(Tiny Tips) – Chronic Pain – Physical therapy, often called PT, can identify, diagnose, and treat movement problems. Physical therapists evaluate patients and then work with them to develop an individualized plan using a range of treatment techniques designed to restore function and mobility, reduce pain, and improve quality of life. Physical therapy is an active rather than a passive form of treatment: Many treatment plans include strengthening and stretching exercises that patients can practice at home.
How it works
The goal of physical therapy is not just to treat symptoms, but to address the underlying cause of pain or limited mobility to provide long-term relief. For example, a patient’s back pain may be caused by poor posture or weak core muscles, which can be improved with exercises. Knee pain caused by arthritis can be relieved by strengthening the muscles around the joint to better protect it.
Physical therapists can also provide hands-on treatments to help heal problem areas, including physical manipulation of the area, ultrasound therapy, and dry needling. The final technique involves inserting drug-free needles through the skin into muscle areas to unblock or inactivate trigger points, thereby relieving pain and improving range of motion. Therapists can prescribe assistive devices, such as splints for carpal tunnel syndrome or braces after a knee injury.
Chronic pain is complex, notes Colleen Louw, a physical therapist, spokesperson for the American Physical Therapy Association (APTA) and director of the Exercise Evidence-Based Pain Specialist Certification Program. “Physical therapists are increasingly adopting a biopsychosocial approach. We are committed to empowering patients through education, helping them understand the cause of their injuries and reduce their fear of movement so they can get back to their lives.”
Relieve chronic pain symptoms
Lowe said common chronic pain conditions seen by physical therapists include low back pain, fibromyalgia and knee arthritis. Recently, physical therapy has gained attention as a treatment modality that may reduce opioid overuse. Physical therapy is one of the first methods recommended in the Centers for Disease Control and Prevention’s new draft pain management guidelines.
The draft guidance states: “There is high-quality evidence that exercise therapy (an important modality in physiotherapy) for back pain, fibromyalgia, and osteoarthritis of the hip or knee can reduce pain and improve symptoms immediately after treatment. function, and this improvement lasts for at least a year.” “At least two to six months.”
Meanwhile, a scoping review found an association between early PT intervention for painful symptoms such as low back pain, joint pain and recovery from orthopedic surgery and patients being less likely to subsequently take opioids.
Various studies show that physical therapy is effective in treating certain chronic pain conditions:
Knee Pain One study found that patients with knee osteoarthritis who received physical therapy had less pain and disability after one year than those who received steroid injections.
Sciatica One study found that patients with back pain due to sciatica who were referred to physical therapy after an initial diagnosis had lower disability and lower back pain intensity than patients without sciatica.
Pelvic pain physical therapy is also used to treat chronic pelvic pain. One study examined gynecological cancer patients and found that those who received pelvic floor physical therapy had less pain, improved sexual function, and fewer urinary symptoms.
General health and well-being benefits
Physical therapy has a wide range of uses, from preventing falls in older adults to recovering from surgery. Many health conditions treated by physical therapists include stroke recovery, pelvic pain, chronic fatigue syndrome, and rotator cuff injuries.
The main goal of PT is to help people overcome problems that prevent them from being more active. This is crucial because a range of studies have shown that increased exercise and activity can benefit a variety of physical and mental health problems and reduce overall mortality. “Exercise is good medicine,” Law said.
How to use it
Physical therapy is provided by licensed physical therapists in a wide range of hospitals, private practices, pain clinics, and outpatient programs. Physical therapists are increasingly offering virtual appointments.
According to APTA, your primary care physician can provide a referral, or you can go directly to a physical therapist without a referral. Some physical therapists specialize in treating chronic pain.
Cost: Is PT expensive? Is it covered by health insurance?
Many insurance plans, including Medicare, workers’ compensation, and private insurance companies, will pay for physical therapy that is deemed medically necessary and performed by a licensed physical therapist or a licensed physical therapist assistant under the supervision of a physical therapist Fees for Services.
What happens
Be prepared for your visit by wearing comfortable clothing that allows you to stretch and move freely. At your first appointment, the physical therapist will take a detailed medical history, including questions about your condition and current symptoms.
They’ll perform a physical exam, usually assessing your strength, flexibility, and balance, and look for other signs and symptoms, such as unexpected warmth in an area, which may indicate an infection, or loss of sensation, which may indicate damage to the spine, nerve problems, Referral for medical evaluation may be indicated.
You can use your hands to feel the affected area or its surroundings. You may be asked to perform daily activities, such as walking or getting up from a chair, so that the physical therapist can observe how you move. After the examination, your physical therapist will discuss your treatment goals and work with you to develop a treatment plan.
In addition to in-office therapy sessions, you’ll often be given homework: Your physical therapist may show you exercises and coach you on how to perform your daily activities more healthily.
Considerations
You may be worried about injuries from physical therapy. “People with chronic pain are often afraid to move. They worry that any exercise will cause them pain or make their condition worse,” Louw said. The first step, she says, is building trust with patients. This may mean gradually increasing the amount of exercise so that the patient is able to move around again with confidence.
If you experience pain or discomfort, please contact your physical therapist. He may adjust your treatment or suggest strategies such as using ice cream to relieve pain after treatment. “For example, I might recommend that someone with knee arthritis exercise in a pool to reduce stress on the joints,” Lu says.
PTs may need self-discipline to keep up with prescribed exercises. APTA states: “The hard work you put in during your physical therapy session will be rewarded.”
Resources
American Physical Therapy Association
Editorial Sources and Fact-Checking
- Benefits of Physical Therapy. American Physical Therapy Association.
- Dry Needling. Cleveland Clinic. January 1, 2018.
- About Physical Therapists and Physical Therapist Assistants. ChoosePT.com.
- Proposed 2022 CDC Clinical Practice Guideline for Prescribing Opioids. Federal Register. February 10, 2022.
- Brown-Taylor L, Beckner A, Scaff KE, et al. Relationships Between Physical Therapy Intervention and Opioid Use: A Scoping Review. PM&R. June 2021.
- Deyle G, Allen D, Allison S, et al. Physical Therapy Versus Glucocorticoid Injection for Osteoarthritis of the Knee. The New England Journal of Medicine. April 2020.
- Fritz JM, Lane E, McFadden M, et al. Physical Therapy Referral From Primary Care for Acute Back Pain With Sciatica: A Randomized Controlled Trial. Annals of Internal Medicine. January 2021.
- Cyr MP, Dostie R, Camden C, et al. Improvements Following Multimodal Pelvic Floor Physical Therapy in Gynecological Cancer Survivors Suffering From Pain During Sexual Intercourse: Results From a One-Year Follow-Up Mixed-Method Study. PLOS One. January 2022.
- Symptoms and Conditions. ChoosePT.com.
- Posadzki P, Pieper D, Bajpai R. et al. Exercise/Physical Activity and Health Outcomes: An Overview of Cochrane Systematic Reviews. BMC Public Health. November 2020.
- Health Insurance and Physical Therapy. ChoosePT.com.
- Leerar PJ, Boissonnault W, Domholdt E, Roddey T. Documentation of Red Flags by Physical Therapists for Patients with Low Back Pain. Journal of Manual and Manipulative Therapy. 2007.
- Preparing for Your Visit with a Physical Therapist. ChoosePT.com.