Physical Therapy: Rehabilitation Principles, Coordination, and Collaboration

Musculoskeletal concerns account for nearly 40% of visits to primary care, and up to 20% of cases result in a referral for physical therapy. Physical therapists are independent, doctoral-level clinicians with expertise in the evaluation and treatment of musculoskeletal and neuromuscular conditions. Family physicians can effectively coordinate and collaborate with physical therapists by identifying patients for referral, using core rehabilitation principles to bridge care to physical therapy, and understanding the effectiveness of adjunctive modalities used by physical therapists to augment neuromuscular reeducation and therapeutic exercise. Slow resistance exercises are an integral part of many musculoskeletal rehabilitation programs. They are as effective as eccentric-only exercises for some conditions, are easier to describe, and require less frequency. Pain-monitoring rules are helpful in guiding treatment. Rehabilitation programs that allow for some pain have shown improvements in pain and return-to-play clearance times equivalent to those of pain-free programs. When patients do not progress with appropriate rehabilitation, physicians should assess factors that impede recovery, including suboptimal adherence, persistent mechanical overload, insufficient improvement, and inappropriate exercise prescription.