PT Classroom - Wound Care Basics for the Physical Therapist ׀ by Ryan Garman, MPT


Ryan Garman graduated from Marquette University with his Master of Physical Therapy degree. His training in physical therapy includes orthopedics, inpatient rehab, and wound care. Ryan is a certified clinical instructor through the APTA and enjoys mentoring physical therapy students. He is currently a physical therapist practicing at United Hospital System.


The skin is the body’s largest organ and is responsible for protection, temperature regulation, and sensation. As skin ages, it becomes dehydrated, has decreased blood flow and loses its elasticity. The various layers of the skin which includes the epidermis, dermis, and subcutaneous tissue becomes more susceptible to an injury as a result of these changes. An everyday accident such as bumping your arm on the refrigerator could even result in damage to the skin!

Wound care is a specialty area of physical therapy that involves prevention, assessment, and treatment of acute or chronic wounds. Physical therapists often come across patient populations that may be more susceptible to the development of wounds. Therefore, they have the opportunity to help these patients minimize or prevent such occurrences. They accomplish this by helping patients understand how pre-morbid conditions such as diabetes or vascular insufficiency can influence the body’s response to external stimuli. They also educate and teach patients who have diabetes or poor venous return how to regularly perform foot inspections, avoid prolonged positions and increase their activity levels so they minimize their likelihood of developing a wound.

Types of Wounds
Vascular wounds which are due to venous insufficiency are characteristically associated with edema, a large amount of drainage, hemosidering staining (brown discoloration), and pain when the foot is in a dependent position. Treatment generally includes compression bandages such as Unna boot or Profore wrapping.

Arterial insufficiency wounds occur more often distally, have pain from intermittent claudication, and can become necrotic or gangrenous. Revascularization needs to take place for these wounds to heal.

Neuropathic wounds or “diabetic wounds” are generally located on the plantar surface of the foot and involve peripheral neuropathy. These wounds may be due to trauma, prolonged pressure, or poor foot care.

The most common type of wound is a pressure ulcer and is more prevalent in acute care or long term care settings where a patient may have impaired mobility, decreased mental status, incontinence, or non-compliance. The importance of repositioning, using appropriate cushions and mattresses, and giving attention to bony prominences may prevent prolonged pressure and development of a chronic wound.

Understanding the Wound
Assessment of a wound includes staging a pressure ulcer (Stage I superficial to Stage IV deep), identifying tissue quality (necrotic tissue, slough), measuring and identifying drainage (serous or purulent), and describing odor. Measuring for sinus tracts, undermining, and tunneling is also necessary. Being able to recognize an infection can effect the treatment methods used in wound care as well.

The treatment of wounds can change with the introduction of every new type of dressing or chemical. While it is sometimes indicated, the use of betadine whirlpools in wound care is no longer the popular alternative to treating infection or hydrating eschar. Based on the type, location and assessed characteristics of any individual wound, the therapist and doctor must decide on an appropriate treatment plan. The key goals in determining how to treat a wound are to reduce risk factors, eliminate non-viable tissue, increase mobility of soft tissues, protect viable tissue as it develops, and to educate patients and caregivers in order to prevent further recurrence.

Listed below are various dressing types and their uses (not an all-inclusive list):
• Absorptives: for drainage
• Alginates: for drainage and uneven borders or tunneling
• Film Dressings: for shallow wounds with potential to auto-debride
• Foams: for absorbing drainage
• Hydrogels: to give moisture to the wound
• Hydrocolloids: clean wounds and promote auto-debridement
• Antimicrobials: for infected wounds
• Compression dressings: for wounds due to venous disease

Listed here are other treatment options for wound care (not an all-inclusive list):
• Whirlpool
• Pulsed Lavage
• Ultrasound assisted wound treatment
• Infrared light therapy
• Electrical Stimulation
• Vacuum Assisted Closure


Last revised: April 10, 2008
by Ryan Garman, MPT

Birmingham, J.V. (2006). Complete Wound Care: Prevent-Assess-Debride-Treat. JVB Enterprises, Inc.

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Please review our terms and conditions carefully before utilization of the Site. The information on this Site is for informational purposes only and should in no way replace a conventional visit to an actual live physical therapist or other healthcare professional. It is recommended that you seek professional and medical advise from your physical therapist or physician prior to any form of self treatment.

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