Physical therapy (PT) is a profession that treats physical dysfunction or injury with the use of special exercises, techniques and devices.

PPT, also called physiotherapy, can be used to treat a wide variety of injuries, conditions and diseases. In children, PT may be used to treat cerebral palsy, muscular dystrophy, spina bifida and other muscular and structural disorders.

Medical conditions in adults that may be treated with PT include stroke, post-surgical rehabilitation (e.g., joint replacement) and degenerative diseases such as arthritis. Individuals with conditions such as back pain, muscle strains and sports injuries may also benefit.

Goals vary depending on the type of injury or medical condition. In most cases, PT works to strengthen muscles, increase the range of motion of joints, promote healing, reduce pain and improve the patient's mobility and endurance.

Patients usually receive a physical examination by a physician before they are referred to physical therapy. The physician may order a PT evaluation and treatment for a specific condition.

When patients are seen by a physical therapist, they will receive an evaluation, including a review of a medical history describing pain symptoms and any previous surgeries and treatments. Measurements of strength, flexibility, joint motion, endurance and posture may be taken to assess the patient’s status.

Physical therapy incorporates a number of techniques geared toward the patient’s condition. Exercise therapy is the most common, but manipulation therapy, thermotherapy, cryotherapy, hydrotherapy, therapeutic ultrasound and electrical therapy may also be used.

Physical therapy (PT) is a profession that treats physical dysfunction or injury with the use of special exercises, techniques and devices.

Physical therapy, also known as physiotherapy, is used to treat disorders of the muscles, bones and joints. PT may incorporate the use of techniques such as exercise, heat, cold, water, massage, electricity, light, sound and magnetism.

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is both a physiological and psychological experience. Physical therapy uses a variety of treatment techniques aimed at addressing the physiological aspects of pain, such as:

• Tissue damage or trauma
• Reduced range of motion
• Inflammation
• Ischemia (inadequate flow of blood to a part of the body)
• Edema (swelling)

Patients who receive PT often receive treatments aimed at addressing the psychological aspects of pain as well as the physical components.

Physical therapists work in many inpatient and outpatient settings, including hospitals, rehabilitation centers, nursing homes, schools, workplaces and home health (in the patient's home).

Many patients seek physical therapy to improve range of motion (ROM) in one or more areas of the body. ROM is a term used to describe the normal distance and direction a joint can move. Reduced range of motion can occur from an injury, but also can occur during the natural process of aging.

When a person has a chronic condition (e.g., lower back pain), normal or limited movement may decrease stress or discomfort of healing tissue. Patients experiencing pain often move in ways that decrease the impact to an injured area, prevent further damage, reduce pain and facilitate the repair process. However, this sort of guarding can restrict ROM and cause other complications.

Some goals of treatment may be to:

• Minimize abnormal movement
• Restore range of motion
• Address gait disturbances and improve walking
• Facilitate healing
• Increase muscle strength and control
• Improve posture and balance
• Increase endurance
• Facilitate healing
• Improve ability to complete everyday tasks
• Assess the need for assistive devices such as a cane, walker or wheelchair
• Teach compensatory strategies
• Educate the patient, family members and caregivers

In cases of chronic pain, abnormal movements that occur over a prolonged period of time may contribute to the pain. For instance, awkward, repetitive movements can cause decreased flexibility, joint stiffness and muscle atrophy. Physical therapy may be able to correct the movements and educate the patient on how to avoid further damage.

Depending on the condition, an individual may also receive other treatments, such as occupational therapy or speech therapy.

Physical therapy may be performed by a registered physical therapist (RPT) or a physical therapy assistant (PTA). In the United States, RPTs earn a graduate degree from an accredited program, pass a national licensure examination and receive a state license as well. PTAs, who complete a two-year degree program and in most states must be licensed or certified, work under the supervision of an RPT. Therapists must also take continuing education classes to maintain their license and ability to practice. In addition, PT aides or rehab technicians, who are typically trained on the job, may help with duties such as setting up equipment.

In the United States, physical therapists must pass an exam and receive a license before they begin working in the field. In addition, physical therapists must take mandatory continuing education classes to maintain their license and ability to practice.

Along with occupational therapists, RPTs may choose to undergo additional training in hand therapy and, after passing an additional examination, become a certified hand therapist (CHT). Some physical therapists specialize in other areas, such as sports medicine, stroke or cardiac rehabilitation, spinal cord injuries or children’s neuromuscular conditions.  

Physical therapy may be used to treat numerous injuries, conditions and diseases. Common pediatric injuries, conditions and diseases (including those present at birth) that may be treated in children include:

• Developmental delays
• Cerebral palsy
• Muscular dystrophy
• Chromosome disorders
• Spina bifida
• Scoliosis (abnormal sideways curve of the spine)

• Fetal exposure to alcohol or drugs
• Traumatic brain injuries, spinal cord injuries, brachial plexus (a network of nerves serving the arm) injuries or other acute trauma
• Limb deficiencies
• Muscle weakness
• Muscle or joint pain

Common pain conditions in adults that may be treated with physical therapy include:

• Back pain. Back pain is one of the most common medical conditions in the United States. Causes include herniated discs, sciatica, degenerative disc disease, spinal stenosis and osteoporosis. Patients who experience back pain, particularly in the lumbar area, may be treated with physical therapy.

• Neck pain. Conditions such as whiplash or a pinched nerve in the cervical spine can cause neck pain.
  
  
• Knee pain. Injuries to the anterior cruciate ligament (ACL) are among the most common of all sports-related knee injuries in the United States. Thousands of people sustain a torn or ruptured ACL each year requiring surgery and/or physical therapy. Injuries of the menisci (cartilage pads) are also common.

• Hip pain, leg pain and foot pain. Many conditions of the lower extremities may cause gait disturbances that can be addressed in physical therapy.
  
  
• Arthritis. Common types of arthritis include osteoarthritis and rheumatoid arthritis. This condition is particularly common in the hands, fingers, knees and hips.

• Shoulder pain. Frozen shoulder is a term used to describe a stiff shoulder joint with reduced range of motion. In most cases, the condition is reversible, although treatment may last several months. Injuries to the rotator cuff (muscles that attach by tendons to the upper arm bone) and shoulder impingement syndrome (symptoms that result from compression of the rotator cuff tendons and subacromial bursa, a fluid-filled sac that separates the bones of the shoulder joint) are also common.
  
  
• Tendinitis (inflammation of a tendon). The most common cause of tendinitis is overuse. This condition can occur in various areas of the body, including the hands, elbows and knees.
  
  
• Elbow pain. Tendinitis is the most common condition affecting the elbow. It is frequently referred to as tennis elbow (lateral epicondylitis) when there is an injury to the outer tendon and golfer elbow (medial epicondylitis) when there is an injury to the inner tendon.
  

• Bursitis (inflammation of the bursa). A bursa is a fluid-filled sac that functions as a gliding surface to reduce friction between the tissues of the body. There are 160 bursae in the body, located in areas such as shoulders, elbows, hips and knees. The most common location of bursitis is in the shoulder.
  
  
• Complex regional pain syndrome (a chronic condition that may occur after an injury to the arm or leg). It is often described as a burning sensation and is much worse than anticipated for the injury.
  

• Myofascial pain syndrome (MPS). MPS, a chronic condition that affects the fascia (connective tissue that covers muscles), may involve a single muscle or a group of muscles. It may be caused by injury or excessive strain in various areas of the body.
  
  
• TMJ disorder. The temporomandibular joints (jaw joints) connect the lower jawbone (mandible) to the skull. These joints are used more than any other joint in the body. Many people experience pain and dysfunction in these joints at some point in their lives. This can affect the jaw and jaw joint as well as muscles in the face, shoulder, head and neck.

PT also addresses many other conditions, including burns, lupus, Parkinson's disease, multiple sclerosis, stroke and debility due to conditions such as heart failure, diabetes or dementia. Patients may also be referred for rehabilitation after surgery, such as arthroscopy, joint replacement, carpal tunnel release, spinal surgery or heart surgery.

Before beginning physical therapy (PT), a patient typically has a physical examination from a physician, often an orthopedist. A physician must provide a medical prescription for physical therapy that indicates the diagnosis and recommendation for treatment. The physician will note any restrictions, such as weight-bearing status after a hip replacement or blood pressure and heart rate during cardiac rehabilitation.

Once physical therapy is prescribed, the patient will be seen by a registered physical therapist (RPT), who will review the patient's medical history and conduct an evaluation. The medical history covers medications and any previous therapy or surgeries.

Patients may be asked to fully describe the pain. They may be asked to complete a pain assessment form or be given a diagram of the body and asked to mark areas of the body where they are experiencing pain. Questions to pinpoint the pain may include:

• Can you describe the pain?
• Where does it occur?
• How long have you experienced the pain?
• Have you experienced this type of pain in the past?
• Is the pain constant or does it come and go?
• Are there any movements that make it worse?
• Do you have limited movement?

During the evaluation, a physical therapist will test movement by asking the patient to move a body part or by moving it manually. Measurements of strength, flexibility and joint motion will be obtained. Balance, posture and endurance also may be assessed in a variety of modes. Any gait disturbances or impairments in ambulation (walking) or wheelchair mobility will be noted.

After the evaluation, the physical therapist will review the results with the patient and ordering physician. A plan of treatment, including goals and methods of therapy, will be covered as well.

In physical therapy (PT), patients may be treated using a wide variety of techniques, including:

• Exercise therapy. This is the most frequently used type of PT. It is often used to treat chronic or acute pain. Based on the results of the initial evaluation, the physical therapist will determine the appropriate exercise mode, frequency, intensity and duration.

Treatment may include isometric, isotonic, aerobic and aquatic exercises. It can use a wide variety of exercises designed to improve strength, range of motion (ROM), coordination, endurance, balance and posture. Exercises may be active (patient controls movement without assistance) or passive (movement is achieved through manipulation by the physical therapist). Exercise therapy may be used in the rehabilitation of a wide range of medical conditions, such as strokes, joint replacements and ailments related to aging.

• Manipulation therapy. A variety of techniques used to produce passive movements that are not usually under the patient's control. It can include movement and massage therapy. Therapists may perform specialized techniques such as Neuro-Developmental Treatment to address neuromuscular deficits. Manipulation therapy can decrease pain and increase flexibility of joints and soft tissues. It is often performed in combination with exercise therapy.
  
  
• Thermotherapy (heat therapy). Often used in combination with other types of therapy, such as exercise and manual therapy. Moist heat can be relaxing and reduce muscle spasms and pain. Heat can be applied through the use of hot packs, moist towels, water bottles, ultrasound therapy, infrared lamps and paraffin wax baths. Hydrotherapy may be incorporated because warm water relaxes muscles and joints and promotes increased ROM.
  

• Cryotherapy (cold therapy). Applying cold to painful areas reduces neuromuscular transmission, pain and swelling. Cold can be applied through cold packs (a plastic pouch that is stored in the freezer), vapocoolant sprays (available at pharmacies) and ice bags.
  
  
• Electrotherapy (medical treatment using electrical currents). One type of electrotherapy used frequently to treat patients is transcutaneous electrical nerve stimulation (TENS). TENS uses low-voltage electrical current and is performed using a small, battery-powered machine. Two electrodes are connected from the machine to the painful area, creating a circuit of electrical impulses that travel along nerve fibers. When the current is delivered, some people experience less pain. TENS can be used with relieve pain from many medical conditions, including tendinitis and bursitis. Patients may be instructed in home use of TENS.

Shortwave diathermy uses high-frequency oscillating electrical current to raise the temperature in tissues. Large body parts, such as the back and thighs, and deep body parts, such as the hips, may be treated with shortwave diathermy. This type of therapy penetrates deeper into the tissue than traditional electrical and heat methods.

• Iontophoresis (introduction of medication into tissues beneath the skin using electricity) and phonophoresis (introduction of medication into tissues beneath the skin using ultrasound). These methods are sometimes used to treat conditions such as neck pain, back pain, rotator cuff injuries and arthritis.
  
  
• Traction (a procedure in which a mechanical device is used to correct fractures or dislocated bones, overcome muscle spasms or relieve pressure).

Most physical therapy incorporates a combination of therapies geared toward a patient’s specific condition. Therapy uses a wide variety of equipment including weights, exercise balls and bands. Examples of devices that are used to improve ambulation (walking) and mobility include parallel bars, training stairs, treadmills and balancing devices.

After completing treatment, physical therapists usually recommend additional exercises that can be completed by patients on their own. These exercises may be combined with general activities, such as walking or swimming.

For patients being discharged from hospitals, rehabilitation centers and other inpatient settings, physical therapists may perform a home evaluation, sometimes with an occupational therapist, to assess the individual's safety awareness, degree of independence, and need for any adaptive equipment (e.g., cane), home modification (e.g., wheelchair ramp) or additional therapy offered at home or at an outpatient center.

There are many potential benefits of physical therapy, including:

• Patients gain education about their conditions.
  
  
• Patients learn therapeutic techniques, some of which can be used on their own.
  
  
• Some patients experience pain relief.
  
  
• Some patients experience improved range of motion, strength, coordination and balance.
  
  
• Patients can learn ways to prevent further injuries or pain.

There are potential risks as well. Though not common, these may include injuries from excessive exercise or thermal injuries from misuse of thermotherapy, cryotherapy, ultrasound therapy or other modalities.

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about physical therapy (PT):

1. Can physical therapy help treat my acute pain condition?
   
   
2. Can it help with my chronic pain or other condition?
   
   
3. Am I likely to find PT painful?
   
   
4. Do I have any restrictions during or after PT, such as how much of my body weight I can put on my leg?
   
   
5. What type of exercises will improve my condition? Are there any I need to avoid?
   
   
6. Will my PT include heat, cold, water, electrical therapy or other techniques?
   
   
7. Should I be trained in using these treatments at home, such as TENS or hot packs?
   
   
8. Does physical therapy pose any risks for me?
   
   
9. Where can I find a good physical therapist?
   
   
10. For hand or arm pain, do you recommend that I see a certified hand therapist? Are there other certifications or specializations I should look for?
    
    
11. How long will my PT last? How will goals be set and progress be assessed?