Physical Therapy for Falls
Q. About a year and a half ago, a dear friend slipped and fell while we were shopping. She landed on her derriere. After the incident, although she was shaken up, she was able to get to her feet and sit on a bench in the store. Unfortunately, the bench collapsed and she fell again! (She’s morbidly obese.)
My friend followed up with her physician, and all X-rays were normal. Even so, she has been complaining of severe central/lower-back pain since the two incidents.
She and I are nurses and co-workers. To alleviate the pain, she has tried physical therapy, along with a series of injections, but her symptoms never completely go away. Are there any other suggestions or recommendations you can offer?
Becky, Mesa, AZ
A. Based on the mechanism of injury, I can narrow it down to three possibilities: bony fracture or contusion, muscle strain, or disc-related pathology. The fact that X-ray imaging showed no bony involvement rules out the possibility of a fracture. Additionally, the timeframe you provided rules out muscle strain, which normally takes between four and six weeks to heal, leaving the disc(s) to be the probable source of the pain.
As a rule, any kind of pain someone experiences is either caused by inflammation, or it’s mechanical—affected by positions or movements. Because the injections (which fight inflammation) didn’t help, I believe the issue is mechanical and that your colleague most likely has an unresolved disc bulge or a slight herniation of the disc wall itself. The good news is that that there are no symptoms occurring down either of her legs, which indicates the potential for recovery.
I strongly recommend that your friend visit The McKenzie Institute’s website at www.McKenzieMDT.org to find a credentialed physical therapist in her area. As I’ve said before, just because someone has undergone physical therapy doesn’t mean a competent physical therapist administered the treatment.
Q. A few months ago, a long-time friend of mine was in a horrible car accident. She has been in and out of consciousness since. Although she has been more conscious than unconscious over that period, she’s still unable to communicate verbally or move any of her limbs.
She was recently transferred to a rehabilitation center. I was told she’d be there for three to six months and would be receiving physical therapy every day. My question is, if she’s unable to move on her own, what kind of services will she be receiving?
Adam, Denver, CO
A. I’m sorry to hear about your friend’s unfortunate accident.
Although I won’t speak to the consciousness issue (that’s best left to the appropriate medical experts), I can’t stress enough the importance of the daily physical therapy she’ll be receiving at the rehabilitation center.
When a joint isn’t moved over an extended period, it along with the soft tissue that attaches to it stiffens. Eventually, it can become so rigid that it can take weeks to stretch back out. To avoid this condition, one of the main treatments your friend will be receiving is passive range of motion, or PROM. Every day, the physical therapist will literally move all her body’s joints, and other soft tissue, throughout their full range. This treatment will help maintain range of motion and joint integrity, preventing contractures. It will also aid her body’s circulation and return blood to the heart more efficiently.
Additionally, the physical therapist will work closely with the nursing staff on other issues, such as positioning to prevent skin breakdown, avoiding vulnerable and sensitive superficial nerves when applying modalities for any residual swelling, transferring the patient, and so on. Physical therapy will also play a vital role in helping her re-learn motor function when the time comes.
I wish her well and hope for a good recovery.
Q. I’m a seventeen-year-old high school senior, and I’ve been talking with my guidance counselor about career options. What is the difference between a physical therapist and an occupational therapist?
Timothy, Tucson, AZ
A. Great question!
A physical therapist (PT) is highly trained in the musculoskeletal system. PTs are masters of human anatomy, physiology, and the stages of healing—with and without the use of various modalities, (heat and cold therapy, ultrasound, electrical stimulation, exercise, and manual therapy)—to achieve the most desired functional outcome for a specific joint or region of the body.
Traditionally, an occupational therapist (OT) has similar training, but is less focused on the body’s musculoskeletal anatomy and physiology. An OT’s focus is more on functional activities of daily living, or ADLs. For example, if a patient has suffered a stroke and has residual weakness or neurological complications, an OT will work with and train that patient to perform all his or her necessary ADLs (bathing, cooking, cleaning, dressing, and so on) using adaptations of the environment and/or compensatory strategies.
Unfortunately, the roles of OTs and PTs have become convoluted over the years. To break it down simply, nowadays, let’s assume both are assigned to the same patient in a rehabilitation setting. In this scenario, most people think the OT will focus on any upper-extremity issues. Meanwhile, they assume, the PT will focus on any walking, transfer, balance, or lower-extremity strengthening issues. I don’t know where or how this misguided notion started, but it’s a reality with which we therapists must contend in a clinical setting.
I might be a little biased, but I believe a career as a physical therapist—which now requires a doctorate (DPT) and a few more years of education—will open up many paths over the span of your professional life. A PT career isn’t limited to providing rehabilitation services for the general public; many opportunities also exist in college athletics, with professional sports teams, on a consultation basis for business ergonomics, and more.
Occupational therapy, meanwhile, is a valuable adjunct for those with disabilities. OTs can make real differences in their patients’ lives by teaching them to be more independent.
Good luck! My best wishes for a rewarding future.
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"Physical Therapy for Falls"
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 ...