Remember the old adage “no pain, no gain?” Despite the promise to heal and gain ground on recovery, many people skip prescribed physical therapy because they fear it will be painful. However, modern physical therapy is much more comfortable for most patients than in days gone by. As a matter of fact, one of the primary goals of PT is to reduce or eliminate a patient’s long-term pain resulting from an injury, surgery or medical condition.
The U.S. Centers for Disease Control recommends PT as one of the first strategies to fight chronic pain, effectively treating the pain instead of masking the symptoms. PT can help patients avoid addictive pain medications, as well as surgery for some conditions. For many other patients, PT is an effective alternative to opioid pain medications especially for pain that lasts longer than 90 days. Opioid prescriptions are appropriate for cancer treatment, end-of-life care and carefully managed acute-care cases of pain.
PT can be uncomfortable when it requires the stretching of long-unused muscles, but the goal is always to optimize results while minimizing pain.
Physical therapists are licensed health care professionals who help patients through physical movement and other non-invasive, non-drug methods. Treatments range from exercises to the application of heat or cold, all carried out under a therapist’s supervision. Physical therapy can help a patient to accomplish various milestones:
▪ Reduce or eliminate muscular or joint-related pain
▪ Improve mobility and function
▪ Recover from a stroke
▪ Recover from a sports injury
▪ Improve balance and prevent falls
▪ Manage age-related issues
Beyond the common bone and joint ailments that PT is often associated with, it can also aid in recovery from a heart attack, help control blood sugar for diabetics through exercise and help manage pain due to chronic diseases. Usually, a primary care or specialty physician refers patients to physical therapists, but patients also can seek therapy directly.
Setting individual goals
A PT plan of action begins with the physical therapist and patient working together to establish an individualized treatment plan. There is first a patient evaluation and goal-setting session. The number of visits varies depending on the patient’s underlying condition and personal goals. For example, a person who slipped on the grass and suffered a first-degree hamstring strain might have four to six PT visits over a six-week period, while someone recovering from ACL surgery might be looking at 15 to 20 visits over a six month period.
Goals also vary depending on the individual patient. A sedentary office worker might aim for an easy-to-achieve range of motion, while a basketball player might set higher goals of pain-free high-intensity running and jumping. At the initial evaluation, the therapist and patient decide on one to five specific activities to enhance and measure, from walking to standing up from a chair.
Traditionally, physical therapists have measured these goals by objectively evaluating range of motion and strength. More recently, the profession has added subjective patient-specific function scales. The patient rates a particular activity, such as riding a bike, on a scale from 0 to 10, with 0 indicating the patient can’t perform the activity at all and 10 meaning the patient can do the activity as desired, with no pain. For instance, a patient recovering from knee surgery might start with a 0 on climbing steps and eventually progress to a 9 or 10.
These function scales help the therapist determine whether a patient truly is advancing toward specific goals. Technology might tell the therapist that the patient’s shoulder range of motion has improved substantially. However, if the patient still rates “putting on a shirt” at 5 out of 10 pain level, that gives the therapist new information to use in determining the problem and changing the treatment plan.
Patient-driven function scales not only measure progress, but also help to satisfy the requirements of health insurance companies for evidence-based treatment. The American Physical Therapy Association urges its members across the country to focus on quantifiable results that can help determine best practices to improve the quality of life for patients with particular diagnoses.
Dean Plafcan is a physical therapist with Penn State Sports Medicine.