Five Types of Physical Therapy

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Spine

Spinal cord and nerves. These "electrical cables" travel through the spinal canal carrying messages between your brain and muscles. Nerve roots branch out from the spinal cord through openings in the vertebrae (foramen).

Intervertrebral disks. In between your vertebrae are flexible intervertebral disks. They act as shock absorbers when you walk or run.

Intervertebral disks are flat and round and about a half inch thick. They are made up of two components:

  • Annulus fibrosus. This is the tough, flexible outer ring of the disk.
  • Nucleus pulposus. This is the soft, jelly-like center of the disk.                                                                                                                                                                                                                                                                                                                     

    Cervical radiculopathy most often arises from degenerative changes that occur in the spine as we age or from an injury that causes a herniated, or bulging, intervertebral disk.

    Degenerative changes. As the disks in the spine age, they lose height and begin to bulge. They also lose water content, begin to dry out, and become stiffer. This problem causes settling, or collapse, of the disk spaces and loss of disk space height.

    (Left) Side view of a healthy cervical vertebra and disk. (Right) A disk that has degenerated and collapsed.

    As the disks lose height, the vertebrae move closer together. The body responds to the collapsed disk by forming more bone —called bone spurs—around the disk to strengthen it. These bone spurs contribute to the stiffening of the spine. They may also narrow the foramen—the small openings on each side of the spinal column where the nerve roots exit—and pinch the nerve root.

    Degenerative changes in the disks are often called arthritis or spondylosis. These changes are normal and they occur in everyone. In fact, nearly half of all people middle-aged and older have worn disks and pinched nerves that do not cause painful symptoms. It is not known why some patients develop symptoms and others do not.

    Herniated disk (side view and cross section)

    Herniated disk. A disk herniates when its jelly-like center (nucleus) pushes against its outer ring (annulus). If the disk is very worn or injured, the nucleus may squeeze all the way through. When the herniated disk bulges out toward the spinal canal, it puts pressure on the sensitive nerve root, causing pain and weakness in the area the nerve supplies.

    A herniated disk often occurs with lifting, pulling, bending, or twisting movements.

    Symptoms

    In most cases, the pain of cervical radiculopathy starts at the neck and travels down the arm in the area served by the damaged nerve. This pain is usually described as burning or sharp. Certain neck movements—like extending or straining the neck or turning the head—may increase the pain. Other symptoms include:

  • Tingling or the feeling of "pins and needles" in the fingers or hand
  • Weakness in the muscles of the arm, shoulder, or hand
  • Loss of sensation
  • Some patients report that pain decreases when they place their hands on top of their head. This movement may             temporarily relieve pressure on the nerve root.

The field of physical therapy has sub-specialties in five distinct practice areas:

Orthopedic

Orthopedic physical therapy focuses on restoring function to the musculoskeletal system, including joints, tendons, ligaments and bones. Many sports injuries fall into this category. Treatment methods include stretching, strength training, endurance exercises, hot and cold packs, ultrasound, electrical muscle stimulation and joint mobilization.

Geriatric

Geriatric physical therapy focuses on the unique movement needs of older adults. This includes treatment for conditions such as arthritis, cancer, osteoporosis, Alzheimer's disease, joint replacement and balance disorders. The goal of geriatric physical therapy is to help restore mobility, reduce pain, accommodate physical limitations and increase physical fitness.

Neurological

Neurological physical therapy focuses on neurological conditions and impairments, such as Alzheimer's disease, brain injury, cerebral palsy, multiple sclerosis, Parkinson's disease, spinal cord injury and stroke. Treatment plans attempt to achieve the highest level of autonomous function for living as independently as possible for as long as possible. Physical therapists concentrate on teaching clients to adapt to visual, balance, mobility and muscle loss impairments for activities of daily living.

Cardiopulmonary

Cardiovascular and pulmonary physical therapy focuses on helping individuals who suffer from cardiovascular and pulmonary conditions, such as heart attacks, chronic obstructive pulmonary disease (COPD) and pulmonary fibrosis. The goal of this sub-specialty is to increase endurance and improve functional independence.

Pediatric

Pediatric physical therapy focuses on the unique needs of infants, toddlers, children and adolescents. Early detection is desirable when a child experiences problems that inhibit natural movement and learning. Physical therapy is used for children suffering from diseases or injuries, including:

  • acute injury
  • birth defects
  • developmental delays
  • genetic disorders (e.g., cerebral palsy)
  • head trauma
  • limb deficiencies
  • muscle diseases
  • orthopedic disabilities

Physical therapists use therapeutic exercise, modalities and treatments to help children alleviate pain, regain strength and range of motion, master proper body mechanics for balance and flexibility and improve gross and fine motor skills.

Two emerging sub-specialty practices in physical therapy are:

Vestibular Rehabilitation, which focused on balance problems caused by deficits in the inner ear, such as vertigo or dizziness.

Women's Health, which focused on relieving pelvic pain, reducing lymphatic swelling and controlling urinary incontinence.