Wednesday, January 21, 2015

REPOST: Expert advice for the millions who are referred to physical therapy each year

While physical therapy helps stabilize joints, restores flexibility, and improve strength, several of its techniques are not backed by sound science. Consumer Reports offers the following tips to help physical therapy patients avoid pitfalls:  

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Many physical therapists hesitate to push patients, especially older ones. That’s unfortunate, because you need to tax yourself to make gains.

Maybe you’re recovering from surgery or dealing with a condition such as arthritis or back pain. Or maybe you’re just combating the aches and pains of advancing years. But one way or another, there’s a good chance that at some point you’ll join the millions of people who are referred to a physical therapist each year.

Much of what goes on in those visits — especially exercise and hands-on therapy — can help by boosting strength, restoring flexibility and stabilizing joints. But some techniques aren’t backed by sound science and can even do more harm than good. And some physical therapists perform proven remedies improperly or spend too much time on things that you can do without their guidance. To help you avoid the pitfalls, Consumer Reports talked with experts at the American Physical Therapy Association to come up with these five recommendations:

Don’t waste too much time with ice and heat.

Applying a cold compress soon after a sprain or strain can reduce swelling, and using heat later can ease pain. But it’s not worth spending much time with your therapist on those treatments, because they don’t speed recovery.

That also applies to heat from ultrasound machines. “It’s like the coffee in the waiting room,” says Anthony Delitto, a physical therapist who worked with the APTA on its recommendations. “It makes patients feel good, but it’s not very helpful.” In one study, for example, there was no difference in recovery time between patients treated with either real or sham ultrasound. So treat injuries at home with cold and heat. But if your therapist wants to ice you down or heat you up, ask him to focus on other treatments.

Do expect to push yourself when exercising.

Strength training may be a cornerstone of physical therapy, but many therapists hesitate to push patients, especially older ones. That’s unfortunate, because to make gains you have to tax yourself. And the best way to do that is under the supervision of a professional. So if you think that you can handle heavier weights or tougher exercises, say so.

Don’t rely on machines after knee replacement.

If you have had a knee replaced, your therapist might send you home with a continuous passive motion machine. The hope is that the device, which extends and then bends your legs, will control pain and speed recovery. Sounds good — but there’s no evidence that it works. And some people think that because the device moves their legs for them, they don’t need to do real exercises. Bad idea.

Starting exercise-based therapy within 24 hours of surgery can restore motion, prevent blood clots and shorten hospital stays. So say yes to exercise but no to continuous motion machines.
●Do get pushed around.

Your therapist will probably spend considerable time poking, prodding and pushing you, sometimes in ways you wish she wouldn’t. Let her; it can help.

Mobilization and manipulation, for example, can feel like massage. Mobilization involves stretching and holding joints in ways that you can’t do on your own, or rhythmically pushing on joints to relax muscles. It’s used to restore motion after surgery or an injury. Manipulation, which is often used for back or neck pain, involves small, quick thrusts from the therapist’s hands.

Don’t expect much from whirlpools.

Whirlpools have been used to clean burns, scrapes and other wounds for more than 100 years. But it’s now clear that they can spread infection, so they shouldn’t be used for those purposes. Some physical therapists use cold whirlpools to treat swollen joints and warm ones for sore muscles. That’s unlikely to spread infection, but as with other kinds of hot and cold therapy, it probably won’t do much to speed recovery.

Brent Morgan Waco is a physical therapist from Minneapolis, Minnesota. Get more tips on health and wellness by following him on Twitter.