Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Physical Therapy


Related Terms

  • Physical Medicine
  • Physical Rehabilitation
  • Physiotherapy
  • PT
  • Therapeutic Exercise

Specialists

  • Physical Therapist

Comorbid Conditions

  • Cancer
  • Cardiopulmonary disease
  • Dementia
  • Diabetes mellitus
  • Obesity
  • Psychiatric disorders

Factors Influencing Duration

Disability is not associated with the different PT modalities, but rather with the underlying condition being treated.

Medical Codes

ICD-9-CM:
93.01 - Functional Evaluation
93.02 - Orthotic Evaluation
93.03 - Prosthetic Evaluation
93.04 - Manual Testing of Muscle Function
93.05 - Range of Motion Testing
93.06 - Measurement of Limb Length
93.07 - Body Measurement; Girth Measurement; Measurement of Skull Circumference
93.09 - Diagnostic Physical Therapy Procedure, Other
93.11 - Assisting Exercise
93.12 - Active Musculoskeletal Exercise, Other
93.13 - Resistive Exercise
93.14 - Training in Joint Movements
93.15 - Mobilization of Spine
93.16 - Mobilization of Other Joints
93.17 - Passive Musculoskeletal Exercise, Other
93.18 - Breathing Exercise
93.19 - Exercise, Not Elsewhere Classified
93.21 - Traction, Manual and Mechanical
93.22 - Ambulation and Gait Training
93.23 - Orthotic Device Fitting
93.24 - Training in Use of Prosthetic or Orthotic Device; Training in Crutch Walking
93.25 - Forced Extension of Limb
93.26 - Manual Rupture of Joint Adhesions
93.27 - Stretching of Muscle or Tendon
93.28 - Stretching of Fascia
93.29 - Forcible Correction of Deformity, Other
93.31 - Pool Exercise, Assisted
93.32 - Whirlpool Treatment
93.33 - Hydrotherapy, Other
93.34 - Diathermy
93.36 - Cardiac Retraining
93.37 - Prenatal Training; Training for Natural Childbirth
93.38 - Physical Therapy, Combined, without Mention of the Components

Overview

Physical therapy (PT) is the healthcare profession concerned with the evaluation, treatment, and prevention of physical disabilities caused by disease or injury. This medical discipline is used as a conservative measure prior to, in conjunction with, or following other treatment options such as medicines or surgery. PT is practiced in hospitals, rehabilitation centers, private therapist-owned offices, extended care facilities, home health agencies, special diagnostic clinics in outpatient treatment centers, academic institutions, fitness and wellness centers, and research centers.

PT as a profession has been recognized in the US for more than 75 years. The profession began with a focus on the rehabilitation of individuals from diseases such as polio. Since then, PT has branched out from traditional areas such as orthopedics and neurology into areas like women's health, ergonomics, and cardiopulmonary disease. PT is practiced throughout the world, with teams of visiting therapists from Europe and the US traveling to developing nations to provide instruction on therapeutic techniques, as well as the use of equipment such as crutches and prosthetic limbs.

PT uses a wide variety of techniques, ranging from soft tissue and joint mobilization to acupressure and trigger point release, to help restore and improve flexibility of muscles, tendons, and joints. PT also uses various techniques for soft tissue healing, such as hydrotherapy, electrical stimulation, application of cold or heat, shortwave diathermy, low-level laser therapy, and ultrasound. Therapeutic exercise is an important part of PT, helping to strengthen muscles and joints weakened by disease and injury.

Source: Medical Disability Advisor



Reason for Procedure

The goal of PT is to enhance human movement and function and to assess, prevent, and treat movement dysfunction and physical disability. Many individuals are advised to obtain PT services while recovering from surgery, accidents, and illnesses. PT can help improve mobility in older individuals when effects of disease are coupled with a decrease in physical activity. It is used to prevent potential scarring and loss of movement and strength from musculoskeletal dysfunction associated with pain, edema, weakness, fatigue, and tissue degeneration.

PT is used to preserve as much normal joint motion as possible in individuals who have sustained burns. It is used after spinal cord injuries to optimize function and strength of paralyzed or weak limbs, and with individuals following strokes (cerebrovascular accidents) and heart attacks (myocardial infarctions) to help restore ordinary life skills to the maximum possible extent. Individuals with cancer use PT to build strength and relieve discomfort. Individuals also may undergo PT to help strengthen and restore neuromuscular function to the trunk and limbs after fractures, joint replacements, nerve injuries, or disease processes such as osteoarthritis or rheumatoid arthritis. PT intervention helps individuals regain functional mobility in bed, when moving between surfaces (transfers), and with ambulation (gait training). Therapeutic exercise prescribed by a physical therapist is believed to enhance traditional medical and surgical treatment. For example, individuals undergoing heart surgery are found to recover more quickly when exercise is included in their recovery regimen.

Source: Medical Disability Advisor



How Procedure is Performed

In general, PT begins with a specific diagnosis and a referral from a physician, often accompanied by recommendations for particular treatments although in many states individuals may seek PT treatment directly. On the first visit, the physical therapist will conduct an evaluation assessing the individual's medical history, range of motion, strength, neurological involvement, and functional level. The therapist and the individual treated make both short-term and long-term goals. Next, a plan of care is written by the therapist and discussed with the individual and sometimes approved by the physician. From that point on the therapist will decide, if the treating physician has not already done so, how frequently and for what period of time the individual will be seen in PT.

If the individual's diagnosis includes pain and swelling, the PRICE principle (protection, rest, ice, compression, elevation) is initially used, often in conjunction with electrical stimulation and, occasionally, ultrasound. Once pain and swelling have subsided, the therapy will move to a focus on returning range of motion, strength, and coordination. The final step is to incorporate activities that will help the individual return to home or the previous work environment. A home program will be initiated at the time the individual is first evaluated and will gradually progress in difficulty and duration of the sessions up to the date of discharge. Patient education is an important aspect of the PT program.

The physical therapist employs specific manual and mechanical therapeutic techniques (modalities) as called for by the diagnosis and the symptoms. The effectiveness of these modalities varies based on the condition being treated and the experience of the therapist (Coombes; Di, 2012; Di, 2013; Hutchinson; van).

Massage therapy, also known as soft tissue mobilization, is a manual method of treatment that helps restore movement and function of muscles and joints by improving circulation and eliminating metabolic toxins from muscles. In this technique, the therapist rubs the individual's muscles with massage lotion, first using broad, light strokes and then focusing on specific points of tightness or tenderness with deeper, more concentrated pressure. Treatment time can vary from 2 minutes for cross-fiber friction massage to up to 30 minutes for intensive massage therapy.

Acupressure is a manual technique in which pressure is applied to specific points on the body to relieve pain and promote balance among the physiological systems. Different acupressure points correspond to different areas of the body. For example, applying pressure to the area between the thumb and forefinger decreases headache.

Hydrotherapy utilizes whirlpools or Hubbard tanks to allow individuals to exercise in a warm, buoyant, gravity-eliminated environment. Individuals engaging in hydrotherapy are supported by the water and experience less stress through the joints, and therefore less pain. The water also provides resistance, which can help increase muscle strength.

Electrical stimulation passes electrical currents through surface electrodes to provide pain control (transcutaneous electrical nerve stimulation [TENS]) or muscle re-education (neuromuscular electrical stimulation [NMES]). TENS utilizes low-level electrical currents to block the pain message before it is perceived by the brain. NMES applies stronger electrical currents to an area of high motor nerve concentration in a muscle (motor point) to elicit a muscle contraction.

Cold therapy uses a variety of techniques to constrict blood vessels and reduce swelling. Ice packs can be applied directly to an area of increased swelling and pain for 10 to 15 minutes at a time. Vapocoolant spray is often used to numb a painful muscle prior to passive stretching to ensure a full-range stretch. Ice massage can be performed on a sprained ligament or strained tendon to numb the area before cross-friction massage is performed.

Heat treatment increases the extensibility of soft tissues, enhances blood flow, increases function of the tissue cells, and helps relieve pain. Ultrasound therapy converts electrical energy into mechanical sound waves that provide heat to deeper muscles, tendons, ligaments, and bones. Diathermy is a form of heat treatment that uses high-frequency electrical current to selectively heat the deep muscular tissues. Fluidotherapy utilizes dry heat from cellulose particles circulated by a stream of continuous air; this technique is useful for heating body parts that have an irregular surface area, such as the hand. Paraffin is also used for heating uneven surfaces of the body. It consists of a paraffin-melted wax and mineral oil that is heated to 125° F (51.7° C).

Individuals with circulatory disorders and/or cardiac and pulmonary conditions may need special attention when receiving PT; this is especially true when various forms of exercise are used.

Source: Medical Disability Advisor



Prognosis

Outcome of specific therapeutic procedures varies with diagnosis, severity of impairment, motivation, social support, and comorbidity. Some individuals may not return to their prior level of function due to inability to successfully treat the underlying condition, which may include progressive illnesses such as Parkinson's disease. However, with adaptive equipment, individuals can expect to participate in their prior activities to some degree.

Massage therapy has been shown to decrease muscle tightness, increase the flexibility of muscles and tendons, and promote healing of ligaments.

Acupressure may provide pain relief as a result of pressure applied to specific points on the body.

Hydrotherapy has been shown to promote increased range of motion and strength while decreasing stress throughout the body. Although a study found hydrotherapy to be less than effective in treating lower back pain, it is helpful in treating fractures from osteoporosis (Sinaki).

Electrical stimulation (TENS mode) has been shown to decrease pain. Muscle strength has been shown to increase when electrical impulses (NMES mode) are delivered to a muscle during therapeutic exercise to aid in muscle contraction. Another research study showed that TENS is not helpful for certain problems, such as pain in the lower back area. Other studies focused on PT and the elderly found that TENS effectively treats knee pain from surgery, such as arthroplasty of the knee.

Cold therapy has been shown to be effective in decreasing pain and swelling in an injured area.

Individuals who have pain in muscles and bones experience a positive outcome and reduction in pain from heat treatments, such as ultrasound, diathermy, fluidotherapy, and paraffin treatment.

Some studies show that hydrotherapy, TENS and ultrasound are not helpful for certain problems, such as low back pain. However, the efficacy of these therapies is debated because other studies—particularly a small study done on individuals with piriformis syndrome, a condition characterized by pain in the back and gluteal region causing traumatic sciatica—did demonstrate some improvement with ultrasound (Papadopoulos).

Source: Medical Disability Advisor



Complications

Some individuals may experience muscle soreness and/or fatigue when flexibility and/or strengthening exercises are begun. Symptoms usually subside with or without modifications to the treatment plan.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions depend on the disorder being treated. The employee will need time off for visits to the physical therapist.

Upon returning to work, the physician and therapist may advise the individual to resume work with only 4 hours a day and then slowly progress to a full workday. If lifting is required on the job, the physician may prescribe weight restrictions and require the individual to follow proper lifting techniques as instructed by the physical therapist.

Risk: Physical therapists are trained in how to approach, treat, and educate individuals with complex hand, trunk, and upper and lower limb injuries. There is always a risk of injury with therapy; however, therapy is often required to obtain maximum function.

Capacity: Capacity is one of the topics that the therapist will review with the individual as part of education and training. This education is important to assist the injured individual to understand goals, limitations, and expectations.

Tolerance: Pain is the limiting factor along with the specific injury, and tolerance is one of the topics that the therapist will review with the individual as part of education and training. This education is important to assist the injured individual to understand goals, limitations, and expectations.

Accommodations: The therapist can help with understanding of reasonable accommodations and may be able to provide adaptive aids.

Source: Medical Disability Advisor



Maximum Medical Improvement

This is a broad category making MMI difficult to provide. Please see specific diagnosis for which the physical therapy is being provided for details.

Possible range of 30 to 180 days (wide range reflecting variable conditions requiring OT).

Source: Medical Disability Advisor



References

Cited

Coombes, B. K., et al. "Effect of Corticosteroid Injection, Physiotherapy, or Both on Clinical Outcomes in Patients with Unilateral Lateral Epicondylalgia: A Randomized Controlled Trial." Journal of American Medical Association 309 (2013): 461-469.

Di, P. J. "Disability, Impairment, and Physical Therapy Utilization After Arthroscopic Partial Meniscectomy in Patients Receiving Workers' Compensation." Journal of Bone and Joint Surgery 94 (2012): 523-530.

Di, P. J. "Limited Physical Therapy Utilization Protocol Does Not Affect Impairment And Disability In Workers' Compensation Patients After Rotator Cuff Repair: A Short-Term Follow-Up Study." Journal of Shoulder and Elbow Surgery 22 (2013): 409-417.

Hutchinson, M. R. "Are We Wasting Money on Rehabilitation For Patients Receiving Workers' Compensation? Commentary on an Article by John Di Paola, MD.." Journal of Bone and Joint Surgery 94 (2012): e38.

Papadopoulos, Elias C., and Safdar N. Khan. "Piriformis Syndrome and Low Back Pain: A New Classification and Review of the Literature." Orthopedic Clinics of North America 35 1 (2004):

Sinaki, Mehrsheed. "Nonpharmacologic Interventions: Exercise, Fall Prevention, and Role of Physical Medicine." Clinics in Geriatric Medicine 19 2 (2003): 337-359.

van Middelkoop, M. , et al. "A Systematic Review on the Effectiveness of Physical and Rehabilitation Interventions For Chronic Non-Specific Low Back Pain. ." European Spine Journal 20 (2011): 19-39.

Source: Medical Disability Advisor






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