Topic Overview
What is physical therapy?
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.
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Actionsets are designed to help people take an active role in managing a health condition. |
| Balance exercises for vertigo | |
| Core stabilization | |
| Rehabilitation for a meniscus tear | |
| Rehabilitation for multiple sclerosis | |
Types of Physical Therapy
Exercise
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
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:
- Using ice and cold packs.
- Ice massage.
- Rest, ice, compression, and elevation (RICE).
- Ice or cold packs for children.
Heat
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
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.
For more information, see hydrotherapy.
Ultrasound
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 and chronic health conditions
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:
- Spinal stenosis
- Chronic obstructive pulmonary disease (COPD)
- Rheumatoid arthritis
- Parkinson's disease
- Temporomandibular problems
- Multiple sclerosis
- Vertigo
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 |
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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. |
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| 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 |
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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. |
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| 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: | http://www.apta.org |
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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. |
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References
Citations
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.
Credits
| Author | Shannon Erstad, MBA/MPH |
| Editor | Kathleen M. Ariss, MS |
| Associate Editor | Pat Truman |
| Primary Medical Reviewer | Martin Gabica, MD - Family Medicine |
| Specialist Medical Reviewer | David A. Fleckenstein, MPT - Physical Therapy |
| Specialist Medical Reviewer | Kathie Hummel-Berry, PT, PhD - Physical Therapy |
| Last Updated | March 8, 2007 |
David A. Fleckenstein, MPT - Physical Therapy
Kathie Hummel-Berry, PT, PhD - Physical Therapy
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