Chapter 8. The Intervention

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.

The purpose of the physical therapy intervention is 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. Normally, this is achieved with a gradual progression of strengthening and flexibility exercises, while avoiding further damage to an already compromised structure.1 For the contractile tissues, such as the muscles, this is accomplished through measured rest, rehabilitative exercise, high-voltage electrical stimulation, central (cardiovascular) aerobics, general conditioning, and absence from abuse.2 The inert structures, such as ligaments and menisci, rely more on the level of tension and force placed on them for their recovery, which stimulates the fibroblasts to produce fiber and glycosaminoglycans.3 The progression to high-functional demands or sports-specific exercises may be made, depending on the patient's requirements. For the athlete, the criteria for return to play should include no pain, full pain-free 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