Diagnoses

Fibromyalgia

Fibromyalgia is a clinical diagnosis that describes widespread pain coupled with chronic, engulfing fatigue, and difficulty with sleeping. Other symptoms may include irritable bowel, headaches, restless leg syndrome, and anxiety/depression. Fibromyalgia presents with a wide range of symptoms and it is important to work closely with a physician to rule out other diagnoses. Recently, physical therapy has been shown to be an effective treatments for fibromyalgia (1). Physical therapists will work on progressive resistance exercise (PRE) to systematically increase tolerance to activity and allow for a return to higher function. People who experience pain for long periods of time begin to feel higher levels of pain with less stimulus or input to the body. This is described as central sensitization. Central sensitization is a development in the central nervous system (brain and spinal cord) in which the processing of information from the body is altered and misperceived. This results in higher levels of pain caused by non-painful stimuli such as clothes rubbing the area or lifting light weight (2). Physical therapists will take the time to educate the person on what and why this is happening. They will provide interventions and exercise to increase activity, improve mobility, and regain control of daily function. People with fibromyalgia often come to accept the pain they are experiencing as inevitable. This doesn’t have to be. Allow a physical therapist who specializes in working with people with chronic pain to work closely with you to regain control of your life.

Osteoporosis & Osteopenia

Osteoporosis is a process that occurs with age in which bone density is lost over time. The loss of calcium of the bone causes the bone to become more brittle and thinner. Osteoporosis is often measured on a spectrum. A more brittle bone is at an increased risk of fracture and stress fracture. Women are more susceptible to osteoporosis due to hormonal changes, and resultant low calcium levels. Tobacco use, and a family history of osteoporosis are also contributing factors (3). Physical therapy’s role in osteoporosis is to strengthen the muscles around the thinning bones. When muscles pull on the bones with resistance training it stimulates increased bone growth of that muscle. Weight bearing resistance training, especially weight bearing through the spine, has been shown to stimulate bone growth of weakened bones. It is important to receive proper training because incorrectly using resistance training can cause stress fractures.

Temporomandibular Joint Dysfunction or TMD

The temporomandibular joint (TMJ) is a bilateral joint that connects the jaw to the skull. The TMJ allows for complete movement of the jaw and mouth for speaking, breathing, and chewing. In between the two bones of the TMJ is a disc that allows for smooth, repetitive movement. The joint is used to extensively throughout the day, becoming overused with resultant pain. A common pathology of the TMJ disorder is disc displacement, where the disc is displaced from between the two bones. This can cause pain, clicking, and even a “locked” jaw. Physical therapists use joint mobility to re-position the disc into its proper placement. Another common jaw pain is called myofascial pain in which the muscles surrounding and supporting the TMJ are overused and spasm. Physical therapists will work on postural awareness and activity modification to reduce the stress of the muscles and decrease over-activation of the jaw muscles.

Urinary Incontinence

Urinary incontinence is the loss of ability to control the bladder. Symptoms of incontinence can range from mild leakage of urine to complete loss of bladder control. The complete loss of bladder control may be a sign of a medical emergency and it is important to contact a physician immediately. There are two major types of incontinence: urge and stress.

• Urge incontinence is when there is a strong desire to void the bladder with a resulting, involuntary loss of urine. This is a due to a hypersensitive bladder or overly strong bladder contractions at inappropriate times. Physical therapists are highly specialized and trained with this population. Therapy can include bladder and sphincter relaxation exercises as well as strengthening of the pelvic floor. In some cases, biofeedback can be helpful.

Stress incontinence is the involuntary loss of bladder during increased abdominal pressure. The loss of urine often occurs when sneezing, coughing, or lifting heavy objects. Normally, the internal sphincters in the bladder system contract tight enough to counteract the increased abdominal pressure. With stress incontinence, the sphincters and pelvic floor are no longer able to create enough force to keep urine in. This is a common finding for pregnant or past-partum women. Although many women accept this as “normal”, it is a treatable problem with specific exercise and physical therapy intervention.

The vestibular system creates the sense of balance and spatial awareness in the body. To maintain balance, the vestibular system works with the visual system, sensory system, motor system, and the central nervous system. The vestibular system is largely comprised of the inner ear, including the cochlea and the labyrinth system of the inner ear. Through the process of small crystals moving in a fluid within circular canals in the ear, the body is able to perceive acceleration, decelerating, turning, and the relationship to gravity. When the vestibular system is working properly, it processes information seamlessly. When the system malfunctions it can cause dizziness, vertigo, loss of balance, nausea, and even vomiting. It is important to work with your primary care physician or specialist to determine the cause of symptoms and rule out non-vestibular disorders. Physical therapists are educated in vestibular re-training and interventions which can greatly improve balance and equilibrium. Common diagnoses that are seen in physical therapy are Benign Paroxysmal Position Vertigo (BPPV), post-concussion symptoms, and peripheral vestibulopathy. Working with a physical therapist can provide interventions for decreased vertigo and dizziness as well as strategies to improve balance and equilibrium. 

Concussion & Post-Concussion Symptoms

A concussion is a result of a jarring or blunt trauma to the head causing movement of the brain within the surrounding fluid (cerebrospinal fluid). The impact and trauma to the brain can result in a wide variety of symptoms. Common symptoms after a concussion are headache, nausea/vomiting, light and sound sensitivity, difficulty concentrating, difficulty reading, and poor tolerance to using electronics. Immediately after concussions it is recommended to reduce activities that result in increased symptoms. For some people, symptoms may only last 24-48 hours while other may experience symptoms for months to years. For the sub-population of people dealing with symptoms for an extended period of time, it is called post-concussion symptoms. Physical therapy is often prescribed for these individuals to address symptoms and provide a safe return to daily function and recreational activities. For people with difficulty concentrating, reading, or with poor balance, vestibular training is a vital aspect to physical therapy. When dealing with headaches, physical therapy can work on postural strengthening, decreasing muscle spasm, and correcting muscle imbalances. Often times, after a concussion, it is difficult to raise the heart rate and blood pressure without symptoms. Physical therapists have a standardized program to systematically acclimate the body to tolerate more strenuous exercise. 

Arthritis

Arthritis is a degenerative process that occurs mostly in the weight bearing joints. As we age, there is general wear and tear at the joints that cause breakdown of the smooth joint surfaces. Most of the joints in the body are synovial joints, meaning they have a smooth articular cartilage at the end of each bone. This allows for pain-free movement. Over time, that cartilage breaks down which results in stimulus to the underlying bone. In response to that stimulus, the underlying bone begins to produce more bone growth. As the bone grows the space that usually provides a buffer for the joint is narrowed and results in “bone on bone” communication. When this occurs, it can be painful and limit the mobility of that joint. Arthritis is a normal process as one ages and it affects each person differently. For some, they never experience arthritis pain whereas others can experience arthritis pain as early as their fourth decade. Physical therapy’s role in arthritis is to increase the strength of the muscles around the joint to reduce the force being transmitted through the bones. Identifying arthritis on an x-ray or other imaging, does not necessarily indicate pain will precipitate. Working with a physical therapist has been shown to be as effective as knee surgery when it comes to arthritic changes (4). The most common joints to experience arthritis pain are hips, knees, spine, and feet because of their weight bearing capacity.