2008-05-02 / Columnists

Eye On Physical Therapy

Commentary By Dr. Tim Rohrs, DPT

A few days ago, one of my patients was lamenting the fact that she was not really feeling any better. Her shoulder pain waffled between slightly better and slightly worse. Our conversation took a turn when I asked her if she was doing any of her home exercises. I often go to great lengths to make sure that our patients get a home exercise program that consists of pictures and verbal descriptions of the exercises they are to be completing at home. It includes how many to do, and how frequently, as well as how to do them and, as a bonus gift, I give them a few lengths of thera-band with which to exercise. Often times, I ask the patient if he or she is serious about doing exercises at home, as I would rather save a tree and save the rubber bands for those who really are going to do them at home. "Ms. Jones" had assured me that she was going to do them, and her exercise kit was assembled, instructions given and she was sent on her merry way.

She replied, "How am I supposed to do the exercises at home when my shoulder hurts so much?" I replied, "How can your shoulder stop hurting if you don't do exercises at home?" She viewed me rather skeptically and quite honestly like I was nuts. Now to the soap box:

Some pains are easily explained: some injury, or physical insult, moderate to severe joint degeneration like osteoarthritis, a sports injury with a muscle or ligament or tendon strain/ sprain.

Other pains are not so easily explained; they are "insidious", sneaky. These syndromes often start with no clear explanation and sometimes without a clear date. They start with an ache once or twice a week and progress in intensity and frequency until it is a constant unwelcome companion. This type of pain is usually due to a bio mechanical dysfunction. Patients ask me what that means, all the time. A bio mechanical dysfunction is a movement disorder of a joint due to some joint mobility malfunction, a muscle imbalance where some muscles are too tight, others too weak. Because of this dysfunction the joint does not operate properly and tendons, muscles and even nerves may be pinched and damaged. The only way to correct this is to correct the underlying dysfunction. Sure, electric stimulation may help to numb the pain and ultrasound can help decrease inflammation, but they help you feel better, they don't get you better. There is no way to increase the flexibility of some muscles and strengthen others without doing the exercise.

If you have been to therapy before and made progress, you may have fallen into an old trap. You felt 70% to 90 percent better and stopped attending physical therapy prior to being discharged by your doctor or therapist. I would bet my bottom dollar that at some point the pain started to return. You felt better but were not actually better. You had decreased the pain and inflammation but did not correct the underlying cause. "Ms Jones" promised to start her exercise program.

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