Physical therapy has many faces

Conway McLean, DPM

Sue, a new retiree, finally is willing to take the “time off” to have that knee replacement she has needed. The procedure goes smoothly, and after a week of recovery in the hospital, she is sent for various strengthening exercises. Soon, she is back to having a busy, active lifestyle. John, a university student, sprains his ankle playing ultimate frisbee, and is in significant pain. He gets referred to me for care, and is prescribed musculoskeletal laser treatments. After a few sessions, he is back to playing the sport he enjoys so much.

Elizabeth, a working mother with two kids, has bunion surgery, and comes in for a series of treatments in hopes of shortening her post-operative recovery time. Her therapy consists of electrical stimulation, infra-red light treatments, and cold compression, speeding her healing, and reducing the swelling sufficiently to allow her return to normal shoe gear, and her role as caregiver to her young children.

Jim, an elderly gentleman, suffers a fall, which, although causing no serious damage, certainly scares everyone enough to get their attention. Jim admits to experiencing instability, and balance issues. He goes for a series of exercise sessions aimed at improving his leg and core strength, his flexibility, as well as his balance.

Natalie is an over-weight woman who has had diabetes for over a decade. She develops an open sore on the side of her foot, which, despite proper wound care, does not appear to be healing appropriately. She goes in for cold laser treatments to the wound, as well as a novel form of electric stimulation, termed FREMS therapy. Both of these stimulate blood flow to the area and aid in the healing process. The wound goes on to close in a timely fashion.

What do all these people have in common? They have all experienced some form of physical therapy. Many do not realize how varied are the many presentations and variations of this important component of modern medicine. It is used to relieve pain, improve circulation, decrease swelling, reduce muscle spasm, improve function, increase strength and flexibility.

Generally, when people think of physical therapy, an image of strengthening and stretching exercises comes to mind, and, although this is a vital aspect of PT (as physical therapy is often referred to), there is so much more to it.

A general definition of physical therapy is the treatment of disease, injury, or deformity by various physical methods such as massage, heat treatment, and exercise, rather than by drugs or surgery. PT is a form of therapy used to preserve, enhance, or restore movement and physical function, which has been impaired or threatened by disease, injury, or disability.

Physical therapy utilizes therapeutic exercise, physical modalities (eg ultrasound, electrotherapy, and many others), assistive devices, and patient education and training.

Who can deliver physical therapy? A different question is who can prescribe PT? Only a physician can prescribe it, but PT can be delivered by physical therapists, as well as doctors. To further muddy the waters, there are doctors of physical therapy, termed physiatrists (aka doctor of physical medicine and rehabilitation). Although physical therapists are not doctors, they do have a certain freedom to evaluate problems, and provide therapies and exercises as they see fit. The prescribing physician may have a specific plan in mind, and write a prescription with a certain regimen outlined, yet the therapist may have different ideas. This can occasionally leave the prescribing physician slightly puzzled, perhaps even frustrated.

A simple way to think about physical therapy is to look at the goals of treatment. The great majority of the time, PT is recommended to either speed healing or to produce better, more capable body mechanics. The former is often achieved through the use various devices designed to help the body with healing. One example would be the aforementioned cold laser, used to shorten the healing time of an injury. Professional athletes frequently utilize the abilities of this type of laser to obtain pain relief, aid in soft tissue healing, and as an adjuvant treatment in promoting soft tissue repair. The cold laser has no side effects, and no complications with its use, and does not heat the area being treated, but instead, improves the health of the cells in the region.

Physical therapy quite frequently involves exercises of some kind, specifically designed for your injury, condition, or to help prevent future health problems. Exercise is anything you do in addition to your regular daily activity that will improve your flexibility, strength, coordination, or endurance. It even includes changing how you do your regular activities to give you some health benefits. For example, if you park a little farther away from the door of the grocery store, the extra distance you walk is exercise.

Exercise can include stretching to reduce stress on certain joints, core stability exercises to strengthen the muscles of your trunk and hips, or lifting weights to strengthen the muscles responsible for walking. A good physical therapist should also teach someone how to do appropriate exercises at home, so they can continue to work toward their individual fitness goals, and so aid in the prevention of future problems.

A different classification of PT looks at the various problems treated. For example, orthopedic physical therapy focuses on restoring function to the musculoskeletal system, including joints, tendons, ligaments and bones. Many sports injuries fall into this category. Treatment methods include stretching, strength training, endurance exercises, hot and cold packs, ultrasound, electrical muscle stimulation and joint mobilization.

Geriatric physical therapy focuses on the unique movement needs of older adults. The goal of geriatric physical therapy is to help restore mobility, reduce pain, accommodate physical limitations, improve balance and increase fitness. Neurological PT focuses on conditions such as Alzheimer’s disease, brain injury, spinal cord injury and stroke. Treatment plans attempt to achieve the highest level of autonomous function, for living as independently as possible, for as long as possible. Physical therapists concentrate on teaching clients to adapt to visual, balance, mobility and muscle loss impairments for activities of daily living.

Cardiovascular physical therapy focuses on helping individuals who suffer from cardiovascular and pulmonary conditions, such as heart attacks, chronic obstructive pulmonary disease and pulmonary fibrosis. The goal of this sub-specialty is to increase endurance and improve functional independence. Since the heart is a muscle, physical therapy, when properly performed, can help to provide a stronger, healthier heart muscle.

Often, physical therapy is prescribed as an adjunct to some treatment. Sue, who had the knee replacement, would have gone on to heal sufficiently with time, but physical therapy helped to speed her recovery, and also provide for a better over-all outcome. If you have suffered some injury, or had some procedure performed, most assuredly, there is some form of physical therapy which will aid in your recovery efforts. This is not to say that the best and most effective strategies are always instituted. As in all fields of medicine, there are the good and the bad. But one of the best things about physical therapy is that it’s rare to do harm. The same can’t be said for most medications, and many surgical procedures. So talk to your physician about whether some type of physical therapy would be helpful in speeding your recovery, and getting you back to those activities you enjoy, hopefully those that provide for a stronger, healthier you!

Editor’s note: Dr. Conway McLean is a podiatric physician now practicing foot and ankle medicine in the Upper Peninsula, having assumed the practice of Dr. Ken Tabor. McLean has lectured internationally on surgery and wound care, and is board certified in both, with a sub-specialty in foot orthotic therapy. Dr. McLean welcomes questions, comments and suggestions at