[Medicine-for-people] Physical Therapy

[Douwe Rienstra]

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Medicine for People!

November 2005

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Contents
-Physical Therapy:  My Secret Weapon
 - What Physical Therapists Do
 - Physical Therapy and Athletes
 - Physical Therapy and the Female Bladder
 - Physical Therapy and Back Pain
 - Local Physical Therapy Clinics
-Appendix:  How Are Physical Therapists Trained?
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Coming Next Week:   Preparing for the flu

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=== Physical Therapy:  My Secret Weapon ===


A patient in her 50s came to me with a chronic sore shoulder, a painful
knot in her upper back, and a stiff neck.  She had already seen several
specialists and was at the end of her rope.  An orthopedic surgeon had
X-rayed her, found nothing to operate on, and told her to try to relax.  A
course of chiropractic treatments not only failed to fix the problem, but
made it worse.  Now tension would build up in her neck, so that she
frequently had to "pop" it, much to her discomfort and embarrassment.  She
feared she had permanently injured her neck and shoulder. The answer was my
secret weapon against musculoskeletal problems -- physical therapy.

The physical therapist taught the patient how to stretch and strengthen the
affected area.  He gave her a daily regimen of arm lifts to strengthen
specific muscles and increase circulation to the neck and shoulders.  After
six weeks, the neck popping ceased and the painful knot stopped hurting.
After three months, she found she could cut back from daily exercise to
once or twice a week and still keep her neck and shoulder supple and mostly
pain free.

This is not an unusual story.  Often a patient comes to me with pain in a
joint, shoulder, knee, or hip.  All of us naturally fear the worst, so we
think we have arthritis or some physical damage to a tendon or joint.  More
often, however, the joint is not damaged.  It is complaining because one or
more muscles operating the joint are in spasm or have become so weak that
other muscles are pulling the bones in an unnatural direction.  Physical
therapists are uniquely able to identify and treat conditions such as this.

= What Physical Therapists Do =
Physical therapists assess strength, posture, movement patterns, joint
alignment, and nerve function to determine the cause of pain and
dysfunction.  They use exercise, movement retraining, joint mobilization,
deep tissue massage, and other measures.  Physical therapy can also improve
age-related issues such as poor balance and incontinence.  In my
experience, physical therapy frequently allows a person to eliminate pain
that has existed for many years.

Be warned, however, that even the best physical therapist cannot heal you
without your help. They will give you physical homework and success depends
upon you.  

= Physical Therapy and Athletes =
Some years ago a patient in his mid-fifties ran a 10-K race without
adequate preparation. He put mind over matter and, in a burst of speed, he
finished with some very fit runners.  Immediately after the race, his right
knee began to throb in pain.  Now every coach knows that putting a poorly
conditioned athlete, no matter how talented, onto the field is asking for
an injury, but amateur athletes do it all the time.  For this particular
athlete, I prescribed anti-inflammatory drugs and rest. The pain continued.
 We began to worry about age-related degeneration of his knee, but I
wondered if some physical therapy might help.

Sven Solvic at Uptown Physical Therapy examined the patient, found there
was a bit of wear in the knee but felt that the pain was due to a weakness
of the medial part of the quadriceps muscle in the front of the thigh.  My
patient faithfully performed the exercises Sven recommended.  After a month
or two of exercise and 90 percent improvement in his knee pain, he again
visited Sven, who modified the exercise program.  With that, the pain
resolved and has not recurred, even during vigorous activity.

The next time you watch a football game or tennis match or go to the
ballet, remember it is a rare professional athlete who would dream of
performing without the help of a physical therapist.  Any time an athlete
is injured, physical therapists are there to analyze the cause, help with
the healing, and take measures to prevent a similar injury in the future.

= Physical therapy and the female bladder =
You may have seen the commercial that advertises medication for a woman who
cannot sit through a movie because she has "gotta go."  Advertisers know
this is a huge market.  Many women leak urine with coughing, sneezing, or
associated with the urge to urinate.

One 40-year-old patient complained to me that she leaked urine frequently
during the day. She wet herself when anxious, drinking water, driving home,
or just opening the door to her house. She had to change her skirt or pants
about twice a day. She started using a topical estrogen, and we suggested
she consult Amy Irene Lynch, a physical therapist at Dirksen Physical
therapy in Hadlock.

Amy Irene has advanced training in pelvic problems and about an 80 percent
success rate in helping women "get dry."  She explained to our patient that
incontinence is often due to weakness of the pelvic floor muscles from
childbirth, disuse, hormone changes, or overactive bladder.  She treated
her with strengthening, dietary changes, and urge control techniques.

Our patient worked for about three months with Amy Irene.  At the end of
that time, she was dry most days.  She had problems only on long auto
trips, when she had to wear a pad because of occasional leakage.  She was
much drier than she'd ever dreamed she could be.  

Incontinence does not magically go away.  Left untreated, it only gets
worse as a woman gets older.  The best time to start getting help is today.

= Physical Therapy and Back pain =
Many of our patients try massage for chronic problems such as back pain.
While there are some exceptional massage therapists, most of the time even
the most excellent among them cannot do more than relax tight muscles.
Physical therapists will teach you specific exercises to strengthen the
abdominal muscles, positioning techniques to help decompress nerves, and
movement strategies to protect the back.  The average patient will obtain
longer lasting relief and prevent future problems more reliably in the
hands of a physical therapist.

Whatever treatment you seek for back pain, be it chiropractic, massage, or
physical therapy, you have a right to ask the therapist what his or her
success rate is, how many visits the treatment will take, what will be
required from you, and what results you can expect.  Whomever you consult,
if you do not improve within four to six treatments, I'd try something
else.  Good treatment should not result in dependence or constantly
repeated visits that go on for months.  Instead, it should focus on
restoring function and giving you the tools to prevent the problem from
reoccurring.

The take home message is this:  Athletes are not the only people who need
physical training and conditioning. Even if you are not a weekend warrior,
your job may require physical strength and skills.  Don't keep them up, and
you'll be in my office with an on-the-job injury.  If that happens, I
promise I'll send you to physical therapy to get you toughened up and
prevent future injury. 

= Local Physical Therapy Clinics
There are a number of excellent physical therapists in our area.  We refer
most of our in-town patients, especially our athletic types, to Uptown
Physical Therapy (385-1035).  Our Tri-area patients usually go to Dirksen
Physical Therapy in Hadlock (385 9310). Both clinics give a significant
discount if you pay in full at the time of service. 

You do not require a physician's referral to see a physical therapist,
though your insurance company will require it if you want them to pay for it.

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= Appendix:  How Are Physical Therapists Trained? =
In medical school, we met physical therapy students studying
musculoskeletal anatomy alongside us in the cadaver laboratory.  Like us,
they needed a college degree to get into school. Today they are required to
have another two to three years of class study and practical internships to
complete their training.

Physical therapists are not to be confused with physiatrists, doctors of
the medical specialty known as Physical Medicine and Rehabilitation, or PM
& R.  Physiatrists help people with severe musculoskeletal disabilities,
such as those arising from polio, a vehicular accident, or stroke.  If a
person requires an artificial limb, a PM & R doctor will oversee the
process of fitting and adjusting that artificial limb.

Physiatrists are the specialists who train physical therapists. With the
additional exception of orthopedic surgeons, competent physical therapists
have a better knowledge of the mechanics of muscles and joints than most
physicians.

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Extra Edition Next Week -- Preparing For The Flu

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=== Recent issues of Medicine for People! ===
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http://www.rienstraclinic.com/newsletter/2005/2005Oct.html
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August 2005 - Water, Your Number One Home Remedy
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June 2005 - Health and Living, Practical Steps to Health
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May 2005 - The School Sisters of Notre Dame
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Medicine for People! is written by Douwe Rienstra MD, edited by Carolyn
Latteier, and published at Port Townsend, Washington.
Copyright November, 2005

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