2003-05-23 / Columnists

Eye On Physical Therapy

By Tim Rohrs
Eye On Physical Therapy By Tim Rohrs

More and more patients are taking an active role in their own health care. Unfortunately, they may not have all the information possible to make an informed decision about medications that have been prescribed for them. All too often I hear patients comment to me "Yes, the MD prescribed _______ (fill in the blank) Celebrex, Vioxx, Bextra, etc. but I am not taking it." They go on to explain, "Since the anti inflammatory drug only takes the pain away and not really curing my rotator cuff sprain, I’m not taking it. I don’t want to mask the pain". Of course if the medication is not helping in reducing their pain, then that is a separate issue and should be discussed with the MD. Inflammation after an injury is part of the normal healing process. White blood cells infiltrate an injured joint or muscle and clean out debris from the area. This inflammation can be noticed by a redness and warmth over the affected area, joint pain and stiffness and loss of joint function. This same inflammation, which is a normal part of the healing process, can also cause problems if left unchecked. The increased number of cells and inflammatory substances within the joint cause irritation, wearing down of cartilage (cushions at the end of bones) and swelling of the joint lining. This prolonged exposure to inflammation can be the start of the arthritic process and joint degeneration. We all hope an acute injury will heal on its own, and we put off seeing the doctor in hopes that it will. But leaving an injured joint exposed to the inflammatory process for months and months is not good.

While anti-inflammatory medications do reduce pain, they also are an important part of the management of an injury. Without pain control, most people tend to use the injured body part less and less, letting it become weaker and stiffer. The body itself tries to protect the area through muscle guarding and spasms. When muscles go into spasm you can picture a sponge being squeezed as hard as can be. When in that contracted position no new liquid can enter the sponge. The same holds true for muscles in chronic spasm; they experience decreased blood flow, resulting in muscles that are sore and tender to touch and hurt to move.

It is much easier for patients to participate in physical therapy when they are experiencing less pain not more pain. It takes much longer for injured parts to heal and for patients to progress through therapy when we have to deal with the pain issue first.

So the next time your MD prescribes an anti inflammatory medication, remember it is an important part of the overall management of your injury. Discuss with your doctor the need and purpose of all medications that are prescribed for you.

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