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From a young age, we’re brought up to believe that creaking joints and aching muscles are natural as we grow older. When back pain or stiff joints start, many of us accept it as normal because we may be over 50. However, this is not an accurate philosophy to live by.
As Physical Therapists, we understand that joints can become less free with age but we also know that manual therapy intervention can help restore mobility. The key to aging well is to keep moving. Let the staff at Integrated Rehab help you age your best!
What Is Manual Therapy?
Manual therapy is a hands-on approach to pain management. As an Orthopedic Manual Therapist, when a patient first comes to the clinic a comprehensive Initial Evaluation is done for two reasons:
- To identify what structures are contributing to the patient’s complaints of pain
- To rule out any possible medical conditions which might warrant referral back to the MD
Physical Therapists then utilize a variety of skilled interventions to mobilize soft tissues and joints, which helps to improve range of motion and reduce pain from tissue inflammation or restriction. These interventions may include: Muscle Energy Techniques, Mulligan Mobilization, Myofascial Release, Strain/Counterstrain, Craniosacral Therapy and Visceral releases.
Rather than accepting random pains and restrictions in our bodies as natural signs of aging, manual therapy allows us to discover and resolve these problems.
An interesting point is that in some basic orthopedic problems, the source of the pain might be very clear. However, in other orthopedic conditions, the location of pain and the source of the problem are not necessarily the same! In these cases, a skilled manual therapist will think “outside the box” and assess other areas. Let’s see some examples!
Manual Therapy for the Athlete
Let’s say a volleyball player sprains his ankle coming down from a block – many clinics would solely evaluate and treat the ankle. At Integrated Rehab, we screen the entire kinetic chain: the pelvis, hip, knee and foot/ankle because something else might have been misaligned by the fall. These dysfunctions, left untreated as the athlete grows, may result in hip, knee or back pain many years later from the compensatory movements they developed at a young age.
Perhaps another athlete, a baseball pitcher, comes to us with a back problem. Is his form causing the problem? Did he slide into home plate and collide with the catcher? Could a previous injury in another area of the body be contributing to the discomfort? He may be feeling pain in the lower back, but the evaluation reveals that there is actually weakness in the right shoulder causing him to alter his form. How is this possible? The shoulder is connected to the back! Myofascial release helps us understand.
Fascia is a connective tissue that winds throughout the whole body. Fascia exhibits two thousand pounds per square inch of pull on the body! This connective tissue allows our tissues and organs to move freely throughout the body, but scar tissue from a shoulder surgery or microtears in the tissue from a rotator cuff strain could restrict that motion, causing a tug all the way down into the back because of the attachment of the latissimus dorsi. Once that scar tissue is released, it will no longer affect other areas of the body.
Manual Therapy for the Public
As another example, a 40-year old woman with two children comes to our clinic and mentions she has pain in her mid-back from a fall, is tired all the time and unable to take deep breaths. She reports she has two children that were delivered by C-section and that she has had her gall bladder removed.
This examination might reveal the source of the problem to be a restriction in her respiratory diaphragm, located below the ribcage. When tissues do not get enough oxygen, the muscles get tired faster. If we work the connective tissue to restore the motion in the respiratory diaphragm, she’s likely to feel better.
However, the source might also be scar tissue from the removal of the gall bladder or from the C-sections. In this case, visceral manipulation might be the most helpful intervention. In simple terms, visceral manipulation evaluates the relationship between our organs, muscles and joints. If there are restrictions in the mobility/motility of the organs or adhesions around the organs from surgery our bodies react by moving around the restricted area, until the repetition leads to pain.
How about this situation: “I was just picking up a piece of paper, nothing heavy, and my back went out!” Muscle Energy techniques, osteopathic in origin and based on the fact that our muscles have structures called spindles, might be the treatment of choice in this case. You see, when the spindle gets stretched beyond its “safety zone”, the muscle “protects the body” by going into spasm. Gentle contractions used in Muscle Energy techniques allow the therapist to “reset” the tension in the spindle by realigning the joints and turning off the “warning signal” to the brain now that the trauma has gone away.
Manual Therapy for Treating Chronic Pain
Manual therapy covers a scope of dysfunction, including chronic pain. For instance, a patient might have fibromyalgia, diabetes or chronic fatigue syndrome. As opposed to a young athlete who often can get right back out on the playing field, treating people with chronic pain requires a great deal of time, education and patience.
Our job as Physical Therapists is to help them realize these symptoms did not develop overnight. Much like an onion, patients with chronic pain have built up layers of compensation in their tissue and movement patterns and have decreased overall strength. It is our job to figure out how to utilize our various manual therapy techniques to peel those layers back and help regain strength and motion.
Our treatment starts with restoring function; often the pain is the last to go away. For example, if someone can only sit for five minutes without pain, our goal would be to increase their comfortable sitting time. While the patient may be frustrated that the pain still surfaces, the ability to sit for an hour until discomfort sets in shows great progress.
To break the cycle, patient education is a VITAL component. One factor we focus on is when to do at-home exercises for maximum results. Exercising the moment you experience pain, rather than at the end of the day when it has compounded, allows patients to better manage their symptoms.
Manual Therapy for Strength & Conditioning
As we grow older, it becomes even more important to remain active. Many people think strength and conditioning is only for athletes, but its principles can also be applied to the general population of PT patients. If someone comes to us with knee pain, we are going to help this patient mobilize and strengthen the hip, knee, ankle joints as well as the lower back.
In achieving this without reinjury, one principle we follow is called work load: The amount of stress put on our tissues. When working with an injured patient, you have to understand how much work load the injured tissue can take during a session. Even if the patient is responding well to treatment, we never adjust the work load on a tissue more than 10 percent from what we did in a prior session. We want the issue to adapt naturally, not exacerbate the pain with too much work too soon.
Education comes into play again when we encourage people to be patient and not push too hard. You may think, “I did 10 reps today, I’ll go home and do 100!” or “I lifted a one-pound weight, so I’ll lift a four pound weight.” However, this overexertion increases the workload on that tissue exponentially and you’ll likely come back to us in more pain. When it comes to strengthening and rehabilitating tissues, we educate all patients on the varied ways to achieve results for a healthy lifestyle moving forward.
At Integrated Rehab we are proud of our staff, who have a diverse knowledge of the human body and different physical therapy techniques to treat our patients. If you’ve been experiencing pain with age, we want to help restore your mobility and function. To learn more, schedule an appointment at the clinic location nearest you!