Physical therapy is a method of treatment which uses physical modalities and technic to alleviate pain and improve patient functioning. The concept is different to that of medication and other chemical therapies. Physical therapy is almost free of side effects when performed by a physical therapist or other specialist after being prescribed by doctor. However, if it is not performed correctly serious side effects can follow. Physical therapy can be divided into manual therapy and exercise therapy.
Hot packs may have been used by human beings to treat pain since they discovered fire. When a hot pack is applied the circulation of blood around the wounded area speeds up. When blood circulation speeds up, the wound repairs faster, and the matter which is causing the pain is removed – thereby alleviating the pain. Hot packs work directly on the nerves to alleviate pain. Care needs to be taken in cases of diabetes or decreased skin sensitivity because the patient could get burnt. Furthermore, diabetes patients need to be careful because blood from necessary tissues can move towards the skin.
In contrast with hot packs, cold packs or ice packs decrease blood circulation. If you get hurt, or after having surgery, you bleed and the wounded area becomes inflamed and swells up. In such cases a cold pack or ice pack should be applied. In serious cases a treatment called a cryotherapy is used to reduce persistent swelling.
Ultrasound allows heat to penetrate deep into the tissue. Heat from a hot pack cannot penetrate the skin more than 1-2mm. The blood carries warmth away from areas where there is a lot of heat. That is why a hot pack is called ‘superficial heat’. However, ultrasound is used in cases of joint contracture or for other reasons where heat needs to be transmitted deep into the tissue. Ultrasound is called ‘deep heat’ or ‘vigorous heat’. If ultrasound is used incorrectly the tissue could overheat or other side effects could occur, so it should only be used by a physical therapist or other qualified practitioner. The reason for using ultrasound is that when heat is applied the tissue becomes soft and tender, making it stretch easily. Ultrasound should be used if you have stiff joints or a contracture due to frozen shoulder (adhesive capsulitis) or a bone fracture etc., so that the tissue doesn’t tear and you can return back to the normal state in a short period of time. What’s more, ultrasound relaxes the muscles to alleviate pain.
Electrical stimulation alleviates pain by producing a pleasant sensation in the painful area which competes with the pain. It is the same principle as when you have a stomach ache and your mother strokes your tummy so it hurts less. Scientists believe that when a nerve impulse passes through the spinal cord or brain it goes through a checkpoint. Pain is alleviated because it passes through the checkpoint together with the pleasant sensation, thus slowing the passage of the painful sensation. This is called ‘gate control theory’. There are no specific side effects.
Mechanical traction is a method of treatment using a machine, whereby the neck and back are pulled. This reduces pressure on the spine, so a disk can be temporarily inserted. Furthermore, the neck and back are pulled and the muscle is stretched, thus alleviating pain. In cases of severe spinal arthritis or severe spinal stenosis, a spinal cord injury could occur. Also, in cases of carotid stenosis there is a possibility of paralysis, so it is essential that this procedure only be performed when prescribed by a specialist. The method of hanging upside down to reduce spinal pressure actually increases blood pressure in the brain and paralysis can occur – thus care must be taken. It is not correct to advertise DRX or mechanical traction as a solution for all spinal pain.
There are various types of massage. At Dr. Kim’s Pain Therapy Center, the treatment methods known as ‘deep massage’ and ‘myofascial pain release’ are used.
Exercise therapy is necessary in order to reduce pain and improve patient functioning. Exercise therapy can be divided broadly into range of motion exercises (which increase the movement of joints) and strengthening exercises. Range of motion exercises can be divided into PROM, AAROM, AROM, and stretching, according to the degree of strength.
The joints in our bodies should move properly, and muscles and ligaments have to maintain their optimum length. If the body is not moving due to illness, bone fracture, injury, lack of exercise, etc., the joints stiffen, painful to move and susceptible to injury. In addition, if the pain is severe, the surrounding muscles will stiffen in order to protect that part, making it difficult to move. Then the joints and muscles gradually become harder and stiffer.
PROM (Passive Range of Motion)
These exercises are used when bone or ligament should not take any pressure.The therapist moves the joint.
AAROM (Active Assistive ROM)
When the patient has recovered to some degree, the patient and the therapist move the joint together.
AROM ( Active ROM)
The patient moves himself the joint according to the therapist’s instructions.
Exercise performed after recovering from a bone fracture or injury where the patient increases the movement of joints and muscles with the force. Even though the therapist helps, the patient does most of the work.
If the muscles weaken due to various kinds of injuries, pain, lack of exercise, etc. the pain becomes severe and it is impossible to move properly. If you don’t move because it hurts, then muscles become even weaker, then the pain will worsen, and it becomes a vicious cycle. At Dr. Kim’s Pain Therapy Center, we help you to exercise using various kinds of equipment and techniques according to your condition
Spinal injections called epidural injections have been used since 1952 in the treatment of back pain. Beginning in the latter half of the 1980s, a type of x-ray machine called C-Arm entered the market which was far safer than previous models, and it became possible to administer spinal injections faster and safer. If spinal injections are administered together with physical therapy the effect is far greater. After the pain is soothed by the spinal injection, good results can be achieved using exercise therapy and rehabilitation treatment.
The reasons spinal injections are effective is that we administer a powerful anti-inflammatory steroid right near the nerve root. If a spinal disk comes out and the nerve root is pressed down, it will become inflamed making the nerve root and disk swell up. When the steroid is injected, the inflammation of the nerve root and the surrounding tissue subsided, and pressure on the nerve root reduced to relieve the pain. Also, the pain disappears due to the effect of the anesthetic used in conjunction.
The oral steroid can function as an anti-inflammatory medication. However, steroids taken in large doses have harmful side effects on the various organs because they go all over the body. On the other hand, spinal injections deliver medicine into the narrow spinal canal, so there are considerably fewer side effects on the whole body.
How long the effects of spinal injections last: The effects of steroids and anesthetic agents are temporary, however once the inflammation has gone down it generally doesn’t go back to its previous state. The reasons for back pain are varied and complex, thus it is impossible to say unequivocally how long the pain will be alleviated for. Many people have their pain alleviated and can go about their normal daily lives after just one injection. However, some people have a spinal injection, and then after about a month they return to the same condition as they were prior to the injection. Scientific study results show that the duration of pain relief for sciatic neuralgia caused by a disk is around 80% after one year, and pain caused by spinal stenosis is around 50%.
The side effects of spinal injections: According to experienced specialists side effects from spinal injections are very rare.
Dural Puncture: In 0.5% of cases the spinal dura (membrane) is punctured resulting in a headache lasting several days. The headache will be felt when sitting or standing, but it goes away when lying down. The use of a C-Arm x-ray machine greatly reduces this side effect.
Infection of the spinal canal: Cases are extremely rare if sterilization is done correctly. It is uncommon except in AIDS patients or other instances where immune function is markedly compromised. It occurs in less than 0.01% of cases.
Bleeding: Nerve damage from bleeding in the spinal canal is extremely rare. In cases where anticoagulants such as Coumadine, Plavix, Pradaxa, Heparin, and Lovenox are being used, spinal injections should not be administered. It is best to stop taking aspirin for around 10 days. It is essential that you consult your regular doctor when you stop taking aspirin. It is best to stop taking anti-inflammatory pain killers (analgesics) for three days.
Minor side effects: In some cases temporary side effects may include headache, sleep disturbance, pain around the injection site, hyperglycemia, facial flushing, swelling of the arms and legs, etc.
Facet Joint Injections
The spine has 31 bones stacked one on top of the other from top to bottom. There are joints between the spine so that it can move smoothly. This joint can become painful due to a car accident or arthritis.
Facet joint injections are used in both diagnosis and treatment. In some cases it is difficult to distinguish radiculopathy from muscle or ligament damage, or spinal joint damage. In such cases the medial branch nerve should be isolated, and if the pain disappears then facet joint pain can be diagnosed.
Just blocking the facet joint nerves can, in itself, often make pain caused by facet joints disappear in the long term. Nerve block is effective in breaking the vicious cycle of pain.
Steroids are also injected directly into the facet joints. It has a similar effect to blocking the facet joint nerves.
If knee or shoulder pain is severe steroids are injected directly into the joint. Intra-articular injection is a method of inserting powerful anti-inflammatory steroids into the joint. When inflammation is severe, the steroids reduce the inflammation of the joint and the surrounding tissue. Also, the pain disappears due to the effect of the anesthetic used in conjunction.
The oral steroid can function as an anti-inflammatory medication. However, steroids taken in large doses have harmful side effects on the various organs because they go all over the body. On the other hand, intra-articular injections deliver medicine inside the small joint space, so there are considerably fewer side effects on the whole body. Possible temporary side effects include pain around the injection site, hyperglycemia, facial flushing, swelling of the arms and legs, etc.
Hyaluronic Acid Injections
Hyaluronic acid injections are used to treat osteoarthritis of the knee. A cartilage component is extracted and inserted into the joint. There are several different products such as Synvisc, Hyalgan, Orthovisc, etc. but the effects are almost identical. These products are extracted from rooster combs and are based on bacteria grown in the laboratory. One treatment will alleviate knee pain for 6 to 12 months. Aside from pain around the injection site, there are no specific side effects.
In 1997 the National Institutes of Health announced their position on acupuncture saying it “is effective in controlling post-operative and chemotherapy nausea and vomiting, and post-operative pain, etc., and is a useful alternative treatment for drug addiction, stroke rehabilitation, headache, menstrual cramps, fibromyalgia syndrome, arthritis, backache, asthma, anxiety/panic attacks, and insomnia.” To put it simply, oriental rehabilitation medicine using needles in the treatment of disease dates back to ancient times in the East. The Chinese classic, the ‘Yellow Emperor’s Inner Canon’, introduces the 12 meridians and acupuncture. Acupuncture has been used as an important treatment in China, Korea, and other Eastern countries for more than 2000 years. In oriental medicine, ailments of the human body are solved by adjusting the flow of qi. Acupuncture particularly focuses on solving problems caused by disease simultaneously inside the human body.
The benefits of acupuncture can be summarized as follows:
1.Acupuncture treats diseases which affect the internal organs by adjusting the flow of qi.
2.Acupuncture alleviates pain by adjusting nerve function. It follows the flow of qi along the meridian, so if you insert a needle at point A, that stimulus passes through the central nerve and is transmitted to the brain. The brain then sends the stimulus to point B.
3.Acupuncture has the effect of expanding and contracting the blood vessels, thus easing blood circulation. It can also treat diseases of the circulatory system.
Oriental rehabilitation medicine provides treatments for paralysis caused by central and peripheral nerve damage, disorders occurring in the musculoskeletal system, and other essential rehabilitation treatments. Traditional oriental medicine uses acupuncture to improve whole body function (it does not just treat localized pain) within the fastest possible time, so the patient can get rid of the disease.