Physical therapy as a profession started in the late 1800s to early 1900s as a way of aiding rehabilitation of patients with poliomyelitis, which first affected children in the United States in 1894. One of the first people to practice physical therapy as a profession was a woman named Mary McMillan, who later served in World War I. She and other physical rehabilitation specialists and reconstruction aides, as they were called then, founded the American Women’s Physical Therapeutic Association in 1921. The next year, the name of the organization was changed to the American Physiotherapy Association, and men were admitted. Current practitioners are physical therapists and physical therapist assistants. According to the Bureau of Labor Statistics’ most recent data (annual average, 2002), 72% of physical therapists are women. Approximately 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, but a Doctor of Physical Therapy degree is also available. Following graduation, licensure requires that the trainee pass a stateadministered 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).
Patients are referred to physical therapy for a variety of reasons—some conditions include orthopedic complaints (back, neck pain), orthopedic injuries or surgery, traumatic brain injury, stroke, congenital disorders (in children), and urinary incontinence (especially in women). Physical therapy services typically require prior authorization from insurance companies and services are not covered in all plans. According to the American Physical Therapy Association, physical therapy includes several steps. First, the physical therapist or physical therapy assistant examines and evaluates patients with disabilities, impairments, functional limitations, and health conditions in order to formulate a diagnosis, prognosis, and intervention. 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). The person referred for physical therapy may undergo a specialized physical examination by the physical therapist or assistant to evaluate the functional limitation that is of concern.
Second, the physical therapist or assistant designs, implements, and modifies therapeutic interventions to lessen existing impairments and functional limitations. 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. Examples of the use of these interventions are discussed below.
Third, the physical therapy professional helps people prevent injury and disability by promoting the maintenance of fitness, health, and quality of life. An excellent use of physical therapy is preventative, ranging from work with the elite athlete on proper athletic techniques to work with the elderly to prevent falls. Fourth, the professional engages in consultation, education, and research.
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, many other agents and techniques are utilized by the physical therapy professional.
Many people are referred to physical therapy treatment when an injury occurs, often leading to pain. 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.
In summary, physical therapy is useful in the prevention and treatment of disability and physical limitation. Multiple techniques are employed by the physical therapy professional to achieve the goals of therapy.