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What is Physical Therapy?

This is probably the most common blog topic for PT's and that in and of itself is a little concerning. From a health care perspective PT is considered "conservative care" because it does not require the administration of heavy sedatives like anesthetic or pain medication and does not require invasion of the human body in order to be successful. There are some exceptions to this rule but for the most part this holds true.

Physical therapy is conservative care because it does not involve the invasion of the human body.

Oh your not invading my body? Then what are you doing to me?

As physical therapists it our job to utilize physical modalities and methods to address painful injuries and dysfunctions that occur as the result of traumatic and non-traumatic processes. AKA we use you to treat you, rather than knives and pills.

Who needs PT: Anyone who is experiencing musculoskeletal pain, loss of function, or impaired ability to perform desired activities. I separate function from desired activities because a week in the hospital from an infection may impair your ability to stand and walk (functional activities) but you may be just fine doing a crossword puzzle (desired activity). Likewise a marathon runner who suffers a severe bout of plantar fasciitis may have no issue walking to and from his/her car, going to work, fixing meals and doing daily activities, but can't run a mile due to pain (desired activity).

How does PT work: Physical therapy employs physical means to produce a change in the human body. For example if your left hamstring is hurt from starting up the soccer season and it doesn't seem to be resolving in a few days there may be a reason for the irritation beyond normal training adaptation soreness. If you go see a PT they will take a look at your hamstring, and the places that it attaches to check for impairments. If they find that your right hip and knee look and feel great, but your left hip doesn't rotate well in the socket, your leg doesn't flex up to your stomach the way your right leg does, and when the therapist extends your leg behind you it pulls on your back significantly more while assessing the left than the right, there is a plausible cause for your hamstring issue. In this fabricated scenario your left hip does not operate the way your right hip does, and your hamstring is paying the price. Now that a plausible cause has been identified, interventions like stretching and exercise are employed to address your impairments (not just the soreness in the hamstring), and then a plan to gradually progress exercise that involve your injured hamstring until it is pain free, the impairments are eliminated, and you are performing your desired activity uninhibited. Sounds pretty straightforward, but as with anything there are varying degrees of complexity that can arise.

Let's dabble in some complexity.

As Humans we have the ability to alter our behaviors, from a large scale like changing from a couch potato to a 5k runner in a couple months, to a very teeny tiny scale like habitually activating our low back muscles and quads over our abs and glutes. This picture shows what many refer to as "Lower Crossed Syndrome" and it is indicative of scenario just mentioned. "Short-tight" hip flexors (iliopsoas and erector spinae) and "weak-long" abdominals and glutes.

There is a good amount of research to say that syndromes like this cause pain, and a good amount to say that it doesn't cause pain. Why? Because humans are complex, and honestly there is really no way to know.

So what do we do as PT's? We address the impairments we have been taught to identify. These impairments are muscular (flexibility and strength) as well as neurological (nerve mobility, autonomic balance, etc). With proper treatment (exercise and manual technique selection) and exercise compliance these muscular relationships/postures/neurologic drives can resolve and so can pain.

Now, unlike many treatment methods, PT results do not come immediately. Have you ever been given a round of antibiotics and not finished them? That treatment requires you to remember to eat something once a day, how will you remember to carve out 20 minutes of your day and perform PT exercise when, as a society, we don't focus on one thing for more than 7 seconds on average. How can you stay motivated to perform the exercises when the results are rarely immediate and the correlation is not crystal clear between the exercise and your pain?

It is my belief that the PT's most crucial job is to motivate. Motivate individuals to make a change. Whether you believe you take great care of yourself, running daily and eating right, if you are developing pain a change must occur for you to break the cycle. Do I mean stop what your doing and do something less demanding? No, not usually.

What I mean is find out what scenarios are contributing to your pain so you can develop a logical plan to address it.

To summarize, What is Physical Therapy?

Physical Therapy is the approach to resolving musculoskeletal pain and dysfunction that requires an individual in pain to recognize that a change must occur, a licensed, educated professional to identify what changes must be made, and together, the individual and the professional devise a logical, reasonable plan to address the pain and dysfunction so that the individual may participate in their desired and functional activities free of painful limitation. This plan may include physical modalities such as ice, heat, dry needling, electric-stimulation, manual therapy as well as physical interventions such as general and specific exercise to improve the quality and resiliency of human tissues.


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