Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.
Physical therapy techniques have been used in adults, children, and the elderly for a wide variety of conditions. Due to the many kinds of techniques used by physical therapists and multiple conditions treated, this section only provides selected examples of adverse effects and is not a comprehensive list. Due to malpractice concerns, it is possible that not all adverse effects have been reported in the available literature.
Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with a qualified healthcare professional before beginning any treatments. Based on the available literature, physical therapy appears generally safe when practiced by a qualified physical therapist. However, complications are possible. Treatment options should be considered carefully. Based on one large study, there were no reported adverse events resulting from the physical therapists' diagnoses or management during a 40-month period.
There is considerable study investigating whether physical therapy should be initiated immediately or following a waiting period. For example, patients who return to physical therapy after a deep vein thrombosis are more likely to develop a pulmonary embolism than patients who return later (no sooner than 48 to 72 hours). In contrast, it is thought that keeping areas immobilized for long periods of time may also carry risk factors.
Physical therapy is often used in patients recovering from surgery whose postoperative pain may be severe. This can complicate early physical therapy. Pain medications may be given, which in turn may carry risk factors for anti-inflammatory-drug- or aspirin-induced gastrointestinal complications. However, physical therapy interventions may alter absorption and distribution of drugs that are administered transdermally (through the skin), subcutaneously (under the skin), or intramuscularly (injected into the muscle). Medication adjustments may be necessary.
Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the physical therapy literature although causality is unclear. Erectile dysfunction has also been reported.
Chest physical therapy, among other kinds of physical therapy, may increase metabolic rate, oxygen consumption, heart rate, and blood pressure. Repetitive exercises can have cardiovascular effects. A patient's cardiac and pulmonary risk factors should be assessed to determine whether heart rate and blood pressure should be monitored. Moreover, the physical therapy method of inversion (placing the heart above the head) may increase blood pressure (both systolic and diastolic). Caution is advised when using inversion as a treatment technique for low back pain. Patients with high blood pressure may need to avoid this technique.
In some very low birth weight premature infants and young children, physical therapy techniques, such as passive motion and chest percussion therapy, may increase the likelihood of bone fractures.
In the elderly, walking backwards during physical therapy has resulted in falls and considerable morbidity. Safety precautions are advised when performing challenging tasks in populations with risk factors.
Hemophilia A patients may have a greater bleeding risk after blood transfusion when physical therapy is started within eight hours of a blood transfusion.
Physical therapy has been used in pregnancy, specifically to treat women with pelvic girdle pain during pregnancy, and at three, six, and 12 months postpartum. Reports of major adverse effects are lacking in the available literature, but caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.