General Info
Article written by Kathy Wasowski, PT, OCS Board Certified Orthopedic Specialist
Orthopedic physical therapy focuses on the assessment and treatment of injuries and disorders of the neuromusculoskeletal system, and prevention of further injuries. The neuromusculo- skeletal system is composed of muscles, bones, and the tendons that connect them together, joints and the ligaments that connect them, and the peripheral nervous system that makes the muscles function. Orthopedic physical therapy is most commonly thought of for outpatient clinics (private practices/hospital outpatient), but it is also involved in the rehabilitation of injuries such as a fractured (broken) hip while still in the hospital. Subspecialty areas such as industrial rehabilitation for injured workers, sports rehabilitation, job site evaluations for ergonomic modifications of work stations to better fit the employee, and treatment of chronic pain syndromes are also part of orthopedic physical therapy. Orthopedic PT is the type of physical therapy the average person is likely to be involved with for a sprained back or knee surgery.
Orthopedic physical therapy would probably be beneficial to patients with the following diagnoses as well as many other bone/joint/muscle problems:
Neck and/or Low back pain/sprain/strain
- Spinal disc disease and sciatica
- Shoulder injuries including rotator cuff tear and frozen shoulder
- Knee problems including ligament and cartilage (meniscus) injuries
- Repetitive motion injuries such as tendinitis, carpal tunnel syndrome, tennis elbow
- Foot/ankle pain
- After most orthopedic surgeries for the spine/arms/legs for rehabilitation of stiffness and weakness
- Arthritis (rheumatoid arthritis/osteoarthritis/and other collagen diseases)
- After fractures (including 'pinning') and artificial joint replacement surgeries
- Fibromyalgia and other problems with chronic pain.
- Most athletic injuries
- Orthopedic problems due to pregnancy
- Headaches, TMJ and facial pain
All therapy begins with an initial evaluation (assessment) to determine which structure is the most affected and to plan what would be the most effective treatment for this particular injury and patient.
Physical therapy treatment for an orthopedic problem might include some of the following based on the therapist's assessment of the best treatment plan for this patient's specific problem and what the physician has ordered:
Physical modalities including heat/cold, ultrasound, electric stimulation, warm paraffin, compression pumps, traction are often used to decreased pain, muscle spasm and swelling, and improve motion.
Gait training may be performed to instruct the patient in a more normal walking pattern, or to instruct the patient in use of a walker, cane, or crutches.Instruction in posture and body mechanics/ergonomics modifications (how you move most effectively) for reduction of stress on the body is a frequent component of PT. For low back pain, learning to pick up heavy objects correctly, or how to rearrange your desk setup and position yourself to reduce carpal tunnel/tendinitis problems can make a major difference in pain levels even without other interventions. Another type of body mechanics modification may be taught to an athlete to show them a change in their golf stroke so their back won't hurt, or how to pitch to help avoid rotator cuff surgery without losing speed or even instructing a musician how to hold their instrument differently to decrease pain in their hands.
Exercise of various types is an extremely important component of orthopedic PT to help stretch tight joints and muscles, strengthen weak muscles and improve functional use and endurance of the affected body part as well as general conditioning. This will involve exercises in the clinic with or without resistance with a wide variety of high and low tech equipment, as well as instruction in how to safely exercise at home or in the gym to continue progressing.
Another important part of a home program for patients experiencing longstanding pain is instruction in self treatment techniques such as self acupressure and triggerpoint massage, positions and exercises that relax muscle spasm at home, and specific relaxation and breathing techniques. Biofeedback may also be part of a PT program to help with muscle relaxation or strengthening.
Most orthopedic physical therapists go to continuing education classes to upgrade their hands on skills in orthopedic manual therapy. Many people typically think of general massage as being the main hands on technique in therapy, but most therapists are trained to do much more specific treatment to work on tight joints in the spine and extremities (joint mobilization) and soft tissues including muscles/tendons and fascia (soft tissue mobilization). Joint mobilization is the skilled movement of a joint in a specific direction and amount of pressure to improve joint mobility which will help with function and pain. Soft tissue mobilization does the same thing for tight muscles also focusing very specifically on the area of restriction. It involves a wide variety of techniques including myofascial release, strain/counterstrain, trigger point/acupressure and many others with different pressures/length of holding time to 'loosen' tight muscles and surrounding structures which helps with joint mobility, spasm, pain and ability to function more normally.
We cannot "fix" everything. There are some conditions that have gone on so long or are so severe, that the permanent damage cannot be completely undone. In general, most patients benefit from therapy. Many times by improving the motion available, improving strength and flexibility of the muscles around the joint, teaching coping skills on how to protect the area from further irritation by modifying how you move, this is enough to give significant relief and improve functional level in everyday activities, even in conditions like arthritis, or degenerative disc disease where there is damage.