Physical Therapy Treatments — What To Expect When Your Go For Physical Therapy

Yup, in 21st century, some people still think that physical therapists are just some bunch of dignified masseur and masseuse. As primitive as that may sound, it’s still a fact, though to a lesser degree now than before.

So what sort of treatment would you expect when you go for physical therapy? First of all, it really depends on the condition. The physio will start off with interview and assessment to get all the details pertaining to your chief complaints. From there, the physical therapist will do one or more of these:

Manual Techniques

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These are various interventions done with delicate and skilled maneuvers with the therapist’s hands. This is why the uniformed layman thinks we are just giving some form of  massages. Ouch! But these hand works actually take years of learning and practice with scientific evidences to back them up. These techniques include joint mobilization or manipulation, myofascial releases, neurodynamic techniques, stretching and muscle energy techniques, and the list goes on depending on the physiotherapist’s training and expertise.

Therapeutic Exercises

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These are exercises designed to specific conditions. There are exercises for low back pain, and neck pains, and shoulder problems and scoliosis. There are exercises for Parkinson’s disease, stroke, and cerebral palsy. There are exercises to relive pain, correct posture, improve muscle control, increase strength and endurance, improve balance and stability, etc… you get the idea.

Thermal Agents

A physical therapist may choose to use some heating agents prior to doing manual techniques and giving exercises. Thermal modalities can provide temporary pain relief, increase local and systemic circulation which can be helpful in sub-acute and chronic stages of injury or inflammation, and increase tissue extensibility which is ideal  prior to stretching. The most common heating agents today are hot packs and ultrasound. Hot packs can cover a larger area of the body and the feeling of warmth can give some relaxing effect. However, the effect is only superficial. Therapeutic ultrasound is thought to have a deeper effect and only applied for a few minutes. Again, these are adjunct treatment and at times may not be necessary.

Cryotherapy

As fancy as it may sound, it’s actually just the application of cold for therapeutic purposes. Icing is most commonly used in acute musculoskeletal injuries for the purpose of relieving pain and reducing swelling and inflammation. Some argue that since inflammation is the initial stage of the healing process of an injured tissue, icing can only disrupt and delay healing process. Again, depends on the therapist’s clinical decisioning. Where swelling and inflammation are severe, icing maybe one of the first line of treatments in acute injuries along with compression and rest with some controlled movement.

Neuromuscular Electrical Stimulation [NMES].

Use of low frequency currents to facilitate muscle contractions. NMES is basically used in patients with paralysis as a result of injury to the nervous system circuit. Muscles need to contract to maintain its integrity and facilitates circulation. A paralyzed muscle losses its ability to contract voluntarily and NMES is used to electrically induce muscle contractions. In the past, high frequency currents like TENS and Interferrential current is used to relieve musculoskeletal pain. With increasing manual therapy techniques which afford lasting pain relief, these modalities are now rarely used. Although some clinicians still rely on these modalities, be sure to consult therapists who actually do hands-on treatments. Passive modalities like TENS and heating agents are not effective for long-term pain relief. And remember that the site of pain is not always the source of dysfunction.

Aquatic Therapy

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Not so many physical therapy clinics are equipped with a pool for aquatic therapy. But specialty clinics, especially those working among geriatrics and neurologic patients may have one. Water supports body weight, provides some resistance to range of motion, and eliminates the effect of gravity making exercising more tolerable.

So these are just some of the many physiotherapy treatments available to you. Again, the use of any of this will depend on your chief complaint, overall condition and further findings from your assessment. Except for manual therapy and therapeutic exercises which can, and should be, used in almost any, if not, all conditions. I would recommend that you ask the therapist if they do manual techniques in their treatment. Remember that modalities like hot packs, ultrasound, and electrical stimulators are only adjunct treatments and oftentimes not really necessary.

In recent years, many more new treatments are used in combination to the aforementioned treatments.

Examples of these are the following.

Dry Needling

pt dry needling

This the use of acupuncture needles to treat trigger points and muscle spasms and therefore relieves musculoskeletal pain. The therapist uses needles that pierce the skin to deactivate trigger points and the like in order to normalize the function of a certain muscle or joint and also to reduce the pain felt by the patient. Dry needling, in effect, releases the pain in the muscle and reduces the swelling and tension in that certain muscle area.

Muscle [Kinesio] Taping

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While muscle taping is not new, what many therapists use now are the stretchable colored tapes you most likely see on athletes. It’s known by the name Kineseo Taping, to distinguish it from other kinds of muscle taping. These are durable tapes that can stay on the skin even for 2-3 days… or more. It is used for many muscle and joint problems to help relieve pain, improve joint stability, inhibit or facilitate a muscle or muscle groups, drain swelling, correct posture, and some believe it can improve sporting performance.

These are just few of the common treatments used by physical therapist. Again, treatment depends on the physiotherapist’s assessment on your condition, as well as the physio’s training and expertise. While two different physician will give same prescription for low back pain, two PTs may give different treatments for same condition.

Suffering from injury or simply want to be more active? Consult a physical therapist now…

UPDATE to this blog: More than a year since I wrote this blog, my approach to physical therapy treatment have changed. I didn’t take a course in dry needling and I am happy for it. It is invasive, some clients swear that it’s painful, while I have found a much simpler way to tone down tensed muscle. It’s just a matter of understanding pain neuroscience and applying it to your treatment strategies.

Also, use of electrophysical agents have been proven to have of no significant therapeutic effects. I prescribe it to clients as home treatment but 10-120 minutes of that in the clinic is a waste of time. Much can be accomplished with manual and movement therapies that produce more significant and long lasting improvement.

The Detrimental Effects of Sitting

Sitting too much is bad. Sitting is the new smoking! It’s a killer… literally!

There was an article I have read on the internet entitled “Sitting is the Smoking of the Generation.” True enough. The average time that a person sits working in an office is 8 hours. Even more for some. Then we drive going home, and then spend a few more hours at home watching TV, working on the computer, or checking on what’s up with our social media friends.

There have been many published studies about the detrimental effects of sitting. Lack of physical activity kills roughly as many people as smoking, one article says. More than 5.3 million deaths would be avoided each year if all inactive people exercised, about the same toll as the 5 million deaths annually from smoking. Yes, that’s how bad sitting too much is.

evolution of man

But what exactly happens when we spend the whole day sitting? 

Well, hear ye…

Effects on the back:

Prolonged sitting can be a cause of low back pain. We know now that posture of whatever type [there is no real “bad” posture unless we speak of aesthetics where sitting or standing straight and tall is desirable], but staying in any position for long period can cause strain on the back muscles that might eventually lead to back pain.

Not only can prolonged habitual sitting cause low back pain, but it can also produce strain on the neck and upper trunk muscles causing neck pain and possible recurrent headaches. Again, it can be more from repetitive stress on the muscles and nerves than actual “faulty” posture.

Effects on the Circulation:

Sitting for long periods can slow down circulation. Normally, muscle contractions of leg musculatures aid to pump the blood back to the heart. With sitting with very little to no movement, blood pools down in the leg causing damage to the blood vessels producing varicosities, or even thrombosis.

There’s e-mail, e-card… and then there’s e-thrombosis. It’s a variant of DVT [deep venous thrombosis] due to, what else, but sitting for long periods of time. It is the formation of blood clots [called thrombus] in the lumens of the blood vessels of the legs.

Effects on Other Organs:

There have also been studies that show that sitting can cause problems in our body’s other vital organs, like the heart, pancreas, and colon. For example, the pancreas produces insulin but the muscles cannot utilize them because the muscles of a seated person are practically idle. This unutilized insulin can cause diabetes. One study found that a decline in insulin response in just a day of sitting.

So what can we do?

Since prolonged sitting leads to immobility, the solution is to move frequently during the day. Take “microbreaks” every 30 minutes or so. When watching television, take a walk during commercials. A walk to the kitchen to get water, for example. If working in your office, I guess you just have to be creative. You can set an alarm in your cellphone for example, to remind yourself that it’s time to move.

Here are some things you can do as you take those microbreaks.

  • Stand up straight and try to raise your hands with arms straignt as far as you can feeling a good stretch of you whole body. Hold for a few seconds. Repeat 2-3 times.
  • Follow this up with backwards bends of the spine. Spread your feet part for support, stand straight, put your hands on your lower back, then bend backwards as far as you can. This somehow counteracts the forward position you do while working in your desk.
  • Contract your calf muscles by doing heel raises a few times. This helps mobilize the circulation in the legs.

It only takes 1 minute or so to so these three activities. We just have to be diligent about doing them.

  • It’s a good advice to alternate between standing and sitting position while working.

These are just few, simple things that you can do… But really, there are more movements you need to do with your arms. Consult your physical therapist for thorough assessment and exercise program especially if you start having lower back or neck pain. You might also need to have your breathing pattern checked!

Final words: This is taken form an article I read “Desk Jobs Can Be Killers, Literally”, by Richard Lovett,

“The message is clear: Sitting still for hours at a time might be a health risk regardless of what you do with the rest of your day… Just as you cannot compensate for smoking 20 cigarettes a day by a good run on the weekend, a bout of high-intensity exercise may not cancel out the effect of watching TV for hours on end. Patel’s study found that people who spent hours sitting had a higher mortality rate even if they worked out for 45 to 60 minutes a day. The researchers call these people “active couch potatoes.”

Hope this article helps. Stay healthy.

Any additional points you can give? Feel free to share in the comment section.

Love and peace.