|
Overview
| Making the Diagnosis
| Getting Help
| Fast Facts
| Myths and Misconceptions
| Children
and Pain
Pain Definitions
| Medications
| Complementary
| Physical Therapy
| Psychology
|Surgery
Physical Therapy
Active physical therapy is the most important part of CRPS
treatment at almost any stage. It is especially crucial for physical therapists
to help activate a CRPS-effected limb as soon as possible since this alone may
be the most important factor in favorable treatment outcomes, according to
scientific evidence.
Passive therapy, such as hot packs and massage, may be helpful in
the initial stages, but must be converted to active therapy, such as exercises
and strengthening techniques, as soon as possible.
CRPS patients tend to splint (hold still) an involved limb.
Instead, it's important to move the limb as normally as possible. In addition
to patience, understanding and tender loving care, the physical therapist has
access to a number of techniques to reduce pain and swelling, increase
tolerance to touch (when allodynia is present) and encourage movement. The
techniques used will differ among patients and within the treatment plan of
individual patients as they experience changes in the stages of CRPS and
associated symptoms. Some of the most common physical therapy techniques are:
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Skin desensitization by applying various degrees
of pressure to areas of allodynia, or abnormal sensitivity to non-painful
stimulation such as touch, gentle pressure, etc.;
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Reduction of swelling with pressure dressings
(wraps or stockings);
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Heat application;
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Underwater exercises in a warm bath or pool;
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Stretching and strengthening exercises;
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"Stress-loading," a technique to encourage
weight-bearing activity in involved limbs;
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Monochromatic infrared stimulation, a new and
unproven technique;
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Electrical stimulation of muscles and
nerves. There is no evidence that one
type of transcutaneous electrical nerve stimulation (TENS) reduces pain better
than another and all (there are many brands) may increase pain and have to be
abandoned. Electrical muscle stimulation
(EMS) can be very helpful in reducing pain by stimulating movement in muscles
that are in spasm and/or have become atrophied, or weakened. Proper use of this and the TENS equipment can
be taught by well-qualified physical therapists or equipment manufacturers'
representatives (although beware of reps who tout their equipment over
others). Most physicians, including pain
specialists, do not have this particular expertise. Be wary, too, of anyone who expects you to
operate stimulation equipment strictly from written instructions. That practice
is doomed to failure.
While important in its own right, physical therapy is best
delivered by a multidisciplinary team. It is most useful when the pain medicine
physician is administering appropriate drugs or nerve blocks, the psychologist
is helping with secondary emotional issues, and so on. Physical therapy alone usually is not an
adequate treatment for CRPS, and may have to be used for very long
periods of time. This can present health care coverage problems with insurance
providers who are accustomed to limiting physical therapy to a certain number
of visits.
Overview
| Making the Diagnosis
| Getting Help
| Fast Facts
| Myths and Misconceptions
| Children
and Pain
Pain Definitions
| Medications
| Complementary
| Physical Therapy
| Psychology
|Surgery
|