1. Megan Vogelsong<br />Professor Stephanie Quinn <br />English 2950-710<br />15 April 2011<br />The Effects and Effectiveness of Physical Therapy Treatment<br />Have you ever heard of words such as active assist exercise, active resistive exercise, activities of daily living, ultrasound, electrotherapy, iontophoresis, or stimulation treatments? If so, it was probably in a physical therapy setting. These are just some of the many different types of treatments that physical therapists use to help their patients recover from various physical injuries, disabilities, or other physical setbacks. <br />What are the effects of physical therapy treatment, and how effective are the different types? I will research and analyze this question throughout my research paper. I became interested in this topic back in high school when I really started to get involved in running cross country and track. While doing so, I found myself getting injured on a couple of occasions, thus spending a lot of time in our local physical therapy center. I love helping others, and the time I spent there really got me interested in the different types of treatment available to help other people like myself who become injured due to sports or other activities. This question has evolved from first, getting the spark to want to be a physical therapist, and secondly, the jobs and work that goes along with it. From job shadows and interviews, I have gained a lot more knowledge on physical therapy and what physical therapists do. The main question that I wish to answer through my research is how effective different treatments are for different people with various physical disabilities. I will answer this question by answering smaller questions that go along with this. Some of these include: What are different types of disabilities and injuries that need physical therapy? What are the different types of treatment options for disabilities and injuries? How is each treatment option performed? How severe is the disability or injury, and how long of a treatment plan will each patient need?<br />Many people throughout the United States need physical therapy multiple times a week to help increase their physical abilities. Because of this and the great number of people that use physical therapy, there is a need for this study. Many people do not even realize how many people receive physical therapy throughout the United States. Patients can include anyone from infant to elderly, making the number of patients even higher. I think this study will be useful because it will weed out the less important and effective treatment options available. This will in turn lead to physical therapists selecting more effective treatments and increasing the healing and activity to help patients overcome their physical disabilities and injuries to a speedy recovery.<br />The intended audience for my research will be the public. Since many people of all ages need physical therapy throughout each community, this information that I will research and analyze will be useful and helpful to many people. This information will also of course be important for physical therapists since they use these different treatments every day. <br />I will research the different types of treatments that physical therapist use. From these findings, I will research what each treatment is used for and how it helps patients physically. Then, I will analyze my findings from using the research I will attain and my own opinions and knowledge to conclude whether certain types of treatments are effective to help physical therapy patients with disabilities, injuries, or other physical setbacks in their lives.<br />The first type of treatment option, and a more familiar and simple type, includes active assist exercises. Active assist exercises help injured patients maintain joint flexibility and muscle strength while they are recovering. With this treatment, the patient will move their arm, leg or other part of body through normal or the best available range of motion they have while receiving assistance from a specialist or use of an object or device. An example of an active assist exercise could be heel slides on a towel. This extension and flexion of the knee can help increase the strength to help with healing. This can also be seen when treating hip flexion. In this case, arm strength can be used to help assist the patient to ensure they are receiving a full range of motion. When the hip is in a weak state, the muscle group normally responsible for movement must contract. There are many different types of activities used in this type of treatment, but those are just a few examples (Walker PT).<br />This picture below shows how the heel exercise is performed. You start lying down flat on your back with your legs out straight in front of you. Then you slide your heel up towards your buttocks while bending your knee, one leg at a time. While doing this exercise in repetition and several times a week, the patient can help increase their strength in their knee (ehow). <br />This treatment is effective, but it must be done consistently to retain the strength. The bending of the knee not only helps in strengthening it, but it also helps the knee’s range of motion due to the increased ease of bending the knee that the patient will receive from performing this exercise. This exercise should be done by doing 1 to 3 sets of 8 to 10 repetitions. At first, while the knee is weak and the range of motion is small, a smaller amount of sets and repetitions will be done. As strength and range of motion increases, it is important to increase sets and repetitions until the amount of strength needed and healing is maintained. This treatment option is effective, but may take consistency and a longer treatment plan. This treatment thus works faster in less severe cases. <br />A type of treatment similar to active assist exercises is active resistive exercises. These are also simple forms of treatment available to help increase the strength of muscles, but they are also used to generate greater force. Many times this treatment will involve the use of weights to help better increase strength. There are three main steps to help perform this treatment effectively. They include 1. Perform a small number of repetitions until the patient feels fatigue, 2. Allow sufficient rest between exercise for recovery, and 3. Increase the resistance as the ability to generate force increases. Patients in this treatment plan will also usually start with 8 to 12 repetitions, 1 to 3 sets, and 2 to 3 days a week (ptjournal.apta).<br />People who are healthy can also see benefits from using active resistive treatment exercises. This is because this treatment can help to improve athletic performance by generating a greater force from strengthening exercises. Resistive exercises also decrease risk factors for osteoporosis, help regain strength after time off from an injury, pathology, or disuse, and help decrease lower back pain. Sometimes long-term benefits can be seen depending on the condition. In fracture rehab, long-term benefits are usually uncertain, but in pulmonary rehabilitation, patients usually maintain the benefits. The negatives of this treatment include an increase in muscle spasms, and an increase in the forces required through healing tissues such as in bones after fractures (JAMA).<br />A single-blind clinical trial was conducted on active resistive exercises to test the effectiveness of them. “The test concluded that there was an 8% decrease in physical disability, an 8% decrease in pain, and an increase in the distance walked in a six minute walk. There were also faster times on lifting and carrying tasks” (JAMA). Thus, this treatment gives a reasonable improvement to elderly with osteoarthritis of knees and should definitely be part of their treatment plan. This treatment can be seen as effective to many people, but more so in less severe cases (JAMA). <br />The third type of treatment I will discuss is called ultrasound. Ultrasound is a type of physical therapy treatment that generates high frequency sound waves to specific body areas through a round-headed probe. The sound waves are able to travel deep into tissue while creating mild heat. While performing ultrasound, gel is used to help move the probe and generate heat. Circular motions are used on the area, and the waves produce a tingling sensation. The heat that is produced helps to draw blood into the tissues. This in turn delivers oxygen and nutrients while removing wastes from cells. Ultrasound helps to reduce pain and inflammation, decrease muscle spasms, and accelerate healing (spineuniverse). <br />Even though ultrasound seems like a very effective type of treatment, the effectiveness on reducing pain is still questioned. Tests were conducted, and none of them showed evidence of pain relief achieved. This type of treatment may still be effective though if used more frequently and over a longer period of time (sciencedirect).<br />Next, transcutaneous electrical nerve stimulation (TENS), or stimulation treatment for short, is a type of treatment option to help a specific injured area. It can be used in many cases such as muscle, joint, tendon or nerve pain, inflammation, and many others. Stimulation works by surrounding the affected area with four small electrode pads. The pads are hooked up to a device that sends a certain frequency of electrodes back and forth to each other through the affected area. Stimulation usually helps to decrease muscle and joint tightness, and it can also decrease inflammation (TENS for low back pain).<br />A study was conducted to conclude the effectiveness of TENS treatment compared to massage. Patients with acute or chronic lower back pain were treated with TENS in a double-blind study. The study compared stimulation at intense levels to gentle mechanically administered massages. Simulation treatment produced significant increases in pain relief and a significant improvement in straight leg raising and range of motion. Stimulation can be conducted at low intensities for a longer period of time or at higher intensities for a shorter period of time. In this test, 10 out of 14 patients said they could feel an improvement with the stimulation treatment. “In the massage treatment, only 38% of patients felt a decrease in their lower back pain, but in TENS treatment, 85% of the patients saw improvements” (TENS for low back pain). This shows how much greater the effectiveness of stimulation treatment is compared to a massage. This also helps to conclude that stimulation treatment can be seen as a very effective form of treatment especially in patients with lower back problems (TENS for low back pain).<br />Iontophoresis treatment is very similar to that of TENS, but it only uses two patches, one of which includes ion medication. “Through a continuous, low-voltage, and direct current, iontophoresis introduces a topically applied, physiologically active ion into the epidermis and mucous membranes” (hynppharmaceuticals). This treatment works like a magnet because negatively charged ions are repelled by negative electrodes and vice versa with positive ions. It can also administer medication deeper into tissues (1-3 cm). It is safe and cost effective, especially compared to injection therapy. Conditions usually disappear in six or less treatment sessions. Iontophoresis can be used to treat tendinitis, bursitis, fasciitis, neuritis, and synovitis. In less specific cases, iontophoresis is used to treat acute and chronic inflammation, localized pain, fungal infections, small ulcers, calcium deposits, trigger points, and even plantar warts. There are only a couple of negatives with this type of treatment. They include a small risk of tissue burns and blistering from high intensities or skin that was not cleaned (hynppharmaceuticals). <br />Because of the high healing rate with only about six treatments needed, iontophoresis can be seen as a very successful solution to many different types of physical therapy problems. It can also help in severe cases. The addition of the ion medication is a major plus to this treatment option. There are also different and specific types of ions that can be used for the different injuries or physical problems. This treatment is high in technology and will most likely be seen as a successful treatment option for many more years to come. <br />The final treatment option I will analyze is one that is newer to physical therapy. It is called the 830 Laser. It can be compared to ultrasound in some ways, but it does not use heat. The 830 Laser sends light, or photons, into injured tissues and stimulates healing while reducing pain instantly. The photons stimulate and energize cells to repair and strengthen them at extremely fast rates. This treatment also does not wear off, but instead, it actually increases the body’s healing abilities. The 830 Laser reduces pain, decreases inflammation, and regenerates tissues. It also has a 90% effective rate in patients. Because of all this information, this treatment option is very effective in almost all cases. I can also see it being used a lot in the future, especially since it is a newer invention. <br />In conclusion, there are so many different types of physical therapy treatments out there available to anyone who needs them. Many are very effective, but it does depend on the injury or disability as well as the individual person. Some types of physical therapy may work great for some people while they may not work at all for others. Physical therapists can examine the patient and look at their history to help them develop the best treatment plan for them. I think active resistive exercises, stimulation, iontophoresis, and the 830 Laser are the most effective forms. We will most likely see them continued to be used in much of the future, until technology takes over and even more advanced forms of physical therapy become available. The future looks bright for physical therapy, and there is good hope to those who need it.<br />Works Cited<br />Davis, Dana L., and Susan Spinasanta. quot;
Ultrasound: A Common Treatment Used in Physical <br />Therapy.quot;
Back Pain, Neck Pain, Sciatica - Symptoms Exercises Treatments Causes. Spineuniverse, 6 Feb. 2010. Web. 10 Apr. 2011. <http://www.spineuniverse.com/treatments/physical-therapy/ultrasound-common-treatment-used-physical-therapy>.<br />Ettinger, Walter H., Robert Burns, Stephen P. Messier, William Applegate, W. Jack Rejeski, <br />Timothy Morgan, Sally Shumaker, Michael J. Berry, Mary O'Toole, Johnny Monu, and Timothy Craven. quot;
A Randomized Trial Comparing Aerobic Exercise and Resistance Exercise With a Health Education Program in Older Adults With Knee Osteoarthritis, January 1, 1997, Ettinger Et Al. 277 (1): 25 %u2014 JAMA.quot;
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ScienceDirect - Pain : Ultrasound Therapy in <br />Musculoskeletal Disorders: a Meta-analysis.quot;
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Active Assisted Range of Motion Exercises | EHow.com.quot;
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Transcutaneous Electrical Nerve Stimulation <br />For Low Back Pain.quot;
A Comparison of TENS and Massage for Pain and Range of Motion 63.4 (1983): 489-93. Apr. 1983. Web. 28 Mar. 2011.<br />Scifers, James R. quot;
Iontophoresis: Maximizing Treatment Effectiveness.quot;
Iontophoresis: <br />Maximizing Treatment Effectiveness: 1-7. Web. 28 Mar. 2011. <http://www.hnppharmaceuticals.com/pub_dwnlds/pdf/therapists/Ionto/Ionto_Max_effectivness.pdf>.<br />Taylor, Nicholas F., Karen J. Dodd, and Diane L. Damiano. quot;
Progressive Resistance Exercise in <br />Physical Therapy: A Summary of Systematic Reviews.quot;
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