By definition, physiotherapy professionals fall under healthcare professionals as per the NCAHP Act.
As per the definition of “physiotherapy professional” in the act schedule, it answers three key questions.
- What can a physiotherapy professional do as per the NCAHP Act 2021?
- What are the limitations and boundaries on which physiotherapists can function as per the NCAHP Act 2021?
- What tools and techniques can physiotherapists use as per the NCAHP Act 2021?
What can a physiotherapy professional do as per the NCAHP Act 2021?
- Comprehensive examination
- Appropriate investigation
- Provides treatment
- Prevention
- Screening
- Diagnosis
- Health promotion
- Fitness
Comprehensive examination: It is the thorough and detailed assessment of physical condition, functional disability, and overall health to identify movement-related issues, functional impairments, and the underlying cause of pain or dysfunction related to physical health.
Example:
- Patient history – Detailed history, lifestyle, activity levels, symptoms and onset etc
- Musculoskeletal examination – ROM, MMT, Posture assessment, palpation, functional movement, special orthopaedic tests.
- Neurological examination – Reflex, sensory, Balance and coordination
- Cardiovascular examination – Heart rate, blood pressure, auscultation of heart and lungs, Exercise stress testing, six-minute walk test, chest expansion measurements, etc.
- Functional movement and gait assessments
- Work-related and ergonomic assessments
- Sports and athletic performance and injuries
- Chronic pain and psychosocial assessments – Physiotherapists also asses psychological and social factors contributing to patients condition. E.g., Kinesophobia (Measures the fear of movement or reinjury)
Appropriate investigation: Investigations that are vital for confirming diagnosis, treatment and monitoring progress.
Examples
- Clinical tests and assessments
- Range and strength
- Posture and gait
- Imaging referral ( When necessary to confirm or to rule out certain conditions)
- Functional assessments
- Electrophysiological tests – Eg. EMG, Nerve conduction velocity (Investigations can be done in collaboration with other healthcare professional)
Provides treatment: This refers to interventions aimed at movement, physical function, relieving pain, and promoting health.
Prevention: It refers to interventions aimed at reducing the risks of injury, disabilities, or physical health conditions before they occur.
- It involves taking proactive steps to maintain or improve health or reduce the likelihood of developing issues or reoccurrence of injuries.
- Injury prevention
- Prevention of recurrence of previous injuries
- Fall prevention
- Post-surgical complications
- Ergonomic and lifestyle-related issues related to physical health.
Screening: It is a proactive process that detects problems early, even before symptoms manifest.
Diagnosis: It is a process of identifying conditions that affect movement, posture and physical function.
It differs from medical diagnosis, which focuses on disease or injury.
Health promotion: It helps people stay healthy and teaches or educates them on injury prevention, managing physical conditions, and improving overall physical health.
Fitness: It means improving physical health, strength and movement to help people stay active and healthy.
What are the limitations and boundaries drawn for physiotherapists to function as per the NCAHP Act 2021?
- Movement
- Functional Dysfunction
- Malfunction
- Disorder
- Disability
- Healing “and”
- Pain from trauma and disease
Movement: It involves regular movements.
Example: Walking, running and fine movements
Functional Dysfunction: It refers to difficulties in performing everyday activities.
Example: Bending, lifting, climbing stairs, sitting down or reaching overhead
Malfunction: It refers to an underlying defect or failure in the specific body part. Physiotherapists help in recovery, injury management, rehabilitation etc
Example: Torn meniscus or Knee ligament.
Disorder: It refers to specific physical conditions that disrupt normal movement.
Example: Osteoarthritis, Tendinitis etc
Disability: It refers to functional limitations that may be temporary or permanent.
Example: Stroke, Parkinson’s
Healing: It is a multifaceted process that has the following four aspects:
- Tissue repair
- Pain management
- Restoration of movement
- Functional recovery
Pain from trauma and disease:
- Trauma could include things like falls, fractures, or sprains,
- Disease refers to conditions like arthritis, diabetes, or nerve problems.
What tools and techniques can physiotherapists use?
- Physical Modalities
- Exercises
- Mobilisation
- Manipulation
- Electrical agents
- Thermal agents
- Other Electro therapeutics
Physical Modalities: These refer to various physical treatments or tools to reduce pain, improve mobility, and promote healing. These modalities include techniques such as stretching, myofascial release, and soft tissue manipulation. These treatments help manage symptoms like inflammation, muscle tension, and pain, supporting the body’s natural healing process.
Exercises: These refer to specific physical activities or movements designed to improve strength, flexibility, balance, coordination, and overall physical function. These exercises are tailored to address a patient’s individual needs, such as recovering from an injury, managing pain, improving mobility, or preventing future problems. Physiotherapists guide patients through exercises to help them regain function, enhance fitness, and improve their quality of life.
Mobilisation: It Refers to a hands-on technique used to gently move joints or soft tissues to improve flexibility, reduce pain, and restore normal movement. It involves slow, controlled movements applied to stiff or restricted areas, such as joints or muscles, to increase the range of motion and improve overall function. Mobilisation is commonly used to treat conditions like joint stiffness, muscle tightness, or injuries.
Manipulation: It Refers to a hands-on technique involving quick, controlled movements applied to joints, usually in the spine or limbs, to improve joint mobility, reduce pain, and restore proper function. It often involves a high-velocity, low-amplitude thrust that may produce a “popping” or “cracking” sound. This technique is used to relieve joint stiffness, improve alignment, and enhance movement. Manipulation is typically used in cases of joint restrictions, back or neck pain, and other musculoskeletal conditions.
Electrical Agents: These refer to treatments that use electrical currents to stimulate muscles, nerves, or tissues to reduce pain, promote healing, and improve muscle function. These agents are often used in devices such as Transcutaneous Electrical Nerve Stimulation (TENS), Neuromuscular Electrical Stimulation (NMES), or Interferential Current Therapy (IFC). Electrical agents can help manage pain, reduce inflammation, improve circulation, and support recovery in various musculoskeletal and neurological conditions.
Thermal agents: It refer to treatments that use heat or cold to manage pain, reduce inflammation, and promote healing. Heat therapy (e.g., hot packs, infrared heat) is used to relax muscles, improve blood flow, and ease chronic pain, while cold therapy (e.g., ice packs, cold compresses) is applied to reduce swelling, numb pain, and control inflammation, especially in acute injuries. These thermal agents are commonly used to support recovery and enhance the effectiveness of other treatments.
Other Electro therapeutics: It refers to a range of treatments that use electrical energy to stimulate nerves, muscles, or tissues to manage pain, enhance healing, and improve muscle function. Here is a list of some of the latest and advanced electrotherapeutics used in physiotherapy, apart from traditional methods like IFT, TENS, and E-stim:
Shockwave Therapy (Extracorporeal Shockwave Therapy – ESWT):
- This therapy uses acoustic waves to promote healing in tendons, ligaments, and muscles. It is especially used for chronic conditions like plantar fasciitis, tennis elbow, and calcific tendinitis.
- Pulsed Electromagnetic Field Therapy (PEMF):
- Uses electromagnetic fields to stimulate cell repair and promote tissue healing. It is commonly used for bone healing (e.g., fractures) and to reduce pain and inflammation.
- High-Intensity Laser Therapy (HILT):
- A more advanced form of laser therapy that penetrates deeper tissues to reduce pain and inflammation. It is used in conditions like osteoarthritis, soft tissue injuries, and musculoskeletal pain.
- Microcurrent Therapy:
- Uses very low-intensity electrical currents to stimulate cell activity and promote tissue repair. It is commonly applied to accelerate wound healing, reduce pain, and improve muscle performance.
- Functional Electrical Stimulation (FES):
- FES involves stimulating nerves and muscles to improve motor function, especially in patients with neurological disorders like spinal cord injuries or stroke. It helps improve mobility and muscle strength.
- Diadynamic Therapy (Bernard Currents):
- Uses modulated electrical currents for pain relief and muscle relaxation. It is particularly useful in treating muscle spasms, acute pain, and post-injury recovery.
- H-Wave Therapy:
- This is a form of electrotherapy that uses low-frequency electrical stimulation to promote healing, improve circulation, and reduce pain. It is commonly used in patients with chronic pain and muscle rehabilitation needs.
- Galvanic Stimulation:
- A form of direct current therapy used for tissue healing, pain relief, and reducing edema. It is particularly useful for conditions like muscle weakness, soft tissue injuries, and nerve damage.
- Cryoelectrotherapy (Cryostimulation + Electrotherapy):
- Combines the benefits of cryotherapy (cold therapy) with electrotherapy to treat acute injuries, reduce inflammation, and promote tissue healing.
- Biofeedback Therapy:
- It uses sensors to provide real-time feedback about muscle activity, helping patients learn how to control or retrain their muscles. This therapy is often used for rehabilitation in conditions like pelvic floor dysfunction and post-stroke recovery.
For more details, read the following blog titled: Key Questions on Physiotherapists’ Autonomy, Scope, and Distinction Under the NCAHP Act 2021