“Ready for some more pain and torture?” Our front office receptionist jokingly asks as an established patient arrives to check in for their appointment. The patient laughs and is looking forward to their appointment. This leads you to wonder, is physical therapy pain and torture?
In short, no. When I began working here I had a vague idea of what physical therapy encompassed; mostly thinking it revolved around exercise. Many people carry this stigma of “pain and torture” or that “it’s just exercises.” I am writing today to better help individuals understand what physical therapy can look like for them and more specifically what that first appointment would entail. Although, exercise is an important piece to the puzzle, many other components come together to create the dynamic rehabilitation therapy program and I have seen it transform lives.
INITIAL EVALUATION
That first appointment is your initial evaluation and it starts out with a discussion of what the you are being seen for; asking several questions about the condition, pain level, prior level of function, and how it is currently affecting the way you are living; i.e. work, school, recreational activities, etc. This helps develop your goals and will help in creating a treatment plan. After the discussion piece, the therapist will get right to assessing your range of motion/flexibility, strength, posture, balance, and coordination.
1. Range of motion and Joint mobility:
o Passive – the therapist will have you relax so that the joint may be moved by the therapist.
o Active – you will actually do the movement yourself and the therapist will observe.
This helps the therapist have an idea of what is limiting your range of motion in the joint. It could be muscle strength/weakness, muscle tightness, an imbalance in the combination of muscle strength and tightness, or from tightness in the actual joint capsule.
2. Strength – can be assessed in a number of ways depending on the body part:
o Manual muscle testing – therapist will use both gravity and resistance to test the muscle’s strength and its ability to contract.
o Other more functional exercises will also be used; such as, how many times you can stand up and sit down in a specified amount of time.
3. Posture/balance/coordination:
o Direct observation – looking at your body mechanics while standing and sitting.
o Static or dynamic balance assessment – standing on one leg or using an outcome measure such as; BERG, TUG etc.
o Cerebellar function testing – having you do finger to nose, heel to shin.
TREATMENT PLAN
After that initial evaluation you will enter into your treatment plan. As you will see exercises are on the below list, but take notice how it is a small portion of the whole! Frequently, I will see therapists working on their patients and I cannot help but think to myself, “awe, that looks like it feels nice. I want physical therapy too!” The modalities and hands-on work are very therapeutic and keep you coming back for more.
1. Progression of exercises tailored for the patient.
2. Modalities:
o Ultrasound – hand-held transducer is applied to your injured area and sound waves heat tendons, muscles, and other tissues to improve blood flow, helping the healing process.
o E-stim – electrodes attached to your skin that cause the muscles to contract and relax. Relief for muscle spasms/pain/swelling and muscle re-education.
o Iontophoresis – uses electrical current to help topical medications penetrate through the skin. Also helps with softening scars and reduce joint calcium deposits.
o TENS – uses low voltage electrical current on the skin to override pain sensations.
o Traction – can be done manually or with a machine that uses halters for the neck or belts for the lower back. This creates space in the spinal segments for relief of nerve pain.
o Heat – can be moist or dry heat; increases circulation, reduces swelling, relaxes muscles, and prepares tissue for other treatments.
o Cold – reduces swelling/inflammation, as well as muscle spasms and pain.
3. Hands-on work, might include:
o Soft tissue mobilization – therapist uses hands to push/pull/knead muscles/ligaments/ tendons/nerves to break down/reduce scar tissue to improve range of motion, functionality, and lengthens muscles and tendons.
o Myofascial release – gentle massage and stretching of myofascial tissue, helps with skeletal muscle immobility, improves blood/oxygen/lymphatic circulation.
o Trigger point release - painful nodules in the muscles are released by applying direct pressure for 30-120 seconds, once released you will stretch the muscle. Dry needling may also be used to release these tight nodules.
o Joint mobilizations or manipulations – manipulations are a quick movement in the joint often causing a “pop” or “crack.” Mobilization is a slower movement of the joint in a specific direction. This treatment helps increase joint mobility and decreases tension in the surrounding muscles.
GOAL
The ultimate goal of physical therapy is to help get you back to the activities and lifestyle you want with minimal pain/difficulty/limitations within reason. You will play a very active role in the plan made by the therapist. If any exercises or modalities are not helping we can always modify the plan to find new ways to reach your goals. Once the pain is gone, it is still important to finish your plan of care as the therapist may still be correcting the impairment that led to the initial injury so they do not become a reoccurring event. As one long standing patient always says of her therapist, “she keeps me walking!” Physical therapy is an excellent first step in tackling many conditions and injuries. With the skills learned in physical therapy you could be on your way to the best version of yourself.