There are many different approaches to managing your spine pain in physical therapy. Generally, all of them fall under these categories.
- Joint manipulation and mobilization: These approaches consist of thrust and non-thrust techniques, with the goal being to reduce pain, relieve stress on nerves, and improve joint ROM.
- Soft tissue manipulation: These approaches generally consist of decreased acute and chronic muscle holding around the spinal joints, improving ROM, and decreasing pain.
- Nerve mobilization: Treatment used to improve nerve mobility and increase the space for the nerve to function.
- Patient Education: Providing good information about the condition, instruction with self-care activities, and decreasing fear avoidance and anxiety about the condition.
- Passive Modalities: These include ultrasound, electrical stimulation, moist head, laser, and cold modalities. These do not require the active participation of the patient.
- Vestibular Rehabilitation: Therapist used to improve the functional of the vestibular system, including eyes, ears, and upper cervical spine.
- Dry Needling: Using acupuncture needles to deactivation a trigger point in the muscle.
- Exercise-based programs: Most spine approaches have acknowledged the role of spinal muscles in reducing incidence for spinal pain
a. Motor control/balance based programs: PNF patterns, dynamic motor control strategies
b. Stretching based programs: Yoga, or other flexibility based programs like myofascial release.
c. Aerobic programs: often an underemphasized approach that focuses on cardiopulmonary and cardiovascular performance; also to improve muscle endurance
d. Strength training programs: Weight Training or other approaches used to improve muscle power
e. Spinal stability based program: many different approaches that focus on improving the ability of the spinal muscles to perform well around spinal joints, especially after acute ligamentous injury or joint instability/hypermobility.
f. Functional Movement Systems: Using movement patterns to identify patterns of weakness and loss of flexibility.
I have been somewhat reluctant to have a list of “services” that I provide on my website. My reasoning is that I believe good clinical care should not have a strong “treatment bias”. In other words, physical therapy does not work well when the client is pushed into a treatment paradigm that is not needed for their particular condition.
Here are a few examples:
• Although there are some really nice thing about yoga that I really like, not all clients need or should do yoga. Some clients should avoid any vigorous stretching programs. In some cases, these program may increase the patient’s symptoms and make their condition worse. This is often true for patients that have very irritation nerve roots or significant instability in their spine.
• Despite popular opinion, not every condition will respond well to Dry Needling. Dry Needling can be effective in managing some conditions, but using this modality as a sole treatment and in absence of other compelling approaches is, at best, incomplete and ineffective care. I had a former colleague who realized after a few visits that the patient was only getting temporary relief from Dry Needling. After re-examine the client, the patient responded better to nerve glides and mobilization and was discharge two visits later.
The best approaches should be based on a solid, comprehensive subjective and clinical exam, rather than the available skill set of the physical therapist. At Metropolitan Physical Therapy, our goal is to provide compelling approaches to manage your pain and your condition. You, as our client, can expect us to discuss your condition and all the relevant, plausible physical therapy options to manage your pain and get you back to living your life.