Physical Therapy: An Overview

Following an injury or surgery, or if you have a chronic health issue or impairment, your health care provider may refer you for physical therapy. But what exactly is physical therapy, and will it work for your particular condition?

This article will answer these and other questions you may have about physical therapy so that you can play an active role in your ongoing health.

What Is Physical Therapy?

image: person using exercise band in physical therapyPhysical therapy, (also called PT), is a healthcare profession that focuses on improving the functioning of various parts of the body, including the musculoskeletal system (e.g. bones, joints, and muscles), the nervous system, the heart and lungs, and the skin.

Many people are surprised that PT isn’t just for neck, shoulder, and back problems. Physical therapy can provide significant benefits to those with such varied ailments as chronic obstructive pulmonary disease (COPD), headaches, incontinence, osteoporosis, and traumatic brain injury.

A physical therapist’s goal is to first thoroughly evaluate and then help each individual in a way that alleviates pain and helps them achieve the greatest possible mobility and daily functionality, often reducing the need for prescription pain relievers.

Physical therapists use a wide variety of techniques to achieve this goal, including physical manipulation, massage, exercise, and other therapies which we’ll discuss below.

Physical therapy is also useful to prevent future injuries and dysfunction.

The concept of physical therapy goes all the way back to Hippocrates, who first began using massage, manual therapy, and hydrotherapy to help his patients recover from illness or injury. As a profession, physical therapy was first recognized in Sweden in the early 1800’s, and later made its way to the United States.

Historic events like the First World War and the outbreak of polio demonstrated the need and the effectiveness of physical therapy, and it soon became commonplace in hospitals and care centers across the country.

In the 1950’s and beyond, standalone physical therapy clinics and facilities began to appear, and physical therapists can now be found in a variety of settings, such as public schools, private homes, nursing homes, colleges and universities, sports and fitness settings, as well as hospitals and major medical facilities.

If you are a sports fan, you can be confident that your favorite team has its own staff of physical therapists to help its players prevent and recover from injury.

In most states, physical therapists are required to be licensed and registered, often after completing a Master’s Degree or Doctoral Degree and many hours of practical, supervised training.

What Types of Techniques Do Physical Therapists Use?

image: man pulling apart an exercise band under the supervision of a physical therapistWhile certainly not inclusive, here are some of the many techniques physical therapists use in a professional setting:
  • Therapeutic exercise – This includes passive or active range of motion exercises to increase strength, range of motion, and/or flexibility.
  • Guided stretching.
  • Functional strength training, which helps you perform everyday activities more safely and easily.
  • Joint mobilization, which helps decrease joint pain and improve mobility.
  • Massage to help ease pain and repair damaged muscles and tissues.
  • The use of dry and moist heat to increase blood circulation to injured areas, as well as relax muscles and ease pain.
  • Using ice to decrease pain and inflammation.
  • Ultrasound, which has a deep-heating effect on the tendons, muscles, and ligaments.  This often reduces pain, speeds healing, and improves the flexibility of these tissues prior to movements and exercises.
  • Electrical stimulation, which involves mild, painless stimulation of the muscles via patches on the skin to decrease pain or reduce spasms.
  • Gait training – This may involve anything from using crutches to learning proper running form, all intended to improve your ability to stand, walk, and run.
  • Kinesiology taping, or K-tape – A flexible fabric that pulls and stretches as you move to help with muscle movement, manage bruising and swelling, and to lessen pain.

Does Physical Therapy Actually Work?

image: man holding his lower back in painReliable scientific studies show that physical therapy is effective in reducing pain and improving function for many musculoskeletal and other problems.

  • Lower back pain, a common complaint, responds very well to physical therapy.[1]
  • Those with osteoarthritis of the knee joint may be able to delay, or even prevent, surgery following a combination of manual therapy and supervised exercise.[2]
  • Patients with lumbar spinal stenosis, (a condition involving the compression of spinal nerves in the lower back), who underwent physical therapy experienced the same level of improved function and reduced symptoms as those who opted for surgery.[3]
  • Other conditions for which physical therapy produces equally effective results as surgery, thus avoiding the costly and sometimes risky aspects of surgery, are Carpal Tunnel Syndrome,[4] meniscal tears, rotator cuff tears and degenerative disk disease.[5]
  • Physical Therapy has been shown to improve the quality of life and cardiopulmonary fitness for those who suffer from asthma, as well as reduce their symptoms and their need for medications.[6]
  • Physical Therapy can also help reduce the length of patients’ stays in both ICU and hospital settings and improve their long-term functional abilities.[7]

In addition to studies, there is a great deal of anecdotal evidence reported across the internet as to the sometimes life-changing benefits of physical therapy.

Check out seven such success stories here.

You also probably know friends, family or co-workers who have undergone some form of physical therapy. If they’re willing to share, they can be great resources in helping you learn how you might benefit from PT.

What Should I Expect When I Go to A Physical Therapist?

You should expect to undergo a thorough physical exam and evaluation.

This will include a health history and some testing procedures to evaluate such things as posture, gait, movement and flexibility, as well as muscle and joint motion and performance.

You will receive a clinical diagnosis, a prognosis for your condition, a plan of care, as well as short and long-term goals for therapy.

You can expect to then receive physical therapy treatment based upon the therapist’s diagnosis and evaluation, as well as recommendations for self-management of your ongoing care. You will often receive training in exercises to do at home that are essential for your healing.

How Long Does Physical Therapy Take to Work?

As each individual case is different, it’s impossible to say precisely how long you may need physical therapy.

Much of the success of PT treatment depends upon the patient’s willingness to complete the course of care prescribed by the physical therapist.

Experts say that the better approach is to focus on the goals of physical therapy.

Working with your physical therapist, you should set very specific goals and work toward achieving them, taking the time to celebrate each time you hit a new milestone.

Is Physical Therapy Covered by Insurance?

stethoscope and piggy bank with wood backgroundIt is important to note that you do not need a doctor’s referral to be evaluated by a physical therapist, but it is always best to check with your insurance representative about whether you should to avoid coverage issues.

As all healthcare plans are different, some cover physical therapies while others do not. Still others cover PT but to a lesser extent.

For example, employer-sponsored policies are more likely than other types of health insurance to cover physical therapy, but be sure to check the details of your employer’s plan before you sign up. For example, a job-based plan will likely cover most of the cost for PT at an in-network clinic, but less or not at all for an out-of-network provider.

Individual policies, such as those purchased through the federal or a state marketplace after the passage of the Affordable Care Act, must cover physical therapy, but often do so with more significant limits.

Specifically, while individual policies can’t put a dollar limit on PT care, they are allowed to restrict how often physical therapy treatment is received, what types of PT you can receive, and how many times a policyholder can receive treatment.

Furthermore, these policies may only reimburse you for treatment if you use in-network providers. Lastly, because many individual policies have high deductibles, you may end up paying for most of your physical therapy out of pocket until you reach the plan’s deductible.

People who have Medicare, particularly Medicare Part B, are generally covered for many forms of PT.

However, there are a number of caps, exceptions, and restrictions to this coverage.

First, it only covers outpatient therapy, which means physical therapy is not covered if you’ve been admitted to the hospital.

Second, Part B caps what it will pay out each year at $2,080, as of 2020.[8] If you reach that cap, you can request an exception. You would ask your physical therapist to provide documentation that shows their services are medically reasonable and necessary for you. If Medicare agrees with your therapist, it will continue to pay its share of your physical therapy costs.

In contrast to Medicare, Medicaid often does not cover physical therapy. The Federal government considers such treatment an “optional benefit,” and therefore leaves it up to individual states to decide whether to cover it or not. Some do, but unfortunately many do not.

Call your state’s Medicaid office to find out.

female physical therapist manipulating man's legIf you are uninsured, your only option is to pay out of pocket. Because insurance companies negotiate costs with all types of care providers, including physical therapists, individuals without insurance may end up paying more per session.

Physical therapy may cost anywhere from $50 to $350 per session depending upon what type of treatment you receive and for how long. It is still worth asking a PT provider if they have sliding-scale fees for those without insurance and if they will negotiate a payment plan with you.

Conclusion

Each year, physical therapy helps millions of people relieve pain, restore function, and improve their strength and mobility. It has become an established medical discipline that uses numerous methods to help with a vast array of physical ailments.

It is hoped that this article has answered some of your questions about physical therapy. If you feel PT may be helpful to you, speak with your physician or visit a trusted physical therapy clinic in your area for an evaluation.

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[1] Kuczynski JJ, Schwieterman B, Columber K, Knupp D, Shaub L, Cook CE (December 2012). “Effectiveness of physical therapist administered spinal manipulation for the treatment of low back pain: a systematic review of the literature”. Int J Sports Phys Ther. 7 (6): 647–662.

[2] Deyle, Gail D.; Henderson, Nancy E.; Matekel, Robert L.; Ryder, Michael G.; Garber, Matthew B.; Allison, Stephen C. (1 February 2000). “Effectiveness of Manual Physical Therapy and Exercise in Osteoarthritis of the Knee”. Annals of Internal Medicine. 132 (3): 173–81.

[3] Wise, Jacqui (7 April 2015). “Physical therapy is as effective as surgery for lumbar spinal stenosis, study finds”. BMJ. 350: h1827.

[4] “Carpal Tunnel Syndrome: Physical Therapy or Surgery?”. The Journal of Orthopaedic and Sports Physical Therapy. 47 (3): 162. March 2017.

[5] https://www.choosept.com/Benefits/Default.aspx

[6] Bruurs, Marjolein L. J.; van der Giessen, Lianne J.; Moed, Heleen (1 April 2013). “The effectiveness of physiotherapy in patients with asthma: A systematic review of the literature”. Respiratory Medicine. 107 (4): 483–494.

[7] Paton, Michelle; Lane, Rebecca; Hodgson, Carol L. (October 2018). “Early Mobilization in the Intensive Care Unit to Improve Long-Term Recovery”. Critical Care Clinics. 34 (4): 557–571.

[8] https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM11532.pdf