The practice of Physical Therapy involves the use of therapeutic exercise and physical therapy modalities such as ultrasound, electrical stimulation, low level laser and traction to improve the function of the musculoskeletal system.
The practice of Physical Therapy and Chiropractic have both evolved in such a manner to have become more similar than in the past. When I was still an undergraduate student in the early 1980’s at California State University Northridge, I took courses on exercise physiology and exercise prescription taught by Physical Therapists. I remember discussing the subject of Chiropractic Manipulation with them at that time. The official stance at that time of both the medical profession and the physical therapy profession was that there was no proven evidence for the value of manipulation. How times have changed. Physical Therapist now take abbreviated, much shorter courses on the art of manipulation in an effort to catch up to the Chiropractic profession’s 100 year legacy in the art of manipulation.
On the Chiropractic side, Chiropractors have been training in the use of physical therapy modalities such as ultrasound, electrical stimulation, low level laser, hot and cold therapy and traction since these tools were first invented. Exercise prescription has also become an integral part of chiropractic practice as well. Here is a list of some of the physical therapy modalities we use at the clinic.
Therapeutic ultrasound has been used for more than 50 years and is still used frequently in Chiropractic Clinics, Physical Therapy Clinics and Rehabilitation wards of Hospitals around the world. Dentist also use ultrasound technology as a standard treatment to clean teeth. When the head of an ultrasound machine is placed against a body part using a special gel or under water, the sound head sends high frequency sound waves deep under the skin. These sound waves have several healing properties including:
1. The Ability to Move Fluids: If you place an ultrasound head in a bucket of water and point the head toward the surface, you will see that the sound head actually creates a wake in the water. When the sound head is placed against the skin of a body part it produces the same effect inside your body. This is a powerful tool to flush excess fluid buildup associated with inflammation out of a swollen area, accelerating the healing process.
2. Increased Blood Flow: When the machine is set in a continuous mode, ultrasound causes the individual molecules of your muscles, tendons, ligaments and joints to vibrate. This causes deep heating which improves blood flow to the damaged tissue. It is not possible to get this kind of deep heating effect from applying heat to the surface of the body, such as when we use hot packs. We often set the machine in this mode after the acute inflammation has passed and we are further along in the healing process.
3. Improves The Flexibility Of Scar Tissue (Collagen Fibers) :
ACUTE INJURED BODY PART → INFLAMMATION → SCAR TISSUE FORMATION
When you damage a muscle, tendon, ligament or joint, there is a certain degree of tearing or stretching of the damaged tissue. To heal, your body needs to repair the damaged tissue by laying down collagen fibers over the damaged tissue. These collagen fibers form what is known as scar tissue. We all have seen scar tissue form on our skin after suffering a cut. The same thing happens deep under the skin when you damage a muscle, joint, ligament or tendon. Scar tissue is absolutely necessary for repair of the injured body part. The problem so commonly encountered with scar tissue is that the patient’s body often creates too much of it and of poor quality, meaning the scar tissue formed lacks enough flexibility to function similarly to the original tissue. Applying ultrasound is one of the tools used to insure maximum possible flexibility of the scar tissue formed. Just as a dentist uses ultrasound to loosen plaque on teeth, we use ultrasound to soften scar tissue. If a patient suffers an injury and fails to treat it properly, including using ultrasound over the damaged tissue, they are most likely going to be left later with inflexible scar tissue which leads to lost range of motion in the damaged body part and in some cases chronic pain. For example see the case below:
Joe is a 48 year old male who is inactive due to a busy workload. Joe used to be a star athlete back in High School. Joe goes to his family Thanksgiving Day dinner. The kids were out throwing a football around the yard before dinner and Joe decided to join them. Joe rears back to throw a long pass hoping to recapture some of the glory of his high school days. He feels a twinge in his shoulder while throwing the ball and stops playing. The next day he can hardly lift his arm because it hurts so badly. He goes to his GP and is given some anti-inflammatory medicine and advised not to throw the football again. The patient’s pain gradually subsides but not completely and after about 6 months, he begins to experience some neck pain as well, which prompts him to seek treatment at our clinic. Upon taking a history and examining him, the true consequences of failing to seek more aggressive treatment of the original injury come to light. He is now found to have developed hardened thickened rotator cuff tendons and decreased ranges of motion in his shoulder. He has now dug himself a deeper hole by allowing excessive scar tissue to form on his rotator cuff muscles. The chronic loss of range of motion in his shoulder eventually caused the secondary problem in his neck. A rehabilitation program was started for both his neck and shoulder and he was able to completely rid himself of the neck and shoulder pain. He was unfortunately left with a permanent 15 % reduction in the range of motion of the shoulder. One can only wonder if he could have maintained 100% range of motion in the shoulder had he started treatment at the time of injury.
POOR POSTURE→MILD CHRONIC INFLAMMATION → SCAR TISSUE FORMATION
Scar tissue can also form due to the effects of chronic mild irritation to a body region, creating an ongoing mild inflammation, leading to a gradual chronic deposition of scar tissue in broad areas such as the joints, muscles and fascia of the spine and surrounding areas. Classic examples of this are when someone spends far too many hours sitting at a desk working on a computer or driving hours a day. Too much sitting puts a constant strain on the postural muscles, often leading to increased scar tissue formation in the fascia surrounding the muscles. This leads to someone having been described as having “rock hard” muscles. Ultrasound is one of the tools we use to soften these rock hard muscles, in addition to performing deep tissue muscle work, fascial release and spinal manipulation.
4) Relaxes Tight Muscles and Reduces Trigger Point Activity: As mentioned above, ultrasound is able to soften hard muscles. It also is able to reduce the trigger point activity in muscles, allowing them to more fully relax.
Electrical stimulation is a commonly used physical therapy tool. We often use Interferential Nerve Stimulation and High Volt Muscle stimulation. Electrical Simulation assists in pain relief and reducing muscle spasms. Interferential stimulation can also deactivate trigger points in muscles.
Low Level Laser Therapy
Low level laser is the latest physical therapy tool to have gained popularity. These lasers are able to send intense light deep into a muscle, nerve, tendon, ligament or joint. When laser light illuminates these deep structures, it stimulates the cells to work faster. When the damaged cells work faster, they heal more quickly.
Low Level Laser speeds tissue repair and reduces pain and inflammation wherever the beam is applied. Low level laser also reduces trigger point activity. Low Level Laser has been used for many years on back pain, neck pain, shoulder and knee pain, sports injuries, arthritic joints and neuropathic pain syndromes. Low Level Laser is being used by the US military, Premier Division Soccer Teams, Olympic Teams, Formula 1, Rugby and Cricket teams. Most hospitals also have low level laser machines in their Physical Therapy wards.
Traction involves applying a distractive force on the spinal joints to gently separate the joint spaces. This has the effect of increasing the space between the vertebrae where the spinal nerves exit the spine. Traction is particularly effective for herniated discs in the cervical (neck) and lumbar (low back) spine.