Physical Therapy (Physiotherapy)

Overview

Physical therapy (physiotherapy) may be used as a non-surgical treatment that combines targeted exercise, hands-on techniques, education, and physical modalities to improve movement and function. It can be considered for musculoskeletal injuries, post-operative rehabilitation, neurologic conditions, balance problems, and chronic pain syndromes. Outcomes often include improved strength, flexibility, endurance, balance, and activity tolerance, with pain reduction that can vary by condition and individual factors. A plan of care typically spans multiple visits over weeks to months and may include a home program to support progress between sessions.

Indications

This procedure may be considered when:

• •Low back pain or neck pain, including mechanical pain patterns and activity-related symptoms
• •Osteoarthritis and other degenerative joint conditions that can limit mobility and function
• •Post-operative rehabilitation after orthopedic procedures (e.g., joint replacement, ligament reconstruction) when prescribed as part of recovery
• •Sports or overuse injuries (e.g., tendinopathy, sprains/strains) with strength, flexibility, or load-tolerance deficits
• •Neurologic conditions (e.g., stroke, Parkinson disease, multiple sclerosis) that may affect gait, balance, and motor control
• •Balance disorders and fall risk in older adults, including deconditioning and vestibular-related dizziness when appropriate
• •Work-related or repetitive strain conditions that can benefit from ergonomic training and graded activity

How It Works

The procedure typically involves several coordinated steps:

• •Clinical evaluation typically identifies impairments (e.g., limited range of motion, weakness, altered motor control, pain sensitivity) and links them to functional limitations.
• •Goal setting generally uses measurable outcomes (e.g., walking distance, stair tolerance, sit-to-stand performance, joint range) and patient-reported measures when available.
• •Therapeutic exercise can apply progressive overload principles to improve muscle strength and tendon capacity, often using graded resistance and volume progression.
• •Mobility interventions may target joint and soft-tissue extensibility through stretching, active range-of-motion work, and manual techniques to reduce stiffness and improve movement options.
• •Neuromuscular re-education can emphasize coordination, proprioception, and motor learning via task-specific practice and feedback to refine movement patterns.
• •Pain modulation may occur through multiple mechanisms, including improved tissue tolerance, reduced threat perception, and short-term symptom relief from modalities in selected cases.
• •Gait and functional training typically uses repetitive practice of meaningful tasks (e.g., transfers, stairs, lifting, reaching) to improve efficiency and confidence.
• •Balance and vestibular-focused therapy may use habituation, gaze stabilization, and postural control exercises to reduce dizziness and improve stability when appropriate.
• •Manual therapy can be used to address mobility restrictions and symptom irritability, often paired with exercise to support longer-term functional change.
• •Education typically covers pacing, activity modification, ergonomics, and self-management strategies that can support adherence and reduce recurrence risk.
• •Progression generally is guided by symptom response, objective re-testing, and functional milestones, with adjustments to intensity, frequency, and complexity.
• •Discharge planning often includes a long-term maintenance program and criteria for return to work, sport, or higher-level activities based on function and tolerance.

Risks

As with any surgical procedure, potential risks include:

• •Temporary symptom flare or increased soreness after exercise progression or manual therapy, often resolving over a short span
• •Muscle strain or tendon irritation if load progression exceeds current tissue tolerance, particularly with high-intensity strengthening or plyometrics
• •Joint irritation or increased inflammation in irritable arthritic conditions when activity volume increases too quickly
• •Dizziness, nausea, or imbalance during vestibular or balance training, particularly early in habituation-based programs
• •Skin irritation or burns with heat/cold or electrical stimulation modalities if parameters or skin sensitivity are not well matched
• •Bruising or tenderness after soft-tissue techniques, including instrument-assisted methods, especially in people with fragile skin
• •Falls during gait or balance training in higher-risk individuals, particularly without appropriate guarding or assistive devices
• •Nerve irritation symptoms (e.g., tingling, radiating pain) during certain movements or mobilizations in susceptible conditions
• •Delayed recognition of a non-musculoskeletal cause of symptoms if warning signs are subtle, which can require medical evaluation and care coordination

Recovery Expectations

Recovery follows a gradual progression:

• •Initial evaluation and plan of care development typically occurs during the first visit, with baseline measures recorded the same day.
• •Early symptom modulation and movement confidence may improve over a span of 1–3 weeks for some acute conditions, although variability is common.
• •Strength and endurance gains often require a span of 6–12 weeks of progressive exercise, depending on starting fitness and condition severity.
• •Post-operative rehabilitation commonly spans several weeks to months, with milestones generally aligned to surgical protocols and tissue-healing constraints.
• •Return to higher-demand activities (e.g., running, heavy lifting, sport) may require a span of 8–24+ weeks in many cases, depending on injury type and functional testing.
• •Home exercise adherence and activity pacing often influence the span of recovery, with periodic reassessment used to adjust progression.
• •Discharge from supervised therapy typically occurs when functional goals are met or progress plateaus, with a maintenance program often continued over an ongoing span.
• •Recurrence prevention commonly involves continued conditioning and ergonomic or technique changes over a longer span, particularly for chronic or recurrent conditions.

Alternatives

Depending on individual circumstances, alternatives may include:

• •Watchful waiting and activity modification with self-directed gradual return to activity for selected mild conditions
• •Medications for pain or inflammation as part of clinician-directed care, when appropriate for the condition
• •Injections (e.g., corticosteroid injections in selected inflammatory conditions) when clinically indicated
• •Occupational therapy for upper-extremity function, activities of daily living training, and adaptive strategies
• •Chiropractic or osteopathic manipulation in selected musculoskeletal conditions, depending on patient factors and local practice
• •Psychological or behavioral pain management approaches (e.g., cognitive behavioral therapy) for chronic pain and disability
• •Surgical evaluation and operative management for structural problems that do not respond to conservative care or that have urgent features

Sources

• Mayo Clinic - Back pain: Physical therapy and exercise (Conservative care overview)
• Cleveland Clinic - Physical Therapy (What it is and what to expect)
• AAOS OrthoInfo - Physical Therapy for Orthopedic Conditions (Rehabilitation overview)