movement. Not all physical therapists are sports-medicine specialists, however. The Find-A-PT link on the web site of the physical therapy association (www.apta.org) lists 15 specialties other than sports medicine, including wound management, wheelchair mobility and hand rehabilitation.
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