You must have heard of physical therapy, more commonly known as physiotherapy in the UK. But have you ever considered what physical therapists do or what happens during a physical therapy session? In this article, we will be covering the role of a physical therapist, as well as the benefits, techniques and misconceptions of physical therapy. 

Physical therapists are trained healthcare professionals who specialise in treating conditions that limit function in movement. This can range from helping people overcome symptoms such as pain and stiffness, to supporting bones and muscles after injuries or surgeries. The goal with physical therapy is mobility rehabilitation to improve the function of muscles and joints. 

The role of a physical therapist

To become a physical therapist, you will require a degree. It involves 3-4 years of undergraduate training at university to obtain a degree in physiotherapy or a Doctorate in Physical Therapy (DPT) in some countries. Physical therapists work alongside doctors and study many of the same topics, such as anatomy and physiology. But, they are not doctors and do not prescribe medication or perform surgery. Physical therapists may specialise and there a variety of different population groups they work with. Physical therapists work with children, athletes, the elderly, post-surgical patients and people with neurological or congenital conditions. 

Who Can Benefit from Physical Therapy?

• Sporting injuries: Such as broken bones, sprains, strains and cartilage/ligament damage at joints.
• Post-surgical recovery: After a knee or hip replacement surgery
• Chronic pain conditions: Commonly lower back pain or joint pain in arthritis, helping to delay or even avoid surgeries¹
• Neurological conditions: People who have had a stroke or have Parkinson’s, cerebral palsy, muscular dystrophy or multiple sclerosis would benefit from physical therapy
• Cardiopulmonary conditions: Conditions affecting the heart and lungs such as chronic obstructive pulmonary disease, cystic fibrosis or severe lung infections, requiring therapy of the chest and of the breathing muscles
• Osteoporosis (loss of bone mass) and falls: Improving balance and bone density in the elderly to prevent falls
• Controlling bowel or bladder function: By strengthening the muscles that control them through pelvic floor exercises
• Adapting to devices: Such as walkers, canes or even an artificial limb
• Dizziness and balance issues: A physical therapist may recommend vestibular therapy. The vestibular system is located in the inner ear and coordinates our balance, coordination, eye movements and spatial awareness

The Physical Therapy Process

During an initial assessment with a physical therapist, they will take  medical history and then perform a physical examination. The therapist will then create a tailored program specific to your symptoms and needs, incorporating one or more of different treatment techniques that are available. You may be asked to do home exercises in between sessions and your physical therapist will monitor your progress. Part of your sessions will revolve around patient education so that you learn about your body mechanics and anatomy. 

Treatment techniques used by physical therapists

1. Exercise programs

Tailored exercise programs that target muscle strength, flexibility and coordination have been proven by research to improve outcomes of recovery.² Resistance based exercises are exercises that strengthen muscles through movements that cause the muscle to contract against a resistance. For example, using weights such as dumbbells, or resistance from resistance bands or even using bodyweight as resistance with squats and push ups. 

Resistance training slows down bone loss in women who are post-menopausal and even increases bone mineral density (BMD) in some cases. This is great news because having higher bone mineral density reduces the risk of fractures. This is particularly important in the elderly who are more likely to have both osteoporosis (weaker bones) and are at higher risk of having falls.³

2. Manual therapy 

This involves manual manipulation, massage and mobilisation of muscle and soft tissue with the hands. Research shows that this technique can be very helpful for those struggling with chronic pain from arthritis or lower back pain. This particular technique helps to improve both joint mobility and results in significant relief of pain. In one particular study looking at manual therapy, the chances of receiving opioid based pain medication prescription reduced by 30% at the one year follow up mark.⁴

3. Ultrasound

Ultrasound uses sound waves to create heat inside muscles, which promotes increased blood flow to the area. The heat and increased blood flow increases how much collagen tissue can extend, helping tight muscles and scar healing. The increased blood flow also promotes healing and can reduce both pain and inflammation.^5,6 

However it is important to note that results ofultrasound is mixed with some research suggesting that the effectiveness of ultrasound is similar to placebo in certain conditions.⁷

4. Hydrotherapy

Hydrotherapy, or aquatic therapy, is especially beneficial for those with arthritis or who are having rehabilitation after a surgery. Research shows that the buoyancy of water reduces the pressure placed on a joint, allowing for better mobility and reduced pain. A study on patients with arthritis showed that there was a significant reduction in joint pain as well as increased function with hydrotherapy.⁸

Cryotherapy, which is ice based therapy, is well known to be particularly helpful for reducing pain and inflammation after injuries, especially in the first 48 hours.⁹

5. TENS (Transcutaneous electrical nerve stimulation)

Transcutaneous electrical nerve stimulation delivers low voltage electrical impulses directly to nerves to reduce pain. This is done through placing electrodes on the skin. The stimulation of the nerves triggers a reduction in pain and so this is most helpful for conditions such as arthritis, lower back pain or post surgical pain.¹⁰

How long does the process take?

The number of sessions and how long the process will take will vary depending on the condition that is being treated. Sprains and strains may only require 2-6 weeks with 1-2 sessions a week. 

Chronic conditions such as lower back pain or arthritis would require more time and may go on for 8-12 weeks. Lastly, surgical procedures, like a total knee replacement or ligament reconstruction require plenty of time to heal and recover from. They typically require several months of physical therapy, taking 3-6 months on average.¹¹

Where does physical therapy take place?

• Sport centres
• Hospitals
• Nursing and residential homes for the elderly
• Schools and universities
• General Practice
• Outpatient clinics
• Private practice
• Rehabilitation centres

Occupational therapist versus physical therapist

You may be wondering what is the difference between an occupational therapist and a physical therapist. They are related but different forms of practice. Physical therapists focus on improving the function, strength and mobility of joints and certain movements. Occupational therapists however focus on improving a person’s ability to regain the ability to perform day to day tasks, such as eating, showering or dressing.

People who have had surgeries or injuries usually benefit from having both a physical therapist and an occupational therapist. For example, a stroke or a knee replacement operation may need to relearn how to dress themselves or how to get in and out of the bath. This would be aided by an occupational therapist. They also would benefit from improving their strength to walk independently again and reduce pain. This would be aided by a physical therapist. 

Summary

Physical therapists are trained healthcare professionals that work side by side with doctors to help people regain strength, mobility and function in their muscles and joints. They focus on improving movement disorders and pain, and are different to occupational therapists who help people regain the ability to perform day to day activities such as dressing, eating and showering. They help people of all ages overcome pain and limited mobility. They help people with lung problems, sporting injuries, neurological problems, bowel or bladder problems and much more. They use many different treatment modalities from massage to ultrasound. If you have a condition that is limiting you, reaching out to a physical therapist could be the first step in regaining function. 

FAQs

What conditions do physical therapists treat? 

Physical therapists treat a range of conditions to help manage pain and improve mobility function. From neurological conditions such as stroke and Parkinson’s, to sporting injuries, bowel and bladder conditions, lung conditions and post surgical pain.

What techniques do physical therapists use? 

Physical therapists use a range of different treatment modalities. Most commonly they use manual therapy, massage, resistance exercise, ultrasound, hydrotherapy, cryotherapy and TENS.

How long does physical therapy last? 

This depends on the condition and will range from a few weeks for minor sporting injuries such as strains and sprains, to several months to help someone regain strength and mobility after an operation.