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1st Dec

2014

Reasons Why Orthopedic Manual Physical Therapy can Work Better than Traditional Physical Therapy

In the August, 2014 newsletter, I briefly discussed what Orthopedic Manual Therapy means, and what makes a physical therapist qualified to practice it. Today I will expand a bit on the topic, by explaining a few key ways that skilled orthopedic manual physical therapists can identify and treat specific movement abnormalities and associated tissue changes, and why doing so can mean the difference between reducing pain while enhancing tissue regeneration, and causing more pain and tissue compromise.

When we experience pain in an area, there is spontaneous onset of muscle guarding, a state of constant contraction, of certain muscles locally, and often also in a specific pattern of distant muscles. If this muscle guarding remains, it will quickly shut down circulation to the area, depriving it of nutrients and oxygen, and often causing the soft tissues to adhere and harden. If we have had an injury involving joints, there may be local swelling and again muscle guarding and pain. As the condition heals, the inflammation and pain may subside and even go away, but the joint is often left stiff due to remaining scar tissue. This makes this joint and surrounding joints and soft tissue vulnerable to re-injury and strain.

The skilled manual physical therapist can through palpation (examination through touch) assess the degree of mobility of all joints, including in the spine, and of adjacent soft tissues. If muscles and fascia are found to be tight or guarded, specific soft tissue mobilization and myofascial release techniques can reduce such excess tone or tightness. A joint which has become reduced in mobility can be freed up manually with joint mobilization or manipulation to allow joint surfaces to glide or spin better. This is essential, as exercises performed on a very stiff joint would increase compression within the joint, which could aggravate the condition and lead to more pain and muscle guarding. Soft tissue mobilization or massage alone would not correct this situation.

Another great benefit of joint mobilization and manipulation is its effect on the nervous system. These techniques, if performed with skill, stimulate nerve receptors imbedded in the joint capsules, which cause the guarded muscles to relax, which also reduces the pain, and allows for better motion. If we can then follow up with specific gentle exercise with many repetitions, this pain relieving effect is enhanced

These pain relieving measures furthermore act as to raise and reset the threshold level, at which impulses from nerves responsible for pain, nociceptive fibers, will actually make us feel pain. When pain has been present for some time, this pain threshold tends to get lowered, making pain more easily reproduced with activities, and more pronounced. Therefore, the more effective we can be in lowering the pain perceived, the quicker we can progress treatment with specific exercise therapy, to enhance tissue regeneration, and restore normal movements. The tools that the orthopedic manual physical therapist can utilize, are much more effective in accomplishing this, than modalities frequently used in traditional physical therapy, such as ultrasound, electrical stimulation, laser, mechanical traction, and often even exercise therapy without being accompanied by manual treatment, as described.

Please feel free to share this information with anyone you know.

All of us at Mossberg & Associates Physical Therapy wish you a very happy and healthy holiday season.
Best wishes,

Gunnar

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