Clinical Question

Physical Therapist vs. Chiropractor

Many patients are curious about the difference between these two health practitioners.

Chiropractors specialize in manipulating bone structure (such as the spine) to improve the function of the joints and or nervous system.  They are very well known for manipulating the spine to help decrease low back pain.  A lot of patients frequent a chiropractor’s office several times a year for many years to manage their ailments.  A chiropractor has an aggressive approach to treatment.

Physical Therapists specialize in treating injury or dysfunction with exercises, manual techniques, neuromuscular re-education, and postural re-education to improve function throughout life.  A patient will attend a physical therapist 2-3 times a week for on average 6 weeks to improve function/decrease pain and gain education on how to further these gains with independent exercise.  Physical Therapy is a conservative treatment option and one which should be used in the first line of defense against injury.

In my professional opinion, it is in the patient’s best interest to understand the difference between these two disciplines before choosing the treatment option that is appropriate.  With acute injury, one should first go to a physical therapist.  If the patient has tried physical therapy and finds they have not met their goals, then they should look into seeking a chiropractors services.  A chiropractor offers more of an aggressive approach to treatment by using manipulations so a lot of times this is inappropriate for an acute injury, such as a car accident, ankle sprain, sport injury, etc.

If you are unsure what type of discipline best suits you, feel free to contact Harbor Physical Therapy with questions.

Why Do My Joints Ache When the Weather Gets Cold?

Many patients come to physical therapy asking ‘why’ – why they have increased pain when it rains, snows, or just when the weather gets cold.  This question has been researched minimally and considering the amount of patients that report these findings, one would think there would be more research on this topic.

The main theories are as follows:

1. Change in Barometric Pressure – This theory is based on a study of a balloon in a Barometric Chamber.  The Barometric pressure is decreased and the balloon increases in size.  Therefore, the drop in pressure can similarly cause tissues around the joints to swell.  Because a drop in barometric pressure precedes a storm, patients can ‘predict’ when a stormfront is approaching.  Typically, patients with arthritis or a previous joint injury are the patients that report these weather-related findings.

2. Psychological – Another theory mentions that people tend to feel pain in their joints during bad weather, rather than preceding bad weather.  The theory claims that people are less likely to feel the pain on warm, sunny days.  This concept could be due to the increased release of endorphins, with increased sun light and people mentally feel better when it is nicer outside.

3. Humidity – This is my personal theory.  I believe patient’s joints have increased lubrication when there is more humidity in the air.  Just like a hinge requiring lubrication to move in a fluid motion, our joints require constant lubrication to move without restriction and pain.  Therefore, when the humidity decreases, there is a decrease in lubrication of our joints, which in turn causes pain.  This is why most people with arthritis like to move down south to enjoy year-round warmer weather.

In summary, there is no definitive reason why people report increased pain at their joints when the weather changes.  It is suprising how little research is done on this topic.  I believe there is validity for people feeling the change in weather in their joints; however, there does not seem to be a clear reason why it is experienced.  Thoughts?

Clinical Question – Strain vs. Sprain

What is the difference between a strain and a sprain?

Strain- A strain occurs to a muscle or tendon from an acute injury.  An example of this is when someone is in a car accident.  The person’s muscle/tendon is over contracted or over stretched depending on the position of the person during the accident.  Common symptoms are pain, weakness, decrease range of motion, and muscle fatigue. 

Sprain- A sprain occurs to a ligament in response to an overstretch or tear. An example of a sprain is when a patient steps off a curb and lands on the outside of their foot, this results in an ankle sprain.  Common symptoms are pain, swelling, brusing, and decreased range of motion.

Clinical Question – Tendinitis

What is Tendinitis?

Tendinitis is an inflammation of a tendon.  This is most often caused by overuse.  Common areas that develop tendinitis are at the elbow, back of the ankle, knee, and shoulder.  Symptoms of tendinitis are tenderness to touch over the tendon, pain with movement, decrease range of motion, decrease strength, and swelling of the tendon.  Physical Therapy is beneficial for patients with tendinitis because it decreases symptoms and strengthens/stretches the injured area to prevent re-injury.

Clinical Questions – Frequency of Therapy

How often do I have to come to physical therapy to get better?

Depending on what diagnosis brings you to physical therapy, the physical therapist will determine the appropriate frequency per week.  Typically, post-operative patient require 3 times a week initially and gradually progress to 1-2 times a week.  As you continue to improve, the therapist will decrease the frequency of your treatment to progress you to independent exercise.

Clinical Question – Sitting Posture

Will strengthening my stomach muscles help me with my sitting posture at work?

Yes, by strengthening your core muscles it will allow you to maintain an ideal sitting posture for a longer duration.  Having weak core muscles will cause you to sit with a more forward flexed posture and you will not be able to sustain good posture throughout your workday.

Clinical Question- Ultrasound

What is Ultrasound?

Ultrasound is used during physical therapy when a patient presents with pain, soreness, or tightness of a specific body part.  It uses high frequency sound waves that travel to muscle and tissue and warm up the targeted areas by increasing blood flow.  The majority of the time, ultrasound is used in conjunction with massage techniques to further decrease muscle tightness and pain in the treated area.

Clinical Question – Postoperative

After orthopedic surgery, how long will it take me to feel “back to normal?”

There are many factors that go into healing and everyone heals at a different rate.  Typically, it takes about a year to feel “back to normal.”  After receiving surgery to one of your extremities and completing physical therapy, patients usually report continued swelling at the end of the day.  After surgery, patients report that swelling is the last symptom to decrease.  With any orthopedic surgery, patients will usually gain approximately 80-95% of their original function and strength.  However, this all depends on the success of surgery, if a revision was performed, and the overall outcome of physical therapy.

Clinical Question – Ice vs. Heat

Should I apply ice or heat for pain?

First you need to determine if you have pain from an acute injury or chronic injury.  An acute injury has a rapid onset and is short-lived.  A chronic injury happens gradually and is long-lasting.  For acute injuries, you should apply ice for 10-15 minute intervals several times a day for up to 3 days.  For chronic injuries, you should apply heat for 15-30 minutes intervals as needed.  If you find your symptoms still persist after approximately 48 hours of heat/ice treatment, you should contact your physician or physical therapist for further treatment options.

Clinical Question – Stress

When I have a stressful day, why do I have more neck and back pain?

When stressed, people tend to contract their muscles.  For example, people tend to elevate their shoulders toward their ears when stressed, thus causing increased tightness at the muscle on top of the shoulder (Upper Trapezius).  This leads to increased muscle tightness, which in turn can cause more pain.

Regarding physical therapy of your neck and back.  If you continue to have increased stress in your life while receiving physical therapy, this will lengthen the amount of time it takes to have a successful treatment outcome.  During therapy, the therapist will provide you with techniques to prevent further tightening of your neck and back musculature.