| RUUD VUIJSTERS P.T. Practice of Pain Management, Inc. | |
 |
218 Rue Beauregard Ste.E Lafayette LA 70508 |
| RUUD VUIJSTERS P.T. Practice of Pain Management, Inc. | |
|
218 Rue Beauregard Ste.E Lafayette LA 70508 |
Pain Management Physical Therapy Manual Therapy Pain and Suffering Ergonomics and Prophylaxis
Physical Therapy Treatment
The goals of physical therapy treatment are basically threefold: The first goal is to determine the most effective means of decreasing or controlling the patients pain. This may include the use of modalities such as cold, heat and ultra-sound, as well as soft tissue mobilization and passive/active exercise. The second goal is to correct as much as possible the dysfunctions identified during the initial evaluation. This usually involves manual therapy techniques to normalize muscle tone, restore proper muscle length and muscle strength, and mobilize joints to regain functional movement in the spine and extremities. The third goal is to restore the patient's confidence in the ability to move and enjoy physical activities with reduced fear of further injury or pain. This will require an understanding and application of limitations on a physical, mental and/or emotional level.
Cryotherapy involves the application of ice or cold-packs. This form of therapy produces a peripheral vasoconstriction followed by periodic vasodilatation to maintain tissue viability at low temperatures. Other physiological effects include decreased nerve conduction velocity and decreased activity of the peripheral sensory organs, thus decreasing the pain perception. The gate theory of Melzack and Wall offers a further explanation of pain relief on the basis of competitive inhibition at the spinal cord or brainstem level induced by the intense peripheral stimulation of the cold application. Cold packs, which are available commercially, are inexpensive and easily used alternative to ice massage. Care must be taken to prevent frostbite over bony prominences. Usually 20 minutes of application is sufficient.
Heat is primarily used to promote sedation, muscle relaxation and pain reduction. Its physiological effects include decreased vasomotor tone, increased tissue metabolism and increased circulation. The increased circulation aids in restoring proper nutrition and elimination of toxins from the muscle. Heat also raises the threshold of sensory nerve endings and thereby may alter the pain-spasm-pain cycle. It also increases connective tissue extensibility, thus setting an excellent stage for muscle stretching immediate following the heat application. Heat treatment is contraindicated the first 48 hours after trauma or injury. As with cold treatment, 20 minutes of application is sufficient.
Ultrasound provides deep heating to soft tissue, such as muscle, tendon and ligament. It also has nonthermal effects that additionally increase connective tissue extensibility. Phonophoresis is a modality in which the energy of ultra sound can is used to drive medicine deeper into the soft tissue.
Soft tissue mobilization is frequently used in treating painful conditions. It can aid in the ongoing clinical evaluation by giving the physical therapist a sense of muscle tone and the presence of localized muscle spasm and myofascial triggerpoints. Its therapeutic effects are from both reflex and mechanical actions. The circulation increases in the area treated, which assists in blood and lymph return, while friction techniques can be very useful in softening scar tissue or dense, adherent connective tissue bands. Its reflex action is a result of stimulation of peripheral receptors leading to muscle relaxation and patient sedation.
Exercise therapy is indicated in order to enable the patient to recondition and learn to move in a functional pattern. Patients with chronic pain often have experienced prolonged periods of decreased activity and possible numerous surgical traumas. As activity decreases, more muscles weaken and become contracted, which creates new sources of pain, especially on movement. As a result activity becomes further decreased, far out of proportion to the actual disability. For example, a patient with chronic low back pain often presents eventually with sacroiliac dysfunction, neck and upper back pain, and headaches secondary to the progressing deconditioning, eventually leading to poor posture, sustained muscle spasms and dysfunctional movement patterns. As a result any and all activities become painful. Therefore exercise therapy tailored to the individual patient, based on findings in the initial evaluation and changes in patient's status during the therapy program, is a crucial component of the therapy plan.