Physical therapy goes beyond rehabilitation from injuries


Diane Peltz – Contributing Writer

Lynn Calhoun, a patient in a balance program, uses therapy equipment to make her steadier on her feet.

When people think of physical therapy, they probably picture someone who has had an injury and is trying to strengthen their muscles. Often folks relate physical therapy to athletes trying to get back in the game after an injury or recovery following surgery. Today’s physical therapy treatments offer much more than they did in the past. 

Some diagnoses that are common to Physical Therapy (PT) patients include low back pain as a result of spinal stenosis or degenerative disc disease; shoulder pain as a result of tendinopathy or partial rotor cuff tear; knee pain as a result of osteoarthritis; decreased balance leading to falls; and post operative therapy from joint replacements. 

How PT works

Conventional physical therapy begins with an initial examination that reveals underlying impairments that need to be improved in order to alleviate the patient’s symptoms or address the current complaints. In the examination, the therapist and patient agree upon an appropriate plan of care to follow, which is often two or three times per week. Typically, a home program is provided by the therapist to keep the patient working on the days they do not attend appointments at the clinic. Most clinic appointments are 40-60 minutes in duration and the time begins with a warm-up followed by appropriate activities and exercises to address the originally established impairments. Most people have a goal to have minimal pain so that their normal routine is not limited.  

Franklin boasts three major physical therapy clinics. Each clinic offers their own specialized service.  

Balance Training

Healthworks offers a balance program for people who have fallen or who have had near falls. Every 11 seconds, an older adult is treated in an emergency room for a fall-related injury.  This loss of balance can occur gradually over time, it can occur after a long hospital stay or recent illness, and it can occur as a result of what people know as vertigo. Hip and ankle weakness often leads to balance problems, as does poor posture. Strength and flexibility movements can help counteract these problems. These are often as simple as leg lifts while seated in a chair, or “knee marching.” They may also practice standing on one leg, walking heel-to-toe, or tracking the movement of your thumb with your eyes as you move it in various positions. 

Balance and gait are inextricably linked because they tend to impact one another. Even if you don’t think you’re in danger of falling over, that “running out of steam” while walking that is often attributing to aging muscles could be something else. The problem might actually be slowing reflexes, which make moving around seem more strenuous than it is. By the same token, poor posture and gait can throw off those reflexes.

In fact, the balance and gait systems both rely to some extent, on a complex number of body systems that include the inner ear, the eyes, the joint-muscle-nerve system, and of course cognitive functions. Therapy that improves gait and balance works with all of these systems to keep them functioning in harmony.

Gait and balance training has a range of benefits, with avoiding injuries being at the top of the list. Beyond lessening the chances of falling or feeling dizzy, clients are also more likely to feel confident with their footing. In addition, aches and pains from poor posture are likely to decrease as well.

At therapy and balance centers, therapists realize how important balance and walking are for independent living, as well as for work activities, exercise, sports and enjoying life in general.

That’s why a range of programs and therapies are provided to evaluate and treat balance disorders:

• Assessment and Evaluation Programs

• Difficulty Walking

• Gait Training and Balance Programs

• Fall Prevention and Balance Retraining

• Manual Therapy

• Fitness and Wellness Programs

• Vestibular Rehab

• Functional Training

Lynn Calhoun is a patient in a balance program. Calhoun has a vestibular problem (inner ear, irreparable) which affects her balance. She is not steady on her feet and is somewhat “out of focus’, not quite dizzy but not right. Physical therapist Lauren Avery has been working with Calhoun. Avery and several physical therapists at the clinic, have been doing mostly fun and inventive, and very challenging exercises to help her.

“I have grown stronger, somewhat more steady, and we are still at work,” said Calhoun.

It has been nearly a year since she has been in the balance program and she has some good and some bad days, but she is still working toward her goal and making steady progress. One piece of equipment that is used in the balance program is the “shuttle” where the floor moves in all directions. Patients are attached to a harness for safety and they practice balancing on this moving floor. Many balance exercises are done on top of a squishy mat that is unstable. Calhoun explains, “the sight-limiting glasses that the team dreamed up to limit my vision, as I am so vision dependent for balance, are wonderful.”

At the Crawford Senior Center they are also getting into the balancing act.   “A Matter of Balance” classes have been in session for the past several weeks.  Amelia Capaforte-Jones is the certified instructor facilitating these classes. The classes are an eight session group program that uses a variety of activities to address factors affecting fear of falling and teaches fall prevention strategies. The activities include group discussion, problem solving, skill building, assertiveness training, videotapes, sharing practical solutions and exercise programs. Each session is two hours in length, including a break for some light refreshments. The program is designed for people that have a desire to learn how to reduce their risk of falling or have a desire to improve balance, flexibility and strength.

Hand and lower arm pain

Nantahala Physical Therapy offers a unique program for arm and hand pain. Therapist Charlotte Weingartner is a Certified Hand Therapist (CHT) the highest level of competency in the profession. The intricate anatomy of the arm and hand frequently requires very delicate surgery, often with microscopic techniques. The technical complexity of these kinds of surgeries necessitates a high level of competence by therapists with advanced skills in upper quarter rehabilitation during postoperative recovery. Therapists must be knowledgeable about these advanced surgical techniques and postoperative therapy programs to become CHTs. They must also remain current with changes in hand therapy practice. Requirements for this certification include at least five years of clinical experience as a physical therapist, a minimum of 4,000 hours in direct practice in hand therapy, and successful completion of advanced clinical skills and theory in the upper limb rehabilitation. Only 5,400 individuals worldwide hold this marked designation. 

Dry needling is another therapy technique used for the treatment of pain and movement impairments. Using a sterile “dry” needle (one without medication or injection), the therapist inserts one or more needles through the skin into areas of the muscle. Research shows that dry needling improves pain control, reduces muscle tension, and normalizes dysfunctions of the motor end plates, the sites at which nerve impulses are transmitted to muscles. This can help speed up the patient’s return to active rehabilitation. Randy Phillips, one of the dry needling experts says, “80% of patients see pain relief from this procedure.”

Aquatic therapy is beneficial to many patients, especially those with arthritis, fibromyalgia and joint injuries. The buoyancy that results from the body being submerged in water supports the weight of the patient, reducing the force of stress placed on the joints. The viscosity of water also provides an excellent source of resistance that can be easily incorporated into an aquatic therapy exercise program, and the warmth of the water assists in relaxing the muscles and vasodilates vessels, increasing blood flow to injured areas.

Incontinence therapy

Mountain Physical Therapy also has a unique form a treatment options for patients suffering from incontinence and lymphedema. The therapy used to help patients with incontinence is a combination of specific exercises to strengthen the pelvic floor, which is a group of muscles that is a major support system for abdominal and low back area. Many patients with weak pelvic floor also suffer from low back pain. Physical therapist Cherisse Sansone educates clients on diet and the irritants that the person may be eating or drinking that may be increasing their urinary incontinence. 

  Another form of therapy is lymphedema therapy. Lymphedema therapy is performed according to the patients needs. This involves a combination of lymphatic massage and bandaging to decrease the swollen area due to cancer treatment (radiation), surgery, injury, or it can be genetic. “Healing always depends on the injury and health of the person and sometimes, does this person want to get better. I hate to say it”, she remarks, “but some people have an emotional investment in being sick or disabled.” “We see our patients for usually, a one hour treatment, longer for lymphedema patients.” Sansone insists, “Be your biggest advocate for your health and wellbeing.”

Pre-op therapy

“Physical therapy prior to an operation is strongly recommended,” said Avery. “It allows the patient to become familiar with the physical therapy staff and establish a good rapport prior to surgery, it gives the patient the opportunity to be educated on what to expect and how to best prepare the home environment, so that they will be more likely to come home immediately after the surgery.  And most importantly it has been proven to improve patient outcome post surgically.” 

Many surgeons are now recommending completing physical therapy prior to surgery and will write a referral if one is needed. 

“There are other surgeons who do not readily advocate for physical therapy; thus, that is when being an advocate for yourself comes into play,: said Avery. “As a patient you have a right to request physical therapy prior to surgery or any time you feel that  you need help regaining or maintaining your function. Simply asking your surgeon or even your primary care provider to help get a physical therapy appointment set up is all that is needed.” For those who have private insurance such as Blue Cross, United Health Care, Aetna, etc., referrals for PT are not required. Medicare and Medicaid do require a referral but most doctors will give a patient a referral just by asking for one.