There are many types of physical therapy treatment techniques, including but not limited to, manual therapy, modalities (Ultrasound, E-Stim), and therapeutic exercise. At Endurance Physical Therapy, we have a very strong emphasis on manual therapy and this is why…
With every injury, whether it be traumatic, acute, chronic, or just plain silly (ie. turning over in bed and getting a strain in your back), there is a corresponding mechanical dysfunction in one or more joints. The mechanical dysfunction of a joint leads to increased shearing and/or compressive forces, further increasing inflammation and pain, creating a self perpetuating cycle that will prevent the tissue from fully healing and the joint from being fully functional. But because our bodies are amazing, and only concerned with getting “the job” done, they will adapt in order to work around the mechanical dysfunction. At first, this can be very helpful, but if the mechanical dysfunction is not resolved, the “work around” or compensation pattern, will eventually create more areas of inflammation and dysfunction, turning our bodies into a mechanical mess. For this reason, a thorough evaluation is key in properly treating all patients that come through our doors.
When a patient comes in for therapy, the first thing we do is talk with the patient about what happened (mechanism of injury), how long it has been going on, and what makes the pain worse and better (aggravating/relieving factors). This gives us valuable information as to which joint(s)/tissue are involved and what type of mechanical dysfunction (problem with the joints, muscles, nerves, and fascia) there may be. Often we’ll talk about many body regions, which can seem odd at first, but once the cause of the issue is spotted, all those annoying questions will make sense.
Next we do a comprehensive evaluation, during which, we use our hands to feel the areas of restriction and the changes in the tissue that may be restricted, inflamed, or lax (loosey-goosey). We’ll feel the joint and tissues as they move through certain motions, and we’ll poke and prod specific areas to feel the condition of the muscles, tendons, and other tissues. Once we have the information we need, we can develop a manual therapy treatment plan to address all the tissues and joints involved in the mechanical dysfunction. Fair warning: The longer you’ve ignored the problem, the more body regions are going to be involved the dysfunction.
Manual therapy is a hands on approach that mobilizes joints, decreases scar tissue and adhesions, decreases muscle restrictions, and encourages proper tissue healing. When working with restricted joints and tissue it can be like pealing off onion layers. The mobility will not be fully restored in one session, it is accumulative. It is also important to note that active patient participation is important here. When patients are compliant with the exercises or physical therapist’s instructions for home, they will maintain the gains made in the therapy sessions. This is when pain and symptoms start to centralize (improve/change) and we get to the core of the problem. Once the joint is mobile and moving appropriately, a strengthening and stabilization program will be dramatically more effective and less painful.
Once the balance of mobility and strength has been achieved, the shearing and/or compressive forces on the joint/tissue lessen or are eliminated, the inflammatory process is reduced, pain minimizes and you start to regain your active lifestyle (the ultimate goal!).
This is why Diane and I feel so strongly about and focus so heavily on manual therapy. A joint needs to be moving well in order to be strengthened and stabilized, so you can return to living your life.
Heal to Live!