How to Choose a Therapist

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:

• Experience. PTPN requires that practice owners have at least three years of experience before they can join PTPN.
• 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.
• 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 in choosing an office.
• Convenience. Can they accommodate your schedule? Are they open early, late or on weekends if you need those appointments?
• Reputation. What have you heard from other community members or other healthcare workers? Word of mouth is usually a therapist's best referral source.
  
  

• 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.
• 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).
• 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.
• 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.

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. Compounding 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 taking 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.

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.

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 outdated 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 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. Check with your physical therapist for any special instructions for your particular injury.

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  

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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