I walk by a strip mall with a physical therapy center. Having had knee replacement and shoulder surgery, I have endured many hours of physical therapy. I guess you know you’re old when you’re on a first-name basis with your physical therapist. I do believe in physical therapy; there is no question that my physical condition improved after receiving it. I will say that there is a wide difference in physical therapists. The first physical therapy I received was in a place associated with my doctor. I even had to sign a form saying I was aware that the doctor had a financial interest in the business. It was apparent after a few visits that the focus of the business was mainly profit. There were four or five physical therapists and twice that many “assistants,” who I’m sure were paid much less. The physical therapists had at least four to five patients during the same hour, thereby allocating most of their duties to the “assistants.” There was no individual attention from the therapists.
The next time I needed physical therapy, I went online and found a physical therapy clinic run by physical therapists. It was much smaller, and I received the individual attention I wanted and deserved. I will say that you MUST do the physical therapy exercises provided at home, or you will not recuperate. I have known people who did not think they were important who are still limping three years after surgery. At any rate, physical therapy can be extremely valuable. Let’s learn more about it.
Military physical therapists working with patients on balance problems, orthopedic, amputee, examining patient's strength, flexibility, joint range of motion balance and gait.
According to Wikipedia, physical therapy — also known as physiotherapy — is one of the medical health professions that by using evidence-based kinesiology, exercise prescription, health education, mobilization and electrical and physical agents, treats acute or chronic pain, movement and physical impairments resulting from injury, trauma or illness typically of musculoskeletal, cardiovascular, respiratory, neurological and endocrinological origins. Physical therapy is used to improve a patient's physical functions through physical examination, diagnosis, prognosis, patient education, physical intervention, rehabilitation, disease prevention and health promotion.
In addition to clinical practice, other activities encompassed in the physical therapy profession include research, education, consultation and administration. Physical therapy is provided as a primary care treatment, or alongside or in conjunction with other medical services. In some jurisdictions, such as the United Kingdom, physical therapists have the power to prescribe medication.
Overview
Physical therapy addresses the illnesses or injuries that limit a person's abilities to move and perform functional activities in their daily lives. Physical therapists use an individual's history and physical examination to arrive at a diagnosis and establish a management plan. When necessary, they incorporate the results of laboratory and imaging studies like X-rays, CT scan or MRI findings. Electrodiagnostic testing e.g., electromyograms and nerve conduction velocity testing may also be used. PT management commonly includes prescription of or assistance with specific exercises, manual therapy and manipulation, along with mechanical devices such as traction and electrophysical modalities which include heat, cold, electricity, sound waves, radiation, assistive devices, prostheses, orthoses and other interventions. In addition, PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness- and wellness-oriented programs for healthier and more active lifestyles, providing services to individuals and populations to develop, maintain and restore maximum movement and functional ability throughout the lifespan. This includes providing therapeutic treatment in circumstances where movement and function are threatened by aging, injury, disease or environmental factors. Functional movement is central to what it means to be healthy. Physical therapy is a professional career which has many specialties including musculoskeltal, orthopedics, cardiopulmonary, neurology, endocrinology, sports medicine, geriatrics, pediatrics, women’s health, wound care and electromyography. Neurological rehabilitation is in particular a rapidly emerging field. PTs practice in many settings, such as private-owned physical therapy clinics, outpatient clinics or offices, health and wellness clinics, rehabilitation hospital facilities, skilled nursing facilities, extended care facilities, private homes, education and research centers, schools, hospices, industrial workplaces or other occupational environments, fitness centers and sports training facilities.
Physical therapists also practice in the nonpatient care roles such as health policy, health insurance, health care administration and as health care executives. Physical therapists are involved in the medical/legal field serving as experts, performing peer review and independent medical examinations.
Education varies greatly by country. The span of education ranges from some countries having little formal education to others having doctoral degrees and post-doctoral residencies and fellowships.
History
Physicians like Hippocrates and later Galen are believed to have been the first practitioners of physical therapy, advocating massage, manual therapy techniques and hydrotherapy to treat people in 460 BC. After the development of orthopedics in the eighteenth century, machines like the Gymnasticon were developed to treat gout and similar diseases by systematic exercise of the joints, similar to later developments in physical therapy.
The earliest documented origins of actual physical therapy as a professional group date back to Pehr Henrik Ling — "Father of Swedish Gymnastics" — who founded the Royal Central Institute of Gymnastics in 1813 for manipulation and exercise. Up until 2014, the Swedish word for a physical therapist was sjukgymnast — someone involved in gymnastics for those who are ill — but the title was then changed to fysioterapeut or physiotherapist, the word used in the other Scandinavian countries. In 1887, PTs were given official registration by Sweden's National Board of Health and Welfare. Other countries soon followed. In 1894, four nurses in Great Britain formed the Chartered Society of Physiotherapy. The School of Physiotherapy at the University of Otago in New Zealand in 1913 and the United States' 1914 Reed College in Portland, Oregon, graduated "reconstruction aides." Since the profession's inception, spinal manipulative therapy has been a component of the physical therapist practice.
Modern physical therapy was established towards the end of the 19th century due to events that had an effect on a global scale, which called for rapid advances in physical therapy. American orthopedic surgeons began treating children with disabilities and began employing women trained in physical education and remedial exercise. These treatments were applied and promoted further during the polio outbreak of 1916. During the World War I, women were recruited to work with and restore physical function to injured soldiers, and the field of physical therapy was institutionalized. In 1918 the term "reconstruction aide" was used to refer to individuals practicing physical therapy. The first school of physical therapy was established at Walter Reed Army Hospital in Washington, D.C., following the outbreak of World War I.
Research catalyzed the physical therapy movement. The first physical therapy research was published in the United States in March 1921 in "The PT Review." In the same year, Mary McMillan organized the American Women's Physical Therapeutic Association, now called the American Physical Therapy Association. In 1924, the Georgia Warm Springs Foundation promoted the field by touting physical therapy as a treatment for polio. Treatment through the 1940s primarily consisted of exercise, massage and traction. Manipulative procedures to the spine and extremity joints began to be practiced, especially in the British Commonwealth countries, in the early 1950s. Around the time that polio vaccines were developed, physical therapists became a normal occurrence in hospitals throughout North America and Europe. In the late 1950s, physical therapists started to move beyond hospital-based practice to outpatient orthopedic clinics, public schools, colleges/universities health-centers, geriatric settings — skilled nursing facilities, rehabilitation centers and medical centers. Specialization for physical therapy in the U.S. occurred in 1974, with the Orthopaedic Section of the APTA being formed for those physical therapists specializing in orthopaedics. In the same year, the International Federation of Orthopaedic Manipulative Physical Therapists was formed, which has ever since played an important role in advancing manual therapy worldwide.
Education
Educational criteria for physical therapy providers vary from state to state and from country to country, and among various levels of professional responsibility. Most U.S. states have physical therapy practice acts that recognize both physical therapists and physical therapist assistants and some jurisdictions also recognize physical therapy technicians or aides. Most countries have licensing bodies that require physical therapists to be a member of before they can start practicing as independent professionals.
Canada
Canadian physiotherapy programs are offered at 15 universities, often through the university's respective college of medicine. Each of Canada's physical therapy schools has transitioned from three-year Bachelor of Science in Physical Therapy or BScPT programs that required two years of prerequisite university courses — five-year bachelor's degree — to two-year Master's of Physical Therapy or MPT programs that require prerequisite bachelor's degrees. The last Canadian university to follow suit was the University of Manitoba which transitioned to the MPT program in 2012, making the MPT credential the new entry to practice standard across Canada. Existing practitioners with BScPT credentials are not required to upgrade their qualifications.
In the province of Quebec, prospective physiotherapists are required to have completed a collee diploma in either health sciences, which lasts on average two years, or physical rehabilitation technology, which lasts at least three years, to apply to a physiotherapy program or program in the university. Following admission, physical therapy students work on a bachelor of science degree with a major in physical therapy and rehabilitation. The B.Sc. usually requires three years to complete. Students must then enter graduate school to complete a master's degree in physical therapy, which normally requires one and a half to two years of study. Graduates who obtain their M.Sc. must successfully pass the membership examination to become a member of the Ordre professionnel de la physiothérapie du Québec. Physiotherapists can pursue their education in such fields as rehabilitation sciences, sports medicine, kinesiology and physiology.
Most physical rehabilitation therapists complete their college diploma at Collège Montmorency, Dawson College or Cégep Marie-Victorin, all situated in and around the Montreal area.
After completing their technical college diploma, graduates have the opportunity to pursue their studies at the university level to perhaps obtain a bachlor’s degree in physiotherapy, kinesiology, exercise science or occupational therapy. The Université de Montréal, the Université Laval and the Université de Sherbrooke are among the Québécois universities that admit physical rehabilitation therapists in their programs of study related to health sciences and rehabilitation in order to credit courses that were completed in college.
To date, there are no bridging programs available to facilitate upgrading from the BScPT to the MPT credential. However, research Master's of Science or MSc and Doctor of Philosophy or PhD programs are available at every university. Aside from academic research, practitioners can upgrade their skills and qualifications through continuing education courses and curriculums. Continuing education is a requirement of the provincial regulatory bodies.
The Canadian Physiotherapy Association offers a curriculum of continuing education courses in orthopedics and manual therapy. The program consists of five levels of seven courses of training with ongoing mentorship and evaluation at each level. The orthopedic curriculum and examinations takes a minimum of four years to complete. However, upon completion of level two, physiotherapists can apply to a unique one-year course-based master's program in advanced orthopedics and manipulation at the University of Western Ontario to complete their training. This program accepts only 16 physiotherapists annually since 2007. Successful completion of either of these education streams and their respective examinations allows physiotherapists the opportunity to apply to the Canadian Academy of Manipulative Physiotherapy or CAMPT for fellowship. Fellows of the Canadian Academy of Manipulative Physiotherapists or FCAMPT are considered leaders in the field, having extensive post-graduate education in orthopedics and manual therapy. FCAMPT is an internationally recognized credential, as CAMPT is a member of the International Federation of Manipulative Physiotherapists, a branch of the World Confederation of Physical Therapy and the World Health Organization.
Scotland
Physiotherapy degrees are offered at three universities: Robert Gordon University in Aberdeen, Glasgow Caledonian University in Glasgow and Queen Margaret University in Edinburgh. Students can qualify as physiotherapists by completing a four-year bachelor’s of science degree or a two-year master's degree, if they already have an undergraduate degree in a related field.
To use the title “physiotherapist,” a student must register with the Health and Care Professions Council — a UK wide regulatory body — on qualifying. Many physiotherapists are also members of the Chartered Society of Physiotherapists, which provides insurance and professional support.
United States
The primary physical therapy practitioner is the physical therapist who is trained and licensed to examine, evaluate, diagnose and treat impairment, functional limitations and disabilities in patients or clients. Physical therapist education curricula in the United States culminate in a doctor of physical therapy or DPT degree, with some practicing PTs holding a master of physical therapy degree and some with a bachelor’s degree. The entry-level degree is the doctor of physical therapy degree, which typically takes three years after completing the bachelor's degree. PTs who hold a master’s or bachelor’s in PT are encouraged to get their DPT because APTA's goal is for all PTs to be on a doctoral level. WCPT recommends physical therapist entry-level educational programs be based on university or university-level studies, of a minimum of four years, independently validated and accredited. Curricula in the United States are accredited by the Commission on Accreditation in Physical Therapy Education or CAPTE. According to CAPTE, as of 2017 there are 31,380 students currently enrolled in 227 accredited PT programs in the United States, while 12,945 PTA students are currently enrolled in 331 PTA programs in the United States. Updated CAPTE statistics list that for 2015–2016, there were 30,419 students enrolled in 233 accredited PT programs in the United States.
The physical therapist professional curriculum includes content in the clinical sciences e.g., content about the cardiovascular, pulmonary, endocrine, metabolic, gastrointestinal, genitourinary, integumentary, musculoskeletal and neuromuscular systems and the medical and surgical conditions frequently seen by physical therapists. Current training is specifically aimed to enable physical therapists to appropriately recognize and refer non-musculoskeletal diagnoses that may presently be similar to those caused by systems not appropriate for physical therapy intervention, which has resulted in direct access to physical therapists in many states.
Physical therapy-related jobs in North America have shown rapid growth in recent years, but employment rates and average wages may vary significantly between different countries, states, provinces or regions. A study from 2013 states that 56.4% of physical therapists were globally satisfied with their jobs. Salary, interest in work and fulfillment in job are important predictors of job satisfaction. In a Polish study, job burnout among the physical therapists was manifested by increased emotional exhaustion and decreased sense of personal achievement. Emotional exhaustion is significantly higher among physical therapists working with adults and employed in hospitals. Other factors that increased burnout include working in a hospital setting and having seniority from 15 to 19 years.
According to the United States Department of Labor’s Bureau of Labor Statistics, there were approximately 210,900 physical therapists employed in the United States in 2014, earning an average $84,020 annually in 2015 — or $40.40 per hour — with 34% growth in employment projected by the year 2024. The Bureau of Labor Statistics also reports that there were approximately 128,700 physical therapist assistants and sides employed in the United States in 2014, earning an average $42,980 annually — or $20.66 per hour — with 40% growth in employment projected by the year 2024. To meet their needs, many health care and physical therapy facilities hire "travel physical therapists," who work temporary assignments between 8 and 26 weeks for much higher wages; about $113,500 a year. Bureau of Labor Statistics data on PTAs and Techs can be difficult to decipher, due to their tendency to report data on these job fields collectively rather than separately. O-Net reports that in 2015, PTAs in the United States earned a median wage of $55,170 annually or $26.52 hourly, and that Aides/Techs earned a median wage of $25,120 annually or $12.08 hourly in 2015. The American Physical Therapy Association reports vacancy rates for physical therapists as 11.2% in outpatient private practice, 10% in acute care settings and 12.1% in skilled nursing facilities. The APTA also reports turnover rates for physical therapists as 10.7% in outpatient private practice, 11.9% in acute care settings and 27.6% in skilled nursing facilities.
Circulatory system
Cardiovascular and pulmonary physiotherapy
Cardiovascular and pulmonary rehabilitation respiratory practitioners and physical therapists offer therapy for a wide variety of cardiopulmonary disorders or pre- and post-cardiac or pulmonary surgery. An example of cardiac surgery is coronary bypass surgery. Primary goals of this specialty include increasing endurance and functional independence. Manual therapy is used in this field to assist in clearing lung secretions experienced with cystic fibrosis. Pulmonary disorders, heart attacks, post-coronary bypass surgery, chronic obstructive pulmonary disease and pulmonary fibrosis treatments can benefit from cardiovascular and pulmonary specialized physical therapists.
Clinical electrophysiology
This specialty area includes electrotherapy/physical agents, electrophysiological evaluation, physical agents and wound management.
Geriatric physical therapy
Geriatric physical therapy covers a wide area of issues concerning people as they go through normal adult aging but is usually focused on the older adult. There are many conditions that affect many people as they grow older which include — but are not limited to — the following: arthritis, osteoporosis, cancer, Alzheimer’s disease, hip and joint replacement, balance disorders, incontinence, etc. Geriatric physical therapists specialize in providing therapy for such conditions in older adults.
Integumentary physical therapy
Integumentary physical therapy includes the treatment of conditions involving the skin and all its related organs. Common conditions managed include wounds and burns. Physical therapists may utilize surgical instruments, wound irrigations, dressings and topical agents to remove the damaged or contaminated tissue and promote tissue healing. Other commonly used interventions include exercise, edema control, splinting and compression garments. The work done by physical therapists in the integumentary specialty do work similar to what would be done by medical doctors or nurses in the emergency room or triage.
Neurological physical therapy
Neurological physical therapy is a field focused on working with individuals who have a neurological disorder or disease. These can include stroke, chronic back pain, Alzheimer's disease, Charcot-Marie-Tooth disease or CMT, ALS, brain injury, cerebral palsy, multiple sclerosis, Parkinson’s disease, facial palsy and spinal cord injury. Common impairments associated with neurologic conditions include impairments of vision, balance, ambulation, activities of daily living, movement, muscle strength and loss of functional independence. The techniques involved in neurological physical therapy are wide-ranging and often require specialized training.
Neurological physiotherapy is also called neurophysiotherapy or neurological rehabilitation. It is recommended for neurophysiotherapists to collaborate with psychologists when providing physical treatment of movement disorders. This is especially important because combining physical therapy and psychotherapy can improve neurological status of the patients.
Orthopedic physical therapy
Orthopedic physical therapists diagnose, manage and treat disorders and injuries of the musculoskeletal system including rehabilitation after orthopedic surgery, acute trauma such as sprains, strains, injuries of insidious onset such as tendinopathy, bursitis and deformities like scoliosis. This speciality of physical therapy is most often found in the out-patient clinical setting. Orthopedic therapists are trained in the treatment of post-operative orthopedic procedures, fractures, acute sports injuries, arthritis, sprains, strains, back and neck pain, spinal conditions and amputations.
Joint and spine mobilization/manipulation, dry needling — similar to acupuncture, therapeutic exercise, neuromuscular techniques, muscle reeducation, hot/cold packs and electrical muscle stimulation e.g., cryotherapy, iontophoresis, electrotherapy, are modalities employed to expedite recovery in the orthopedic setting. Additionally, an emerging adjunct to diagnosis and treatment is the use of sonography for diagnosis and to guide treatments such as muscle retraining. Those who have suffered injury or disease affecting the muscles, bones, ligaments or tendons will benefit from assessment by a physical therapist specialized in orthopedics.
Pediatric physical therapy
Pediatric physical therapy assists in early detection of health problems and uses a variety of modalities to provide physical therapy for disorders in the pediatric population. These therapists are specialized in the diagnosis, treatment and management of infants, children and adolescents with a variety of congenital, developmental, neuromuscular, skeletal or acquired disorders/diseases. Treatments focus mainly on improving gross and fine motor skills, balance and coordination, strength and endurance as well as cognitive and sensory processing/integration.
Sports physical therapy
Physical therapists are closely involved in the care and well-being of athletes including recreational, semi-professional and professional participants. This area of practice encompasses athletic injury management under five main categories:
1. Acute care – assessment and diagnosis of an initial injury.
2. Treatment – application of specialist advice and techniques to encourage healing.
3. Rehabilitation – progressive management for full return to sport.
4. Prevention – identification and address of deficiencies known to directly result in — or act as precursors to — injury, such as movement assessment.
5. Education – sharing of specialist knowledge to individual athletes, teams or clubs to assist in prevention or management of injury.
Physical therapists who work for professional sport teams often have a specialized sports certification issued through their national registering organization. Most physical therapists who practice in a sporting environment are also active in collaborative sports medicine programs too.
Women’s health physical therapy
Women's health physical therapy mostly addresses women's issues related to the female reproductive system, childbirth and post-partum. These conditions include lymphedema, osteoporosis, pelvic pain, prenatal and post-partum periods and urinary incontinence. It also addresses incontinence, pelvic pain and other disorders associated with pelvic floor dysfunction. Manual physical therapy has been demonstrated in multiple studies to increase rates of conception in women with infertility.
Comments