Some might consider Elsa Amaral’s role as a physical therapist at Penn to be an accidental career.

In 2001, while living in Hoboken, N.J., and working for Macy’s in Manhattan, she injured herself during a skiing trip and wound up in physical therapy.

“I wasn’t looking to go through a career change, but in therapy, something just clicked,” Amaral says. “I liked that you had close interactions with people. I liked that it was an environment that was comfortable and one-on-one. I liked that therapy was a helping profession, and that therapists worked for goals that were really important to people’s livelihoods. I had always been interested in the human body and how it moves, and I talked a bit to my own therapists about their job, and it was something that seemed like a good fit for me. I thought, ‘I could do this.’”

So, she decided she would. She packed up, left the Big Apple, and enrolled in a physical therapy program at the University of St. Augustine for Health Sciences in Florida.

“When I look back, I see that it’s one of the best decisions I ever made,” Amaral says.

These days, she says, she loves waking up and coming to work. As a Senior I Physical Therapist for Penn Therapy & Fitness, Amaral is part of a newly formed clinical team at the Penn Medicine University City building at 3737 Market St., an advanced treatment and outpatient facility that brings a multitude of specialties together under one roof, including physical therapy.

As part of the region’s first Musculoskeletal Center—merging orthopedic surgery, physical therapy, occupational therapy, speech therapy, pain medicine, internal medicine, family and sports medicine, rheumatology, and musculoskeletal radiology—Amaral is an integral part of the team that is pioneering the Aqua Therapy program in the facility’s new therapy pool, equipped with a treadmill, activity monitoring, and therapeutic jets.

“With this new pool, we really get to think out of the box as therapists,” Amaral says. “It raises questions like, ‘What all can the pool provide for our patients? How can we use this to treat our athletes?’ There’s a lot of trial and error, but it’s all to create a better pool program and provide better patient care.”

The Current met with Amaral on the third floor of the new facility to talk about Penn Therapy & Fitness, the therapeutic benefits of water, and the challenges of a career in physical therapy.

Q: What falls under the umbrella of Penn Therapy & Fitness?
A: Good Shepherd Penn Partners is the preferred provider of therapy services for the University of Pennsylvania Health System. Penn Therapy & Fitness is mainly comprised of outpatient sites, and we’re growing throughout Pennsylvania and New Jersey. There are a lot of specialties that fall within physical therapy. You can be a general physical therapist, where you can evaluate anyone who walks in the door, with the exception of some specialties. Some therapists specialize more in orthopedics and sports, like we have at Weightman Hall, while some are more neuro-based. Then, there are therapists that go for additional certification and training such as lymphedema specialization, women’s health, hand therapy, work conditioning, and there are even other sub-specialties in the orthopedic world. For instance, we have some therapists who specialize in the lower back, some in the shoulder. I’m one of two therapists here that treats the jaw for TMD [temporomandibular joint disease.] Not every site is going to have those specialty services, but many do.

Q: Do you have any other specialties?
A: I mainly treat a general orthopedic patient population—that’s my interest. I do treat the jaw and am experienced with treating in the pool. There’s a team of four of us who treat at the pool. For 10 hours of the week, I go to the Hospital of the University of Pennsylvania and am part of the hemophilia clinic, as part of a comprehensive team comprised of a hematologist, physical therapist, social worker, nurse, and research team. We generally see patients for comprehensive visits and during follow-up or as needed visits. Hemophilia is a bleeding disorder, and many times these patients will have bleeding into their joints or muscles, which can cause joint and other musculoskeletal damage, requiring a PT.

Q: What is an average day like for you?
A: There’s not really such a thing as an average day. I’m treating most of the time, so my day consists of evaluations of new patients coming in for care, or return patients coming in for follow-up visits. All of the therapists here are involved in providing new ideas for the clinic as well. We have monthly meetings called clinical programming, which are like in-services to educate fellow co-workers. Every therapist is involved with the daily upkeep of, ‘How can we make our clinic better?’ Especially in a new clinic like this. We’re always shooting ideas off of one another.

Q: How do you create a plan for patients whose ability levels and goals are often wildly different?
A: Initially we do an evaluation, like a consultation. We find out why they are seeking therapy. We conduct an in-depth history assessment, discuss their goals, and perform an objective exam consisting of components of strength, range-of-motion, balance, sensory, special tests, movement coordination, and patterns. Let’s just say the patient is having pain when they walk. As therapists, we ask, ‘Is that because there’s range of motion loss? Is that because they’re tight somewhere?’ So you’re really trying to find the cause of their pain, and that dictates the plan. Their plan of care is usually revolved around the patient’s goals. We plan out the steps they’re  going to have to take to get them there, and the types of things we need to do to make it work for them. You’re thinking about each patient on an individual basis, and it really starts with their history—that’s the most important thing.

Q: Tell me about the aqua therapy team.
A: We offer aqua therapy five days out of the week in the morning, and we usually have a therapist that’s here treating. It’s really no different than treating on land. You’re basically doing the same treatment in a different environment. A lot of the same principles of what you would utilize on land, you’re just using them in water. You’re thinking of the physics of the water and how that will translate with what the patient can do. We also have some neat equipment such as a treadmill and water jets, which the patients love.

Q: What are some of the benefits of aqua therapy as opposed to therapy on land?
A: The pool has many unique properties. You have something called buoyancy, which means the water is taking up part of your weight. For instance, if you are standing in the water at waistline, 50 percent of your body weight is being replaced by the water. As an example, patients who have arthritis feel good in the water because they’re not fully weightbearing. Sometimes a physician will order a patient to go in the water because they want them to get early range-of-motion and early weight-bearing after surgery. Water also has hydrostatic pressure, which helps with swelling. A patient who, say, has lymphedema might benefit from being in the water. Water also has viscosity resistance, and the pool here is heated. Anyone who goes in the pool is going to feel nice and relaxed and exercised. Sometimes they come in with seven-out-of-10 pain, and they leave with two-out-of-10 pain. They’re able to move better in the water, which boosts their confidence and keeps them motivated to continue with their rehab.

Q: What injuries do you treat in the pool?
A: We’ll see arthritic conditions, such knee arthritis, spine joint and disc degeneration, neck and shoulder pain, fibromyalgia, post-surgical, such as after total knee or hip replacement, to name more of the common diagnoses. We also get diagnoses of balance and neurological origin. We have a lift in the pool that can lower patients in who cannot independently get in without help. In some cases, it’s just a patient who is not tolerating land and a doctor will recommend the pool. The patients really look forward to it.

Q: What’s the most challenging part of your job?
A: Every therapist goes into PT because they want to help people. Unfortunately, not everyone gets better. So the most challenging part is trying to tailor the best treatment plan for that patient and focus on what’s motivating them and having the patience to meet them where they are at. It can be hard to get people to be preventative when they are feeling good at the moment. It’s not that we don’t want to see the patients again, but really, you don’t—you want them to lead a good quality of life long-term and adopt healthybehaviors.