Exercise

Exercise is anything you do in addition to your regular daily activity that will improve your flexibility, strength, coordination, or endurance. It even includes changing how you do your regular activities to give you some health benefits. For example, if you park a little farther away from the door of the grocery store, the extra distance you walk is exercise. Physical therapy nearly always involves exercise of some kind that is specifically designed for your injury, illness, condition, or to help prevent future health problems. Exercise can include stretchingto reduce stress on joints, core stability exercises to strengthen the muscles of your trunk (your back and abdomen) and hips, lifting weights to strengthen muscles, walking, doing water aerobics, and many other forms of activity. Your physical therapist is likely to teach you how to do an exercise program on your own at home so you can continue to work toward your fitness goals and prevent future problems.

 Fitness: Increasing Core Stability

Manual therapy

Manual therapy is a general term for treatment performed with the hands and not with any other devices or machines. The goals of manual therapy include relaxation, less pain, and more flexibility. Manual therapy includes:

• Massage, which applies pressure to the soft tissues of the body such as the muscles. Massage can help relax muscles, improve circulation, and ease pain in the soft tissues.
• Mobilization, which uses slow, measured movements to twist, pull, or push bones and joints into position. This can help loosen tight tissues around a joint and help with flexibility and alignment.
• Manipulation, which uses rapid, forceful movements to position the bones and joints. This is a more aggressive treatment. Discuss the pros and cons of manipulation with your doctor or physical therapist.

Education

Physical therapy almost always includes education and training in areas such as:

• Performing your daily tasks safely.
• Protecting your joints and avoiding reinjury.
• Using assistive devices such as crutches or wheelchairs.
• Doing home exercises designed to help with your injury or condition.
• Making your home safe for you if you have strength, balance, or vision problems.

Specialized treatments

In some locations, physical therapists are specially trained to be involved in other types of treatment, including:

• Vestibular rehabilitation, which helps your inner ear respond to changes in your body position. This is helpful if you have problems with vertigo, or a feeling that you or your surroundings are spinning or tilting when there is actually no movement. Rehabilitation (rehab) can help you get used to the problem so you know when to expect it. And rehab can train your body to know how to react.
• Wound care. Wounds that are very severe or don’t heal well, often because of poor blood flow to the area, can require extensive care. This may include special cleaning and bandaging on a regular and long-term basis. Sometimes oxygen treatment or electrical stimulation is part of the treatment.
• Women’s health. Physical therapists often work with women on exercises to help control urinary incontinence or to relieve pelvic pain.
• Oncology (cancer care), to help if cancer or treatment for cancer causes you to have problems with movement.
• Decongestive lymphatic drainage, which is a special form of massage to help reduce swelling when the lymphatic system is not properly draining fluids from your tissues.

Cold and ice

Ice and cold packs are used in physical therapy to relieve pain, swelling, and inflammation from injuries and other conditions such as arthritis. Ice can be used for 10 to 20 minutes at a time. In some cases, ice may be used several times a day. Some therapists also use cooling lotions or sprays. For more information, see:

• Using Ice and Cold Packs.
• Ice Massage.
• Rest, Ice, Compression, and Elevation (RICE).
• Ice or Cold Packs for Children.

Heat

Heat can help relax and heal your muscles and soft tissues by increasing blood circulation. This can be especially helpful if a joint is stiff from osteoarthritis or from being immobilized. Heat can also relax the muscles before exercise. But heat can also increase swelling in an injured area if it is used too soon. For more information, see:

• Heat After an Injury.
• Paraffin Wax for Osteoarthritis.

Hydrotherapy

Hydrotherapy is the use of water to treat a disease or to maintain health. The term “hydrotherapy” (water therapy) can mean either exercise in the water or using water for care and healing of soft tissues. This type of therapy is based on the theory that water has many properties that give it the ability to heal.

• Water can store and carry heat.
• Water is found in different forms, such as ice, liquid, or steam. Ice may be used to cool, liquid is used in baths and compresses at varying pressures or temperatures, and steam is used in steam baths or for breathing in.
• Water can help blood flow.
• Water also has a soothing, calming, and relaxing effect on people, whether in a bath, shower, spray, or compress.
• Exercise in water takes the weight off a painful joint while also providing resistance.

For more information, see Hydrotherapy.

Ultrasound

Ultrasound therapy uses high-pitched sound waves to ease muscle spasms and relax and warm muscles before exercise, to help relieve pain and inflammation, and to promote healing. Although the use of ultrasound is common, some studies show a benefit from this treatment and others do not. Some physical therapists do not recommend deep-heating techniques. Discuss the benefits and risks with your physical therapist or doctor before starting this therapy. This type of treatment is not generally used for children.

Electrical stimulation

Electrical stimulation is the general term that describes the use of electrical current to create an effect in the body. There are several uses for electrical stimulation.

• Physical therapists sometimes use electrical stimulation at low levels to reduce the sensation of pain. It may work either by “scrambling” pain signals to mask feelings of pain or by causing the body to produce natural pain-killers called endorphins.
• Physical therapists can also use electrical stimulation to cause muscles to contract (tense). This type of therapy can help maintain muscle tone when muscles would otherwise lose strength or help teach muscles to contract again. Examples of this type of therapy include:
  • Electrical stimulation after a stroke to keep some tone in the shouldermuscles so they hold the joint together better and prevent pain.
  • Electrical stimulation to keep leg strength in a person who has severe arthritis of the knee and whose pain increases with exercise.
  • Electrical stimulation to get muscles at the front of the thigh working in the proper order after knee surgery.
• Electrical stimulation is being studied as a way to help with healing of wounds and broken bones.

Therapydia’s recent  2013 Physical Therapy Blog Awards made me realize how tight knit, knowledgeable, and insightful the PT social media community is.  As the profession continues to grow, and as more PTs take the social media plunge, we need to be able to effectively point them in the right direction.  It will become increasingly important for those already involved in the community to promote each other, and to make sure that quality content is easy to find.  Being a relatively new member of the community myself, I found it both time consuming and difficult to find the quality content and innovative voices that I craved.  So, to save the next curious PT the time and energy, I’ve compiled a list of 13 PT blogs that I have found to be unique, useful, and forward thinking.  This list is not ranked in any particular order, and isn’t comprehensive. I’m sure I missed some great content, so please feel free to add blogs (and yell at me if you want) in the comments:

13. BodyinMind

So after focusing my intro solely on PTs, I’ll throw a curve ball and start the list with a blog that isn’t specifically targeted to PT.  Body in Mind is a group of Australian clinician/scientists exploring chronic pain as it relates to the body, brain, and mind.  Based out of Adelaide (sorry, couldn’t resist linking to this song), Body In Mind focuses on providing evidence-based research & analysis on the issues encountered in every orthopedic clinic.

12. MikeReinold.com

Winner of Therapydia’s coveted Best Overall Blog for 2013, which should be enough to make you click on the link and check it out.  Seriously, stop reading this description and just click the link.

11. The Manual Therapist

What really stands out to me about this blog is its interactivity with its viewers.  Whether it be Q&A sessions, or incorporating authors from some of the other blogs on this list, The Manual Therapist has a way of conveying a sense of community that isn’t easy to cultivate.

10. Physical Therapy Diagnosis

You’ll notice a theme as you go through this list: the authors of these blogs care deeply about our profession.  Tim Richardson is no exception,  as evidenced by the header on the blog, “Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide.”

9. Allan Besselink

A blog that is forward thinking, with a nice mix of serious & lighthearted topics, and written by someone with extensive clinical experience and an obvious passion for the profession.    Here is one of my favorite posts of his.

8. Forward Thinking PT

Another blog focused on EBP and advocacy   They do a great job incorporating video into their posts, which I love.  After you’ve gone through their blog, be sure to check out the rest of the site; they have really valuable resources including a list of clinical prediction rules and analysis of commonly utilized orthopedic special tests (including sensitivity and specificity of each test!)

7. DrJarodCarter.com

Here’s a great blog for the private practice owners out there, specifically those operating or considering operating a cash-based clinic.  The blog is both a ‘How To’ for starting a PT clinic as well as a place for general musings and industry analysis.

6. PT Think Tank

If I’m being honest, this is the only blog on the list that isn’t in my “PT Blog Bookmark Folder”.  The reason it’s not in the folder is because it has its own place on my bookmark toolbar.  It was one of the first places I stumbled upon when I first found the online PT community, and their messages immediately resonated with me. Plus, us Quinnipiac grads need to stick together.  If you are just entering the social media scene, their PT Hashtag Project is required reading.

5. In Touch Physical Therapy

Penned by Harrison Vaughan, DPT out of Virginia.  This blog is rich with content, and its tagline explains it much better than I ever could: “Physical Therapy Blog on Evidenced-Informed Orthopedics, Manual Therapy and Knowledge Translation from Academia to Clinical Practice”.

4. Evidence In Motion Blog

EIM is well known throughout rehabilitation for its focus on education and advocacy, and their blog doesn’t disappoint.  I hope that over time I can find a way to convey my passion for the profession with only half the force, clarity, and effectiveness of these guys.  If you want to know where the profession is going, what you should be doing, or just want to get pumped up reading about physical therapy (which I wasn’t sure was possible a year ago), head over and dive in.

3. WebPT Blog

Wait, doesn’t WebPT also have an HEP Tool? GASP! Get them off the list!

Seriously, I’ve got to give credit where it’s due: WebPT provides great content.  If you are struggling to figure out what the heck PQRS is, or what Medicare is going to do next, this is a great place to start.

2. PranaPT Blog

I was thinking about combining this with WebPT into one, because Ann Wendel contributes to both, but in the end I decided they should be separated.  Another solid resource if Medicare leaves you scratching your head, and also a place to catch up on what’s happening in the profession and why it matters.

1. PT Talker

A blog that’s focused on advocating for both the profession as a whole, as well as for the individual experts within our field.  It is a catch-all type of blog, with a wide breadth of information.  Some of the posts are available in MP3, which is handy when you’re on the go.

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I want to stress that these are not the 13 best PT blogs available.  Instead, they are 13 PT blogs that I have come across that provide relevant, consistent, and high-quality content.  I may very well have missed a few gems, so please add them in the comments!

Ryan Klepps PT, DPT – TheraVid LLC.