What is Physical Therapy?
I get this question all the time and it’s surprisingly difficult to answer. Everyone has a different perception of what physical therapy is based on an experience in the past, something read on Google, or a story from uncle Lester at Thanksgiving last year. To make things even more complicated, there can be large differences in how a patient is treated at one clinic versus another.
I believe using an analogy of a mechanic is the best way to start to define physical therapy. While a mechanic diagnoses and fixes a car to run optimally, a physical therapist diagnoses and treats the body to move optimally.
Let’s start by breaking down the first step of physical therapy diagnosis. At your first visit, a thorough evaluation occurs consisting of an extensive review of your complaints. This first step is crucial because, as a physical therapist, I check to make sure your complaints are not something more serious. If I suspect something more serious, I will refer you to the appropriate specialist. If not, I continue on to an exam.
The exam consists of tests that I determine from the previous review of your complaints. The goal of the exam is to figure out the structure that is hurt and why it is hurting. The ‘why it is hurting’ is really the important part of the exam – as it will guide my treatment. Once this step is complete, I spend time educating you, the patient, on both the ‘what’ and ‘why’ so there is a very clear understanding of the problem at hand. I typically use pictures, analogies, and models that make sense (I avoid medical jargon and crazy long medical phrases at all costs). If I ever use the phrase ‘spondylolisthesis’ and do not explain what that means, you have full permission to call me out.
Once your condition is fully explained, I move on to treatment. Treatment is chosen based on three things that are weighted equally (as shown in Figure 1).
Clinical expertise consists of my experience as a physical therapist and what I typically see that works and doesn’t work. Best evidence consists primarily of recent research that is shown to be effective. Your own patient values are how you would prefer to be treated. Combining these aspects typically results in an effective treatment plan and a happy patient. It’s a win-win with proven results.
I also stratify treatment based on the stage of your condition. What does that mean?
Patients can typically be placed in 4 major categories of treatment:
- Inflammatory: the initial pain/inflammation you feel after a recent injury or flare-up of an old injury. In this stage of treatment, I will educate you on ways to remove or modify a provoking activity, provide gentle hands on techniques, use tape to decrease the stress on a structure, or use a wide range of other modalities (ice, heat, ultrasound, electrical stimulation) if the pain is severe.
- Segmental Movement Impairment: This is a stage of treatment that consists of treating a restriction or weakness at a joint. Joint mobilization (oscillating movements)/manipulation (quick movement), stretching, and strengthening are all common treatments in this stage.
- Functional Movement Impairment: This is a stage that consists of more multi-joint involvement where coordinated movement between body segments is needed. This stage consists of multi-joint exercise, movement corrections, and promoting normal movement patterns.
- Conditioning deficit: This stage is typically where more general conditioning is needed. Many times I will discharge a patient at this stage of treatment with a home exercise program.
An Example of Our Process
To better explain these stages, the following is an example of a patient who has recently undergone a total knee replacement. The knee will be sore, swollen, and stiff initially after surgery. This is the inflammatory stage, and the initial 1-2 visits will likely consist of reducing swelling and pain in the area. This may be accomplished through more gentle movements and PRICER (protection, rest, ice, compression, elevation, referral). Once pain and swelling have decreased, the focus will be on regaining movement at the knee with a primary emphasis on segmental movement. At this stage, more aggressive hands-on techniques and stretching will be used to regain normal knee movement. Furthermore, exercises to strengthen muscles around the knee joint will be issued and performed. Once the knee is moving well the primary emphasis of treatment will be on functional movement. After a knee replacement, this will usually consist of using exercise to improve movements such as walking, navigating stairs, and getting up and down from a chair or the floor. Finally, once all functional movements are able to be performed, a patient is placed in a conditioning treatment pathway, which may consist of starting a patient on a normal walking or biking program to ensure this patient will not have future problems with the replacement.
I hope this overview helps explain my overall methodology to treatment. As always, if you have questions feel free to call, email, or stop by the clinic!