Since kinesiology became a regulated health profession in Ontario in 2013, kinesiologists continue to add to their professional experience and knowledge and are making ground further into the scope of practice overlap not only with physiotherapy, but also with medicine and occupational therapy. An experienced kinesiologist may provide assessments and treatments that look exactly like what someone would receive from a physiotherapist. This would depend on many factors, not only including the client’s status, medical history, needs, and payer, but also most importantly on the training and education gained by the kinesiologist in order to provide these services safely.
The problem with the “kinesiologist vs physiotherapist” debate:
As one of the newest regulated health professions in Ontario, kinesiology is not as well-known as more established professions, like physiotherapy. Although many other articles written on this topic outline specific duties or skills each profession offers, they are more of an example of how the professions can work together in a specific environment, such as a rehabilitation clinic, and don’t really define either profession’s role in health care. These job descriptions are based on business practice, not scope of practice, put in place to make the company operate smoothly and efficiently.
So, it’s not hard to understand why many people think that a scope of practice is a list of protected techniques and therapies owned solely by one group over another. Actually, a profession’s scope is supposed to define its range of responsibility to the public: the Ministry of Health and Long-Term Care in Ontario, who sets the scopes of practice for Ontario’s health professions, deliberately ensured that related professions’ scopes overlap so that the public may choose their healthcare based on their individual prerogatives. This reportedly also controls health care costs by creating a competitive environment between providers, which ultimately benefits both the individual and the system.
Where the differences between kinesiology and physiotherapy actually exist:
Now that we understand a bit better how the overlap of scope of practice can be a good thing for patients, here are the differences that can influence or direct each profession in their services:
Kinesiologists must complete a 4-year university degree that meets the standards set out by the College of Kinesiologists of Ontario. This ensures a comprehensive education in biomechanics of movement, physiology of exercise and disease, and motor learning in developmental and degenerative conditions. Most programs provide a single cooperative placement in the final academic year that is related to an area of the student’s interest.
In contrast, Physiotherapists complete a very focused 2-year Master of Physical Therapy degree, after completing a bachelor’s degree. Although many kinesiology graduates go on to enrol in physiotherapy programs, an undergraduate degree in a health, or science-related field is not required for physiotherapy. However, clinical placements are oriented directly toward practice areas across the profession, including hospitals.
Physiotherapy, by definition, is a clinical profession. And as a result, their members focus on the assessment and treatment of impairments that cause pain and loss of function. Although kinesiology shares these same principles, kinesiologists can work in clinical or non-clinical practice, or a mix of the two (known as mixed practice.)
Most people are familiar with kinesiologists in clinical practice – that is, in a rehabilitation facility, hospital, or a health, wellness or fitness business. Yet many kinesiologists work in non-clinical practice such as academic research and teaching, ergonomics and occupational safety, clinic management, and coordinating the care of people who are injured, where physiotherapists are far less represented.
Most, if not all, private health insurance programs will pay for physiotherapy treatments up to a certain limit. Kinesiology is less popular but some large insurance companies are starting to add kinesiology services to their policies. For many years, insurers have paid for kinesiology assessments and treatments for motor vehicle accidents and workplace injuries, however provincial legislation beneifits physiotherapists to a much larger degree in these areas.
In the majority of cases, kinesiologists bill their clients directly for their services. Where insurance coverage is an important factor in the choice between these two professions, physiotherapy may be preferred by clients.
A controlled act is a technique that poses an increased harm to the client, and as a result requires additional training and supervision to be delivered safely. Physiotherapists are approved to perform six of the fourteen controlled acts defined by the Ministry of Health and Long-Term Care of Ontario. Some of the common controlled acts include acupuncture, spinal manipulation, internal treatment and assessment of pelvic pain, and communicating a diagnosis of musculoskeletal pathology. In order to perform many of these acts, a physiotherapist must take additional training and examinations to become rostered by the College of Physiotherapists of Ontario to ensure they deliver safe and appropriate treatment.
Controlled acts fall outside of the scope of practice of kinesiologists as well as several other health professions; however, under some conditions a controlled act can be delegated to a Kinesiologist when the authorizing health practitioner is not available.
Kinesiologist vs Physiotherapist: the strengths are in the both the similarities and the differences
Despite these differences, kinesiologists and physiotherapists are able work very well together in order to provide care to their clients. Working within a team environment may mean that some common skills are assigned to one professional over the other, but this should always be done with the patient’s best interest in mind.
In my own experience, I work very differently with clients who are seeing me exclusively compared to those who are being followed by another health professional or team. And although you may think it would be discouraging to give up some control in helping a client, I find that focusing on a specific treatment modality (e.g., exercise, stretching) and coordinating with another professional’s treatment instead of doing it myself (e.g., joint mobilizations) actually improves the client’s progress with both of us. It also allows an opportunity for professional communication and collaboration, which is not only a college standard of practice, but also can have a very positive effect on professional development and future referrals.
For newly registered kinesiologists, focusing on a particular skillset closest to their university education (e.g. exercise prescription) can improve their confidence with clients before progressing to more advanced skills such as physical assessment and hands-on techniques.
Regardless of profession, every practitioner needs to understand the limits of their abilities and have options for referring clients whose needs outstretch their skills. Regulation has allowed kinesiologists to expand our practices far beyond previous barriers, but we also need to know when other professions need to be consulted on any particular case.
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John Gray, RKin, MSc, CSCS