Physical Therapy

My Secret Weapon

A patient in her 50s came to me with a chronic sore shoulder, a painful knot in her upper back, and a stiff neck. She had already seen several specialists and was at the end of her rope. An orthopedic surgeon had X-rayed her, found nothing to operate on, and told her to try to relax. A course of chiropractic treatments not only failed to fix the problem, but made it worse. Now tension would build up in her neck, so that she frequently had to "pop" it, much to her discomfort and embarrassment. She feared she had permanently injured her neck and shoulder. The answer was my secret weapon against musculoskeletal problems - physical therapy.

The physical therapist taught the patient how to stretch and strengthen the affected area. He gave her a daily regimen of arm lifts to strengthen specific muscles and increase circulation to the neck and shoulders. After six weeks, the neck popping ceased and the painful knot stopped hurting. After three months, she found she could cut back from daily exercise to once or twice a week and still keep her neck and shoulder supple and mostly pain free.

This is not an unusual story. Often a patient comes to me with pain in a joint, shoulder, knee, or hip. All of us naturally fear the worst, so we think we have arthritis or some physical damage to a tendon or joint. More often, however, the joint is not damaged. It is complaining because one or more muscles operating the joint are in spasm or have become so weak that other muscles are pulling the bones in an unnatural direction. Physical therapists are uniquely able to identify and treat conditions such as this.

What Physical Therapists Do

Physical therapists assess strength, posture, movement patterns, joint alignment, and nerve function to determine the cause of pain and dysfunction. They use exercise, movement retraining, joint mobilization, deep tissue massage, and other measures. Physical therapy can also improve age-related issues such as poor balance and incontinence. In my experience, physical therapy frequently allows a person to eliminate pain that has existed for many years.

Be warned, however, that even the best physical therapist cannot heal you without your help. They will give you physical homework and success depends upon you.

Physical Therapy and Athletes

Some years ago a patient in his mid-fifties ran a 10-K race without adequate preparation. He put mind over matter and, in a burst of speed, he finished with some very fit runners. Immediately after the race, his right knee began to throb in pain. Now every coach knows that putting a poorly conditioned athlete, no matter how talented, onto the field is asking for an injury, but amateur athletes do it all the time. For this particular athlete, I prescribed anti-inflammatory drugs and rest. The pain continued. We began to worry about age-related degeneration of his knee, but I wondered if some physical therapy might help.

Sven Solvic at Uptown Physical Therapy examined the patient, found there was a bit of wear in the knee but felt that the pain was due to a weakness of the medial part of the quadriceps muscle in the front of the thigh. My patient faithfully performed the exercises Sven recommended. After a month or two of exercise and 90 percent improvement in his knee pain, he again visited Sven, who modified the exercise program. With that, the pain resolved and has not recurred, even during vigorous activity.

The next time you watch a football game or tennis match or go to the ballet, remember it is a rare professional athlete who would dream of performing without the help of a physical therapist. Any time an athlete is injured, physical therapists are there to analyze the cause, help with the healing, and take measures to prevent a similar injury in the future.

Physical therapy and the female bladder

You may have seen the commercial that advertises medication for a woman who cannot sit through a movie because she has "gotta go." Advertisers know this is a huge market. Many women leak urine with coughing, sneezing, or associated with the urge to urinate.

One 40-year-old patient complained to me that she leaked urine frequently during the day. She wet herself when anxious, drinking water, driving home, or just opening the door to her house. She had to change her skirt or pants about twice a day. She started using a topical estrogen, and we suggested she consult Amy Irene Lynch, a physical therapist at Dirksen Physical therapy in Hadlock.

Amy Irene has advanced training in pelvic problems and about an 80 percent success rate in helping women "get dry." She explained to our patient that incontinence is often due to weakness of the pelvic floor muscles from childbirth, disuse, hormone changes, or overactive bladder. She treated her with strengthening, dietary changes, and urge control techniques.

Our patient worked for about three months with Amy Irene. At the end of that time, she was dry most days. She had problems only on long auto trips, when she had to wear a pad because of occasional leakage. She was much drier than she'd ever dreamed she could be.

Incontinence does not magically go away. Left untreated, it only gets worse as a woman gets older. The best time to start getting help is today.

Physical Therapy and Back pain

Many of our patients try massage for chronic problems such as back pain. While there are some exceptional massage therapists, most of the time even the most excellent among them cannot do more than relax tight muscles. Physical therapists will teach you specific exercises to strengthen the abdominal muscles, positioning techniques to help decompress nerves, and movement strategies to protect the back. The average patient will obtain longer lasting relief and prevent future problems more reliably in the hands of a physical therapist.

Whatever treatment you seek for back pain, be it chiropractic, massage, or physical therapy, you have a right to ask the therapist what his or her success rate is, how many visits the treatment will take, what will be required from you, and what results you can expect. Whomever you consult, if you do not improve within four to six treatments, I'd try something else. Good treatment should not result in dependence or constantly repeated visits that go on for months. Instead, it should focus on restoring function and giving you the tools to prevent the problem from reoccurring.

The take home message is this: Athletes are not the only people who need physical training and conditioning. Even if you are not a weekend warrior, your job may require physical strength and skills. Don't keep them up, and you'll be in my office with an on-the-job injury. If that happens, I promise I'll send you to physical therapy to get you toughened up and prevent future injury.

Local Physical Therapy Clinics

There are a number of excellent physical therapists in our area. We refer most of our in-town patients, especially our athletic types, to Uptown Physical Therapy (385-1035). Our Tri-area patients usually go to Dirksen Physical Therapy in Hadlock (385 9310). Both clinics give a significant discount if you pay in full at the time of service.

You do not require a physician's referral to see a physical therapist, though your insurance company will require it if you want them to pay for it.

Appendix: How Are Physical Therapists Trained?

In medical school, we met physical therapy students studying musculoskeletal anatomy alongside us in the cadaver laboratory. Like us, they needed a college degree to get into school. Today they are required to have another two to three years of class study and practical internships to complete their training.

Physical therapists are not to be confused with physiatrists, doctors of the medical specialty known as Physical Medicine and Rehabilitation, or PM & R. Physiatrists help people with severe musculoskeletal disabilities, such as those arising from polio, a vehicular accident, or stroke. If a person requires an artificial limb, a PM & R doctor will oversee the process of fitting and adjusting that artificial limb.

Physiatrists are the specialists who train physical therapists. With the additional exception of orthopedic surgeons, competent physical therapists have a better knowledge of the mechanics of muscles and joints than most physicians.

CJK April 6, 2006