A physical therapist (PT) or physiotherapist is a health care professional trained to promote health by preventing physical disabilities; evaluating and rehabilitating patients with disabling pain , injury, or disease; and treating patients with a variety of physical methods (as distinct from surgical or medical treat-ments). Licensed physical therapists in the United States may be assisted by physical therapy assistants (PTAs) under their supervision.
Physical therapists are trained, in the words of the World Confederation for Physical Therapy, to “provide services to individuals and populations to develop, maintain and restore maximum movement and functional ability throughout the lifespan.” Although massage and other forms of hands-on healing techniques have long been used by traditional Chinese, Indian, and Native American systems of medicine, physical therapy was not recognized as a separate health care profession until 1920, when the Chartered Society of Physiotherapy was formed in the United Kingdom.
Physical therapy grew rapidly as a profession after 1920 because of the needs of wounded World War I veterans for physical rehabilitation. Sister Elizabeth Kenny (1880–1952), an Australian nurse, brought the need for physical therapists to worldwide attention through her work in treating and rehabilitating polio victims. Kenny developed a series of exercises and recommended the use of hot compresses during the acute stage of the disease, rather than keeping the patient immobilized by a plaster cast or brace as had been the custom. After World War II, the need of a new generation of combat veterans for rehabilitation led to the introduction of degree programs in physical therapy in Europe and North America. As of early 2008, the rapid aging of the baby boomer generation and the determination of many seniors in the United States to remain independent as long as possible has led to an expansion of the number of degree programs for PTs. As of 2007 there were 209 accredited programs for physical therapy in American colleges and universities.
A qualified physical therapist has been specifically trained to:
- Perform a comprehensive physical examination of the senior and his or her needs for health maintenance or rehabilitation.
- Diagnose the patient's physical disorder or problem and draw up a treatment plan.
- Work with physicians and other health care professionals, referring the patient to an orthopedic surgeon or other specialist when necessary.
- Carry out a program of physical interventions within their area of expertise. The physical interventions that a PT may use include therapeutic massage, joint manipulation, ultrasound therapy (the use of high-frequency sound waves to produce warmth in injured tissues), electrotherapy, hot packs, or ice packs.
- Evaluate the outcome of the treatment program and make changes as needed.
- Work with seniors to prevent the loss of mobility before it occurs by developing exercise and fitness programs suitable for older adults.
- Educate the senior and his or her family about self-management and health maintenance.
Physical therapists may be found in almost any hospital or outpatient setting as part of a health care team; in rehabilitation hospitals, they may work closely with physiatrists, who are physicians specializing in physical medicine and rehabilitation. They may also work in private practice as independent first-contact health care professionals. Some PTs work in schools, sports or fitness facilities, workplaces, home health care agencies, hospices , or nursing homes .
Care team role
The PT's role in the senior's health care team depends somewhat on the specific disorder, as physical therapy is tailored to the individual patient. In general, the PT works closely with the patient's primary care physician and other specialists involved in the senior's care. Some of the specific conditions or injuries physical therapists are trained to help with include:
- Orthopedic disorders, including lower back pain, osteoporosis, and osteoarthritis.
- Soft-tissue injuries, such as sore muscles or sprains and dislocations resulting from falls.
- Neurological disorders, including stroke and Parkinson's disease.
- Burns and other injuries to connective tissue.
- Cardiovascular disorders, including congestive heart failure and chronic obstructive pulmonary disease (COPD).
To be licensed as a physical therapist in the United States, a person must first complete an accredited physical therapy program after graduating from a four-year college or university with a major in one of the sciences. Some degree programs in physical therapy are masters' programs, but most (85%) American programs now offer a doctorate in physical therapy, the D.P.T. degree. Physical therapy programs in the United States begin with basic science courses in biology, chemistry, and physics, and then introduce the student to specialized courses in kinesiology, biomechanics, the anatomy of the nervous system, human growth and development, diagnostics, techniques of physical examination, and the use of various therapeutic procedures. Classroom work is followed by supervised clinical education.
Biomechanics —The application of engineering principles to the study of living organisms, particularly in regard to muscular activity and movement.
Kinesiology —The scientific study of the anatomy and mechanics of human body movement.
Physiatrist —A physician who specializes in physical medicine and rehabilitation.
Physiotherapist —An alternate term for physical therapist.
Prognosis —A medical professional's prediction of the course of a disease and the probability of the patient's recovery.
Rehabilitation —The process of restoring a patient to a condition of health or useful and constructive activity.
After receiving a physical therapy degree, the candidate must pass a national licensing examination and meet additional requirements that vary from state to state. As of 2008 there are about 170,000 PTs in the United States.
Physical therapist assistants, are graduates of two-year associate (junior college) degree programs and are registered, certified, or licensed according to the requirements of the state in which they practice. PTAs work under the direction of a fully licensed PT. They are trained to teach patients various exercise programs for flexibility and coordination; to instruct patients in the use of crutches, canes, or walkers; and to use massage or ultrasound therapy on patients. They may be asked to assist the PT in documenting and reporting on the patient's progress.
In the United States and Canada, licensed physical therapists can seek advanced training in certain medical or surgical specialties, including orthopedics, neurology, cardiovascular medicine, sports medicine, pediatrics, physiatry, and geriatrics. Some PTs also pursue specialized training in electrophysiological testing and measurement.
Because contemporary physical therapy emphasizes the patient's responsibility for full participation in the treatment program, physical therapists are trained to communicate with patients and family members as well as with other health care professionals. A senior receiving physical therapy can expect a clear explanation of his or her diagnosis, a full discussion of the treatment plan, the therapist's prognosis (prediction of the outcome), and a description of what is expected of the patient.
Pagliarulo, Michael A. Introduction to Physical Therapy. St. Louis: Mosby, 2001.
Scott, Ronald W. Foundations of Physical Therapy: A 21st-century Focused View of the Profession. New York: McGraw-Hill, Medical Publishing Division, 2002.
Hakim, R. M., A. Roginski, and J. Walker. “Comparison of Fall Risk Education Methods for Primary Prevention with Community-Dwelling Older Adults in a Senior Center Setting.” Journal of Geriatric Physical Therapy 30 (February 2007): 60–68.
Newstead, A. H., J. G. Walden, and A. J. Gitter. “Gait Variables Differentiating Fallers from Nonfallers.” Journal of Geriatric Physical Therapy 30 (March 2007):93–101.
Freedman, Vicki A., and Robert F. Schoeni. Disability, Long-Term Care, and Rehabilitation: Emerging Questions and Data Needs. Background paper prepared for the National Long-Term Care survey of the National Academies. Washington, DC: National Academies, 2006.
Hills, Everett C., MD. “Adult Physiatric History and Examination.” eMedicine. January 23, 2006 [cited February 7, 2008]. http://www.emedicine.com/pmr/topic146.htm.
American Physical Therapy Association (APTA), 1111 North Fairfax Street, Alexandria, VA, 22314, (703) 684-APTA (2782), (800) 999-2782, (703) 684-7343, http://www.apta.org/.
National Institute on Aging (NIA), Building 31, Room 5C27, 31 Center Drive, MSC 2292, Bethesda, MD, 20892, (301) 496-1752, (800) 222-4225, (301) 496-1072, http://www.nia.nih.gov/.
World Confederation for Physical Therapy (WCPT), Kensington Charity Centre, 4th Floor, Charles House, 375 Kensington High Street, London, United Kingdom, W14 8QH, +44 (0)20 7471 6765, +44 (0)20 7471 6766, [email protected], http://www.wcpt.org/index.php.
Rebecca J. Frey Ph.D.