CHAPTER 8: The Intervention

CHAPTER OBJECTIVES

At the completion of this chapter, the reader will be able to:

1. Understand and describe the principles of a comprehensive rehabilitation program during the various phases of healing.

2. Discuss the various components of the intervention and their respective importance.

3. List the clinical tools that can be used to decrease pain and inflammation and promote healing.

4. Discuss the intrinsic and extrinsic stimuli that can be used to promote and progress healing.

5. Describe the benefits of each of the electrotherapeutic modalities.

6. Describe the benefits of each of the physical agents and mechanical modalities.

7. Understand the rationale for the therapeutic techniques used in each of the three stages of healing.

8. Understand the importance of patient education.

OVERVIEW

Intervention is organized into three categories¹:

1. Remediation. Consists of enhancing skills and resources or reversing impairments and assumes that the potential for change exists in the system and the person.

2. Compensation or adaptation. Refers to the alteration of the environment or the task and is the approach taken when it is determined that remediation is not possible.

3. Prevention. Refers to the management of anticipated problems.

The purpose of the physical therapy intervention is to prevent any anticipated problems whenever possible, and to safely return a patient to his or her preinjury state, with as little risk of reinjury as possible and with the minimum amount of patient inconvenience. The latter is normally achieved by reducing inflammation followed by a gradual progression of strengthening and flexibility exercises while avoiding damage to an already compromised structure.² For muscles and tendons, this is generally accomplished through measured rest, physical therapy procedures and techniques including, manual therapy, high-voltage electrical stimulation, central (cardiovascular) aerobics, resistance exercises and general conditioning, while avoiding compromise to the healing structures. For the inert structures, such as ligaments and menisci, more emphasis is placed on controlling the level of tension and force placed on them to stimulate the fibroblasts to produce fiber and glycosaminoglycans.³ Beyond the healing phase, the progression may include advancing to high-functional demands or sports-specific exercises, depending on the patient’s requirements. For the athlete, the criteria for return to play should include no pain, full pain-free range of motion (ROM), normal flexibility/strength/balance, good general fitness, normal sports mechanics, and demonstration of sports-specific skills.⁴

According to the “Guide to Physical Therapist Practice,”⁵ an intervention is “the purposeful and skilled interaction of the physical therapist and the patient/client and, when appropriate, with other individuals involved in the patient/client care, using various physical therapy procedures and techniques to produce changes in the condition consistent with the diagnosis and prognosis.”

Three components comprise the physical therapy intervention: coordination, communication, and documentation; patient/client-related instruction; and direct interventions (Box 8-1).⁵