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Therapies

physical therapy

What is It?
How Does It Work?
What You Can Expect

Health Benefits

How To Choose a Practitioner

References

Evidence Based Rating Scale
 

What Is It? 

Physical therapy is a field of medical care that employs exercise and massage, as well as such agents as heat, light, and water, to treat certain physical disabilities. The specialty first came into its own when wounded soldiers returned from the front after World War I and needed rehabilitative care. Later during the polio epidemic that raged from the 1930s to 1950s, the need for this type of rehabilitation increased even more.  

Today, both conventional and alternative practitioners recommend physical therapy to relieve pain, improve muscle strength and mobility, and restore basic body functions such as standing, walking, and grasping in those who are recovering from surgery or accidents, or who are suffering from debilitating ailments (such as arthritis or stroke). It is also used to treat those who are physically handicapped. Often physical therapy may be combined with occupational therapy. (1) 

How Does It Work? 

As its name might suggest guided exercise is a mainstay of physical therapy. When a limb has lost its full range of motion or muscles have grown weak during a long period of recuperation, a physical therapist will devise a program of carefully chosen movements to help restore function. If a person suffers from back problems, the therapist may suggest extension and flexion exercises to improve the strength and flexibility of the spine. Isometrics, resistance exercises, stretching, and stationary biking might also be recommended depending on the nature of the ailment. 

Massage is also a common part of physical therapy. Used mainly to relax tense or tight muscles (which can inhibit healing), it can also increase circulation, reduce swelling, and stretch adhesions--the fibrous bands of scar tissue that may be limiting movements. 

In addition, physical therapy helps to relieve the underlying pain of stiffened joints through the use of heat treatments such as whirlpool baths, compresses, and heat lamps. And ultrasound waves- high-frequency sound waves that vibrate tissues and produce heat- can speed healing in deeper body tissues. Cold treatments or ice packs are typically employed to calm muscle spasms and to reduce swelling and inflammation. Patients may also be given what's known as contrast hydrotherapy, a water treatment that alternates heat with cold to dramatically stimulate circulation in a particular area of the body. 

Directing therapy towards improving a patient’s ability to perform Activities of Daily Living (ADLs) is another important goal of physical therapy. For example, if after a stroke, a patient needs to relearn a basic function such as holding a spoon or turning a doorknob, a physical therapist can help. Patients may also be taught how to use crutches, prosthetic devices, or other mechanical aids when necessary.  In addition, physical therapists can advise patients on proper posture and gait, so that they can move more efficiently and function more easily. They may also suggest better ways of positioning and using the body in the workplace if the problem is due to repetitive stress injury. (2)  

What You Can Expect 

In the initial visit to a physical therapist, medical history and current injury status will be reviewed. Patients should provide information about any prescriptions they are taking as well as information about any tests that have been done such as x-rays and MRI's. If possible, patients should bring copies of those tests with them. Patients should come dressed in comfortable clothes that allow access to the injured area. The physical therapist will evaluate patients through conversation regarding the injury, measuring strength and perhaps performing additional diagnostic tests such as tolerance for distance walked. The therapist will determine range of motion, which is the distance a joint can be moved in a certain direction. Range of motion (ROM) is measured in angle degrees using an instrument called a goniometer. If the ROM indicates limited motion in the joint, the therapist will determine if the cause is pain or tightness in muscles, ligaments or tendons. (3)  

Some therapists are also trained to perform electromyography (EMG), a procedure in which a thin needle is inserted into a muscle to record the muscle's electrical activity. An EMG can help to diagnose a condition such as carpal tunnel syndrome, a neuromuscular disorder or a disease such as Amyotrophic Lateral Sclerosis (Lou Gehrig's disease). (4) 

Once the evaluation is complete, the therapist will create an assessment and personalized plan of care for each patient. After the initial visit, patients are scheduled for additional visits based on their plan. The therapist will utilize a variety of manual and mechanical therapeutic techniques that can help patients to move, reduce pain, restore function, and prevent disability. Manual techniques might include massage, myofascial release or acupressure (applying pressure to acupuncture points without the use of needles to relieve pain and promote balance). Mechanical techniques may include hydrotherapy, the application of hot or cold packs, therapeutic ultrasound, or electrical stimulation with transcutaneous electrical nerve stimulation (TENS) or neuromuscular electrical stimulation (NMES). In TENS, a low-level electrical current blocks the pain message before it is perceived by the brain; while in NMES a strong electrical current is applied to a specific point in a muscle to elicit a muscle contraction. (2, 5, 6) 

Health Benefits 

The American Physical Therapy Association's website lists a number of disorders for which physical therapy may help to improve mobility and restore function. Specifically, physical therapy may benefit: 

Arthritis. Physical therapy has been proven and recommended for the management of rheumatoid arthritis (RA) to prevent joint damage and functional loss and to relieve pain. Physical therapy is usually used in conjunction with other types of RA treatment including medications. (7) Additionally, non-surgical and non-pharmacological treatments are recommended as the first line of therapy for knee and hip osteoarthritis. Techniques such as exercise therapy and manual therapy may reduce pain and increase joint function in these disorders. (8)

Back pain.  Massage techniques such as Swedish massage and deep-tissue massage can ease the discomfort of low-back pain by boosting circulation to the muscles and tissues. Massage has also been shown to lower levels of stress hormones, calm muscle spasms and pain, raise levels of pain-killing endorphins, and improve sleep. (9) In one study, 26 individuals with back pain due to a lumbar herniated disc ("slipped disc") were given 15 sessions of conventional physical therapy that included ultrasound, lumbar traction, hot packs, and electrotherapy. At 4-6 weeks after treatment, individuals continued to report significant reductions in pain and sleeping disturbances; standardized disability scores were lower and both patient and physician global assessments of well-being were improved. In addition, they reported increased lumbar mobility; however in five patients the size of the herniated mass was reduced while in three patients it had increased. (10) While physical therapy has been shown to be helpful for back pain, a 2010 review of studies found conflicting evidence for the association between low back pain and general levels of work and leisure time physical activity, suggesting that guidance from the therapist plays an important role. (11)  

Cancer.  Physical fitness has been shown to play an important role in the management of cancer-related neuropathic pain. When pain has already set in, guidance from a physical therapist may facilitate finding those strengthening activities that are manageable. Techniques such as massage used in an integrative approach may alleviate other discomforts related to cancer therapy. (12)  E.g., breast cancer surgery that includes axillary (under the arm) lymph node dissection may compromise lymphatic drainage resulting in chronic swelling of the arm and hand. Physical therapy helps to reduce swelling and minimize the accompanying problems and discomfort. 

Carpal tunnel syndrome. In carpal tunnel syndrome (CTS), the median nerve that runs from the forearm into the hand becomes compressed at the wrist and causes pain, numbness, or weakness in the palm side of the thumb and fingers. A 2010 review of studies indicated strong and moderate evidence supporting the short-term effectiveness of physical therapy techniques such as ultrasound and electromagnetic field therapy in addition to steroids, nocturnal splinting, and the use of ergonomic keyboards. However, little evidence exists for the long-term effectiveness of these techniques. (13) 

Chronic pain. In addition to back pain, a number of chronic pain disorders have responded well to physical therapy. About 25% of pregnant women are diagnosed with a condition known as pelvic girdle pain (PGP) which is characterized by pain in the pelvic joints and problems with walking, standing, and sitting. Physical therapy that focuses on body awareness and specific functional training has been found to have a good and long-lasting effect on the management of PGP. (14) 

Overactive pelvic floor syndrome is characterized by mild to severe chronic pain and defecation difficulties that can lead to chronic constipation. Interstitial cystitis, a condition of chronic bladder irritation, has also been linked to imbalances in pelvic floor musculature. Physical therapy specific to the pelvic floor has been found to be useful in managing these conditions. (15) 

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) occurs in men of all ages and is characterized by persistent discomfort or chronic pain in the pelvic area. It negatively affects quality of life and sexual function in men. In one case study, two men were treated with manual therapy applied to the pelvic floor by a physical therapist. The therapist also instructed them in progressive muscle relaxation, flexibility exercises, and aerobic exercises. Both men reported decreased pain and improved quality of life based on the scores from their individual NIH Chronic Prostatitis Symptom Index questionnaires. (16). 

Diabetes. A physical therapist can help with managing diabetes by developing individual exercise programs that restore and improve motion and improve circulation to the extremities. (17) 

Fibromyalgia. Fibromyalgia is characterized by fatigue, muscular pain and tenderness, as well as problems with thinking and memory. Moderate exercise including aerobic conditioning, strengthening, stretching, and manual therapy have been shown to decrease pain, improve function, overall physical health, and sleep in patients with fibromyalgia. (18) A physical therapist can teach patients to manage pain signals and manage symptoms through exercise. (19)  

Headache. Cervicogenic headache—head pain that arises from problems in the neck or cervical spine—can improve with physical therapy. In one study, 200 patients randomized to six weeks of treatment with manipulative therapy, low-load endurance exercise or both had significantly reduced frequency of headaches 12 months later compared to controls. Physical therapy with exercise is recommended as first-line therapy for cervicogenic headache in UpToDate. (30) 

Muscle aches and pains. In two studies of individuals with writer's cramp, repeated sessions with TENS was shown to improve motor skills and handwriting. (20, 21) And a 2008 study showed massage was effective in reducing muscle pain by as much as 50%. (22) 

Osteoporosis.  In a 2010 review of studies, exercise was widely recommended for reducing osteoporosis, falls, and related fractures. Long-term (greater than six months) supervised exercise enhanced bone strength in children but not adults. However, measurable increases in bone strength may take longer to achieve in adults as they are beyond the age of rapid bone growth. (23) Another systematic review on optimizing bone strength throughout life revealed that the exercise groups showed significant improvements in physical function, pain and vitality compared to controls. (28)   

Sports injuries. In a 2010 study, 101 patients with ankle sprain were given either the standard therapy of Protection, Rest, Ice, Compression, and Elevation (PRICE), or PRICE plus early therapeutic exercise during the first week after the sprain. The group that included exercise had improved ankle function during the first week and into the second week. (24) For knee injuries, the McConnell multimodal physiotherapy regimen has been shown to be effective. This regimen includes stretching, mobilization, massage, balance training, and general conditioning. (25) 

Stroke. After a stroke, an individualized physical therapy plan is an important aspect of rehabilitation. In one study, participants received either the standard rehabilitation program or the standard program combined with thermal stimulation (TS) on the upper extremity 3 months after the stroke. TS was done three days a week for 30 minutes each day for eight weeks. At the end of the study, the TS group showed significant improvement in upper extremity motor recovery compared to the control group based on their scores on the Stroke Rehabilitation Assessment of Movement and Action Research Arm Test. (26) 

Surgery Rehabilitation.  The American Society of Shoulder and Elbow Therapists guidelines for rehabilitation of the shoulder following arthroscopic surgery are based on the principle of gradually applying stress through an appropriate integration of range of motion, strengthening, and shoulder girdle stabilization exercises during rehabilitation and daily activities. The ultimate goal is a return to athletic activities or demanding work activities 4-6 months after surgery. (27) Similar strategies are appropriate for virtually any joint surgery, especially joint replacements.   

How To Choose a Practitioner  

Although many physical therapists (P.T. s) work in hospitals, nearly 80% practice in outpatient clinics, rehabilitation or skilled nursing facilities, schools, hospices, or patients' homes. Most, but not all, states now allow direct access to physical therapists without a physician’s order. Most health insurance plans cover physical therapy, but some may limit the number of visits within a specific time period. If you need physical therapy, contact your insurance provider and/or read your insurance policies carefully to see if the limit is "per condition," "per calendar year," or "per episode of care." Other plans permit a few visits, after which preauthorization is needed for additional visits. 

A physical therapist will be a graduate of an accredited physical therapy program and have a valid, current license to practice in the state. Approximately 210 colleges and universities offer professional education programs in physical therapy. All physical therapists are required to have either a master's degree or a clinical doctorate—usually the Doctor of Physical Therapy (DPT) degree. After graduation, physical therapists must pass a state-administered national licensure exam. Other requirements for these practitioners vary with state regulations. A physical therapist may team with a physical therapy assistant (PTA). These assistants work under the direction and supervision of the physical therapist, and must complete a two-year technical education program. In over 40 states, physical therapist assistants must also be licensed, certified, or registered. Licensure requires that they meet specific educational and examination criteria. (3) 

For additional information see the entries on Occupational Therapy, Massage, and Hydrotherapy in the WholeHealthMD Reference Library 

References 

1. Catalogs.com Info Library. Website available at http://www.catalogs.com/info/b2b/the-history-of-physical-therapy.html. Accessed January 4, 2011.
2. Medical Disabilities Guidelines. Website available at http://www.mdguidelines.com/physical-therapy. Accessed January 10, 2011.
3. Physical Therapy Notes. Website available at l http://www.physicaltherapynotes.com/2010/11/range-of-motion-types-of-range-of.html. Accessed January 10, 2011.
4. American Academy of Family Physicians' Briefing on Needle Electromyography (EMG). Available at http://www.aafp.org/online/etc/medialib/aafp_org/documents/policy/state/emg.Par.0001.File.dat/stateadvocacy_EMG.pdf. 
Accessed January 10, 2011.
5. Laguna Physical Therapy and Hand Rehabilitation. Website available at http://laguna-pt.com/expect. Accessed January 4, 2011.
6. American Physical Therapy Association. Website available at http://www.moveforwardpt.com/why-a-pt/#2. Accessed January 5, 2011.
7. Kavuncu V, Evcik D. Physiotherapy in rheumatoid arthritis. MedGenMed. 2004 May 17;6(2):3.
8. Abbott JH, Robertson MC, McKenzie JE, Baxter GD, Theis JC, Campbell AJ; MOA Trial team. Exercise therapy, manual therapy, or both, for osteoarthritis of the hip or knee: a factorial randomised controlled trial protocol. Trials. 2009 Feb 8;10:11.
9. Furlan AD, Imamura M, Dryden T, Irvin E. Massage for Low Back Pain: An Updated Systematic Review Within the Framework of the Cochrane Back Review Group. Spine (Phila Pa 1976). 2009 Jun 25.
10. Kamanli A, Karaca-Acet G, Kaya A, Koc M, Yildirim H. Conventional physical therapy with lumbar traction; clinical evaluation and magnetic resonance imaging for lumbar disc herniation. Bratisl Lek Listy. 2010;111(10):541-4.
11. Sitthipornvorakul E, Janwantanakul P, Purepong N, Pensri P, van der Beek AJ. The association between physical activity and neck and low back pain: a systematic review. Eur Spine J. 2010 Nov 27.
12. Cassileth BR, Keefe FJ. Integrative and behavioral approaches to the treatment of cancer-related neuropathic pain. Oncologist. 2010;15 Suppl 2:19-23.
13. Huisstede BM, Hoogvliet P, Randsdorp MS, Glerum S, van Middelkoop M, Koes BW. Carpal tunnel syndrome. Part I: effectiveness of nonsurgical treatments--a systematic review. Arch Phys Med Rehabil. 2010 Jul;91(7):981-1004.
14. Stuge B. Diagnosis and treatment of pelvic girdle pain. Tidsskr Nor Laegeforen. 2010 Nov 4;130(21):2141-5.
15. Rognlid M, Lindsetmo RO. Overactive pelvic floor syndrome. Tidsskr Nor Laegeforen. 2010 Oct 21;130(20):2016-20.
16. Van Alstyne LS, Harrington KL, Haskvitz EM. Physical therapist management of chronic prostatitis/chronic pelvic pain syndrome. Phys Ther. 2010 Dec;90(12):1795-806. Epub 2010 Sep 23.
17. American Physical Therapy Association-Diabetes. Website available at http://www.moveforwardpt.com/find-your-condition/diabetes/ Accessed January 10, 2011.
18. Häuser W, Klose P, Langhorst J, Moradi B, Steinbach M, Schiltenwolf M, Busch A. Efficacy of different types of aerobic exercise in fibromyalgia syndrome: a systematic review and meta-analysis of randomised controlled trials. Arthritis Res Ther. 2010;12(3):R79.
19. American Physical Therapy Association-Fibromyalgia. Website available at http://www.moveforwardpt.com/find-your-condition/fibromyalgia/ Accessed January 10, 2011.
20. Tinazzi M, Zarattini S, Valeriani M, Stanzani C, Moretto G, Smania N, Fiaschi A, Abbruzzese G. Effects of transcutaneous electrical nerve stimulation on motor cortex excitability in writer's cramp: neurophysiological and clinical correlations. Mov Disord. 2006 Nov;21(11):1908-13.
21. Tinazzi M, Farina S, Bhatia K, Fiaschi A, Moretto G, Bertolasi L, Zarattini S, Smania N. TENS for the treatment of writer's cramp dystonia: a randomized, placebo-controlled study. Neurology. 2005 Jun 14;64(11):1946-8.
22. Frey Law LA, Evans S, Knudtson J, Nus S, Scholl K, Sluka KA. Massage reduces pain perception and hyperalgesia in experimental muscle pain: a randomized, controlled trial. J Pain. 2008 Aug;9(8):714-21.
23. Nikander R, Sievänen H, Heinonen A, Daly RM, Uusi-Rasi K, Kannus P. Targeted exercise against osteoporosis: A systematic review and meta-analysis for optimising bone strength throughout life. BMC Med. 2010 Jul 21;8:47.
24. Bleakley CM, O'Connor SR, Tully MA, Rocke LG, Macauley DC, Bradbury I, Keegan S, McDonough SM. Effect of accelerated rehabilitation on function after ankle sprain: randomised controlled trial. BMJ. 2010 May 10;340:c1964.
25. Brukner PD, Crossley KM, Morris H, Bartold SJ, Elliott B. Recent advances in sports medicine. Med J Aust. 2006 Feb 20;184(4):188-93.
26. Wu HC, Lin YC, Hsu MJ, Liu SM, Hsieh CL, Lin JH. Effect of thermal stimulation on upper extremity motor recovery 3 months after stroke. Stroke. 2010 Oct;41(10):2378-80.
27. Gaunt BW, Shaffer MA, Sauers EL, Michener LA, McCluskey GM, Thigpen C; American Society of Shoulder and Elbow Therapists. The American Society of Shoulder and Elbow Therapists' consensus rehabilitation guideline for arthroscopic anterior capsulolabral repair of the shoulder. J Orthop Sports Phys Ther. 2010 Mar;40(3):155-68.
28. Li WC, Chen YC, Yang RS, et al. Effects of exercise programmes on quality of life in osteoporotic and osteopenic postmenopausal women: a systematic review and meta-analysis. Clin Rehabil 2009;23:888–96.
29. Jull G, Trott P, Potter H et al. A randomized controlled trial of exercise and manipulative therapy for Cervicogenic headache. Spine,2002;27:1835.
30. Biondi DM, Bajwa MD, Cervicogenic headache, http://www.uptodate.com/online/content/topic.do?topicKey=headache/7529&source=preview&selectedTitle=20~150&anchor=H13#H13, accessed January 11, 2011.

Evidence Based Rating Scale

The Evidence Based Rating Scale is a tool that helps consumers translate the findings of medical research studies and what our clinical advisors have found to be efficacious in their personal practice into a visual and easy to interpret format. This tool is meant to simplify the information on supplements and therapies that demonstrate promise in the treatment of certain conditions.

 

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Date Published: 04/19/2005
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