| ICD-9-CM: |
| 93.0 - | Physical Therapy |
| 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 |
| 93.1 - | Physical Therapy Exercises |
| 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 |
| 93.2 - | Physical Therapy Musculoskeletal Manipulation, Other |
| 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 |
| 93.3 - | Physical Therapy Therapeutic Procedures, Other |
| 93.31 - | Pool Exercise, Assisted |
| 93.32 - | Whirlpool Treatment |
| 93.33 - | Hydrotherapy, Other |
| 93.34 - | Diathermy |
| 93.35 - | Heat Therapy, Other; Acupuncture with Smoldering Moxa; Hot Packs; Hypothermia NEC; Infrared Irradiation; Moxibustion; Paraffin Bath |
| 93.36 - | Cardiac Retraining |
| 93.37 - | Prenatal Training; Training for Natural Childbirth |
| 93.38 - | Physical Therapy, Combined, without Mention of the Components |
| Physical therapy (PT) is the 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. Physical therapy is practiced in hospitals, rehabilitation centers, private offices of physical therapists, extended-care facilities, home health agencies, special diagnostic clinics in outpatient treatment centers, academic institutions, fitness and wellness centers, and research centers.
Physical therapy as a profession has been recognized in the US for 75 years. The profession began with a focus on the rehabilitation of individuals from diseases such as polio. Since then, physical therapy has branched out from traditional areas such as orthopedics and neurology into areas like women's health, ergonomics, and cardiopulmonary disease. Physical therapy 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 equipment such as crutches and prosthetic limbs.
Physical therapy uses a wide variety of techniques, ranging from soft tissue massage to acupressure, to help restore and improve flexibility of muscles, tendons, and joints. Physical therapy also uses various techniques for soft tissue healing, such as hydrotherapy, electrical stimulation, application of cold or heat through the use of shortwave diathermy, microwave, and ultrasound. Therapeutic exercise is an important part of physical therapy, helping to strengthen muscles and joints weakened by disease and injury. |
Source: Medical Disability Advisor
| The goal of physical therapy is to enhance human movement and function and to assess, prevent, and treat movement dysfunction and physical disability. Many individuals are advised to obtain physical therapy services while recovering from surgery, accidents, and illnesses. Physical therapy 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 from musculoskeletal dysfunction associated with pain, edema, weakness, fatigue, and tissue degeneration.
Physical therapy is used to preserve normal joint motion in burn victims. It is used in spinal cord injuries to optimize function and strength of paralyzed or weak limbs, and with stroke victims to help restore ordinary life skills. Cancer patients use physical therapy to build strength and relieve discomfort. 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
| In general, physical therapy begins with a specific diagnosis and a referral from a physician, often accompanied by recommendations for particular treatments. 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 physical therapy.
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 ultrasound. Once pain and swelling have subsided, the therapy will move to a focus on returning range of motion and strength. 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 up to the date of discharge. Patient education is an important aspect of the physical therapy program.
The physical therapist employs specific manual and mechanical therapeutic techniques as called for by the diagnosis and the symptoms.
Massage therapy is a manual method of treatment that helps restore movement and function of muscles and joints by improving circulation and eliminating metabolic toxins stored within 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-friction massage to up to 1 hour 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 (TENS) or muscle re-education (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 massages 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 muscle, tendons, ligaments, and bone. 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 physical therapy. This is especially true when various forms of exercise are used. |
Source: Medical Disability Advisor
| Outcome 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.
Outcomes of specific therapeutic procedures may vary among individuals. 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.
Individuals who have pain in muscles and bones experience a positive outcome and reduction in pain from heat treatments, such as diathermy, fluidotherapy, and paraffin treatment.
Some studies do show, however, that hydrotherapy, ultrasound and TENS are not helpful for certain problems, such as low back pain. The efficacy of these therapies is debated, however, because other studies—particularly a small study done on patients with Piriformis syndrome, a condition characterized by pain in the back and gluteal region causing traumatic sciatica—did demonstrate some improvement with ultrasound (Papadopoulos).
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, however, focused on physical therapy 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.
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). |
Source: Medical Disability Advisor
| 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
| 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. |
Source: Medical Disability Advisor
| 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): MD Consult. Elsevier, Inc. 7 Oct. 2004 <http://home.mdconsult.com>.Sinaki, Mehrsheed. "Nonpharmacologic Interventions: Exercise, Fall Prevention, and Role of Physical Medicine." Clinics in Geriatric Medicine 19 2 (2003): 337-359. MD Consult. Elsevier, Inc. 7 Oct. 2004 <http://home.mdconsult.com/das/journal/view/44885742-2/N/14008702?sid=341972512&source=MI>. |
Source: Medical Disability Advisor
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