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Relief Through Movement


Physical Therapy for Chronic Pain


Chronic pain can be a debilitating condition, limiting your mobility and impacting your daily life. The CDC estimates that around 50 million Americans experience chronic pain, and 17 million have substantial reductions in activity because of pain. Beyond limiting activity or your ability to work, chronic pain has been linked to depression, Alzheimer’s disease, and substance abuse.


Chronic pain is complex. There’s no single intervention to treat it, but physical therapy should be part of the mix. Here’s why:


How PT Approaches Pain:
Physical therapy often provides relief that’s just as effective as medication but without the potential side effects. Here’s a breakdown of how PT tackles pain and its effectiveness:

Identify the Root Cause: PT goes a step further than medication that masks pain. Therapists assess your posture, muscle strength, flexibility, and joint mechanics to pinpoint the source of your discomfort.

Address the Underlying Issues: Based on the evaluation, PT focuses on strengthening weak muscles that support your joints, improving flexibility for a better range of motion, and correcting any imbalances or postural problems that might contribute to pain.

Use A Multi-Faceted Approach: A PT treatment plan will be customized based on the evaluation. In addition to therapeutic exercise, a PT might use various techniques. Examples include:
• Manual Therapy: PTs use massage, joint mobilization, and trigger point therapy to address muscle tension, improve circulation, and alleviate pain.
• Modalities: Techniques like ultrasound, heat therapy, or electrical stimulation can reduce inflammation, promote healing, and manage pain.
• Aquatic Therapy: A warm, therapeutic pool supports your body and joints while offering gentle resistance. This can often make it easier to start moving again after being in pain for an extended time.

Educate and Empower Patients: PTs equip you with the knowledge and tools to manage your pain independently. This might include learning a new exercise routine, how to modify activities, or how to modify your daily schedule when you’re feeling better (or worse) than normal.

It’s also becoming increasingly likely that you’ll learn how pain works. Research shows that combining pain education with physical therapy is an effective treatment.

If you’re struggling with chronic pain, call your physical therapist. They might have the key that will unlock a pain-free life.
 
References:
1. Chronic Pain Among Adults — United States, 2019–2021 | MMWR (cdc.gov)
2. The impact of combining pain education strategies with physical therapy interventions for patients with chronic pain: A systematic review and meta-analysis of randomized controlled trials, Physiotherapy Theory and Practice, 37:4, 461-472 DOI: 10.1080/09593985.2019.1633714
3. Preferred Communication Strategies Used by Physical Therapists in Chronic Pain Rehabilitation: A Qualitative Systematic Review and Meta-Synthesis, Physical Therapy, Volume 102, Issue 9, September 2022, pzac081 Preferred Communication Strategies Used by Physical Therapists in Chronic Pain Rehabilitation: A Qualitative Systematic Review and Meta-Synthesis – PubMed (nih.gov)
4. The Influence of Cognitive Behavioral Therapy on Pain, Quality of Life, and Depression in Patients Receiving Physical Therapy for Chronic Low Back Pain: A Systematic Review https://onlinelibrary.wiley.com/doi/abs/10.1016/j.pmrj.2018.09.029

Physical Therapy is a Tree With Many Branches

Starting a career in physical therapy is like climbing a tree. Everyone starts with the same trunk, but pretty quickly, you have to make some decisions about which way you’re going to go. What kind of people do you want to work with? Where do you want to practice? And how far up the tree do you want to climb? You’ll get to grow professionally – learning more, getting better clinically, and maybe even improving your sales and business skills, but that’s not all. Physical therapy gives you a chance to grow personally too.

Pick your people

You can pick the type of people you want to work with – sports physical therapists work with athletes, helping them recover from injuries and improve performance through exercise and hands-on techniques. Geriatric physical therapists work with elderly patients on mobility problems, pain or managing chronic conditions. Pediatric physical therapists work with infants and children providing developmental assessments and helping them improve their gross motor skills.

Pick your place

You can also pick where you work – there are physical therapy jobs in nursing homes, hospitals, outpatient clinics and schools. Physical therapists provide care wherever people need it. So far, we’ve only mentioned the more common places you’ll find PTs – if you want to specialize further, you may find yourself working only in the ICU with critical care patients, in a factory doing industrial rehabilitation and ergonomics, in a women’s health clinic, or even working in a preventative, public health role.

Grow professionally

Most physical therapy careers start in a general role, working with all types of different patients. If you work in a large health system, you may even rotate between settings. But as you find the type of people you like to work with and the setting you prefer, you have the option to improve your skills and focus on a specialty area of practice. Again, you have lots of options on how to do this. You could:
● Take an internship position or join a fellowship program
● Attend workshops or conferences
● Read journals and textbooks
● Collaborate with your colleagues and mentors
● Take courses in other areas of medicine
● Study abroad or take courses online


Grow personally

Your clinical skills aren’t the only thing a career in physical therapy can grow though – you’ll grow personally as well. You have to learn to have compassion and empathy when you work with ill or injured people. You have to work as a part of a team. You need sales skills – most people aren’t going to want to make changes in their routines, or do the exercises you prescribe at home. You’ll learn to work with people who have different opinions and different viewpoints from all kinds of cultures and backgrounds.

You may also have a chance to improve your business skills. You could advance out of the clinical setting and into a management role. Some PTs start their own practices, or a company in a field related to physical therapy like wellness, performance, injury prevention or population health for large corporations.

Wherever you start in physical therapy, you’ll have a lot of options on where you end up. Chances are you’ll explore more than one branch of the physical therapy tree. That’s OK, having the chance to grow and change is part of what makes PT so exciting!

Finally, Some Good News About Back Pain

Back pain is a huge problem in developed nations worldwide. It has or will affect most of us. The
current estimate is that 80% of people will experience back pain at least once. It is the single
biggest cause for disability, the third most common reason for doctor visits, and one of the most
common reasons for missing work.


It’s also expensive. Back and neck pain makes up the biggest healthcare expense in the US,
totaling $134 billion spent in 2016. The next two most expensive conditions were diabetes —
$111 billion in spending — and ischemic heart disease at $89 billion.


Diabetes and heart disease being so expensive to treat doesn’t surprise most folks – they can
both lead to other major problems, require long term medication, could require surgery, and
both can be fatal. Back pain won’t kill you, usually doesn’t require long term medication, and
usually doesn’t require surgery either. Why is it so expensive?


The first reason is that it’s so common. The second reason is that our current system isn’t very
good at treating it. Current recommendations include starting with activity modification, and
active treatments like physical therapy. Research backs this up, showing better outcomes and
lower costs with early PT. Unfortunately, only 2% of people with back pain start with PT, and
only 7% get to PT within 90 days. At the same time, a study looking at about 2.5 million people
with back pain in JAMA showed that 32.3% of these patients received imaging within 30 days of
diagnosis and 35.3% received imaging without a trial of physical therapy. Both of these things
go against current practice guidelines for treatment of back pain.


A new pilot program being rolled out by TRICARE, the insurance system used throughout the
US military is waiving the payment owed by the patient for up to three PT sessions in an attempt
to improve the use of what the Defense Health Agency calls “high value” treatment for low back
pain. The theory is that once a person sees some benefit from PT treatment, they’re likely to go
back for more. This is the “try it before you buy it” approach – think of the 7-day free trial Netflix
offers, free samples poured in wineries and craft breweries, or the folks you see standing
around in supermarkets with food on toothpicks. TRICARE’s data seems to indicate that it works
just as well for healthcare as it does for other businesses. In a press release they state that
once people attend one session of physical therapy, they’re likely to go back for more, no matter
what their co-pay is. But TRICARE found that higher co-pays could be a barrier to people trying
that first visit. For the group of patients with the highest co-pays in the system, only 38% of the
people prescribed PT attended the first visit. That’s about half the rate of attendance found in
the lowest co-pay group.


The fact that such a major insurer is looking into the value of PT is great news for everyone. If
TRICARE can show that lowering the cost of PT for patients can improve outcomes and save
insurance companies money, other major insurers will likely follow. This could improve the lives
of millions of people every year while reducing the huge cost of treating low back pain for the
country. That seems like a win for everyone involved.

In Person or Virtual PT? Maybe Both!


Virtual physical therapy has quickly moved from a niche offering to the mainstream. Having more options is great, but it can also complicate decision making. Having an understanding of the benefits of both can help make clear which one would best help you meet your goals.


In Person Physical Therapy


The main advantage of traditional “brick and mortar” PT is that the therapist is in the room with you. That means they can move around to see how you’re moving from different angles, physically adjust your position or movement as you exercise, and physically examine you – testing your strength, measuring your range of motion, etc. They can also use things like manual therapy, electrical stimulation or ultrasound when you’re in the clinic. In person PT may work best for:

● New patients – the ability to physically examine you makes it easier for your PT to accurately diagnose what’s going on
● Less active patients – if you’re not used to exercising and moving, having someone physically present to coach you along can be a big benefit
● People with complicated or chronic conditions – if your back has been hurting for the last 5 years and you’ve been ignoring it, providing a diagnosis and treating it totally virtually will be difficult for your PT
● Less motivated patients – virtual PT requires you to do most of your exercises by yourself. If you need someone watching over you to make sure you do them, in person PT might work better for you


Virtual PT


The main benefit of virtual PT is convenience. Because virtual PT relies on you doing most of your exercise and treatment on your own, appointments can be shorter. This also means that motivation is a prerequisite to choosing virtual PT. The fact that you don’t have to travel to the clinic makes it easier to squeeze a visit into a busy schedule. Virtual PT works well for:

● Athletes and others with good body awareness – being on your own for your home exercise program requires you to be in tune with your body and how it’s moving
● People with common athletic injuries – things like tendonitis, sprains, strains, plantar fasciitis, and overuse injuries are commonly treated by PTs. Because of that, there is a template for treatment that is easily adapted to individual needs.
● People who are comfortable with technology – you don’t have to be a technology whiz, but having some familiarity with skype, facetime, or zoom helps!
● Existing and returning patients – if your physical therapist knows you, it’s easier to treat you virtually.

Both options have benefits and limitations. One or the other might be right for you and your needs, but they’re not mutually exclusive. Combining the two can work well for many people. Doing an in person visit for your initial evaluation and perhaps a follow up visit or two will let your therapist provide an accurate diagnosis and get you started on your exercise program. Once you’re comfortable with your exercise program, you can transition to virtual visits.

Imaging Can Improve Physical Therapy Treatment

Physical therapists are experts in the musculoskeletal system, and typically use patient
history and a good physical exam to come to a diagnosis and treatment plan. However,
PTs are increasingly using diagnostic imaging as they become the practitioner of choice
for musculoskeletal injuries. Many PTs have access to diagnostic ultrasound right in the
clinic, and in some practice settings like the military, and certain ACOs, therapists have
the ability to order imaging like x-rays, CT scans and MRIs.

The research indicates that PTs are effective in using their ability to order imaging when
it exists. A study of 108 imaging orders by PTs providing musculoskeletal primary care
in a direct-access sports physical therapy clinic found that advanced diagnostic imaging
was ordered appropriately in over 80% of cases.

So, PTs are good at appropriately ordering imaging, but how does it improve
treatment? A case study published in the July 2015 issues of the Journal of Manual &
Manipulative Therapy gives a good illustration:
The patient was a very active dentist who had chronic mid and upper back pain. He had
a known history of benign neural tissue tumors of his head and upper back region, but
no specific diagnosis for his back pain had been provided. After examination, the PT
decided to start treatment for the patient’s back pain, but also order x-rays and an MRI
of the symptomatic part of the patient’s spine. The MRI showed a previously
undiscovered meningioma, or benign tumor of the membrane that covers the spinal
cord.

The benefit to this patient was that the PT could continue treatment without making
referrals and waiting for someone else to order the images. Also, once the tumor was
discovered, the PT could select exercises and manual techniques that would help the
patient, but avoid putting stress on the area of the tumor. It also allowed the PT to
educate the patient on fitness activities that would be safe and appropriate.

The case study has a quote that sums up the benefits of imaging combined with PT
nicely: “Orthopaedic physical therapists have high levels of musculoskeletal expertise
and extensive knowledge of typical patterns and behaviors of musculoskeletal
conditions. These competencies and experiential knowledge enable them to
appropriately recognize situations requiring additional diagnostic screening for nonmusculoskeletal pathology.
This case demonstrates how privileges to order musculoskeletal imaging studies assisted the physical therapist in providing optimal,
patient-centered care. The physical therapist in this case was able to continue
treatment without multiple referrals back to the medical provider to obtain imaging,
and so provided more cost-efficient and convenient care.”

Reference article and case study:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5046964/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4534847/

The Number One Thing You Can Do to Improve Your Physical Therapy Experience

Dealing with the pain and limited mobility associated with an injury or illness can be stressful for so many reasons. You might have questions like, “How long will I be sidelined?” and “What do I need to do to get better?” Or maybe you’re worried about how you’ll pick your children up from school, walk to the train for your commute or prepare meals for your family.
These are all perfectly normal concerns. Luckily, there are some ways that you can gain control over the situation and ensure that you return to the activities you care most about—especially if physical therapy is part of your plan.

What you can do before your very first appointment—and during physical therapy—to take control of that injury-related stress? First and foremost, it’s important to come prepared for physical therapy. And no, I’m not talking about dressing appropriately and arriving on time (or even better, 15 minutes ahead of your scheduled appointment). That stuff is important, of course, but there’s one thing you can do in the days leading up to your appointment that will set you up for success.

Any guesses? I’m talking about starting a list. What kind of list? Well, every time that you feel pain in the affected area or notice an activity that is harder than it was pre-injury, add it to the list! And the more specific you are, the better. Here’s an example to help drive this point home: Let’s say that you’re recovering from a moderate meniscus tear and you have an appointment with your physical therapist in three days. Take notes on how your knee feels first thing in the morning after you’ve been off your feet. How does your knee react when you stand up from a chair—does it feel unstable? Or do you find that you need to clutch the back of the couch on your way to the bathroom? Sharing each of these details helps your physical therapist understand your limitations beyond the injury printed on your intake form.

Now let’s take that list a step farther and add some details about the activities that you typically participate in on a regular basis. Let’s say that you normally play a weekly round of golf, spend your mornings weeding your garden or meet up with friends for a four-mile walk two evenings a week. These activities have become an important part of your life so let’s make sure that they’re factored into your list, perhaps in the “what you hope to get out of physical therapy” category. Painting a clear picture of how active you are—and what types of activities and sports you participate in—can help your physical therapist design an individualized treatment plan and to better help you on your road to recovery.

Have you been to physical therapy lately for an injury? Did you find anything else that helped maximize your time in rehab or that improved communication with your physical therapist?

80% of Americans Experience Back Pain, But 100% of PTs Know How to Prevent It

Got back pain? You’re not alone. Eighty percent of Americans suffer from low back and neck pain at some point in their lives. Let that sink in. With such great odds that you—or someone close to you—will one day become a statistic, wouldn’t it make sense to arm yourself with preventive strategies and knowledge? Physical therapy is a good place to start.
By performing a thorough evaluation, a physical therapist can identify the muscular, postural and skeletal limitations that could one day lead to an episode of back pain. As part of the assessment, she will observe as you perform a series of exercises and then gather an account of your daily activity level and environmental factors like operating machinery or working at a desk 40 hours a week.
The PT will then use all of this knowledge to design a personalized exercise program and teach you a few APT-approved strategies to prevent back pain:
Use good body positioning at work, home and during recreational activities.
Keep the load close to your body during lifting.
Ask for help before lifting heavy objects.
Maintain a regular physical fitness regimen— staying active can help to prevent injuries.

Lifestyle can play a big role in back pain. In fact, inactivity and incorrect body mechanics while participating in certain activities are two of the biggest contributors to back pain. In addition to the strategies listed above, it’s also helpful to pay attention to little things throughout your day. That could add up to bigger problems down the line. Let’s go back to that desk job for a minute: How often do you get up to walk, stretch and move throughout the day? A good rule of thumb is to stand up or move every 30 minutes. You may get bonus points with your boss, too, as your productivity soars due to the increased activity.
While low back pain rarely becomes serious or life-threatening, it can be quite painful and interfere with our daily lives. Working with a physical therapist can help patients identify the factors that might contribute to back pain and help to develop a prevention plan. But the healthcare professionals are also a great place to turn when you’re seeking treatment for back pain or hoping to prevent a recurrence.
With such good odds that you could one day become a low back pain statistic, why not do everything in your power today to change your trajectory? Seems like another good reason to find an activity (or better yet, two or three activities) that you enjoy, make it a regular part of your day and stick to it!

ARTHRITIS & FIBROMYALGIA & AQUATIC THERAPY

Relaxation is one of the most important aspects of controlling arthritis and fibromyalgia pain. Therapeutic warm water provides sensory stimulation, which encourages relaxation and stress relief. Combining this warm water with our deep penetrating massage system can greatly reduce the stress and pain on aching muscles and joints.
Walking on the underwater treadmill or exercising against the resistance jets can also help manage your pain. When standing chest deep in water, the body is 80% weightless, bearing only 20% of its body weight. This weightlessness significantly reduces the stress on joints and muscles.
BENEFITS OF AQUATIC THERAPY FOR THOSE WHO SUFFER FROM ARTHRITIS AND FIBROMYALGIA:
-Relaxation
-Increased joint range of motion
-Pain relief
-Enhanced mobility
-Improve flexibility
-Mobility and strength
-Removes weight from joints and bones
-Strengthens muscles and joints after surgery
-Decreased side effects

Call Freedom today to set up your appointment OR ask about our free 30 minute session.

Patients Reap the Benefits of Playing a More Active Role in Physical Therapy

Patients can no longer be passive players in the game of health. Studies show that informed patients are not only more engaged during physical therapy but also reap the benefits in overall health and well-being.

Those who understand why they’ve been referred to physical therapy, are actively engaged in the process, and develop useful self-management skills are more likely to achieve lasting results. With a few pointers, building one’s health literacy doesn’t have to be an overwhelming prospect.

To get the most out of your rehabilitation, it’s important to keep an open line of communication with your physical therapist. Your physical therapist is a wealth of knowledge and is there to help you regain mobility and relieve pain. The interaction should be positive, informative, and collaborative. Here are a few questions to ask your physical therapist so you may understand the rehab approach and how it impacts your injury or illness:
Why have I lost function/why do I hurt?
Your physical therapist has been trained to determine why a particular injury causes a loss of mobility or interferes with your ability to complete a task. It’s helpful for patients to gather information and understand the body’s mechanics as it relates to an individual injury.
Did my lifestyle contribute to this issue?
Your physical therapist will gather information about your lifestyle in order to identify habits that might be contributing to the problem. Perhaps the patient needs to wear shoes with support and limit time in flip flops. Or maybe the patient is experiencing low back pain due to poor posture at work.
How will physical therapy help me?
Physical therapists work with patients to devise an individualized and concrete care plan. You should feel comfortable asking your physical therapist why a specific goal has been chosen, how it will help you, and what you personally need to do to succeed.
What can I do to make sure I get better?
Showing up for appointments is only half the battle. Being ready to participate and understanding what you should be doing in between appointments is critical. You should be prepared to carry over goals at home and make modifications to habits at home and work to change contributing behavior.

It’s important that you feel comfortable asking your physical therapist questions and continue to understand how you can contribute to your care plan. Advocating for your own care and maximizing educational opportunities will give you the confidence and tools to succeed in physical therapy and beyond.

Yearly Physical Therapy Visits are Just as Important as Annual Cholesterol Tests

You know the drill: During your annual visit, your primary care physician will order a cholesterol test. Combined with an assessment of health measures such as diet and exercise, the results of the cholesterol test will provide your physician with the information she needs to make a recommendation. If the results are positive, you might hear: “You’re doing great, keep doing what you’ve been doing!” If the results are unfavorable, then you’re more likely to be told: “I’d like you to walk for 20 additional minutes each day and eat cholesterol-lowering foods like oatmeal.”

Over time, high cholesterol can cause fatty deposits to form in your arteries, putting you in a high-risk category for heart disease and stroke. Similarly, the cumulative effects of poor posture or a muscular imbalance, for example, can take a toll on your body and inhibit your ability to move properly. That’s where a physical therapist comes in: Annual PT “checkups” can catch the musculoskeletal problems that put you at risk for injury or limit your ability to function down the
line.

One of the best tools in a PT’s prevention arsenal is the movement screen. By analyzing your fundamental movements with a movement screen developed for their own practice or one that requires certification such as the Functional Movement Screen (FMS™), PTs can get a clear picture of what the future will bring for you. Based on the information gathered, a physical therapist can help you safely reach your fitness goals and teach preventive strategies that can be
incorporated into your daily life.

Of course, it’s best to schedule your checkup before you’re experiencing a problem. That way, your physical therapist can establish a baseline based on your functional level at that time and use it to identify changes during subsequent annual visits. The effects of poor posture or a muscular imbalance may not be immediately apparent to you, but they will be to your PT.

An annual “checkup” gives your PT an inside look at your musculoskeletal system, which is comprised of your muscles, bones, cartilage, tendons, ligaments, joints and other connective tissues. It’s important that these essential internal structures are working together to support, stabilize and move your body.

Just as taking an annual trek to the primary care physician helps to monitor your cholesterol levels—and prevent heart disease—yearly physical therapy appointments allow your PT to identify and address any changes in the way you move before they become something more.

Call today to set up your appointment with one of the best physical therapists in town!