or physiotherapy (sometimes abbreviated to PT)
is a health
care profession primarily concerned with the remediation
of impairments and disabilities and the promotion of mobility,
functional ability, quality of life and movement potential
through examination, evaluation, diagnosis and physical
intervention. It is carried out by physical therapists
(known as physiotherapists in most countries) and
physical therapist assistants (known as physical
rehabilitation therapists or physiotherapy assistants
in some countries). In addition to clinical practice, other
activities encompassed in the physical therapy profession
include research, education, consultation, and administration.
Definitions and licensing requirements in the United
States vary among jurisdictions, as each state has enacted
its own physical
therapy practice act defining the profession within
its jurisdiction, but the American
Physical Therapy Association (APTA) has also drafted
a model definition in order to limit this variation, and
the APTA is also responsible for accrediting physical
therapy education curricula throughout the United
States of America. In many settings, physical therapy
services may be provided alongside, or in conjunction with,
therapy involves the interaction between therapist(s), 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
therapists often work together in conjunction to provide
treatment for patients. In some cases, physical rehabilitation
technicians may provide physiotherapy services.
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
PTs use an individual's history
examination to arrive at a 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 therapeutic treatment 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.
therapy is a professional career which has many specialties
rehabilitation is in particular a rapidly emerging field.
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,
industrial and this workplaces or other occupational environments,
centers and sports
therapists also practise in the non-patient care roles such
as health policy,
health insurance, health care administration and as health
Physical therapists are involved in the medical-legal field
serving as experts, performing peer review and independent
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
of physical therapy
and later Galenus
are believed to have been the first practitioners of physical
therapy, advocating massage,
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
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
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
Since the profession's inception, spinal manipulative therapy
has been a component of the physical therapist practice.
physical therapy was established towards the end of the
19th century due to events that had an effect on a global
scale, which called for rapid advances in physical therapy.
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.
Manipulative procedures to the spine and extremity joints
began to be practiced, especially in the British Commonwealth
countries, in the early 1950s. Around this time when polio
vaccines were developed, physical therapists have become
a normal occurrence in hospitals throughout North America
and Europe. In the late 1950s, 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. 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.
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. Most countries have licensing bodies that require
physical therapists to be a member of before they can start
practising as independent professionals.
primary physical therapy practitioner is the Physical Therapist
(PT) who is trained and licensed to examine, evaluate, diagnose
and treat impairment, functional limitations and disabilities
in patients or clients. Currently, most Physical Therapist
education curricula in the United States culminate in a
of Physical Therapy (DPT) degree,
but many currently practising 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.[citation
needed] 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 PT
programs in the United States.
physical therapist professional curriculum is as rigorous
as the traditional medical curricula and 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).
for the Physical Therapist professional degree include:
to determine when patients/clients need further examination
or consultation by a physical therapist or referral
to another health care professional.
Examine patients/clients by obtaining a history from
them and from other sources. Examine patients/clients
by performing systems reviews. Examine patients/clients
by selecting and administering culturally appropriate
and age related tests and measures. Tests and measures
include, but are not limited to, those that assess:
a. Aerobic Capacity/Endurance, b. Anthropometric Characteristics,
c. Arousal, Attention, and Cognition, d. Assistive and
Adaptive Devices, e. Circulation (Arterial, Venous,
Lymphatic), f. Cranial and Peripheral Nerve Integrity,
g. Environmental, Home, and Work (Job/School/Play) Barriers,
h. Ergonomics and Body Mechanics, i. Gait, Locomotion,
and Balance, j. Integumentary Integrity, k. Joint Integrity
and Mobility, l. Motor Function (Motor Control and Motor
Learning), m. Muscle Performance (including Strength,
Power, and Endurance), n. Neuromotor Development and
Sensory Integration, o. Orthotic, Protective, and Supportive
Devices, p. Pain, q. Posture, r. Prosthetic Requirements,
s. Range of Motion (including Muscle Length), t. Reflex
Integrity, u. Self-Care and Home Management (including
activities of daily living [ADL] and instrumental activities
of daily living [IADL]), v. Sensory Integrity, w. Ventilation
and Respiration/Gas Exchange, x. Work (Job/School/Play),
Community, and Leisure Integration or Reintegration
Evaluate data from the examination (history, systems
review, and tests and measures) to make clinical judgments
Determine a diagnosis that guides future patient/client
Determine patient/client prognoses.
of Care: Collaborate with patients/clients, family members,
payers, other professionals, and other individuals to
determine a plan of care that is acceptable, realistic,
culturally competent, and patient-centered.
physical therapy interventions to achieve patient/client
goals and outcomes. Interventions include: a. Therapeutic
Exercise, b. Functional Training in Self-Care and Home
Management, c. Functional Training in Work (Job/School/Play),
Community, and Leisure Integration or Reintegration,
d. Manual Therapy Techniques (including Mobilization/Manipulation
Thrust and Nonthrust Techniques), e. Prescription, Application,
and, as Appropriate, Fabrication of Devices and Equipment,
f. Airway Clearance Techniques, g. Integumentary Repair
and Protection Techniques, h. Electrotherapeutic Modalities,
effective culturally competent instruction to patients/clients
and others to achieve goals and outcomes.
Health Promotion, Fitness, and Wellness: Provide culturally
competent physical therapy services for prevention,
health promotion, fitness, and wellness to individuals,
groups, and communities. Apply principles of prevention
to defined population groups.
completing a Doctor of Physical Therapy program are
also required to successfully complete clinical internships
prior to graduation.
the province of Quebec, prospective physiotherapists are
required to have completed a 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 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,
provinces in Canada have changed their Bachelors in Physiotherapy
degree program with the 3 years of college / university
pre-requisite into a Masters in Physiotherapy with the requirement
of a Bachelors Degree including certain pre-requisite courses.
therapist assistants may deliver treatment 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
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
for the physical therapist assistant associate degree include:
coursework as required by individual programs.
Therapy Technicians or Aides
jurisdictions allow physical therapists to employ technicians
or aides or therapy assistants 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.
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 program in physical rehabilitation
technology and successfully pass the membership examinations
of the Ordre professionnel de la physiothérapie du Québec
(OPPQ) in order to practise legally in the country.
physical rehabilitation technicians complete their college
diploma at Collège
College, or Cégep
Marie-Victorin, all situated in and around the Montreal
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,
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.
the United States of America
duties and education requirements for Physical Therapy Technicians
or Aides may vary according to employer, but education requirements
range from high school diploma or equivalent to completion
of a 2-year degree program.
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.
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.
the United States of America
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
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
that Aides/Techs earned a median wage of $23,680 annually
or $11.39 hourly in 2011.
the body of knowledge of physical therapy is extremely large,
PTs usually specialize in a specific clinical area. While
there are many different types of physical therapy,
Board of Physical Therapy Specialties list eight specialist
certifications. Most Physical Therapists practicing under
a specialism will have undergone further training.
and pulmonary rehabilitation respiratory
practitioners and physical therapists treat a wide variety
of cardiopulmonary disorders or pre and post cardiac or
pulmonary surgery. An example of cardiac surgery is cabg.
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
fibrosis. Disorders, including heart
attacks, post coronary
bypass surgery, chronic
obstructive pulmonary disease, and pulmonary
fibrosis, treatments can benefit[citation
needed] from cardiovascular and pulmonary
specialized physical therapists.
specialty area encompasses electrotherapy/physical agents,
evaluation (EMG/NCV), physical agents, and wound management.
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,
disease, hip and joint replacement, balance disorders,
etc. Geriatric physical therapists specialize in treating
conditions in older adults.
(treatment of conditions involving the skin and all its
related organs). Common conditions managed include wounds
and burns. Physical therapists may 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.
physical therapy is a field focused on working with individuals
who have a neurological
disorder or disease. These can include stroke,
chronic back pain, Alzheimer's disease, Charcot-Marie-Tooth
disease (CMT), ALS,
brain injury, cerebral
palsy and spinal cord injury. 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. The techniques
involve in neurological physical therapy are wide ranging
and often require specialized training.
physiotherapy is also called neurophysiotherapy
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 spine mobilization/manipulation, dry
needling, therapeutic exercise,
neuromuscular techniques, muscle reeducation, hot/cold packs,
muscle stimulation (e.g., cryotherapy,
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.
physical therapy assists in early detection of health problems
and uses a wide variety of modalities to treat disorders
in the pediatric population. These therapists are specialized
in the diagnosis, treatment, and management of infants,
children, and adolescents with a variety of congenital,
developmental, neuromuscular, skeletal, or acquired disorders/diseases.
Treatments focus on improving gross
motor skills, balance
and coordination, strength and endurance as well as cognitive
processing/integration. Children with developmental
bifida, or torticollis
may be treated[citation
needed] by pediatric physical therapists.
therapists can be involved in the care and wellbeing of
athletes including recreational, semi-professional (paid)
and professional (full-time employment) participants. This
area of practice encompasses complete athletic injury management
under 6 main categories:
care - assessment and diagnosis of an initial injury;
- application of specialist advice and techniques to
- progressive management for full return to sport;
- identification and address of deficiencies known to
directly result in, or act as precursors to injury
- sharing of specialist knowledge to individual athletes,
teams or clubs to assist in prevention or management
therapists who work for professional sport teams often have
a specialized sports certification issued through their
national registering organisation. Most Physical therapists
who practise in a sporting environment are also active in
sports medicine programs too.
health physical therapy addresses women's issues related
to the female reproductive system, child birth, and post-partum.
These conditions include lymphedema, osteoporosis, pelvic
pain, prenatal and post partum periods, and urinary incontinence.
It also addresses incontinence, pelvic pain, and other disorders
associated with pelvic floor dysfunction.
in the field of Oncology and Palliative care is a continuously
evolving and developing specialty, both in Malignant and
non-malignant diseases. Rehabilitation for both groups of
patients is now recognized as an essential part of the clinical
pathway, as early diagnoses and new treatments are enabling
patients to live longer. it is generally accepted that patients
should have access to an appropriate level of rehabilitation,
so that they can function at a minimum level of dependency
and optimize their quality of life, regardless of their
2012 systematic review
found evidence to support the efficacy of spinal
manipulation administered by physical therapists to
patients. The same review found that physical therapy spinal
manipulation seems to be safe and improves the outcome for
individuals with low back pain.