OverviewPhysical therapy involves the interaction between therapist, patients or clients, other health care professionals, families, care givers, and communities in a process where movement potential is assessed and diagnosed and goals are agreed upon.* Physical therapy is performed by a therapist and sometimes services are provided by a physical therapist assistant (PTA) acting under their direction. Physical therapists and occupational therapists often work together in conjunction to provide treatment for patients. In some cases, physical rehabilitation technicians may provide physiotherapy services.*PTs are healthcare professionals who diagnose and treat individuals of all ages, from newborns to the very oldest, who have medical problems or other health-related conditions, illnesses, or injuries that limit their abilities to move and perform functional activities as well as they would like in their daily lives.* PTs use an individual's Medical history|history and physical examination to arrive at a medical diagnosis|diagnosis and establish a management plan and, when necessary, incorporate the results of laboratory and imaging studies. Electrodiagnostic testing (e.g., electromyograms and nerve conduction velocity testing) may also be of assistance.* PT management commonly includes prescription of or assistance with specific exercises, manual therapy, education, manipulation 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 services 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 has many specialties including sports, wound care, Electromyography|EMG, cardiopulmonary, geriatrics, neurologic, orthopaedic and pediatrics. PTs practice in many settings, such as outpatient clinics or offices, health and wellness clinics, rehabilitation hospitals facilities, skilled nursing facilities, extended care facilities, private homes, education and research centers, schools, hospices, industrial and this workplaces or other occupational environments, health club|fitness centers and sports training facilities.*Physical therapists also practice in non-patient 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 qualifications vary 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 of physical therapyPhysicians like Hippocrates and later Galenus 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 Per Henrik Ling, “Father of Swedish Gymnastics,” who founded the Royal Central Institute of Gymnastics (RCIG) in 1813 for massage, Joint manipulation|manipulation, and exercise. The Swedish word for physical therapist is sjukgymnast = someone involved in gymnastics for those who are ill. 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, which graduated "reconstruction aides."* Modern physical therapy was established in Britain towards the end of the 19th century. Soon following American orthopedic surgeons began treating children with disabilities and began employing women trained in physical education, massage, and remedial exercise. These treatments were applied and promoted further during the Polio outbreak of 1916. During the First World War 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 Physical Therapy Association (now called the American Physical Therapy Association (APTA). 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 (orthopedics)|traction. Manipulative procedures to the spine and extremity joints began to be practiced, especially in the British Commonwealth countries, in the early 1950s.* Later that decade, physical therapists started to move beyond hospital-based practice to outpatient orthopedic clinics, public schools, colleges/universities health-centres, geriatric settings (skilled nursing facilities), rehabilitation centers and medical centers. In 1921 in the United States physical therapists formed the first professional association called the American Women's Physical Therapeutic Association. This gave birth to what is known today as the APTA (American Physical Therapy Association), and currently represents approximately 76,000 members throughout the United States. The APTA defines physical therapy as: "clinical applications in the restoration, maintenance, and promotion of optimal physical function."* 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.
EducationEducational 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 (PT) and physical therapist assistants (PTA), and some jurisdictions also recognize physical therapy technicians (PT Techs) or aides.
Physical TherapistsThe primary physical therapy practitioner is the Physical Therapist (PT), who is trained and licensed to examine, evaluate, diagnose and treat impairments, functional limitations and disabilities in patients or clients. Currently, most Physical Therapist education curricula in the United States culminate in a Doctor of Physical Therapy (DPT) degree,* but many currently practicing PTs hold a Master of Physical Therapy degree and some hold a Bachelor's degree. The World Confederation of Physical Therapy (WCPT) recognizes there is considerable diversity in the social, economic, cultural, and political environments in which physical therapist education is conducted throughout the world. 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 as being at a standard that accords graduates full statutory and professional recognition.* WCPT acknowledges there is innovation and variation in program delivery and in entry-level qualifications, including first university degrees (Bachelors/Baccalaureate/Licensed or equivalent), Masters and Doctorate entry qualifications. What is expected is that any program should deliver a curriculum that will enable physical therapists to attain the knowledge, skills, and attributes described in these guidelines. Professional education prepares physical therapists to be autonomous practitioners, that may work in collaboration with other members of the health care team. Curricula in the United States are accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE). As of 2011, APTA reports that 222 out of 227 entry-level professional degree programs accredited in the United States are at the doctoral level.* According to CAPTE, as of 2012 there are 25,660 students currently enrolled in 210 accredited List of Physical Therapy Schools in the United States|PT programs in the United States.*The physical therapist professional curriculum includes content and learning experiences 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).
Curricula for the Physical Therapist professional degree include:
In CanadaIn the province of Quebec, prospective physical therapists are required to have completed a Diploma of Collegial Studies|college 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 athletic therapy program in university. Following admission, physical therapy students work on a bachelor of science 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 member of the Ordre professionnel de la physiothérapie du Québec (OPPQ). Physiotherapists can pursue their education in such fields as rehabilitation sciences, sports medicine, kinesiology, and physiology.
Physical Therapist AssistantsPhysical therapist assistants may deliver treatments and physical interventions for patients and clients under a care plan established by and under the supervision of a physical therapist. Physical therapist assistants in the United States are currently trained under associate degree|associate of applied sciences curricula specific to the profession, as outlined and accredited by CAPTE. As of August 2011, there were 276 accredited two-year (Associate degree) programs for physical therapist assistants In the United States of America.* According to CAPTE, as of 2012 there are 10,598 students currently enrolled in 280 accredited PTA programs in the United States.*
Curricula for the physical therapist assistant associate degree include:*
Physical Therapy Technicians or AidesSome jurisdictions allow physical therapists to employ technicians or aides to perform designated routine tasks related to physical therapy under the direct supervision of a physical therapist. Some jurisdictions require physical therapy technicians or aides to be certified, and education and certification requirements vary among jurisdictions.
In CanadaIn the province of Quebec, physical rehabilitation technicians (also known as physical therapy technicians) are health care professionals who are required to complete a three year college diploma in physical rehabilitation technology and successfully pass the membership examinations of the Ordre professionnel de la physiothérapie du Québec (OPPQ) to practice legally.
Most physical rehabilitation technicians complete their Diploma of Collegial Studies|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 bachelor's degree in physiotherapy, kinesiology, Exercise Science|exercise science, or occupational therapy. The Université de Montréal and the Université de Sherbrooke are among the Québécois universities that admit physical rehabilitation technicians in their programs of study related to health sciences and rehabilitation in order to credit courses that were completed in College education in Quebec|college.
In the United States of AmericaJob duties and education requirements for Physical Therapy Technicians or Aides may vary by employer, but education requirements range from high school diploma or equivalent to completion of a 2-year degree.* O-Net reports that 64% of PT Aides/Techs have a high school diploma or equivalent, 21% have completed some college but hold no degree, and 10% hold an Associate's Degree.*
EmploymentPhysical 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.
In the United States of AmericaAccording to the United States Department of Labor's Bureau of Labor Statistics, there were approximately 198,600 Physical Therapists employed in the United States in 2010, earning an average $76,310 annually, or $36.69 per hour, with 39% growth in employment projected by the year 2020.* The Bureau of Labor Statistics also reports that there were approximately 114,400 Physical Therapist Assistants and Aides employed in the United States in 2010, earning an average $37,710 annually, or $18.13 per hour, with 45% growth in employment projected by the year 2020. To meet their needs, many healthcare 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 2011, PTAs in the United States earned a median wage of $51,040 annually or $24.54 hourly, and Aides/Techs earned a median wage of $23,680 annually or $11.39 hourly in 2011.*
Specialty areasBecause the body of knowledge of physical therapy is quite large, some PTs specialize in a specific clinical area. While there are many different types of physical therapy,* the American Board of Physical Therapy Specialties list eight specialist certifications. Most Physical Therapists practicing under a specialism will have undergone further training.
Cardiovascular & pulmonaryCardiovascular and pulmonary rehabilitation respiratory practitioners and physical therapists treat a wide variety of individuals with cardiopulmonary disorders or those who have had cardiac or pulmonary 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. Disorders, including heart attacks, post coronary bypass surgery, chronic obstructive pulmonary disease, and pulmonary fibrosis, treatments can benefit from cardiovascular and pulmonary specialized physical therapists.*
Clinical electrophysiologyThis specialty area encompasses electrotherapy/physical agents, Electromyography|electrophysiological evaluation (EMG/NCV), physical agents, and wound management.
GeriatricGeriatric 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 and include but are not limited to the following: arthritis, osteoporosis, cancer, Alzheimer's disease, hip and joint replacement, balance disorders, Urinary incontinence|incontinence, etc. Geriatric physical therapists specialize in treating older adults.
IntegumentaryIntegumentary system|Integumentary (treatment of conditions involving the skin and related organs). Common conditions managed include wounds and burns. Physical therapists utilize surgical instruments, mechanical lavage, dressings and topical agents to debride necrotic tissue and promote tissue healing. Other commonly used interventions include exercise, edema control, splinting, and compression garments.
NeurologicalNeurological physical therapy is a field focused on working with individuals who have a neurological disorder or disease. These include Alzheimer's disease, Charcot-Marie-Tooth disease|Charcot-Marie-Tooth disease (CMT), Amyotrophic lateral sclerosis|ALS, brain injury, cerebral palsy,l.g.b.syndrome, multiple sclerosis, Parkinson's disease, spinal cord injury, and stroke. Common impairments associated with neurologic conditions include impairments of vision, balance, ambulation, activities of daily living, movement, muscle strength and loss of functional independence.* Physiotherapy can address many of these impairments and aid in restoring and maintaining function, slowing disease progression, and improving quality of life.
In layman's terms, neurological massage is directed toward correcting and healing out-of-normative body systems, unlike traditional massages, such as Swedish massage, that are directed toward comfort and relaxation.
OrthopedicOrthopedic physical therapists diagnose, manage, and treat disorders and injuries of the musculoskeletal system including rehabilitation after orthopedic surgery. This specialty 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, therapeutic exercise, neuromuscular reeducation, hot/cold packs, and electrical muscle stimulation (e.g., cryotherapy, iontophoresis, electrotherapy) are stimulus modality|modalities often used 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.