Andy Tullis / The BulletinBarrett Ford, owner of Step & Spine Physical Therapy, performs a lateral flexion stretch during physical therapy on Kasey Lohman of Redmond. Ford also has a physical therapy clinic in Sisters, where the rate of physical therapists to residents is very high.

When Chuck Brockman first moved to Bend 12 years ago, a surgeon joked that back when he practiced in the Midwest, his knee replacement patients just wanted to be able to get to the corner pub or from their office to their car.

“Here in Bend, they want to ski, they want to play tennis and they want to horseback ride,” said Brockman, director of physical therapy for Therapeutic Associates in Bend. “There is a different expectation on how we live our lives here in Bend.”

Aside from being mildly offensive to Midwesterners, the remark serves to illustrate an important point about the people here in Bend: We’re an active bunch. Since Central Oregonians expect to be doing more, longer, it stands to reason that we might need more help when we run into roadblocks — aches, pains, tears, breaks.

That’s one theory that could explain the high number of physical therapists practicing here. A Bulletin analysis of physical therapist licenses in Oregon revealed that Bend has among the highest rates of physical therapists per capita in the state: about 18.5 per 10,000 residents. That’s almost three times the statewide average of 7.3 per 10,000 residents.

“Probably one degree of separation is all you need before you bump into a physical therapist somewhere,” said Burke Selbst, the co-owner of Focus Physical Therapy in Bend.

The seven Oregon cities with per-capita rates of physical therapists higher than Bend are smaller cities with populations between 2,174 and 26,879, where a modest number of the providers skews the rates disproportionately high. Sisters, for example, has only eight physical therapists, but in a town of only 2,174 people, that’s 36.8 physical therapists per 10,000 residents, the third highest rate in the state.

While Bend’s active population ensures its physical therapists don’t go hungry, the providers tend to be active people themselves, which could also explain why so many choose to live and work in Central Oregon. The Oregon Physical Therapist Licensing Board provided the number of licensed physical therapists in Oregon listed by the cities they work in, although Rick Sullivan, the board’s licensing coordinator, added the caveat that some may live in other states and simply hold licenses in Oregon.

Avoiding surgery

Physical therapy also is becoming an increasingly attractive, less expensive alternative to surgery for some, and a growing body of research is showing that physical therapy can delay or even prevent the need for surgery later on.

Last year, surgeons with Harvard University-affiliated Brigham and Women’s Hospital and six other hospitals published a study in the New England Journal of Medicine that found physical therapy to be just as effective as surgery in healing torn knee cartilage. In fact, the researchers pointed out that a torn meniscus can work as a shock absorber, which emphasizes the importance of repairing it with physical therapy over surgically removing parts of it.

Nancy White, senior director for clinical practice and research for the American Physical Therapy Association, said private health insurance has long provided extensive coverage for physical therapy, but now that it’s seen as a less expensive option, more insurers are encouraging their clients to seek physical therapy before resorting to more expensive options.

Joint replacements, such as hips and knees, are among the conditions for which physical therapy can be an effective alternative, White said.

Lower back pain is another example, she said. The U.S. has seen a dramatic increase in lumbar spine surgeries, particularly lumbar spinal fusions, in which vertebrae are fused to reduce movement between them. Between 1996 and 2001, the number of lumbar fusions performed in the U.S. grew 113 percent, according to a 2005 study in the journal Spine.

Physical therapy can, in some cases, prevent the need for such surgeries, White said.

“Its value is being recognized in so many different aspects of our population,” White said. “It’s seen as an alternative to prolonged use of medication and surgery. I think it’s a really great career, but it’s also an important aspect of health care that I think people are starting to recognize.”

A study performed by Therapeutic Associates, a company with 76 practices in the Pacific Northwest, including Bend, found that seeing a physical therapist within 14 days of experiencing lower back pain resulted in an average total savings of more than $4,000 per patient over the course of treatment.

Increasing demand

The U.S. Bureau of Labor Statistics predicts the demand for physical therapists will grow 36 percent in the U.S. between 2012 and 2022, more than three times the average growth rate for all occupations during that time.

White said she thinks that’s partially because it’s no longer just athletes and active people who need the care. It’s a broader population of aging individuals and the increasing recognition of physical activity as a preventive measure against health conditions. Physical therapists also comprise a large proportion of staff members who work in skilled nursing facilities, nursing homes and home health services, she said.

Step & Spine Physical Therapy, which opened its first location in Sisters in 2010 and expanded into Redmond two years later, announced this month it’s opening a new clinic in Bend’s NorthWest Crossing neighborhood in June 2015. Barrett Ford, who owns the practice with his wife, Jodi, said in addition to the eight to 12 staff members he’ll hire for the Bend clinic, he’s actively hiring more physical therapists in Sisters and Redmond.

“Honestly, I’m having a heck of a time keeping up with staffing,” he said.

Ford agrees there are a number of reasons behind the high number of physical therapists in Bend. Not only are the residents active, but physical therapists tend to be active, too. More importantly, though, Central Oregonians are active while they age.

“As they come up against these barriers of, ‘I can’t run like I used to, I can’t play like I used to,’ they’re looking for ways to do those,” he said. Physical therapy can help with age-related issues like stiffness, a lack of balance and back pain, he said. “They don’t want to stop. They want to keep going.”

But the top reason Ford said he thinks physical therapy is growing is cost. Any form of medical treatment is expensive, but physical therapy is a conservative intervention that could save people money, he said. One example could be hip replacements, an expensive surgery. Often, hips have become osteoarthritic, and if patients can regain backward motion or extension and internal rotation, sometimes that can spare them from needing surgery, Ford said.

“Gaining motion oftentimes reduces the pain and increases function,” he said, “and they can be fine that way.”

— Reporter: 541-383-0304,

tbannow@bendbulletin.com