1.12: Physical Therapy

Learning Objectives

1. Define Physical Therapy.
2. Describe how a PT might use common fitness equipment in uncommon ways.
3. Know the difference between mobility and flexibility.

Physical therapy has a long history that can be traced back to ancient Greece, where Hippocrates used massage and hydrotherapy to treat his patients. In the 19th century, physical therapy emerged as a formal profession, and the first physical therapy school was established in Sweden in 1813 by Pehr Henrik Ling. In the United States, physical therapy began to develop as a profession after World War I, when many soldiers returned home with injuries and disabilities that required rehabilitation.

A modern physical therapist is a licensed healthcare provider that uses physical means to treat a disease or injury as opposed to pharmaceutical drugs or surgery. Oftentimes a person will be referred to physical therapy by their primary care medical doctor. Physical therapists can provide treatment to help someone recover from a wide range of medical issues including rehab after a stroke, recovery from a traumatic incident like a car crash, or even learning how to use an artificial limb.

The role of the physical therapist is to evaluate and assess the needs of the patient, develop a treatment plan, and guide the patient through the rehabilitation process. This may include working with the patient to improve their strength, flexibility, or joint range of motion as well as addressing any pain or dysfunction. Physical therapists also educate their patients on how to continue the rehabilitation treatment on their own at home for long-term preventative care.

Physical therapists can improve the lives of people of all ages from a young athlete recovering from surgery or sports injury to an elderly person improving their strength and balance to prevent a fall.

In 1921 physical therapy became a recognized profession in the United States with the establishment of the American Physical Therapy Association (APTA). A doctorate in physical therapy (DPT) is required to practice in the United States, as well as pass national and state certification exams. According to APTA - "Physical therapists and physical therapist assistants help people to maximize their quality of life. They work with people of all ages and abilities and in a variety of settings. They help people rehabilitate from devastating injuries, manage chronic conditions, avoid surgery and prescription drugs, and create healthy habits."

Becoming a PT

Schools and Requirements

A career in physical therapy will usually involve some specialization in working with a particular population or in a specific area. Some of the different specializations may include pediatrics, adult, geriatric, home health, hospital acute care, outpatient, burn/wound care, orthopedics, cardiac rehab, neurological and private practice.

“If exercise could be packed into a pill, it would be the single most widely prescribed, and beneficial, medicine in the nation, but when asked 4 out of every 5 adult Americans say they have never been advised by a physician to exercise”

-Robert Butler M.D

Physical therapists are that cross-over point between medical doctors and kinesiologists, using physical movement and exercise to recover and strengthen the body from many ailments. A physical therapy office often looks more like a gym than a hospital room, with a wide variety of equipment to treat different health issues.

Physical therapy can be used to treat a wide range of conditions from minor musculoskeletal injuries like sprains and strains to more serious bone fractures and joint dislocations. Physical therapists can also work with patients with neurological conditions from a stroke or spinal cord injury.

Physical therapists use a variety of techniques to treat their patients including exercises, stretches, and hands-on therapy. Exercise is an important component of physical therapy as it can improve muscular strength and cardiovascular conditioning. Cardiovascular health improvements are beneficial for patients with respiratory conditions. Hands-on therapy, also known as manual therapy, involves the use of the therapist’s hands or a tool to physically manipulate the patient’s soft tissue and joints. Massage and joint mobilization are manual therapy techniques. Electrotherapy is the use of electrical stimulation to promote healing and pain reduction. A PT may also use heat or cold to reduce pain and inflammation.

What “tools” does a PT use?

Free weights, much like those at your gym, but using lighter weights focusing on recuperation. Free weights can be used focusing on unilateral movements, rebuilding strength, or in combination with other equipment. Functional training activities are designed to improve a person’s ability to complete daily tasks like walking, standing from a seated position, and reaching to grab objects.

Unstable equipment to stand to focus on developing or recuperating strength in the foot, ankle, and core all essential for maintaining balance while moving in an upright manner. The less stable the equipment is the more difficult maintaining balance is, and the appropriate device needs to be used for the goals of the patient. Here is an example of some balance-related exercises that could be used in PT. If some of these moves are too difficult for a person to complete have them stand next to a wall to place their hand on for assistance until they feel confident in their abilities.

Level of Difficulty	Exercise
1	Standing on one foot with eyes open
2	Standing on one foot with eyes closed
3	Standing on one foot while turning head from side to side
4	Standing on one foot while raising the opposite arm and leg
5	Standing on one foot on a balance board
6	Single leg Deadlift
7	Walking heel–to–toe in a straight line
8	Standing on one foot with a weighted ball toss
9	Side plank with leg lift
10	Pistol squat

Critical Thinking

Try out the movements in the chart above, do you agree with their ranked difficulty? Would you reorder the list? Why? What are a few other useful balance exercises?

Inflated large exercise balls create instability in a variety of exercises. Also known as “yoga balls” can be used seated to engage the core and pelvic floor muscles, a great replacement for an office chair. A wide variety of other exercises can be performed using this tool to either make some activities easier (a squat with the ball on the wall for extra stability and form control) or make other activities harder (a push-up with feet elevated on top of the ball).

Resistance bands are essentially giant rubber bands that can be used to create a changing amount of tension across a movement as the band is stretched further. Resistance bands can be used in place of free weights for many exercises if the actual weight is of concern, but they can also be used to apply different pressures during movements when anchored or held by the physical therapist. These are also great options for patients to use at home because they are relatively inexpensive and not a burden to travel with (as a set of kettlebells would be).

Suspension trainers (common brand TRX) are long adjustable fabric straps with handles usually anchored high on a wall or off of a pull-up bar that can be used for a huge number of exercises without the need of weights. These can be great for offering more control in movements when compared to a resistance band. Suspension trainers can be used to modify or progress movements as the client needs.

Stretching straps are also fabric straps but are used to allow individuals to hold stretching positions they might not be able to achieve without them.

Common household items can also be put to great use by a resourceful physical therapist. Many people develop plantar fasciitis (inflammation of connective tissue on the bottom of the foot) and a great way to treat and strengthen the feet is to do toe curls with a towel on the ground under the foot, slowly pulling the towel under your foot by grabbing the towel and curling the toes.

A common misconception is that mobility (also referred to as range of motion) is the same as flexibility. While these terms might have been used interchangeably some years ago, now they are thought of as two distinct but related measures of movement.

Flexibility is the ability of muscle tissue to passively lengthen. The more flexible a muscle is the longer it can lengthen. An overly simple idea here is if someone can bend forward and touch their toes, or maybe even put their palms flat on the ground. That person would be said to have more flexible hamstrings than a person that could not touch their toes. The physiology of how the muscle fibers stretch was covered in Chapter 6.

Mobility is the ability of a joint to move through a range of motion. That range could be limited by injury, swelling, pain, or other issues restricting movement. It is a normal part of aging for humans to lose mobility and flexibility as we get older or get injured. Improving flexibility and mobility is very important for a person to maintain normal or healthy activity and function. Yoga poses can be a great tool for improving flexibility and mobility.

Three other closely related aspects of human movement that a physical therapist could focus on would be balance, stability, and posture.

Balance is the ability to move under control and maintain an upright posture. Moving predominantly on two legs is a challenge. Humans, birds, and some apes are the only animals that walk upright bipedally, on two legs. In Chapter 9, balance and upright posture were covered in detail. Many neurological or musculoskeletal issues can disrupt a person’s ability to balance, making the simple task of walking impossible.

Joint stability refers to the ability of a joint to maintain proper alignment and control movement within its normal range of motion. Joints rely on a complex interplay of bones, ligaments, tendons, muscles, and other tissues to achieve stability.

When a joint is stable, it can withstand normal forces and stresses without excessive movement or deviation from its normal position. This helps prevent injury and damage to the joint and surrounding tissues. For example, a stable knee joint is less likely to suffer ligament sprains or cartilage damage during physical activity.

Conversely, when a joint is unstable, it is more vulnerable to injury and damage. This can occur when the structures supporting the joint are weakened or compromised, or when there is abnormal movement or alignment of the joint. For example, an unstable shoulder joint may be more susceptible to dislocations or rotator cuff injuries.

Posture is the anatomically ideal position for your body to be in while standing, sitting, or laying down. Upright posture combines balance, stability, and dozens of muscles working together to prevent you from falling over. Many people suffer from postural problems from sitting at a computer desk or looking down at a phone for many hours a day.

The spine can be incorrectly bent or curved in three different classifications, kyphosis, lordosis, and scoliosis. Depending on the severity, these could have a minimal health impact or all the way up to severe life impairment.

Critical Thinking

How are mobility and flexibility different? Why are they important? What are some examples of when a physical therapist might focus on one or the other?

Many people without an athletic or kinesiology background incorrectly group personal trainers (Chapter 10), athletic trainers (Chapter 11), and physical therapists (this chapter) together as the same job, or do not quite know the difference. Now that you have completed these three chapters you should be able to clearly identify the differences and similarities in these roles.

Critical Thinking

What is your current understanding of the differences and similarities between personal trainers, athletic trainers, and physical therapists? Please summarize below and compare your answers to what you wrote in Chapter 10.