Physical therapy Evidence

safety

Physical therapy techniques have been used in adults, children, and the elderly for a wide variety of conditions. Due to the many kinds of techniques used by physical therapists and multiple conditions treated, this section only provides selected examples of adverse effects and is not a comprehensive list. Due to malpractice concerns, it is possible that not all adverse effects have been reported in the available literature.
Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with a qualified healthcare professional before beginning any treatments. Based on the available literature, physical therapy appears generally safe when practiced by a qualified physical therapist. However, complications are possible. Treatment options should be considered carefully. Based on one large study, there were no reported adverse events resulting from the physical therapists' diagnoses or management during a 40-month period.
There is considerable study investigating whether physical therapy should be initiated immediately or following a waiting period. For example, patients who return to physical therapy after a deep vein thrombosis are more likely to develop a pulmonary embolism than patients who return later (no sooner than 48 to 72 hours). In contrast, it is thought that keeping areas immobilized for long periods of time may also carry risk factors.
Physical therapy is often used in patients recovering from surgery whose postoperative pain may be severe. This can complicate early physical therapy. Pain medications may be given, which in turn may carry risk factors for anti-inflammatory-drug- or aspirin-induced gastrointestinal complications. However, physical therapy interventions may alter absorption and distribution of drugs that are administered transdermally (through the skin), subcutaneously (under the skin), or intramuscularly (injected into the muscle). Medication adjustments may be necessary.
Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the physical therapy literature although causality is unclear. Erectile dysfunction has also been reported.
Chest physical therapy, among other kinds of physical therapy, may increase metabolic rate, oxygen consumption, heart rate, and blood pressure. Repetitive exercises can have cardiovascular effects. A patient's cardiac and pulmonary risk factors should be assessed to determine whether heart rate and blood pressure should be monitored. Moreover, the physical therapy method of inversion (placing the heart above the head) may increase blood pressure (both systolic and diastolic). Caution is advised when using inversion as a treatment technique for low back pain. Patients with high blood pressure may need to avoid this technique.
In some very low birth weight premature infants and young children, physical therapy techniques, such as passive motion and chest percussion therapy, may increase the likelihood of bone fractures.
In the elderly, walking backwards during physical therapy has resulted in falls and considerable morbidity. Safety precautions are advised when performing challenging tasks in populations with risk factors.
Hemophilia A patients may have a greater bleeding risk after blood transfusion when physical therapy is started within eight hours of a blood transfusion.
Physical therapy has been used in pregnancy, specifically to treat women with pelvic girdle pain during pregnancy, and at three, six, and 12 months postpartum. Reports of major adverse effects are lacking in the available literature, but caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.

evidence table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
 
Incontinence (Grade: B)
A variety of techniques have been used to improve incontinence (loss of urinary control), such as pelvic-floor neuromuscular electrostimulation combined with exercises, pelvic floor muscle exercises alone (Kegel exercises), vaginal cones, and vaginal balls. Outcome measures studied have included bladder volume, vaginal palpation, and perceptions of improvement. Overall, short-term improvements have been seen with pelvic floor exercises and vaginal balls. Physical therapy appeared more effective than biofeedback techniques based on one trial. Physical therapy has been shown to be an effective treatment for dysfunctional voiding in children. Higher-quality trials and comparisons with placebo are needed to confirm these results.
Knee osteoarthritis (Grade: B)
Physical therapy for osteoarthritis of the knee may provide short-term benefits, but long-term benefits do not appear better than standard treatments. Physical therapy, either as an individually delivered treatment or in a small group format, appears effective. Only one available study compared physical therapy to a sham group (subtherapeutic ultrasound) and found that a combination of manual physical therapy and supervised exercise was beneficial for patients with osteoarthritis of the knee. One method of physical therapy, infrared, short-wave diathermy-pulsed patterns and interferential therapy, showed more effectiveness than intra-articular hyaluronan drugs in two studies. One successful exercise program used a sling suspension system. More study using consistent treatment protocols and outcomes measures would be helpful.
Pain (Grade: B)
Physical therapy has been used to treat a wide variety of pain syndromes including patellofemoral pain syndrome, wrist pain, post-operative pain, and chronic pain. Pain associated with athletic injuries, such as groin pain, are often treated with physical therapy. Despite some mixed evidence, there are several trials that compare physical therapy techniques to placebo controls for the treatment of patellofemoral pain syndrome that have found beneficial effects. Also, continuous low-level heat wrap therapy may be helpful in common conditions causing wrist pain and impairment. Long-term studies with more standardized outcomes measures would help make a stronger recommendation.
Whiplash (Grade: B)
There is emerging evidence that physical therapy may be beneficial for reducing the time to heal following whiplash injury. Studies have found benefit of physical therapy and active exercises over standard of care. According to one study, manipulative treatment may shorten recovery time faster than physiotherapy treatment. Higher-quality trials with control groups would help make a stronger recommendation.
Achilles tendonitis (Grade: C)
Physical therapy (crutches, orthoses, and eccentric exercise training) has been used in the management of pain for Achilles tendinopathy and tendon ruptures. Results are unclear. More study is needed to drawn any firm conclusions.
Acute lymphoblastic leukemia (Grade: C)
Based on limited study, the combined use of physical therapy plus a home exercise program may be beneficial in children with acute lymphoblastic leukemia. Stretching, strengthening, and aerobic exercise may improve ankle dorsiflexion active range of motion and knee extension strength. More study is warranted.
Ankylosing spondylitis (Grade: C)
Several clinical trials have compared supervised group physical therapy to unsupervised daily exercises at home for the treatment of ankylosing spondylitis. Further well designed studies are needed before a firm recommendation can be made.
Asthma (Grade: C)
Chest physical therapy and physiotherapy breathing retraining have been studied in both children and adults to improve quality of life and improve lung function in severe and acute asthma. Early evidence is mixed. Studies often include combination treatment with drug therapy or are not well-designed, which make it difficult to assess the magnitude of benefit, if any, of physical therapy alone. More research is warranted.
Back pain (Grade: C)
Despite the large amount of research conducted on physical therapy cost-effectiveness and treatments for back pain (including chronic and acute low back pain, lumbar disc herniation, pregnancy-related back pain, work-related back pain), there is a lack of conclusive evidence that physical therapy is more effective than other treatments or placebo. Examples of specific techniques used include home-based exercise programs, mobilization and extension techniques, flexion exercise, breathing therapy, Masai barefoot technology, and the McKenzie method. There are questions in the literature as to whether physical therapy regimens should be tailored to fit the individual's back pain, as not all back pain is alike.
Bone density (Grade: C)
Supervised or home-based physical therapy has been used in combination with resistance and endurance training in physically frail elderly women taking hormone replacement therapy to improve bone density. Long-term high-intensity weight-bearing exercise programs have also been used in rheumatoid arthritis patients with some success. In premature infants, improvements were seen in weight gain, growth, bone mineral content, bone mineral density, bone area, and bone mass following physical therapy. Although early study is promising, more studies are needed in this area.
Brain injury (Grade: C)
Patients with chronic traumatic brain injury often have gait (movement) disorders. Physical therapy techniques such as treadmill training and weight-bearing gait training have been used with mixed results.
Breast cancer (Grade: C)
Physical therapy programs are often used following mastectomy (breast cancer surgery). These may include arm mobilization, shoulder strengthening, prevention and treatment of upper extremity edema, and education about arm function. One study suggested that immediate postoperative physical therapy may increase shoulder range of motion, but more high quality trials are needed.
Bronchitis (chronic) (Grade: C)
Respiratory therapy has been used in the treatment of bronchitis, and the FLUTTER device has been studied for its beneficial effects. Results are unclear and additional research is needed.
Cardiovascular conditions (Grade: C)
Physical therapy has been studied to improve peak oxygen consumption, work rate, general cardiovascular health, and distance walked during six minutes. In particular, physical therapy has been used to treat coronary syndrome X (syndrome X), which is a chronic pain disorder with exercise-induced chest pain. Early evidence is promising, but additional study is needed to make a firm recommendation.
Carpal tunnel syndrome (Grade: C)
Carpal bone mobilization and median nerve mobilization have both been studied for the treatment of carpal tunnel syndrome. Based on one study, no significant differences were found between treatments or compared with control groups. More study is needed in this area.
Cerebral palsy (Grade: C)
Children with cerebral palsy are frequently referred for physical therapy, yet the effectiveness of treatment has not been well-documented. Numerous physical therapy techniques have been used to treat movement/motor disorders associated with cerebral palsy, including hippotherapy (physical therapy utilizing the movement of a horse), sensory-perceptual-motor training, neurodevelopmental physical therapy, and functional physical therapy. Conservative physical therapy regimens have also been used in combination with electrical stimulation, infant stimulation, botulinum toxin A, and selective dorsal rhizotomy. Results are inconclusive.
Chronic obstructive pulmonary disease (COPD) (Grade: C)
There may be a beneficial effect of respiratory rehabilitation in terms of improved tolerance to exercise and improved quality of life for COPD patients. Studies have investigated the use of physical therapy with drugs, as well as the difference between manual and mechanical techniques; few studies have compared respiratory physiotherapy to control groups. Examples of manual respiratory physical therapy techniques include postural drainage, chest percussion, vibration, chest shaking, directed coughing, or forced exhalation technique. Higher-quality trials are needed to make a firm recommendation.
Chronic prostatitis (Grade: C)
There is insufficient evidence in this area. Additional studies are needed before a recommendation can be made.
Chronic venous insufficiency (CVI) (Grade: C)
There is insufficient evidence in this area. Additional studies are needed before a recommendation can be made.
Circulatory disorders (Grade: C)
Various types of supervised and unsupervised physical therapy programs such as compression, cold-temperature stimuli, gymnastics, walking, and sauna have been used to improve circulation in the legs. Early evidence suggests small benefits when physical therapy is used in combination with drugs. More study is needed to make any firm conclusion.
Complex regional pain syndrome (Grade: C)
Complex regional pain syndrome involves persistent pain, allodynia (light touch causing pain), and vasomotor signs. Early evidence suggests that physical therapy may have a better effect than occupational therapy or no treatment for the reduction of pain in some patients. Physical therapy, especially home-based programs, may also be more cost-effective. Additional research is needed.
Congestion (Grade: C)
Both manual and mechanical respiratory physiotherapies have been studied in cystic fibrosis and lobectomy patients. Results are mixed and it is unclear whether certain physical therapy shows benefits over standard drug therapy alone or over placebo treatments. More evidence is needed to clarify these findings.
Cystic fibrosis (Grade: C)
Cystic fibrosis is a genetic disorder affecting the mucus lining of the lungs, leading to breathing problems and other difficulties. Chest physical therapy (postural drainage, percussion, and vibration) may be used to clear bronchial secretions, as well as mechanical devices, such as the Flutter valve. However, well-designed studies that compare physical therapy to placebo or other interventions are lacking. Additional research is needed in this area.
Dementia / Alzheimer's disease (Grade: C)
Physical therapy has been primarily studied for its effects on balance and mobility in people with Alzheimer's disease and dementia. One study on long-term care residents with Alzheimer's disease found that an exercise program improved mobility. Another study on elderly people with mixed dementia found that interdisciplinary physical therapy may improve balance, but its effects on cognitive function were limited. Conversely, a study on elderly people with dementia and a mobility problem found that physical therapy may not improve mobility. Further research is needed before a conclusion can be made.
Down's syndrome (Grade: C)
Based on early study, orofacial physical therapy may be beneficial in treating oral motor function, facial expression, the occurrence of malocclusions, and hypertrophic tonsils in Down's syndrome children. In addition to physical therapy, treadmills have also been used to help reduce the delay in walking onset in infants. Sensory integrative therapy, vestibular stimulation, and neurodevelopmental therapy are other techniques studied. Due to the various methods studied across trials, comparison is difficult and a firm conclusion cannot be reached at this time.
Facial palsy (Grade: C)
Facial palsy is commonly treated by physical therapy with various therapeutic strategies and devices. There is conflicting evidence of significant benefit or harm from physical therapy treatments for this condition.
Fall prevention (Grade: C)
Early study of individually tailored programs of physical therapy in the home appears promising for the reduction of falls in elderly women. More study is warranted in this area before a stronger recommendation can be made.
Fatigue (Grade: C)
There is inconclusive evidence on whether physical therapy may help reduce cancer-related fatigue. Additional study is needed in this area.
Fibromyalgia (Grade: C)
Early research indicates that a self-management based program of pool exercises and education may improve the quality of life of patients with fibromyalgia and their satisfaction with treatment. In one study, physical therapy did not show better effects when compared with hypnotherapy. Better-designed trials are needed to make a firm conclusion.
Fractures (Grade: C)
Physical therapy has been primarily studied as a method of shortening the duration of healing time following cast immobilization of fractures. Additionally, a supervised physical therapy program has been used in children with osteogenesis imperfecta, a genetic disorder in which bones are abnormally fragile and may fracture easily. Physical therapy in this population may improve aerobic capacity and muscle force and reduce fatigue. Overall, however, the evidence is still mixed and more study is needed.
Frozen shoulder (Grade: C)
Intensive physical rehabilitation treatment, including passive stretching and manual mobilization (stretching group), has been compared with supportive therapy and exercises within the pain limits for the treatment of frozen shoulder. Results are inconclusive and more study is needed.
Guillain-Barre syndrome (Grade: C)
There is limited study of physical therapy for the treatment of Guillain-Barre Syndrome (GBS), a self-limiting autoimmune disorder that causes neuromuscular deficits. Further research is needed.
Headache (Grade: C)
Physical therapy has been used to treat chronic headache, migraines, tension-type headaches, and cervicogenic headaches. Available studies have used combination treatments of standard physical therapy in addition to psychotherapy, medications, or adjusting dental occlusion. Better-designed trials of PT alone are needed before it can be recommended.
Heart failure (Grade: C)
Both supervised and home-based exercise training can enhance exercise capacity in patients with chronic heart failure. However, there is no consensus regarding a rehabilitation program for these patients and the literature often suggests individually-tailored programs. Due to the lack of standardization, duration of treatment, and various outcomes measures, more study is needed before a firm recommendation can be made.
Hip fractures (Grade: C)
Physical therapy appears beneficial as a method of shortening the duration of healing time from hip fracture recovery after surgery, improving quality of life, or as preparation for hip replacement surgery in the elderly. Home-based programs, gait retraining programs, high vs. low-intensity programs, early vs. late interventions, and multicomponent rehabilitation have all been studied with mixed results.
Hip pain (Grade: C)
There is little available research on the physical therapy treatment of hip pain. Mobilization and manipulation techniques have been studied. More research is needed in this area.
Hypertension (high blood pressure) (Grade: C)
There is insufficient available evidence in this area. Additional research is needed.
Joint problems (Grade: C)
Physical therapy has been used to treat a variety of joint problems, including chronic ankle instability, clubfoot (a birth defect of the ankle/foot), impingement syndrome, and knee, thumb, elbow, shoulder, wrist, and ankle movement disorders. Most studies stress early intervention to speed recovery, although studies that compare early intervention to later intervention, spontaneous healing, and other modalities, including sham treatments, are lacking. Better-designed trials are needed before a firm recommendation can be made.
Joint problems (rotator cuff, SIJD) (Grade: C)
Several studies have used physical therapy techniques plus passive motion to improve function, reduce pain, and improve muscle strength and range of motion for sacroiliac joint dysfunction (SIJD) and rotator cuff repair. Both video-tape and personal instruction approaches have been studied with no apparent differences in results. Additional high-quality studies are needed in this area.
Kashin-beck osteoarthropathy (Grade: C)
Early evidence shows that physical therapy may be better than multivitamins for treating Kashin-beck osteoarthropathy, although results are unclear. Additional evidence is needed to make a firm recommendation.
Knee pain (rehabilitation) (Grade: C)
Physical therapy programs such as independent home exercise, supervised exercise, and open and closed kinetic chain exercises have been studied for their effect on decreasing recovery time following anterior cruciate ligament (ACL) reconstruction or traumatic dislocation of the knee. Although studies indicate that some kind of rehabilitation and movement are beneficial, the sum of the evidence does not favor physical therapy over traditional home therapy or other treatments. Additional study is warranted.
Knee replacement surgery (Grade: C)
Physical therapy has been used to treat complications and/or help with recovery after knee replacement surgery. Examples of treatments used include knee braces, shoe lifts, custom-fitted shoe inserts, electrical stimulation, peroneal nerve releases, and Botox® injections. Instruction in kneeling is a useful addition to physical therapy following knee replacement. Additional study is needed in this area.
Lung function (Grade: C)
There is inconclusive evidence in this area. Additional study is warranted.
Lymphedema (Grade: C)
Various types of physical therapy have been employed in the treatment of lymphedema, such as complex physical therapy (CPT), self home maintenance therapy (bandage/wearing of elastic garment and exercise), and pneumatic compression. No high-quality trials show benefit of these therapies over other therapies or controls. Physical therapy has also been used in combination with sodium selenite application. Additional study is needed in this area.
Multiple sclerosis (MS) (Grade: C)
There is insufficient evidence for the treatment of multiple sclerosis with PT. Additional research is needed in this area.
Muscle atrophy (Grade: C)
There is insufficient evidence for the treatment of muscle atrophy with PT. Additional research is needed in this area.
Muscle spasticity (Grade: C)
There is insufficient evidence showing physical therapy's effect (specifically, ultrasound techniques) on reducing muscle spasticity. Additional research is needed in this area.
Muscle tension (Grade: C)
There is conflicting evidence regarding physical therapy's ability to lengthen hamstring muscles or increase hamstring flexibility. Additional research is needed in this area.
Musculoskeletal conditions (Grade: C)
There is not enough evidence to support the role of physical therapy for the treatment of meralgia paresthetica (a musculosketetal condition). Physical therapy has also been suggested as a possible treatment for a genetic disorder called multiple pterygium syndrome (MPS). Additional research is needed in this area.
Myofascial pain (TMJ) (Grade: C)
There do not appear to be any distinguishing effects on myofascial pain, tempromandibular disorders (TMJ), or function impairment in the available literature between arthroscopic surgery, arthrocentesis, and physical therapy. Most studies using physical therapy use it in combination with educational instruction. Additional study is needed to make a firm recommendation.
Neck and shoulder pain (Grade: C)
Physical therapy has been studied for various neck and shoulder pains, shoulder dysfunction, adhesive capsulitis, quadriplegic shoulder pain, acute neck pain, cervical radiculopathy, cervico-brachial pain syndrome, and shoulder impingement syndrome among other conditions. Techniques studied in combination with conservative physical therapy include gymnastics, strengthening exercises, electrotherapy, thermotherapy, massage, cervical traction, and tissue mobilization. It has been proposed that modified manipulative therapy regimens are more effective than traditional physiotherapy in reducing pain and increasing function in many of these conditions. Some studies have found short-term benefits of manual therapy over general medical care. Physical therapy has been compared with acupressure, the Feldenkrais method, and drug interventions although it is still unclear whether physical therapy is better or worse than short-term spontaneous healing or long-term healing. More high-quality studies are needed before a firm recommendation can be made.
Nerve disorders (Grade: C)
There is insufficient available evidence. Physical therapy has been combined with music therapy to treat children with Erb's palsy. However, additional study is needed in this area.
Nerve pain (Grade: C)
Physical therapy has been used to treat diabetic nerve pain and chemotherapy-induced nerve pain. There is not enough scientific evidence to make a firm recommendation for this use.
Neurological disorders (Grade: C)
There is insufficient evidence in this area. Additional studies are needed.
Orthostatic hypotension (Grade: C)
There is insufficient evidence in this area. Additional studies are needed.
Osteoarthritis (Grade: C)
Physical therapy has been used in the treatment of gonarthritis and hand, hip, and knee osteoarthritis. Manual therapy has sometimes shown better outcomes on pain, stiffness, hip function, and range of motion, although it is unclear whether sham treatment or other modalities would be comparable to physical therapy. Additional study is needed in this area.
Parkinson's disease (Grade: C)
Management of Parkinson's disease typically aims to obtain symptom control, reduce clinical disability, and improve quality of life. In addition to medications, physical therapy aims to improve balance, postural control, walking, and to reduce falls. Physical therapy techniques may have short-term benefits, but the available evidence is unclear. One meta-analysis indicated that physical therapy is beneficial when used in combination with medications, but the effects of physical therapy alone are unknown. Additional high-quality studies are needed.
Peripheral artery disease (Grade: C)
There is insufficient evidence available in this specific area. Additional study is needed.
Plantar fasciitis (Grade: C)
There is good evidence that low-intensity laser irradiation, a widespread but controversial physical therapy agent, is not an effective treatment of plantar fasciitis when compared with sham laser treatment for plantar fasciitis. Other therapies such as extracorporeal shockwave treatment have been studied, but low-quality study designs prevent a strong recommendation from being made. Additional information is needed in this area.
Pneumonia (Grade: C)
Early evidence suggests that chest physiotherapy techniques such as postural drainage, external help with breathing, percussion, and vibration are not better that receiving advice of deep breathing instructions in the treatment of pneumonia. Additional evidence is needed in this area.
Pregnancy problems (pelvic girdle pain) (Grade: C)
Physical therapy with a focus on specific stabilizing exercises may be more effective than a regimen without specific stabilizing exercises in the treatment of pelvic girdle pain, functional status, and quality of life. Based on one study, there were no differences between giving patients information, doing at home physical therapy, or in-clinic physical therapy. Additional higher-quality research is needed in this area.
Pulmonary conditions (Grade: C)
Lung hyperinflation is a technique used by physiotherapists to mobilize and remove excess lung secretions, reinflate areas of pulmonary collapse, and improve oxygenation. Studies have compared manual vs. mechanical interventions and found no differences between the two. However, studies are lacking that compare physical therapy to placebo or other interventions. Additional research is needed in this area.
Quality of life (Grade: C)
There is insufficient available evidence in this specific area. Additional studies are needed.
Rehabilitation (cardiac) (Grade: C)
Physical therapy has been used during cardiac rehabilitation with or without beta-blocker medication. More research is needed in this area to draw a firm conclusion.
Rehabilitation (geriatric) (Grade: C)
One-on-one physical therapy has been compared to structured social visits for geriatric rehabilitation. Home-based physical therapy programs have also found modest benefits in walking, bathing, upper- and lower-body dressing, transferring from a chair, using the toilet, eating, and grooming in elderly patients. Early evidence does not show a strong benefit of physical therapy. More studies are needed in this area.
Rehabilitation (vestibular) (Grade: C)
Patients with chronic vestibular disorders typically have complaints of unsteadiness, imbalance, and/or motion intolerance. Various types of rehabilitation have been tried, although vestibular rehabilitation, a specific approach to physical therapy aimed at reducing dizziness and imbalance by facilitating central nervous system compensation for peripheral vestibular dysfunction, has been used the most. Results are generally positive, but more well-designed studies are needed before a firm conclusion can be drawn.
Rheumatoid arthritis (Grade: C)
Several studies have indicated that treatment of rheumatoid arthritis should be conducted by a specially trained physical therapist and that physical therapy may help improve morning stiffness and grip strength. A long-term high-intensity exercise program has been suggested by some, and beneficial effects may last up to one year. Despite promising early evidence, better-designed studies are needed to draw a firm conclusion.
Sciatica (Grade: C)
There is not enough available evidence. Additional study is needed in this area.
Skin ulcers (Grade: C)
Early evidence suggests that high voltage stimulation or pulsed electrical stimulation may speed the healing of some types of skin ulcers. More research with similar outcomes measures is needed to confirm these findings.
Spine problems (Grade: C)
There is insufficient available evidence supporting a role for physical therapy in improving spinal mobility, treating chronic spine disorders, or in treating myelomeningocele. Additional study is needed.
Sprains and strains (Grade: C)
Physical therapy has been studied to reduce the healing time of acute ankle ligament sprains and acute hamstring sprains. Certain aspects of physical therapy, such as progressive agility, trunk stabilization exercises, and icing, may be more beneficial than static stretching, but results are unclear. More large studies of higher-quality are needed.
Strength enhancer (Grade: C)
Physical therapy has been used with biofeedback training to enhance strength in patients with foot drop (a birth disorder where the foot is twisted out of shape or position), and has also been used in elderly patients recuperating from acute illnesses. Well-designed studies are needed before a recommendation can be made.
Stroke (Grade: C)
Physical therapy is a popular choice for patients undergoing stroke rehabilitation. It aims to strengthen weakened muscle groups through repetitive motion, increase overall function including cognitive function, and improve gait and walking. Available studies have used a variety of exercises, which makes it nearly impossible to compare the evidence. Furthermore, physical therapy is often used as a control group in these studies and rarely do studies find a significant difference between physical therapy and other interventions. Higher quality studies are needed to make a firm recommendation.
Surgical recovery (Grade: C)
Many studies have shown that when physical therapy is used before or immediately after a long period of immobilization, such as bed rest associated with hospitalization, the result is a shorter overall hospital stay with fewer complications. Physical therapy techniques are often used following cardiopulmonary bypass surgery, abdominal surgery, and other surgical procedures, as well as for the prevention of pulmonary complications. Several studies do not show any difference between various chest physiotherapy treatments, such as incentive spirometry, intermittent positive pressure breathing (IPPB), or deep breathing exercises. Overall, it is difficult to compare treatment outcomes across the various studies.
Tendonopathies (tendon dysfunctions) (Grade: C)
Posterior tibial tendon dysfunction is a relatively common problem of middle-aged adults that usually is treated operatively. One study suggested that early stages of tendonopathies could be effectively treated nonoperatively with an orthosis and structured exercises. Aside from orthosis, exercise, stretching, and extracorporeal shock wave therapy may be of use for tendonitis of the shoulder. Additional research is needed in this area.
Tennis elbow (Grade: C)
Lateral epicondylitis (commonly known as tennis elbow) is one of the most common upper extremity pain syndromes. Compared with corticosteroid injections, physical therapy appears less effective for treating tennis elbow, but studies are mixed and a firm recommendation cannot be made at this time. Physical therapy techniques such as cold pack use, progressive strengthening, or stretching exercises may be helpful for reducing the recurrence of symptoms. Studies using extracorporeal shock wave therapy or low-frequency electrical stimulation found conflicting results.
Thyroiditis (Grade: C)
There is insufficient available information on physical therapy as a treatment for thyroiditis. Additional study is needed before a recommendation can be made.
Tinnitus (Grade: C)
There is limited study on the effects of physical therapy in tinnitus. One study found that acupuncture showed more benefit on reducing the severity of tinnitus and improving quality of life than physical therapy. More study is needed in this area.
Vertigo (Grade: C)
Physical therapy has been used to treat vertigo (specifically, benign paroxysmal positional vertigo). Physical therapy protocols are not well outlined, and there is limited study comparing physical therapy vs. other modalities. Nevertheless, physical therapy may be helpful for vertigo but more study is needed to make a firm recommendation.
Wound care (Grade: C)
Physical therapy techniques such as laser treatment have been used to clean and heal wounds. More research is necessary prior to physical therapy being recommended for this use.
Low birth weight (Grade: D)
Physical therapy does not appear to help motor performance in infants born very preterm with very low birth weight. Besides the lack of benefit, available studies show a risk of causing fractures in preterm infants.