Physical Therapy: Explaining the Difference
by Lorraine Kingham-Pitt, PT, MTC

The body is a beautiful and complex piece of engineering. The musculoskeletal system is designed to work optimally with a delicate balance of flexibility and strength during posturing and motion. The muscles supporting the skeleton flow through graceful arcs of movement whether the application is for a dance sequence or simply swinging a bag of groceries out of a shopping cart.

Our young bodies certainly start out that way, taking these complicated feats of engineering in stride and for granted. But then life happens. It is true to say that when someone walks into the room for physiotherapy services evaluation, that person is the sum of his or her life’s work and play. By the time we reach our forties - and sometimes earlier when there are more complicated histories - there are many layers of restrictions and compensation that may be contributing to a problem. Some may be the real scars left from a traumatic accident, while others may simply be the result of habit.

For many physical therapy patients there is also a dominant emotion that is accompanying their pain or decrease in function. A common expression is the sense of outrage that your body has failed in some way, or is producing persistent pain, effectively stopping you from enjoying activities that contribute to your sense of self and quality of life. Often, too, there is fear. These feelings can be exacerbated with a trip to the physician’s office, since patients often undergo diagnostic testing that may well reveal some level of arthritis or degeneration in their joints. These findings can really frighten patients and can make them feel hopeless; they may remember how elderly relatives were incapacitated with pain and could not function well. This is when the sense of “well self” becomes challenged and the sense of vitality starts to fade. Individuals may start to live “to spite the pain” or may stop many of the activities that give quality to their lives. In most cases, this is unnecessary.

So let me tell you a common story. A patient in his early fifties came in for evaluation. He had had some numbness in both thighs, coming and going over the past few years. However the numbness had become more constant, and more worrying, over the past few months. It had started to wake him from his normal sleeping position on his side. He had consulted a physician who did some testing which was significant for “spinal stenosis” or narrowing of the spinal canal. The patient had discussed his options with the physician who suggested epidurals. The patient had researched this idea and wished to pursue more conservative options. At this point the patient suggested physical therapy and the physician agreed. It is important to note that patients are often their own advocates in this process.

The patient’s symptoms were much more persistent on the right side. This bias was reflected in the patient s posture during evaluation and was influenced by a muscle that had shortened out of habit from his sitting position. I shared this observation with the patient and also encouraged him to think about how long it takes stenosis to develop to the point that it is visible on x ray. It did not suddenly develop three months prior, when his symptoms became much increased! These observations were logical to the patient and he started to feel a little hope. This is a pivotal point in any treatment plan; it needs to make sense to the patient in order that they will engage.

Normalizing the postural alignment and releasing the tight muscle was the first step in the process, as we did so the numbness became less frequent. There were other problems we addressed such as biomechanics that were less than optimal in the surrounding joints; ergonomic challenges for the sleeping position as well as when sitting at the computer; and developing a home program that was enjoyable for the patient as well as sympathetic to the work we were doing and his underlying condition. During sessions, we developed a concise set of exercises to support the extensive amount of manual work performed in the treatment sessions. Throughout, the patient was being thoroughly educated about the nature and behavior of his condition.

The bottom line is that the patient’s x rays remain unchanged, yet he is now free of symptoms. Should they start to resurface, he knows what caused it, and therefore there is minimal fear, and he knows exactly what to do about it. The feedback that I receive most consistently from my clients is that they are empowered by the knowledge that they gain from our sessions, and feel that they can make good decisions regarding their problem because of it. The problem need not dictate the quality of life.

In the example above it took eight visits to get the symptoms down to 75 % on a consistent basis, and we weaned out over a further four visits. However, most clients have at least similar recovery for more localized joint and postural issues in approximately 4-6 visits.

In conclusion, physiotherapy evaluation and treatment is a “hands on” approach to musculoskeletal health. All joints and soft tissue can be addressed with these methods - the spine, fingers, toes and everything in between. There is a significant emphasis on manual techniques during the sessions, and patients comment that for this reason the evaluations feel very thorough. The patient’s symptoms are usually reproduced in the evaluation in order to isolate specific structures or movements that are causing problems. The more closely these can be pinpointed, the quicker the results will be. Exercises associated with physical therapy are prescribed in order to support changes made during the sessions

Lorraine Kingham-Pitt, PT, MTC, fondly known as Brit PT, was educated at St. Thomas Hospital in London, UK, and graduated in 1991. She is currently completing her graduate degree from the University of St. Augustine, a private PT school specializing in manual therapy techniques and theory. New clients are being accepted at the Lotus Center on Lawndale Drive. Please call 336 235-2730 for an appointment or e-mail questions to britpt@triad.rr.com