12 Surprising Things Physical Therapy Treats

NOTE: I have personally practiced in the states of Washington and California. Other states may have different systems/ procedures in place for the Physical Therapy treatment of the following conditions.

Orthopedic Physical Therapy

When we think of physical therapy, outpatient orthopedic physical therapy is typically what comes to mind. Orthopedics primarily addresses problems with muscle, tendon, ligament, and bone.

Here is a List of Some Common Non-Operative Orthopedic Conditions Addressed by Outpatient Orthopedic Physical Therapy:

1. Acute Ankle Sprain
2. Arch of the Foot Pain (Plantar Fasciitis)
3. Anterior Knee Pain (Patellofemoral Pain)
4. Knee Arthritis
5. Hip Pinching Pain (Hip Impingement)
6. Hip Arthritis
7. Acute Low Back Pain (Acute Disc Irritation)
8. Posture-Related Neck Pain (Neck Postural Dysfunction)
9. Front of Shoulder Pain (Biceps Irritation)
10. Shoulder/ Upper Arm Pain (Rotator Cuff Irritation)
11. Tennis Elbow
12. Hand Arthritis

Here is a List of Some Common Operative Orthopedic Procedures that Require Rehabilitation by Outpatient Orthopedic Physical Therapy:

1. ORIF Ankle (Open Reduction Internal Fixation of Tibia or Fibula)
2. ACL (Anterior Cruciate Ligament) Reconstruction
3. Partial Meniscectomy (Knee)
4. Total Knee Replacement
5. Total Hip Replacement
6. Lumbar Decompression
7. Rotator Cuff Repair
8. Cervical Fusion

Outpatient Orthopedics also Addresses the Following Special Populations:

1. Workman’s Compensation/ Labor & Industry

In California, this is referred to as Workman’s Compensation, Worker’s Compensation, or its delightful nickname, Worker’s Comp. In the State of Washington, this is called Labor & Industry, or simply L&I.

This type of Physical Therapy treatment is for individuals who have sustained an injury due to their work or occupation. Whether you are in heavy construction and injure your shoulder lifting something heavy or you are typing 8 hours per day and now have forearm pain (Tennis Elbow), your employer is responsible for helping you get well.

If your pain is related to your work, you need to contact your HR (Human Resources) Department as soon as possible. If your company is small and does not have an HR department, then you should bring this up with your supervisor. They should help you get the care you need.

Typically,

1. Paperwork describing when and how the injury arose will be completed.
2. You will be assessed by a Physician or other Healthcare Practitioner that is contracted to assess Workman’s Comp Cases.
3. You will be referred to Physical Therapy if appropriate.

What Can Physical Therapy Do? With your Physical Therapist, you will discuss the nature of your injury, the nature of your work, and whether or not you intend to return to that same occupation. As with all Physical Therapy treatment, your program centers around what you are trying to return to. If you are seeking return to a job at a computer, plan to work on postural re-education and a strengthening program with an endurance focus. If your occupation is very physical, physical therapy will involve significant strengthening and body mechanics instruction when appropriate.

How to Find Care. Research Physical Therapy Clinics in your area that advertise treatment of Worker’s Compensation/ L&I Cases on their website, call your Physical Therapy Clinic to see if they accept L&I Cases, or ask your Worker’s Comp Physician if they have any PT clinics they would recommend.

2. Motor Vehicle Accident (MVA)

If you have been in a car accident, the insurance of the party determined to be “At Fault” for the collision will cover the cost of any care you may need.

In my clinical experience, the severity of the accident has minimal bearing on how someone feels afterward. I have seen patients in rollover accidents who come away with nothing but mild hip pain and other individuals in minor fender benders that have endured pain for months or even years following.

When to See a Doctor After a Car Accident.

In general, when things are “not right” following car accident you should seek medical care, but if you’re still looking for a list, here it is:

• You were involved in a “severe” accident. If you were in a high speed accident (>60 mph), rollover accident, or you were ejected from your vehicle, you should be evaluated by a doctor.
• You have ANY head symptoms. Nausea, vomiting, headache, dizziness, fainting, etc. Anything that does not feel right with your head that is new/ different than before your accident, go see an MD IMMEDIATELY.
• You have numbness/ tingling in your arms and/ or legs that is new. This is cause for concern and should be assessed by a doctor.
• You cannot walk. No matter what the reason, pain, dizziness, incoordination, whatever it is, if you cannot walk, you need medical attention.
• You cannot turn your head at least 45 degrees. All physical therapists are trained in the Canadian C-Spine Rules. This is a well-studied decision-making tool establishing when people need to undergo x-ray on their neck following traumatic injury. Multiple of these suggestions, including the 45 deg-rule, comes from this well-established set of guidelines.
• You have a body part that you cannot move. If following your accident, you now feel like you cannot move your elbow, your wrist, your ankle, insert whatever body part AND this is new compared to before your accident, seek medical attention right away.

If you’ve been in a small fender bender ONLY and don’t have any concerning symptoms, I wish EVERYONE knew the following recommendations that come from the Neck Pain Clinical Practice Guidelines established by the Orthopedic Section of the American Physical Therapy Association [1]:

1. Patients who perform exercises early in their recovery do better than those whose dominant rehabilitation strategy involves the use of a cervical collar.
2. Early return to normal, non-provocative, pre-accident activities leads to faster recovery.
3. Recovery from Whiplash has a Good Prognosis with conservative care.
4. A positive attitude is important in your recovery. I’m not kidding. The research says that feeling like you’re not going to get better leads to you actually not getting better following a car accident. Check a negative attitude at the door so it doesn’t get in the way of you getting better!

What Can Physical Therapy Do? Depending on the severity of the accident, physical therapy will initially involve symptom management and treatment techniques focused on reducing and relieving pain. As you improve, movement is encouraged and ultimately strengthening. Gradual return to previous activities is guided.

How to Find Care. Research Physical Therapy Clinics in your area that advertise treatment of Auto Accident Cases on their website or call your Physical Therapy Clinic to see if they accept Auto Accident Cases.

Neurological Physical Therapy

When it comes to issues with the nerves, the brain, and the nervous system, Neurological Physical Therapy is there to help.

3. Following a Stroke. Cerebrovascular Accident (CVA).

A stroke, or a cerebrovascular accident, occurs when blood supply to the brain is limited.

How to Detect a Stroke. The FAST Acronym.

F= Facial Drooping
A= Arm Numbness
S= Slurred Speech
T= Time

If you recognize someone is experiencing these symptoms, call 911 immediately.

Stroke Types

Ischemic Stroke. Stroke is due to a blockage in the artery, typically due to a clot or a build up of fatty plaques.

Hemorrhagic Stroke. Bleeding in the brain prevents blood flow from reaching its intended target tissue.

Following a Stroke You May Experience these Symptoms:

1. Limited function in an arm, a leg, or half of the body.
2. Pain due to this limited body function.
3. Difficulty speaking or swallowing.
4. Difficulty thinking.

What Can Physical Therapy Do? Treatment centers around what was affected by the stroke. Physical Therapy would involve improving mobility and neuromuscular control of the impacted limb(s) and body functions with an emphasis on getting you back to what matters most to you.

How to Find Care. Appropriate care depends on the severity of the stroke and is usually guided by your attending physician. Depending on your symptoms and recovery, you may need to be in the Hospital or a Sub-acute Nursing Facility. If you have been discharged from a Sub-Acute Setting, Home Health may be recommended. When you can attend PT sessions outside the home, an Outpatient Neuro Physical Therapy setting would be appropriate. These are often located in hospitals, but are seen on an outpatient basis (no hospital stay required).

For more information about Stroke visit:

American Stroke Association

4. Parkinson’s Disease

Parkinson’s Disease is a progressive (worsens over time) neurological condition. Due to a lack of dopamine (a hormone) in the brain, the following symptoms may develop:

1. Tremor (Trembling/ Shaking)
2. Stiffness
3. Slowed Movement
4. Shuffling Gait/ Walking
5. Decreased Voice Volume

What Can Physical Therapy Do? Physical Therapy for Parkinson’s Disease typically involves addressing your stiffness, helping normalize your gait, and improving balance and coordination.

What is LVST? LSVT BIG and LSVT LOUD are specialized programs that have been designed to specifically address the difficulties that individuals with Parkinson’s Disease have. This program requires additional, advanced training that not all physical therapists have pursued.

To learn more about LSVT or find a LSVT-certified provider you can visit:

LSVT

How to Find Care. Depending on your symptoms, an Outpatient Neuro or Outpatient Orthopedic Physical Therapy setting would be appropriate. While Parkinson’s Disease is a neurological condition, addressing stiffness, gait, and balance/ coordination issues occurs in an orthopedic setting on a daily basis and non complex cases can be treated in an Outpatient Orthopedics clinic. Call your Physical Therapy clinic and see if any of their PTs have experience working with individuals with Parkinson’s Disease.

For more education about Parkinson’s Visit:

Parkinson’s Foundation

5. Multiple Sclerosis (MS)

Multiple Sclerosis is a neurologic condition that arises due to a breaking down of the myelin (protective sheath) on the nerves in the body. Presentation and progression of this condition is highly variable. Symptoms may include:

1. Numbness or tingling in a limb or limbs.
2. Difficulty with coordination or walking.
3. Fatigue.
4. Sensitivity to heat.
5. Vision Dysfunction (such as Blurry or Double Vision).

What Can Physical Therapy Do? Physical Therapy for MS typically involves addressing the muscle weakness and recruitment issues and difficulty with coordination and walking. Strategies to pace yourself to avoid over-fatigue and over-heating are also covered. Depending on the severity of your symptoms and the progression you are experiencing, physical therapy may involve fitting and instruction with an assistive device to keep you as mobile and as independent as possible.

How to Find Care. Depending on your symptoms, an Outpatient Neuro or Outpatient Orthopedic Physical Therapy setting would be appropriate. While MS is a neurological condition, addressing strength, neuromuscular control, coordination, and gait dysfunction occurs in an orthopedic setting on a daily basis and non complex cases can likely be treated in an Outpatient Orthopedics clinic. Call your Physical Therapy clinic and see if any of their PTs have experience working with individuals with MS.

For more information about Multiple Sclerosis visit:

National Multiple Sclerosis Society

6. Cardiac Physical Therapy

Cardiac (relating to the heart) Rehabilitation is typically a specialized program involving exercise and education that helps improve one’s health. A cardiologist may recommend Cardiac Rehabilitation if you have experienced the following (NOTE: Not an All-Inclusive List):

1. Heart Attack
2. Coronary Artery Bypass Graft (CABG, commonly called a “Cabbage”)
3. Coronary Artery Disease
4. Heart Failure
5. Angioplasty or Stent Placement
6. Heart Valve Repair

What Can Physical Therapy Do? Physical Therapists are typically a vital member of the Cardiac Rehab Team. Depending on the severity of your condition and whether or not you have recently undergone a procedure, your physical therapist will address you as a whole person. If you have precautions following a cardiac procedure, they will guide you through. If you need to start cardiovascular exercise, they will work with your cardiologist to choose appropriate parameters for your exercise. If you have been in a bed recovering and are now feeling stiff and immobile, physical therapy can help you. Education will be an essential piece as you need to know what things you can modify in your daily life to decrease your risk of further cardiac issues or events.

How to Find Care. Your cardiologist will be the one to advise cardiac rehab. Due to the complex nature of this type of rehabilitation, they will typically already have a provider or a team in mind that they would like you to work with.

For an excellent article, covering Cardiac Rehab please visit Very Well Health.

7. Pediatric Physical Therapy

Kiddos need Physical Therapy too! From birth until the age of 18, little ones may need help getting their bodies to do everything they are supposed to do. Here is a list of some conditions that children seek Physical Therapy Treatment for:

1. Delay in Reaching Milestones. Whether they are not crawling, sitting, or walking as expected, physical therapy is often used to help them “catch up” to their peers.
2. Decreased Coordination or Muscle Weakness. Pediatric PTs help kiddos hone their motor skills and strengthen their muscles so they can play.
3. Neuromuscular Conditions (e.g. Cerebral Palsy). Physical Therapy helps address the specific challenges of your child’s condition. Whether specialized equipment needs to be fitted or a strategy for classroom participation needs to be built, Pediatric Physical Therapists are superheroes at helping kids maximize their participation.
4. Orthopedic Injuries. Children can also experience orthopedic injuries like adults. Treatment is modified to consider several factors, such as the still developing skeleton and muscles, the different tissue elasticity, and the accelerated healing times

How Can Physical Therapy Help? Conditions similar to those described in #1-3 are typically treated in Pediatric Physical Therapy-specific settings. Many of these are located in schools, but there are also private outpatient pediatric physical therapy clinics as well. Orthopedic injuries across the lifespan are typically treated in an Outpatient Orthopedic Setting. I have treated children as young as 4 years old in my career in an outpatient ortho clinic.

How to Find Care. Your first resource is your Pediatrician. If your child is experiencing Developmental Delay or a Neuromuscular Condition they will typically have a Pediatric Physical Therapist in mind. If your child experienced an orthopedic injury, your pediatrician or sports medicine doctor will usually guide you where you should go. If they do not have a recommendation, call your outpatient orthopedic physical therapy clinic and ask them if they have a PT who can treat your child’s condition.

My classmate from Physical Therapy School is an amazing Pediatric Physical Therapist! I love following her Instagram (see below) for all of the ideas her clinic posts about getting those kiddos mobile and active!

View this post on Instagram

A post shared by WalkTalkPlay ▶️ Preschool Play & Early Development (@walktalkplay)

8. Pelvic Floor Dysfunction

The Pelvic Floor is a sling-like group of muscles that helps support the organs that sit in the pelvis, but also plays a critical role in urination, defecation, and sexual function.

It is becoming more widely known that women who have been pregnant or who have had children can experience some urine leakage with cough, sneeze, or laughter due to the prior increased stress on this group of muscles. This is the most commonly known type of Pelvic Floor Dysfunction.

However, Pelvic Floor Physical Therapists address conditions in both women and men. The following may benefit from treatment by a Pelvic Floor PT:

1. Difficulty controlling bladder or bowel dysfunction.
2. Painful intercourse.
3. Difficulty achieving orgasm.
4. Constipation.
5. Low back pain related to these conditions.
6. Irritable Bowel-like Symptoms.
7. Pain in the pelvic region.

How Can Physical Therapy Help? For mild symptoms, Transversus Abdominis and core strengthening is a great place to start addressing your pelvic floor dysfunction (see the Pelvic Floor Dysfunction Tip Sheet). However, if your symptoms are moderate to severe or chronic (have been present for a long time), Physical Therapy has a whole specialty devoted to the treatment of these symptoms!

For more information, including a resource to help find a Pelvic Floor PT in your area, please visit:

APTA Pelvic Health

9. Lymphedema

Lymphedema is swelling that occurs in one or more limbs, typically as a result of lymph nodes being impacted due to cancer.

Symptoms that May Develop due to this Limb Swelling:

1. Pain due to the Swelling
2. Feeling of Heaviness due to the Added Weight of the Fluid/ Swelling
3. Limited Range of Motion
4. Feeling of Tightness in the Skin

How Can Physical Therapy Help? All physical therapists are very experienced at addressing stiffness, loss of mobility, and helping to manage swelling. However, if you have significant Lymphedema, you may benefit from treatment by a Physical Therapist who specializes in Lymphedema treatment called a CLT (Certified Lymphedema Therapist). They are skilled in Manual Lymphatic Drainage and application of compression garments to help manage your swelling and symptoms.

To learn more about Lymphedema or find a CLT, please visit:

Lymphcare USA

10. Jaw/ Temporomandibular Joint (TMJ)

The Temporomandibular Joint or TMJ is well-known to click and pop. If this clicking and popping is not painful and does not cause dysfunction it is typically not bad for you.

However, you may benefit from Physical Therapy for your TMD (Temporomandibular Dysfunction) if you are experiencing the following:

1. Jaw locking into either an open or a closed position.
2. Difficulty opening your mouth for eating, speech, or other daily activities.
3. Significant jaw pain.
4. Headaches as a result of your jaw pain.
5. Tooth Pain! There are some TMD symptoms that may feel like tooth pain, but the problem actually originates from the TMJ. As with all aches and pains, you need to address the source of the problem in order to get better. Going to the dentist to have your tooth/ teeth examined is not going to help if your pain originates in the jaw!

How Can Physical Therapy Help? Treatment for jaw dysfunction and pain is typically treated by a physical therapist with advanced coursework in TMD. These physical therapists have received further training on how to perform intra-oral (inside the mouth) manipulation of the jaw and the muscles that are involved in mastication, opening, and other relevant functions. They will be able to instruct you in jaw-specific exercises and educate you regarding good habits and whether or not you should consider limiting crunchy or chewy foods based on your symptoms. The neck and poor neck posture may also be a part of a well-rounded physical therapy treatment program for your jaw dysfunction.

How to Find Care. If your physician or dentist has not already recommended a PT who specializes in TMD, call your local physical therapy clinic and ask if any of their PTs treat TMD. Even if the answer is no, they will typically know of a PT in your area that does treat jaw pain.

11. Vestibular Dysfunction

Vestibular Dysfunction primarily refers to feelings of dizziness, vertigo, or light-headedness that occurs due to a problem in the Vestibular System that is housed in the inner ear.

The most common of these conditions is called BPPV (Benign Paroxysmal Positional Vertigo) and is characterized by severe vertigo that lasts typically for 1 minute or less when you go from being vertical to lying down in bed. Most physical therapists feel comfortable performing the Epley Maneuver that addresses the source of this dysfunction.

For most other vestibular conditions, seeking treatment by a physical therapist who has further certification, coursework, or training is typically recommended.

How Can Physical Therapy Help? Dizziness and vertigo are often related to your eyes, vestibular system, and brain providing different opinions on how much you and your head are moving. When they disagree, this mismatch results in dizziness. Vestibular PT often involves exercises that put you and your head in different positions or uses different eye movements to help re-establish good communication with the eyes, the vestibular system, and the brain. Balance and coordination are also heavily intertwined in vestibular care and making sure that your dizziness does not increase your risk of falling will be a high priority.

How to Find Care. Contact your local PT clinic and see if they have a physical therapist who specializes in Vestibular PT. Even if the answer is no, they will typically know of a PT in your area that does treat Vestibular Disorders.

For further education on Vestibular Dysfunction, please visit:

Vestibular Disorders Association (VeDA)

12. Hand Therapy

Depending on where you live, dysfunction and pain at the hand will be treated by different providers. When I was in Southern California, hand therapy was provided almost exclusively by Occupational Therapists (a separate discipline from physical therapy). In Northern California and the state of Washington, hand pain may be treated by PTs or OTs.

Common Wrist/ Hand Conditions that an Outpatient Orthopedics PT May Treat:

1. Carpal Tunnel Syndrome
2. Hand Arthritis
3. 1st CMC (Thumb Arthritis)
4. Stiffness following Jamming a Finger
5. Stiffness following Splinting/ Fracture of a Finger

Physical Therapists and Occupational Therapists can opt to undergo highly intensive training and certification to become a CHT (Certified Hand Therapist). These individuals are incredibly intelligent and skilled when it comes to this complex and essential body part to our function.

Wrist/ Hand Conditions that May Be Better-Treated by a CHT or Hand Specialist:

1. Rehabilitation following Complex Surgeries, such as Flexor or Extensor Tendon Repairs
2. Orthotic/ Splint Fabrication
3. Tools/ Prosthetics for Injuries or Congenital Anomalies
4. Compression/ Crush Injuries
5. Neurological Conditions and Sensitivity Disorders

How Can Physical Therapy Help? Hand Therapy focuses on improving mobility, strength, dexterity, and coordination and decreasing pain and any hypersensitivity. Depending on the condition, splinting, orthotics, prosthetics, and training in use of tools may also be incorporated to help you achieve your highest function.

For more information regarding Hand Therapy and how you can find a Hand Therapist please visit:

American Society of Hand Therapists

Bringing It All Together

At the end of the day, if you are having difficult achieving anything in your life physically, there is probably a Physical Therapist or a Physical Therapy Specialty that exists to help.

If you are curious if physical therapy can help, call your local physical therapy clinic and ask if they have a physical therapist that can help you or knows someone who can help you achieve your goal(s)!

The answer is probably yes!

Get started now!

Resources:

1. Childs JD, Cleland JA, Elliott JM, et al. Neck Pain. J Orthop Sports Phys Ther. 2008;38(9):A1-34.