Many physical therapy sessions have been put on hold during the coronavirus lockdown. Yet, patients rely on these regimens for chronic pain relief as well as to heal traumatic injuries.
PPM talked to board member and physical therapist Tiziano Marovino, DPT, MPH, about how he is helping his patients to continue with their sessions at home via virtual telemedicine visits.
"My patients have not only been willing to become more self- responsible for their treatment programs but that they fully expect it," he says. "They do not wish to simply stay home and wallow in pain until facilities reopen; they want to be guided through a home pain therapy plan and virtually coached through any queries or problems."
His center in Ypsilanti, Michican, is, therefore changing the way it operates. Below are some of the exercises and devices he is recommending to patients, including visual demonstrations that you can download and print for easy home use.
Talk to your physical therapist or provider about whether these exercises can work for you and how many reps/sessions you should do a day or week. You might also consider whether Dr. Marovino's recommended devices (listed below) could help ease your pain until rehabilitation and PT clinics, as well as planned interventional treatments, resume normal operations.
By far, the most requested “do-at-home” intervention from patients, says Dr. Marovino, has been the provision of varied stretches for whatever area is hurting.
Specific stretches can help to reduce pain, make muscle contraction more efficient, and help to release entrapped nerves. Below are techniques for stretching the spine and hip.
Another prominent request from Dr. Marovino's patients has been for exercises that build strength, stamina, and endurance in the muscles and in the heart and lungs, as well as for aerobic exercises.
Strength training is, in fact, known to reduce musculoskeletal (MSK) pain.There are many simple and inexpensive ways that a resistance circuit can be devised using stationary objects, leather belts, or even a table leg. Dr. Marovino says his practice has mailed TheraBand kits to some patients (you can ask your provider about this or consider ordering similar bands online). These heavy-duty resistance bands are typically color-coded according to tensile strength.
Core training can be used to strengthen the body overall but also as a motor control exercise, shares Dr. Marovino. Strengthening your core can also help with urinary retention and urinary incontinence.
The training stimulus needed for stabilization exercises is different than that used for stretching, strenghtening, or aerobic training exercises - stability training can be done daily and are not over-exertive.
See below for simple core exercises that can be done using an exercise or yoga ball.
Several home-use and portable devices have been proven to provide clinical-grade pain relief, says Dr. Marovino. Individuals looking to avoid medications or procedures can use these devices, often at far lower cost and with no side effects. Below are a few options that Dr. Marovino often recommends, but he notes that there are many more available that are worth trying, adding that everyone responds differently to different devices.
Transcutaneous electrical nerve stimulation (TENS) devices apply an electrical current to the surface of the skin that is designed to stimulate cutaneous nerve endings. Your spinal cord is thereby flooded with “noise” so that the pain signal no longer registers in the brain. Depending on how you set the stimulation parameters, these units can stimulate the release of endorphins/enkaphalins and dynorphins as well.
MENS, also referred to as subliminal stimulation, uses exponentially less amperage than a TENS unit, but do not let the current strength fool you, says Dr. Maovino. It can provide powerful pain relief. The lower current, along with changes in pulse frequency, results in less skin resistance and a clearer target for relief.
: VibraCool. More on whole body vibration for pain management. See if TENS therapy may work for you.
Phototherapy/Light Therapy. Light therapy can include applications involving light emitting diodes (LEDs), infra-red and/or ultraviolet lamps, or laser devices – each with its own nuances. These types of devices are being more regularly used for human performance as well as for rehabilitative care after an injury to improve recovery and function, says Dr. Marovino.
: The Willow Curve is one example of a combination LED/laser device that available without a prescription. This device can provide medical-grade pain relief at an affordable price and has a wide array of applications from wound healing to straight-forward pain relief using infra-red light combined with artificial intelligence.
Vibration Technology. The literature on exercise, health, and human performance has grown exponentially over the past decade, especially regarding the use of vibration devices, says Dr. Marovino. Whole body vibration training (WBV) has become a staple at many fitness and anti-aging centers across the country as an exercise recovery intervention but it is somewhat controversial, he notes. There is evidence supporting the use of these WBV plates/platforms for conditions such as chronic low back pain as the technology may induce muscle and tendon changes in soft tissue.
: Dr. Marovino's clinic has found that traditional WBV devices typically provide general pain-relieving effects, however, these devices are not necessarily feasible or available for home use.
However, a newer portable and more specific device (VibraCool) was developed not long ago and has become a popular home pain device. Originally developed for pediatric application (Buzzy) to provide numbness over a topical area that is about to be inoculated, this device can provide adult-sized analgesia in a matter of minutes by simply placing it over the painful body part, he says. The device has a wide spectrum of usage, from sports injuries to chronic idiopathic pain in the sacroiliac region (SI joint pain) or lower back. The Oska Pulse is another vibration device option.
Vasopneumatic/Compression Devices. The use of compression sleeves for the lower or upper body has grown since research demonstrated it may have benefits beyond removing excessive extracellular fluid. There is also evidence to suggest that intermittent decompression therapy may cause epigenetic changes in muscle, for example, that stimulates capillary and protein expression – which can improve performance and reduce disability.
: Dr. Marovino's facility has used NormaTech to treat persistent swelling in the arms or legs due to lymphedema or after orthopedic surgery, but it may also work to relieve general muscle soreness.