Updated: Dec 25, 2019
Orthopedic manual physical therapy is frequently performed with the purpose of reducing pain or improving mobility and function. The mechanisms behind these effects of manual therapy are exceedingly complex. (Here is a brief overview: "What Is Orthopedic Manual Physical Therapy?", and here is a comprehensive summary of the scientific literature on the mechanisms of how orthopedic manual physical therapy works.)
Likewise, our current understanding of pain science greatly surpasses the outdated and disproven theory that goes as follows: “Pain fibers send a pain signal from an injured or damaged body part to the brain so that the person can do something about it.” (Here are 6 common myths about pain along with the scientific evidence to refute them.)
This post, however, will take a brief pragmatic journey through how an expert orthopedic manual physical therapist might successfully blend orthopedic manual physical therapy with pain science to best care for each individual seeking care.
The Subjective Interview
To be able to effectively treat pain, it is imperative that an orthopedic manual physical therapist spends considerable time talking with patients: inquiring of the specific behavior of symptoms, asking how symptoms impact them and their life, elucidating their goals for seeking care, and just listening to their story.
During this discussion, a skilled orthopedic manual physical therapist would be alert to information that may help to guide additional discussion on topics such as pain science, the limitations of MRI or X-ray reports, the body’s healing process, and so forth. For instance, if the patient gives indication of fears and anxiety, depression, symptom catastrophizing, or avoidance of activity due to fear of pain, this information may assist the orthopedic manual physical therapist in determining whether the remainder of the appointment time would be best spent by discussing any of these topics at length, by listening to and addressing their concerns and fears, by transitioning into the physical examination, or by referring the patient to another health care provider as appropriate.
Many individuals who experience chronic or persistent pain, have significant fear about MRI or X-ray findings, or feel great apprehension about performing specific movements or engaging in certain activities, need sufficient time to speak with an orthopedic manual physical therapist who is knowledgeable about these topics. For these individuals, the discussion and evidence-based education that the orthopedic manual physical therapist will provide can lay an excellent foundation on which to build their pain management.
The Physical Examination
When a physical examination is deemed appropriate, a competent orthopedic manual physical therapist would plan the examination so that it is customized for the unique patient and their goals as well as appropriate for their symptoms. For instance, if pain were fairly low and were to subside quickly after a painful movement, a thorough examination might be planned to ensure comprehensiveness without any fear of exacerbating symptoms afterward. If, on the other hand, the pain were severe and were to require much time to settle down after a painful movement, a discerning physical therapist would examine as little as possible but as much as necessary in an effort to mitigate symptom exacerbation while gathering sufficient data to successfully plan subsequent care.
Some common goals of the physical examination include identifying specific movements that change symptoms or movements that reveal deficits in mobility or quality of motion. Oftentimes, creating a plan of care that revolves around these findings will lead to successful treatment in individuals with acute or subacute pain. However, a biomechanical approach like this to chronic or persistent pain would be grossly insufficient. As discussed above, the longer the duration of symptoms, the less important the tissues are. Additionally, chronic pain may not present with consistent and predictable aggravating and easing factors of a mechanical nature.
Since one of the predictors of chronic pain is acute pain, a skilled orthopedic manual physical therapist must treat acute pain very well – stopping the sensory bombardment into the central nervous system, providing treatment that will calm it, and identifying any potential for chronicity in the patient. Likewise, the orthopedic manual physical therapist would avoid language or terminology with patients that might create increased anxiety, a fear of certain movements, or a dependency on the therapist. Lastly, while orthopedic manual physical therapy may have positive effects on pain and mobility, it alone would not be enough to successfully manage patients with chronic pain – it must be balanced with other interventions including tactful therapeutic neuroscience education as well as a graded exercise progression in order to best desensitize the area of concern.
If you are one of the many individuals seeking relief from pain, find an orthopedic manual physical therapist who is knowledgeable and current in the science of pain and who knows how best to manage it - whether it's acute, subacute, or chronic pain. Equally as important is finding the best setting for your care which should include sufficient one-to-one time with your orthopedic manual physical therapist to allow you the opportunity to be heard and to have all of your questions answered. Here are a few more tips on how to choose the best orthopedic manual physical therapist.
Dr. Damon Bescia is a fellowship-trained Doctor of Physical Therapy, board certified in orthopedics and sports physical therapy, who specializes in Orthopedic Manual Physical Therapy and serves Naperville and its surrounding communities by way of his Concierge Practice, providing private one-to-one orthopedic manual physical therapy for his clients. For more information, please visit https://www.napervillemanualphysicaltherapy.com.