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Getting
Well
How
to Choose a Therapist
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Getting
well
Getting back to work
Staying independent
Staying fit
Exercise tips |
After suffering from an illness or injury,
patients may be referred by their physicians for physical
therapy, or other rehabilitation therapy, and they may
be given the names of recommended practitioners. But how
do patients know which therapist will achieve the best
results? Here are some points to consider when choosing
a therapist:
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Experience.
PTPN requires that practice owners have at least three
years of experience before they can join PTPN.
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Services.
Do they offer services that match your needs?
For example, if you have a hand problem, and the office
mainly treats back injuries, you may need to go elsewhere.
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Location. Is
the office near your work or home? Therapy can often
occur two or three times a week. Driving time should
be a factor is choosing an office.
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Convenience.
Can they accommodate your schedule? Are they open early,
late or on weekends if you need those appointments?
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Reputation. What
have you heard from other community members or other
healthcare workers? Word of mouth is usually a therapist's
best referral source.
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- Cleanliness.
How clean is the facility? Do you feel good walking into
the office? PTPN members must pass an on-site inspection,
during which office appearance is a critical item.
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Licenses and registration.
Therapists are licensed by the state or registered and should
be able to show you a license or registration that has not
yet expired (the expiration dates are right on the license).
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Communication. Briefly
interview the prospective therapist to evaluate your ability
to work together and to communicate effectively. If you
don't feel comfortable with the therapist, try another one.
Often, practices have more than one therapist so you may
be more comfortable with a different therapist at the same
location.
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Therapist involvement. Are
evaluations performed, and treatments rendered or supervised
by the therapist? Aides and assistants are not qualified
to perform evaluations and should not be rendering treatment
unless supervised.
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| Self-Treating
Injuries: Heat or Ice Which
is Right for Self-Treating Injuries?
When self-treating injuries, the question of using ice versus
applying heat to treat a soft tissue injury - ligaments and
muscles - is a point of confusion. With this confusion is
the theory that icing an injury is effective only during the
first 24 hours.
Runners,
cyclists and other athletes with injury pain often find that
applying a heating pad or tasking a hot shower will minimize
pain, but this method usually only provides temporary relief.
When the pain returns, it can often feel even more intense.
Heat can be an important factor in rehabilitating
injuries, but usually only after the initial inflammation
has subsided.
How
long one should ice the injury depends on the size and type
of injury. The opinion that icing is only effective during
the first 24 hours is an out-dated approach. There
are times when the injury is still bleeding for two or three
days, and ice should be used every 20 minutes with no heat
on the affected area. A simple way to judge
the self-treatment is to
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touch
the area. If it feels warm, no heat should be used. When inflammation
has settled, heat can be used with quick contrasts of icing.
For example, 5 minutes of heat, 2 minutes of ice, and another
5-7 minutes of heat. The contrast treatment should be repeated
3-5 times.
In more acute cases, such as chronic swelling
or chronic tendonitis, a physical therapist might recommend
using the contrast as an immediate treatment.
By carefully treating your injury and using
discretion, you will get better quicker, instead of prolonging
the agony.
ICE: Ice is a vasoconstrictor;
it constricts blood vessels. Icing damaged tendons or muscles
that are inflamed will prevent torn open vessels from swelling
so much, and from further compressing normal blood flow to
body parts. Cooling the injured area reduces inflammation
and helps the healing process. Use ice as soon
as possible after an injury, or when you feel pain starting.
Elevating the injury, as well as wrapping for compression
will also help prevent swelling.
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| Managing
Lymphedema with Rehabilitation Therapy
As a breast cancer survivor, Mary Rosenberg,
PT, CLT-LANA, (PTPN member, Hollywood Physical Therapy Associates,
Hollywood, California) became interested in the side effects
of cancer treatment, including lymphedema -- an accumulation
of lymphatic fluid that causes swelling, most often in the
extremities, and occasionally in other parts of the body.
Left untreated, the condition worsens and may interfere with
wound healing and lead to serious skin infections.
Cancer surgeries that require removal of, or radiation therapy
to the lymph nodes put patients at risk for developing secondary
(acquired) lymphedema. A third of women who undergo removal
of the lymph nodes near the armpit for breast cancer will
develop lymphedema of the arm, a chronic and irreversible
condition that can develop several weeks, months or even years
after surgery or radiation. Primary lymphedema can be inherited
and present at birth as the result of missing or impaired
lymphatic vessels, or it can develop later in life from trauma
or unknown causes.
Rosenberg is one of a growing number of specially
trained physical and occupational therapists that successfully
treat women and men who suffer from both types of lymphedema
with complete decongestive therapy (CDT), a totally noninvasive
technique that combines manual lymph drainage (MLD), compression,
remedial exercises, and skin care.
MLD consists of gentle massage techniques
used to move stagnant fluid away from blocked lymph nodes
and process through intact lymphatic structures. It reinitiates
the natural pumping and contractile state of the lymph system
that is destroyed in
lymphedema. During the initial two-week
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period,
special short stretch compression bandages and foam are worn
day and night to reduce girth faster and prevent a
reaccumulation of the fluid. Later, patients can replace the
bandages with gradient compression garments, such as stockings
and fitted arm sleeves. Patients continue to wear bandages at
night while sleeping, and also when they perform simple exercises
to facilitate lymph flow.
“Since lymphedema is a lifelong condition,
a patient education program for self-care is crucial for long-term
success,” says Rosenberg. “I teach patients and/or
their families or support person how to do a modified form
of self-MLD and how to use compression garments. I instruct
them in proper skin and nail care because patients with a
weakened immune system are more susceptible to infections.”
Rosenberg, a certified MLD and CDT therapist
who passed the national certification exam administered by
the Lymphology Association of North America (LANA), says,
“There are no safe surgical or drug treatments to date
for lymphedema. Because of its complex and individualized
nature, lymphedema treatment should be performed by an experienced
lymphedema therapist. One path begins with completing an MLD/CDT
certification course of at least 125 hours. There are a variety
of schools which offer MLD/CDT programs, such as Vodder, Le
Duc and Casley-Smith."
As part of her dedication to a more personal
approach to physical therapy, Rosenberg runs a free monthly
lymphedema support group at her clinic. She notes, “My
goal for lymphedema patients is long-term health. This means
that I need to not only put them on the road to recovery,
but also to educate them in the methods of prevention.”
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