Wound care is far more than just changing a dressing! When dealing with wounds, there are many things to consider.
It’s important to take note of how the wound formed in the first place, in order to prevent further wounds from developing. It’s also very important to know what type of wound it is – as all wounds are not created equal! You also want to take note of how the wound may be impacting the way the person is able to move around and function in their environment. Once you know what you’re dealing with, you can develop a plan to treat it. There are many different team members that can (and should!) be involved in the wound care process… one of them being Physical therapists!
If you are not sure where or how to start your wound care journey, this course is a must for you: A Comprehensive Guide to Wound Care: Tools for the Everyday Clinician
Let’s explore some of the ways a Physical Therapist can be an effective member of a wound care team.
Prevention
The best-case scenario is to stop the wound before it starts! This is where persistent patient and caregiver education can make a huge difference. There are many disease processes that put patients at higher risk for developing wounds, such as diabetes, chronic venous insufficiency, spinal cord injury, etc. Each situation will be different from the next, but providing various tools and resources to these patients is essential. Many times this will include footwear or positioning devices to provide protection and/or prevent high pressure on bony prominences.
Direct and Indirect Wound Care:
There are also many ways that a Physical therapist can provide direct wound care or provide an adjunct treatment that would facilitate faster healing through increasing circulation, etc. Here are some examples of how a physical therapist can affect changes in wounds:
- Sharp Debridement – Sharp debridement is a component of physical therapy wound management involving the use of forceps, scissors or a scalpel to remove devitalized tissue, foreign material or debris from a wound bed. Depending on the state you are practicing in, this may require extra training before putting it into practice.
- Pulsed lavage with suction – This is a method of wound cleansing that allows for more control over the pressure of the irrigation used. This allows for more bacteria to be removed as well as loose necrotic tissue and debris left on the wound bed. Continued research is needed to identify the exact parameters (or psi) to use for each specific type of wound, but this is a great option for PTs to use in wound cleansing.
- Electrical stimulation – High-voltage pulsed current (HVPC) can be used to increase capillary perfusion, and therefore increase oxygenation of the wound bed. This will then encourage granulation and fibroblast activity and speed up wound healing.
- Ultrasound – Physical therapists use therapeutic ultrasound to deliver mechanical vibrations of a high or low frequency to promote cellular healing. Physical therapists frequently use therapeutic ultrasound to ease pain, improve circulation, and improve soft tissue mobility. In addition, using ultrasound can assist in wound and injury healing, pain relief, and the reduction of inflammation.
- Laser – Laser therapy can help to create a more ideal environment for wound healing by promoting an highly oxygenated setting and helps bring more needed nutrition and white blood cells to the area to promote healing.
- Ultraviolet light therapy – According to reports, ultraviolet therapy is a promising addition to treatment for chronic wounds infected with resistant bacteria because it kills bacteria and speeds up wound healing. Psoriasis, atopic dermatitis, vitiligo, mycosis fungoides, and hand/feet eczema all benefit from ultraviolet therapy. Despite the fact that ultraviolet therapy has been shown to be effective in the treatment of wounds and other skin conditions and that physical therapists play a significant role in its application, anecdotal evidence suggests that this treatment method is not commonly used in regular clinical practice.
- Negative pressure wound therapy – A technique known as negative pressure wound therapy (NPWT) aids in wound healing by removing fluid and infection. The wound is covered with a special dressing (bandage) and a gentle vacuum pump is attached.
- Lymphatic drainage and compression bandage techniques – In order for a wound to heal, it has to have a certain balance in its environment. If too many “toxins” are present, the wound will take longer to heal. This is where the lymphatic system comes in! If there is edema present with the wound, we must clear the area of the stagnant lymphatic fluid in order for the “toxins” to be flushed out and the wound to get the nutrients to it that it needs.
Manual lymphatic drainage (MLD) is a gentle, stretching massage that helps move lymphatic fluid out of swollen limbs by stretching the skin. It is not the same as a traditional massage. In order to facilitate the flow of lymphatic fluid, MLD focuses specifically on the lymph vessels. Your unaffected areas receive therapy first, allowing the fluid to “decongest” the area or move out of the affected area. MLD helps open the leftover working lymph gatherers and move protein and liquid into them, as well as to assist with accelerating lymph liquid course through the lymphatics. A multi-layered compression bandage complex used in conjunction with manual lymphatic drainage techniques will further facilitate the movement of lymph out of the area of the wound, which will allow for the wound healing process to move forward.
- Exercise – In many instances, weakness and/or diminished mobility worsen wounds. An exercise program will be created by a physical therapist so that the person with a wound can move around their environment as safely as possible without risk of injury. Physical activity and exercise can sometimes speed up the healing process by improving circulation to the area and relieving pressure around the area through frequent repositioning.
- Scar management – There are several techniques a Physical therapist can use to help manage scars after a wound has healed. These include massage, myofascial release, cupping, stretching, taping, IASTM, and desensitization.
How do I get started in wound care?
Don’t delay! Wound care is already within your scope of practice as a Physical therapist! You can start with the basics and go from there. There are several training courses to become more skilled as you gain more confidence. A Comprehensive Guide to Wound Care: Tools for the Everyday Clinician is a great one to start with. This course will give you all the necessary knowledge and tools that you can use with your patients right now! This course not only with give you the confidence to start treating wounds, but will also allow you to have more informed discussions with the team and become part of the decision making process for what to include in the plan of care.
How do I become a specialist in Wound Care?
If you’re looking to continue your wound care journey, there are several options out there for Physical therapists to become certified specialists. Check these out and see what you would need to do to qualify and apply for these certifications.
Board-certified Wound Management Clinical Specialist
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Ruth Polillo, MSPT, CBIS: Ruth graduated with a Master of Science in Physical therapy degree from Thomas Jefferson University in 2005, and has gained experience in every setting a therapist can work in. She is a co-founding member of ARC & an enthusiastic presenter! Ruth is passionate about continuing education and making hands-on clinical skills available to clinicians.
