Two people come in the same week with the same shoulder. One wants to serve a tennis ball again. The other wants to reach the top shelf and get a shirt on without help.
Same joint, same injury on paper, and two different plans. That gap is roughly where physical therapy ends and occupational therapy begins.
By The First Rehabilitation Team · Reviewed by Dr. Dave Kashuba, Ph.D.
The short version
Physical therapy is aimed at the body part. Restore the motion, rebuild the strength, resolve the pain, get the mechanics working again.
Occupational therapy is aimed at the day. The "occupation" in the name has nothing to do with your job. It means everything that occupies your time: dressing, cooking, bathing, driving, handling a phone, getting through a shift at work. An occupational therapist starts from the task you cannot do and works backward to whatever is stopping you, which might be strength, or coordination, or memory, or simply that your kitchen is arranged for a version of you that had two working hands.
Dr. Dave Kashuba puts the split in patient terms. Some people, he says, are "building up their rotator, building up their knee, building up their ankle to go back running, playing sports. Other people are just wanting to get off the chair and be able to make themselves a pot of coffee without pain." Both are legitimate goals. They are not the same goal, and they do not get the same plan.
Nobody gets a cookie cutter
Dave is blunt about why the distinction matters: "no cookie cutters. Everyone gets evaluated, everyone gets treated differently. In many industries that's not politically correct, but in ours it is."
His reasoning goes past paperwork. "No two bodies are alike, no two human beings are alike," he said on the show. "The parts, they're generally the same, but nobody has the same set." Everyone has a slightly different angle to produce the same motion, which is why we train our therapists to look at the person rather than the diagnosis.
Practically, that means the evaluation decides the discipline, not the referral slip. Sometimes the answer is physical therapy. Sometimes it is occupational therapy. Often it is both, running together, with the two therapists talking to each other about the same patient.
What occupational therapy actually does here
Our occupational therapy program works on activities of daily living: the dressing, bathing and cooking that independence is made of. It covers upper extremity function and coordination, which is where it hands off to and borrows from our certified hand therapy program. It includes post-stroke recovery, where the work is task specific rather than general conditioning. It covers cognitive rehabilitation, the memory and attention and problem solving side of living safely on your own. And it covers return to work, using graded conditioning and simulated job tasks, which is why so much of our workers' compensation work sits on the OT side.
Ergonomics belongs here too. Sometimes the fastest win is not more strength but a different chair, a repositioned monitor, or a piece of adaptive equipment that takes a task from impossible to routine.
The signal that you need one of us
Orthopedic surgeon Dr. Richard Weiner, on our podcast, gave the cleanest version of when to stop waiting. You seek help, he said, "when your symptoms interfere with ADLs, which means activities of daily living."
That is a useful test precisely because it is not about pain scores. Pain is hard to rank and easy to talk yourself out of. Whether you can carry a laundry basket up the stairs is not. Dave says the same thing in his own words: you know it is time when you cannot do the normal things you like to do. People retire for a reason, and the reason was not a rocking chair.
Which one should you ask for?
Honestly, you do not have to decide. That is the evaluation's job, and getting it wrong is not on you.
Come in and tell us what you cannot do right now. If the answer is a motion, we will probably start on the physical therapy side. If the answer is a task, we will probably start on the occupational therapy side. If it is both, you will see both, in the same building, with people who compare notes.
We serve North Palm Beach and the surrounding Palm Beaches, including West Palm Beach. Call 561-624-4263 or request an evaluation. Our FAQ answers more occupational therapy questions, and you can hear Dave work through this on the Pain 2 Power podcast.
This article is general information, not medical advice. Every situation is different, so please consult a qualified professional about yours.