Introduction: Physical Therapy Intervention

Introduction to Physical Therapy Intervention

• This unit focuses on the principles of therapeutic exercise and manual therapy relevant to orthopedic physical therapy practice.

Overview of Therapeutic Exercise and Manual Therapy

• The application of therapeutic exercise and manual therapy is based on:

  • Patient's clinical presentation

  • Stage of tissue healing

Manual Therapy Intervention

• Concepts discussed include:

  • Manipulation grades

  • Mechanical effects

  • Neurophysiological effects

  • Psychological effects of manual therapy

• Contraindications to Manual Therapy:

  • Situations where manual therapy should not be applied.

Exercise Prescription Principles

• Principles of exercise prescription covered include:

  • Specific Adaptation to Imposed Demands (SAID) principle

  • FITTVP Principle: Frequency, Intensity, Time, Type, Volume, and Progression

Foundations for Intervention

• The Guide to Physical Therapy Practice defines intervention as:

  • Purposeful interactions between the physical therapist and assistant with patients.

• Eight distinct intervention categories, two of which are:

  • Manual therapy

  • Therapeutic exercise

Considerations for Interventions

• When selecting interventions, considerations include:

  • Patient's level of tissue irritability

  • Time since injury

  • Psychosocial yellow flags

• Desired outcomes of the intervention may include:

  • Returning to specific functional activities

  • Reducing impairments to body function

  • Promoting optimal health

  • Reducing environmental challenges

Problem-Oriented Approach

• Dutton suggests the use of a problem-oriented approach:

  • Consider specific functional needs of the patient

  • Establish mutually agreed-upon rehabilitation goals

• Shared decision-making is vital:

  • Collaboration with the patient assists in choosing interventions.

Understanding the Clinical Problem

• Physical therapist must adequately understand:

  • Current tissue injury cycle (inflammatory, proliferative, maturation phases)

  • Movement characteristics needed for desired functional activities.

Clinical Presentation and Intervention Strategies

Acute Presentation

• In acute cases, focus is on tissue irritability and healing times.

  • Example: An acute ligament injury two weeks ago indicates a proliferative phase with high tissue irritability.

Contemporary Care Approach

• Move from traditional RICE to POLICE, which stands for:

  • Protection

  • Optimal loading

  • Ice

  • Compression

  • Elevation

Treatment Strategies

• Protection means avoiding painful movements while facilitating safe movement and loading of tissues.

  • Educate patients on performing partial active range of motion within tolerance instead of immobilization.

• As pain-free ranges of motion increase, manual therapy and therapeutic exercises can be progressed.

Tissue Healing Process

Phases of Healing

• Newly laid collagen must be protected and oriented properly:

  • Adequate tensile loading is necessary to ensure proper collagen alignment (e.g., heel tendon).

• Exercise prescription must optimize healing and facilitate movement return.

Manual Therapy Considerations

• Controlled stress should be applied to healing tissues via:

  • Joint-specific mobilizations

  • Soft tissue mobilizations

  • Gentle contract-relax techniques

• Important to monitor amounts and direction of force applied during treatment.

Progress to Remodeling Phase

• Goals shift to:

  • Restoring full range of motion

  • Enhancing muscle performance parameters such as strength, endurance, power, and speed

• Focus on task-oriented approach for future exercises, including:

  • Strength requirements

  • Speed and movement directions

  • Environmental considerations

Final Phases of Rehabilitation

Manual Therapy and Therapeutic Exercise Goals

• Additional manual therapy should focus on:

  • Restoring full accessory motion

  • Implementing passive stretching and myofascial release techniques where needed

Early Phases of Rehabilitation

• Manual therapy and therapeutic exercises should promote modified movement in injured tissues to:

  • Enhance fibroblastic activity

  • Remove edema or effusion

Proliferative Phase Interventions

• Interventions can focus on nuanced loading of healing tissues to:

  • Align collagen fibers parallel to surrounding fibers

  • Enhance overall tissue health and strength

Final Phase Interventions

• Therapeutic exercises and manual therapy emphasize:

  • Mobility, balance, endurance, strength, and power necessary for specific functional activities

  • These factors must align with the initially identified PT goals.