What is physical therapy (physiotherapy)? What does a physical therapist (physiotherapist) do?

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MNT Knowledge CenterPhysical therapy or physiotherapy (UK/Ireland/Australia) is a branch of rehabilitative medicine aimed at helping patients maintain, recover or improve their physical abilities.

Physical therapists or physiotherapists (UK/Ireland/Australia) work with patients whose movements may be undermined by aging, disease, environmental factors, or sporting hazards.

Physical therapy also means the treatment of any pain, disease, or injury by physical means.

A physical therapist seeks to identify and maximize quality of life and movement potential through prevention, intervention (treatment), promotion, habilitation, and rehabilitation.

Habilitation means making somebody fit or capable of doing something.

Rehabilitation means making somebody fit or capable of doing something they can no longer do properly or at all, but used to be able to – i.e. restoring an ability or abilities.

Promotion means the process of enabling people to increase control over and improve their health.

Physical therapy is a clinical health science

Physical therapy is not alternative therapy. It is a clinical health science. Physical therapists study medical science subjects, including anatomy, neuroscience and physiology in order to acquire the health education needed for prevention, diagnosis, treatment, rehabilitation, etc., of patients with physical problems.

The physical therapist works in hospitals, GP (general practice, primary care medicine) practices, and the community. In the vast majority of countries a physical therapist must be fully qualified and registered by law. In order to become registered the physical therapist must have graduated with a university degree in physical therapy or a health science university degree that included a physical therapy course.

A qualified physical therapist is an expert in the examination and treatment of people with cardiothoracic, musculoskeletal and neuromuscular diseases; focusing on conditions and problems that undermine patients’ abilities to move and function effectively.

Physical therapy is based on science

According to the Chartered Society of Physiotherapy, UK:

    “Physiotherapy is science-based, committed to extending, applying, evaluating and reviewing the evidence that underpins and informs its practice and delivery. The exercise of clinical judgment and informed interpretation is at its core.”

What does a physical therapist do?

According to the Chartered Society of Physiotherapy, UK, physical therapists use their training and skills to treat a wide range of physical problems linked to different systems in the body, including:

  • Neuromuscular systems – concerned with both nerves and muscles. Nerves include the brain, spine and nerves throughout the body. Neuromuscular refers to neuromuscular junction – where nerves and muscle fibers meet, and also includes neuromuscular transmission – the transfer of information, impulses, from the nerve to the muscle.
  • Musculoskeletal systems – an organ system that gives us the ability to move using our muscles and bones (muscular and skeletal systems). The musculoskeletal system gives us form, movement and stability. The musculoskeletal system includes our bones, muscles, cartilage, tendons, ligaments, joints, and other connective tissue.
  • Cardiovascular systems – include the heart and the circulatory systems. The circulatory system carries nutrients and oxygen via blood vessels to the tissues of the body and removes waste and carbon dioxide from them.
  • Respiratory systems – include organs that are involved in breathing, such as the lungs, bronchi, trachea, larynx, throat, and nose.

In many countries doctors increasingly refer their patients to physical therapists, which is resulting in more and more patients going straight to the physical therapist without having first seen a doctor.

The physical therapist works autonomously, usually as part of a team with other health care and social care professionals.

Physical therapy is much more than just dealing with sports-related injuries

Below are some examples of diseases and conditions physical therapists treat, often as a result of a doctor’s referral:

  • Asthma – the physical therapist will interview the patient with asthma, listen to the chest with a stethoscope, monitor how the patient breathes and how the chest moves, possibly test the patient’s breathing while exercising, and liaise with other healthcare professionals who treat the patient. The physical therapist will help the patient learn how to breathe in a more relaxed way, this may include breathing exercises, advice on physical activity, strategies to overcome and manage wheezing and other symptoms linked to asthma – all of which significantly contribute towards the patient’s recovery.
  • Back pain – the physical therapist will examine the patient’s back, determine how it is affecting his/her life, and check some other aspects of the patient’s health. The physical therapist may perform manual therapy, help the patient learn how to manage the pain, what to do to speed up recovery and prevent recurrence. The therapist will draw up a program which probably includes exercise, tailored specifically to the patient’s health, ability and fitness level.
  • Cerebral palsy – the physical therapist, along with other healthcare professionals, is involved in helping the child or adult achieve his/her potential for physical independence and fitness. The therapist also liaises closely with the patients’ caregivers or parents. If the patient is a child, the physical therapist helps him/her and the parents/caregivers on how best to acquire skills which improve independence.
  • Incontinence – physical therapy is vital for the rapid recovery of urinary continence of women after childbirth and men after certain surgical procedures on the prostate gland. Depending on the patient’s needs and physical health, this may involve pelvic floor exercises, advice on what to eat and drink, electrical stimulation or biofeedback. Studies have shown that recovery of urinary function after a radical prostatectomy (surgical removal of the prostate) is likely to be much faster and better if the man sees a physical therapist.

Physical therapy is also very much an integral part of treatment for neck pain, whiplash, stroke, osteoarthritis, osteoporosis, and multiple sclerosis.

Five most common specialty areas of physical therapy

Orthopedic physical therapy

The orthopedic physical therapist treats injuries and disorders of the musculoskeletal system; this also includes rehabilitation for post-orthopedic surgery patients. The therapist is a specialist in the treatment of:

  • Post operative joints
  • Sports injuries
  • Arthritis
  • Disease or injuries affecting muscles, bones, ligaments or tendons
  • Amputations

Geriatric physical therapy

The focus here is on the older adult. The geriatric physical therapist is a specialist in the treatment of the following:

  • Arthritis
  • Osteoporosis
  • Cancer
  • Alzheimer’s disease
  • Hip replacement
  • Joint replacement
  • Balance problems
  • Incontinence

The main goal is to get the patient mobile again, pain management, and optimizing fitness levels, among others.

Neurological physical therapy

The neurological physical therapist is specialized in treating patients with a neurological disorder or disease. This may include patients with:

  • Alzheimer’s disease
  • Cerebral palsy
  • Multiple sclerosis
  • Paralysis
  • Parkinson’s disease
  • Poor balance
  • Spinal cord injury
  • Stroke
  • Vision impairment
  • Walking difficulties

Cardiovascular and pulmonary rehabilitation physical therapy

The specialist works with patients who have a disease or disorder of the heart, circulatory system, or pulmonary system. The focus here is to improve the patient’s endurance and physical independence. Patients with pulmonary problems, such as cystic fibrosis, may need manual therapy to get fluid build-up out of the lungs. The specialist commonly works with:

  • Patients recovering from a heart attack
  • Those recovering from bypass surgery
  • Patients with chronic obstructive pulmonary disease (COPD)
  • Patients with pulmonary fibrosis

Pediatric physical therapy

The pediatric physical therapist treats children with various diseases and disorders. The physical therapist is also trained to diagnose health problems early on. Examples of patients may include children with:

  • Spina bifida
  • Cerebral palsy
  • Torticollis

A brief breakdown of what a physical therapist does:

A physical therapist provides services that help..

  • restore function
  • improve mobility
  • relieve pain
  • prevent permanent disabilities
  • limit permanent disabilities
    • ..of patients who have an injury or disease.

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The physical therapist..

  • restores..
  • maintains..
  • promotes..
    • ..general fitness and health.

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The physical therapist..

  • examines the patient’s medical history
  • tests and measures the patient’s..
    • strength
    • range of motion
    • balance
    • coordination
    • posture
    • muscle performance
    • respiration
    • motor function
      • ..and then develops the patient’s plan describing a treatment strategy and its targeted outcome.

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The patient’s treatment typically includes..

  • exercise, which may focus on..
    • endurance
    • strength
    • flexibility

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The physical therapist will encourage the patient to..

  • use his/her muscles to increase..
    • flexibility
    • range of motion

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Some patients will be taught more advanced exercises aimed at improving..

  • balance
  • strength
  • coordination
  • endurance
    • ..so that they are better able to go about their daily activities at home and at work.

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To reduce swelling, physical therapists use..

  • ultrasound
  • hot packs
  • cold compresses
  • electrical stimulation

To reduce pain, and improve flexibility and circulation, physical therapists may use..

  • traction
  • deep-tissue massage

To help with mobility and dexterity, physical therapists teach patients how to use..

  • prostheses
  • crutches
  • wheelchairs
  • other adaptive devices
    • ..and how to exercise to speed up recovery.

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The physical therapist keeps notes on the patient’s progress, carries out periodic examinations, and adapts treatment along the way as required.

The physical therapist liaises with doctors, nurses, dentists, teachers, social workers, occupational therapists, speech-language pathologists, audiologists, and parents or caregivers.