Physical Therapy Often ‘the Best Medicine’ for Pain
Fourth in a series
If you’ve been having pain, you’re not alone. Surveys show that about 20% of Americans have chronic (long-lasting) pain at any given time.
Back pain is especially common. About 80% will experience it at some point during their lifetime. About 60% recover within six weeks, and up to 90% within 12 weeks. If you’re in the 10% who don’t recover quickly, though, you may end up with chronic back pain.
That probably means you take over-the-counter medicines like acetaminophen (Tylenol) or ibuprofen (Motrin). If that doesn’t seem to be enough, in rare cases your doctor may prescribe opioids, such as oxycodone, or combination pills, such as Vicodin or Percocet. They can help in the short term, but opioids can be addictive and there’s limited evidence they help long-lasting pain.
One thing that research shows can help – for new or chronic pain – is exercise therapy.
“Exercise is the best medicine; for your spine, your arthritis, exercise is it,” says Christopher Plastaras, MD, a physiatrist and clinical director of musculoskeletal spine and sports rehabilitation medicine at MossRehab, Einstein Healthcare Network’s nationally renowned physical medicine and rehabilitation hospital.
That’s where physical therapists come in. They understand how the joints, nerves, muscles, and other connective tissues all work together and how to improve strength, function, and range of motion with specific exercises. This often leads to reduced pain.
Work and Patience That Pays Off
The approach requires work and patience, but it can help many people with a variety of problems.
You may start with your primary care doctor or consult a physical medicine specialist, or physiatrist, like Plastaras. “I listen – that’s what I do mostly. Then I connect people with the right type of physical therapists given their problem.” Many therapists have doctorates in their field, sometimes with specialty training as well.
A physical therapist will work with you to help you learn and perform exercises that are tailored to your needs. Since you are in pain and may have an injury, the exercises will be carefully chosen and often will be easy at first. They may gradually become more challenging as you improve.
Modifying what you do at work, at home and elsewhere also can be important, Dr. Plastaras says. “One thing that can go a long way is activity modification – how you pick your child up, how you tie your shoes, and any accommodations you may need at work.”
Physical therapists may use a variety of pain control techniques and provide education for how to best manage your condition. Your doctor may prescribe pills or injections to ease pain temporarily so you can get the most benefit from physical therapy.
Different Approaches for Each Person
The specialties of two MossRehab therapists, Mitchell Prewett, MSPT, Cert. MDT, and Teresa Gero, PT, DPT, illustrate how different approaches to physical therapy can help those with a variety of needs.
Prewett, who works at MossRehab Center City, is certified in the McKenzie Method of assessment and treatment for certain problems of the spine and other joints. For patients with pain that occurs with movement in a particular direction, doing specific exercises can sometimes help the body to fix itself, he says.
Gero, who practices at MossRehab Tabor Road, specializes in helping patients with long-term pain, especially back pain, that has severely limited their lives. Her approach may be very gradual to help overcome patients’ limited mobility and fear of movement.
Prewett says that the McKenzie Method is most effective within the first 12 weeks of the injury or whatever causes the pain. But he says it can help people who have tried other treatments first – it just takes longer.
For example, one common problem that the McKenzie Method can help with is a herniated, or bulging, disc. This is when the gel-like material that acts as a shock absorber between vertebrae in the spine gets pushed out of place.
In this position, “it’s catching either fibers or nerves and causing pain in your back or down your leg,” Prewett says.
Prewett begins by asking questions. For someone with a particular type of herniated disc, “sitting will be worse, and walking will be better. We take them through different movements – say, standing and forward bending or standing and backward bending.”
If the pain occurs or gets worse in certain positions – known as a directional preference – then it’s likely to be a problem of body mechanics, something that needs to be moved back into place.
McKenzie Method Exercises
That’s where McKenzie Method exercises often can help. Research shows that for the right patients they relieve back pain better than more generalized exercise.
“If we can figure out how it acts, then we can use the opposite forces to put the joint or soft tissue back into place,” Prewett says. “So, I say, ‘I want you to go home. I want you to back bend until you start to feel strain or pain to squeeze on that tissue.’”
The exercises themselves may hurt, but they should get more comfortable, sometimes in the first session, he says. “We have to explain to the patient, don’t be afraid of this pain. We’re attacking the tissue to push it back in place.”
Gero specializes in helping people who have become more and more restricted by pain. Some of them are taking large doses of opioids.
“Most people will tell you they’re coming in with 10 out of 10 pain and they took their opiate medication an hour ago,” she says. “So it’s not even doing anything to the pain.”
Dealing With Pain Processing Disorders
Pain is the body’s warning system for danger. But the process that produces pain is complex. It includes the brain, the nervous system, and the emotions. When things go wrong in this process, pain can persist even after the original injury is healed.
“Really it’s a pain processing disorder,” Gero says. “That’s the subset of patients that I specialize in.”
Though exercise is crucial, Gero’s patients have barriers to taking advantage of that approach. They may be depressed, have poor social support – and may be afraid to move because of pain.
The approach Gero favors for complex pain that has not responded to other types of treatment may include very gentle graded exercise, relaxation techniques, mind-body therapies, education and empowerment. She often refers people to programs such as meditation and cognitive behavioral therapy.
“Our approach to physical therapy includes helping people to understand what pain is, what types of things affect it, so that you can be empowered to have more control,” Gero says.
“We account for people’s fear or extreme sensitivity to movement,” she says. “So we might begin by just having them imagine movement and then gradually progressing to very small, gentle movements.”
Over time, people progress to exercise that can build strength and vitality. “The effect of that is better movement, less distress, and better quality of life,” Gero says. “We don’t necessarily focus on eliminating the pain, but it does often diminish.”