Physical Therapy

Physical therapy helps people move better. It includes several types of exercise, transfer training, walking (gait) training, and techniques that make movement safer or easier. It aims to increase endurance, make joints less stiff, strengthen muscles, reduce pain, and improve coordination and balance. Techniques to treat pain and inflammation are also used. Physical therapists work closely with occupational therapists.

Aerobic exercise: Aerobic exercise strengthens the heart and lungs and helps increase endurance. As endurance increases, any physical activity becomes less tiring. Walking, bicycling, and swimming are aerobic exercises. Consulting with a doctor before starting an aerobic exercise program may be important, especially for people who have had a heart or lung disorder or who have been very inactive.

Range-of-motion exercises: Moving joints through their range of motion helps make muscles and joints less stiff. Inactivity for several days (for example, after a stroke or surgery) makes the muscles around joints stiff. So joints may become less flexible. That is, their range of motion may become limited. Limited range of motion can cause pain, and the person cannot function as well. Range-of-motion exercises can help the person do daily activities.

Before range-of-motion exercises are started, physical therapists evaluate the person's range of motion with an instrument that measures angles of joint motion (goniometer). If flexibility or range of motion is extremely limited, surgery or special casts are sometimes needed before range of motion can be improved.

Range-of-motion exercises may be passive (in which a therapist moves the joint), active-assistive (in which the person needs some help moving the joint), or active (in which the person moves the joint without any help). During passive or active-assistive range-of-motion exercises, therapists move the joint gently to avoid injury, although some discomfort may be unavoidable. For improvement to occur, a joint with limited range of motion must be moved far enough to cause some discomfort. A person may begin with passive or active-assistive exercise and, as strength increases, move to active exercise.

Muscle-strengthening exercises: To make a muscle stronger, a person must exercise against resistance that is gradually increased. When a muscle is very weak, no extra resistance is needed. The force of gravity provides enough. As a muscle becomes stronger, resistance is gradually increased with elastic bands or weights. This type of exercise also increases muscle size (mass) and endurance.

The two main types of muscle-strengthening exercises are isotonic and isometric. Isotonic exercises involve contracting a muscle to move a joint. Isometric exercises involve contracting a muscle without moving a joint. Isometric exercises can be done in bed, for example after hip or knee surgery.

Coordination exercises: Exercises to improve coordination involve repeating a movement that works more than one joint and muscle. Examples are picking up an object or touching a body part. Such exercises are often used for people who have had a stroke.

Balance exercises: Exercises can improve the ability to maintain balance while standing, sitting, and moving. Standing on one leg is an example. Tai chi may be used to improve balance. Exercises that improve strength and coordination may also help with balance.

Transfer training: Some people need to learn a safe way to move (transfer) from one place to another—for example, from a bed to a chair (or wheelchair) or from a chair to a toilet. The need may be temporary (until the ability to walk is recovered) or permanent.

Different techniques are used in transfer training depending on whether the person can bear weight on one or both legs, has good balance, or is paralyzed on one side of the body. Special devices, such as a chair with a raised seat, can sometimes help. Some people cannot transfer by themselves. They can learn how to help another person help them transfer. They may need to wear a special cloth strap around the waist called a gait belt. A therapist or a caregiver trained to use the belt can grasp it securely and thus help people transfer safely. A transfer board can be used as a bridge to slide across from wheelchair to bed, toilet, or bathtub seat. These boards are light-weight planks of smooth wood or plastic. Mechanical lifts may be used by a caregiver to help with transferring. Therapists teach caregivers how to help with transferring.

Gait training: This training improves the ability to walk, with or without help. Before starting gait training, some people need to do exercises that improve strength, range of motion, balance, and coordination. Gait training may be needed after bed rest, a stroke, or the amputation of a leg. A gait belt may also be used during gait training to help prevent falls.

After walking safely on a level surface, the person may be taught to step over curbs or climb stairs. For going up stairs, the stronger or uninjured leg goes first. For going down stairs, the weaker or injured leg goes first. The phrase "good is up, bad is down" can help people remember. If possible, the person should go up and down the stairs with the railing on the uninjured side.

Some people require an assistive device for walking. If a joint does not support weight and buckles readily, a leg or an ankle brace is needed. If the legs are weak or balance is a problem, a cane or walker can be used.

See the figure Choosing and Using a Cane.

Crutches are seldom recommended for older people because their arms may not be strong enough to use crutches safely. Even when used correctly, crutches can make arthritis in the shoulders worse.

See the figure Choosing and Using a Walker.

If people cannot walk with a cane or walker, a wheelchair or scooter can help them stay active. A wheelchair or scooter may be needed all the time or only for long distances. Wheelchairs come in many varieties. Choosing the most suitable one, getting one that fits properly, and learning how to use it correctly are important for safety and comfort.

See the sidebar Wheelchairs and Scooters.

Tilt table: Some older people need therapy for dizziness due to an excessive fall in blood pressure that occurs when they stand (orthostatic hypotension). A tilt table is commonly used for this purpose. For the procedure, a person lies face up on a padded table with a footboard and is held in place with safety belts. The table is tilted very slowly until the person is nearly upright. How long the position is held and how often the procedure is repeated depend on the person's response.

Electrical stimulation: Sometimes muscles do not function normally because nerves are damaged. Such muscles can be stimulated electrically to help prevent them from wasting away (atrophying). An electrical current is transmitted through electrodes placed on the skin. The current stimulates the muscle to contract automatically. Electrical stimulation may help prevent muscle wasting in people who are paralyzed (for example, after a stroke or an accident).

Another type of electrical stimulation, called transcutaneous electrical nerve stimulation (TENS), is used to treat certain kinds of pain. TENS uses a gentle oscillating current. TENS produces a tingling sensation without increasing muscle tension. TENS may be applied through electrodes attached to the skin or through a hand-held device. It may be applied several times a day for 20 minutes to several hours. The timing and length of stimulation vary because each person responds differently. Often, people are taught to use the TENS device at home, so that they can use it as needed.