Physical Therapy Series: Introduction

Physical therapy is likely the greatest treatment option an orthopedic surgeon has in his tool kit to cure musculoskeletal ailments. Unfortunately, it is also the most misunderstood treatment by patients. My goal is to help the patient understand the benefits of therapy. Physical therapy can be broken down into three phases. The first phase is “Prehab '' or preventive physical therapy. There are a few body parts that the majority of people will injure during their lifetime. While an injury is often a surprise to the patient, the physician will often consider it a right of passage of middle age. Some of these injuries are so common all patients would benefit from prehab by spending a few minutes each week keeping these body parts flexible and strong. Certain occupations or activities are even more prone to injury. Think of the manual laborer and back pain or the baseball pitcher and shoulder/elbow pain. Injuries are so common in these groups that prehab exercises are critical if you do not want to find yourself on the sideline of life. The second phase of physical therapy, and most individuals’ first experience with physical therapy,  is “injury treatment.” For many ailments, physical therapy is the first line of treatment. With these injuries a high percentage of patients will heal with therapy only. With other injuries, therapy is critical for proper healing and long term success after another treatment. The therapy may be required for full recovery after a prolonged period of bracing or rest. It may be necessary after medication or an injection. There are many surgeries where post-op therapy is critical to the healing process and long term success. A common apprehension among patients is that they cannot imagine doing exercises when they are in pain, so initially physical therapy may seem counterintuitive. However, the therapist has a wide array of modalities to decrease pain and swelling. They are trained to recognise what pain is critical in the short term for long term benefit. Communication between the therapist and the patient is important. Therapy is a gradual process and often requires a level of patience. Some patients can move aggressively towards increasing flexibility and strength in an injured joint while others will require modalities to calm the inflammation and swelling. If you need convincing, think of the athletes. After any injury, they are evaluated by the athletic trainer. Modalities to calm the injury down are started almost immediately and therapy exercises are started at the appropriate time. The third phase of physical therapy is the “recovered phase”. When the pain goes away you often consider yourself healed, but this is only partly true. Many orthopedic injuries have a tendency to pop up again. Ankle sprains are a great example of this.  One sprained ankle is often  followed by more sprains. If you sprain your ankle you should continue doing your ankle exercises to prevent further ankle sprains. Similarly, if you recover from rotator cuff surgery you should continue your shoulder exercises in both shoulders to prevent new tendon tears. If you have had a knee injury you should continue your strengthening exercises to prevent arthritis but also make any arthritis you may develop tolerable. This does not mean you need to spend several hours with the therapist. It only takes a few minutes each week to greatly decrease your chance of re-injury. 

 Before moving along further I need to mention another group who is often against therapy. These are the patients who already consider themselves strong and/or flexible. Again, think of the athletes. The most elite athletes are in constant “prehab” and start “injury treatment” almost immediately after any injury. No matter how flexible you are, you will tighten up after injury and could benefit from therapy. No matter how strong you are, your strength likely comes from the major muscles such as the deltoids, pecs, biceps, triceps, glutes, quads, and hamstrings at the expense of more accessory muscles such as the shoulder, hip, and spine stabilizers. So when I order physical therapy, I am not kicking sand in your face or making a comment on your physique or fitness level. I am just trying to move you along to recovery. 

Over the years I have noticed the great benefit that people receive having a friend or family member (me) who also happens to be an orthopedic surgeon. One of the goals of TheRealHouseMD is to give people who do not have a friend in orthopedics some of the same benefits my own family has. It is common for a friend or family member to call or text with an orthopedic injury. The probable diagnosis can often be made over the phone. The severity of the injury can be determined as well. My advice can range from telling the friend to call the ambulance, to going to the local emergency room, to going to the local ambulatory clinic, to coming to the office over the next few days, to instruction on how they should initially treat the injury. The benefit to my friends is they often save countless hours of sitting in emergency rooms or making a trip to my office for things they can treat themselves. Many of these injuries are minor, but could become more problematic if left untreated. Often, the treatment is to try some simple home therapy exercises. On many occasions, formal physical therapy or further treatment is only needed if they do not steadily improve. Recent examples are my daughter in Texas and my cousin in South Carolina were having hip pain. It only takes a few questions to determine that therapy would likely cure the issue and further treatment would not be necessary unless therapy failed. I simply found some good videos on youtube and forwarded them to my family members. This gave them the opportunity to initiate treatment before the problem worsened. Everyone has a computer in their pocket so health information is just a quick smart phone search away. The problem is turning yourself into Doctor Google can be confusing and possibly dangerous. My goal is to provide the reader with some initial therapy exercises they can use in the “prehab” phase and the “recovered phase”. During the “injury phase”, you need to listen to your own body. For minor injuries you can start these exercises. For more severe injuries you need to contact your physician. A footnote for those who believe I exaggerate. My cousin’s cousin just called with new onset patellar tendinitis. After a two minute phone call a treatment plan has already started.