Tuesday, March 31, 2015

The Power of Manual Therapy

Physical Therapists (PTs) use a number of different strategies to help restore an ailing client’s functionality. The three most popular restorative propellers are: manual techniques, modalities, and exercises. These three treatment resources are commonly combined into some fashion that aide in physical rehabilitation. As a passionate physical therapist, certain distinct things being practiced often bother me. For starters, it BLOWS my mind when a new client comes into my office for an evaluation with me, and tells me that they were treated in a previous PT facility that did little to no manual therapy. It also BLOWS my mind when referring medical doctors (MD’s) have prior conversations with patients strongly advocating the use of modalities as a major component in restoring functionality. Great… Thanks to that and their status on the hierarchy of the medical system, a nescient patient is now brain-washed into believing a passive, non-cerebral object is going to bring him/her to fame. Furthermore, I now have the pleasurable responsibility to try to convince otherwise; which, is more often than not, an impossible task. Concisely, manual therapy (hands-on treatment) is the driving force behind healing in physical rehabilitation. Simple.

Before I indulge in discussion about the preeminence of manual techniques, let’s define the term. Manual therapy can be defined as all the hands-on techniques that help reduce pain, increase mobility, increase muscle firing, increase strength, facilitate movement, increase function, decrease edema and/or reset or re-align anatomical segments. These techniques are provided by healthcare professionals in rehab such as: physical therapists, occupational therapists, chiropractors, osteopaths and the like. Manual therapy techniques include: joint mobilizations, soft tissue manipulations, deep tissue massages, rolfing, passive muscle stretching, muscle energy techniques, and proprioceptive neuromuscular facilitation to name a few. There are multiple reasons for the administration of manual treatment; moreover, the importance of manual work with injured patients is extensive.

For starters, it allows for an objective feel of the soft or bony tissue by the treating clinician. Clinicians can get an overall assessment of the static quality of the palpated tissues, as well as, the dynamic quantity and quality of movement. Moreover, certain manual techniques can deliver soothing sensations, which help patients feel better and puts them at ease. Most importantly, manual therapy can shorten the injured party’s convalescence by directly targeting the problematic source. Manual techniques can help a client move better, move faster, and restore proper movement mechanics by increasing a patient’s range of motion in a specific joint.

On the other-hand, modalities are therapeutic agents, or machines mostly powered by electricity, that are designed to contribute to healing. These modalities include: electrical stimulation, moist heat, ice packs, ultrasound and the like. The inherent problem is that there is currently little to no scientific evidence in medical literature that advocate the rehabilitative efficacy of these said modalities.

Hands on techniques help develop a successful therapeutic relationship, which I’ll blog about on my next post. In my everyday practice, I employ hands-on techniques, and have developed great bonds with my clients. The fact of the matter is that the patient/client has to first trust you to allow you to touch them. It drives down insecurities and helps not only the physical rehabilitation process, but the never negligible mental rehabilitation process as well. Injury takes a toll on people’s body and psyche often equally. The warmness of your heart can be felt through your hands.

Bottom line: Passive modalities do NOT suffice. I know we are in the information age, and the trend is to believe that nearly all machines nowadays can take the place of humans, but this is not true for physical rehabilitation. For all patients and physical rehab clinicians out there, please know that the best way to tackle the issues head-on is hands-on.

 Clifford Civil, PT, DPT, ACSM-HFS

Wednesday, March 11, 2015

Six Reasons to See a Pelvic Floor Physical Therapist Postpartum

Having a baby is a joyful and fulfilling experience but also can take a heavy toll on your body. Growing and carrying a baby for nine months followed by delivery might cause new aches and pains that a Pelvic Floor Physical Therapist can help you address. 
Here are six reasons you may need to see a Pelvic Floor Physical Therapist postpartum

1.      Musculoskeletal pain
-          Growing and carrying a baby for 9 months really can take a toll on our musculoskeletal system. Some common postpartum issues include: tight hip flexors, poorly activating abdominal muscles, low back pain and instability through the pelvis.

2.      Weak Pelvic Floor Muscles (PFM)
-          Pelvic floor weakness can lead to symptoms such as poor or weak orgasm, urine leakage and/or a feeling of “falling out” vaginally.

3.      Prolapse
-          “falling down” or “downward displacement” of the bladder, uterus and/or rectum
-          This can happen in varying degrees and symptoms can include “falling out” feeling vaginally or even vaginal tissue extending externally.

4.      Diastasis Recti
-          The separation of rectus abdominis muscle which can happen during pregnancy.
-          You might notice you have this if you attempt to do a crunch and see a half football shaped bulge vertically on your stomach.

5.      Incontinence
-          Urine leakage, a common compliant post-partum, is another reason to see us!
-          Prolapse, weak PFM and poor neuromuscular control of PFM can all cause this annoying symptom.

6.      Scar sensitivity
-          A sensitive scar can be the cause of painful intercourse, can limit your ability to perform a kegel and/or can cause tension in pelvic floor muscles leaving you with pain.

We, at Duffy &Bracken PT, have the skill set and tools to help you feel like yourself again. We use biofeedback equipment to measure pelvic floor muscle strength, manual skills to treat pain and our skill and experience to teach and encourage you along the way. Let’s not forget what our bodies went through over the last nine months! We need to take care of ourselves and be proactive about our health and wellness; after all we are now responsible for a little one. See you soon!

Candice Amat, PT, DPT