Back and neck pain is among the top five reasons for doctor's visits, says Dr. Michael Cannon, associate professor of family practice at St. Louis University Medical School. This pervasive condition has many root causes, each requiring specific treatments. Some patients require physical therapy, some require surgery, and others require both.
And with today's growing emphasis on treatments that are less invasive and cost effective, physical therapy is becoming a valid alternative for many.
Certified physical therapists go through a regimen of training qualifying them to safely perform certain rehabilitative treatments with goals of reducing pain and regaining function. Much of their work also involves education of the patient. Their therapies involve successive movements, each building upon the other.
Many types of physical therapy exist. The cornerstones of treatment are therapeutic exercise and functional training, notes Andrew Guccione, senior vice president for practice and research at the American Physical Therapy Association.
Often this involves a program combining manual technique and also graded exercises to increase the range of motion and muscle ability, using weights and other devices. Occupational therapy is another emphasis of physical therapy engaged to either help repair or lessen the effects of certain back conditions that hinder normal activities. Therapy can take place in an outpatient clinic, the patient's home, a hospital, the workplace, a wound center, a skilled nursing facility, or rehab center. Very often, rehab centers look like mini-gymnasiums, only with specialized equipment calibrated to measure progress.
Nick Pesce, physical therapist (PT), owner, and administrator of Momentum Rehab, describes physical therapy as the science of evaluating, diagnosing, and treating patients who have impairments, functional limitations, disabilities or changes in health resulting from disease, injury or other causes.
"PTs use various tests and measures to identify the causes of difficulties and to track progress of treatment," he says. "They use physical methods, modalities, and education to alleviate pain and regain function." These include forms of heat, cold, and electrotherapy to help alleviate pain, decrease swelling, increase strength, and promote healing. Methods include therapeutic exercise, manual therapy, functional training, and use of assistive devices and adaptive equipment to increase strength, range of motion, endurance, wound healing, and functional independence. Another goal is to decrease pain, swelling, and muscle spasms.
PTs first do a comprehensive evaluation, Pesce explains. "Education is a large part of treatment - showing and explaining to the patients what is wrong to help them better manage their neck and/or back. We train the patient in body mechanics, posture, and activity modification."
More specifically, Pesce notes, PTs treat initial pain, inflammation, and muscle spasms with heat and cold, electrotherapy, manual therapy (soft tissue and spinal mobilizations), and light specific exercise. As pain decreases, they focus on regaining range of motion, strength, and endurance, while encouraging correct body mechanics and postures. Final stages of back care include regaining muscular control and reaction time to help prevent further injury.
Physical therapists usually work closely with the patient's physician to coordinate care. Physical therapy differs from chiropractic or osteopathy, Pesce says. "There is much overlap in the care these practitioners provide, and the professions are evolving and their approaches are changing," Pesce says. Osteopathy began as a hands-on profession, which used soft tissue mobilization and spinal manipulation, but now, doctors of osteopathy (DOs) are related to MDs in that they prescribe medicine and have many privileges that MDs have. DOs focus on preventive health care and receive specialized training in the musculoskeletal system, according to the American Osteopathic Association. They emphasize understanding ways an injury or illness in one part of the body can affect another part of the body.
DOs also use their hands to diagnose injuries and illness and encourage the body's natural tendency to heal. Using osteopathic manipulative treatment, they move muscles and joints with stretching, gentle pressure, and resistance, according to the association. Chiropractic clinics traditionally placed an emphasis on spinal adjustments, using manipulations of the spine to adjust the position of the vertebrae. That would stem from a viewpoint that back pain sufferers could have part of their vertebrae out of proper position, placing pressure on a nerve.
"Chiropractic physicians are portal of entry health care providers who are specialists in conservative treatment of spine complaints," says Richard Cole of Cole Pain Therapy Group. They use spinal manipulation along with rehabilitation and therapeutic modes in their treatment approach, he says, and have diagnostic responsibilities. They can refer patients on a case-by-case basis to physical therapists and surgeons. Chiropractors also counsel patients on lifestyle modification, exercise and diet.
Cole notes that modern physical therapy also has additional roles in spine assessment, prevention and treatment. PTs also uses spinal mobilizations or manipulations as a tool, in concert with a physician, with a primary objective of regaining motion if a spinal joint is tight. All practitioners often emphasize use of specific exercises and education. Some of the hallmarks of physical therapy in particular are that it offers active and resistive exercise, range of motion and isometric exercises, along with prevention programs to avert recurring problems, notes Angie Whitfield, director of marketing at Campbell Clinic Orthopaedics.
"What I find in my practice of physical therapy is that it is the educational and therapeutic exercise portion of the treatment has the long-lasting effects," says Susan Pearson, a physical therapist. "I recall a quote from one of my educational classes, saying: 'Treat you and I will help you today - teach you and I will be helping you tomorrow.'"
Physical therapists must graduate from an accredited school of physical therapy, then pass national boards and be licensed by the state. Today, almost all schools are training PTs on at least master's degree levels. The clinical doctorate is known as the DPT degree. Physical Therapy Assistants must complete a two-year college education program and may work only under the direction and supervision of a physical therapist, according to the American Physical Therapy Association, another medical organization bound by a code of ethics.
Nowadays, all credible spine care providers are moving to kindred, though specific modes of treatment. The focus of conservative spine care has moved from passive care (simple bed rest) to active care.
"The choice of a therapist can be critical to the successful conclusion of a conservative treatment program," says Mark Temme, director and chief therapist of OrthoMemphis Physical Therapy. "Manual skills are essential. Be sure to ask your doctor about manual therapy the next time you seek care for the neck or back."
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