Orthopedic physical therapy can be life-changing. A skilled physical therapist (PT) can get you back on track with your daily activities after surgery, an injury, accident, or illness.
That’s because an orthopedic PT specializes in diagnosing and treating conditions that affect any part of your musculoskeletal system.
An orthopedic PT works to integrate all your other bodily systems — especially your neurological and cardiovascular systems — with your musculoskeletal system to treat your injury or condition appropriately.
In this article, we’ll take a closer look at what orthopedic physical therapy is, when you may need it, and the types of treatments it includes.
Orthopedic physical therapy involves the care of your entire musculoskeletal system, which includes your:
- ligaments and tendons
- connective tissue
A PT who specializes in orthopedics can evaluate your condition and diagnose the issue or condition you have. This will include:
- determining the appropriate movement diagnosis
- creating a treatment plan
- administering therapeutic care
- educating you about how to manage your current injury or condition to prevent further injury
Orthopedic physical therapy is provided in outpatient clinics, hospitals, skilled nursing facilities, sports facilities, and even in your home.
The entry-level degree for a PT these days is a clinical doctorate. So when you go to work with a PT, you’re working with a doctor of physical therapy, who has completed three years of graduate school studies.
“Orthopedic physical therapists treat almost any condition that affects your ability to move or function physically in your daily life,” said Steve Vighetti, a fellow of the American Academy of Manual Orthopedic Physical Therapists.
Let’s look at some of the most common conditions and issues that are treated by orthopedic PTs.
Conditions affecting the musculoskeletal system
Orthopedic physical therapy can be a primary or complementary treatment option for the following types of musculoskeletal conditions:
- frozen shoulder
- knee instability
- joint pain
- limited range of motion
- lower back pain
- Lyme disease
- muscular dystrophy
- Parkinson’s disease
- plantar fasciitis
- spinal stenosis
Some PTs specialize in treating specific patient populations.
A sports PT, for example, can help athletes move safely in an effort to prevent injuries. They can also help athletes recover from sports-related injuries.
A PT who works primarily with older adults can help their patients improve their balance to prevent falls. They can also help older adults recover from knee or hip replacement surgery, or maintain their strength and mobility as they age.
Other PTs specialize in helping people recover from conditions like cancer or low back pain, or the effects of pregnancy and childbirth.
“One condition people may not associate with physical therapy is pelvic floor dysfunction,” Vighetti said.
“People accept urinary incontinence and painful sex almost as rights of passage after you’ve had a couple of children. It’s something people may not even realize you can get help for — but you can. You can make changes and see real improvements.”
Rehabilitation after surgery
After you have surgery, orthopedic physical therapy may help reduce pain, normalize your walking, improve your range of motion, and prevent excessive scar tissue buildup.
Additionally, it may also help you regain your balance, strength, and mobility.
Patients often work with orthopedic PTs after surgeries such as:
Rehabilitation after acute injury
- manage pain and swelling
- function with the weight-bearing restrictions your doctor recommends
- regain as much of your range of motion as possible
- rebuild your strength
- learn how to move in ways that don’t make your condition flare up again
Rehabilitation after chronic injury
A chronic injury is damage to your body that occurs over time, usually because your movement patterns have caused small, repetitive injuries to your tendons, bones, or joints. Examples of chronic injuries include:
An orthopedic PT can analyze your movement patterns to isolate the source of the injury. They can also help you manage symptoms like pain and swelling, and can educate you about how to move safely to avoid injuries in the future.
Orthopedic PTs use a wide range of therapeutic modalities, exercises, assistive devices, and patient education methods to help you.
Depending on how your therapist uses these treatments, they may be:
- passive modalities (the therapist gives you a treatment), or
- active modalities (you perform or participate in a movement)
Here are some examples of treatments that may be used with orthopedic physical therapy.
Orthopedic PTs use both cryotherapy (cold therapy) and thermotherapy (heat therapy) to treat musculoskeletal pain and swelling.
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Your therapist will create an exercise plan that will likely include strengthening, mobility, or balance-building exercises.
It’s a good idea to practice the exercises with your therapist at first so you know you’re doing them correctly. Once you know how to do the exercises properly, you will be encouraged to do them at home on a regular basis to help boost your strength and mobility.
E-stim (TENS or NMES)
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When a PT uses this treatment modality, the therapist attaches an e-stim device to the injured area of your body.
There are two main types of e-stim devices. They include:
- TENS. Transcutaneous electrical nerve stimulation (TENS) uses low voltage electrical current to provide pain relief. It’s thought that the electrical impulses may help block pain receptors from being sent from your nerves to your brain.
- NMES. Neuromuscular Electrical Stimulation (NMES) uses a device that sends electrical impulses to nerves. This causes your muscles to contract. It’s thought that the repeated muscle contractions can improve blood flow and help repair injured muscles.
Traction takes the pressure off compressed or damaged joints. It can be conducted with a piece of equipment or with the therapist’s hands, and is considered helpful for people with:
- neck pain
- lower back pain
- degenerative disc conditions in the spine
Your therapist may incorporate water therapy into your treatment plan. You may perform exercises in a pool or whirlpool as part of your rehabilitation.
This type of therapy can be especially helpful if you have joint issues or injuries because water provides gentle resistance. The buoyancy that water provides helps support you while you exercise, which reduces the impact you place on your joints.
Soft tissue manipulation
A soft tissue manipulation is a form of manual physical therapy in which the PT uses hands-on techniques on your muscles, ligaments, and fascia. This is done to break adhesions and to optimize your muscle function.
This technique involves a therapist moving your joint firmly and carefully in the desired direction. Like soft tissue manipulation, it is a manual technique.
In some states, PTs are permitted to use dry needling, a technique that’s similar to acupuncture.
With this technique, the therapist inserts a thin needle into a specifically targeted muscle with a trigger point — usually one that is the source of tension or pain.
Laser or light therapy
Orthopedic PTs may use
Kinesiology tape is an extremely flexible band of tape made of stretchy fabric. This therapeutic tape, which often comes in bright colors or snappy patterns, is applied to specific areas of the body.
Although there is little research to support its effectiveness, anecdotal evidence suggests that kinesiology tape may help:
- provide support
- reduce pain and inflammation
- decompress trigger points
- boost circulation
- improve lymphatic drainage
- improve flexibility
In all 50 states in the United States, patients have the right to direct access. This means you can go to an orthopedic PT without getting a doctor’s referral first.
Some states have set conditions and limitations on direct access, however.
In some states, the number of times an orthopedic PT can treat you without a doctor’s order is limited. In other states, the types of treatments you can receive without a doctor’s order are regulated.
The American Physical Therapy Association has outlined each state’s guidelines for self-referrals and direct access.
“It’s important for patients to know that they have a choice about which physical therapist they go to,” Vighetti said.
“Your doctor may have a relationship with a particular physical therapist, but that doesn’t mean you have to use that therapist. If you find a physical therapist you like, you can absolutely go there. You always have a choice.”
To get the most out of each physical therapy session, it’s important to:
- Work with a PT you trust and feel comfortable with. One of the most important elements in your treatment is the trust you build with your therapist.
- Ask questions if you’re not sure about any part of your treatment plan.
- Set clear, realistic goals you can measure.
- Be honest about your pain tolerance.
- Follow through on your home exercise plan. If you aren’t sure how to do an exercise, or how often, make sure you discuss this with your physical therapist.
- Go to all of your appointments, even if you’re feeling better.
- You can look for a board-certified Orthopedic Certified Specialist (OCS). To earn certification as an orthopedic specialist, a PT must pass a stringent board exam, and must either complete an APTA-certified clinical residency in orthopedics or have practiced at least 2,000 hours of direct patient care in the area of orthopedics.
- You can look for a board-certified Sports Certified Specialist. If you want to optimize your athletic performance, find a clinic that specializes in orthopedic sports physical therapy.
- You can look for a trained manual therapist. Manual therapists are trained in diagnostics and treatments that focus on hands-on treatments.
- You can talk to friends, colleagues, neighbors, and teammates to find out about their positive and negative experiences with local physical therapists.
- You can read online reviews. More and more, patients are writing about their treatment experiences online. You can read reviews in apps and on websites you trust.
- You can use the PT finder capabilities of recognized PT organizations like the American Physical Therapy Association (APTA) or the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT). Often, you can simply type in your zip code to find a licensed therapist practicing close to your home.
- You can ask to visit the clinic before you begin treatment. Do you see therapists actively engaged with patients one-on-one? Does the facility appear clean and well-equipped? Does the front office staff treat you with respect? Will the cancellation, billing, and scheduling policies work for you?
An orthopedic PT specializes in diagnosing and treating conditions and injuries that affect any part of your musculoskeletal system. This includes your muscles, bones, ligaments, tendons, or connective tissues.
Depending on your condition, your therapist will use a variety of therapeutic modalities, assistive devices, and manual therapies to repair damage, reduce pain, and restore your physical abilities.
In most cases, you can go to a PT without getting a doctor’s referral first. But there may be a limit on the number of times you can see an orthopedic PT, or the treatments you can get for a particular condition.
Once you find a therapist you trust, commit to the treatment plan, and communicate openly with your therapist so you can get back to doing the things you love.