October is National Physical Therapy Month. This month-long event, designated by the American Physical Therapy Association (APTA), raises public awareness of the many benefits of physical therapy (PT). PT is useful in improving mobility, recovering from injury, managing pain and chronic conditions, and as a supplement or even alternative to pain management with opioids.

Who are Physical Therapists and Physical Therapy Assistants?

Physical Therapists (PTs) are movement experts who improve quality of life through prescribed exercise, hands-on care and patient education. After making a diagnosis, physical therapists create personalized treatment plans based on their individual needs. PTs treat people of all ages and abilities and empower them to actively take part in their own care. To ensure the best possible care, PTs often work with other members of a patient’s health care team.

Physical therapist assistants (PTAs) work with patients under the direction of a PT and teach and demonstrate exercises that help improve mobility, strength and coordination. Care provided by a PTA may include teaching people exercise for mobility, strength and coordination, training for activities such as walking with crutches, canes, or walkers, massage, and the use of physical agents and electrotherapy such as ultrasound and electrical stimulation. PTAs may also measure changes in the patient’s performance as a result of the physical therapy provided.

After performing an evaluation, PTs create personalized plans of care that can help you:

Improve mobility and function
Manage pain and chronic conditions
Avoid surgery
Reduce the use of opioids and other prescription drugs
Recover from injury
Prevent future injury and chronic disease

When and where do you see a physical therapist?

Pain management is just one reason to work with a PT. They can also help you prevent future injury or chronic conditions. You do not need a physician’s referral to make an appointment with a PT for an evaluation. PTs can specialize in a variety of areas, including geriatrics, neurology, oncology, orthopedics, pediatrics, sports and women’s health.

There are a variety of practice areas of physical therapy, including geriatrics, orthopedics, acute care, and more. Each practice area will meet the needs of the individual patient by targeting their specific needs.

PTs provide treatments in:

Hospitals, outpatient clinics or offices
Inpatient rehabilitation facilities
Skilled nursing, extended care or subacute facilities
Schools, education or research centers
Fitness centers and sports training facilities
Hospice settings
Your workplace
Your home

Physical Therapy and Opioids

Physical therapy is recommended to manage pain, and has been cited as an alternative to opioids for managing pain after an injury or after surgery. According to the Centers for Disease Control and Prevention (CDC), sales of prescription opioids have quadrupled in the United States, even though “there has not been an overall change in the amount of pain that Americans report.” In response to a growing opioid epidemic, the CDC released opioid prescription guidelines in March 2016. The guidelines recognize that prescription opioids are appropriate in certain cases, including cancer treatment, palliative care, and end-of-life care, and also in certain acute care situations, if properly dosed.
But for other pain management, the CDC recommends non-opioid approaches including physical therapy. Physical therapists treat pain through movement, hands-on care, and patient education – and by increasing physical activity you can also reduce your risk of other chronic diseases.

But for other pain management, the CDC recommends non-opioid approaches including physical therapy.
Patients should choose physical therapy when…

… The risks of opioid use outweigh the rewards.
Potential side effects of opioids include depression, overdose, and addiction, plus withdrawal symptoms when stopping opioid use. Because of these risks, “experts agreed that opioids should not be considered firstline or routine therapy for chronic pain,” the CDC guidelines state. Even in cases when evidence on the long-term benefits of non-opioid therapies is limited, “risks are much lower” with non-opioid treatment plans.

… Patients want to do more than mask the pain.
Opioids reduce the sensation of pain by interrupting pain signals to the brain. Physical therapists treat pain through movement while partnering with patients to improve or maintain their mobility and quality of life.

… Pain or function problems are related to low back pain, hip or knee osteoarthritis, or fibromyalgia.
The CDC cites “high-quality evidence” supporting exercise as part of a physical therapy treatment plan for those familiar conditions.

… Opioids are prescribed for pain.
Even in situations when opioids are prescribed, the CDC recommends that patients should receive “the lowest effective dosage,” and opioids “should be combined” with non-opioid therapies, such as physical therapy.

… Pain lasts 90 days.
At this point, the pain is considered “chronic,” and the risks for continued opioid use increase. An estimated 116 million Americans have chronic pain each year. The CDC guidelines note that non-opioid therapies are “preferred” for chronic pain and that “clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient.”

Physical therapists can play a valuable role in the patient education process, including setting realistic expectations for recovery with or without opioids.

Managing Pain: Questions to Ask your Health Care Provide

Asking questions about your treatment plan is a great way to ensure that your health care provider understands your goals and that you can partner in your care. These questions can help you start that conversation.

Pain Questions

• Why do I have pain?
• How long will it take for me to heal from this injury or surgery?

Self-Management Questions (What can I do?)

• What activities should I avoid?
• How can I speed up the healing process?
• How can I go back to what I was doing before I had pain?
• Is there anything else I can to do to feel better?

Medication Questions (If Applicable)

• Why are you giving me this medication? What will it do for me? How long do I need to take it?
• What will happen to me if I take this medication? What is the risk of addiction? What is the effect of not taking this medication?
• Is this medication an opioid? Are there other medications I could take instead?
• Are there other options, such as physical therapist treatment, that I can try instead of (or in addition to) medication?

Physical Therapy Success Stories: Joanne

When Joanne’s experience with hip pain began, it wasn’t just standing and walking that was a challenge. The 57-year-old art teacher soon found that she was struggling to love her job.
“It became harder and harder to just have the joy of teaching art in my heart,” said Joanne, who had to stop teaching 9 years later when her hip pain overwhelmed her.

“Pain stole that part of my life from me.”

Five years later, Joanne elected to have both hips replaced, starting with the most damaged one. The first surgery and subsequent physical therapy went well, and Joanne was back to work and exercising in 6 weeks. About 12 months later, Joanne was as fit as she had been in years. Then the pain began to grow in the other hip, and a year later it became time for the second hip replacement.

Unfortunately, that experience didn’t go as well. After surgery, Joanne experienced significant muscle weakness. Of particular concern were her abductor muscles, which had suffered from years of neglect as Joanne had improvised ways to move without pain.

Her surgeon prescribed targeted and aggressive physical therapy for abductor strengthening and gait training. That’s when she began to work with physical therapist Kurt Mason, PT, DPT, a board-certified orthopedic clinical specialist, at the Marc A. Asher, MD, Comprehensive Spine Center, The University of Kansas Hospital.

Within 2 months, Joanne got stronger, and much more. She regained strength and mobility, and a much improved walking gait. She was then released to return to fitness class.
“I learned that quality of movement is better than just ‘getting it done,'” Joanne said of her new and improved gait. “I feel like I’m 25. I feel like I have a quality of life I didn’t even have when I was 40.”

Today, Joanne capitalizes on her renewed sense of youth by continuing to exercise. She also is employed at an art museum, where she works with local educators and has recently added teaching to her schedule. She cherishes the ability to walk through the galleries without discomfort.
She often looks back through the art journal she kept while going through physical therapy, marveling at how quickly things changed and wishing she’d addressed the problem sooner.

“Being older doesn’t have to mean living in pain,” she said. “Yeah, there’s frustration 1 week, and 2 days later you’re making progress, keep going.”

“I’m a huge cheerleader for physical therapy and honoring the expertise of the therapists.”

What We Offer

At the Fisher Rehabilitation Center, EdenHill’s state-of-the-art rehabilitation facility, our skilled team will work to restore your independence after surgery or hospitalization. Visit our website to read more about the services and amenities we offer, or contact us to discuss the various physical therapy options we offer.

Adapted from choosept.com and apta.org.