Why Physical Therapy Works
Physical therapy “works” for many ailments because your physical therapist (PT) identifies impairments via an evaluation and then sets up a plan to overcome them. Whether it’s weakness, tightness, obesity, lack of coordination and/or endurance, the goal of physical therapy is to enable you to do what you want to do with minimal challenge.
The “key” to physical therapy is constructing a specific plan of care that, over time, will change how you move so that joint stress diminishes and overall fitness increases. People ideally suited for physical therapy include those with diabetes, back pain, arthritis, knee pain, shoulder pain and fibromyalgia.
Consider an example of a real-life patient.
Why Physical Therapy Works for Back Pain
Barbara had back pain for 7 years that started after she was rear-ended in her car by a truck. During this time, she was prescribed muscle relaxers, narcotics (i.e., pain medication), acupuncture, chiropractic manipulation, massage and prolonged rest. All these methods gave her relief, but her back pain would return within hours and prevent her from doing what she loved (e.g., skiing, playing with her kids, gardening). She wanted something that would provide a more sustained, long-lasting effect. Her doctor told her that MRI and X-rays were normal, so pain must have been coming from something other than damaged spinal tissues. But from where?
Her doctor finally suggested physical therapy, which she began at a physical therapy clinic 8 miles from her house. During the initial hour-long evaluation, the physical therapist discovered that Barbara had developed considerable weakness throughout her body, but especially in her legs, hips and upper back due to being sedentary. This weakness appeared to be linked to her low back pain because when these muscles were tested, her pain was worsened because she would move into compromised spinal positions due to weakness and poor coordination. Barbara’s physical therapist also found tightness in her hamstrings, chest and hip muscles that appeared to be related to her low back pain because after these muscles were stretched, her pain diminished.
Her physical therapist also watched her walk on a treadmill and noticed that Barbara’s gait was abnormally slow, with her swinging her right foot to the side when taking a step and becoming tired/short of breath after only 8 minutes. Barbara also struggled to use her trunk muscles appropriately when asked to do so.
Given Barbara’s weakness, stiffness, deconditioning and poor motor control, her physical therapist designed a customized program to enhance strength, flexibility, endurance and coordination. Over the next 8 weeks, Barbara went to physical therapy twice per week and performed exercises at home. By the end of 8 weeks, Barbara’s pain was reduced 75% and she had returned to skiing, gardening and playing with her children. How did this happen?
Research is clear: 95% of all low back pain cases are “non-specific” and due to overuse, not internal derangement (Archives Physical Medicine Rehabilitation 2014). This means that, in most cases, low back pain arises due to irritation from compensatory mechanisms, such as weakness, tightness and/or poor coordination. For example, if your thighs are weak, you may arch your back when performing simple daily activities which can irritate your spine over time.
If a sustained treatment is sought, impairments should be addressed through physical therapy that focuses on active treatment methods rather than a passive approach (e.g., hot packs, ultrasound, manual therapy). In other words, the cause of the back pain must be addressed.
Passive treatments provide only temporary relief because they do not address the cause of a health problem. This applies not just to low back pain, but also conditions such as osteoarthritis, diabetes, heart disease and others. Passive treatments are most effective when used to supplement an active treatment plan as opposed to being the focus (New England Journal of Medicine 2009).
In Barbara’s case, physical therapy worked because the physical therapist thoroughly evaluated her, identified specific impairments related to her low back pain, constructed a treatment plan to overcome those impairments and she followed through appropriately. Most importantly, the physical therapist carefully monitored her during her treatments to make sure she used proper technique and intensity.
Therefore, if you are going to physical therapy, make sure your physical therapist explains why you will be doing the treatment plan he/she has constructed and how it will help give you the sustained benefits you’re seeking. Then it’s up to you to follow directions during and after physical therapy discharge so you can minimize risk of recurrence.