2007-10-26 / Columnists

Eye On Physical Therapy

Commentary By Dr. Tim Rohrs, DPT

The number one reason people seek physical therapy treatment is pain. Pain, in its most simplified form, is the brain's perception of electrochemical signals from damaged tissue. In some cases the cause of the pain is clear; a fall to the floor, hitting your thumb with a hammer, or some other trauma. In many cases, the cause is not so clear. When the cause is not clear, it's off to the doctor to find out what's going on. The doctor takes the history and performs an evaluation, as well as ordering assorted tests, including blood work, x-rays or an MRI.

Certainly there are causes of pain which need immediate attention and intervention. Having cancer or a tumor can be painful. Gallstones, kidney stones, appendicitis and such will cause severe pain. A fractured bone may cause pain. Few would argue that these diagnoses need treatment. A tumor might need surgery, radiation or chemotherapy. A fracture might need some metal pins and plates to mend, or at the least, a cast applied. In fact, many treatments are as uncomfortable for the patient as the pain that initially brought them to the doctor. Patients deal with this pain because they realize that it could be the difference between life and death; it could mean the difference between walking and being in a wheelchair. In most cases, patients do not tell their doctor to take away their pain but leave the underlying cause of it alone. No one says to the doctor "this brain tumor is painful so take away the pain, but its ok to leave the tumor there". No one says "Hey doc, this broken leg is painful, please relieve the pain, but don't set the bone."

Almost every day, physical therapists are confronted with this situation. A patient will come in and tell the therapist they want their treatment to include heat, electric stimulation, ultrasound and massage, but no exercise. Why? First, I think their thoughts are misguided by technology and bells and whistles. "Exercise and flexibility are low tech, but those fancy electric stimulators and therapeutic ultrasound must be the key to pain relief." While these modalities may provide some temporary reduction in their pain, they are not the long-term solution. The underlying cause of the pain needs to be addressed. The cause may be weakness, stiffness, muscle imbalance or injury. Physical therapy is rehabilitation. Pain relief is the domain of medicine.

Just as a doctor would not provide pain relief for a brain tumor without the removal of the tumor, the physical therapist strives to correct the underlying dysfunction. This correction includes therapeutic exercise, stretching and resistance training. I have often admonished patients and newly minted physical therapists that exercise is job one; that I can get someone healthy with a well-designed exercise program, but cannot do the same using just electric stimulation or ultrasound, without the exercise.

What good is pain relief if the underlying dysfunction leads to a rotator cuff tear or being unable to kneel in church, or being unable to walk without a walker?

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