All of the following describe generally accepted, well established and widely used physical therapy procedures and modalities provided at Accelerate Physical Therapy. These procedures are used as primary or adjunctive techniques in soft tissue treatment for the progressive development of strength, mobility and to improve functional outcomes.
Physical Therapy Procedures
The level of complexity can characterize the following physical therapy procedures and the expertise required to perform the task. These procedures involve training exercises or modalities requiring more specific skill than those characterized as modalities, but may be provided by assistants under the direct supervision of a licensed physical therapist.
Soft Tissue Mobilization is the skilled manual application of techniques designed to normalize movement patterns through the reduction of soft tissue pain and restrictions for the following reasons:
Muscle spasm around a joint
Joint Mobilization is the passive movement performed in such a manner (particularly in relation to the speed oft he movement) that it is, at all times, within the ability of the patient to prevent the movement if they so choose. Skilled manual joint tissue stretching is used to improve, and as possible, normalize joint movement of the spine and extremities and is performed for the following reasons:
To improve joint play/mobility
Improve intrascapular arthrokinematics
Reduce pain associated with tissue impingement or friction
Functional Activities involve the instruction, active-assisted training and/or adaptation of activities or equipment and has the following results:
Improves a person’s capacity for homemaking, including meal preparation
Improves a person’s capacity form communication, utilizing equipment
Facilitates return to work at previous level of function in lifting, driving, climbing, pushing, pulling, etc.
Job site modification to decrease postural dysfunction/pain
Therapeutic Exercise with or without mechanical assist or resistance has the following indications:
Improve cardiovascular fitness
Improves muscle strength and coordination
Improves connective tissue strength and integrity
Promotes circulation to enhance soft tissue healing/metabolism
Increases bone density
Increases endurance, reduces fatigue
Massage – Manual or mechanical manipulation of soft tissue to achieve:
Reduced muscle spasms
Improved outlying circulation
Increased muscle tone prior to exercise
Increased muscle length
Neuromuscular Re-education is the skilled application of exercise with manual, mechanical or electrical facilitation and through its use enhances motor response, strength and recruitment rate with independent control.
Neurodevelopmental Activities/Reflex and Sensory Integration/Proprioceptive Neuromuscular Facilitation (PNF) involves the skilled use of activities and exercises that promote neuromuscular responses through carefully timed proprioceptive stimuli to normal neurologically developed sequences. It also improves neuromotor response and reduces risk of impromptu muscle failure. It improves tolerance and enhances strength, normalizes movement patterns and improves cell waste and bacteria removal, and increases the muscular sense and perception of movement, stabilization and reaction time. These techniques achieve sensitization, or if required, desensitization of joint movement.
Gait Training – Crutch walking or walker instruction to a person with lower extremity injury or surgery:
Promotes normal gait pattern with assistive device
Promotes safety in proper use of assistive device
Instructs in progressive use of more independent devices (platform walker, walker, crutches, an cane)
Instructs in gait on uneven surfaces and steps (with and without railings) to reduce risk of fall or loss of balance
Instruction in the use of equipment to limit weight bearing for the protection of a healing injury or surgery
Straight Plane Exercises with or without mechanical assistance or resistance has the following effects:
Improves strength and coordination
Improves reaction, recruitment and endurance
Supervises safe progression of resistance
Teaches techniques which promote accelerated muscle development
Increases size and strength in musculotendinous tissue and tensile strength
Activities of Daily Living involves the instruction, active-assisted training and/or adaptation of activities for personal care or equipment for mobility and self-care. This includes:
A person’s capacity in mobility and self-care to move from floor or sitting levels to standing, fluently and without pain.
Aids in sleeping without pain, grooming and self care including hygiene.
P.T. Physical Agents (Modalities)
The primary use of thermal modalities is for pain, swelling and to improve the rate of healing soft tissue injuries. Extended use is supported by consistently measured changes. Certain diagnoses and post surgical conditions may require periods of treatment beyond the normal ranges of 3-6 weeks.
Additional procedures are occasionally necessary to help control swelling, pain or inflammation during the rehabilitation process. They may be used intermittently as a therapist believes appropriate, or regularly if there is specific measured improvement during the treatment.
If our patient is not responding within 3-4 weeks, alternative treatment, further diagnostic studies, or further consultations with their physician or another physical therapist should be considered.
Ultrasound is the use of sonic generators to deliver acoustic energy for thermal and/or non-thermal soft tissue treatment. There may be a concurrent delivery of electrical energy. Ultrasound can be used to obtain the following results:
Softening scar tissue and reduce pain associated with scar tissue and adhesions
To soften collagen fiber
Accelerate soft tissue healing process
Increase flexibility of muscles and tendons
Reduce muscle spasms and reduce pain associated with muscle spasms
Reduce pain or raise the pain threshold before exercise, postural training and gait training
Reduce muscle spasm to promote increased movement
Increases circulation to aid healing
Lowers body tissue temperature for reduction of inflammation
Lessens pain resulting from injury or exercise by increasing the pain threshold
Reduces swelling and hemorrhage. Used in combination with compression and elevation
Lessens pain and inflammation from tendinitis and bursitis
Diminishes muscle spasm to promote stretching and decreases exercise induced muscle soreness
Increases circulation to aid healing
Applies electrical current (AC or DC) over skin to muscles, joints or other soft tissue for the following reasons:
Relaxes muscle spasms (including TENS)
Reduces pain (including TENS)
Iontophoresis – The transfer of medication (including but not limited to steroidal anti-inflammatories and pain relievers) through the use of electric stimulation. This procedures has the following results:
Reduction in swelling
Aids circulatory problems in the extremities
Decreases muscle spasms
Breaks down calcium deposits and softens scars
Phonophoresis – The application of ultrasound using a medicated lubricant that introduces molecules into the tissue similar to those used in iontophoresis.
Contrast Baths – Involves alternating immersion of the extremities; promotes circulation and has the following results:
Reduces swelling in the subacute stage of healing
Improves outlying circulation
Decreases joint pain and stiffness
A form of heat application that uses paraffin wax/mineral oil mixture applied safely at 126 degrees Fahrenheit.
Symptomatic resolution of pain
Elevates pain threshold
Prepares for exercise, mobilization of the distal extremities and gait training