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:

• 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.
• Reduction of swelling with pressure dressings (wraps or stockings)
• Heat application
• Underwater exercises in a warm bath or pool
• Stretching and strengthening exercises
• "Stress-loading," a technique to encourage weight-bearing activity in involved limbs
• Monochromatic infrared stimulation, a new and unproven technique
• 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.

The Feldenkrais Method

The Feldenkrais method is a type of bodywork that uses gentle movements to promote personal awareness of the body, increase flexibility and improve coordination. One of the key philosophies of the Feldenkrais method is that there is no separation between the mind and body and that, as the body strengthens and gains new forms of movement, the mind will also strengthen and improve.

Unlike manipulative physical therapies such as massage or Rolfing, Feldenkrais practitioners generally view the work as a way to expand one’s knowledge of self and promote the connection between the mind and the body. Classes – called “Awareness through Movement” – focus on teaching small, precise movements that can be beneficial to people of all fitness levels and abilities. One-on-one Feldenkrais is called “Functional Integration.” Many people find the experience relaxing and helpful.

For more information, please see our full article on the Feldenkrais Method or visit www.feldenkrais.com.