2. What can a Physical Therapy program do for me that I cannot do on my own?
Many patients may think that they know how to properly exercise, manage their pain and rehabilitate themselves. I have commonly been given explanations from patients for why they do not need therapy – ie: “I have had this before and I know what works for me” or “I know what is causing this, b/c my neighbor had the same thing so I will just do what she did” and attempt to manage themselves. A Physical Therapist is a specialist skilled and educated specifically in proper rehabilitation. We are continually educated as to management for different dysfunctions, differentiation of one dysfunction/injury from another and work closely with the referring physician in the development of a rehabilitation program specifically designed for each individual. The other important aspect to remember with physical therapy is that each individual is different. We all have different types of bodies, different patterns of movement, different alignments and different habits. A physical therapist, along with their trained staff, monitor each individual and attempt to correct improper habits, alignments and movement patterns.
Most importantly with therapy is education. Because of healthcare guidelines and reimbursement changes, your physician may not have the time that they need to explain to you exactly what your injury/dysfunction/disability is and why/how it occurred. Your therapist is specialized in this and many times will be the one to educate you on the specifics of your problem and what the course of action will be to correct it and hopefully prevent it from reoccurring. P.T. focuses on education, correction and prevention.
3. How long is it going to take?
This is such a popular question. It seems that everyone has to have timelines, which is understandable b/c we all have lives to lead. Your physical therapist is aware that rehabilitation can be an imposition. I always reply to these statements by explaining that because each person is different, rates of healing are different. We can usually get an idea of your progression within 2 weeks. I also explain to my patients that even though they have other things to do, rehab. Is important and takes time just as injuries generally have taken a significant amount of time to progress to the point of injury or pain.
The other factor that patients must understand is that, even though we are here teaching you and rehabilitating them, it is their responsibility to do their Home Program. This is a major factor in how quickly one recovers.
4. Who benefits from therapy?
Many and all can benefit from therapy. As an active therapist, I work out and am always observing others. I very rarely come across individuals with perfect body mechanics, training techniques or movement patterns. This is where wellness comes into play.
Typically, the most appropriate patients are those who have been in accidents (work, auto, or falls), athletes with overstress injuries, arthritic patients, pre & post-operative patients, and those with general deconditioning or strains.
5. What will I have to do in therapy?
Therapy generally encompasses pain relief, strength and flexibility training, proper postural alignment, regaining movement or range of motion, improving and correcting posture, endurance training, relaxation and stress relieving techniques, balance and coordination training, proper walking, education, safety awareness and development/implementation of a home exercise program.
Remember that each individual is different, so each rehab/physical therapy experience and program is different. Be patient with yourself, your physician and your physical therapy staff. Healing takes time, diligence and compliance. If you think you may be a candidate for physical therapy, speak to your physician or to a therapist. We never will say no to questions.
Correcting Sitting Posture and Instruction in Proper Lifting Techniques
The therapist may have identified poor, or slouched sitting posture during the initial examination, which is most often the case, especially with a patient history as described above. The PT can instruct this patient in proper sitting posture using a lumbar roll, which is a special pillow designed to maintain the “lordotic curve,” or hollow, in the low back. This correction of sitting posture assists in minimizing the onset of pain. The instruction would also include applying the concept of posture correction to sitting in a car, at the office, and any other place specific to the patient’s daily routine. Interrupting prolonged sitting posture with breaks to walk to the fax machine or to the copier on a regular basis would also be appropriate.
Instruction in proper bending and lifting should also be provided. With a history as described above, activities that require repetitive or sustained bending, like gardening, aggravate the patient’s symptoms. These activities should be temporarily avoided until the pain is under control. As the person is able to resume bending, education in proper bending and lifting techniques should be provided in order to prevent the onset of low back pain during this episode as well as to prevent future episodes.
Even though there are specific activities this patient should avoid, there are a multitude of activities in which this patient could participate pain free. Since this patient feels good while playing basketball and when working out at the gym, these activities should continue. However, it is critical that AFTER the patient exercises, the patient should be cautious to maintain good sitting posture, as it is often the case that a patient will feel good while exercising, but develop low back pain a few hours later when sedentary.
Once pain-control techniques are well understood, a patient should quickly progress to an aerobic conditioning program. It has been found that aerobic activity assists in bringing nutrients to structures in the spine. Some of these structures, like the disc, have a relatively poor blood supply and rely on body movements and aerobic activity to circulate nutrients to these structures. When a person is sedentary, less of these nutrients are able to get to the structures in the spine to keep them healthy.
Aerobic-conditioning activities should be chosen based on a patient’s interest, availability, and coincide with the type of problem that the person has. Generally, a walking program, elliptical trainer, and upright bicycle are good choices. The program should be performed at least three times a week for thirty to forty minutes each session.
Strengthening and Flexibility Exercises
Once the pain is under control, spine and lower extremity flexibility exercises should be initiated. In the above example, this patient needed to avoid activities that required him to bend forward because they aggravated his pain. Once the pain is stabilized, however, his ability to bend forward may be limited and stiff due to avoidance of this activity. Therefore, restoring flexion movement is critical to return the patient to full activities. Additionally, any limitation of flexibility of the legs should also be addressed, as tightness in these muscles may inhibit a person’s ability to maintain certain postures and positions necessary to control back pain.
As the pain in the back stabilizes, strengthening exercises should also be incorporated into the PT program. The trunk muscles themselves, the abdominals and spine extensors, should be directly strengthened. Additionally, activities that require the trunk to maintain a stable position, while strengthening the upper and lower body, should also be included. Leg strengthening is important as well, so that a person can properly lift objects from the floor using their legs muscles rather than those of the back. A home program of strengthening exercises should also be included that are easy to do and require minimal equipment.
Minimizing “Bed Rest”
Gone are the days of prolonged bed rest. Most often, even with acute back pain, engaging in proper movements and postures as well as a progressive return to activities has been found to be much more successful in terms of controlling low back pain and allowing a return to normal activities more quickly. Bed rest leads to a loss of muscle mass, reduced joint lubrication, social isolation, and a severe disturbance in sleep patterns.
Patients with neuropathic chronic pain frequently exhibit abnormal sensation throughout all or part of the affected area. This often includes increased sensitivity to stimuli such as touch, pressure, or temperature. Desensitization can be an effective way to treat hypersensitivity, especially when used in combination with other medical and/or therapeutic interventions.
Desensitization involves application of “unpleasant” stimuli to the hypersensitive area. These stimuli are things that the body is routinely exposed to and do not elicit a painful response when presented to non-affected areas of the body, thus they are not harmful or damaging. The items used for desensitization vary, depending on what the affected area interprets as painful. Stimuli may consist of different textures/fabrics, light or deep pressure, vibration, heat or cold.
A desensitization program is designed to provide consistent stimulus to the affected area for short periods of time, frequently throughout the day. These small bursts of therapeutic activity shower the brain with sensory input. The brain responds to this demand by acclimating to the sensation, thereby gradually decreasing the body’s pain response to the particular stimuli. In short, your body gets used to it-the stimulus becomes tolerable and no longer elicits the maximal pain response.
Use of Passive Modalities
Although the emphasis of a good back rehab program is returning to function and activity while learning to control the symptoms of low back pain, there are instances where the use of “passive modalities” is indicated. In most cases, passive modalities should be used in conjunction with other, more active forms of physical therapy during treatment. Modalities can be utilized early in the course of physical therapy care to help control pain. However, as the physical therapy program progresses, the focus should move away from the use of modalities and include a progressive increase in activity and exercise and instruction in self-treatment techniques.
Passive modalities are described as the application of some form of cold, heat, or electricity to the body to assist in pain management. These modalities are referred to as “passive,” as the recipient does not have to actively participate. The modality is applied while the patient is at rest. The most common forms of heat include moist hot packs and ultrasound. Cold treatments, or cryotherapy, can be used to minimize pain as well. This can be administered in the form of cold packs and ice massage to the low back. Fluoromethane is a spray that can also be applied to the skin by the therapist, and is usually followed by a series of therapist-assisted stretches.
Electric stimulation can also be used to control pain. Some specific types include TENS (transcutaneous electric nerve stimulation) and microcurrent. In cases where TENS has been found to be helpful in controlling pain, especially chronic pain, a portable TENS unit can be obtained for home use.