Chronic pain is not every therapist’s favorite to treat. As it was my (flexible, balanced) opportunity back into the outpatient orthopedic world, I decided to go for it and start working at a pain management center. The reason I have stuck with it for so long, as I continue to treat patients in chronic pain and under pain management care, is that we have found techniques that actually work for the patients with chronic pain that are willing to try them.
Dry Needling
I can’t speak highly enough of the dry needling training and certification I received through Myopain Seminars. From their effective teaching of anatomy to prioritization of patient safety, I never thought I would be this confident with needles as a PT, but here we are. Definitely my highest rated form of manual treatment by those with chronic pain. One of the first patients I ever needled said the effect of dry needling provided more immediate and effective relief than what any narcotic medication had ever given him. Also great for those clients not in chronic pain, of course.
Kinesiotape
There are many techniques and courses out there, but my Certified Hand Therapists and I really love what Allison Taylor has developed, which I use all over the body, especially for ankles, knees, lumbar spine, cervical spine, and shoulder pain (check out her courses and YouTube page). We love using the Hampton Adams brand via Amazon, as nearly all of our patients’ skin can tolerate it (make sure to screen for adhesive allergies first) and its continuous rolls decrease the amount of wasted tape that accumulates with other brands’ pre-cut strips.
Desensitization
Classic neuro technique using different textures, varying pressures, with the affected area in as a relaxed, supported position as possible. Bonus is that little to no equipment is required, and it’s a nice gateway to PROM, AAROM, etc. when an affected area is too sensitive to begin with/patient unable to tolerate at first. Cotton balls, rice, towels, sheets, and more can be great additions to hands-on desensitization in order to increase tolerance to various textures.
Gait Training
Small tweaks to the assistive device (AD), ensuring the AD is being used in the correct hand with upright posture, simple education on the value of heel-toe gait pattern and why we want knee extension at initial contact has gone really far with my patients with chronic pain. PT failed them so many times previously, or they admit that they did not previously give PT a fair shake, and so many tell me that they never got to this information in earlier bouts of therapy. Teaching the why of gait training seems to really stick and their gait improves immediately with few cues required. It’s a quick take home message that’s easy enough to start on Day 1, at their Initial Evaluation.
I hope these help! I recognize that 3 out of 4 of these are manual interventions, and it’s just what I have found works best to get my patients of this population in a place to then try movement and exercise or other functional activities. Explaining the necessity of pairing manual interventions with movement for the biggest effect before starting, then creating buy-in by implementing an effective manual technique really improves pt willingness to then try new or familiar movements and increases chances for more consistent follow ups in a population that is slightly notorious for being less than consistent in physical therapy.
Let me know how these go for you, or how these have been working for you in the clinic thus far! Leave a comment or send me an email!