Treatment

Physical therapy treatment addresses all aspects of a patient's pain including the impairments, functional limitations, and diminished ADL life. Frequently, clinicians approach a pain problem with a surgery; however, it is often more effective to address the limitations directly while the pain is being addressed medically via pharmacologic and interventional strategies. If this fails, then at least the patient is stronger, more flexible, and better educated. The same patient will also have improved movement patterns and is otherwise better able to recover from surgical intervention. Often, physicians use a sequential algorithm for treatment. For example, they first try pain medication, followed by interventional techniques such as injections, then physical therapy, and finally surgery. Usually, the next treatment is only begun when the previous one has failed. We feel that a complimentary approach is more effective. In other words, physical therapy intervention ought to be started early and in conjunction with the other treatments. In this way, the physical therapist can capitalize on the (possibly temporary) pain reduction achieved with the intervention by implementing treatments for improving function. Typically, patients attend physical therapy one to three times per week for sessions lasting 30-60 min long. This treatment is a combination of active and passive treatments. Many physicians suggest treatment courses lasting 6-12 weeks. In many cases this is appropriate, whereas in other cases a shorter or alternately a longer course is more appropriate.

We feel that the frequency of these treatment sessions should be increased or decreased based on the patient's ability to participate, goals, motivation, and progress during treatment. The reason for this is that often patients are seen —two to three times per week but are not able to tolerate this intensity of treatment and often are not able to implement the behavioral changes that are necessary. In other cases, the treatment is limited by physiology. For example, it takes several weeks to obtain significant muscle strength changes. If a patient's movement pattern is limited by strength but he/she is able to demonstrate the ability to correctly perform a home exercise program, it may be more beneficial (and cost-effective) to see a patient once every few weeks to progress the program and check exercise technique rather than several times per week. On the other hand, seeing a patient once per month to advise on body mechanics and progress program might be the best plan in these other cases. In extremely complex cases, we have followed patients once every 3 months to progress their program and prevent relapse. Many patients report that they are more willing to self-progress their function and activities if they know that they have a follow-up visit scheduled. This also allows the patient to use the physical therapist as a resource rather than stalling until they have severely exacerbated symptoms. In some simple cases, few visits with a physical therapist are enough for the patient to learn the tools they need to manage their own condition (Chou and Huffman 2007, Madigan et al. 2009, Assendelft et al. 2004, Deyo and Weinstein 2001).

The following segment includes the treatment interventions that a physical therapist may use as part of their treatment program.

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