Physical Therapy in Pain Management

The profession of physical therapy has recently come to a crossroads with direct public access in 39 states and mandatory entry level doctorate education at all universities offering PT curriculums by 2006. As physical therapists (PT) become more autonomous practitioners and evolve into a doctoring profession, the public, as well as the clinical community, should begin to better understand the versatility of physical therapy as it pertains to pain management. PT’s are in a rather unique position to offer a multitude of therapies that can impact the disability, impairment, and state of wellness of patients. Physical therapy has, in the past, suffered from an identity crisis of sorts, partly due to its evolution as a supportive specialty of medicine, and partly due to the multi-modal nature of the occupation. Unlike other disciplines that rely on a singular type of treatment, physical therapy encompasses a multitude of treatment techniques, some of those pertaining to pain treatment will be discussed in this article. Physical therapists have historically worked closely alongside medical doctors in the different specialty areas such as pediatrics, neurology, gerontology, orthopedics, cardiology, occupational medicine, etc. Physical therapists can be found practicing in both in- and out-patient settings, along with numerous other sectors of healthcare including corporate, industrial, private, and institutional areas.

Physical therapists can play an important role in pain management through the various types of therapies and techniques that are used daily. As exercise specialists, many PT’s will use various forms of exercise as a therapeutic modality that not only promotes and restores normal function of all bodily systems, but as a primary pain management tool as well. With this thought as a segue into the main body of the article, let us begin by first describing this most basic and fundamental physical therapy treatment—one that has withstood the test of time, the scrutiny of science, and yet, perhaps, continues to be underrated by medical professionals.

Exercise Therapy
The role of physical therapy in many conditions treated by the physical therapist will inevitably have functional restoration as a primary long term goal. To restore function means different things to different patients depending on the condition being treated. The kinesiological components that drive function include strength, muscular and aerobic endurance, flexibility, balance, power and agility. When these attributes are in synchronous relationship with each other and other body systems, an individual would be expected to have normal basic function and neuromuscular control. Therapeutic exercise is the modality of choice to achieve optimal neuromusculo-skeletal function. Humans operate under the “law of use: use it or lose it,” and it really is that simple. Wolfe’s and Davis’s laws are the scientific expression of the law of use. Both bone and soft tissue will remodel according to the stresses imposed on each. Physical therapists combine an understanding of the role of targeted therapeutic exercise as it applies to a pathological condition. By using the foundational sciences of pathology, kinesiology, and biomechanics, the PT formulates a specific therapeutic exercise regimen for a multitude of patient problems, ranging from stroke and head/spine injuries to work/sports injuries. Post-surgical rehabilitation of knees, hips, and shoulders are very common assignments for the PT, and exercise forms the basis for these treatment plans. Exercise is used for strengthening protocols to increase postural trunk and peripheral joint control, as well as for core stabilization programs. Work injured clients are taught correct posture and efficient body mechanics, so as to ensure a safe return to work scenario. Athletes are reconditioned with recovery of optimal power and muscular endurance levels. Stroke patients regain strength and mobility on the paretic side using exercise therapy that challenges and provides a training effect to the involved side.

Please refer to the Nov/Dec 2005 issue for the complete text. In the event you need to order a back issue, please click here.