FACTS

You have probably heard of the profession of physical therapy. Maybe you have had a conversation with a friend about how physical therapy helped get rid of his or her back pain, or you might know someone who needed physical therapy after an injury. You might even have been treated by a physical therapist yourself. But have you ever wondered about physical therapists–who they are and what they do? Many people are familiar with physical therapists’ work helping patients with orthopedic problems, such as low back pain or knee surgeries, to reduce pain and regain function. Others may be aware of the treatment that physical therapists provide to assist patients recovering from a stroke (e.g., assisting them with recovering use of their limbs and walking again).

The ability to maintain an upright posture and to move your arms and legs to perform all sorts of tasks and activities is an important component of your health. Most of us can learn to live with the various medical conditions that we may develop, but only if we are able to continue at our jobs, take care of our families, and enjoy important occasions with family and friends. All of these activities require the ability to move without difficulty or pain.

Because physical therapists are experts in movement and function, they do not confine their talents to treating people who are ill. A large part of a physical therapist’s program is directed at preventing injury, loss of movement, and even surgery. Physical therapists work as consultants in industrial settings to improve the design of the workplace and reduce the risk of workers overusing certain muscles or developing low back pain. They also provide services to athletes at all levels to screen for potential problems and institute preventive exercise programs. With the boom in the golf and fitness industries, a number of physical therapists are engaged in consulting with recreational golfers and fitness clubs to develop workouts that are safe and effective, especially for people who already know that they have a problem with their joints or their backs.

The cornerstones of physical therapy treatment are therapeutic exercise and functional training. In addition to “hands-on” care, physical therapists also educate patients to take care of themselves and to perform certain exercises on their own. Depending on the particular needs of a patient, physical therapists may also “mobilize” a joint (that is, perform certain types of movements at the end of your range of motion) or massage a muscle to promote proper movement and function. Physical therapists also use methods such as ultrasound (which uses high frequency waves to produce heat), hot packs, and ice. Although other kinds of practitioners will offer some of these treatments as “physical therapy,” it’s important for you to know that physical therapy can only be provided by qualified physical therapists or by physical therapist assistants, who must complete a 2-year education program and who work only under the direction and supervision of physical therapists.

Most forms of physical therapy treatment are covered by your insurance, but the coverage will vary with each plan. Most states do not legally require patients to see their physicians before seeing a physical therapist. Most of the time all you have to do is ask your doctor if physical therapy is right for you.

Reference: APTA

Physical therapists are experts at treating musculoskeletal disorders. We assess and address the cause of the problem. Our treatment techniques treat the cause, not the symptom. Our goals are long term relief of pain and return of function and activities. At our office we holistically treat the patient looking at the entire body, not just the local area of pain or dysfunction.

Who is better to see, a PT that works for a physician or a large corporation, or a PT that owns a private practice? In our private practice, the patient’s care is our number one priority. There are no corporate quotas to make or salaries of non-treating management to pay. We treat how we feel is the best for our patients. One on one with extended time.

You will be evaluated at your first visit by one of our highly skilled licensed physical therapists. We do our absolute best to keep you for all follow up visits with the same therapist. If scheduling conflict arises or if your therapist feels one of the other therapists’ skills would better suit you, you will be asked to see another therapist. We all have similar skills but all have had additional specialized training in different areas. We communicate well about our patients. You will always have a choice to stay with your original physical therapist.

Sometimes, yes. For many of our patients, pain relief is their primary goal. We accomplish this with myofascial release, hands-on techniques, stretches, joint mobilization, modalities such as ultrasound, E-stim, heat or ice to name a few. Some of our soft tissue techniques address tight, painful muscles so working on them may create some pain, but this is a good type of pain and is never to the point where you cannot tolerate it. If areas are sensitive we use much less pressure and will gradually ease into more pressure and the pain lessens.

Trauma, inflammatory responses, and/or surgical procedures create myofascial restrictions that can produce tensile pressures of approximately 2,000 pounds per square inch on pain sensitive structures that do not show up in many of the standard tests (x-rays, myelograms, CAT scans, electromyography, etc.)

Myofascial release is a safe and very effective hands-on technique that involves applying gentle sustained pressure into the myofascial connective tissue restrictions to eliminate pain and restore motion. This essential “time element” has to do with the viscous flow and the piezoelectric phenomenon: a low load (gentle pressure) applied slowly will allow a viscoelastic medium (fascia) to elongate.   Myofascial release treatment is performed directly on skin without oils, creams or machinery. This enables the therapist to accurately detect fascial restrictions and apply the appropriate amount of sustained pressure to facilitate release of the fascia

The medical approach is to drug patients so they temporarily are free from pain, but does nothing about the “straight-jacket” of pressure that is causing the pain. Traditional physical, occupational and massage therapy treats the symptoms caused by the pressure of the “straightjacket” of the Myofascial system, but does nothing about the “straightjacket” of pressure that causes and perpetuates the symptoms. This is why so many patients only have temporary results never seeming to get better with traditional therapy. Only Myofascial Release treats the entire Myofascial mind/body complex eliminating the pressure of the restricted Myofascial system (the straightjacket) that causes the symptoms.

SOURCE: WWW.MYOFASCIALRELEASE.COM

There are dozens of different types of treatment interventions. Your treatments will vary according to your diagnosis and the progress you are making. Here is a list of treatment interventions:

Myofascial Release – as described at length in the above question

Active Range of Motion (AROM) – the patient lifts or moves a body part through range of motion against gravity. AROM is usually one of the first modalities prescribed for arthritis.

Active Assistive Range of Motion (AAROM) – therapist-assisted active range of motion. This is usually prescribed for gentle stretching or strengthening for a very weak body part.

Stationary Bicycle – with or without resistance. This is usually prescribed for improving the strength and/or range of motion of the back or lower extremities as well as cardiovascular endurance.

Gait or Walking Training – the analysis of walking problems by visually examining the interaction of the low back and the joints of the thighs, legs, and feet during the various stages of walking, including initial contact, loading response, mid stance, terminal stance, pre swing, mid swing, and terminal swing. Many back, thigh, leg, ankle, and foot problems may be caused by or manifest themselves in subtle gait abnormalities.

Isometrics – muscle contraction without joint movement. This is usually prescribed for strengthening without stressing or damaging the joint (e.g., arthritis, or exercises to be performed in a cast, or right after surgery if recommended by the therapist/doctor).

Isotonics- muscle(s) contracting through the ROM with resistance. This is usually prescribed for strengthening.

Soft Tissue Mobilization – therapeutic soft tissue kneading/massaging of body tissue performed with the hands. Soft tissue mobilization may be used for muscle relaxation, to decrease swelling, to decrease scar tissue adhesions, and for pain relief.

Joint Mobilization – hands-on therapeutic procedures intended to increase joint mobility. Mobilization is usually performed to increase mobility, delaying progressive stiffness, and to relieve pain. Most of our mobilizations are Maitland and Mulligan based.

Proprioceptive Neuromuscular Facilitation (PNF) – a system of manually resisted exercises performed in diagonal patterns that mimic functional movements. PNF was initially used in developmentally and neurologically impaired patients but now is used in almost every aspect of neuromuscular retraining from athletes in sports facilities to the very weak in hospitals and nursing homes.

Posture Training – instruction in the correct biomechanical alignment of the body to reduce undue strain on muscles, joints, ligaments, discs, and other soft tissues. There is an ideal posture, but most people do not have ideal posture. Therapists educate patients about the importance of improving posture with daily activities. Stretching and strengthening exercises may be prescribed to facilitate postural improvement and to prevent further disability and future recurrences of problems.

Progressive Resistive Exercises (PRE) – exercises that gradually increase in resistance (weights) and in repetitions. PRE is usually prescribed for reeducation of muscles and strengthening. Weights, rubber bands, and body weight can be used as resistance. We also utilize a cross-fit style exercise program for more advanced patients.

Passive Range of Motion (PROM) – the patient or therapist moves the body part through a range of motion without the use of the muscles that “actively” move the joint(s).

Stretching/Flexibility Exercise – exercise designed to lengthen muscle(s) or soft tissue. Stretching exercises are usually prescribed to improve the flexibility of muscles that have tightened due to disuse or in compensation to pain, spasm or immobilization.

Cryotherapy or Cold Therapy – used to cause vasoconstriction (the blood vessels constrict or decrease their diameter) to reduce the amount of fluid that leaks out of the capillaries into the tissue spaces (swelling) in response to injury of tissue. Ice or cold is used most frequently in acute injuries, but also an effective pain reliever for even the most chronic pain.

Neuromuscular Electrical Stimulation (NMES) – the application of electrical stimulation to aid in improving strength (e.g., the quadriceps muscle after knee surgery or injury). NMES is also used to decrease pain and swelling and to relieve muscle spasm.

Neck Traction – a gentle longitudinal/axial pull on the neck, either manual or mechanical, intermittent or continuous for relief of neck pain, to decrease muscle spasm and facilitate unloading of the spine.

Heat – heat is recommended to decrease chronic pain, relax muscles, and for pain relief. It should not be used with an acute or “new” injury.

Transcutaneous Electrical Nerve Stimulation (TENS) – a relatively low voltage applied over painful areas through small self-adhesive electrodes. The electrical stimulation “disguises” or “overrides” the sensation of pain. It is a small, portable unit, used in intervals, to control pain and reduce dependence on drugs. It is usually prescribed for relief of pain as a home unit.

Ultrasound – ultrasound uses a high frequency sound wave emitted from the sound head when electricity is passed through a quartz crystal. The sound waves cause the vibration of water molecules deep within tissue causing a heating effect. When the sound waves are pulsed, they cause a vibration of the tissue rather than heating. The stream of sound waves helps with nutrition exchange at the cellular level and healing.

You will have been given self-treatment techniques, stretches, and strengthening exercises as your maintenance program once finished with PT. Make sure you are compliant with this after PT program. If this is not effective, give us a call and we can direct you as to what you should do. We may be able to guide you on a different stretch or self-treatment, you could try massage, or if it hasn’t been more than 30 days you may return to physical therapy and we will assess what has changed.

We will make sure you are well educated on the proper stretches, exercises, self-treatment and management techniques. We will often encourage you to join a fitness center or engage in an exercise program outside your home to progress your overall strength and fitness. We can help direct you to these places. We have many of our physical therapy patients return on a regular basis for massage therapy with one of our licensed massage therapists. Our massage therapists are trained in many of the same techniques we use in physical therapy and can communicate with us about your specific needs to make sure any problem areas are addressed. Self-care and continuation of your home program is important to make sure you continue to stay well.