Integrated Patient Care Plan

Dealing with chronic pain may involve working not only with medical doctors but also with specialists in related areas, such as physical therapy, occupational therapy, or behavioral therapy.

Physical Therapy Methods
Under a doctor’s supervision, the physical therapist treats chronic pain with a number of methods, depending on the patient’s ailment. Some of these methods lead up to exercise therapy and some relieve symptoms.

Often, some trial and error is involved. Ideally, physical therapy enables the patient to begin an integrated plan of flexibility, strength, endurance, and conditioning exercises that reduces disability and increases ability.

As an example, physical therapy for osteoarthritis can include an education in what constitutes good posture. Postural correction can take pressure off arthritic joints and affected muscles. At home, the patient can follow through by making sure he or she has proper back support with furniture and car seats. The patient can make sure he or she has a firm mattress, since a poorly designed mattress that is too soft or too hard can intensify discomfort and pain.

Standard posture is defined as a skeletal alignment in which the parts of the body are relatively arranged in a state of balance that protects the supporting structures against injury or progressive deformity. Small microinjuries, stress, and tension result from poor postural habits. Eventually poor posture can compress joint surfaces, cause adaptive shortening of soft tissues and put additional strain on ligaments and disc structures. Poor standing, sitting, or sleeping posture habits all contribute to pain. Habits such as thrusting the head forward to look at a computer monitor, to watch a television screen, or to read a book can increase pain. The first step is learning what constitutes poor posture and consciously working to correct it.

Standing Posture
The ideal standing posture is between an exaggerated “military” stance and slumping forward. The head should be balanced on the neck bones without straining and with shoulders relaxed. Instead of standing with your weight on your heels, rock forward until most of your weight is on the balls of your feet. This causes your head and shoulders to settle naturally into a more balanced position.

Sitting Posture
If when you stand up you feel stiff, your sitting posture may be poor. This can be from poor postural habits. It can also come from uncomfortable furniture that does not support your back. Specially designed chairs support the back, as does inserting a pillow between the chair and the small of the back. If you push your car seat too far forward or too far back while driving, you may crane your head too far forward and strain the back or neck muscles.

As a rule, do not sit in any one position for a long time without taking a break.

Reclining Posture
It can be hard on your back to lie on your back to watch television or to read with your back propped up too sharply. Also harmful to your back is sleeping on your stomach with your head turned to one side. The best posture is to sleep on your side with limbs loosely flexed. You should use a good plump pillow thick enough to support the neck comfortably.

Tips to Improve

  • Sit in a straight-back chair with your back supported
  • Keep your car seat upright so that your hips are at a 90-degree angle
  • Think tall when you stand and keep your stomach muscles tight
  • Stand with your weight on both feet
  • Maintain a healthy weight and exercise regularly
  • Sleep on a firm mattress and use a pillow that comfortably supports your neck
  • Wear comfortable shoes without high heels
  • Avoid tight jeans and tight belts
  • Don’t carry bags on your shoulder, such as a purse, that weigh more than two pounds

This technique involves the physical therapist moving or stretching particular parts of the body for the patient. If the patient’s normal range of movement has shrunk, the physical therapist slowly enlarges it with therapeutic exercises. Passive movement is sometimes preceded by heat and cold applications to reduce muscle spasms and corresponding pain. A “spray and stretch” can also be used. This technique involves spraying the skin with a rapidly evaporating liquid that cools the skin and relaxes the muscles, allowing the therapist to stretch the body part to a fuller extension. Stretching the muscle out to its original resting length is the only way to achieve long-term relief. As a rule, pain should not persist more than one or two minutes after this type of stretching. Gradually, the therapist shifts over to active movement assisted by the patient.

This technique helps to relieve pain in sensitive knots or areas of muscle or connective tissue, which send pain elsewhere. Trigger points can be desensitized by a number of methods, including “spray and stretch,” TENS, ultrasound, vibration and massage.