Physical therapy services include therapeutic interventions tailored to the specific needs of the patient. Such interventions include therapeutic exercise programs to increase strength and endurance, as well as application of various other modalities including, but not limited to, heat, cold, electrical stimulation, ultrasound, hydrotherapy, and massage or mobilization techniques. These services must be rendered under a written plan of care established by a physician or other qualified non-physician practitioner (e.g., physician assistant), and must be performed by a licensed physical therapist, or by assistive personnel under the supervision of a licensed physical therapist; if performed by assistive personnel, such services shall not exceed his or her education, training and/or licensure. To be considered medically necessary, these modalities must also be proven and accepted as effective and/or safe for the treatment of disease or injury.
Various types of treatment that do not generally require the skills of a licensed physical therapist include, but are not limited to:
- Passive range of motion (ROM) treatment, which is not related to restoration of a specific loss of function;
- Any of the following treatments when given alone or to a patient who presents no complications of disease, illness, or injury: hot packs, hydrocollator, infrared heat, whirlpool baths, paraffin baths, Hubbard tank, contrast baths.
A maintenance program consists of activities that preserve the patient’s present level of function and prevent regression of that function. Maintenance begins when:
- therapeutic goals of the treatment plan have been achieved, and/or when no additional functional progress is apparent or expected to occur; and/or
- maximum medical improvement has been achieved; and/or
- therapy fails to provide durable, condition-specific corrective benefit; and/or
- therapy is not reasonably expected to improve health status in a reasonable and predictable period of time; and/or
- therapy is not primarily to support continuance of the improvement achieved; and/or
- therapy is not primarily provided to prevent relapse.
Maintenance services typically do not require the services of a licensed physical therapist and include, but are not limited to:
- Repetitive exercise to improve gait, maintain strength and endurance, and assistive walking such as that provided in support for feeble or unstable patients;
- Range of motion and passive exercises that are not related to the restoration of a specific loss of function, but are useful in maintaining range of motion in paralyzed extremities;
- General exercise programs, even when recommended by a physical therapist.
Kinesiology does not diagnose or treat disease, but rather uses manual muscle testing (analysis which detects minor functional imbalances) to detect the root causes of illness and to assess ways to improve your health and well-being. Kinesiology uses massage, nutrition, and contact points to help with emotions and anxieties, specific personal dietary intake and supplements for nutritional deficiencies, structural imbalances, and energy blocks. Kinesiology is primarily preventive in that it is intended to balance the whole person, to enhance health and well-being, and to ward off disease.
Percussion hammer is a device that gives deep muscle massage with vibration and percussion of as much as 3000 pulses per minute.
Spray and Stretch Technique involves passively stretching the target muscle while simultaneously applying Fluori-Methane or “vapor coolant” spray topically. Spray and Stretch is thought to produce temporary anesthesia by lowering skin temperature, thereby allowing the muscle to be passively stretched toward normal length; this is done to help activate trigger points, relieve muscle spasm, and reduce referred pain.
Fluidotherapy is a form of dry, convective heating that uses pulverized organic materials that are suspended and circulated in a heated air stream.
Intermittent motorized traction and intersegmental traction are methods of mechanical massage and spinal mobilization of soft tissue. This is done using a specialized bench table that has roller-type cams beneath the surface. The rollers slowly travel the length of the spine, stretching spinal joints.
Craniosacral therapy (CST) is a type of gentle manipulation and light-touch therapy involving the bones and soft tissues of the head, spine, and pelvis. Practitioners assert CST reestablishes the normal flow of fluids, particularly cerebrospinal fluid, and thus restores health; no significant clinical trials have tested these assertions. CST has been used to treat a variety of disorders, including pain, injuries, and fatigue, as well as to reduce tension and increase general well-being and health.
Diathermy is a form of heat therapy in which high-frequency electrical currents are used to heat deep muscular tissues. Heat accelerates tissue repair by increasing local blood flow and speeding up cellular metabolism, relieves stiffness by helping tissues to relax and stretch, and increases the patient’s pain threshold by reducing nerve fiber sensitivity. There are several types of diathermy. In shortwave diathermy, the body part to be treated is placed between two capacitor plates and heat is generated as high-frequency electrical current travels through the body tissue between the plates. Ultrasound diathermy uses high-frequency acoustic vibrations to generate heat in deep tissue. Microwave diathermy uses radar waves to heat tissue, but these cannot penetrate deep tissue. Other types of diathermy can be used to kill abnormal growths, such as warts and tumors, and to help control bleeding in surgical procedures. .
There are two types of lasers: high power and low power. High power lasers give off heat and are used to cut through tissue. Low power lasers, or LLLT, do not give off heat. LLLT produces beams of red light that can penetrate the surface of the skin and provide topical heating through photochemical processes in the cells. LLLT is used for a variety of purposes. When used for cessation of smoking, LLLT works along the same principle as acupuncture, and is sometimes called laser acupuncture. This consists of a low-level laser beam to specific points of the body, which is said to control withdrawal symptoms by stimulating release of endorphins.
Neurostructural integration therapy is a non-invasive type of soft tissue bodywork therapy that is used for a wide range of conditions from acute pain to chronic conditions. In theory, neurostructural integration therapy causes deep relaxation, allowing the musculature of the body to ‘reorganize’ itself via natural activation of various neural reflexes, which is thought to provide lasting relief from pain and dysfunction while increasing energy levels.
A hydrocollator is a heating unit that provides a supply of temperature-consistent hot packs.
A hydrotherapy bed is a type of water bed that has strategically located spa jets. The jets create water pulsation that heats and massages the patient’s back when he is lying on the bed. This has been used as a substitute for hot packs and massage.