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.
Gyrotonic machines are thought to increase range of motion and develop coordination by working major muscle groups interdependently and in an integrated manner. The Gyrotonic Pulley Tower Combination Unit was the first piece of Gyrotonic Equipment to be sold to the public. Since then other equipment has been developed, including: the Jumping Stretching Board, the Archway, the Leg Extension Unit, and the GYROTONER®. Each piece of equipment has it's own unique features, and functions, providing an extensive range of exercise options. These pieces of equipment are not part of a physical therapy program. (24)
Kinesio Tape (KT) is a specialized, thin, elastic tape that can be stretched up to 120%~140% of its original length, making it quite elastic compared with conventional taping. Kinesio taping differs from conventional taping and/or strapping in that instead of providing support, the purpose of kinesio taping is to assist with partial to full range of motion by applying pulling forces to the skin over the targeted muscles. (25) KT is air permeable and water resistant and can remain in place over several days.
The Pettibon System is described as follows. “In The Pettibon System, exercises are performed to decrease hysteresis in these tissues using the Wobble Chair™ and the Pettibon Repetitive Cervical Traction™. From a clinical standpoint, the exercises are performed at the beginning of a patient visit prior to manipulative intervention. This reduces the overall resistance of the soft tissues to the manipulative force, thus allowing that force to assume a more corrective role. Once the manipulative techniques are administered, the patient then wears the Pettibon Weighting System while the soft tissue is less resistant. Therefore, in The Pettibon System, all of the components of the spine are corrected and rehabilitated as a unit, using rehabilitative procedures designed to target each type of tissue specifically. Finally, another type of isometric exercise is used to rehabilitate normal spine alignment. Pettibon has slightly modified the performance of these exercises by creating the Linked Exercise Trainer™ on which they are performed...Areas of muscle imbalance can therefore be isolated and strengthened using the Linked Exercise Trainer, thus reinforcing corrective spinal changes.” (26) One of the uses of the Pettibon System is to correct scoliosis.