ABOUT PHYSICAL THERAPY

Physical therapy is often recommended by our health care providers if we are injured or if we suffer from chronic problems. Physical therapy is a licensed occupation that requires much study. Medical systems like Kaiser Permanente include a Physical Therapy Department. There are also private companies that offer this service. It is commonly available. In discussing this subject I am including Occupational Therapy in with Physical Therapy. (Occupational Therapy focuses on returning people to function in their day to day lives. Hand injury rehabilitation is especially based upon that.)
Typically you meet with a physical therapist after your doctor has posted diagnoses and recommended treatments. The therapist shows you exercises that can help your condition. In addition to taking you through your paces, they formulate a home program. Within that program it is not unusual to have certain exercises repeated multiple times per day.
I notice several things about physical therapy after observing many hundreds of seniors over the last 20 years:
  • People are reluctant to ask their doctor for physical therapy.
  • Often patients attend physical therapy sessions but don't do the home program as prescribed.
  • After completing the therapy program most do not continue to do the recommended exercises on their own.

My own physical therapy escapade:

I had a fall on January 6th, 2021. I broke my shoulder and crushed my wrist. The wrist required surgery. Luckily the shoulder did not. The first 2 months were extremely painful. It was difficult to sleep or ever get comfortable. The pain was the most intense that I have ever experienced.
​I started physical therapy 2 weeks after the fall, while in great pain. A shoulder therapy program was necessary as well as a separate hand therapy program. For the first 6 weeks I performed the PT shoulder program 3 times a day and the OT hand program 3 times a day. After 6 weeks I went down to doing the shoulder work only twice a day. Each session would take 30-45 minutes. Some of the exercises were especially painful and scary to perform. As my shoulder healed I got better at them. Then I would be given new exercises that would at first be painful too.
My recovery has been amazing. My doctor was stunned at my efforts. During our last appointment several weeks ago, his mouth actually dropped open when he saw how well I could move my arm. The reason for my success is because of the physical therapy exercises, but it's my own dedication to sticking to the program no matter what that has really mattered.

It makes a difference.

Here are two examples that illustrate what happens when you do not complete the recommended physical therapy. (Both these examples are coincidentally about shoulder injuries. The same things can be stated about any type of injury: hip or knee replacements, shoulder replacements, hip fractures, etc.)
  1. A friend had a severe shoulder injury did the PT sessions but couldn't get motivated to do the home program. The result is her arm motion is limited. Now she can't lift her arm all the way up. She hurt her arm several months before I hurt mine.
  2. Someone else I know had a difficult accident and severe shoulder injury. He also goes to all PT sessions but he cannot do the home program because it hurts too much. His shoulder has now been diagnosed as being frozen. His injury occurred 6 months ago. He is still in constant pain.
When you don't do the home program, or when you skip the therapy, there are 3 major effects:
  1. You do not heal as well or as quickly.
  2. The home program is designed to keep you moving. When you do not move as consistently as recommended, the body stiffens, in the area affected especially.
  3. The home program helps you to move through the pain instead of avoiding it. We naturally resist pain especially when we are in chronic pain. But as you see, moving through pain is often necessary to really heal.
There is another factor at play in these situations: We have a tendency to think that time heals all. And to some extent that is true. The break in my upper arm took almost exactly 2 months to heal, as it would probably for anyone. However, stiffness does not get better with time. It gets worse. Much worse. One goal of physical therapy is in effect to restrain the body's natural but detrimental stiffening process.

Move Through the Pain

Learn to tell the difference between pain that means you should stop and the pain that comes through recovery. The pain of arthritis for instance is a pain to move through. As your body moves, the pain ultimately diminishes. When you are injured you often have to also move through pain as you recover. But sometimes pain is a warning. The difference is hard to tell, one reason why physical therapists should be relied upon to guide our recovery.

Recommendations:

  • If your doctor does not offer physical therapy for you then ask for it. They will often approve it.
  • It is not enough to do sessions with a therapist if you want to really improve. It is essential that you do the home program as well.
  • Doing the home program once a day is often not enough. Do it as prescribed. The rewards make it all worthwhile.
  • Taking days off is not a good idea. Remember that your body wants consistency not vacations.
  • If it hurts to do the PT exercise, tell your therapist. They will adjust it. 
  • If it hurts to do the PT exercise, do something that doesn't hurt. 
  • Sometimes when it hurts you have to do it anyway. Breathe and pull your belly in while doing it and often the pain disappears.
  • Don't abandon the exercises once your physical therapy sessions are complete. Take the particularly helpful exercises and include them in your fitness program. You can always do the complete PT home program on your own to manage outbreaks if you need to.
Published May 31. 2021.