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

Building a Successful Therapeutic Relationship!

The patient-therapist relationship is vital to the success of the patients' plan of care. Although that theory may seem obvious, the value of a functional relationship between a PT and their patient is sometimes neglected whether consciously or unconsciously. Good service is invaluable!

So how do we develop this relationship?

Open Dialogue: From the initial evaluation all the way to discharge, therapists and their respective patients should be continuously discussing the progression of their therapeutic program. Therapists should be assessing what's giving positive results, no results, or negative results.

Education: Therapists should be consistently keeping their patients aware and engaged by educating them on what may be causing any symptoms, the plan to treat it, why they're doing what they're doing, and what to expect from it all. Being that a therapeutic program has time limitations, it's also quite essential and beneficial for the patient to be given lasting information to take from their care in order to be responsible for their health in the forthcoming days after they have been discharged.

Accountability: On the other hand, therapists are not the only takers to responsibility. Patients MUST be willing to trust in the therapist's creative plan, follow the therapist's guidance, and take the initiative to perform their Home Exercise Program (HEP) regularly. Patients should be open enough to tell therapists how they feel about their current treatment program. I ask my patients how they feel about their treatment at almost every subsequent appointment.

When there's a good communicative relationship between the two parties, it creates a larger potential for a successful therapeutic experience even if physical therapy is determined to not be the cure to their specific disorder. As a Physical Therapist, I think I can speak for a grand number of other therapists when I say we find gratification in gratifying. Personally, it serves as a humbling reward for a patient to express gratitude for how they were treated throughout the patients' tailored program. It is the fuel that keeps my wheels turning (or my hands mobilizing to keep things in perspective).

 

Clifford Civil, PT, DPT, ACSM-HFS

clifford@duffyandbracken.com

Cliffs Notes: Your Guide to Physical Therapy!

About a month ago, Duffy & Bracken owner, Ann Duffy wrote a passionate blog detailing both the role and the ability of physical therapists in providing preventative services and helping to curb ever-growing healthcare costs. A few weeks later, D & B director, Renuka Pinto, wrote an equally fervent blog highlighting how physical therapists can help individuals invest in their health with the same proactive, calculating approach they take to investing in their financial well-being. As luck would have it, these blogs were posted around the same time that a very poorly-informed segment aired on Dr. Oz, grossly misrepresenting what we as physical therapists actually know and do. (Disclaimer: if you are currently attending PT and receiving the type of care depicted in Dr. OZ's segment, please find a new physical therapist ASAP) To this end, I felt it only appropriate that I complete the D & B blog trifecta and devote this entry to summarizing the many skills that we as physical therapists possess, and reiterating how we can help you, the health care system, and the country as a whole .

Despite what Dr. Oz would have you believe, physical therapists are not merely the keepers of the machines, wielding ultrasound and electrical stimulation units against the dark forces of persistent low back pain, reinforced by our trusty sidekicks, the hot and cold packs; quite the contrary. Currently, to become a physical therapist, one must attend 3 years of graduate schooling, in addition to their undergraduate or post-baccalaureate. Pre-requisites for PT school are the same as those required for med school, generally with the addition of courses like exercise physiology and kinesiology in place of organic chemistry. Physical therapy graduate course work includes biomechanics, physiology, kinesiology, pharmacology, and radiology. PT students study pathology of not just the musculoskeletal system, but also pathologies of the neurological, cardiopulmonary, genitourinary, gastrointestinal, and integumentary systems. Following roughly 7 years of schooling, physical therapists currently graduate with their doctorate, and then enter the health care industry with an identity that is often time misunderstood, and a role that is severely underutilized by the general public.

Here are the cliffs notes as to what a physical therapist is, and what we actually do:

Physical Therapists are musculoskeletal specialists. With extensive coursework in anatomy and physiology, physical therapists possess the knowledge to both diagnose and treat nearly all musculoskeletal pathologies or refer patients to the appropriate practitioners if needed.

Physical Therapists are movement experts. With a strong foundation in biomechanics and kinesiology, physical therapists are trained to analyze everything from your gait to your golf swing. We can determine why your knee hurts when you go down the stairs, help you decrease your half marathon time, and tell you which shoes are best for your needs.

Physical Therapists take an active role in your recovery. Physical therapists use manual techniques such as joint and soft tissue mobilizations, taping in conjunction with therapeutic exercises to facilitate a return to full function. It is our hands, not the hot packs that will make you better.

Physical Therapists are easily accessible. Thanks to Direct Access, patients in New York can see a physical therapist (who has been practicing for at least 3 years) WITHOUT a referral from a physician. Patients are allowed to attend physical therapy for 10 sessions or 30 days before they are required to see their doctor and obtain a prescription.

Physical Therapists don't just cure pain, we can also prevent it. Physical therapists can predict your likelihood of injury by watching you perform simple functional movements. Additionally, patients are provided with home exercise programs and educational tools that allow them to prevent the reoccurrence of injuries and employ self-management strategies should symptoms return.

Physical Therapists help save you money. Although co-pays can be frustrating, attending physical therapy can help people get out of pain quicker, help people avoid invasive surgical procedures, and decrease the amount of medications that a patient needs to take. Six sessions with a $20-$35 co-pay and an adjustment to your workstation versus back surgery. I'll let you do the math.

If you're reading this blog, there's a good chance that you already know the benefits of attending physical therapy. However, I ask that you share this blog with your friends and family, and anyone who's complained to you about their stiff neck and their sore knee. For those of you who just had a mind-blowing experience, carry this knowledge with you and see a physical therapist the next time that ankle (or knee, shoulder, elbow, back, neck) starts acting up.

Carmen Shante Cofield, DPT, CSCS

Duffy & Bracken Physical Therapy

NO PAIN, NO GAIN!

My Duffy & Bracken Physical Therapy one year Anniversary is fast approaching. As the PR & Marketing Director, I wear multiple hats but one hat I didn't see coming was that of (wait for it) ....PATIENT. You see while finishing my Masters Degree, I worked from home for three years. As you can imagine, when I started commuting to Downtown NYC to work and began moving around more and more, I started feeling all sorts of aches and pains in my body. Even though I went to the gym when I could and got a work out in here or there....my mental activity certainly didn't make up for all my physical inactivity.

I figured how convenient for me....I work at a physical therapy clinic so I could just get a quick fix and be on my way. Boy was I wrong...TOTALLY wrong.

Many of you will want to argue with me that the 'No Pain, No Gain' philosophy is actually a myth and pain is not required to have a quality workout. Trust me I get! But I'm not here to argue that point....the truth is that Physical Therapy is unlike any other visit to your doctor's office. It most times will require more than just the quick fix even I expected. Like everyone else I was going to have to put in the work if I wanted to be pain free.

Here is what I learned while walking a mile in your shoes as a PT patient:

1. It may pain you to have manual therapy. Physical Therapy is not like getting a massage at your neighborhood spa. Manual therapy techniques are not as relaxing, it can even be uncomfortable, but trust your therapist to be your guide to long term freedom from pain.

2. It will pain you to do your exercises everyday. No one likes to do them but they are an integral part of your treatment plan....don't neglect them. And if you ever find yourself in pain again after being discharged, the first question you should ask yourself is ...have I been doing my home exercise program.... then make an appointment.

3. It will pain you to carve out a couple of hours a week for 4-6 weeks. Having been in your position, I definitely understand how difficult it can be to make time for treatment. We know your busy but don't be what I like to call a 'Repeat Offender'. Repeat offenders are patients who start feeling better in the middle of their treatment and decide that they don't need therapy anymore. They end up back in therapy because they didn't commit to the process. Would you tell your cardiologist that you don't need your heart medication anymore?

4. It may pain you to dip into your pockets for those co-pays at every visit. Yes, we know it adds up but we didn't make the rules we just enforce them. If you think about it...can we really place a price tag on being pain free and able to live your life to its fullest without physical limitations.

Anyone who has successfully completed their PT treatment plan will tell you that the benefits far out weigh the costs. When it comes to PT...No Pain, No Gain! So yes, it may be a pain in one way or another but most things worth doing are usually not easy. If you are currently in a PT treatment plan, commit to it and if your living in pain, you don't have to....make an appointment today!

Kieffer Pearce

PR & Marketing Director

A Note to Holiday Travelers from Duffy & Bracken Physical Therapy

It's that time of year again; where for two weeks straight we overindulge and uderperform. We become so busy with holidays parties, and spending time with family, that we neglect to take care of our physical well-being. For those who are traveling during the holidays, we inadvertently put our home exercise program on hold and make a resolution to begin again in the New Year. However, this does not have to be the case. There are simple steps we can take to ensure that we work those squats and bicep curls into our holiday plans.

DEPARTURE:

Just as we make a list of items we will be packing into suitcases and travel bags, we can also make a list of necessary and sufficient items we need for exercise.

1. Exercise Sheets: If you have been diligently keeping up with your exercise routine, you may not think this is necessary. However, it doesn't hurt to have them as a reference.

2. Therabands: Packing weights is not only impractical for many, but will definitely ensure that you have exceeded the baggage weight restrictions. Therabands are great substitutes for many strengthening exercises.

3. Tape: If taping is a regular part of your therapy, it may be a good idea to purchase a roll and learn how to do it yourself.

4. Sombra: If you have been introduced to it during treatment, this pain relieving gel will come in handy for those muscle and joint pains that are associated with long travel.

EN ROUTE:

Many of us have fallen in the trap of being completely immobile during long journeys.

Just remember to KEEP MOVING!

For long plane, train, or bus rides do your stretches often, or when you feel your body becoming stiff. Take a walk through the aisles and if this is not possible adjust your sitting position ever so often. For those with neck or back pain, talk to your therapist about purchasing neck or lumbar support rolls.

ARRIVAL:

Do your best to incorporate your exercise routine into your holiday plans. Find time in the morning or before you go to bed to do your exercises. Do your lunges or calf raises while brushing your teeth, or your single-handed tricep and bicep curls while drinking your coffee. Simple items around your hotel room can also be useful. For cold packs, freeze a bottle of water, or place ice cubes into a towel. For heating packs, dampen towels and warm in microwave (just for a few seconds). Taking a long cold or warm shower may also help.

From your departure to arrival time, there are many ways to ensure that your exercise routine is not placed on hold. Talk to your Duffy & Bracken therapist about tips and tricks that are specifically designed for your needs.

Keeping up with your routine ensures that you will have a HAPPY & PAIN FREE NEW YEAR!

 

Rhea Farquhar, PT Aide & GTS Trainer