Practice Pain Free Dentistry
Practice Pain Free Dentistry
These blogs posts and podcasts provide quality evidenced based information about the physical practice of dentistry. Learn how to practice pain free, to create healthy habits and to promote a healthy environment for your entire team.
Dr Juanita Benedict

Why Physical Therapy May Not Have Worked for You

7/5/2015 2:35:11 PM   |   Comments: 0   |   Views: 114
As a therapist, there is nothing more disturbing than to have a patient/client sit in my office and say these words, "I've had PT in the past, but it didn't help."  Those words are typically spoken by people who feel forced into physical therapy by their doctor (or insurance company) before surgery or when no one else in their medical circle has been able to address the problem. I know immediately that I my efforts will have to be almost Herculean to combat the notion that physical therapy is a waste of his/her time.  

I have the same conviction when I often read about dental professionals who have "tried" therapy and who have not been able to find relief and leave disheartened.  

If you have tried physical therapy before for your aches and pains associated with dentistry but it "didn't help" or "only helped for a short time",  please allow me to share some insight that I have gained throughout my practice.

1. All physical therapy is not the same.  

Physical therapists are a very diverse group of practitioners with a broad range of, interests and knowledge.  The interests of any one particular physical therapist will absolutely effect your treatment.   

If you work with a therapist that has received advanced training or board certification in manual therapy, most likely, you will receive passive modalities (massage, joint mobilizations, fascial releases, etc.).  Exercise may or may not be as crucial to that therapist.  

If you work with a therapist that has a background in orthopaedics, you may not receive any passive modalities, but instead have a very heavy exercise program designed specifically to address dysfunction.

Some therapists will use electrical stimulation religiously, others see it as a waste of time.  Some will use ultrasound, while others proclaim that research does not support it.  Some will only choose to treat the area that is problematic, and yet others want to treat things that may seem unrelated, but ultimately could lead to the source of the pain.  One physical therapist may insist that the Mckenzie method is the only appropriate way to treat patients, yet his neighbor may argue that Paris' strategies have better results.  I could drone on, but I think you get the picture.

So, just because one approach in physical therapy didn't work, don't assume that all physical therapy is ineffective. Those strategies were not well suited for you. There are other strategies that will help you.  

2. Exercise is not effective if it is not performed.

There was a study done to determine the compliance of patients with home exercise programs provided by physical therapists.  It revealed that only 35% of patients were actively performing the home exercises prescribed by their physical therapist.  Interestingly, especially for dental professionals, the more educated you are, the less likely you are to be compliant with your program.  

Physical therapists are somewhat to fault here.  There are sometimes unrealistic time and resource expectations placed on patients.  Home programs should be specific and education provided on how to implement the exercises in a meaningful way. 

In other other words, you shouldn't have to carve out 2 hours of your day dedicated to exercising so that you can manage your back pain.   The exercises should also be interesting and challenging so that you can stay motivated to perform them.  Guidance on when and how to progress is key so that you can change things up and not get bored.  Joining a gym should not be a requirement to maintain gains found in therapy.  It is unrealistic and frankly poor program design.

However.....consistency with an exercise program is key to achieve and maintain the desired result.  A physical program does not just manage pain, but decreases stress and improves your overall health and vitality.  Unfortunately, the last two are rarely motivators compared to pain.   Ultimately, you are the one in control and you have to equate the exercise prescription with pain prevention/management. It is the exact same mentality you need to achieve with compliance of medication.  It is your body and your responsibility.

3. Ergonomic considerations are paramount.

As dental practitioners, it is not a question of if you will encounter awkward prolonged positioning, but rather when and for how long. The frequency and duration of compromised postures depends on so many variables including chairs, positioning of patient/equipment/computers, use of loupes, lighting, practicing four handed dentistry, cell phone usage, etc.........The list is seemingly endless.

If a physical therapist tells you that you need to just change the way your sitting and does not offer any real strategies that you can apply, please leave and find another therapist.  Find one who understands what you do for a living. You will save yourself a lot of time and money.  That therapist may very well be able to improve your pain level in a perfect situation, but your profession demands that your body is able to handle less than ideal circumstances.  You need an expert that will help you learn to perform your tasks pain free.

Ergonomic changes may need to be occur before you will get long term relief.  Exploration of all of the variables that can contribute to your pain should be a significant part of your therapy plan.  In fact, I will argue that it is one of the most important.  This alone has been the driving factor for me to enter into the workplaces and actually observe the set up and workings of dental professionals.  You may not want your therapist in your office, but perhaps you can provide video or pictures.  

You may consider an certified ergonomic specialist.  They are typically physical therapists and occupational therapists.  Distinguishing designations are CEAS and BCPE.  Although physical therapists are trained in general body mechanics and should always take into account these factors, someone that has received specialized training will be more focused on your work space and how it relates to your problems.

Remember, the first point: Not all physical therapy is the same.

So, if you have "tried PT" and it "didn't work", it is important that you know why.  Resigning yourself to live and work in pain is not necessary.  Take time to seek out the treatment that is best suited for you.   

Physical therapy is a wonderful tool and should be sought out often for those in pain.  It is non-invasive with highly skilled interventions and very specific and individualized plans to improve your impairments and decrease pain levels.   

If you still have questions or concerns about why physical therapy may not have worked for you, let me know.  Join the discussion on the forum page and check back often or feel free to email me directly.

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