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1st Mar

2013

Physical Therapy Should Treat Both Function and Pain

There is almost universal agreement, that for a treatment approach of most musculoskeletal conditions to be considered successful, the level or character of pain should be reduced or made more manageable. However, there are many different models of healthcare, which approach the treatment from a different angle. At times, a combination of these approaches, are necessary to achieve the optimal results, as in some chronic pain disorders.

Within the field of physical rehabilitation, the approaches also vary greatly. Some methods focus on reducing or controlling the pain as their primary purpose, and put little stress on enabling the person to attain a certain level of activity or function which can be maintained. This may include treatments such as cold, heat, ultrasound, iontophoresis, electrical stimulation, cold laser, general forms of massage, and even spinal manipulation without subsequent exercise.

Other methods encourage avoidance of activities or positions which have caused pain in the past, including exercise approaches which e.g. always keep the back straight in order to prevent low back pain, and which favors isometric held contractions without back movements.

Even within the field of Orthopedic Manual Physical Therapy, there are differences, with some approaches focusing primarily on reducing the pain and improving mobility short-term. However, although there may be a place for these described treatment methods, results are often temporary, unless the goal of the treatment is also to treat function, and improve the affected tissues’ tolerance to stresses that daily activities subject them to.

It is now accepted that musculoskeletal tissues respond to the stresses we put on them, in a negative or positive way, depending on the health of the tissues, and the dosage of the physical stresses that we apply. Therefore, a treatment program which both aims at decreasing pain and improving a person’s tolerance to movements and activities has a greater chance of producing lasting improvement and enabling the person to become more active. In sports, this principle of treatment is essential to return the athlete to competition.

The goal, then, is to train the body to do something that it had difficulty handling in the first place, within reason. A tendon which initially got strained from over-use work or running, needs to be trained to better tolerate such activities through regeneration of the tissue. A strained or degenerated low back disc may be exercised in ways that it can better tolerate twisting and bending. Bones which are osteoporotic or brittle can be built up through weight bearing exercise and resistance training, to lessen the chance of fractures. Even moderately arthritic joints can be exercised with high repetition movements without excessive loading or impact, to lubricate the worn joint cartilage, while also building muscular support to protect the joint.

Best wishes,

Gunnar

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