Physical Therapy Made Simple: A Fun Guide On Responsibility, Injury, Positioning, and Posture

Introduction

Among the many healthcare occupations in the medical field, physical therapy is definitely one of the cooler topics to learn about! Physical therapy, also referred to as physiotherapy, is the healthcare profession that is focused on restoring and improving movement and physical function. (National Center for Biotechnology Information) 

As taken from an article published by PROVO College, institutionally accredited by the Accrediting Bureau of Health Education Schools (ABHES), physical therapists hold the responsibility for: 

• Conducting patient assessments to evaluate and their therapeutic needs.

• Formulating a plan based on each patient’s condition and goals.

• Delivering hands-on patient care through a wide variety of modalities.

• Modifying treatment plans based on how the patient responds.  

Fun fact: Physical therapy can date back all the way to ancient Greece! The practice of using exercise, massage, and hydrotherapy to promote health and deal with injury can be awarded to Hippocrates, “The Father of Medicine” (NAPA Center)

Examples of Physical Therapist Activities

Amongst the previously mentioned work and responsibility that physical therapists (PTs) have and are expected to manage, they also have other work that includes treating people of all ages with back and neck injuries. (American Physical Therapy Association).

Patient’s therapeutic needs and individualized treatment plans will differ, as factors including age, weight, injury, etc make them unique from other patients. The most practiced activities amongst PTs in the United States, according to the U.S. Bureau of Labor Statistics, will be listed below. 

• Specific exercises to improve strength, endurance, and flexibility. 

• Gait training 

• Balance training 

• Proprioception training 

• Massage 

• Stretching 

One of the activities used by many physical therapists is positioning. Positioning, defined by physiopedia, is an “essential intervention to improve circulation, reduce oedema, and prevent the development of skin breakdown and pressure injury.” 

Fun fact: Oedema is swelling that is caused by excess fluid trapped in the body’s tissues! (Mayo Clinic)

Positioning

This tool is primarily used in physical therapy to help patients regain their control over their body by having them perform specific exercises, positions, and movements. For the most part, positioning doesn’t have limitations. Physicians just need to make sure that before delivering the treatment plans the positioning will improve their patients’ current status. PTs additionally need to take into consideration the patients’ baseline posture, source(s) of pressure, and orthopedic status when determining which kind of positioning would best help their clients. 

Fun fact:  PTs also use assistive devices with their patients! They are used to aid the patient during positioning. Some examples of these devices include splints, pillows, towels, and sleep systems. 

The table below will display common positions, their purpose, their descriptions, and their assistive devices.

Position	Description	Purpose	Assistive Devices
Fowler’s Position (Semi-sitting or Semi-recumbant)	The patient’s head of bed should be elevated to around 45-60 degrees.	Fowler's and High Fowler’s reduces aspiration and eases swallowing. This position helps the patient in many ways. It promotes lung expansion, improves tolerance of the upright position, reduces intracranial pressure, and intraocular pressure.	Pillows, foot board, profiling bed or wedge
Lateral or Side lying Position	The patient lies on one side with the top leg in front of the bottom leg with hip and knee flexed. By flexing the top hip and knee and placing this leg in front of the body, a wider, and more triangular base of support and stability will be made. This increase in flexion of the top hip and knee provides greater stability and balance for the patient.	Promotes better back alignment. This position reduces lordosis and improves body weight distribution. It decreases the severity of a patient’s sleep apnoea. Provides pressure relief for the sacrum and ischial tuberosity and heels.	Pillow and wedges
Prone Position	The patient lies on their abdomen with their head turned to one side. Hips are not flexed.	This position aids the patient’s prevention and management of hip and knee flexion contractures. Improves blood oxygenation. Drains secretions.	Pillows, face cut out on treatment surface, plinth, rotaprone devices
Reverse Trendelenburg Position	Elevate the head of bed and lower the foot of bed or tilt table with the patient’s arms to their side.	Reacclimates the patient to upright positions after a long period of time spent in bed rest. Minimizes gastroesophageal reflux.	N/A
Sim’s or Semi-Prone Position	The patient lies halfway between side lying and prone with lower arm behind and upper arm flexed at the shoulder and elbow. Their upper leg should be more acutely flexed at the hip and the knee than the lower leg.	This position prevents aspiration. It provides pressure relief for the patient’s sacrum. A position used for comfort while sleeping when pregnant.	Pillows
Standing	The patient's body held upright. Shoulders, hips, and feet aligned  with weight supported by the feet.	Improves the patient’s tolerance and endurance of the upright position. Promotes an increase of bone density and an increase of lower limb weight bearing.	Tilt tables, orthotics,  standers, body weight support systems
Supine (Dorsal Recumbent)	The patient lies on their back, anatomical position. Their head and shoulders can be slightly elevated with the use of pillows for comfort, unless contradicted.	The most commonly used position. Used to support the patient’s assessment. Recovery and rest position.	Float heels, splints, heel protectors, wedge, pillows
Trendenlenburg Position	The patient’s head should be lowered. Their foot of bed should be elevated or a tilt table with their arms to their sides.	This position promotes blood flow back to the heart. Good position for chest physiotherapy.	Tilt table, vital signs, abdomen binder

Posture

Cleveland Clinic, a worldwide healthcare system, defines posture as “the natural way you hold your body.” In other terms, posture is the way your body holds itself. It’s important to maintain good posture because it prevents aches and pains around your body by ensuring that your muscle joints, ligaments, and muscles don’t bear any excessive strain and weight. By maintaining good posture, you reduce risks of injury and improve simple organ functions such as breathing! 

Static Posture vs Dynamic Posture 

Static- How you hold your body when still (such as when you’re sitting or standing).

Dynamic- How your body remains aligned and stable during movement (such as running or walking). 

The Benefits of Good Posture

Earlier I mentioned that good posture prevents aches and strains around your body and helps improve organ function, but what else does good posture do for our bodies? 

The benefits of good posture include the following:

• Reduced back pain 

• Less headache 

• Increased confidence 

• Higher energy levels 

• Higher lung capacity 

It’s important to keep good posture! Let’s look now at what we should do to keep our bodies aligned healthily and what we should avoid in order to do this. 

ACTIVITY	DOs	DON’Ts
Sitting	Shoulders over hips. Feet flat on the floor. Low back support provided. Chin directly aligned with the chest.	Slouching. Sitting on the edge of the chair. Sitting without any support for your forearms.
Tying shoes	Place foot on the opposite knee when tying laces. Keep back straight and bend from the hips rather than the spine.	Bending too forward. Putting strain on your back.  Rounding your spine.
Sleeping	Use a pillow to support your neck. Knees slightly bent. Mattress is firm.	Sleeping in the fetal position. Pillow supports your head and not neck. Sleeping on stomach.
Getting in a car	Body is fully on the seat when sitting. Body was lowered down to the seat slowly and carefully. Make sure to use a hand to reach behind you for the back of the seat and use the other hand for the front of you.	Twist your back. Enter too quickly. Slouching.
Getting out of a car	Use support from the car frame. Take your time. Lower your legs down gently.	Pivoting your weight onto your pelvis. Twisting your back. Leaning heavily on the car door. Straining your back.

The Negative Impacts Caused by Bad Posture Over Time

If we are not careful, we can injure our backs severely over time. In fact, it is reported in an article published by Healthdirect Australia, that “Back strains happen when you pull or twist a muscle or tendon in your back.” Furthermore, Brittany Lawton reported in an article for Albany Chiropractor and Physical Therapy that poor posture can even cause major health issues along the line. An example of this includes exacerbating arthritis, also known as increased pain on muscles and joints!

Fun Fact: A task doesn’t need to be strenuous, tiring, or heavy to put strain on or expose our bodies to risk of injuries! Physiopedia reported in an article titled “Injury Prevention and Body Mechanics” that months and years of faulty body mechanics and poor posture can cause the injuries because of the wear and tear effect it has on our bodies. 

Body Mechanics

Thompson River University defines body mechanics as ‘the coordinated effort of muscles, bones, and the nervous system to maintain balance, posture, and alignment during moving, transferring, and positioning patients.”  In simpler terms, Brown University Health explains body mechanics as "the way we move during daily activities.” Proper body mechanics include maintaining proper posture, using strong leg and core muscles, having a stable base of support for your body, and maintaining neutral, aligned spinal positions. (Physiopedia) 

Different Kinds of Back Injuries 

Back injuries, reported by Dr. Mark Hosko, MD, affect many parts of the back, including muscles, ligaments, discs, and tendons! In an article for Portland Urgent Care that focuses on back injuries, he writes: “Back pain affects thousands of people every day and can lead to pain, disability, and many other complications.” Under this will be a table that includes the most common types of back injuries and injuries that fall under their specific category. 

(Information taken from Mayo Clinic)

Name of Injury	Injuries	Symptoms	Treatment
Muscle and Ligament  Injuries	Sprains, strains, myofascial pain syndrome	Swelling, limited use of joint, bruising	Heat and cold therapies, pain medication, physical therapy
Disc Injuries	Herniated Disc	Tingling, numbness, weakness	Rest, pain relievers
Vertebral Injuries	Fractures, spondylolisthesis, spinal stenosis	Difficulty with balance, numbness, paralysis	Bracing, medications, rest
Other	Soft tissue injuries, whiplash	Neck pain, stiffness	Muscle relaxations, physical therapy

Thank you so much for reading! 

Written by Gabrielle B and researched by Keegan W

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