help me doc; my therapy is making me worse

HOW CAN MY THERAPY BE MAKING ME WORSE?

Physical Therapy

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Physical Therapy

All 3 pics from Wellcome Trust L0011094

Physical Therapy

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Can therapy really make some people worse?  It certainly does, and happens more often than you might realize.  I am not just talking here about therapy done by therapists, but by chiros, physiatrists, DO’s, athletic trainers, etc, etc.   On many occasions I HAVE PICKED ON CHIROS for sometimes promoting the idea that given enough adjustments, chiropractic can solve anything — including CHRONIC PAIN.  Today I am going to tackle similar situation in a related field.  Why do some people get worse with their therapy?

It’s certainly not like most people are getting worse with their therapy.   In fact, therapy is highly beneficial for most people.  There is, however, a significant group of people who actually get worse with therapy.  I probably see a disproportionate number of these folks because I deal with so many Chronic Pain patients, but believe me when I tell you they are out there in numbers greater than anyone cares to admit.  Let’s talk about this group for a moment, and cover a few of the reasons they might fail to respond to their therapy.

  • SEGMENTAL MOTION NOT ADDRESSED:  It’s fairly easy to see whether or not RANGE OF MOTION is diminished in a given area, and begin stretching that area in an attempt to increase motion.  This approach works on many people.  In fact, it works on most people.  However, if we are talking about certain areas of the body (for instance, THE NECK); because there are seven individual vertebrae that make up the neck’s bony skeleton, each and every individual bone must be moving freely and independently of the vertebrae both above it and below it in order to have normal range of motion.   Attempting to stretch the neck without first making sure that each individual bone is moving freely, PUTS TREMENDOUS AMOUNTS OF MECHANICAL STRESS on surrounding vertebrae and discs (think about a BICYCLE CHAIN where multiple segments are fused together —- HERE is an anatomical animation).   The problem is, mechanical stress not only causes pain, but is the known cause of Degenerative Arthritis as well (HERE).  

  • SPINAL ALIGNMENT / POSTURE NOT ADDRESSED:  The best example I can think of has to do with the proper lordotic curve of the neck (HERE).  When you don’t have it, your chances of any number of bad outcomes rise dramatically (HERE). 

  • SCAR TISSUE (FIBROSIS) NOT ADDRESSED:  This one is huge.  In similar fashion to chiros who believe that with enough adjusting, they’ll restore range of motion, therapists are doing something similar.  Only instead of adjustments, they are using stretching.  Stretching is great.  However, you can’t stretch your way through the serious SCAR TISSUE and FIBROSIS (HERE or HERE) that so often results in CHRONIC PAIN SYNDROMES.

  • RESISTANCE TRAINING TOO SOON:  If you follow my site, you see that I am a huge fan of RESISTANCE TRAINING.  The problem is that if Scar Tissue is not addressed properly, Resistance Training could quite possibly make things worse.  The whole goal of addressing Scar Tissue is to untangle and lengthen the tissue.  Working muscles against resistance contracts (i.e shortens) them.  Once you are ready; fine.  But starting Resistance Training too soon is a recipe for problems.

  • TOO MUCH EMPHASIS ON MODALITIES:  Although they aren’t really making people worse, 25 years of experience has shown me that most modalities (ultrasound, electric stimulation, etc) are not incredibly effective — particularly for helping those dealing with Chronic Pain.  The only modality I use in my clinic is COLD LASER because it works completely different than others do (I do use both OXYGEN and WBV with our SPINAL DECOMPRESSION protocol.  If you love modalities and feel they are beneficial, that’s fine.   Instead of paying someone else to use these on you, go on Ebay and buy your own so you can use them whenever you want.

  • INFLAMMATION NOT ADDRESSED AT ITS SOURCE(S):  A therapist that’s done an incredible job of this is , author of IT STARTS WITH FOOD.  Although most doctors and therapists would tell you that this bullet point has been addressed because the patients is on “THE BIG FIVE,” NSAIDS and Corticosteroids are not addressing inflammation at it’s source.  They are mopping up a continual mess, instead of trying to shut of the source of said mess.  If you want to really understand why INFLAMMATION is such a huge, but largely misunderstood piece of the Chronic Pain puzzle, just click the link.  I could have actually added another bullet here that says, “NOT RECOGNIZING THAT CERTAIN PROBLEMS ARE SYSTEMIC INSTEAD OF LOCAL“.

Therapy is awesome.  But it has to be done properly, and in the right order.  There is no one-size-fits-all solution to Chronic Pain.   However, a failure to deal with SUBLUXATION and Scar Tissue before progressing on to more intense stretching and various forms of exercise (therapy) can result in less than optimum results — or even make you worse.

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