Dr. David Thomas, PT, DPT, PPSC

Cadence Physical Therapy Co, Buffalo Grove

It is well documented in numerous published articles and research alike that the sooner/earlier treatment and intervention are sought after a musculoskeletal injury, the better the outcome for the individual. Research has consistently shown that early intervention, specifically physical therapy, has consistently shown that the patient will require fewer treatment sessions for recovery, fewer missed workdays and decreased instances of future re-injuries. When acute injuries are ignored or not properly (depending on the severity of injury), often scar tissue within the soft tissues within and around the area of injury will begin to develop, leading to restricted mobility, decreased strength, restricted mobility/range of motion, hyper/hypo-tonicity of musculature, and above all else, increased risk for re-injury. Extended periods of bed rest or recumbency after injury will only accelerate the aforementioned deficits. In order to minimize risk for the development of scar tissue and future re-injury, pain-tolerable stretching, strengthening, stabilization, and mobilization of tissues and joints (including those above and below the level of injury) should be performed. With consideration of the current opioid epidemic, early intervention for those suffering from musculoskeletal injuries can reduce the likelihood of opioid addiction/dependence to self-manage pain and prevent an acute injury from becoming a chronic one. Additionally, there is a lower subsequent medical service usage for management of pain when physical therapy intervention was utilized in the acute stages, relative to those who allowed their pain to reach the chronic stages. Underutilization of early intervention physical therapy in the geriatric population was also noted.

The vast majority of individuals will throughout some time in their lifespan develop some form of a chronic musculoskeletal injury. Many times the injuries develop from postural deviations or biomechanical compensations/micro-tears due to work-related tasks that manifest over extended periods of time. Despite chronic musculoskeletal pain becoming knowingly more challenging to manage or eliminate entirely, physical therapy has consistently shown to reduce pain levels, improve functional independence, and positively impact the overall quality of life. Opioids become a primary choice of addressing chronic pain for patients which only addresses the symptoms, not the primary issue. Although opioid usage does show high efficacy with addressing pain, higher dosages are commonly needed over time, and commingly, function, strength, stability, balance, and gait do not improve despite lower pain levels. Physical therapy (in conjunction with or without opioids) not only addresses the PRIMARY source of painful symptoms (effectively reducing pain), but improves strength, stability, balance, gait, and ability to perform functional transfers and movement patterns. With the provision of a uniquely individualized Plan of Care tailored specifically to the patient’s deficits, limitations, and impairments (addressing what is directly causing the patient’s pain rather than simply “masking” it), patients suffering from chronic musculoskeletal pain can undoubtedly improve not only their pain but improve their ability to return to activities of daily living and restore their function.

References

1. Zigenfus GC, Yin J, Giang GM, Fogarty WT. Effectiveness of early physical therapy in the treatment of acute low back musculoskeletal disorders. Journal of Occupational and Environmental Medicine. 2000;42(1):35. doi:10.1097/00043764-200001000-00010
2. Fritz JM, Magel JS, McFadden M, et al. Early physical therapy vs usual care in patients with recent-onset low back pain. JAMA. 2015;314(14):1459. doi:10.1001/jama.2015.11648
3. Gellhorn AC, Chan L, Martin B, Friedly J. Management patterns in acute low back pain. Spine. 2012;37(9):775-782. doi:10.1097/brs.0b013e3181d79a09
4. Gladkowski CA, Medley CL, Nelson HM, Price AT, Harvey M. Opioids versus physical therapy for management of chronic back pain. The Journal for Nurse Practitioners. 2014;10(8):552-559. doi:10.1016/j.nurpra.2014.05.008