Mar 29, 2017

Interviewer: What are the methods that physical therapists use to treat pain? It's more than just movement exercises. We'll talk about that next on The Scope.

Announcer: Health tips, medical views, research and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: Tamara Dangerfield is a physical therapist at University of Utah Health Care, and she specializes . . . her branch of physical therapy is pain management. That's what she does. And it might surprise you to find out that there are different ways that physical therapists can help you manage pain. I want to find out more about those. So let's talk about that.

Tamara: There are many things that all physical therapists do. There are other things that some physical therapists do. The things that all physical therapists tend to do that can be very effective, they use electrical stimulation, a TENS unit. A lot of people have tried various forms of electrical stimulation on their own. In the physical therapy, that's often in conjunction with something we do. Yeah, it's just . . .

Interviewer: Those little pads that kind of send those pulses to you.

Tamara: Yeah. But it feels like a little tingly pulse that goes through your skin, and it interrupts the pain signals to your brain, so it's a useful way to treat pain. They use traditional modalities at times, heat based modalities, cold based modalities. There are lots of categories within that. There are laser treatments that are used. There's ultrasound that's used.

Interviewer: Really?

Tamara: There are different technologies to deliver heat or cold, and all of those things tend to have effect at the cellular level, and really, we believe most of what they do is improve blood flow or cellular regeneration to the region, and that's largely how they treat pain. About two years ago in the state of Utah, we now have the option to do dry needling, which is a form of treatment that treats myofascial trigger points. So literally sticking a needle in a trigger point in a muscle.

Interviewer: Is that like acupuncture?

Tamara: The needle is like what they use in acupuncture, but it is very different than acupuncture, primarily because physical therapists are not acupuncturists, and the training and the assessment tools and the treatment tools and techniques that an acupuncturist use are very different than what I would use.

Interviewer: Got you.

Tamara: When I use dry needling, I use that as a way to just get a trigger point and a muscle to release. You can use manual pressure to get trigger points and muscles to release, and different massage types of techniques can also be very helpful. Trigger points cause a lot of pain and a lot of movement restriction, so when you can get those to let go, you restore both of those things. It helps with pain and restores movement.

Interviewer: And if you have a muscle therapist that does manual trigger points and that's not quite working, is the needle like the next step up for those stubborn ones?

Tamara: Yeah. I think typically, that's how it's used. A lot of times, the movement therapies alone work well enough. Sometimes you need to add some manual therapy to that, and when all else fails, you can stick a needle in it. Sometimes it's good to start with that too. It just gets deeper. It allows you to get deeper into the tissues then in a shorter amount of time. But I would just like to add, that all of the modalities, all of the, you know, bells and whistles and things that we use to help treat pain, ultimately need to restore movement, because that is your body's way to treat pain.

Movement is how you keep things functioning in your body, and so if you're using those modalities, again, as some type of opioid or some way to avoid movement and restoring normal movement to a region. So range of motion, strength, flexibility, all of those things that you need to restore normal movement. And sometimes just being aware of the pattern. Those are the things ultimately, that you really need to have your body take care of its own pain.

Interviewer: That sounds a little counterintuitive, right? One would think that if I'm experiencing pain I should not move and let that rest and let it recover, but really movement in a lot of cases helps.

Tamara: Yes. And that's what science has learned more and more. Literature repeatedly points to movement as the way to address chronic pain problems. In the very acute stages of pain, after a surgery, right after an injury, pain is a signal to your body that something's wrong and you should be careful with it, but that doesn't mean that you shouldn't ever move it again. And when the initial injury has healed, it is critical that you start moving again, or else you're just going to end up aggravating something else.

Interviewer: So it sounds like you have a lot of different ways that you can help somebody with their pain if they come to a physical therapist, especially somebody that specializes in it, such as yourself.

Tamara: A lot of different ways.

Interviewer: The goal is to get rid of that pain so you can restore your normal movement which then ultimately helps the pain continue to be managed.

Tamara: Absolutely.

Interviewer: And you find a lot of your patients have success with these methods.

Tamara: Yes. They do. And the other thing that I just would like to add as a pain management physical therapist, and this is not something that you might always find within physical therapy, but I think you'll find more and more is mindfulness based techniques, mindfulness and the use of relaxation techniques, diaphragmatic breathing, even mindfulness meditation, to help keep the nervous system kind of quieted down as you work on restoring movement. Sometimes, movement just becomes so highly associated with pain that people are very afraid of it, and I think that's probably the biggest driver as to why people might stop moving or avoid moving, as they're just afraid of the pain and they haven't learned how to make the movement as comfortable as they can, and to actually figure out how to listen to their body, and how much is okay.

Interviewer: So lean into it a little bit.

Tamara: Lean into it a little bit. Don't be afraid to move, but don't be afraid to change it up a little bit if it's not working. You know, if one type of movement or one type of exercise or something isn't working for you, you can change it. There's different ways.

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