24Jul 2017

UntitledPhysical Therapists (PTs) are extensively educated and licensed health care professionals who diagnose and treat individuals of all ages with medical problems or other health-related conditions or injuries that limit their ability to move and perform functional activities in their daily lives1.

Physical Therapists work with patients to achieve these overall goals1

  • Reduction in pain
  • Increased movement or flexibility
  • Increased strength and endurance
  • Increased functional capacity to perform daily tasks
  • Patient is informed and educated about their condition, treatment and rehabilitation to become competent in self management through appropriate exercise, lifestyle, posture and pacing of activities.

When combined, the above goals increase the overall quality of life for the person and their family. Within these goals, the PT will work WITH each individual patient on their specific goals at an appropriate pace depending on the presentation of symptoms, associated history and functional capacity.

A person may attend physical therapy through a variety of pathways during an episode of pain, after sustaining an injury or due to a new or existing condition.

Here’s how1:

  • Make an appointment directly with a physical therapist for an evaluation
  • Referral from your Primary Care Physician
  • Referral from a speciality for example – Spine, Orthopedic, Rheumatology
  • Pre and post surgery (as an inpatient and as an outpatient)

What will happen during my first physical therapy appointment?

Like a physician, a physical therapist will complete a full subjective history including past medical and surgical history, social history including occupation, hobbies and activities. They will ask questions about your pain to build a picture of where the pain is coming from and how it is affecting your daily life. These questions combine with a thorough physical exam where they assess your posture, movement, strength, sensation and ability to perform functional tasks1. Like physicians, this information enables them formulate a diagnosis and develop a treatment plan suited to your individual needs.

Physical Therapists can use a number of different treatment options1,2 to reduce pain and increase your ability to participate in daily life (work, household tasks, sleep, hobbies, sports). These options will depend on their analysis of the assessment and will be individualised to you.

These options can include:

  • Passive modalities: these include the use of heat, ice, electrical stimulation, ultrasound to a painful area (modalities are the treatment)
  • Manual therapy: means the use of massage, joint mobilisations, myofascial and trigger point release techniques (PT uses his/her hands to treat the joint/muscle/tendon or ligament)
  • Exercise prescription: Includes mobility and flexibility exercises, aerobic training, strengthening exercises. This aspect of treatment ranges from the simplest finger exercises to high intensity aerobic conditioning depending on the individual patient
  • Posture and movement retraining: alteration of posture to restore muscle length, to alter weight bearing or walking patterns to reduce pain and improve functional movements.
  • Education: surrounding healthy joints, movement patterns, how different parts of the body are connected and influence and explaining how certain movements cause pain and why/how treatment will assist in the reduction of symptoms.

A physical therapist will use a combination of the above treatment categories to assist you in your recovery and return to normal function. They may also use yoga or pilates based exercises in conjunction with their treatment or refer you to a yoga or pilates class.

So… I am in pain… what do I do? which comes first? Physical Therapy? Medications? Injections? Surgery?

This is a frequently asked question and unfortunately it is not a simple one-fit-all answer.

Depending on your background history, the intensity and the cause of your pain, you may already have a PT, a neurologist, a rheumatologist, a spine specialist or an orthopedic physician who you attend routinely or, as needed depending on the individual history and presentation. Typically many people present to their primary care physician or PT who completes an assessment and may opt to treat conservatively or where necessary, will refer you to a specialist doctor such as those mentioned above for further assessment and treatment.

Different scenarios of how PT and pain management “fit”together exist1,3. For example, if your pain is intolerable; medications or an injection may be used first in order to reduce the intensity of pain to allow you to attend physical therapy comfortably. On the other hand, physical therapy may be used as a first line of treatment before progressing to medications or injections to relieve pain. Often, for chronic conditions, physical therapy, pain medications and injections work together to maintain and improve pain, function and overall quality of life. Surgery (unless indicated as an emergency or required for a particular condition such as a fracture or compression for example) is often only discussed after all other options have been exhausted. It is important to remember that each person is different, no two presentations of symptoms are ever the same so each treatment plan will be different.

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Clinical research has demonstrated that a multimodal approach through a variety of specialties including physical therapy, pain management, orthopedic, rheumatology, nutrition and psychology ensures the best outcomes for patients in terms of pain management, return to function and overall quality of life3,4. It is important to remember that not every individual patient will need each speciality and the team here in SPNY will discuss the best treatment options for you and the required input from other specialities on an ongoing basis.

A crucial part of physical therapy is the promotion of physical activity and exercise. In a recent gold-standard rated review, exercise and physical activity was not dangerous or caused further damage to those in chronic pain2. In fact, exercise and physical activity fact improve symptoms, increase functional capacity and quality of life2,4. However, it is important to discuss the type, intensity of any physical activity with your physical therapist or physician before starting or changing your current activity.

“Lack of activity destroys the good condition of every human being, while movement and methodical physical exercise save it and preserve it” Plato

References:

  1. apta.org : American Association of Physical Therapy
  2. Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews 2017, Issue 4
  3. aps.org American Pain Society
  4. acsm.org American College of Sports Medicine