2007-09-07 / Columnists

Eye On Physical Therapy

Commentary By Dr. Tim Rohrs, DPT

It seems that during the course of physical therapy, the therapist and patient walk a fine line between the need for pain relief and the need for increasing function. When a patient first starts coming for physical therapy, their primary goal is to eliminate the pain that originally brought them to their doctor's office. In fact, that is usually the only thought on their mind. After a few sessions or weeks, the pain slowly starts to recede. As the pain decreases, we inch closer to that line.

While tissues are healing and strength and flexibility are restored to the joint, the focus should slowly start to change from pain relief to restored function. To accomplish that goal, the therapist will usually try to increase the patient's work load through exercise. At times, this increase in work load or activity may cause to flare up the pain that was being relieved. It is understandable that the patient is reluctant to increase the number of exercises, or to start using heavier weights.

As the patient starts to experience pain relief, I usually ask them what activities they are still having problems doing.

Sometimes the activities are limited by pain, and other times it is from weakness.

People who have had knee surgery may not be able to go up and down stairs or may not be able to kneel in church or get up the high steps on a bus.

Those with shoulder dysfunction may not be able to lift a pot of water off the stove or lift a gallon of milk. By defining what functional limitations they have, we have set some clear goals of what we need to work on.

As we work towards attaining these goals, the patient may experience a short-term increase in pain or muscle soreness.

For some patients, reluctance is replaced by an outright refusal to participate in any strenuous exercise. It is at this time that I try to explain that their knee or shoulder is never going to "magically" start doing those activities again.

They will need to come to the realization that it is better to slowly increase the strength of those muscles in a controlled environment under the supervision of a licensed physical therapist, than to return to those activities at a later date on their own. They run the risk of causing more damage to the tissues that are healing and ultimately may set themselves back even further in the healing process. It is often better to experience these "growing pains" with the therapist so that they can evaluate if the pain is muscle soreness, joint pain or other tissue damage.

The therapist can then change the exercise to accomplish the goal without the pain. In any case, our job is not complete with just relieving pain, if the patient cannot return to all the activities they participated in prior to their injury.

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