Benefits of Physical Therapy

Released on October 25, 2022

PODCAST OPEN:
You’re listening to the Live Yes! With Arthritis podcast, created by the Arthritis Foundation to help people with arthritis — and the people who love them — live their best lives. If you’re dealing with chronic pain, this podcast is for you. You may have arthritis, but it doesn’t have you. Here, learn how you can take control. Our host is Rebecca Gillett, an arthritis patient and occupational therapist, who is joined by others to help you live your Yes.

MUSIC BRIDGE

Rebecca Gillett:
Thanks for joining us on this episode of the Live Yes With Arthritis podcast. Today, we are talking about how you can benefit from physical therapy. Why? Because October is actually Physical Therapy Awareness Month. And I know if you're living with arthritis, you may have been given a referral for physical therapy.

We do know that physical activity is so important to manage our disease, but that's where physical therapy can help. They're the experts in helping us figure out how to move our body when we are in pain and how to adapt that movement. And working with a physical therapist can help you learn modifications to ease the pain or strain that happens when you are moving, whatever type of movement you choose to do. A PT can also help you find and stick with a workout routine that works for you, that will motivate you to keep doing and that you will enjoy.

Today, I have a guest host with me. Suzy Szasz Palmer is one of our long-term Arthritis Foundation volunteers. She sits on our Patient Leadership Council. Welcome to the show, Suzy.

Suzy Szasz Palmer:
Thanks so much, Rebecca. It's really a pleasure to be here. I was diagnosed with systemic lupus in 1969. I was 13 at the time. My first encounter with physical therapy occurred in 1983 during a severe lupus flare that led up to having my spleen removed. And then was followed by compression fractures of the spine. So, physical therapists really taught me how to walk again.

Many years later, I developed osteoarthritis, probably in my 40s. I had a herniated disk of my neck. I've had a hip replacement. Had some issues with my thumb joint. Five years ago, I dislocated my shoulder, which I had done many times before, but on this occasion, I could not pop it back in myself. And that was followed by some pretty intense physical therapy for about five weeks.

Rebecca:
Well, you are a veteran of physical therapy, it sounds like, as am I.

I'm glad to welcome as our guest expert, Teoma Loeb. She is a doctor of physical therapy and the founder and owner of Body Soul, Community Wellness and Physical Therapy in Oakland, California. Welcome to the podcast, Dr. Loeb.

Dr. Teoma Loeb:
It's a pleasure to be here, for sure. Thank you.

Rebecca:
Tell our listeners a little bit about yourself and your area of expertise.

Dr. Loeb:
I'm a former athlete, first of all. I played basketball all through high school and all through college, and that was really my introduction to physical therapy. I'm also an ordained minister. I went to Divinity School at Emory University's Candler School of Theology. And while there, I had the opportunity to specialize in faith and health. And so, a lot of what I do now also is health education to community organizations, such as the Arthritis Foundation, but also faith-based organizations and churches.

Rebecca:
I think people think about physical therapy as just that: physical. I'm an occupational therapist, too, but I feel like we do a lot more than that. The type of practice that you do, you really are looking at the overall well-being of someone, so that is amazing.

Dr. Loeb:
Thank you.

Suzy:
Just to jump in on that: My first encounter I had with a physical therapist in the '80s, when I couldn't walk after my spine compressed. It was really the physical therapist who would took over and was trying to rebuild my life. Trying to get off large quantities of pain killers; I was on narcotics. And she introduced me to one of the first portable TENS units, and that really changed my life.

Rebecca:
I'm not sure how many patients you see with arthritis in your practice. Is that a large population?

Dr. Loeb:
I see patients with arthritis every single day.

Rebecca Gillett:
What does that process look like when somebody first comes to you with physical therapy? A lot of them are hesitant and afraid to come because they don't want to move a joint. How do you ease them into that?

Dr. Loeb:
A lot of times they say, "I wasn't gonna come because I've heard that physical therapists are physical terrorists, and I don't want to be in pain. I'm already in pain, so what are you going to do to me today?" Like, that's the question, "What are you going to do to me?" (laughs) And I'd laugh, and I say, "Well, you know, it just depends."

First, we're just going to start with a conversation. I want them to tell me about what their pain is like. How long has it been going on? How has it progressed over time? And then what limitations do they have functionally? What are they not able to do that they were able to do before, or what can they still do but it just causes them pain to do.

I want to really just get a baseline of information from the patient first. Then that's where the movement examination comes into play. I'm going to look at how the client walks, and I'm going to look at their posture. And we're going to look at the range of motion of the joint or joints in question and the related joints. We're going to check the strength. I'm going to feel what the soft tissue feels like around the area.

Then I can develop a treatment plan of some exercises and some education that is really going to help people get on their way to improving in their function, improving their quality of life and them getting back to what they really want to do.

Suzy:
I think one of the things I've learned over time: the difference between pushing through some pain in a good way and going too far. And that's a tricky thing. I think you learn it over time, but any tips you can give people, so that they don't feel like it's physical terrorism?

Dr. Loeb:
(laughing) When it comes to managing arthritis, especially in dealing with pain, I often tell clients that I don't want their pain to increase. I don't want them to feel like their body is so tense that whatever movement they're doing is going to cause pain. I'm saying, "I don't want your face to change."

When people are in pain, they grimace. They grind their teeth, they squint their eyes. And I'm like, "If your face is changing, then you've gone too far." I want you maybe to just like bump up against the pain. But I definitely don't want you to push through it, because I don't want you to continue that inflammatory cycle or make it worse. I want us to go through what your availability is, as far as range of motion and strength. But I don't want it to be so painful that you're going to have a flare-up after we finish, or your flare-up is going to last for a couple of days.

If you feel like you're going to have pain after every single time that we do something, or as soon as I send you home, you're not going to continue. And you're not going to be compliant. And you're going to give up. I try to just encourage patients to just go through really gently their exercises, but don't push through too much pain. Just bumping up against it a little bit, so your face doesn't change, will work for you.

Rebecca:
My face changes a lot when I'm in pain, so… (laughter)

PROMO:
Movement is the best medicine. But it can be hard when you hurt. Your Exercise Solution is a resource to help you create a customized physical activity routine based on your specific needs and abilities. Learn more at https://www.arthritis.org/health-wellness/healthy-living/physical-activity/getting-started/your-exercise-solution .

Rebecca:
You have to have a rapport with your physical therapist in order to get anywhere.

Dr. Loeb:
Well, for me, I'm a happy-go-lucky, very bubbly person. And I love to have fun with my clients, with my patients. I've learned over time that adults… We're just big kids. We all just want to have fun.

I want to find out what is important to you and how can we make that happen? Or how can we address those needs?

Rebecca:
So, what advice do you have for people, as a patient, to try to make sure that they're comfortable with the PT they're seeing?

Dr. Loeb:
Come in just being honest about what you're experiencing, and really make sure that you get to tell your story. Making sure that you don't feel like you're cut off or anything. Sometimes, you just might need to change providers. And it's OK, because it's about you and your health and your body.

Suzy:
That's great advice, Teoma. I had a hip replacement in 2011. And as it happened, my husband had had one a couple years earlier. And so, my first instinct was to go see the physical therapist he had, because he really liked him a lot. And so, I did a pre-op appointment with him. And we just did not click on Day 1.

He wanted me to use crutches. I didn't want to use crutches. I wanted to use a walker because I knew I'd feel more comfortable. So, I knew right away that that was not a good fit. So, even though it was coming, a recommendation was coming from someone I love and trust, it wasn't the right fit for me. And I think it's important, as you said, for people to be comfortable saying, “This person may be a great therapist, but they’re not good for me.”

Rebecca:
Yeah, I think that's so important. No arthritis journey is exactly the same as another. And so, I think it's important to know, it's OK. There are a lot of physical therapists out there, right?

Dr. Loeb:
We are in abundance.

Rebecca:
I've been dealing with all of my arthritis issues for over 20 years. And in all of this time, I think the physical therapist I found in the last two years, when I dislocated my shoulder and had to go to therapy after, has been the best one that I've ever had in all of my years. And I think it's so important to build that rapport, like we were saying. Because this is a major person on your health care team.

Once in a while, I can just check in with him. And he also does modalities, which is something I wanted to touch on. So, he can do ultrasound and he can do dry needling and different things like that, that I have found beneficial for me. Instead of me taking more medicine, I'll go and see him for a few sessions. That's one of the things that I think we forget: It's not just about the physical activity and modifying exercise, there's other things that PT can do.

Dr. Loeb:
Absolutely. I love that you mentioned dry needling, especially for those listeners that may be in California. We can't do dry needling in California yet. But when I worked in Washington, DC, and Georgia, I did practice dry needling as well. And that was a modality that was beneficial for a lot of my clients.

Rebecca:
Can you explain how it works?

Dr. Loeb:
Dry needling is the process where we typically… It started with addressing trigger points, and the trigger points are pretty much concentrated areas of muscle tightness. Anytime you feel that knot, like in your neck or something, that's a trigger point; but trigger points can be in any muscle. Trigger points cause pain, they cause impaired joint mobility.

To help release those trigger points and improve your joint function and muscle function, you take a small needle, very similar to an acupuncture needle. And physical therapists go right into that muscle, and they hit the needle; they hit the trigger point with the needle.

And it causes typically a twitch response. And that helps relieve some of the inflammatory chemicals that may be built up in a muscle, and also just causes the muscle to relax. They also sometimes use electrical stimulation with the needle to kind of get that internal feeling of electrical stimulation versus placing the pad on the skin.

Rebecca:
People have heard of ultrasound, you know, and moist hot packs, and different things like that.

Dr. Loeb:
Ultrasound is kind of a fading modality. I don't know how often people are using ultrasound. But the TENS, like Suzy's talked about, for pain management typically is used for chronic pain. We still recommend ice and heat. There's cupping. People see the swimmers with the big circular marks on their backs. That's another form of soft tissue mobilization that physical therapists use. That can be a little bit intense but effective as well.

Rebecca:
It's a good reminder that there are things that can help support your pain management, while you are putting together a program of physical therapy that works for you.

Dr. Loeb:
I still want to just note that exercise is going to be your best medicine — and how we tailor your exercise program for your specific needs.

Rebecca:
Are there any surprising benefits that your patients discover from going to physical therapy?

Dr. Loeb:
Improved mental health, improved quality of life. Because pain just changes your mood. It increases stress in your body. It makes people irritable. It makes people depressed.

What people find is, as they start to do the prescribed plan and improve their joint mobility, strength and flexibility, that their mental health starts to improve, their attitude starts to improve, their quality of life starts to improve. Because their pain has now decreased. And now, they feel invigorated again. They feel like they're thriving again. And that makes all the difference in the world.

Suzy:
One of the things that I have found, particularly having used physical therapy on several occasions over many decades, is that it gives me a sense of control. There are things that I can do to take control of my pain that doesn't rely on drugs all the time.

Dr. Loeb:
Yes. I love that you mentioned that sense of control that you gain and that you receive. Because we aren't just your guides; we are just helping you along the way. You're with your body 100% of the time. And your physical therapy session may be 30 minutes, it may be 60 minutes, it may be 90 minutes. But that's just a small fraction of the time that you are with you. So, we really try to encourage… We're just going to guide you and help you with things that might be beneficial. But this is going to be you managing this. And you taking control of your health.

And we want to hear people say: “I’ve got this. I now can control this. Because of how you have assisted me and how you have helped me.” We want you to be independent. That's our goal. We don't want you to see us all the time. (laughs)

Rebecca:
A lot of people often are told to get a brace or some kind of assistive device or assistive equipment. What are your thoughts on that first? And how can physical therapy help find a better fit?

Dr. Loeb:
Before you get a brace, please talk to a physical therapist, because there are a lot of different braces that do a lot of different things. Sometimes, people just buy a brace, not really sure what the purpose of the brace is.

Unless there's a lot of instability going on at a joint, a heavy-duty brace isn't going to be what's important. But maybe something like a compressive brace may be important. When it comes to assistive devices, people may need either a cane or a walker. Most of the time, those are the two primary devices.

Very rarely do they need crutches or what we... You know, the forearm crutches. But if you feel unstable in any way, or unsafe, it is good to use a cane or a walker. But if you're not sure which one you need, you want to contact the physical therapist. And then they can get it properly adjusted for you and show you how to use it properly.

Rebecca:
Yeah, I think that's an important thing because, especially with cane use, a lot of times people are not using that the right way.

Dr. Loeb:
Exactly. If it's your right leg, your right knee, your right ankle, your right hip: You want the cane on the left side. You actually want it on the opposite side, so that it more closely mimics your gait.

Rebecca:
I see it all the time when I'm out and about. And I'm like, "They're using the wrong side. Can I tell them? No, I can't. I gotta stop myself." (laughs)

I think a lot of people will think of physical therapy as post-surgery, to recover from a surgery. Or maybe your doctor makes you go before surgery, so prehab is what they call that. Do you encourage your patients to have a regular ongoing schedule with you, or to check back in with you a certain amount of times? At what point should they come back and see you?

Dr. Loeb:
What every PT professor will always say is, “It always depends, because everybody is different.” I always say, “Hey, check in with me. Let's do this exercise. You're being discharged, I want you to continue your exercises, probably for two to three months. But more importantly, I want you to get back into what you like to do.” And if you're having difficulties doing that, then I want you to reach out to me and say, “Hey, this is where I'm struggling still.”

When it comes to physical therapy, it spans the entire lifespan. What physical therapists are trying to get more in the practice of is, just like you have your annual health checkup — you need to have your annual physical therapy checkup, because we can do a general screen of your balance, of your gait, of your posture, of your strength.

Suzy:
One thing I hope listeners know is that you don't have to have a referral to go to a physical therapist. That's really important. And you're not dependent on your doctor giving you a note that says you can go to a physical therapist. Again, it goes back to that control. If that's what feels right for you, don't take the extra time, the extra money, all of those things, to get that referral. Just call your physical therapist.

Dr. Loeb:
We call that direct access. Yes, a lot of people think that they have to go to their doctor first, before they can go to their physical therapist. But pretty much every state has some form of direct access, where you can call your physical therapist first and set up an appointment with them and be seen before you get a referral.

Some states have different stipulations where you could go to a physical therapist maybe six times, or maybe five times. The physical therapist will let you know. That's not something that you as a patient have to worry about. Physical therapists in their state know what the parameters around direct access are. Physical therapists can definitely be the first line of defense in your musculoskeletal issues.

Rebecca:
Yeah, and of course, insurance always comes into play.

Dr. Loeb:
Yes.

Rebecca:
How much they will cover. Unfortunately. What they decide they will do for you. That's another thing to touch on is: I know some people find it cost prohibitive. Telehealth visits and stuff like that, where, you know, how easy is it to show… Is that something that's more accessible? Is it more affordable to do it that way? Or, you know, navigating the whole copay issue that could be cost prohibitive to people.

Dr. Loeb:
I wouldn't necessarily say that virtual visits with physical therapists change the copays or the costs in any meaningful way. Because our expertise is still our expertise, whether it's going to be in person or virtual.

I've seen people right out of surgery, never came in to see me for an in-person session, and they're doing just fine. Because sometimes it may be more beneficial for me to look and see how well you're moving in your home and in your own environment. And give you recommendations and things that you can do. Don't be discouraged by the virtual visits. Try it out, because it might be the best thing since sliced bread.

Rebecca:
But when it comes to the copays and coming to see you, are there opportunities for people to get on some sort... Like how, if somebody says, “I can't really afford the copays to come two times a week.” What is your advice on how to handle trying to put together a program and access PT?

Dr. Loeb:
We have groups, which makes coming to physical therapy more accessible. We might have a group that you can participate in, versus coming every week. We have classes, specifically, like if you have back pain. And so, we have different types of classes.

There's e-classes. There's just a whole host of educational classes that I know we offer, to help people manage some of those financial challenges. When it comes, maybe for a private practice or a different hospital system, some private practices do offer sliding scales.

But I'm going to make your exercise program maybe a little bit longer than I typically would if I'm... If I knew you were going to see me more consistently and say, “OK, because I can't see you as consistently as I would like to, these are the things that I really want you to focus on. But I'm going to modify your exercise program accordingly, to how often you're able to come in and work with me.”

Rebecca:
I think that just goes back to being very open and honest, you know. I know there's already the hesitation to come, but if your budget and finances are an issue, bring it up.

PROMO:
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Dr. Loeb:
If there are barriers that are limiting you or preventing you from doing your physical therapy exercises, because maybe it just looks too long or takes too much time, how can we address the barriers that you face — or that appear to be barriers — so that we help you to be more successful?

I tell some patients sometimes, "OK, if you don't have 45 minutes, give me 10 minutes. Do whatever you can do in 10 minutes." And let that be OK and let that be enough. And then maybe the next day, you might be able to do 20 minutes. But don't not do anything because you don't have the full 45 minutes or the full hour. Just do what you can in the time that you have.

Rebecca:
When people are having inflammatory arthritis in a number of joints, and they come to you for their visit, what would happen? What would that session look like?

Dr. Loeb:
I want to look at your strength, your balance, your control, your walking, your flexibility.
See where your limitations and inhibitions and deficits are. And focus on that. And if you're having that inflammatory arthritis in multiple joints, I'm going to definitely encourage you to do more whole-body exercise that doesn't really load your body and your joints too much.

So, I'm going to encourage you, if you have access to a bicycle, whether it's an upright bike or a recumbent bike… Or, if you can tolerate it, use the elliptical versus, you know, doing a lot of the pounding with walking. I'm going to encourage you if you have access to a pool, to get in the water. Water is so great to help unload joints when it comes to arthritis. Even if you can't swim, walk in the water, do some high knees. You can do some squats in the water. It's going to feel much different than doing it outside of the water.

Suzy:
Are there some things about physical therapy or some particular aspects that … or it's really important for the physical therapist to be present … that really a patient should not do alone?

Dr. Loeb:
For some people, I'm not going to encourage them to get on the upright bike that they have, or their Peloton, at home on their own, because they're not safe. They're not safe to climb on the bike or they're not safe to get off of the bike. It really depends on safety and what someone's abilities are. You need to see the physical therapist and get those questions answered.

Rebecca:
Safety, of course, first. But also, I think some of it is the fear of doing it on your own. And starting something new. And I think that's where a PT can really help.

Dr. Loeb:
A lot of people come to me, and they say, "Well, you know, I didn't know if I could do this, because I'm afraid of making things worse. I didn't know how much pain I can push through." And so, coming to your physical therapist, they can assess and say, “This is how you're going to do this particular exercise. I know you may have seen it on YouTube, but for your specific body, I want you to do it this way and not that way.”

When it comes to those fine-tuning things, because, yes, participating in exercise, in general, is important. But if you are not sure what those parameters are for yourself, or you've tried the exercise and it just is not working for you, and you just think exercise doesn't work, it's most likely not that. It's probably something with your form, or with your technique, or with your intensity, or with your duration that needs to be modified. And that's where the physical therapist comes in.

Rebecca:
That expert knowledge of personalizing it, right? To you.

Dr. Loeb:
Absolutely.

Rebecca:
We do have a great resource at the Arthritis Foundation on our website called Your Exercise Solution tool. We worked in partnership with the American Physical Therapy Association to develop this content. And it's a bunch of video series based on which part of the body. And we do show how to do that seated, how to modify it. And build up to standing and using resistance bands and stuff like that. And so, that is a great tool.

TYLENOL COMMERCIAL

Rebecca:
We're going to move into the listener segment where we posted a question on social: "How has physical therapy helped you manage your arthritis?"

One person, Amy, says yes, physical therapy has helped when she was 11 or 12 years old after her diagnosis. It was her alternative to physical education at school. And as an adult, she goes anytime she's hurting badly to get tips on how to lessen the pain.

Linden Robertson says, "Physical therapy helped me with my gait. Helped me to walk correctly and provided exercises to loosen up stiff joints." Is there something that you want to address on gait? How can that affect us?

Dr. Loeb:
Any joint, if it's the foot, the knee, your hip, even in your spine: If there's any pain or arthritis, that is most likely going to affect your gait. We're going to look at your ankle, and we're going to look at your hip, in addition to your knee. If it's your hip, we're going to look at your knee, and we're going to look at your spine. If you need an assistive device, making sure you're not walking too fast with it or too slow with it.

Rebecca:
Somebody gave a high-five to your water therapy. “Water physical therapy is the best.” And then the last one I wanted to touch on: Kathy says, "No one can afford physical therapy. The charges are outrageous." We talked a little bit about that, but do you have any tips for Kathy?

Dr. Loeb:
When it comes to prices being outrageous, I think that just looking at, shopping around for, the health care plans, and really seeing what's included. Because most times, it's not just that when you have a health care plan, you're not just buying just the physical therapy plan. Some people look at health care plans, but they never look at the physical therapy piece until they need it.

Rebecca:
Time to use it.

Dr. Loeb:
I would check with any universities in your area that have a physical therapy program. And ask if they have any pro bono clinics, because there are a lot of university physical therapy programs that offer pro bono clinics.

Rebecca:
We always like to ask our guest speaker what your top three takeaways are from our conversation about how physical therapy can benefit people with arthritis.

Dr. Loeb:
Knowing that exercise is going to be your first line of treatment when it comes to managing your arthritis. But if you're unsure about the parameters around your exercise, or what you specifically are able or are having difficulty with, then I would recommend going to your physical therapist for a full physical therapy evaluation. When you go to see your therapist for that physical therapy evaluation, you want to make sure that you have a good rapport with the therapist and that you are heard.

We want to hear what you have to say. And if your therapist isn't making you feel like you're heard and that what you have to say is valuable, then it may be time to shop around. The other thing is just understanding that arthritis is just a term. It isn't the end of the world. It doesn't mean that you have to stop moving and you have to stop living your life. It just may mean that you have to modify how you do that. And a physical therapist can help you with those modifications.

Rebecca:
Suzy, is there anything else you want to add?

Suzy:
I would just kind of expand on Teoma's advice about rapport. You need to be honest with your physical therapist about what's working, what's not working. Even about the payment issues.

Rebecca:
Thank you, Suzy. And I think my biggest takeaway is what you said, is that you feel that physical therapy helps give you a sense of control. And so, I think that's one thing that this podcast is really about.

Dr. Loeb:
Yes.

Rebecca:
Reminding you that there are things in your hands that you can control. So, thank you both for this great conversation. I just appreciate all of your time.

Dr. Loeb:
Thank you so much for having me. I really appreciate it.

Suzy:
Thanks so much.

Rebecca:
I just want to remind our listeners that if you are working on getting moving and putting together a goal for managing your arthritis, don't forget to download our app from your app store: Vim. It's a pain management app tool that you can use to set some goals, to get some physical activity going in your day, to help you manage your arthritis. And we want to thank Tylenol, who is our partner for Vim, for helping us support that program. So, be sure you download Vim.

Thanks again, everyone, for joining us.

PODCAST CLOSE:
The Live Yes! With Arthritis podcast is independently produced by the Arthritis Foundation, to help people living with arthritis and chronic pain live their best life. People like you. For a transcript and show notes, go to https://www.arthritis.org/liveyes/podcast . Subscribe and rate us wherever you get your podcasts. And stay in touch!