While physical rehabilitation and physical therapy are linked, and some people may even use the terms interchangeably, a few subtle differences separate them. The relationship between physical rehabilitation and physical therapy is much like the difference between rectangles and squares: all squares are rectangles, but not all rectangles are square. Likewise, all physical therapy falls under the umbrella of physical rehabilitation, while physical rehabilitation encompasses a much wider range of practices.
Physical Rehabilitation
The process of physical rehabilitation begins after someone suffers an injury or other debilitating condition. It is a combination of therapies and forms of support provided by a variety of experts. The goals of rehabilitation will depend on the ways your injury has impacted you. For something fairly minor, like a broken arm, rehabilitation will consist of regaining the use of the muscles that were immobilized in a cast while you were healing. Depending on the severity of the injury, not only do you need to rebuild the muscle, but you may need to relearn how to write or use your hand in other ways.
A more severe injury will require more intensive rehabilitation. A person recovering from a stroke is recovering from a condition that has affected multiple body systems and functions. As such, rehabilitation will target a multitude of needs, including restoring strength and mobility, relearning daily functions like eating or driving, and even regaining the ability to speak clearly. A stroke patient’s rehabilitation team will, as a result, be much larger than the rehabilitation team required by a patient recovering from a broken arm.
Settings for Physical Rehabilitation
Physical rehabilitation can be a long process. It is likely that while you are in the process of rehabilitation, your setting may change, perhaps more than once. Patients who are recovering from surgery or an injury that has required hospitalization will begin their rehabilitation process while in the hospital. Every patient who requires physical rehabilitation will begin in an “invasive” setting and move towards the “least invasive” setting over time. In this context, invasive refers to the degree of independence the patient receives in each setting.
More invasive settings include those in which care is provided around the clock, such as in hospitals or inpatient facilities. Patients have a little more independence in nursing facilities or rehabilitation clinics. From there, patients may receive care in their homes, at outpatient therapy clinics, or at work or school.
Rehabilitation Specialists
While some people use both physical therapy and physical rehabilitation to mean the same thing, physical rehabilitation is a much more general term. It refers to a group of treatments and specialists, all of which focus on specific needs. While the specialists work together to help you meet your goals, each of them approaches your recovery a little differently.
Physiatrist
Also known as a physical medicine and rehabilitation (PM&R) doctor, a physiatrist is a board-certified physician whose practice focuses on physical rehabilitation. These doctors have the same basic medical certification as a general care physician, but they also have specialized training to support the post-injury repair of the brain, spine, nerves, bones, and other tissues.
The physiatrist diagnoses and treats the medical conditions that are affecting you but also coordinates efforts among the rest of the medical professionals who will support your recovery. The physiatrist can administer some treatments that require a medical doctor as overseer
- Nerve blocks or stimulators
- Injections of steroids and other substances for pain management
- EMGs and other studies of the body systems
- Treatments for spasticity
- Biopsies of nerves and muscles
- Prescriptions for medications as well as medical equipment like prosthetics or orthotics
Chiropractor
A specialist trained in chiropractic care can support rehabilitation for conditions affecting the brain, spinal cord, nerves, bones, joints, ligaments, muscles, and tendons. Through chiropractic adjustment and other treatments, as well as training to adjust habits that may have contributed to the injury, chiropractors can help you find relief for pain and restore your body’s highest level of functioning. Those who have sought chiropractic care as part of their rehabilitation plan have enjoyed a reduced risk of repeated injury, potential avoidance of surgical intervention, and pain relief for certain conditions.
Occupational Therapist
Some people confuse the work of an occupational therapist as being related to occupation as defined by a job or career. Instead, occupations for the sake of this form of therapy are any task required for successful daily functioning. That could include toileting, bathing, cooking, and eating, fulfilling job duties, and anything else that is a part of your normal day.
Injuries can significantly impair your ability to complete these kinds of activities. If full recovery is possible, an occupational therapist will help you relearn them. However, if the injury has resulted in permanent disability, the occupational therapist’s goal will be to teach you new ways to complete those daily living activities with adaptations.
When you visit an occupational therapist, they will listen to you explain the various ways that the injury has impacted your life. Depending on your experience, it may feel embarrassing to describe some of the effects, such as on your toileting abilities. However, it is important to be as thorough and honest as possible, or else it may be difficult for you to regain the skills required to avoid embarrassment.
Just as the “occupations” that fill up our days are varied, complex, and rely on a lot of different moving parts, so does occupational therapy cover many complex, varied needs. An occupational therapist may:
- Provide sensory integration therapy
- Teach mindfulness techniques or wound management skills
- Modify activities using adaptive technology and equipment
- Modify medical equipment to address needs
- Prescribe exercises that can support and improve your balance and fine motor skills
- Make changes to your living environment to limit further injury and to increase opportunities for functional success
Speech and Language Pathologists (SLPs)
Speech and language pathologists, sometimes called speech therapists, are also board-certified professionals with specialized training in the areas of speech, language, hearing, swallowing, and cognition. Their purpose is to help with needs related to communication and safe eating and drinking. The clients that a speech and language pathologist may work with are not always in the process of rehabilitation, but some SLPs focus on that population.
As part of a physical rehabilitation team, this can include addressing physical obstacles as a result of a medical condition, such as weakened tongue muscles or deterioration of the voice box. Like occupational therapists, they can also help you relearn how to use the parts of your mouth correctly or can help modify certain needs to improve independent living skills.
If a speech and language pathologist is a part of the rehabilitation team, they may use some of the following interventions to support their patients:
- Implement an exercise routine for improving oral motor skills
- Help clients regain use of language through language drills or other communication-based treatments that will help with aphasia
- Practice conversations and other pragmatic skills involving interpersonal relationships
- Recommendations and support for Augmented and Alternative Communication (AAC)
Physical Therapists
Physical rehabilitation is the umbrella of medical care under which physical therapy is situated. It is just one part of physical rehabilitation. Its focus is on your physical needs: your strength, movement, flexibility, and mobility. Continue reading to understand the differences between the specific work of physical therapy vs. the more generalized medical area of physical rehabilitation.
Physical Rehabilitation vs. Physical Therapy
Just as occupational therapy, speech and language, and all the other branches mentioned above, physical therapy is just one area of physical rehabilitation.
Physical Therapy
While many physical therapists take a holistic approach to their work, the specialized training and focus of physical therapists is what sets them apart from other rehabilitation specialists. Like the other specialists, their goal is to help the patient restore as much of their daily function as possible. Where occupational therapists, for example, focus on fine motor skills or adapted equipment, and speech and language pathologists focus on communication, physical therapists focus on mobility and pain reduction.
Through the use of special treatments, a physical therapist is trained and board-certified to work with the rest of the rehabilitation team to regain use of gross motor skills and movement, as well as to reduce tension and other sources of pain. In their work, physical therapists may do any of the following:
- Work with the rest of the rehabilitation team to develop a treatment plan, including goals and plans for reaching them
- Introduce and ensure the regular practice of specially modified exercises and stretches to help strengthen affected areas and restore flexibility and mobility
- Modify treatments as necessary according to the progress the patient makes during treatment
Physical Therapy Interventions
There are two groups of interventions that physical therapists may use during their time with a patient. Some are passive treatments, requiring little work from the patient. Others are active treatments. Active treatments may be more difficult for those in recovery, but over time and with regular practice, active treatments are the path through which independence is truly gained.
Passive Treatments
Deep Tissue Massage
The focus of deep tissue massage is to manipulate the deeper layers of the muscles and other connective tissues. Using a combination of strokes, finger movements, and targeted pressure, a physical therapist works to release tension in specific muscles and fascia (the connective tissues between muscles). Deep tissue massage is especially helpful for injuries that result in tension that patients carry in the spine, lower back, hips, and buttocks.
Temperature Therapy
The application of both heat and cold have beneficial properties that can help with reducing pain. Some injuries reduce the blood flow in a certain area of the body, causing limited delivery of nutrients and oxygen. A physical therapist will know how to apply heat to these areas to increase the flow of oxygen and ensure that the area receives adequate nutrients. On the other hand, some injuries cause the build-up of inflammation. Applying cold to these areas will reduce circulation and thus reduce pain, swelling, and tenderness caused by inflammatory cells.
TENS (transcutaneous electrical nerve stimulation)
A TENS machine is a special tool that delivers a mild electric current with the goal of stimulating muscle tissues. A physical therapist will connect you to the machine through electrodes, which are positioned along specific pathways of the nervous system. Pulses are delivered to the nervous energy through the electrodes. These pulses can be modified according to client needs.
While TENS is a relatively new intervention, some data suggests that many people find it a helpful addition to their recovery process. Experts believe that the use of a TENS machine can reduce muscle spasms and will also cause your endocrine system to release endorphins, which are your body’s natural painkillers. TENS also helps patients reduce their use of medication to manage pain.
TENS machines can be used in a physical therapy clinic, but there are also models that can be used at home. Such devices may be covered by insurance as a medical device.
Ultrasound
Using sound waves that penetrate muscle tissues, ultrasound can create heat within the body and enhance blood circulation. Increased circulation is associated with reduced muscle spasms, swelling, stiffness, and pain. A major benefit of ultrasound is that it can reach tissues deep within the body but will not necessarily affect the layers of tissue closer to the surface.
Active Treatments
As your pain begins to subside with passive treatments, your physical therapist will work with you on strengthening the areas of your body affected by a medical condition. They will teach you a series of stretches, exercises, and breathing techniques, each of which has been specially chosen and modified according to your needs. You can rest assured that the physical therapist has also considered your level of fitness and that the exercises they choose will be gentle without increasing your pain whatsoever.
These exercises, however, are only effective as long as you practice them consistently. If you are in a more invasive setting, you may have constant support from your physical therapist to help you practice. However, in less invasive settings, you will have to make physical therapy practice a part of your routine. By doing so, you can ensure a faster rehabilitation process.
AICA for Physical Therapy and Physical Rehabilitation
If you are recovering from a medical condition and are beginning or currently in the process of rehabilitation, you can reach out to Conyers AICA to schedule your first visit with one of their expert physical therapists.