How Does Physical Therapy Work?

If you have been referred to physical therapy by your doctor or decided on your own to initiate physical therapy, you may ask, “How does physical therapy work?”.  This is a difficult question to answer because it all depends on the type of physical therapy you receive and your condition.

There are many disciplines in physical therapy, e.g., orthopedic, cardiopulmonary, neurological and geriatric physical therapy.  Each area focuses on patients with health problems specific to its discipline and incorporates a variety of treatment methods:

  • Exercise therapy. The basic component to most physical therapy treatment plans is exercise therapy, which may include strengthening, stretching, proprioceptive neuromuscular facilitation (PNF), endurance training and coordination development.
  • Manual therapy. Treatment involving your physical therapist’s hands placed on your body is called manual therapy, which attempts to reduce pain and enhance motion.
  • Physical agents. Many physical therapists rely on ultrasound, electrical stimulation and other physical agents that they believe may enhance healing.
  • Wound care. Often used in the hospital setting, your physical therapist may help treat your wounds.

Exercise therapy is the treatment method best supported by medical research in its effectiveness to treat a variety of health conditions (Archives Physical Medicine & Rehabilitation 2015).  When prescribed appropriately, exercise therapy can reduce pain, early mortality risk, healing time, obesity and fear of movement while improving strength, range of motion, posture, bone density, cardiopulmonary endurance, balance, self-confidence, muscle mass and brain function (Archives Physical Medicine & Rehabilitation 2002, 2010; Medicine Science Sports & Exercise 1997, 2006, 2014; Journal Cardiology 1994, 2009).  However, in order to receive these benefits, your physical therapist must prescribe your exercise therapy plan appropriately.  Unfortunately, physical therapy schools do not offer standardized training in exercise therapy, so physical therapists must complete additional training outside of degree programs in order to be competent in this area.  Before beginning physical therapy, we recommend checking the background of your physical therapist to ensure that professional and formal training has been completed. Otherwise, you may waste time and money performing ineffective exercises. 

Manual therapy is likely most effective when combined with exercise therapy (Journal of Orthopedic & Sports Physical Therapy 2010, 2013).  Manual therapy works by helping you move better in specific areas to make exercise therapy more effective.  For example, if you have a stiff shoulder, your physical therapist may perform manual therapy on your shoulder joint just before exercise to help reduce pain while enhancing range of motion and coordination.

Physical agents are passive modalities used by physical therapists in an effort to reduce pain and expedite healing.  Ultrasound, electrical stimulation and diathermy are examples of physical agents, each serving a different role depending on the condition treated.  Unfortunately, research is sparse in support of physical agents in physical therapy, so their use should probably be minimized to make room for more effective treatments (Archives Physical Medicine & Rehabilitation 2008, 2011; Physical Therapy 2006, 2009).

Physical therapists with specialized training can also help patients heal wounds.  For example, in the hospital setting, physical therapists may use specific medical tools to help reduce pain and healing time for wounds sustained during or after surgery.

Occasionally, we hear patients state, “Physical therapy didn’t work for me” which usually means an ineffective program was prescribed.  For example, physical therapy that is mostly passive (e.g. ultrasound, hot packs, manual therapy) with poorly monitored exercises often leads to unsatisfactory outcomes.  In order for physical therapy to be effective, an active approach should be emphasized in order to improve key areas such as body mechanics, healing capacity, self-confidence, body fat, strength and endurance. 

If you have the desire, physical therapists should be able to develop a program that works for you.

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