Physical therapy

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Physical therapy is the auxiliary health profession which makes use of physical therapy modalities to prevent, correct, and alleviate movement dysfunction of anatomic or physiologic origin.[1] The discipline includes the assessment of strength and range of motion. Physical therapists, especially for sports medicine, may practice independently, but when under physician supervision, physical and rehabilitation medicine is the relevant specialty.

Prescribing and planning physical therapy

Either a prescribing physician or an independent therapist begins the process by focusing on relief of pain, which will ease the transition into the more stressful restoration of function. General categories include heat, massage and electrical stimulation, with specific decisions about the source/method and places of application. For example, heat can come from hydrotherapy, ultrasonic therapy or diathermy.

Restoration of function includes exercise therapy, relaxation therapy and ambulation. The physical therapist may also work with multidisciplinary teams in pain management and cardiac rehabilitation.[2]

Related disciplines

Where physical therapy concentrates on strength and range of motion, occupational therapy improves function with respect to specific tasks in activities of daily living. Dance therapy, while emphasizing emotional support, also can help movement, as can recreational therapy.

Physical therapy modalities

Direct access

The issue of "direct access", where patients may self-refer directly to physical therapists, is controversial but not unprecedented. In a document called Vision 2020, the American Physical Therapy Association (APTA), the goal is stated
By 2020, physical therapy will be provided by physical therapists who are doctors of physical therapy, recognized by consumers and other health care professionals as the practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, functional limitations, and disabilities related to movement, function, and health. [3]
An issue not mentioned in the summary above is that chiropractors, who are also experts in neuromuscular medicine, now have autonomous practice.

Further, direct access is not a new idea. The current close alliance between physical therapists and physicians began in the 1920s. Dutch physical therapists gave up "this right to gain support from medical physicians in their drive for governmental and societal recognition of the profession...In many European countries, the greatest opposition to early physical therapy came from orthopaedic surgeons who feared infringement upon their fledgling scope of practice. This led to adversarial conditions not unlike those once experienced between chiropractic and medical physicians in North America..." [4] When the U.S. government reduced coverage for veterans in 1922, t many therapists, the majority of whom had previously been employed by the military, to find jobs in the private sector. This too led to conflicts with other manual medicine practitioners including nurses, osteopaths, and chiropractors all claiming to practice physical therapy. It was this early conflict with especially the chiropractic profession that caused therapists to align themselves more closely with medical physicians. As a result, therapists in 1930 voluntary relinquished their right to see patients without physician referral1[5]

Physical therapy and chiropractic

The relationship between the disciplines of physical therapy and chiropractic are complex, and even more so in the health care efficiency debate since chiropractic has been accepted by an NIH Consensus Conference as effective for some conditions. Some practitioners are certified in both and find them synergistic. Other chiropractors are actively challenging changes in the scope of practice of physical therapists that permits the latter to do spinal manipulation. [4]

Some chiropractors have presented themselves as primary care providers following an alternative medicine paradigm. A current argument, however, is that they are complementary rather than alternative providers. One proposal is that "the most appropriate role for the chiropractor is that of a direct-access, conservative and minimalist, neuromusculoskeletal specialist fully integrated in the current health care system and contributing to the evidence-based health care movement."[6]

The two disciplines have different theoretical models, but some therapeutic interventions seem very similar, with questions raised if a valid distinction can be made between mobilization and manipulation, "the latter to be reserved for chiropractors and the former to be used by physical therapists.

Proposed [[Oregon] legislation, SB 357, equated high-velocity low-amplitude spinal manipulation (HVLA) "with chiropractic spinal adjustment and defined both as an impulse adjusting or thrusting by the practitioner's hands of a nature such that the patient cannot prevent the motion. Spinal manipulation or adjustment was further defined as commencing at the point where mobilization ends and the motion encounters the elastic barrier of resistance and ending at the limit of anatomical integrity." The suggested definition for mobilization was that of a movement applied singularly or repetitively within or at the physiological range of joint motion, without imparting a thrust or impulse, with the goal of restoring joint mobility[7]. In contrast, the APTA holds mobilization and manipulation to be synonymous and to include both thrust and non-thrust manual techniques aimed at soft tissue structures and joints60

References

  1. Anonymous (2015), Physical therapy (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. Frederic J. Kottke, Justus F. Lehmann, ed. (1990), Krusen's Handbook of physical medicine and rehabilitation (4th edition ed.), W. B. Saunders, ISBN 0721629857pp. 649-651
  3. Vision 2020, American Physical Therapy Association
  4. 4.0 4.1 Peter A. Huijbregts (2007), Chiropractic Legal Challenges to the Physical Therapy Scope of Practice: Anybody Else Taking the Ethical High Ground?, vol. 15, at 69–80.
  5. Linker B. Strength and science: Gender, physiotherapy, and medicine in early twentieth-century America. J Women's Hist. 2005;17:105–132, quoted by Huijbregts
  6. Craig F Nelson et al. (2005), "Chiropractic as spine care: a model for the profession", Chiropractic & Osteopathy 13: 9, DOI:10.1186/1746-1340-13-9
  7. Oregon Senate Bill 357. 74th Oregon Legislative Assembly, Regular Session 2007.