Do You Need Physical Therapy or Occupational Therapy?

One common question that people with upper extremity injuries have is, "Do I need physical therapy or occupational therapy?" Occupational therapists and physical therapists seem to do similar things. They both help people recover function after injury or illness. So what is the difference between physical therapy and occupational therapy? If you have an upper extremity injury, should you see a PT or an OT?

The American Physical Therapy Association (APTA) defines physical therapy as "movement experts who optimize quality of life through prescribed exercise, hands-on care, and patient education." Physical therapists help people move better and feel better after injury, surgery, or illness. They use a variety of exercise techniques and physical modalities to decrease your pain, improve range of motion (ROM), strength, balance, and endurance.

A physical therapist focuses on the patient's total body. Treatment typically is centered around the lower body, upper body, trunk, or cardiorespiratory system. Your PT will work with you to help you regain your functional mobility if you are having difficulty moving around.

The American Occupational Therapy Association (AOTA) describes occupational therapists as healthcare practitioners who "help people across the lifespan to do the things they want and need to do through the therapeutic use of daily activities (occupations)." 

The meaningful things you do that make up each day are considered your occupations. Are you a parent or a teacher? Do you drive a truck? What specific things must you be able to do to function in your daily roles? These tasks are considered your occupations, and they may become compromised after an injury, illness, or surgery.

The inability to perform these meaningful everyday tasks can lead to functional mobility loss and disability. Your OT can help you regain full function during these tasks so you can get back to your normal lifestyle.

So both occupational and physical therapists work with people to regain normal functional mobility. So how do you choose which one you need? Or does it even matter?

When choosing to visit a physical therapist or occupational therapist after an injury, it helps to consider the injury that you suffered and the type of disability created by your injury.

In general, occupational therapists treat upper extremity injuries. If you injure your finger, wrist, arm, elbow, or shoulder, you may benefit from the skilled services of an OT. If you suffer a lower extremity injury, you should certainly see a physical therapist for rehab.

But both PTs and OTs treat upper extremity injuries. This is where the water gets a little muddy.

Different types of injuries that are often treated by an occupational therapist may include:

• Finger and hand tendon tears
• Surgical repair of finger and hand tendons
• Carpal tunnel syndrome
• Colles' fracture
• Thumb joint arthritis
• Wrist arthritis
• DeQuervain's tenosynovitis
• Tennis elbow or golfer's elbow
• Shoulder pain due to arthritis, fracture, or rotator cuff injury
• Stroke

Each of these injuries or conditions may result in loss of the ability to perform the important functional tasks that you need to do each day. Your OT can help you regain normal range of motion, strength, and mobility to regain the ability to do these tasks.

Types of upper extremity injuries or conditions that are often treated by a physical therapist may include:

• Shoulder tendonitis
• Rotator cuff tear
• Shoulder bursitis
• Proximal humeral fracture
• Tennis or golfer's elbow
• Elbow fracture
• Stroke
• Carpal tunnel syndrome
• Colles' fracture

These upper extremity injuries typically result in loss of range of motion and strength, and therefore usually create difficulty with basic functional use of your arm, wrist, or hand. Your PT can help you regain normal upper extremity function if you have any of these conditions.

As you can see, there is some overlap between these two focuses. Both physical and occupational therapists treat these conditions. So does it matter if you go to an OT or a PT for these? Not really. Your PT or OT will work with you to regain motion and strength and, ultimately, functional use of your upper extremity.

When determining the best treatment and care for any condition, one should examine the published scientific research to help make the best choice. And the available research comparing OT and PT is sparse.

One study published in 2000 compared the outcomes for PT versus OT in a population of patients that had complex regional pain syndrome (CRPS). The researchers found very little difference in outcomes between PT and OT. There was a slight cost-effectiveness difference favoring physical therapy in the study, but this was not considered significant. So, it appears that you could choose either profession to treat CRPS. Other studies comparing the two professions reveal similar outcomes.

It would appear that deciding to go to PT or OT for an upper extremity injury would be a personal choice, and both disciplines would likely be able to help you regain functional independence. And perhaps a joint rehab with PT and OT may be best; your physical therapist can help you regain range of motion and strength while your occupational therapist helps you regain functional use of your upper extremity after injury or illness. This often occurs in hospital-based acute rehab.

Deciding on which healthcare professional to visit for an illness or injury can be confusing. Which is best for your condition? Who will be able to help you return to full function again? If you have an upper extremity injury, should you see a PT or OT? The decision is personal, and it appears that a physical therapist and an occupational therapist can help you recover full function after an upper extremity injury.