Rheumatology Book


Chronic Pain Management with Physical Therapy

Aka: Chronic Pain Management with Physical Therapy, Exercise in Chronic Pain
  1. Protocol
    1. Course: 6-8 months (contrast with 6-8 weeks in acute pain)
    2. Model: Chronic disease management instead of curing an acute condition
    3. Techniques: Active modalities (as opposed to acute strategies that may use passive modalities)
  2. Technique: Body awareness
    1. Become aware of Somatic Sensation
    2. Teach to recognize tension, tightness, postural strain
    3. Start with basic range of motion activities
      1. See Stretching Program
  3. Technique: Habit reversal, ergonomics and energy conservation
    1. Change maladaptive habits (e.g. clenching, poor body Posture)
    2. Teach Posture correction, Muscle relaxation, diaphragmatic breathing
      1. See Posture
      2. Diaphragmatic breathing in for 3 seconds and out for 3 seconds
    3. Practice energy conservation and pacing
      1. Plan ahead, spreading heavy and light tasks throughout the week
      2. Eliminate unnessary tasks during Chronic Pain Flares
        1. Limit bending, reaching, and overhead activity
        2. Avoid rushing and abrupt movements
      3. Practice ergonomics
        1. Slide objects over counter space
        2. Use carts when able
        3. Frequently change positions and intersperse Stretching
  4. Technique: Self care
    1. Engage in active care of the body
    2. Encourage walking, aerobic fitness, Stretching, yoga, Relaxation Techniques, biofeedback
    3. Start with basic Walking Program
      1. See Walking Program
    4. Incorporate Walking Program into an overall fitness program
      1. See Exercise Prescription
      2. Identify an activities for the day
      3. Perform one of these in morning and another in evening
      4. Activity time goal: 10-30 minutes
      5. Examples: Walking, swimming, yoga
    5. Plan body awareness mini-breaks throughout day
      1. Activity goal: 10-20 times daily
      2. Choose a couple of activities to start with and learn new ones over time
      3. Spend 10 seconds to a few minutes each time the activity is performed
      4. Examples
        1. See Diaphragmatic breathing above
        2. Shoulder circles backward and Shoulder drop
        3. Relax, unclench jaw
        4. Conscious position change
        5. Perform stretches as described above
  5. References
    1. Wenzel (2009) Chronic Pain Management UMN CME, Minneapolis

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