Monday, September 10, 2007

Physical therapy - what works and is unhelpful for me.

Since my accident in 1998 I've had physical therapy. It was two years after my accident before I was diagnosed with Complex Regional Pain Syndrome. My therapist for over four years listened to what I said and together we worked at regaining strength. From the outset he knew that there was pain out of proportion to the obvious injury and with this in mind he taught me to do exercises myself at home. There was often an issue of my overdoing it in my quest to gain strength and balance. At the time I had no idea of the importance of not doing too much, of how very counterproductive this was. My therapist encouraged me to get in the pool we had at the time and move in the water. I believe it was because of this advice and his encouragement and recognition of my mistakes in overdoing exercises and teaching me to pace myself that I have avoided complications that others suffer.

A good, compassionate and understanding physical therapist can provide great benefits for sufferers of CRPS. My first therapist was not aware I had CRPS and was not familiar with the condition, but he did listen and between us we found what worked and what was unhelpful.

We worked out that hands on, manipulative physiotherapy caused an alarm reaction for me. It would increase my pain and nerve firing symptoms. and muscle spasms. Teaching me exercises which I could do at home was the best approach. Keeping sessions short and not overstimulating was helpful. This therapist applied passive heat for a period at the end of a short therapy session.

We moved and my new physical therapist was not familiar with CRPS/RSD. He was a manipulative physiotherapist and worked on a region or limb at each session. Manipulative therapy ramped up pain and symptoms. I would get increased muscle spasm especially from stretches, what felt like a rebound reaction. The plan of working on one area or body part was focusing symptoms on that part and I had pain and symptoms in many parts, so I would feel frustrated and worried that my body was getting weaker. My therapist was an excellent manipulative therapist and helped many people but this type of therapy did not suit me.

I changed to a physiotherapist who was familiar with CRPS. This was the start of my going forwards and seeing some improvement in symptoms. This therapist treated the whole body. She explained about the sympathetic and parasympathetic nervous systems and how certain things could ramp up the sympathetic nervous system and make pain worse or activate the parasympathetic and calm things down.

She taught me
  • to breathe in a way that activates the parasympathetic nervous system
  • to exercise bilaterally (both side)
  • to exercise in a way that benefited the whole body and not an isolated part
  • to balance
  • to correct posture (and be mindful of tiredness causing posture changes)
  • to do static postures which gently stretched or relaxed
  • to pace - a little and often
  • to get wet and explained how pressure of water activates the parasympathetic nervous system
  • to do an adapted style of yoga which benefits the whole body
  • to do upside down yoga poses with a pad over my eyes - very calming
  • to meditate and be mindful
  • to listen to my body

This approach to physical therapy suits me. It does not ramp up my symptoms. It gives me time to practice and develop a routine at home. It encourages me to alter and enhance my life style to accommodate my needs. It leaves me feeling empowered and gives me choices.

Above all else, it has worked to lessen pain and symptoms. Physical therapy for me is a necessary lifestyle choice and I now am able to have a routine that is adaptable and do-able for me.

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