Physical Therapies

Physical Therapies

By Judi Hunter M.D.

What are physical therapies and when are they used?
Physical types of therapies are non-pharmacologic and non-medicinal. Physical treatments are treatment approaches that are mechanical in nature. They include therapeutic exercise, hydrotherapy, light, heat, cold, massage, and electricity. They help restore or support normal function or development.

Physical modalities versus physical therapy
There are many physical modalities that help relieve short-term pain:

  • ice or heat
  • transcutaneous electrical nerve stimulation (TENS)
  • acupuncture
  • manual therapies including mobilization and manipulation
  • massage

These modalities are “passive.” They promote a comforting, “fix-me” belief. In isolation, they are not considered “Physical Therapy”for chronic pain.

There is a risk of depending too much on the short-term comforting treatment. The real goal should be to function better over the long-term. In fact, there is little support for the long-term effectiveness of “passive” treatments. These treatments should be used along with active rehabilitation. This can help improve function and quality of life.

What is a physiotherapist?
Physical therapists, also called physiotherapists, are licensed health care professionals. They are concerned with your physical function, movement, and physical potential. You can see a physical therapist for the diagnosis, treatment, and prevention of:

• impairments
• limitations in function
• disabilities related to movement, function, and health

Licensed physiotherapists focus on your rehabilitation. You will be actively involved in your physiotherapy. You may learn how to look after your own injuries, illnesses, or disabilities.

What does a physiotherapist do?
Physiotherapists assess your movement potential. They work toward your mutually agreed upon goals pertaining to maximizing physical function and improving quality of life. They interact with you, other health professionals, and perhaps your family, care givers, and community.

Setting goals is the best way to successfully rehabilitate. When starting physical therapy, you must decide what you want to accomplish. The goals you set should be important to you. They must also be realistic and attainable. Your physical therapist will develop an appropriate treatment program to help achieve your rehabilitation goals.

Finding a physiotherapist
Make sure that you use a licensed physiotherapist. Otherwise, you may not receive the most educated and professional care. Also your insurance will not pay for unlicensed physiotherapy.
In Canada, patients have direct access to physiotherapists. They work in private practice, in hospitals, or for public and private homecare agencies. You can locate a therapist through your physician or through the Canadian Physiotherapy Association.

Why is regular exercise important when you have chronic pain?
Exercise is the key to rehabilitation. Many people with chronic pain have out-of-shape (de-conditioned) muscles. Many also have poor endurance. Pain can lead to a fear and avoidance of activity. Exercise can help improve circulation, muscle tone, tissue healing, and endurance, as well as reduce fear of movement.

Some movements may increase pain if you have a sensitized nervous system. Sometimes when particular movements trigger pain, you may try to avoid those movements. You may use abnormal protective responses or abnormal muscle movements. These can lead to overuse and sprains in initially unaffected areas of the body. This type of chronic pain can be relieved by carefully exposing yourself to movements that you have avoided due to fear of (re)injury.

If you are in a supervised program of activity, you should be gradually exposed to normal movement. This can significantly decrease any fear of pain and movement. In this way, you can help avoid re-injury.
Exercise therapies can also help improve your mood, energy levels, and self esteem.

What is an occupational therapist?
Occupational therapists promote health and well-being through occupation. Occupation refers to the things you do during the course of everyday life. Occupational therapists can help you participate in the occupations that give meaning and purpose to your life. These may include your self-care, work, study, volunteerism, and leisure.

Occupational therapists may work with you as an individual or they may work with groups and communities. They work with anyone who has trouble participating in activities. These challenges may have arisen because of illness or disability, or in the social, institutional, or physical environment.
An occupational therapist assesses, intervenes, improves, and evaluates your ability to function in your occupations. They do this using scientific evidence and professional reasoning.

adapted from the World Federation of Occupational Therapists, 2004