Physical therapy
provides services for people of all ages, from newborns to the very oldest,
when medical problems or other health-related conditions limit their ability to
move and function in their daily lives. A
physical therapist will examine you and develop a
treatment plan to increase your ability to move, reduce pain, restore function,
and prevent disability.
The goals of physical therapy are to
improve your mobility (such as walking, going up stairs, or getting in and out
of bed), to relieve your pain, and to restore your physical function and
overall fitness. Depending on your injury, disease, or condition, you may need
to work on flexibility, strength, endurance, coordination, and/or balance. To
do this, your treatment may focus on preventing problems or treating problems
that affect:
Your muscles, tendons, ligaments, and bones
(musculoskeletal system).
Your nerves and related muscles
(neuromuscular system).
Your heart and related blood vessels
(cardiovascular system).
Your lungs and breathing (pulmonary
system).
Your skin, including wounds and burns.
Any
combination of two or more of these.
Where can I get physical therapy?
Physical therapy
services are delivered in many places, including:
Outpatient
clinics.
Hospitals.
Nursing homes.
Private
homes, through home health agencies.
Schools.
Sports and fitness
facilities.
Work settings.
How do I find a physical therapist?
Your health
professional may recommend a certain physical therapist because he or she knows
that the therapist has expertise with your condition and/or because they have
worked together with patients in the past. Many people find their physical
therapists by talking with friends or family, or even by looking in the
telephone book or on the Internet. Health insurance companies also include
physical therapists in their lists of providers.
Physical
therapists are educated to provide services for a variety of people. Some treat
a wide range of injuries, diseases, and health conditions. Others specialize in
areas such as pediatrics (children's health), geriatrics (health issues of the
aging), orthopedics (conditions of muscles, tendons, ligaments, and bones),
sports physical therapy (recreational or professional sports issues), neurology
(issues with nerves and related muscles), cardiovascular therapy (issues with
the heart and related blood vessels), pulmonary (lung conditions and
breathing), oncology (problems related to the treatment of cancer), and women's
health (issues before and after the birth of a baby, incontinence related to
muscle control in the pelvic region, problems after a mastectomy, and
osteoporosis). Be sure you are seeing a physical therapist with the expertise
to help with your problem, and in a setting where you feel comfortable.
Ask to find out if you need a referral from a doctor. Most states do not
require a referral for you to see a physical therapist, but some do. And some
insurance companies will not pay for physical therapy without a
referral.
Health Tools
Health Tools help you make wise health decisions or take action to improve your health.
Actionsets are designed to help people take an active role in managing a health condition.
Exercise is anything you do in addition
to your regular daily activity that will improve your flexibility, strength,
coordination, or endurance. It even includes changing how you do your
regular activities to give you some health benefits.
For example, if you park a little farther away from the door of the grocery
store, the extra distance you walk is exercise.
Physical therapy nearly always involves exercise of
some kind that is specifically designed for your injury, illness, condition, or
to help prevent future health problems. Exercise can include
stretching to reduce stress on joints, core stability
exercises to strengthen the muscles of your trunk (your back and abdomen) and
hips, lifting weights to
strengthen muscles,
walking, doing water aerobics, and many other forms of
activity. Your physical therapist is likely to teach you how to do an exercise
program on your own at home so you can continue to work toward your fitness
goals and prevent future problems.
Manual therapy is a general term
for treatment performed with the hands and not with any other devices or
machines.1, 2 The goals of
manual therapy include relaxation, less pain, and more flexibility. Manual
therapy includes:
Massage, which applies pressure to the
soft tissues of the body such as the muscles. Massage can help relax muscles,
improve circulation, and ease pain in the soft
tissues.
Mobilization, which uses slow, measured movements to
twist, pull, or push bones and joints into position. This can help loosen tight
tissues around a joint and help with flexibility and
alignment.
Manipulation, which uses rapid, forceful movements to
position the bones and joints. This is a more aggressive treatment. Discuss the
pros and cons of manipulation with your doctor or physical therapist.
Education
Physical therapy almost always includes
education and training in areas such as:
Performing your daily tasks
safely.
Protecting your joints and avoiding
reinjury.
Using assistive devices such as crutches or
wheelchairs.
Doing home exercises designed to help with your injury
or condition.
Making your home safe for you if you have strength,
balance, or vision problems.
Specialized treatments
In some locations, physical
therapists are specially trained to be involved in other types of treatment,
including:
Vestibular rehabilitation, which helps your
inner ear respond to changes in your body position. This is helpful if you have
problems with
vertigo, or a feeling that you or your surroundings
are spinning or tilting when there is actually no movement. Rehabilitation can
help you get used to the problem so you know when to expect it, and train your
body to know how to react.3
Wound care.
Wounds that are very severe or don't heal well, often because of poor blood
flow to the area, can require extensive care. This may include special cleaning
and bandaging on a regular and long-term basis.4
Sometimes hydrotherapy,
oxygen treatment, or electrical stimulation is part of
the treatment.
Women's health. Physical therapists often work with
women on exercises to help control
urinary incontinence or to relieve pelvic
pain.
Oncology (cancer care), to help if cancer or treatment for
cancer causes you to have problems with movement.
Decongestive
lymphatic drainage, which is a special form of massage to help reduce swelling
when the
lymphatic system is not properly draining fluids from
your tissues.1
Cold and ice
Ice and cold packs are used in
physical therapy to relieve pain, swelling, and inflammation from injuries and
other conditions such as arthritis. Ice can be used for 10 to 20 minutes at a
time. In some cases, ice may be used several times a day.5, 6 For more information, see:
Heat can help relax and heal your muscles and
soft tissues by increasing blood circulation.5 This
can be especially helpful if a joint is stiff from osteoarthritis or from being
immobilized, or to relax the muscles before exercise. However, heat can also
increase swelling in an injured area if it is used too soon after the injury.
Most experts recommend waiting at least 48 hours after an injury before using
heat. For more information, see:
Hydrotherapy is the use of water to
treat a disease or to maintain health. The term "hydrotherapy" (water therapy)
can mean either exercise in the water or using water for care and healing of
soft tissues.7 This type of therapy is based on the
theory that water has many properties that give it the ability to heal:
Water can store and carry
heat.
Water is found in different forms, such as ice, liquid, or
steam. Ice may be used to cool, liquid is used in baths and compresses at
varying pressures or temperatures, and steam is used in steam baths or for
breathing in.
Water can help blood flow.
Water also has
a soothing, calming, and relaxing effect on people, whether in a bath, shower,
spray, or compress.
Exercise in water takes the weight off a
painful joint while also providing resistance.
Ultrasound therapy uses high-pitched sound waves to ease muscle spasms and relax
and warm muscles before exercise, to help relieve pain and inflammation, and to
promote healing. Although the use of ultrasound is common, some studies show a
benefit from this treatment and others do not.5 Some
physical therapists do not recommend deep-heating techniques. Discuss the
benefits and risks with your physical therapist or doctor before starting this
therapy. This type of treatment is not generally used for children.
Electrical stimulation
Electrical stimulation is
the general term that describes the use of electrical current to create an
effect in the body. There are several uses for electrical stimulation.8
Physical therapists sometimes use electrical
stimulation at low levels to reduce the sensation of pain. It may work by
either "scrambling" pain signals to mask feelings of pain, or by causing the
body to produce natural pain-killers called endorphins.
Physical
therapists can also use electrical stimulation to cause muscles to contract
(tense). This type of therapy can help maintain muscle tone when muscles would
otherwise lose strength or help teach muscles to contract again. Examples of
this type of therapy include:
Electrical stimulation after a stroke to
maintain some tone in the shoulder muscles so they hold the joint together
better and prevent pain.
Electrical stimulation to maintain leg
strength in a person who has severe arthritis of the knee and whose pain
increases with exercise.
Electrical stimulation to get muscles at
the front of the thigh working in the proper order after knee surgery.
Electrical stimulation is being studied as a
way to help with healing of wounds and broken bones.
What to Expect at a Physical Therapy Visit
At your
first
physical therapy visit, your
physical therapist will review your medical history
and do a physical evaluation. Depending on your diagnosis or symptoms, your
therapist may evaluate your flexibility, strength, balance, coordination,
posture, and/or heart rate and respiration. Your therapist may look at how you
walk or get up from lying down (functional activities), along with how you use
and position your body as you perform activities (body mechanics). The
therapist will work with you to determine your goals for physical therapy and
to begin planning your treatment. You may or may not begin your actual therapy
at the first visit.
Generally, the first goal of treatment is to
decrease any pain and swelling you may have. The next step is usually to
increase your flexibility, and then to increase your strength and endurance.
The goal is always to improve your ability to do your daily tasks activities.
As with any exercise, you may have mild soreness or swelling as a result of
treatment, and these should be noted by your therapist. Your therapist will
monitor your reaction to treatment (for example, if you have swelling or become
out of breath) and will adjust your treatment as needed. This ongoing
assessment and adjustment means that the risk of any injury or complication
from physical therapy is very low.
Your physical therapist will
evaluate your need for special equipment such as particular footwear, splints,
or crutches. If you need equipment, your therapist can help you determine what
to get and either get it for you or tell you where you can find it.
In most cases, part of your physical therapy will be education. Your
therapist may teach you about a home exercise program, proper body mechanics,
and the use of any special equipment you may need. He or she will then
periodically assess how well you are transferring the skills you learn in
therapy to your daily life.
Your physical therapist will
continually reassess your progress toward your treatment goals and will work
with you and your other health professionals to plan for your discharge from
physical therapy.
When Physical Therapy Can Help
Physical therapy and recovery from injury
Physical therapy can help you recover from an injury
and avoid future injury by reducing pain in the soft tissues (muscles, tendons,
and ligaments), improving flexibility and function, and building muscle
strength. Your
physical therapist can also evaluate how you perform
an activity and make suggestions for doing the activity in a way that is less
likely to result in an injury. Following are examples of injuries for which
physical therapy is helpful:
Physical therapy can help you live more easily with chronic or ongoing
health conditions. Your physical therapist will work with you to establish your
goals, then create a program of educational, range-of-motion, strengthening,
and endurance activities to meet your needs. Here are some examples of chronic
conditions that may be helped by physical therapy:
Physical therapy and health conditions requiring a rehabilitation team approach
Some conditions involve several body
systems and can lead to significant disability. These conditions-such as
stroke, brain injury, spinal cord injury, and major cardiopulmonary (heart and
lung) problems-are usually addressed by a team of health professionals. The
team can include doctors; nurses; physical, occupational, and speech
therapists; psychologists; and social workers, among others. Physical
therapists are a critical part of this team, addressing the issues of range of
motion, strength, endurance, mobility (walking, going up and down stairs,
getting in and out of a bed or chair), and safety. The physical therapist may
also get you the equipment you need, such as a walker or wheelchair, and make
sure you can use the equipment appropriately. Following are some examples of
health conditions that commonly involve a rehabilitation team:
Physical therapy and significant health conditions of childhood
Physical therapists also work with children who have
major injuries or health conditions. In addition to addressing the usual issues
of range of motion, strength, endurance, and mobility, the therapist also
considers the child's special growth and developmental needs.
Treatment is often provided in the school or in a facility just for
children. The way physical therapy and other services are delivered in the
schools varies among the states. Talk to your child's health professional,
school, or your local health department if you think your child may qualify for
evaluation or treatment services.
Cerebral palsy is an example of a childhood health
condition that is usually addressed in part by physical therapy. Other injuries
and conditions include brain injury, muscular dystrophy, and arthritis.
Other Places To Get Help
Organizations
American Academy of Orthopaedic Surgeons
(AAOS)
6300 North River Road
Rosemont, IL 60018-4262
Phone:
1-800-346-AAOS (1-800-346-2267) (847) 823-7186
Fax:
(847) 823-8125
E-mail:
pemr@aaos.org
Web Address:
www.aaos.org
The American Academy of Orthopaedic Surgeons (AAOS) provides
information and education to raise the public's awareness of musculoskeletal
conditions, with an emphasis on preventive measures. The AAOS Web site contains
information on orthopedic conditions and treatments, injury prevention, and
wellness and exercise.
American Occupational Therapy
Association
4720 Montgomery Lane, P.O. Box 31220
Bethesda, MD 20824-1220
Phone:
(301) 652-2682
Fax:
(301) 652-7711
TDD:
1-800-377-8555
Web Address:
http://www.aota.org
The American Occupational Therapy Association (AOTA) is the
nationally recognized professional association of approximately 35,000
occupational therapists, occupational therapy assistants, and students of
occupational therapy. AOTA's mission is to advance the quality, availability, use,
and support of occupational therapy through standard-setting, advocacy,
education, and research on behalf of its members and the public.
American Physical Therapy
Association
1111 North Fairfax Street
Alexandria, VA 22314-1488
Phone:
1-800-999-APTA (1-800-999-2782) (703) 684-2782
Fax:
(703) 684-7343
TDD:
(703) 683-6748
Web Address:
www.apta.org
The American Physical Therapy Association is a national
organization representing nearly 70,000 physical therapists, physical therapist
assistants, and students. Its goal is to foster advancements in physical
therapist education, practice, and research. The APTA also provides information
and education to the public about physical therapy and how it is used to treat
certain conditions.
Weiting JM, et al. (2005). Manipulation, massage and
traction. In JA DeLisa et al., eds., Physical Medicine and Rehabilitation: Principles and Practice, 4th ed., vol. 1, pp. 285-309.
Philadelphia: Lippincott Williams and Wilkins.
Cotter AC, et al. (2005). Complementary and
alternative medicine. In JA DeLisa et al., eds., Physical Medicine and Rehabilitation: Principles and Practice, 4th ed., vol. 1,
pp. 465-478. Philadelphia: Lippincott Williams and Wilkins.
Parikh SS, Bid CV (2005). Vestibular rehabilitation.
In JA DeLisa et al., eds., Physical Medicine and Rehabilitation: Principles and Practice, 4th ed., vol. 1, pp. 957-974.
Philadelphia: Lippincott Williams and Wilkins.
O'Connor K (2005). Pressure ulcers. In JA DeLisa et
al., eds., Physical Medicine and Rehabilitation: Principles and Practice, 4th ed., vol. 2, pp. 1605-1618. Philadelphia: Lippincott
Williams and Wilkins.
Basford JR (2005). Therapeutic physical agents. In JA
DeLisa et al., eds., Physical Medicine and Rehabilitation: Principles and Practice, 4th ed., vol. 1, pp. 251-270. Philadelphia:
Lippincott Williams and Wilkins.
Malanga GA, et al. (2005). Sports medicine. In JA
DeLisa et al., eds., Physical Medicine and Rehabilitation: Principles and Practice, 4th ed., vol. 1, pp. 557-575. Philadelphia:
Lippincott Williams and Wilkins.
Becker BE, Cole AJ (2005). Aquatic rehabilitation. In
JA DeLisa et al., eds., Physical Medicine and Rehabilitation: Principles and Practice, 4th ed., vol. 1, pp. 479-492. Philadelphia:
Lippincott Williams and Wilkins.
Pape KE, Chipman ML (2005). Electrotherapy in
rehabilitation. In JA DeLisa et al., eds., Physical Medicine and Rehabilitation: Principles and Practice, 4th ed., vol. 1, pp.
435-463. Philadelphia: Lippincott Williams and Wilkins.
Other Works Consulted
American Physical Therapy Association (2004).
Standards of practice for physical therapy and the criteria. Physical Therapy, 84(1): 90-94.
American Physical Therapy Association (2007). The
physical therapist. APTA Background Sheet 2007.
Available online:
http://www.apta.org/AM/PrinterTemplate.cfm?Section=Home&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=29384.
Klippel JH, et al. (1999). Principles of management of
musculoskeletal disorders section of Principles of diagnosis and management. In
Primary Care Rheumatology, pp. 41-54. London:
Mosby.
Speed CA (2001). Therapeutic ultrasound in soft tissue
lesions. Rheumatology, 40(12): 1331-1336.
U.S. Department of Labor, Bureau of Labor Statistics
(2006). Physical therapists. Occupational Outlook Handbook. Available online: http://www.bls.gov/oco/ocos080.htm.
This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
Weiting JM, et al. (2005). Manipulation, massage and
traction. In JA DeLisa et al., eds., Physical Medicine and Rehabilitation: Principles and Practice, 4th ed., vol. 1, pp. 285-309.
Philadelphia: Lippincott Williams and Wilkins.
Cotter AC, et al. (2005). Complementary and
alternative medicine. In JA DeLisa et al., eds., Physical Medicine and Rehabilitation: Principles and Practice, 4th ed., vol. 1,
pp. 465-478. Philadelphia: Lippincott Williams and Wilkins.
Parikh SS, Bid CV (2005). Vestibular rehabilitation.
In JA DeLisa et al., eds., Physical Medicine and Rehabilitation: Principles and Practice, 4th ed., vol. 1, pp. 957-974.
Philadelphia: Lippincott Williams and Wilkins.
O'Connor K (2005). Pressure ulcers. In JA DeLisa et
al., eds., Physical Medicine and Rehabilitation: Principles and Practice, 4th ed., vol. 2, pp. 1605-1618. Philadelphia: Lippincott
Williams and Wilkins.
Basford JR (2005). Therapeutic physical agents. In JA
DeLisa et al., eds., Physical Medicine and Rehabilitation: Principles and Practice, 4th ed., vol. 1, pp. 251-270. Philadelphia:
Lippincott Williams and Wilkins.
Malanga GA, et al. (2005). Sports medicine. In JA
DeLisa et al., eds., Physical Medicine and Rehabilitation: Principles and Practice, 4th ed., vol. 1, pp. 557-575. Philadelphia:
Lippincott Williams and Wilkins.
Becker BE, Cole AJ (2005). Aquatic rehabilitation. In
JA DeLisa et al., eds., Physical Medicine and Rehabilitation: Principles and Practice, 4th ed., vol. 1, pp. 479-492. Philadelphia:
Lippincott Williams and Wilkins.
Pape KE, Chipman ML (2005). Electrotherapy in
rehabilitation. In JA DeLisa et al., eds., Physical Medicine and Rehabilitation: Principles and Practice, 4th ed., vol. 1, pp.
435-463. Philadelphia: Lippincott Williams and Wilkins.
