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Physical therapy

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Background
Theory
Evidencetable
Tradition
Safety
Attribution
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  • Achilles tendon lengthening, Achilles tendon-lengthening (ATL) procedure, ACLR rehabilitation, active lumbar exercises, active physical therapy, active range of motion exercises, active ROM, acupuncture, acute ankle inversion sprains, acute care for elders, adaptive device and equipment use, adaptive devices, adjusting joint subluxations, AEH, aerosol therapy, afferent stimulation, aggressive physical therapy, aggressive spine rehabilitation, airway clearance devices, airway clearance regimens, airway suctioning, Alexander technique, allopathic medicine, ambulation exercises, Ambulation training, ambulatory physical therapy, ambulatory respiratory rehabilitation, American Physical Therapy Association, amputation alternative, analytic physiotherapy, anatomic ranges of mobility, anatomy, ancillary services, antalgic electrotherapy, applications of cold, applications of physical agents such as heat or cold, aquatic physical therapy, aquatic therapy, arm care, arterial emoblization hyperthermia, arthrographic distension, arthrolysis, arthroscopic distension, assessment, assisted coughing, assistive device and equipment use, athletic trainer, atraumatic recurrent posterior shoulder subluxation, augmented feedback, autotraction, balance, balance reactions, balance techniques training, balance training, balneology, balneotherapy, behavior-oriented physical therapy, behavioral medicine (BM) rehabilitation program, behavioral modification techniques, biofeedback, biofeedback therapy, biomechanics, Bobath, Bobath physical therapy, Bobath therapeutic exercises, body weight-supported treadmill training, botulinum toxin A (BTXA), bracing, breath therapy, breathing exercises, breathing training, bronchopulmonary hygiene physical therapy, burn rehabilitation, BWSTT, CAI simulation program, Canalith repositioning, cardiopulmonary assessment, cardiopulmonary physical therapy, cardiopulmonary physical therapists, cardiopulmonary physiology, cardiopulmonary rehabilitation, central neural blockade, cervical collar, cervical electrostimulation, cervical manipulation, cervical spinal manipulation, cervical traction, chest percussion, chest physical therapy, chest physiotherapy (CP), chest PT, chest shaking, chest vibration, chest wall oscillation, chiropractic education and technique, chiropractic health, chiropractic manipulation, chiropractic radiology education, chiropractic profession, chiropractic therapy, chiropractors, chronic disability prevention, CI therapy, CKC, classification-based physical therapy, climatology, clinic-based rehabilitation, clinic-centered rehabilitation, clinical evaluation, closed chain rehabilitation, closed kinetic chain exercise (CKC), cognitive behavioral therapy (CBT), cold agent application, cold bath, cold compress, cold therapy, combination therapy, communication, complex decongestive physiotherapy, complex physical therapy, compression bandages, compression bandaging, compression garments, compression pump, compression stockings, compression therapy, conservative therapy, Constraint-Induced Movement Therapy (CI therapy), continuous passive motion, continuous positive airway pressure (CPAP), continuous traction, controlled breathing, controlled cough, conventional chest physical therapy, conventional physical therapy procedure, coordination, coordination exercises, coordinative training, cough stimulation techniques, coughing, counter irritation, CPM, CPT, crutches, cryotherapy, cyphosis, dance, debridement of wounds and burns, deep heating agents, deep-tissue massage, diadynamic currents, diagnosis of pathology, diagnosis of musculoskeletal system functional disorders, diaphragmatic breathing, differentiated rehabilitation, DIH, direct injection hyperthermia, directed coughing, disability prevention treatment techniques, distally fixated knee extensor resistance training, documentation and coordination, dressings, Dutch low back pain guideline, dynamic exercise stress testing, eccentric exercises, education, education through repetition of functional tasks, effective listening, electric muscle stimulation, electrical stimulation, electromedicine, electromyographic biofeedback, electromyography, electrophysical agents, electrostimulation, electrotherapeutic agents, electrotherapeutic modalities, electrotherapy, EMG, energy conservation techniques training, Epley maneuver, ergonomics, evidence-based physical therapy, examination, exercise, exercise physiology, exercise prescription, exercise program, exercise therapy, exercise training, exercise treatment, exercises, exercises and physical training, extension closure, extension-mobilization, external vibrations, extracorporeal shock wave therapy, fall recovery techniques training, fear-avoidance-based physical therapy, fitness program, fitting for assistive devices, flexion closure, foot orthotics, first-contact nonphysician care, fitness, Florida Physical Therapy Association, Flutter VRP1, forced exhalation technique, forced expiratory maneuvers, French approach, French physical therapy methods, French technique, function restoring treatment techniques, functional anatomy, functional electrical stimulation (FES), Functional Independence Measure (FIM), functional limitations, functional rehabilitation, functional retraining techniques, functional training, functional training in self-care and home management, GAITRite computerized gait analysis system, galvanization, gerentological physical therapy, geriatric rehabilitation, gestural improvement of the patient (notions of ergonomics, lifting techniques), goniometry, Gross Motor Function Measure (GMFM), group balance skills, group exercises, gymnastics, hand therapist, hands-on treatment techniques, health education, heat, heat agent application, heat and cold treatment, heat therapy, HFCC, high frequency chest compression (HFCC), high-frequency chest wall oscillation, high-frequency oral airway oscillation, high-velocity thrust manipulation, hip extensors, home based rehabilitation, home-based physical therapy (PT), home rehabilitation, hospital-based physical therapist, hospital physical therapy, hospital physical therapy outpatient departments, hot pack, Hot/Ice Thermal Blanket, hydrocollator pack, hydrotherapy, hyperthermia, hypnotherapy, IH, IIH, immersive virtual reality (VR), immobilization, impulse galvanization, infrared, infrared heating, innocuous mechanical stimulation, inpatient rehabilitation programs, instructed coughing, instrumental chest physiotherapy, integumentary physical therapy, intensive cognitive rehabilitation program (ICRP), intensive passive mobilization techniques, intensive physical therapy, interference current, interferential current, internal vibrations, interrupted traction, interstitial implant hyperthermia, interventions, intracellular hyperthermia, inversion traction, iontophoresis, isoinertial trunk extensor strength, isometric trunk extensor strength, joint manipulation, joint mobilization, joint play, joint movement, joint replacement therapy, Kegel exercises, kinebalneotherapy, kinesiology, kinesitherapy, kinetic chain training, Kinetron isokinetic exerciser, Kite and Lovell technique, knee extensor resistance training, knee extensors, knee taping techniques, knowledge of functional anatomy, knowledge of results (KR), laser, laser therapy, leg extensor training, lifestyle modifications, light-therapy, lifting techniques, limb-load monitor, listening, long-duration passive stretch, low energy laser, low-frequency currents, low-intensity home-based physical therapy, low-intensity laser irradiation, lower extremity endurance training, lower extremity training, lumbar posture modification, lumbo-pelvic thrust manipulation, lymph drainage, lymphatic massage, magnetic field, magnetic field therapy, magnetically mediated hyperthermia, Maitland mobilization, manipulation, manipulation package, manipulation under joint anesthesia/analgesia, manipulative therapy, manipulative techniques, manipulative therapists, manual diagnosis, manual handling, manual interventions, manual lymph drainage, manual medicine, manual mobilization, manual physical therapy, manual techniques, manual therapy, manual therapy techniques, Masai barefoot technology, massage, massage therapists, matrix composition, McKenzie method, mechanical agents, mechanical interventions, mechanical modalities, mechanical stimulation, mechanical techniques, mechanical vibration, mechanotherapy, medium-frequency currents, mental imagery, microwave treatment, MMH, mobilization, modified constraint-induced movement therapy (mCIMT), motor function, motor program theory, motor restriction, motor training techniques, movement enhancement, movement dysfunction, movement science, movement therapy, movement treatment techniques, MUJA, multicomponent intervention, muscle relaxation training, muscle relaxation techniques, muscle strength training, muscle strength techniques training, muscle strengthening exercises, musculoskeletal exam, musculoskeletal physical therapy, musculoskeletal system functional disorders diagnosis, musculoskeletal system functional disorders therapy, myofascial release physical therapy, needle suspension, neonatal physical therapy, neurodevelopmental therapy, neurology, nerve conduction testing, neurological physical therapy, neuromodulation, neuromuscular electrical stimulation (NMES), neuromuscular physical therapy, neuromuscular stimulation, neuromuscular stretching principles, neuropsychological knowledge, nondistally fixated knee extensor resistance training, noninvasive respiratory muscle aids, noninvasive ventilation, nonoperative treatment, nonpharmacologic pain reduction, nonpharmacologic therapy, nonpharmacologic treatments, nonsteroidal agents, nonsteroidal anti-inflammatory agents (NSAIDs), nonsurgical options, nonsurgical techniques, nonsurgical treatment methods, nonthermal physical therapy, NSAID, nutrition, nutritional intervention, occupational health, occupational therapy, OKC, open kinetic chain exercise (OKC), oral airway oscillation, orthopaedic physical therapy, orthopedic appliances, orthopedic physical therapy, orthopedic sports medicine, orthotic device and equipment use, orthotics, osteopathic medicine, outpatient physical therapy, outpatient physical therapy treatment, outpatient vascular exercise, overground mobility therapy, pain reduction treatment techniques, palatal plate therapy, parenteral opioids, passive joint mobilization, passive dorsiflexion range of motion, passive modalities, passive muscle stretch tests, passive range of motion (PROM), passive range of motion exercises, passive range of motion (PROM) on intracranial pressure (ICP) and cerebral perfusion pressure (CPP), passive static principles, passive stretching, pathologic ranges of mobility, pathophysiology, patient education, patient related instruction and counseling, pediatric physical therapy, pelvic floor muscle (PFM) training, pelvic floor neuromuscular electrostimulation, pelvic floor physical therapy, pelvic physical therapy, percussion, percutaneous peripheral afferent nerve stimulation, perioperative physical therapy, pharmaceutical treatment, phototherapy, physical agents, physical diagnosis, physical examination, physical medicine, physical medicine specialists, physical modalities, physical performance test (PPT), physical rehabilitation, physical stress theory, physical therapeutic procedures, physical therapist, physical therapist assistants, physical therapist management, physical therapy care, physical therapy clinics, physical therapy consultation, physical therapy-including exercises, physical therapy intervention, physical therapy modalities, Physical Therapy Patient Simulator, physical therapy practice, physical therapy program, physical therapy services, physical therapy techniques, physiological ranges of mobility, physiology, physiotherapeutic modalities, physiotherapeutic techniques, physiotherapeutic treatment, physiotherapist, physiotherapy, pneumatic compression, Ponseti casting, pool exercises, position specific drainage and expectoration exercises, positional feedback stimulation training, positioning treatments, postoperative ambulation, postoperative pain relief, Ponseti technique, postoperative physical therapy, postoperative rehabilitation, post-stroke inpatient rehabilitation, post-stroke PT, postural drainage, postural draining, postural training, posturography, power and stamina training, preoperative PT, pressure therapy, PRET, prevention, prevention education, preventive care, PRICEMM, primary care providers, primary physical therapist, productive activities, progressive resistance exercise (PRE), progressive resistance exercise in physical therapy, progressive resistance exercise training, progressive resistance muscle strength training, progressive resistance strengthening exercises, Proliferation therapy, prolotherapy, prostheses, prosthetic device and equipment use, prosthetic rehabilitation, provision of aids and appliances, psychosocial support, PT, public school physical therapy, pulmonary function tests (PFT), pulmonary rehabilitation, pulsed magnetotherapy, pulsed ultrasound, pursed-lip breathing, quadriceps strengthening exercises, quantitative progressive exercise muscle rehabilitation program (QPE), range of motion exercises, rational physical therapy, reducing nuclear protrusion, regenerative injection therapy (RIT), regular physiotherapy, rehabilitation, rehabilitation exercises, rehabilitation program, rehabilitation specialists, rehabilitation technology, rehabilitation therapy, relaxation, remedial gymnastics, replacement therapy, respiratory exercises, respiratory medicine, respiratory physical therapy, respiratory physiotherapy, respiratory PT, respiratory rehabilitation, respiratory therapy, restoring bony alignment, robot device, safe performance techniques training, sagittal-plane mobility, sauna therapy, scar prevention and reduction, selective dorsal rhizotomy, Semont manoevre, sequential pneumatic compression, serial manipulation, short-duration passive stretch, short-duration stretch, shortwave diathermy, shoulder pendulum exercises, side-lying positions, skin care, smoking cessation, soft tissue massage, spa-therapy, spa therapy, specific therapeutic exercise, spinal cord stimulation, spinal extension, spinal flexion, spinal injury units, spinal manipulation, spinal manipulative therapy, spinal palpation, sport physiotherapy, sports medicine, squat lifting, stabilizing exercises, standard neurorehabilitation (SRP), static balance, stimulation training, strength augmentation, strength training, strengthening of rotator cuff and thoracic musculature, strength-training exercises, stroke rehabilitation, suctioning via the endotracheal tube, superficial agents, supervised outpatient physical therapy, supervised rehabilitation program, supported-sitting positions, surface EMG, task-oriented physical therapy, TENS, therapeutic exercise, therapeutic exercise program, therapeutic management, therapeutic ultrasound, therapy of musculoskeletal system functional disorders, thermal modalities, thermotherapy, three-dimensional imaging of biochemical functions, tissue adaptation, tissue stress model, total contact casting (TCC), total rehabilitative care, traction, training, transcranial electrostimulation (TCES), transcutaneous electrical nerve stimulation (TENS), transcutaneous electrical stimulation (TENS), treadmill, treadmill gait retraining, Tru-Trac traction, trunk strengthening exercise, two and three wheeled walker, three legged walker, ultrasonic diathermy, ultrasonic therapy, ultrasonography, ultrasound, ultrasound intervention, ultrasound therapy, ultrasound treatment, unilateral total knee arthroplasty rehabilitation, unsupervised home exercise knee rehabilitation program, upper extremity training, upper extremity endurance training, upper extremity strength training, US, vascular training, ventilatory muscle training, vestibular rehabilitation, vestibular rehabilitation exercises, vibration, virtual reality (VR) technology, virtual reality physical therapy, vocational rehabilitation, VR physical therapy, walking, walking backwards, water treatments, weight bearing exercises compression therapy, weight distribution, wellness program, whirlpool, wheelchairs, whole body vibration, willed-movement therapy, work reintegration, work integration.
  • Note: This monograph does not focus on evidence where physical therapy was used in combination with drugs, such as pain killers.

Background
  • According to the American Physical Therapy Association, the goal of physical therapy (PT) or physiotherapy is to improve mobility, restore function, reduce pain, and prevent further injury by using a variety of methods, including exercises, stretches, traction, electrical stimulation, and massage. Special tools are used, such as hot or cold packs, crutches, braces, treadmills, prosthetics, compression vests, computer-assisted feedback, lasers, and ultrasound. Patients range in age from newborns to the elderly.
  • Physical therapy was first documented in China around 3000 BC with the use of joint manipulation and massage to relieve pain. The ancient Greek doctor Hippocrates wrote about massage and hydrotherapy in 460 BC, and splints and exercises were used to treat wounded Roman gladiators. The modern discipline of physical therapy emerged to treat soldiers wounded in World War II.
  • Physical therapy is commonly used for musculoskeletal injuries, joint pain or disorders, low back pain, cerebral palsy, and rehabilitation after injury or surgery, including heart surgery or mastectomy. Physical therapy, especially early physical therapy, can be painful, and many patients use medications for pain during therapy.
  • In the United States, all states require physical therapists to graduate from an accredited physical therapy program and pass a licensing exam before they practice. A physical therapy program includes supervised clinical experience and coursework in biology, chemistry, anatomy, and therapeutic techniques. Physical therapists work in hospitals, clinics, nursing homes, schools, sports facilities, and patients' homes. Patients may be referred to a physical therapist by a doctor or may directly contact a physical therapist.

Theory
  • Physical therapy is tailored to the patient's condition and health issues. A common goal of physical therapy is to increase how the patient functions at home and at work.
  • Various types of physical therapy address specific problems. Musculoskeletal physical therapy uses massage and joint movement to increase strength, motor control, and flexibility. Cardiopulmonary physical therapy treats lung and heart conditions, such as cerebral palsy, asthma, and post-heart attack rehabilitation, by clearing the lungs of mucus, ventilating the lungs to ease breathing, or exercising to increase a patient's ability to move. Neurological physical therapy works to restore balance, coordination, and motor function through repeated exercises for patients with spinal injury, Parkinson's disease, Alzheimer's disease, and other brain and nerve disorders. Integumentary physical therapy uses wound cleaning, scar prevention, and scar reduction to help patients with wounds, burns, and other skin-related problems.
  • At the first visit, a physical therapist reviews medical records, examines the patient, and talks with the patient. Physical therapists may spend up to 25% of a visit speaking or listening to a patient to identify current and potential problems. Depending on the patient's health, abilities, and goals, the physical therapist outlines a treatment plan, including the anticipated outcomes and a timetable for reaching goals. The physical therapist may also conduct tests to establish a baseline, to see how much the patient improves during therapy. The patient may be instructed on exercises to do at home.
  • The American Physical Therapists Association recommends that a patient feel comfortable asking the physical therapist any questions about expectations and the proposed plan of care.
  • According to some studies, patients may not follow a physical therapist's instructions for at-home exercises or other interventions, such as shoe inserts. Although not following instructions may be due to illness or disease, not following instructions may slow or reduce progress.

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *


A variety of techniques have been used to improve incontinence (loss of urinary control), such as pelvic-floor neuromuscular electrostimulation combined with exercises, pelvic floor muscle exercises alone (Kegel exercises), vaginal cones, and vaginal balls. Outcome measures studied have included bladder volume, vaginal palpation, and perceptions of improvement. Overall, short-term improvements have been seen with pelvic floor exercises and vaginal balls. Physical therapy appeared more effective than biofeedback techniques based on one trial. Physical therapy has been shown to be an effective treatment for dysfunctional voiding in children. Higher-quality trials and comparisons with placebo are needed to confirm these results.

B


Physical therapy for osteoarthritis of the knee may provide short-term benefits, but long-term benefits do not appear better than standard treatments. Physical therapy, either as an individually delivered treatment or in a small group format, appears effective. Only one available study compared physical therapy to a sham group (subtherapeutic ultrasound) and found that a combination of manual physical therapy and supervised exercise was beneficial for patients with osteoarthritis of the knee. One method of physical therapy, infrared, short-wave diathermy-pulsed patterns and interferential therapy, showed more effectiveness than intra-articular hyaluronan drugs in two studies. One successful exercise program used a sling suspension system. More study using consistent treatment protocols and outcomes measures would be helpful.

B


Physical therapy has been used to treat a wide variety of pain syndromes including patellofemoral pain syndrome, wrist pain, post-operative pain, and chronic pain. Pain associated with athletic injuries, such as groin pain, are often treated with physical therapy. Despite some mixed evidence, there are several trials that compare physical therapy techniques to placebo controls for the treatment of patellofemoral pain syndrome that have found beneficial effects. Also, continuous low-level heat wrap therapy may be helpful in common conditions causing wrist pain and impairment. Long-term studies with more standardized outcomes measures would help make a stronger recommendation.

B


There is emerging evidence that physical therapy may be beneficial for reducing the time to heal following whiplash injury. Studies have found benefit of physical therapy and active exercises over standard of care. According to one study, manipulative treatment may shorten recovery time faster than physiotherapy treatment. Higher-quality trials with control groups would help make a stronger recommendation.

B


Physical therapy (crutches, orthoses, and eccentric exercise training) has been used in the management of pain for Achilles tendinopathy and tendon ruptures. Results are unclear. More study is needed to drawn any firm conclusions.

C


Based on limited study, the combined use of physical therapy plus a home exercise program may be beneficial in children with acute lymphoblastic leukemia. Stretching, strengthening, and aerobic exercise may improve ankle dorsiflexion active range of motion and knee extension strength. More study is warranted.

C


Several clinical trials have compared supervised group physical therapy to unsupervised daily exercises at home for the treatment of ankylosing spondylitis. Further well designed studies are needed before a firm recommendation can be made.

C


Chest physical therapy and physiotherapy breathing retraining have been studied in both children and adults to improve quality of life and improve lung function in severe and acute asthma. Early evidence is mixed. Studies often include combination treatment with drug therapy or are not well-designed, which make it difficult to assess the magnitude of benefit, if any, of physical therapy alone. More research is warranted.

C


Despite the large amount of research conducted on physical therapy cost-effectiveness and treatments for back pain (including chronic and acute low back pain, lumbar disc herniation, pregnancy-related back pain, work-related back pain), there is a lack of conclusive evidence that physical therapy is more effective than other treatments or placebo. Examples of specific techniques used include home-based exercise programs, mobilization and extension techniques, flexion exercise, breathing therapy, Masai barefoot technology, and the McKenzie method. There are questions in the literature as to whether physical therapy regimens should be tailored to fit the individual's back pain, as not all back pain is alike.

C


Supervised or home-based physical therapy has been used in combination with resistance and endurance training in physically frail elderly women taking hormone replacement therapy to improve bone density. Long-term high-intensity weight-bearing exercise programs have also been used in rheumatoid arthritis patients with some success. In premature infants, improvements were seen in weight gain, growth, bone mineral content, bone mineral density, bone area, and bone mass following physical therapy. Although early study is promising, more studies are needed in this area.

C


Patients with chronic traumatic brain injury often have gait (movement) disorders. Physical therapy techniques such as treadmill training and weight-bearing gait training have been used with mixed results.

C


Physical therapy programs are often used following mastectomy (breast cancer surgery). These may include arm mobilization, shoulder strengthening, prevention and treatment of upper extremity edema, and education about arm function. One study suggested that immediate postoperative physical therapy may increase shoulder range of motion, but more high quality trials are needed.

C


Respiratory therapy has been used in the treatment of bronchitis, and the FLUTTER device has been studied for its beneficial effects. Results are unclear and additional research is needed.

C


Physical therapy has been studied to improve peak oxygen consumption, work rate, general cardiovascular health, and distance walked during six minutes. In particular, physical therapy has been used to treat coronary syndrome X (syndrome X), which is a chronic pain disorder with exercise-induced chest pain. Early evidence is promising, but additional study is needed to make a firm recommendation.

C


Carpal bone mobilization and median nerve mobilization have both been studied for the treatment of carpal tunnel syndrome. Based on one study, no significant differences were found between treatments or compared with control groups. More study is needed in this area.

C


Children with cerebral palsy are frequently referred for physical therapy, yet the effectiveness of treatment has not been well-documented. Numerous physical therapy techniques have been used to treat movement/motor disorders associated with cerebral palsy, including hippotherapy (physical therapy utilizing the movement of a horse), sensory-perceptual-motor training, neurodevelopmental physical therapy, and functional physical therapy. Conservative physical therapy regimens have also been used in combination with electrical stimulation, infant stimulation, botulinum toxin A, and selective dorsal rhizotomy. Results are inconclusive.

C


There may be a beneficial effect of respiratory rehabilitation in terms of improved tolerance to exercise and improved quality of life for COPD patients. Studies have investigated the use of physical therapy with drugs, as well as the difference between manual and mechanical techniques; few studies have compared respiratory physiotherapy to control groups. Examples of manual respiratory physical therapy techniques include postural drainage, chest percussion, vibration, chest shaking, directed coughing, or forced exhalation technique. Higher-quality trials are needed to make a firm recommendation.

C


There is insufficient evidence in this area. Additional studies are needed before a recommendation can be made.

C


There is insufficient evidence in this area. Additional studies are needed before a recommendation can be made.

C


Various types of supervised and unsupervised physical therapy programs such as compression, cold-temperature stimuli, gymnastics, walking, and sauna have been used to improve circulation in the legs. Early evidence suggests small benefits when physical therapy is used in combination with drugs. More study is needed to make any firm conclusion.

C


Complex regional pain syndrome involves persistent pain, allodynia (light touch causing pain), and vasomotor signs. Early evidence suggests that physical therapy may have a better effect than occupational therapy or no treatment for the reduction of pain in some patients. Physical therapy, especially home-based programs, may also be more cost-effective. Additional research is needed.

C


Both manual and mechanical respiratory physiotherapies have been studied in cystic fibrosis and lobectomy patients. Results are mixed and it is unclear whether certain physical therapy shows benefits over standard drug therapy alone or over placebo treatments. More evidence is needed to clarify these findings.

C


Cystic fibrosis is a genetic disorder affecting the mucus lining of the lungs, leading to breathing problems and other difficulties. Chest physical therapy (postural drainage, percussion, and vibration) may be used to clear bronchial secretions, as well as mechanical devices, such as the Flutter valve. However, well-designed studies that compare physical therapy to placebo or other interventions are lacking. Additional research is needed in this area.

C


Based on early study, orofacial physical therapy may be beneficial in treating oral motor function, facial expression, the occurrence of malocclusions, and hypertrophic tonsils in Down's syndrome children. In addition to physical therapy, treadmills have also been used to help reduce the delay in walking onset in infants. Sensory integrative therapy, vestibular stimulation, and neurodevelopmental therapy are other techniques studied. Due to the various methods studied across trials, comparison is difficult and a firm conclusion cannot be reached at this time.

C


Facial palsy is commonly treated by physical therapy with various therapeutic strategies and devices. There is conflicting evidence of significant benefit or harm from physical therapy treatments for this condition.

C


Early study of individually tailored programs of physical therapy in the home appears promising for the reduction of falls in elderly women. More study is warranted in this area before a stronger recommendation can be made.

C


There is inconclusive evidence on whether physical therapy may help reduce cancer-related fatigue. Additional study is needed in this area.

C


Early research indicates that a self-management based program of pool exercises and education may improve the quality of life of patients with fibromyalgia and their satisfaction with treatment. In one study, physical therapy did not show better effects when compared with hypnotherapy. Better-designed trials are needed to make a firm conclusion.

C


Physical therapy has been primarily studied as a method of shortening the duration of healing time following cast immobilization of fractures. Additionally, a supervised physical therapy program has been used in children with osteogenesis imperfecta, a genetic disorder in which bones are abnormally fragile and may fracture easily. Physical therapy in this population may improve aerobic capacity and muscle force and reduce fatigue. Overall, however, the evidence is still mixed and more study is needed.

C


Intensive physical rehabilitation treatment, including passive stretching and manual mobilization (stretching group), has been compared with supportive therapy and exercises within the pain limits for the treatment of frozen shoulder. Results are inconclusive and more study is needed.

C


There is limited study of physical therapy for the treatment of Guillain-Barre Syndrome (GBS), a self-limiting autoimmune disorder that causes neuromuscular deficits. Further research is needed.

C


Physical therapy has been used to treat chronic headache, migraines, tension-type headaches, and cervicogenic headaches. Available studies have used combination treatments of standard physical therapy in addition to psychotherapy, medications, or adjusting dental occlusion. Better-designed trials of PT alone are needed before it can be recommended.

C


Both supervised and home-based exercise training can enhance exercise capacity in patients with chronic heart failure. However, there is no consensus regarding a rehabilitation program for these patients and the literature often suggests individually-tailored programs. Due to the lack of standardization, duration of treatment, and various outcomes measures, more study is needed before a firm recommendation can be made.

C


Physical therapy appears beneficial as a method of shortening the duration of healing time from hip fracture recovery after surgery, improving quality of life, or as preparation for hip replacement surgery in the elderly. Home-based programs, gait retraining programs, high vs. low-intensity programs, early vs. late interventions, and multicomponent rehabilitation have all been studied with mixed results.

C


There is little available research on the physical therapy treatment of hip pain. Mobilization and manipulation techniques have been studied. More research is needed in this area.

C


There is insufficient available evidence in this area. Additional research is needed.

C


Physical therapy has been used to treat a variety of joint problems, including chronic ankle instability, clubfoot (a birth defect of the ankle/foot), impingement syndrome, and knee, thumb, elbow, shoulder, wrist, and ankle movement disorders. Most studies stress early intervention to speed recovery, although studies that compare early intervention to later intervention, spontaneous healing, and other modalities, including sham treatments, are lacking. Better-designed trials are needed before a firm recommendation can be made.

C


Several studies have used physical therapy techniques plus passive motion to improve function, reduce pain, and improve muscle strength and range of motion for sacroiliac joint dysfunction (SIJD) and rotator cuff repair. Both video-tape and personal instruction approaches have been studied with no apparent differences in results. Additional high-quality studies are needed in this area.

C


Early evidence shows that physical therapy may be better than multivitamins for treating Kashin-beck osteoarthropathy, although results are unclear. Additional evidence is needed to make a firm recommendation.

C


Physical therapy programs such as independent home exercise, supervised exercise, and open and closed kinetic chain exercises have been studied for their effect on decreasing recovery time following anterior cruciate ligament (ACL) reconstruction or traumatic dislocation of the knee. Although studies indicate that some kind of rehabilitation and movement are beneficial, the sum of the evidence does not favor physical therapy over traditional home therapy or other treatments. Additional study is warranted.

C


Physical therapy has been used to treat complications and/or help with recovery after knee replacement surgery. Examples of treatments used include knee braces, shoe lifts, custom-fitted shoe inserts, electrical stimulation, peroneal nerve releases, and Botox® injections. Instruction in kneeling is a useful addition to physical therapy following knee replacement. Additional study is needed in this area.

C


There is inconclusive evidence in this area. Additional study is warranted.

C


Various types of physical therapy have been employed in the treatment of lymphedema, such as complex physical therapy (CPT), self home maintenance therapy (bandage/wearing of elastic garment and exercise), and pneumatic compression. No high-quality trials show benefit of these therapies over other therapies or controls. Physical therapy has also been used in combination with sodium selenite application. Additional study is needed in this area.

C


There is insufficient evidence for the treatment of multiple sclerosis with PT. Additional research is needed in this area.

C


There is insufficient evidence for the treatment of muscle atrophy with PT. Additional research is needed in this area.

C


There is insufficient evidence showing physical therapy's effect (specifically, ultrasound techniques) on reducing muscle spasticity. Additional research is needed in this area.

C


There is conflicting evidence regarding physical therapy's ability to lengthen hamstring muscles or increase hamstring flexibility. Additional research is needed in this area.

C


There is not enough evidence to support the role of physical therapy for the treatment of meralgia paresthetica (a musculosketetal condition). Physical therapy has also been suggested as a possible treatment for a genetic disorder called multiple pterygium syndrome (MPS). Additional research is needed in this area.

C


There do not appear to be any distinguishing effects on myofascial pain, tempromandibular disorders (TMJ), or function impairment in the available literature between arthroscopic surgery, arthrocentesis, and physical therapy. Most studies using physical therapy use it in combination with educational instruction. Additional study is needed to make a firm recommendation.

C


Physical therapy has been studied for various neck and shoulder pains, shoulder dysfunction, adhesive capsulitis, quadriplegic shoulder pain, acute neck pain, cervical radiculopathy, cervico-brachial pain syndrome, and shoulder impingement syndrome among other conditions. Techniques studied in combination with conservative physical therapy include gymnastics, strengthening exercises, electrotherapy, thermotherapy, massage, cervical traction, and tissue mobilization. It has been proposed that modified manipulative therapy regimens are more effective than traditional physiotherapy in reducing pain and increasing function in many of these conditions. Some studies have found short-term benefits of manual therapy over general medical care. Physical therapy has been compared with acupressure, the Feldenkrais method, and drug interventions although it is still unclear whether physical therapy is better or worse than short-term spontaneous healing or long-term healing. More high-quality studies are needed before a firm recommendation can be made.

C


There is insufficient available evidence. Physical therapy has been combined with music therapy to treat children with Erb's palsy. However, additional study is needed in this area.

C


Physical therapy has been used to treat diabetic nerve pain and chemotherapy-induced nerve pain. There is not enough scientific evidence to make a firm recommendation for this use.

C


There is insufficient evidence in this area. Additional studies are needed.

C


There is insufficient evidence in this area. Additional studies are needed.

C


Physical therapy has been used in the treatment of gonarthritis and hand, hip, and knee osteoarthritis. Manual therapy has sometimes shown better outcomes on pain, stiffness, hip function, and range of motion, although it is unclear whether sham treatment or other modalities would be comparable to physical therapy. Additional study is needed in this area.

C


Management of Parkinson's disease typically aims to obtain symptom control, reduce clinical disability, and improve quality of life. In addition to medications, physical therapy aims to improve balance, postural control, walking, and to reduce falls. Physical therapy techniques may have short-term benefits, but the available evidence is unclear. One meta-analysis indicated that physical therapy is beneficial when used in combination with medications, but the effects of physical therapy alone are unknown. Additional high-quality studies are needed.

C


There is insufficient evidence available in this specific area. Additional study is needed.

C


There is good evidence that low-intensity laser irradiation, a widespread but controversial physical therapy agent, is not an effective treatment of plantar fasciitis when compared with sham laser treatment for plantar fasciitis. Other therapies such as extracorporeal shockwave treatment have been studied, but low-quality study designs prevent a strong recommendation from being made. Additional information is needed in this area.

C


Early evidence suggests that chest physiotherapy techniques such as postural drainage, external help with breathing, percussion, and vibration are not better that receiving advice of deep breathing instructions in the treatment of pneumonia. Additional evidence is needed in this area.

C


Physical therapy with a focus on specific stabilizing exercises may be more effective than a regimen without specific stabilizing exercises in the treatment of pelvic girdle pain, functional status, and quality of life. Based on one study, there were no differences between giving patients information, doing at home physical therapy, or in-clinic physical therapy. Additional higher-quality research is needed in this area.

C


Lung hyperinflation is a technique used by physiotherapists to mobilize and remove excess lung secretions, reinflate areas of pulmonary collapse, and improve oxygenation. Studies have compared manual vs. mechanical interventions and found no differences between the two. However, studies are lacking that compare physical therapy to placebo or other interventions. Additional research is needed in this area.

C


There is insufficient available evidence in this specific area. Additional studies are needed.

C


Physical therapy has been used during cardiac rehabilitation with or without beta-blocker medication. More research is needed in this area to draw a firm conclusion.

C


One-on-one physical therapy has been compared to structured social visits for geriatric rehabilitation. Home-based physical therapy programs have also found modest benefits in walking, bathing, upper- and lower-body dressing, transferring from a chair, using the toilet, eating, and grooming in elderly patients. Early evidence does not show a strong benefit of physical therapy. More studies are needed in this area.

C


Patients with chronic vestibular disorders typically have complaints of unsteadiness, imbalance, and/or motion intolerance. Various types of rehabilitation have been tried, although vestibular rehabilitation, a specific approach to physical therapy aimed at reducing dizziness and imbalance by facilitating central nervous system compensation for peripheral vestibular dysfunction, has been used the most. Results are generally positive, but more well-designed studies are needed before a firm conclusion can be drawn.

C


Several studies have indicated that treatment of rheumatoid arthritis should be conducted by a specially trained physical therapist and that physical therapy may help improve morning stiffness and grip strength. A long-term high-intensity exercise program has been suggested by some, and beneficial effects may last up to one year. Despite promising early evidence, better-designed studies are needed to draw a firm conclusion.

C


There is not enough available evidence. Additional study is needed in this area.

C


Early evidence suggests that high voltage stimulation or pulsed electrical stimulation may speed the healing of some types of skin ulcers. More research with similar outcomes measures is needed to confirm these findings.

C


There is insufficient available evidence supporting a role for physical therapy in improving spinal mobility, treating chronic spine disorders, or in treating myelomeningocele. Additional study is needed.

C


Physical therapy has been studied to reduce the healing time of acute ankle ligament sprains and acute hamstring sprains. Certain aspects of physical therapy, such as progressive agility, trunk stabilization exercises, and icing, may be more beneficial than static stretching, but results are unclear. More large studies of higher-quality are needed.

C


Physical therapy has been used with biofeedback training to enhance strength in patients with foot drop (a birth disorder where the foot is twisted out of shape or position), and has also been used in elderly patients recuperating from acute illnesses. Well-designed studies are needed before a recommendation can be made.

C


Physical therapy is a popular choice for patients undergoing stroke rehabilitation. It aims to strengthen weakened muscle groups through repetitive motion, increase overall function including cognitive function, and improve gait and walking. Available studies have used a variety of exercises, which makes it nearly impossible to compare the evidence. Furthermore, physical therapy is often used as a control group in these studies and rarely do studies find a significant difference between physical therapy and other interventions. Higher quality studies are needed to make a firm recommendation.

C


Many studies have shown that when physical therapy is used before or immediately after a long period of immobilization, such as bed rest associated with hospitalization, the result is a shorter overall hospital stay with fewer complications. Physical therapy techniques are often used following cardiopulmonary bypass surgery, abdominal surgery, and other surgical procedures, as well as for the prevention of pulmonary complications. Several studies do not show any difference between various chest physiotherapy treatments, such as incentive spirometry, intermittent positive pressure breathing (IPPB), or deep breathing exercises. Overall, it is difficult to compare treatment outcomes across the various studies.

C


Posterior tibial tendon dysfunction is a relatively common problem of middle-aged adults that usually is treated operatively. One study suggested that early stages of tendonopathies could be effectively treated nonoperatively with an orthosis and structured exercises. Aside from orthosis, exercise, stretching, and extracorporeal shock wave therapy may be of use for tendonitis of the shoulder. Additional research is needed in this area.

C


Lateral epicondylitis (commonly known as tennis elbow) is one of the most common upper extremity pain syndromes. Compared with corticosteroid injections, physical therapy appears less effective for treating tennis elbow, but studies are mixed and a firm recommendation cannot be made at this time. Physical therapy techniques such as cold pack use, progressive strengthening, or stretching exercises may be helpful for reducing the recurrence of symptoms. Studies using extracorporeal shock wave therapy or low-frequency electrical stimulation found conflicting results.

C


There is insufficient available information on physical therapy as a treatment for thyroiditis. Additional study is needed before a recommendation can be made.

C


There is limited study on the effects of physical therapy in tinnitus. One study found that acupuncture showed more benefit on reducing the severity of tinnitus and improving quality of life than physical therapy. More study is needed in this area.

C


Physical therapy has been used to treat vertigo (specifically, benign paroxysmal positional vertigo). Physical therapy protocols are not well outlined, and there is limited study comparing physical therapy vs. other modalities. Nevertheless, physical therapy may be helpful for vertigo but more study is needed to make a firm recommendation.

C


Physical therapy techniques such as laser treatment have been used to clean and heal wounds. More research is necessary prior to physical therapy being recommended for this use.

C


Physical therapy does not appear to help motor performance in infants born very preterm with very low birth weight. Besides the lack of benefit, available studies show a risk of causing fractures in preterm infants.

D
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)


Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

  • Abscess, acute infections, acute myocardial infarction, allergy, amenorrhea (lack of menstrual period), amputation, amyotrophic lateral sclerosis (ALS), angina (chest pain), angioma (angioma in childhood), arterial emboli, arthritis (bacterial suppurative, osteonecrosis (humeral head)), arthrogryposis, artificial heart transplant, ataxia (early onset), axillary node dissection, balance disorders (mal de debarquement syndrome), bladder disorders (cystitis), blood disorders (Gaucher disease), bone disease (algodystrophy, aseptic necrosis), breathing problems (hyperventilation), burns, bursitis, cancer, collagen-vascular disease, connective tissue disorders, contusions, de Quervain's disease, deconditioning, dermatitis (chronic), diabetes, diabetic complications (muscle infarction, myonecrosis), dialysis, DiGeorge anomaly, drug addiction, drug penetration (percutaneous), Duchenne muscular dystrophy (DMD), dyspareunia (pain with intercourse), dysphagia, dystonia, ear pain (middle ear effusion (MEE)), eating disorders, edema (bone marrow edema syndrome (BMES), idiopathic), elderly housing transition, epilepsy, exercise-induced asthma, fetal development, fever, gastroesophageal reflux disease (GERD), general health maintenance (overall fitness and health), genital disorders (induratio penis plastica (IPP)), gynecologic disorders, hair growth (hirsutism), hearing damage, heel spur, hemophilia, hemorrhage, herpes zoster, Hodgkin's disease, hormonal imbalances (hyperandrogenism), iliotibial band friction syndrome (ITBFS), impetigo, infant development/neonatal care (neonatal assessment), inflammation, inflammatory bowel disease, inflammatory conditions, intermittent claudication, interstitial cystitis, intractable cervical dystonia, Legg-Calve-Perthes disease, leprosy (Hansen's disease), limb lengthening, lyme disease, malaria, mother-child interactions, muscle pain (delayed onset muscle soreness (DOMS)), muscle weakness (postpolio syndrome (PPS)), myopathy, neuromuscular disorders (neuromuscular diseases (chronic), neuromuscular ventilatory failure), obesity, obstetric and gynecological disorders (obstetric brachial palsy, obstetrical paralysis), osteochondrosis, osteoporosis, pancreatitis, paralysis, pelvic floor dysfunction, pelvic lymphadenectomy, percutaneous cervical nucleoplasty, perianal hidradenitis suppurativa, pericranial muscle tension, peripheral enthesitis, pes planus (adult acquired flat foot deformity), Peyronie's disease, physical work capacity (work-injured patients, work-related upper extremity disorders), piriformis syndrome, plagiocephaly, Pompe disease, postherpetic neuralgia, postpartum discomfort, post-polio pain, posttraumatic dystrophy, postural stability, pre-arthritic deformities, promoting flow of breast milk, psychiatric disorders (catatonic syndrome), pulmonary embolism, Pusher syndrome, recalcitrant achillodynia (chronic), recovering from head trauma, relaxation in chronic obstructive pulmonary disease, renal failure, renal impairment, respiratory disorders (mitochondrial encephalomyopathies, respiratory function after gallbladder removal, oxygen transport deficits, rheumatic diseases (juvenile dermatomyositis), scar healing, scleroderma, scoliosis, sensory disturbances (paresthesias), sexual dysfunction, shin splints, sinusitis, Sjogren's syndrome, skin graft healing, sleep disorders (obstructive sleep apnea (OSA)), spinal cord injury (Brown-Sequard syndrome), sports injuries, stress/stress-related problems, Sudeck's dystrophy, suicide prevention, swelling (fingers, dactylitis), systemic sclerosis, teething (bruxism (grinding of the teeth)), thrombosis, tooth disease, torticollis (congenital muscular (CMT)), trauma, varicose veins, vein clots (deep venous thrombosis), vulvodynia, weight loss, Wilson's disease.

Safety

Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

  • Physical therapy techniques have been used in adults, children, and the elderly for a wide variety of conditions. Due to the many kinds of techniques used by physical therapists and multiple conditions treated, this section only provides selected examples of adverse effects and is not a comprehensive list. Due to malpractice concerns, it is possible that not all adverse effects have been reported in the available literature.
  • Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with a qualified healthcare professional before beginning any treatments. Based on the available literature, physical therapy appears generally safe when practiced by a qualified physical therapist. However, complications are possible. Treatment options should be considered carefully. Based on one large study, there were no reported adverse events resulting from the physical therapists' diagnoses or management during a 40-month period.
  • There is considerable study investigating whether physical therapy should be initiated immediately or following a waiting period. For example, patients who return to physical therapy after a deep vein thrombosis are more likely to develop a pulmonary embolism than patients who return later (no sooner than 48 to 72 hours). In contrast, it is thought that keeping areas immobilized for long periods of time may also carry risk factors.
  • Physical therapy is often used in patients recovering from surgery whose postoperative pain may be severe. This can complicate early physical therapy. Pain medications may be given, which in turn may carry risk factors for anti-inflammatory-drug- or aspirin-induced gastrointestinal complications. However, physical therapy interventions may alter absorption and distribution of drugs that are administered transdermally (through the skin), subcutaneously (under the skin), or intramuscularly (injected into the muscle). Medication adjustments may be necessary.
  • Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the physical therapy literature although causality is unclear. Erectile dysfunction has also been reported.
  • Chest physical therapy, among other kinds of physical therapy, may increase metabolic rate, oxygen consumption, heart rate, and blood pressure. Repetitive exercises can have cardiovascular effects. A patient's cardiac and pulmonary risk factors should be assessed to determine whether heart rate and blood pressure should be monitored. Moreover, the physical therapy method of inversion (placing the heart above the head) may increase blood pressure (both systolic and diastolic). Caution is advised when using inversion as a treatment technique for low back pain. Patients with high blood pressure may need to avoid this technique.
  • In some very low birth weight premature infants and young children, physical therapy techniques, such as passive motion and chest percussion therapy, may increase the likelihood of bone fractures.
  • In the elderly, walking backwards during physical therapy has resulted in falls and considerable morbidity. Safety precautions are advised when performing challenging tasks in populations with risk factors.
  • Hemophilia A patients may have a greater bleeding risk after blood transfusion when physical therapy is started within eight hours of a blood transfusion.
  • Physical therapy has been used in pregnancy, specifically to treat women with pelvic girdle pain during pregnancy, and at three, six, and 12 months postpartum. Reports of major adverse effects are lacking in the available literature, but caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.

Attribution
  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Ahlqwist A, Hagman M, Kjellby-Wendt G, et al. Physical therapy treatment of back complaints on children and adolescents. Spine 2008 Sep 15;33(20):E721-7.
  2. Anttila H, Autti-Rämö I, Suoranta J, et al. Effectiveness of physical therapy interventions for children with cerebral palsy: a systematic review. BMC Pediatr 2008 Apr 24;8:14.
  3. Bassett SF, Prapavessis H. Home-based physical therapy intervention with adherence-enhancing strategies versus clinic-based management for patients with ankle sprains. Phys Ther 2007 Sep;87(9):1132-43.
  4. Bellamy SG, Gibbs K, Lazaro R. Physical therapy intervention for an adolescent with a knee flexion contracture and diagnosis of multiple pterygium syndrome. Pediatr Phys Ther 2007 Summer;19(2):140-7.
  5. Castillo RC, MacKenzie EJ, Archer KR, et al. Evidence of beneficial effect of physical therapy after lower-extremity trauma. Arch Phys Med Rehabil 2008 Oct;89(10):1873-9.
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  7. Demirtürk F, Akbayrak T, Karakaya IC, et al. Interferential current versus biofeedback results in urinary stress incontinence. Swiss Med Wkly. 2008 May 31;138(21-22):317-21.
  8. Dumoulin C, Hay-Smith J. Pelvic floor muscle training versus no treatment for urinary incontinence in women. A Cochrane systematic review. Eur J Phys Rehabil Med. 2008 Mar;44(1):47-63.
  9. Hellweg S, Johannes S. Physiotherapy after traumatic brain injury: a systematic review of the literature. Brain Inj. 2008 May;22(5):365-73.
  10. Rauscher L, Greenfield BH. Advancements in contemporary physical therapy research: use of mixed methods designs. Phys Ther. 2009 Jan;89(1):91-100.
  11. Reza Nourbakhsh M, Fearon FJ. An alternative approach to treating lateral epicondylitis. A randomized, placebo-controlled, double-blinded study. Clin Rehabil. 2008 Jul;22(7):601-9.
  12. Roche G, Ponthieux A, Parot-Shinkel E, et al. Comparison of a functional restoration program with active individual physical therapy for patients with chronic low back pain: a randomized controlled trial. Arch Phys Med Rehabil 2007 Oct;88(10):1229-35.
  13. Teixeira LJ, Soares BG, Vieira VP, et al. Physical therapy for Bell s palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2008 Jul 16;(3):CD006283.
  14. van Vlimmeren LA, van der Graaf Y, Boere-Boonekamp MM, et al. Effect of pediatric physical therapy on deformational plagiocephaly in children with positional preference: a randomized controlled trial. Arch Pediatr Adolesc Med. 2008 Aug;162(8):712-8.
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Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.


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