Physical therapist Beth Winkler-Schmit, a fellow in the American Academy of Manual Physical Therapy, discusses rehabilitation philosophies and techniques she employs at Wellnessworks Advanced Physical Therapy (990 N. Corporate Drive, Harahan, 733-0254).
Q: Does physical rehabilitation include helping patients recover from any kind of injury, including those suffered as a result of sports, accidents, surgery or stroke?
A: Yes. I do mostly motor vehicle accidents and sports injuries. Mostly, unfortunately, motor vehicle accidents.
Q: What is your approach to rehabilitation?
A: It's really starting slow, to their pain tolerance. The old philosophy of "No pain, no gain" doesn't apply to physical rehabilitation. It's hard to get patients to understand that. If you push the tissues too much, you'll either stay in the same place, or they'll regress.
Q: Do you do nutrition counseling and lifestyle work with patients?
A: Definitely lifestyle work and changes, depending on what their occupation is. If they're sitting at a desk all day, we'll change where their keyboard is or their chair ... make things ergonomically correct. If they work where they're bending and lifting a lot, we'll have to modify that as well if they're irritating [their injury]. Nutrition is a whole other ballgame; we're not licensed to give nutritional advice.
Q: Are a lot of sports injuries caused by people over-exerting themselves when they're out of shape?
A: Exactly. It's usually overuse. I see a lot of younger kids, high schoolers, with swimming injuries, rotator cup injuries from overuse, a lot of throwing inuuries: baseball, javelin or football. Also from backpacks. Kids come in with these backpacks, where they have to lean over all the way to carry all the books. Then there's contact sports such as football; you can leave to your imagination how they injure themselves there.
Q: What is the No. 1 thing that sends people into rehabilitation at your clinic?
A: Motor vehicle accidents. It's mosly lower back pain and whiplash. Whiplash is very real; it's usually from being hit from behind. Usually, the people being hit are the ones who complain of pain.
Q: Is that because they brace themselves and tighten up their muscles?
A: There's still an argument over whether it's worse to brace yourself or not to know [the impact] is coming.
Q: How many of the physical problems result from excess weight?
A: I would say mostly hip and knee problems. Our knees, because when we walk one knee (at a time) has to withstand the total weight of our body when we take a step.
Q: What do you do for that?
A: A lot of it is trying to heal the tissue and trying to get the knee muscles stronger to withstand the weight of the body. We have a treadmill un-weighting system where the person gets on a treadmill and there's a compressor that takes some of the weight of the body off their knees while they exercise. That really helps. A lot of times, they want to lose weight so their knees get better, but it hurts when they exercise. We also use aquatic exercises in a pool; that's really good as well.
Q: What's the key to successful physical rehabilitation?
A: Compliance, getting them in here and then getting them to do some things at home. Once they see the benefits of what exercise can do, they're more likely to continue. You have to be kind of a sales person to get them to believe in their mind and heart that they can get better.
Q: What circumstances can make success more difficult?
A: Negative attitude. Thinking that "nothing can help me and I'm never going to get better." I think I might see that more in patients who have been sent to [some other physical therapy center] and haven't been helped. I'm sometimes considered the last resort before surgery or something else. People put a lot of faith in me, but if they have faith in themselves they do really well. It's a team effort.
Q: Dispell some misconceptions for us. Is it best to put ice on sprains, heat on sore muscles and soak swollen feet in Epsom Salts?
A: Usually, the first 24 hours after an injury is ice, then heat is after that. That is very arguable, though. If you talk to five different therapists, they may tell you something different. This is my personal preference. Another common misconception of physical therapists is that we just do massage or just do exercise, but we incorporate everything into it: massage, joint mobilization, you have to analyze people's gait to determine what muscle imbalances they have, and set up a physical therapy program.
Q: Do you deal with children?
A: For orthopedic disorders, anything going on in the joints, yes. If they're developmentally delayed, that's a whole different realm.