The Four Stages Of A Physical Therapy Program

Sunday, February 17, 2002 | 0

By Steven Danchik, MA, RPT

The primary goal of physical therapy should always be the restoration of function. Purpose and direction are necessary for effective treatment. There are four general stages of an effective physical therapy program. This article will discuss the first two, and the following article will discuss the last two.

While this pattern is one I often use in constructing a treatment plan, please remember, there are unlimited combinations, permutations and philosophies of treatment.

The initial visit in a physical therapy program is an evaluation by a Registered Physical Therapist and a requirement of the State of California. At this initial assessment, a baseline is created to which the therapist can compare a patient's progress. This is also the juncture at which the science and art of physical therapy combine to personalize a patient's program.

STAGE I Pain Control

Patients come with acute or chronic symptoms, or with an exacerbation of a pre-existing condition. Controlling the pain may require treating accompanying problems such as swelling and inflammation. Pain management is often woven into the fabric of the therapy, as the symptoms ebb and flow during the course of rehabilitation.

Modalities are often used during this stage of treatment utilizing the principles of heat, cold, electricity, sound waves, polarity, physics and chemistry to address the patient's condition. Posture and positioning are critical components. Teaching a patient to utilize pain free positioning can help him at home or at work between therapy sessions.

STAGE II Initiation of Movement

The patient now starts a series of mild exercises to help restore joint function. These exercises will be a combination of passive, active assisted, active and mild resistive.

Joint mobilization and manual therapy techniques may be initiated by the therapist. These are hands-on techniques requiring advanced training and experience. Soft tissue mobilization and myofascial release may also be utilized.

Posture continues to be taught and reinforced. This is beneficial for patients with spine problems, and can help those with extremity involvement.

Muscle re-education using electrical stimulation and biofeedback are other options which may be implemented. Some patients require special taping techniques to normalize anatomy, unload stressed tissues, or provide additional support to injured areas.

My next article will address restoration of function, and advanced strengthening and conditioning.

Steven Danchik, MA, RPT, is a registered physical therapist who has been providing physical therapy to injured workers for over 20 years with offices in Los Angeles, Beverly Hills, Valencia and Van Nuys. Search for him under