Ask the Therapist: PT answers to pain relief
Q: A half a year ago, I had a slip and fall injury at work and sprained my left shoulder. After about five weeks of physical therapy, I was still having difficulty and pain with general mobility. I was assured that it would improve with time and that I should continue to do my home exercises at least daily for another few weeks. When I visited my family doctor, he indicated that I have “frozen shoulder” but didn’t really tell me anything beyond that and that it would get better over time on its own. Now, I can reach overhead pretty well and put on shirts without any problem, but the pain and stiffness really hit me when I try reach behind, such as into my back pocket. I have tolerated this situation for a while, and it is starting to become very frustrating and irritating. Is there anything that you can recommend at this time?
A: Talk about misdirection! I can easily relate to and understand how you’re feeling. I have seen, and worked with, many cases like this in the clinic. From what you’re describing, you have what’s called a soft-tissue dysfunction and not a frozen shoulder or “adhesive capsulitis” as it’s known in the medical community. Each has its own characteristics of movement loss. Your inability to put your hand and arm behind your back due to pain and stiffness reveals a specific dysfunction of the tissue to that particular motion. So what do you do? Watch your posture, put your left hand behind your back and reach back with your right hand, grabbing your left hand’s thumb. Pull it straight up your back until you feel that pain. When you do, release it. Do that repeatedly to remodel and lengthen that tight tissue. After a week or so, it will start to improve. An important point to remember for you: Pain Does Not Equal Harm! The worst thing that you can do in your situation is avoid the pain. If you can, understand that you’re halfway there and then you just have to “shoulder it”.
Q: I am an exercise enthusiast by nature, and I work out in the gym a few times a week. I make sure to get an equal balance of both a good cardio and strength training. I’m in my early forties. Lately I have been having lower back pain that seems to worsen throughout the day while at my desk and during my exercising. I’m not sure what exactly brought it on to begin with. I’ve talked with colleagues at the office who think I may have a herniated disc, and Pilates has been suggested to me to help strengthen my core. From a medical and/or physical therapy standpoint, does that seem like a good idea to you?
A: Your complaints are very familiar. Hold off for now. When you’re ready, Pilates will be a great addition to your exercise regimen. It does sound disc-related in the fact that there could be an obstruction within the disc. Poor sitting postures, especially if sitting behind a desk all day, can cause the nucleus inside a disc to migrate to a different position, which can cause a block in the road. The good thing is that it is low back pain and nothing more. It’s a lot easier to address, fix, and maintain. Try going the other direction. This means that you have to put that nucleus back into place by performing the opposite movement to sitting (flexion) all day, and focus on extension. When your obstruction has been corrected, it would be a great time to start Pilates. If you start too soon, the internal pressures generated by the core strengthening may play havoc with your disc, which is already under too much pressure.
Q: My neurologist recently diagnosed me with an ocular reflex problem. I tend to feel dizzy and nauseous throughout the day depending on what I do. It reminds me of a seasick feeling. I was put on a medication to help curtail it. The doctor also mentioned physical therapy. What would a physical therapist do to help me?
A: It sounds as though you have had a weakening of your Vestibulo-Ocular Reflex or VOR for short. The VOR maintains steady gaze of an object on your eye’s retina, no matter what direction or speed your head is moving. When this reflex is weak there is miscommunication resulting in the symptoms you describe. A trained physical therapist can help strengthen that reflex by stimulating it repeatedly with first easy, then more involved eye, head, and balance exercises. As the VOR is coached it will become stronger, and your symptoms will begin to lessen and then fade.
Q: I am twenty-one years old and play basketball for my school. I twisted my left knee and fell early in the season, but ignored it because it wasn’t too bad at the time. Lately while running on the court I have noticed a burning sensation that seems to be coming from deep inside and getting stronger over time. What could this potentially be and would physical therapy help?
A: It sounds as though you may have a small meniscus tear. The meniscus is the cartilage designed to cushion the long bones in our knees, giving us more mobility. If this is the case it needs to be addressed sooner than later, or the tear can grow, causing locking or buckling of your knee. Depending on the size of a tear, physical therapy can provide great relief by adequate and functional strengthening of your quadricep’s VMO muscle relating to your specific sport, and in trained hands, distraction techniques can help reduce the tear. After puberty, however, the blood supply to the meniscus decreases dramatically and therefore so does its ability to heal itself.
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"Ask the Therapist: PT answers to pain relief"
Scott Kushner, PT, MS, Cert. MDT, is the author of Back to Basics: A No-Duh Guide to Prevent Back Injury – and Maybe Even Surgery. He received his formal education at Thomas Jefferson University, College of Graduate Studies, in Philadelphia. Kushner ...