Physical Therapists (PTs) are certified, licensed health care professionals who treat patients that often have medical issues or other health-related challenges that limit their capabilities to move and function in their daily lives. PTs can also help to avoid the loss of mobility in healthy individuals by developing fitness and wellness programs that improve a patient’s lifestyles.

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Physical therapists use their client’s medical history to diagnose and manage movement dysfunction and improve movement and function or to prevent the onset or exacerbation of symptoms. The terms physical therapy and physiotherapy, and the terms physical therapist and physiotherapist, are interchangeable. PTs are often the primary source of care when movement or musculoskeletal issues arise. Physical therapy is covered by federal, state, and private insurance plans. Physical therapists’ services have an evidence supported, often positive, impact on a patient’s quality of life.

A common patient experience in physical therapy often includes an initial visit where the client history is taken. A system review is then conducted and any required tests are run to establish the existence of any preexisting conditions. Diagnoses and care plans are developed with input from the patient regarding goals and a synthesis of the test results and an intervention plan is established. After a pre-determined timespan a re-examination is conducted and the interventions are modified as necessary. After the desired results are achieved a discharge plan is established and the patient is responsible for continuing a healthy regimen. Physical therapy can be provided only by qualified physical therapists (PTs) or by physical therapist assistants (PTAs) working under the supervision of a physical therapist. Physical therapy services typically require prior authorization from insurance companies and services are not covered in all plans.

History

Physical Therapy as a healthcare intervention first began to appear in the late 19th century as a treatment for polio symptoms which began to appear in the mid 1890’s. An early leader in the development of this modality was Mary McMillan, who with other reconstruction aides, as they were known, established the American Women’s Physical Therapeutic Association in 1921. The following year the organization allowed the entrance of male members and rebranded as the American Physiotherapy Association. Today Physical Therapy is the most popular treatment for any condition that limits movement and current practitioners and roughly 200 colleges and universities offer educational programs in physical therapy. The minimum educational requirement is a post-baccalaureate degree earned at an accredited program. Most programs offer a master’s degree, and a Doctor of Physical Therapy degree is also available. Following graduation, licensure requires that the trainee pass a state-administered national exam. Other practice requirements vary from state to state. In 38 states, physical therapists may practice independently without physician or other provider referral or consultation. Today the governing organization is known as the American Physical Therapy Association.

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Conditions & Treatments

Conditions that are treated with PT include orthopedic complaints such as back or neck pain, orthopedic injuries or surgery, traumatic brain injury, stroke, congenital disorders, and urinary incontinence, and a variety of sports injuries. These conditions are referred to as impairments. Impairment refers to the loss of a psychological, physiological, or anatomical structure or function. Disability means a loss in the ability to perform activities of daily living (ADLs). Physical therapy often involves exercises to promote a range of motion and improve strength. The physical therapist or assistant typically teaches these exercises to the patient, who performs the exercises with the therapist initially. Homework is usually assigned between sessions to improve the physical outcome. When most people think of physical therapy, this modality is what they envision. As mentioned previously, the physical therapy utilizes many other professional agents and techniques. Examples of interventions include therapeutic heat, therapeutic cold (cryotherapy), therapeutic ultrasound, ultraviolet light or laser light, hydrotherapy using whirlpools and aquatic pools, traction devices, continuous passive motion, compression, and electrical stimulation.

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Therapeutic heat is frequently utilized to ease pain, reduce muscle guarding and spasm, and aid tissue elasticity. Heat application may be superficial (e.g., using hot packs, whirlpool, and paraffin) or deep (e.g., using ultrasound or electromagnetic radiation in nonionizing form). Cryotherapy, or cold therapy, helps manage pain, edema, and muscle guarding/spasm. Cold packs, cool whirlpool, and ice massage are three cryotherapy agents. Cold therapy is used for acute injuries, as heat is contraindicated in the acute period because it may increase inflammation. Ultraviolet light has been useful in the treatment of dermatological conditions including psoriasis; lasers have been helpful in promoting tissue healing and treating pain.

Whirlpool therapy has several clinical uses, including pain relief, wound debridement, wound cleansing, and stimulation of circulation. Traction techniques, such as cervical traction and lumbar traction, are useful in conditions that may benefit from an increase in intervertebral space, such as disk herniation, muscle spasm, and arthritis of the spine. Traction works by applying a pulling force via either free weights or a traction machine to the spine. Continuous passive motion is a type of passive motion which is produced using a mechanical device. It is often used postoperatively for joint injuries and reconstructions and is best started within the first postoperative week. Mechanical compression units are another type of motorized device that is used in physical therapy. Such devices deliver compression intermittently to reduce edema. Typically, patients wear compression garments between treatments to maintain improvement. Lastly, electrical stimulation is used to help manage pain, strengthen muscle, stimulate denervated muscle, and ease edema. It is also beneficial in encouraging circulation, wound healing, and fracture repair. A device called a TENS (transcutaneous electrical nerve stimulation) unit has been especially helpful in the management of pain.