What Can Physical Therapy Do for Me?
Treatments - Exercise - Mechanics
Physical Therapy Treatments
Many patients with osteoarthritis (os-t-o-arth-rye-tis) have found exercising in water to be beneficial. A pool offers a gravity-free environment allowing the patient to perform simple exercises without stressing painful joints. Movement increases circulation to affected joints and can help to relieve stiffness. For some patients, swimming is a good exercise to loosen up stiff joints and strengthen muscles.
Electrical Stimulation ('Stim') forces a muscle or muscle group to contract and relax. The therapist places a pair of surface patches containing electrodes on the skin over the area to be treated (e.g. low back). Each patch attaches to a lead (insulated wires) connecting to equipment that controls and regulates the stim. The therapist programs the equipment to deliver the correct amount of stimulation for a set period of time.
The electrical current affects nerve and muscle cells, which may be at rest or reacting to the stimulus. The treatment is not painful. The patient feels a gentle pulsating or on and off sensation. During this treatment circulation is stimulated supplying the target area with oxygen and nourishment necessary for healing. Physical Therapists have used electrical stimulation for more than 15 years to enhance healing, alleviate swelling, and pain.
Heat and Ice
Heat increases circulation, decreases stiffness, pain and muscle spasm. Patients with early signs of arthritis often find substantial relief from symptoms by taking a warm bath or hot shower. This is best done early in the day to help loosen up and alleviate stiffness commonly associated with forms of arthritis (e.g. osteoarthritis). Physical therapists use moist hot packs wrapped in several layers of toweling that is laid or wrapped around the effected area. Unlike a heating pad that only delivers surface heat, a moist hot pack transfers moist heat that penetrates deeply into soft tissues and stimulates local circulation more than heat alone.
Ice decreases pain by slowing the speed of nerve impulses. Inflammation, the body's vascular response to injury may subside with forms of cold therapy. Cold reduces the temperature of tissue beneath the skin. Cold packs, ice massage and iced towels are usually recognized as the first aid following trauma. Application of cold therapy for an extended period of time can harm the skin. Treating with ice should be supervised by a physical therapist, especially when treating an overworked body part.
Hydrotherapy is probably one of the oldest therapeutic treatments. Hydrotherapy is similar to a whirlpool bath. Whirlpool tanks are available in different sizes. Some are designed to accommodate the entire body. During hydrotherapy both the water temperature and agitation are controlled for maximum benefit.
Myofascial Release (my-o-fash-e-al release) improves circulation, decreases muscular tension and increases range of motion. Myofascial release is a form of localized massage affecting the muscle fascia. Muscle and groups of muscle are encased in sheets of fascia. During myofascial release, the fascia is manipulated by hand to systematically stretch the tissue. Scar tissue or tight tissue may be loosened using cross friction motion during massage therapy.
Ultrasound is a common treatment and has been in use for more than 40 years. It produces high-frequency sound waves that pass through the skin to promote deep warming of soft tissues (e.g. muscle). The warming effect enhances circulation and healing. Ultrasound is often used to treat muscle spasm and to relax tight muscles. Unlike a hot pack, ultrasound works without harming the skin. The equipment controls the speed and duration of the sound waves.
Movement and Conditioning
All exercise is supervised by a physical therapist responsible for teaching the patient how to move properly while pushing beyond pain thresholds. Physical therapists want patients to work within a pain free range. This does not necessarily mean exercise will be easy in the beginning. Remember the adage anything worthwhile is worth working for.
Warming-Up the body may be accomplished by riding a stationary bike followed by light stretching. Of course the type of warm-up and therapy is dictated by the patient's individual treatment program. Temporary muscle soreness 24 to 48 hours following exercise therapy is normal and should be expected. As regular exercise continues discomfort will subside. Stretching helps to increase flexibility. Resistive and strengthening exercises may be added as the patient progresses.
Some patients are not able to move the affected area without assistance. The physical therapist will then manually move the affected area (e.g. arm, leg) to increase range of motion.
Physical therapy often includes a customized home exercise program. The instructions may include written and illustrated exercises. Always consult the therapist before starting or changing a physical therapy exercise program. If necessary, changes can be discussed with the patient's physician.
Posture and Body Mechanics
Learning to use proper body mechanics is important to prevent further injury. If the patient is willing to maintain an adequate level of physical fitness, reduce stress, and use proper body mechanics, the risk of injury from activity can be reduced.
Proper posture means maintaining the natural curve of the spine or neutral spine. Good posture helps to minimize stress to the spine. Posture may be the first lesson a physical therapist teaches the patient. Poor posture and body mechanics are two of the leading causes of neck and back pain.
Good posture means the shoulders are held slightly back and level, the ears are in line with the shoulders, the chin is slightly tucked inward, and the pelvis is shifted forward allowing the hips to align with the ankles. Figure 18, Page 161 demonstrates proper posture. Notice the plumb line hangs directly from the ear lobe down the middle of the arm to the ankle.
Avoid Stressful Work Habits
Avoid leaning over the desk for long periods of time. Don't sit too far from the work area without the back supported. Adjust the chair height so the knees are bent at a 90-degree angle. Bend the elbows at a 90-degree angle; elbows may rest on the work surface. Avoid cradling the telephone against the ear and shoulder.
Lifting and Carrying Tips
First, take a look at the object to be moved. If it appears to be too heavy or cumbersome, find help. Remove obstacles in the pathway before lifting the object. Think about how you will maintain good posture. Get as close to the object as possible. Place the feet slightly apart and flat on the floor. Bend at the knees to provide a stable base of support.
Tighten the stomach muscles, keep breathing and smoothly lift the object using the arms and legs - not the back. Try to hold the object at the side and bottom. Keep it close to the body with the back straight and carry the object with the elbows slightly bent.
When carrying shopping bags or luggage, split the load in two. Try to carry the same amount of weight in each hand.
Push or Pull?
Pushing is usually more efficient. Keep the back straight and use the knees to push. Stay close to the object by repositioning the body from time to time.
Consider the size, weight and location of the object. Use a stable stool or ladder to get as close to the object as possible. Stand on the stool or ladder with both feet flat. Try to directly face the object. One hand could be used for additional support. Avoid looking overhead as this could cause neck strain. Consider storing often-used items within easy reach.
This article is an excerpt from the book Save Your Aching Back and Neck: A Patient’s Guide, edited by Dr. Stewart Eidelson.