Physical Therapy From A Very Personal Viewpoint
Is Physical Therapy really worth the cost and time? I recently was asked this question by a Workers Compensation adjuster trainee. My response came from more personal than professional experience.
In 1996, I was walking across a carpeted floor without shoes carrying two boxes. I slipped and fell backwards on my left wrist fracturing it in over 10 places. I was rushed to the emergency room and had my wrist aligned, set and casted. My injury was known as a severe Colles fracture. It was painful. I refused to have pins inserted in my wrist. However, the worse pain was yet to come.
Six weeks after my injury, my cast was removed. The moment the cast was removed I was introduced to my physical therapist. As I have long been a guitar player, I asked if I was ever going to play guitar again. The physical therapist twisted and pulled on my wrist until it swelled up like a balloon. There was two more months of every kind of painful exercise imaginable to get my wrist back in shape.
One of the interesting techniques for soothing my aching wrist involved no medication. I placed my wrist in hot water and then in ice water for a few minutes each. After alternating between icy water and hot water, my wrist would quit hurting for the most part. I was willing to do just about anything to get my left wrist back to a guitar playing mode.
After six weeks, my wrist was actually in great shape. I was able to function like my old self and the guitar playing was back to normal. Typing was painful for quite some time. I asked the orthopedist to satisfy my curiosity and assign a Permanent Partial Disability (PPD) rating due to my Workers Comp background.
The Dr. assigned a PPD rating of 2%. I thought that was an amazing recovery. I owed a large amount of the recovery to the painful, yet important physical therapy.
The bottom line is that in my opinion physical therapy, if followed by the injured employee, can be extremely helpful to recovering from a Workers Compensation injury. It is up to the employee as to how helpful the physical therapy is for their recovery.
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As a Board Certified Occ Med doctor with decades of clinical experience, I know that James Moore is correct: anyone who fractures a bone in 10 places can benefit from physical therapy. The reality is that such patients make up less than one percent of injured workers. Routine referral of back sprains and ankle sprains to 4 to 20 PT visits has been proven (by objective studies) to be unnecessary and wasteful. The vast majority of those patients do not need PT. Most need only time, local ice or heat, OTC anti-inflammatory meds, home exercises (e.g stretching) and temporary reduction of physical demands at work (e.g. light duty) as needed.
If you’re trying to determine if PT is appropriate, first check out your doctor. Then your PT. Referral to a GOOD physical therapist by a GOOD physician is always appropriate. Know your providers.
Physical Therapy in the world is changing dramatically. If one googles advanced practice physiotherapy or consultant physiotherapist the evidence will start raining. Studies that have compared physiotherapists with physicians have proved that a physiotherapist provides better outcomes with less costs for musculoskeletal treatment. In countries with a public health system such as Canada and UK, physiotherapists are primary care practitioners because there is no conflict of interests. Now if we abandon reason (mathematics – statistics) and favor titles and classes, then… well ice, drugs and rest are you best option!
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