Physiotherapy

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Physiotherapy

Topic Overview

What is physiotherapy?

Physiotherapy is a type of treatment you may need when health problems make it hard to move around and do everyday tasks. It helps you move better and may relieve pain. It also helps improve or restore your physical function and your fitness level.

The goal of physiotherapy is to make daily tasks and activities easier. For example, it may help with walking, going up stairs, or getting in and out of bed.

Physiotherapy can help with recovery after some surgeries. Your doctor may suggest physiotherapy for injuries or long-term health problems such as:

Physiotherapy may be used alone or with other treatments.

You may get physiotherapy at:

  • A clinic.
  • A hospital.
  • A nursing home.
  • Your own home, through home health agencies.
  • School.
  • A sports or fitness setting.

What does a physiotherapist do?

Your physiotherapist will examine you and make a treatment plan. Depending on your health problem, your therapist will help you with flexibility, strength, endurance, coordination, and/or balance.

First, your therapist will try to reduce your pain and swelling. Then he or she will probably work to increase your flexibility, strength, and endurance.

Physiotherapy almost always includes exercise. It can include stretching, core exercises, weight lifting, and walking. Your physiotherapist may teach you an exercise program so you can do it at home.

Your physiotherapist also may use manual therapy, education, and techniques such as heat, cold, water, ultrasound, and electrical stimulation.

Treatment may cause mild soreness or swelling. This is normal, but talk to your physiotherapist if it bothers you.

What should you look for in a physiotherapist?

You'll want a therapist who has experience with your health problem. Some physiotherapist are board-certified in areas such as orthopedics, sports, geriatrics, and neurology and may offer more specialized care. Physiotherapists can specialize in:

  • Muscles, joints, tendons, ligaments, and bones.
  • Nerves and related muscles.
  • The heart and blood vessels.
  • Lung problems and breathing.
  • Skin problems, including wounds and burns.
  • Cancer-related problems.
  • Treatment for children, older adults, or women.

Here are some questions to think about when choosing a physiotherapist:

  • Can your doctor suggest one?
  • Do you need a referral from your doctor? Some provinces and private insurance companies require this.
  • Will your provincial health plan or private insurance company pay for your physiotherapy?

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Types of Physiotherapy

Exercise

Exercise is anything you do in addition to your regular daily activity that will improve your flexibility, strength, coordination, or endurance. It even includes changing how you do your regular activities to give you some health benefits. For example, if you park a little farther away from the door of the grocery store, the extra distance you walk is exercise. Physiotherapy nearly always involves exercise of some kind that is specifically designed for your injury, illness, condition, or to help prevent future health problems. Exercise can include stretching to reduce stress on joints, core stability exercises to strengthen the muscles of your trunk (your back and abdomen) and hips, lifting weights to strengthen muscles, walking, doing water aerobics, and many other forms of activity. Your physiotherapist is likely to teach you how to do an exercise program on your own at home so you can continue to work toward your fitness goals and prevent future problems.

Click here to view an Actionset. Fitness: Increasing Core Stability

Manual therapy

Manual therapy is a general term for treatment performed with the hands and not with any other devices or machines. The goals of manual therapy include relaxation, less pain, and more flexibility. Manual therapy includes:

  • Massage, which applies pressure to the soft tissues of the body such as the muscles. Massage can help relax muscles, improve circulation, and ease pain in the soft tissues.
  • Mobilization, which uses slow, measured movements to twist, pull, or push bones and joints into position. This can help loosen tight tissues around a joint and help with flexibility and alignment.
  • Manipulation, which uses rapid, forceful movements to position the bones and joints. This is a more aggressive treatment. Discuss the pros and cons of manipulation with your doctor or physiotherapist.

Education

Physiotherapy almost always includes education and training in areas such as:

  • Performing your daily tasks safely.
  • Protecting your joints and avoiding reinjury.
  • Using assistive devices such as crutches or wheelchairs.
  • Doing home exercises designed to help with your injury or condition.
  • Making your home safe for you if you have strength, balance, or vision problems.

Specialized treatments

In some locations, physiotherapists are specially trained to be involved in other types of treatment, including:

  • Vestibular rehabilitation, which helps your inner ear respond to changes in your body position. This is helpful if you have problems with vertigo, or a feeling that you or your surroundings are spinning or tilting when there is actually no movement. Rehabilitation (rehab) can help you get used to the problem so you know when to expect it. And rehab can train your body to know how to react.
  • Wound care. Wounds that are very severe or don't heal well, often because of poor blood flow to the area, can require extensive care. This may include special cleaning and bandaging on a regular and long-term basis. Sometimes oxygen treatment or electrical stimulation is part of the treatment.
  • Women's health. Physiotherapists often work with women on exercises to help control urinary incontinence or to relieve pelvic pain.
  • Oncology (cancer care), to help if cancer or treatment for cancer causes you to have problems with movement.
  • Decongestive lymphatic drainage, which is a special form of massage to help reduce swelling when the lymphatic system is not properly draining fluids from your tissues.

Cold and ice

Ice and cold packs are used in physiotherapy to relieve pain, swelling, and inflammation from injuries and other conditions such as arthritis. Ice can be used for 10 to 20 minutes at a time. In some cases, ice may be used several times a day. Some therapists also use cooling lotions or sprays. For more information, see:

Heat

Heat can help relax and heal your muscles and soft tissues by increasing blood circulation. This can be especially helpful if a joint is stiff from osteoarthritis or from being immobilized. Heat can also relax the muscles before exercise. But heat can also increase swelling in an injured area if it is used too soon. For more information, see:

Hydrotherapy

Hydrotherapy is the use of water to treat a disease or to maintain health. The term "hydrotherapy" (water therapy) can mean either exercise in the water or using water for care and healing of soft tissues. This type of therapy is based on the theory that water has many properties that give it the ability to heal.

  • Water can store and carry heat.
  • Water is found in different forms, such as ice, liquid, or steam. Ice may be used to cool, liquid is used in baths and compresses at varying pressures or temperatures, and steam is used in steam baths or for breathing in.
  • Water can help blood flow.
  • Water also has a soothing, calming, and relaxing effect on people, whether in a bath, shower, spray, or compress.
  • Exercise in water takes the weight off a painful joint while also providing resistance.

For more information, see Hydrotherapy.

Ultrasound

Ultrasound therapy uses high-pitched sound waves to ease muscle spasms and relax and warm muscles before exercise, to help relieve pain and inflammation, and to promote healing. Although the use of ultrasound is common, some studies show a benefit from this treatment and others do not. Some physiotherapists do not recommend deep-heating techniques. Discuss the benefits and risks with your physiotherapist or doctor before starting this therapy. This type of treatment is not generally used for children.

Electrical stimulation

Electrical stimulation is the general term that describes the use of electrical current to create an effect in the body. There are several uses for electrical stimulation.

  • Physiotherapists sometimes use electrical stimulation at low levels to reduce the sensation of pain. It may work either by "scrambling" pain signals to mask feelings of pain or by causing the body to produce natural pain-killers called endorphins.
  • Physiotherapists can also use electrical stimulation to cause muscles to contract (tense). This type of therapy can help maintain muscle tone when muscles would otherwise lose strength or help teach muscles to contract again. Examples of this type of therapy include:
    • Electrical stimulation after a stroke to keep some tone in the shoulder muscles so they hold the joint together better and prevent pain.
    • Electrical stimulation to keep leg strength in a person who has severe arthritis of the knee and whose pain increases with exercise.
    • Electrical stimulation to get muscles at the front of the thigh working in the proper order after knee surgery.
  • Electrical stimulation is being studied as a way to help with healing of wounds and broken bones.

What to Expect at a Physiotherapy Visit

At your first physiotherapy visit, your physiotherapist will review your medical history and do a physical evaluation. Depending on your diagnosis or symptoms, your therapist may evaluate your flexibility, strength, balance, coordination, posture, and/or heart rate and respiration. Your therapist may look at how you walk or get up from lying down (functional activities), along with how you use and position your body as you perform activities (body mechanics). The therapist will work with you to decide on your goals for physiotherapy and to begin planning your treatment. You may or may not begin your actual therapy at the first visit.

In general, the first goal of treatment is to decrease any pain and swelling you may have. The next steps usually are to increase your flexibility and then to increase your strength and endurance, depending on your condition. The goal is always to improve your ability to do your daily tasks and activities. As with any exercise, you may have mild soreness or swelling as a result of treatment, and these should be noted by your therapist. Your therapist will watch your reaction to treatment (for example, if you have swelling or become out of breath) and will adjust your treatment as needed. This ongoing assessment and adjustment means that the risk of any injury or complication from physiotherapy is very low.

Your physiotherapist will evaluate your need for special equipment such as particular footwear, splints, or crutches. If you need equipment, your therapist can help you know what to get and either get it for you or tell you where you can find it.

In most cases, part of your physiotherapy will be education. Your therapist may teach you about a home exercise program, proper body mechanics, and the use of any special equipment you may need. He or she will then periodically check on how well you are transferring the skills you learn in therapy to your daily life.

Your physiotherapist will continually reassess your progress toward your treatment goals. He or she will work with you and your doctors to plan for your discharge from physiotherapy.

When Physiotherapy Can Help

Physiotherapy and recovery from injury

Physiotherapy can help you recover from an injury and avoid future injury by reducing pain in the soft tissues (muscles, tendons, and ligaments), improving flexibility and function, and building muscle strength. Your physiotherapist can also evaluate how you do an activity and make suggestions for doing the activity in a way that is less likely to result in an injury. Following are examples of injuries for which physiotherapy is helpful:

Physiotherapy and chronic health conditions

Physiotherapy can help you live more easily with chronic or ongoing health conditions. Your physiotherapist will work with you to establish your goals, then create a program of educational, range-of-motion, strengthening, and endurance activities to meet your needs. Here are some examples of chronic conditions that may be helped by physiotherapy:

Physiotherapy and health conditions requiring a rehabilitation team approach

Some conditions involve several body systems and can lead to significant disability. These conditions—such as stroke, brain injury, spinal cord injury, and major cardiopulmonary (heart and lung) problems—are usually addressed by a team of health professionals. The team can include doctors; nurses; physical, occupational, and speech therapists; psychologists; and social workers, among others. Physiotherapists are a critical part of this team. They address the issues of range of motion, strength, endurance, mobility (walking, going up and down stairs, getting in and out of a bed or chair), and safety. The physiotherapist may also get you the equipment you need, such as a walker or wheelchair, and make sure you can use the equipment appropriately. Following are some examples of health conditions that commonly involve a rehabilitation team:

Physiotherapy and significant health conditions of childhood

Physiotherapists also work with children who have major injuries or health conditions. They address the usual issues of range of motion, strength, endurance, and mobility. Also, the therapist considers the child's special growth and developmental needs.

Treatment is often provided in the school or in a facility just for children. The way physiotherapy and other services are delivered in the schools varies among the provinces. Talk to your child's doctor, school, or your local health unit if you think your child may qualify for evaluation or treatment services.

Cerebral palsy is an example of a childhood health condition that is usually addressed in part by physiotherapy. Other injuries and conditions include brain injury, muscular dystrophy, and arthritis.

Other Places To Get Help

Organizations

Canadian Association of Occupational Therapists (CAOT)
CTTC Building, Suite 3400, 1125 Colonel By Drive
Ottawa, ON  K1S 5R1
Phone: (613) 523-2268
1-800-434-2268 (toll-free from Canada and continental U.S.)
Fax: (613) 523-2552
Web Address: http://www.caot.ca/

Canadian Centre for Occupational Health and Safety (CCOHS)
135 Hunter Street East
Hamilton, ON  L8N 1M5
Phone: 1-800-263-8466
(905) 572-2981
Fax: (905) 572-2206
Web Address: www.ccohs.ca
 

The Canadian Centre for Occupational Health and Safety (CCOHS) promotes a safe and healthy working environment by providing information and advice about occupational health and safety.


Canadian Physiotherapy Association
2345 Yonge Street
Suite 410
Toronto, ON  M4P 2E5
Phone: (416) 932-1888
1-800-387-8679
Fax: (416) 932-9708
Email: information@physiotherapy.ca
Web Address: http://www.physiotherapy.ca

References

Other Works Consulted

  • American Physical Therapy Association (2009). Criteria for standards of practice for physical therapy. Available online: http://www.apta.org/AM/Template.cfm?Section=Home&Template=/CM/ContentDisplay.cfm&ContentID=68019.
  • American Physical Therapy Association (2010). Who are physical therapists (PTs)? Available online: http://www.apta.org/AM/Template.cfm?Section=About_Physical_Therapy&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=76986.
  • Basford JR (2005). Therapeutic physical agents. In JA DeLisa et al., eds., Physical Medicine and Rehabilitation: Principles and Practice, 4th ed., vol. 1, pp. 251–270. Philadelphia: Lippincott Williams and Wilkins.
  • Becker BE, Cole AJ (2005). Aquatic rehabilitation. In JA DeLisa et al., eds., Physical Medicine and Rehabilitation: Principles and Practice, 4th ed., vol. 1, pp. 479–492. Philadelphia: Lippincott Williams and Wilkins.
  • Cotter AC, et al. (2005). Complementary and alternative medicine. In JA DeLisa et al., eds., Physical Medicine and Rehabilitation: Principles and Practice, 4th ed., vol. 1, pp. 465–478. Philadelphia: Lippincott Williams and Wilkins.
  • Malanga GA, et al. (2005). Sports medicine. In JA DeLisa et al., eds., Physical Medicine and Rehabilitation: Principles and Practice, 4th ed., vol. 1, pp. 557–575. Philadelphia: Lippincott Williams and Wilkins.
  • O'Connor K (2005). Pressure ulcers. In JA DeLisa et al., eds., Physical Medicine and Rehabilitation: Principles and Practice, 4th ed., vol. 2, pp. 1605–1618. Philadelphia: Lippincott Williams and Wilkins.
  • Pape KE, Chipman ML (2005). Electrotherapy in rehabilitation. In JA DeLisa et al., eds., Physical Medicine and Rehabilitation: Principles and Practice, 4th ed., vol. 1, pp. 435–463. Philadelphia: Lippincott Williams and Wilkins.
  • Parikh SS, Bid CV (2005). Vestibular rehabilitation. In JA DeLisa et al., eds., Physical Medicine and Rehabilitation: Principles and Practice, 4th ed., vol. 1, pp. 957–974. Philadelphia: Lippincott Williams and Wilkins.
  • U.S. Department of Labor, Bureau of Labor Statistics (2009). Physical therapists. Occupational Outlook Handbook, 2010–11 Edition. Available online: http://www.bls.gov/oco/ocos080.htm.
  • Weiting JM, et al. (2005). Manipulation, massage and traction. In JA DeLisa et al., eds., Physical Medicine and Rehabilitation: Principles and Practice, 4th ed., vol. 1, pp. 285–309. Philadelphia: Lippincott Williams and Wilkins.

Credits

By Healthwise Staff
Primary Medical Reviewer Adam Husney, MD, MD - Family Medicine
Primary Medical Reviewer Andrew Swan, MD, CCFP, FCFP - Family Medicine
Specialist Medical Reviewer David A. Fleckenstein, PT, MPT - Physical Therapy
Last Revised April 22, 2011

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information.