Sunday, September 09, 2007

Paucity of prospective randomized clinicl trials means it's challenging to develop evidence based guidelines for physical therapy treatment of CRPS.

Physical therapy is thought to be the corner stone of therapy for patients with Complex Regional Pain Syndrome. Although this is considered most important, as yet little clinical trial evidence exists to develop guide lines for best practice.

Retired Florida Doctor H Hooshmand's website's advice still rings true today. He suggests that two things are counterproductive with physical therapy for CRPS/RSD, (1) too much, too harsh exercise and (2) too little or worse no exercise. He emphasizes pacing and changing activities often.

Washington government protocols 2002,for physical therapy for CRPS suggest establishing a baseline for function, strength and motion and weight bearing where appropriate. Then they suggest a progressive therapy including desensitization program for clinic and home. Progressive assessment and patient home diary is suggested to monitor progress.

The National Pain Foundation also sites active physical therapy as being most important. Stress loading as well as strengthening and stretching is advised.

Professor Edwin Carden, fellow of the American of Pain Management believes the basis of therapy should be the use of passive range of motion and isometric exercises with heat but not ice.

RSD Hope puts forward the idea that "No Pain is all gain" and suggests a combined program of water therapy, cardio and range of motion exercises.

Wikipedia also supports the notion that "inactivity can exacerbate CRPS and perpetuate the pain cycle". It reports that "goal-directed therapy is best, with the patient beginning from an initial point, regardless of how minimal, and then endeavors to increase activity each week." It is felt that the patient should be engaged in doing the therapy for themselves, an active approach.

Google "physical therapy for CRPS" for more information.

Tomorrow I'll post what physical therapy has worked and what is unhelpful for me.

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