"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Tuesday, October 14, 2008

Do physical therapists treat pain?

I took this table (my formatting) from Towards a Common Language for Functioning, Disability and Health to illustrate the role physical therapy plays in the ICF framework.

Note that physical therapy is an intervention at the Activity Limitation level of disability.

Most physical therapists would agree that our specific techniques are addressed towards the Impairment (strength, pain, ROM, swelling, etc.) but that our expected outcomes are at the level of the Activity Limitation.

How the ICF levels of disability are linked to three
different levels of intervention

Medical treatment
Medical care
Health promotion
ImpairmentMedical treatment
Medical care
Prevention of the
development of
further activity
Assistive devices
Personal assistance

Prevention of the
development of
Public education
Universal design
Environmental change
Employment strategies
Accessible services
Universal design
Lobbying for change

There are many ways to assess activity limitations but one of the best clinical ways to assess them is to ask your patient...

"How have you gotten better?"
Then score the patients' response on a 5-point Likert scale: 1 = no difficulty, 5 = cannot do.

Record serial measurements of their activity as you progress them through their physical therapy plan of care.

Remember, pain is an impairment level characteristic.

Physical therapy primarily treats activity limitations.


  1. Tim -

    I don't disagree that "we" as physical therapists use treatment techniques to address impairments, however I think you fail to address that altough there is a mechanical limit that can hinder function there is also that "chemistry" that also has a role in producing that pain. Not to mention the psychology of pain. Ever do a FABQ on a patient? You may address their impairment, but how does that address the fear they may have of returning to activity? Physical therapist do treat pain. However the role is much larger and it involves diagnosing the structural problem, the functional problem and the psychological barriers. Together these make up the "impairment" that the patient suffers from. Bryan Hannley PT

  2. Brian,

    Yes, I use the FABQ to assess my patients.

    Pain is an impairment in the ICF framework.

    Depending on how many years you have been practicing you may have been trained to think of impairments mainly as limitations in ROM and strength.

    However, impairments can also be emotional or mental.

    The FABQ does a nice job of quantifying the emotional component of painful movement.

    The issue I address is assessing pain primarily.

    Since pain is only one of many impairments that can lead to activity limitation it makes sense to broaden our scope and assess more than pain.

    I base my findings on chart audits of physical therapists notes that have as the 'Subjective' only statements qualifying pain and symptoms.

    We actually don't write a SOAP notes because of its classic association with symptom language.

    Instead, we ask the patient first for an 'Activity Statement' that is scored each session with a 5-point difficulty scale (similar to the OPTIMAL).

    Thanks for your response.


  3. Tim -

    I would be very interested to know what your variation from the SOAP note is (not being a fan of them myself). Where could I see an example of the OPTIMAL or your format?

    Bryan Hannley PT


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