Soon after college, Noemi Johansson Miller discovered that falling off a tractor can really hurt. In the following months, she learned that recovery can hurt even more. A recent college graduate now living in the San Francisco Bay Area, she broke her kneecap in the fall. Two weeks after surgery, she had her first physical therapy session, a grueling round of stretching exercises to improve the strength and flexibility of her knee.
"It was obvious to me that the therapy would be helpful, but it was extremely painful at the time," she says.
Twisting, turning, stretching, and kneading -- physical therapy often hurts, at least for a little while. But "the pain has a purpose," says Steven George, PT, PhD, an assistant professor of physical therapy at the University of Florida, and a spokesman for the American Physical Therapy Association. After a few sessions, there's an excellent chance that patients will start feeling less pain, not more. They'll also feel stronger, more confident, and better prepared to deal with the pain in their everyday lives.
Physical therapists have brought relief to many patients suffering from arthritis, low back pain, or injuries to joints and muscles, George says. According to the National Pain Foundation, physical therapy can also help ease "neuropathic" pain that comes from damaged nerves, a common complication of diabetes, cancer and traumatic injuries.
Johansson-Miller went through about six weeks of therapy before taking time off to travel. After nearly two months of lingering pain, she decided it was time to give physical therapy another try. "A lot of the pain that I had was from muscles being really tense," she says. "My physical therapist worked a lot on strengthening individual muscles. That relieved a lot of my day-to-day pain. The improvement has been incredible."
Susannah Bush, a preschool teacher living in Billings, Montana, says physical therapy helped her recover from a painful shoulder injury. Bush was walking her 150-pound Newfoundland on Labor Day when the dog took off unexpectedly, dragging Bush along for the ride. She broke her arm and tore her rotator cuff, forcing her to undergo surgery and months of massage, stretching, and strength exercises. "The physical therapy itself was painful," she says. "At first, I couldn't do much without screaming." But after a while, her shoulder became stronger and more stable, a handy feature when a preschooler needs to get picked up. The therapy had a side effect: She noticed that her pain gradually faded while her shoulder healed.
Tailored treatment
Physical therapy isn't a "one-size-fits-all treatment," George says. Today's therapists tailor their therapy to address the source of pain. If a person with low-back pain has weak back muscles, the therapist will teach exercises that strengthen these muscles. Another patient with back pain may need exercises that make back muscles stronger and more flexible.
When patients come in with sore knees or other joints, physical therapists can use their hands to slowly move the joint through its range of motion. "We can actually touch our patients, and that goes a long way," George says. Such techniques can be especially helpful for patients who have been hobbled by arthritis.
Physical therapists are fully aware that moving a joint can be painful, George says. "It's not realistic to think that a therapy session won't cause pain," he says. Although it's unpleasant, the pain can be helpful in the long-run. When patients gently test their sore joints in a therapists office, they learn that they can move despite the pain. They also learn to think of pain as part of a healing process, not just an aggravation that's interfering with their life.
Of course, no therapy session should end in agony. "There have been cases where physical therapists have pushed too hard," George says. Ideally, the therapist should be checking regularly with the patient to make sure that the therapy isn't getting too intense or too painful, he says.
Other tools
There's more to physical therapy than stretches and exercises. Therapists can give patients other tools to manage their pain. For example, therapists often use either heated wax or cold packs to manage pain during exercises. Therapists may also show patients how to use a device known as a TENS (transcutaneous electrical nerve stimulation) unit, which is designed to relieve pain by sending mild electrical pulses through the skin to the nerves -- a treatment that can inhibit pain transmission in some people.
Once patients master exercises, stretches, and other techniques in the office, they can try them out at home. The ultimate goal of physical therapy, George says, is to give patients more control over their bodies and their pain.
Both Johansson-Miller and Bush reached that goal within a few months. Johansson-Miller gives her knee a regular workout on the elliptical machines at the local gym, and Bush puts her shoulder into her job as a teacher. (Her preschoolers aren't nearly as large as her Newfoundland, but they can be equally rambunctious.) They both still feel some pain, but thanks largely to physical therapy, the pain is a sideshow in their lives -- not the main event.
References
Interview with Steven George, PT, PhD. an assistant professor of physical therapy at the University of Florida and a spokesman for the American Physical Therapy Association
Interview with Noemi Johansson-Miller
Interview with Susannah Bush, a preschool teacher living in Billings, Montana
Kaye V, et al. Transcutaneous electrical nerve stimulation.
http://www.emedicine.com/pmr/topic206.htm
American Physical Therapy Association. Physical therapists can relieve pain.
.
Brant JM. Cancer-related neuropathic pain. Nurse Practitioner Forum ;9(3):154-62.
Minor MA and MK Sanford. The role of physical therapy and physical modalities in pain management. Rheumatic Disease Clinics of North America 25(1) 233-248.
Mayo Clinic. Peripheral neuropathy. http://www.mayoclinic.com/health/peripheral-neuropathy/DS00131/DSECTION=8
Hoeksma HL, et al. Comparison of manual therapy and exercise therapy in osteoarthritis of the hip: a randomized clinical trial. Arthritis and Rheumatism 15;51(5):722-9.
Ottawa Panel. Ottawa panel evidence-based clinical practice guidelines for therapeutic exercises and manual therapy in the management of osteoarthritis;85(9):907-71.
National Pain Foundation. My treatment: Physical therapy. http://www.nationalpainfoundation.org/MyTreatment/articles/NeuropathicPain_TO_PhysicalTherapy.asp
