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Navigating twists, turns of physical therapy

April 14, 2015

Maybe you’re recovering from surgery or dealing with a condition such as arthritis or back pain. Or maybe you’re just combating the aches and pains of advancing years. But one way or another, there’s a good chance that at some point you’ll join the millions of people who are referred to a physical therapist each year.

Much of what goes on in those visits — especially exercise and hands-on therapy — can help by boosting strength, restoring flexibility, and stabilizing joints. But some techniques aren’t backed by sound science and can do more harm than good. And some physical therapists perform proven remedies improperly or spend too much time on things that you can do without them. To help you avoid the pitfalls, Consumer Reports talked with experts at the American Physical Therapy Association to come up with these five recommendations:

Don’t waste too much time with ice and heat. Applying a cold compress soon after a sprain or strain can reduce swelling, and using heat later can ease pain. But it’s not worth spending much time with your therapist on those treatments because they don’t speed recovery. That also applies to heat from ultrasound machines. “It’s like the coffee in the waiting room,” says Anthony Delitto, Ph.D., a physical therapist who worked with the American Physical Therapy Association on its recommendations. “It makes patients feel good, but it’s not very helpful.”

So, treat injuries at home with cold and heat. But if your therapist wants to ice you down or heat you up, ask him to focus on other treatments.

Do expect to push yourself when exercising. Strength training might be a cornerstone of physical therapy, but many therapists hesitate to push patients, especially older ones. That’s unfortunate because to make gains, you have to tax yourself. And the best way to do that is under the supervision of a professional. So, if you think you can handle heavier weights or tougher exercises, say so.

Don’t rely on machines after knee replacement. If you have had a knee replaced, your therapist might send you home with a continuous passive motion machine. The hope is that the device, which extends and then bends your legs, will control pain and speed recovery. Sounds good — but there’s no evidence that it works. And some people think that because the device moves their legs for them, they don’t need to do real exercises. Bad idea. Starting exercise-based therapy within 24 hours of surgery can restore motion, prevent blood clots, and shorten hospital stays. So, say yes to exercise but no to continuous motion machines.

Do get pushed around. Your therapist will probably spend considerable time poking, prodding, and pushing you, sometimes in ways you wish she wouldn’t. Let her; it can help. Mobilization involves stretching and holding joints in ways that you can’t do on your own, or rhythmically pushing on joints to relax muscles. It’s used to restore motion after surgery or an injury. Manipulation, which is often used for back or neck pain, involves small, quick thrusts from the therapist’s hands.

Don’t expect much from whirlpools. Whirlpools have been used to clean burns, scrapes, and other wounds for more than 100 years. But they can spread infection, so they shouldn’t be used for those purposes. Some physical therapists use cold whirlpools to treat swollen joints and warm ones for sore muscles. That’s unlikely to spread infection, but as with other kinds of hot and cold therapy, it probably won’t do much to speed recovery.

(Source: bostonglobe.com)


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