All Physical Therapy is not the same

By: Dale J. Buchberger, PT, DC, CSCS, DACBSP

All physical therapy is not the same. It is common to hear statements like, “I’ve tried physical therapy and it didn’t work”. This statement implies that the individual believes that all physical therapy and all physical therapists are the same, having tried just one and failed. The truth is that there are many specialty areas in the field of physical therapy, and many different types of physical therapists that have different schools of thought. While this is well known in the physical therapy profession, the general public commonly overlooks it. There are several common specialty areas in physical therapy, as well as sub-specialties within each specialty.


Orthopedic physical therapists diagnose, manage, and treat disorders and injuries of the musculoskeletal system. They also help people recover from orthopedic surgery. This specialty of physical therapy is commonly found in the ambulatory outpatient clinical setting. Orthopedic physical therapists are trained in the treatment of post-operative sports injuries, arthritis, and amputations, among other injuries and conditions.  Joint mobilizations, strengthening exercises, hot and cold packs, and electrical stimulation are often used to help speed recovery. Manual therapy is a sub-specialty of orthopedic care and involves joint mobilization, joint manipulation, and advanced soft tissue techniques, such as Active Release Techniques (ART) and Instrument Assisted Soft Tissue Mobilization (IASTM). These various soft tissue techniques are helpful in treating chronic and post-operative scar tissue. Some physical therapists focus more on modalities (hot/cold packs, ultrasound, electrical stimulation), while others focus more on manual therapy; therefore, not all orthopedic physical therapists are the same! Those who have suffered injury or disease affecting the muscles, bones, ligaments, or tendons of the body may benefit from assessment and treatment by a physical therapist specialized in orthopedics or manual therapy. If one particular therapist did not help your condition, you might consider trying another one who uses different techniques. I am a firm believer in the definition of insanity:  you can’t keep doing the same thing and expect a different result!


Geriatric physical therapy covers numerous issues concerning people as they go through the normal adult aging process. These include (but are not limited to) arthritis (degenerative joint disease), osteoporosis, cancer, Alzheimer’s disease, joint replacements, balance problems, and incontinence (a sub-specialty of physical therapy specializing in pelvic floor disorders). Physical therapists specializing in the care of the geriatric patient develop individualized programs to help restore mobility, reduce pain, and improve general fitness. This may also include learning to use assistive devices, such as canes or walkers. Geriatric physical therapy may take place in an outpatient setting, an inpatient (hospital or rehabilitation facility) setting, or if necessary a patients home.


Neurological physical therapists work with individuals who have a neurological disorder or disease. These include Alzheimer’s disease, ALS (Lou Gehrig’s disease), brain injury, cerebral palsy, multiple sclerosis, Parkinson’s disease, spinal cord injury, and stroke. Common symptoms associated with neurological disorders include paralysis, vision impairment, poor balance, difficulty walking, and the inability to function independently. Physical therapists work with patients to reduce these functional deficits and improve their quality of life. Neurological physical therapists typically work in a hospital or rehabilitation facility. Once a patient is independent in activities of daily living they can receive treatment at an outpatient facility.


Cardiovascular and pulmonary rehabilitation physical therapists treat a wide variety of people with cardiopulmonary disorders, including those who have had cardiac or pulmonary surgery. One of the main goals of physical therapy in cardiac rehabilitation is to gradually and safely increase your activity level. While you are in the hospital, the physical therapist will work with you to improve your endurance and functional independence. Once you are discharged from the hospital, you will attend outpatient cardiac rehabilitation for a period of time. Physical therapists in this setting will help you regain a level of fitness that can return you to your previous level of activity.


Pediatric physical therapy assists in early detection of health problems as well as the diagnosis, treatment, and management of infants, children, and adolescents with a variety of injuries, disorders and diseases that affect the muscles, bones, and joints. The physical therapist can incorporate many intervention approaches, including stretching, massage, mobilization, strengthening, and endurance training to enhance the child’s capabilities and prevent deformities and contractures. Treatments can also focus on improving gross and fine motor skills, balance and coordination, strength and endurance, as well as cognitive and sensory processing and integration. Children with developmental delays, cerebral palsy, spina bifida, autism, and torticollis are just a few of the patients that can benefit from treatment by a pediatric physical therapist.


Remember, it’s your right as a patient to choose which physical therapist you want to see!