Physical therapy

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Physical therapy
This physical therapist is assisting two polio-stricken children holding on to a rail whilst they exercise their lower limbs.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Abhishek Singh, B.P.T [2]

Overview

Physical therapy (or physiotherapy as it is known outside the U.S.) is a healthcare profession concerned with prevention, treatment and management of movement disorders arising from conditions and diseases occurring throughout the lifespan. Physical therapy is performed by either a physical therapist (PT) or a physical therapist assistant (PTA) acting under the direction of a PT.[1] However, various non-PT health professionals (e.g., chiropractors, Doctors of Osteopathy) employ the use of some physical therapeutic modalities in practice.[2] A program of physical therapy will typically also involve a patient's caregivers.[3]

Physiotherapy or Physical Therapist or PT is a health care professional who examines, treat, advice & instruct person with movement dysfunction, bodily malfunction, physical disorder, healing and pain from trauma and disease, disability, physical and mental conditions, by using physical agents like exercise, mobilization, manipulation, hydrotherapy, mechanical, and electrotherapy.

PTs utilize a patient's history and physical examination in diagnosis and treatment, and if necessary, PTs will also incorporate the results of laboratory and imaging studies. Electrodiagnostic testing (e.g., electromyograms, nerve conduction velocity testing) may also be of assistance.[4] PTs practice in many settings, such as outpatient clinics or offices, inpatient rehabilitation facilities, extended care facilities, patient homes, education or research centers, schools, hospices, industrial workplaces or other occupational environments, fitness centers and sports training facilities.[5]

For decades, physical therapy practice has been the subject of criticism for its lack of a research base, and "most physical therapists continued to base practice decisions largely on anecdotal evidence."[6] The World Confederation for Physical Therapy, has called on the profession to adopt and adhere to evidence-based practices formally based on the best available scientific sources.[7]

History

A woodcut of the reduction of a dislocated shoulder with a Hippocratic device.

Physicians like Hippocrates and Hector are believed to have been the first practitioners of a primitive physical therapy, advocating massage and hydrotherapy to treat patients in 460 B.C.[8] The earliest documented origins of actual physical therapy as a professional group, however, date back to 1894 when four nurses in England formed the Chartered Society of Physiotherapy.[9] Other countries soon followed and started formal training programs, such as the School of Physiotherapy at the University of Otago in New Zealand in 1913,[10] and the United States' 1914 Reed College in Portland, Oregon, which graduated "reconstruction aides."[11]

Research catalyzed the physical therapy movement. The first physical therapy research was published in the United States in March 1921 in The PT Review. In the same year, Mary McMillan organized the Physical Therapy Association (now called the American Physical Therapy Association (APTA)). In 1924, the Georgia Warm Springs Foundation promoted the field by touting physical therapy as a treatment for Polio.[12]

Treatment through the 1940s primarily consisted of exercise, massage, and traction. Manipulative procedures to the spine and extremity joints began to be practiced, especially in the British Commonwealth countries, in the early 1950s.[13][14] Later that decade, physical therapists started to move beyond hospital based practice, to outpatient orthopedic clinics, public schools, college/universities, geriatric settings (skilled nursing facilities), rehabilitation centers, hospitals, and medical centers.

Specialization for physical therapy in the U.S. occurred in 1974, with the Orthopaedic Section of the APTA being formed for those physical therapists specializing in Orthopedics. In the same year, the International Federation of Orthopaedic Manipulative Therapy was formed,[15] which has played an important role in advancing manual therapy worldwide ever since. In the 1980s, the explosion of technology and computers led to more technical advances in rehabilitation. Some of these advances have continued to grow, with computerized modalities such as ultrasound, electric stimulators, and iontophoresis with the latest advances in therapeutic cold laser, which finally gained FDA approval in the U.S. in 2002.[16]

Physiotherapy modalities

PT’s uses individual’s history and do physical examinations in their diagnosis & setting a treatment protocol, and if necessary, will include the results of laboratory and imaging studies. Physiotherapist uses various modalities like-

  • Exercises like active, passive,aerobic,cardio,strengthening,stretching etc.
  • Hydrotherapy
  • Mobilization
  • Manipulation
  • Electrical Modalities like Ultrasonic Therapy, Laser, Microwave Diathermy, Interferential therapy, TENS (Transcutaneous Nerve Stimulator),Shock Wave Therapy and many more.

Active Exercise Motion derived from a part by doing voluntary contraction and relaxation of its controlling muscles. Active Assistive exercise voluntary contraction of muscles controlling a part, assisted by a therapist or by some other means. Aerobic Exercise a type of physical activity,which increases the heart rate and as a result use of oxygen is increased in order to improve the overall body condition.

Ballistic stretching's rapid, jerky movements employed in exercises,for stretching of muscles and connective tissue.

Buerger-Allen exercises- Perform to enhance blood circulation of the legs and feet. In this exercise the lower limb s are raised to 45-90 degree angle with some support for 2 to 3 minutes until skin blanches. After that the feet and legs are lowered or the patients adopt a high sitting posture for 5 to 10 minutes until redness appears, Followed by flat lying on bed for 10 minutes.

Cardiovascular Exercise are exercises to enhance cardiovascular system capacity. Done at least twice per week, with most programs conducted three to five or more times weekly. The contraction of major muscle groups must be repeated often enough to elevate the heart rate to a target level determined during testing. Used in cardiac rehabilitation, or as a preventive measure.

Corrective Exercise are exercises planned and performed to attain a specific physical benefit, such as maintenance of the range of motion, strengthening of weakened muscles, increased joint flexibility, or improved cardiovascular and respiratory function. Endurance Exercise Involvement of several large groups of muscles and is dependent on the delivery of oxygen to the muscles by the cardiovascular system; used in physical fitness programs as well as cardiovascular and pulmonary function testing.

Isokinetic exercise are dynamic muscle activity performed at a constant angular velocity. Isometric Exercise (Iso= Same, Metric-Length) Active exercise performed against constant resistance, without change in the length of the muscle.

Isotonic Exercise(Iso= Same, Tonic= Tone) are active exercise with negligible change in the force of muscular contraction, with shortening of the muscle.

Kegel Exercises- Exercise for strengthening of pelvic floor and prevention urinary incontinence. Performed by a series of contractions and relaxations of perineal muscles. Done with the help of Kegel’s Exerciser.

McKenzie Exercise are exercise regimen used in the treatment of low back pain and sciatica, prescribed according to findings during mechanical examination of the lumbar spine and using a combination of lumbar motions, including flexion, rotation, side gliding, and extension. It is sometimes referred to as McKenzie extension exercises, but this is a misnomer because the regimen involves movements other than extension.

Muscle-Setting Exercise (Static Exercise) are voluntary contraction and relaxation of skeletal muscles static/constant muscle length or moving the associated part of the body.

Passive Exercise Movement or motion done to a body part or segment by another individual, machine or outside force or by voluntary effort of another segment of patient's own body.

Pelvic Floor Exercise-Combination of strength and endurance exercises of pelvic floor muscles (circumvaginal or perianal). These are used in stress urinary incontinence; the patient is taught to isolate and contract muscles 103 times daily.

Quadriceps Setting Exercise - Isometric exercise to strengthen (Quadriceps) muscles needed for ambulation. The patient is instructed to contract the quadriceps muscle while at the same time elevating and dorsiflexing the heel and pushing the knee toward the mat.

Range Of Motion (ROM) Exercises are exercises that move joint through its full range of motion, that is, to the highest degree of motion of which joint normally is capable; they may be either active or passive.

Examples of range of motion exercises:

  • Flexion: The bending of a joint in the body.(angle between the joint decreases)
  • Extension: A movement opposite to that of flexion in which a joint is in a straight position.
  • Rotation: Pivoting a body part around its axis, as in shaking the head.
  • Adduction: Moving toward the midline of the body or to the central axis of a limb.
  • Abduction: A movement of a limb away from the median plane of the body; the fingers are abducted by spreading them apart.
  • Circumduction: A combination of movements that cause a body part to move in a circular fashion.(combination of all movements like flexion,extension,abduction and adduction).
  • Supination: Extension of the forearm to bring the palm of the hand upward.
  • Pronation: Movement of the forearm in the extended position that brings the palm of the hand to a downward position.
  • Inversion: Movement of the ankle to turn the sole of the foot medially.
  • Eversion: Movement of the sole of the foot laterally.

Resistive Exercises-performed against an opposing force(as tolerated by a person) to increase muscle strength.Resistance applied may be either isometric,isotonic or isokinetic.

Static Stretching Exercise-placement of muscles and connective tissues at their maximum length by a constant force in the direction of lengthening.

Strengthening Exercises- also known as force increasing exercises, prescribed to a person who shows weakness in individual muscles or muscle groups. Performed with relatively high resistance, but with few repetitions(3 to 10) followed by 1-2 minutes of rest.It is performed daily in early stages of rehabilitation.


'''Electro Therapy'''

The therapeutic use of electricity to the human body as in the treatment of pain,paralysis or muscles weakness. Numerous modalities are in use like Ultrasonic therapy(UST),Transcutaneous Electrical Nerve Stimulation(TENS),Interferential Therapy(IFT),Laser,Shock wave Therapy,Diathermy[Long, Short, Micro](Continuous or pulse Mode),Traction(Cervical or Lumbar) and many more.

Ultrasonic Therapy (UST)

Defined as a high frequency acoustic energy,available in longitudinal waveforms in frequency range of .5 to 3.5 MHz. Most commonly used frequencies for treatment purpose in UST are .75 to 3.0 MHz(1 MHz = 1,000,000 cycles/second). Contraindications For UST i-Vascular Conditions like Thrombophlebitis or Phlebothrombosis ii-In Burger's disease,atherosclerosis,varicose veins or any other conditions where blood supply is poor or insufficient iii-Infected Lesion like Cellulites,Abscess or Carbuncles iv-Benign Or Malignant Tumor v-Pregnant Female vi-Person with demand type pacemaker.

Specialty areas

Because the body of knowledge of physical therapy is quite large, some PTs specialize in a specific practice. While there are many specialty areas in physical therapy,[17] the following are the five most common specialty areas in physical therapy:[18]

Cardiopulmonary

Cardiovascular and pulmonary rehabilitation physical therapists treat a wide variety of patients with cardiopulmonary disorders or those who have had cardiac or pulmonary surgery. Primary goals of this specialty include increasing patient endurance and functional independence. Manual therapy is utilized in this field to assist in clearing lung secretions experienced in patients with cystic fibrosis. Patients with disorders including heart attacks, post coronary bypass surgery, chronic obstructive pulmonary disease, and pulmonary fibrosis are only a few examples of those who would benefit from cardiovascular and pulmonary specialized physical therapists.[18]

Geriatric

Geriatric physical therapy covers a wide area of issues concerning people as they go through normal adult aging, but is usually focused on the older adult. There are many conditions that affect many people as they grow older and include but are not limited to the following: arthritis, osteoporosis, cancer, Alzheimer's disease, hip and joint replacement, balance disorders, incontinence, etc. Geriatric physical therapy helps those affected by such problems in developing a specialized program to help restore mobility, reduce pain, and increase fitness levels.[18]

Neurological

Neurological physical therapy is a discipline focused on working with individuals who have a neurological disorder or disease. These include Alzheimer's disease, ALS, brain injury, cerebral palsy, multiple sclerosis, Parkinson's disease, spinal cord injury, and stroke. Common problems of patients with neurological disorders include paralysis, vision impairment, poor balance, inability to ambulate, and loss of functional independence. Therapists work with patients to improve these areas of dysfunction.[18]

Orthopedic

Orthopedic physical therapists diagnose, manage, and treat disorders and injuries of the musculoskeletal system as well as rehabilitate patients post orthopedic surgery. This specialty of physical therapy is most often found in the out-patient clinical setting. Orthopedic therapists are trained in the treatment of post operative joints, acute sports injuries, arthritis, and amputations. Joint mobilizations, strength training, hot/cold packs, and electrical stimulation (e.g., cryotherapy, iontophoresis, electrotherapy[19]) are modalities often used to expedite recovery in the orthopedic setting. Additionally, an emerging treatment in this field is the use of sonography to guide treatments like muscle retraining.[20][21][22][23] Those who have suffered injury or disease affecting the muscles, bones, ligaments, or tendons of the body will benefit from assessment by a physical therapist specialized in orthopedics.

Pediatric

Pediatric physical therapy assists in early detection of health problems and uses a wide variety of modalities to treat disorders in the pediatric population. These therapists are specialized in the diagnosis, treatment, and management of infants, children, and adolescents with a variety of congenital, developmental, neuromuscular, skeletal, or acquired disorders/diseases. Treatments focus on improving gross and fine motor skills, balance and coordination, strength and endurance as well as cognitive and sensory processing/integration. Children with developmental delays, cerebral palsy, spina bifida, and torticollis are a few of the patients treated by pediatric physical therapists.[18]

  • Another PT specialty area is Integumentary (treatment of conditions involving the skin and related organs).

Education

United States

In the U.S., physical therapists must have a graduate degree from an accredited physical therapy program before taking the national licensing examination. Federal law also requires physical therapists to pass the National Physical Therapy Examination[24] after graduating from an accredited physical therapist educational program before they can practice. Also physical therapists must apply for a state license to practice. Each state regulates licenses for physical therapists independently.

According to the American Physical Therapy Association, there were 210 accredited physical therapist programs in 2008–of those 23 offered the Master of Physical Therapy, and 187 offered the Doctor of Physical Therapy (DPT) degree. Most programs are in transition to a DPT program.[25]

Evidence-based practice

For decades, physical therapy practice has been the subject of criticism for its lack of a research base.[6] In a late 1990s survey of English and Australian physical therapists, fewer than five percent (5%) of survey respondents indicated that they regularly reviewed scientific literature to guide practice decisions.[26][27] Despite an overall positive attitude towards evidence-based practice,[28] most physical therapists utilized treatment techniques with little scientific support.[29][30] Although numerous calls have been made for a shift toward the use of research and scientific evidence to guide practice decisions, at least throughout the 1990s, "most physical therapists continued to base practice decisions largely on anecdotal evidence."[30]

To overcome these limitations, the World Confederation for Physical Therapy,[7] the American Physical Therapy Association (APTA),[31] and a number of authors[32] have called on the profession to adopt and adhere to evidence-based practices formally based on the best available scientific sources.[33]

Journals and publications

Physical therapists have access to a wide range of publications and journals.[34] Some are dedicated solely to physical therapy topics, while others (e.g., various orthopedic and surgical journals) cover a broader range of health-improvement topics, including physical therapy.

References

  1. ↑ "Discovering Physical Therapy. What is physical therapy". American Physical Therapy Association. Unknown parameter |accessdaymonth= ignored (help); Unknown parameter |accessyear= ignored (|access-date= suggested) (help)
  2. ↑ "Can Chiropractors and Evidence-Based Manual Therapists Work Together? An Opinion From a Veteran Chiropractor" (PDF). The Journal of Manual & Manipulative Therapy. 14 (2): E15. 2006. Unknown parameter |FIRST= ignored (|first= suggested) (help); Unknown parameter |LAST= ignored (|last= suggested) (help)
  3. ↑ "Description of Physical Therapy - What is Physical Therapy?]". World Confederation for Physical Therapy (WCPT). Unknown parameter |accessdaymonth= ignored (help); Unknown parameter |accessyear= ignored (|access-date= suggested) (help)
  4. ↑ http://www.aptasce-wm.org/documents/guidelines/ENMG%20EvaluationGuidelines.pdf
  5. ↑ http://www.apta.org/AM/Template.cfm?Section=Physical_Therapy&TEMPLATE=/CM/HTMLDisplay.cfm&CONTENTID=33205
  6. ↑ 6.0 6.1 "Evidence based practice and physiotherapy in the 1990's". Physiotherapy Theory and Practice. 17. Unknown parameter |FIRST= ignored (|first= suggested) (help); Unknown parameter |LAST= ignored (|last= suggested) (help)
  7. ↑ 7.0 7.1 "Declarations of Principle - Evidence Based Practice". World Confederation for Physical Therapy. 2007-06. Retrieved 2007-12-21. Check date values in: |date= (help)
  8. ↑ Wharton MA. Health Care Systems I; Slippery Rock University. 1991
  9. ↑ http://www.csp.org.uk/director/about/thecsp/history.cfm
  10. ↑ http://physio.otago.ac.nz/about/history.asp
  11. ↑ http://www.reed.edu/about_reed/history.html
  12. ↑ http://www.rooseveltrehab.org/history.php
  13. ↑ McKenzie RA. The cervical and thoracic spine: mechanical diagnosis and therapy. Spinal Publications Ltd. New Zealand. 1998 pp: 110
  14. ↑ McKenzie R. Patient Heal Thyself. Worldwide Spine & Rehabilitation 2(1) 2002; pp 16-20
  15. ↑ http://www.ifomt.org/ifomt/about/history
  16. ↑ http://www.eugenept.com/history.html
  17. ↑ http://www.apta.org/AM/Template.cfm?Section=Chapters&Template=/CM/ContentDisplay.cfm&CONTENTID=36890 text here
  18. ↑ 18.0 18.1 18.2 18.3 18.4 Types of Physical Therapy
  19. ↑ Cameron, M. (2003). Physical Agents in Rehabilitation - From Research to Practice, USA: W.B. Saunders Company. ISBN 0-7216-9378-4
  20. ↑ http://www.rtuspt.com/resources/references.php
  21. ↑ http://dx.doi.org/10.1016/S0268-0033(02)00011-6
  22. ↑ http://www.ncbi.nlm.nih.gov/pubmed/17970407?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
  23. ↑ http://jospt.org/issues/articleID.690,type.2/article_detail.asp
  24. ↑ http://fsbpt.org/ForConsumers/PhysicalTherapy/index.asp
  25. ↑ http://www.apta.org/AM/Template.cfm?Section=Student_Resources&CONTENTID=46936&TEMPLATE=/CM/ContentDisplay.cfm
  26. ↑ "Physiotherapists' reasons for selection of treatment techniques: A cross-national survey". Physiotherapy Theory and Practice. 15: 235–246. Unknown parameter |FIRST= ignored (|first= suggested) (help); Unknown parameter |LAST= ignored (|last= suggested) (help)
  27. ↑ "Physiotherapists' use of evidence based practice: A cross-national study". Physiotherapy Research International. 2(1): 17–29. Unknown parameter |FIRST= ignored (|first= suggested) (help); Unknown parameter |LAST= ignored (|last= suggested) (help)
  28. ↑ Jette, Diane U. (2003-09). "Evidence-Based Practice: Beliefs, Attitudes, Knowledge, and Behaviors of Physical Therapists". Physical Therapy. 83 (9): 786–805. PMID 12940766. Retrieved 2007-12-21. Unknown parameter |coauthors= ignored (help); Check date values in: |date= (help)
  29. ↑ "PracticalResearch". Physiotherapy. 80: 337–339. Unknown parameter |FIRST= ignored (|first= suggested) (help); Unknown parameter |LAST= ignored (|last= suggested) (help)
  30. ↑ 30.0 30.1 Schreiber, J. (October 2005). "A review of the literature on evidence-based practice in physical therapy". The Internet Journal of Allied Health Sciences and Practice. 3 (4). Retrieved 12/1/07. Check date values in: |accessdate= (help)
  31. ↑ "Evidence-Based Practice". American Physical Therapy Association. Retrieved 2007-12-21.
  32. ↑ Schreiber, J. (2005-10). "A Review of the Literature on Evidence-Based Practice in Physical Therapy". The Internet Journal of Allied Health Sciences and Practice. 3 (4). Retrieved 2007-12-21. Unknown parameter |coauthors= ignored (help); Check date values in: |date= (help)
  33. ↑ Bridges PH, Bierema LL, Valentine T (2007). "The propensity to adopt evidence-based practice among physical therapists". BMC Health Serv Res. 7 (103). doi:10.1186/1472-6963-7-103. PMID 17615076.
  34. ↑ Mapping the literature of physical therapy. E M Wakiji. Bull Med Libr Assoc. 1997 July; 85(3): 284–288.

See also

External links

National associations

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