When asked about physical therapists and what types of conditions they treat, most people probably think about ankle sprains, back pain, ACL and meniscus tears, rotator cuff issues, broken bones, and possibly sports injuries overall. While these and other musculoskeletal conditions do account for the majority of physical therapists’ patient load, the range of physical therapy goes far beyond them. Some of the less common conditions physical therapists treat include various pulmonary, cardiovascular, and balance issues, but their role can be just as vital in the management of these patients.

Cardiopulmonary rehab: treatment for pulmonary and/or cardiovascular issues

Any condition involving a problem with the lungs that leads to breathing complications is classified as a pulmonary disorder. The most common of these is chronic obstructive pulmonary disease (COPD), which is the 10th most prevalent disease in the world and expected to become the 5th leading cause of death by 2050. COPD causes the airways of the lungs to become less efficient at moving air and it leads to shortness of breath, coughing and wheezing, excessive mucus, and difficulty taking a deep breath. Chronic bronchitis and emphysema are both types of COPD. Other common pulmonary disorders include asthma, lung cancer, pulmonary fibrosis, and sarcoidosis.

Cardiovascular disorders are defined by a dysfunction of the heart and blood vessels. Heart disease, heart failure, coronary artery disease, hypertension (high blood pressure), hypotension (low blood pressure), and cardiac events like a heart attack are all cardiovascular disorders, which often have serious implications for patients. Some disorders, like pulmonary hypertension (high blood pressure in the blood vessels that lead from the heart to the lungs), involve both the cardiovascular system and the lungs.

Since the heart, lungs, and blood vessels are all closely associated with one another, a specialized form of therapy called cardiopulmonary rehabilitation is recommended as an effective treatment many pulmonary and/or cardiovascular disorders. While a primary care physician and possibly a specialist will serve as the leading provider to guide treatment decisions for these conditions, cardiopulmonary rehabilitation provided by a physical therapist can serve as an important adjunct to help patients become more physically active. Each cardiopulmonary rehabilitation plan is unique, but most will include one or more of the following interventions:

• Breathing retraining, including proper breathing techniques to maximize oxygen intake and consumption Education on the early warning signs of distress
• An appropriate exercise program, including endurance and strength training
• Guidance on how to increase daily physical activity levels
• Medication management guidance
• Instructions on disease pathology, infection control, and energy conservation

Vestibular rehab is strongly recommended for balance disorders

Vertigo is the feeling that things are moving, rotating, rocking, or spinning when a person and their environment are completely still. It occurs when there is a problem with the vestibular system that interferes with communication between the brain and other areas of the body. This communication breakdown leads to perceived motion—the primary symptom of vertigo—as well as other symptoms like dizziness, nausea/vomiting, balance disturbance, and headaches.

Millions of Americans experience vertigo and related symptoms each year, with one study reporting that as many as 35% of adults over the age of 40 have dealt with a vestibular dysfunction at some point in their lives. There are several conditions that can cause vertigo, such as inner ear infections, migraines, stroke, surgery, and head injuries, but the two most common issues are vestibular neuritis and benign paroxysmal vertigo disorder (BPPV).

The good news for patients is that BPPV and other causes of vertigo are very treatable. Physical therapy is regarded as one of the most effective vertigo treatments and it has been proven to significantly reduce symptoms. And best of all, many cases of vertigo can be completely resolved in just a few treatment sessions. The specific treatments used depends on what condition is present, but some of the most common interventions include the following:

• Balance retraining exercises: these types of exercises will have the patient shift their body weight in various directions while standing to improve the way information is sent to the brain
• Gaze stabilization exercises: these are designed to keep vision steady while making rapid side–to–side head turns and focusing on an object, which will help the brain adapt to new signaling from the balance system
• Epley maneuver: an extremely effective technique for cases of BPPV involving the posterior canal of the ear that works by allowing the free–floating crystals to be relocated by gravity back to the utricle; has been found to resolve vertigo in approximately 90–95% of patients
• In another simple maneuver, your physical therapist will guide you through a series of 2–4 positions, each of which should be held for up to two minutes; as with the Epley maneuver, these position changes are designed to move the crystals from the semicircular canals back to the appropriate area of the inner ear
• Balance retraining exercises may be needed for some patients that continue to experience balance issues after the vertigo has subsided

As you can see, physical therapy has many applications beyond what most patients might expect, but it can be doubly effective for those who also have a musculoskeletal disorder. For example, if a patient with pulmonary hypertension has been told to exercise more often but is unable to do so because of knee pain, a physical therapist can help address their knee pain and simultaneously provide exercise recommendations that are considerate of their limitations. It’s a win–win for any patient dealing with these issues, and that’s why we strongly advise you to contact us if you’re being hindered by any pulmonary, cardiovascular, or balance issues.

In the final post of our series, we’re focusing on the wrist and elbow. The elbow is the link between the upper and lower arm, and it can be subjected to repeated stress from many daily activities. As a result, most elbow–related injuries that physical therapists treat result from repetitive stress, either from one’s occupation or from certain sports. The wrist is comprised of 15 bones, which are connected by three primary joints and several other smaller joints, plus numerous muscles, ligaments, and tendons that reinforce these connections. Any of the structures of the wrist can be damaged by extreme movements—like twisting, bending, or a direct impact—that force it beyond its normal range of motion, or from repetitive use.

Below are some of the most common elbow and wrist conditions treated by physical therapists:

• Golfer’s elbow (medical epicondylitis): this condition results from repeated bending of the wrist, which damages the muscles and tendons in the elbow and eventually leads to inflammation; it’s most common in golfers, but can occur from other sports and activities that strain the elbow, and the clearest indication is pain on the inside of the elbow that’s most noticeable when performing any type of gripping activities

Tennis elbow (lateral epicondylitis): a repetitive strain injury caused by repeatedly performing the same movements—in tennis, other racquet sports, or one’s profession—over and over; common symptoms are pain and a burning sensation on the outside of the forearm and elbow that gets worse with activity, as well as weakened grip strength

• Ulnar collateral ligament injury: the ulnar collateral ligament, which connects the inside of the upper arm bone to the inside of your forearm, is frequently damaged or torn in youth baseball from young pitchers throwing too often without rest; a tear will sideline a player for an extended period
• Carpal tunnel syndrome: a repetitive strain injury that affects about 5% of the population; results from regularly performing tasks that require repetitive hand motion, awkward hand positions, strong gripping, mechanical stress, or vibration; starts with a burning/tingling sensation, but eventually pain, weakness, and/or numbness develop in the hand and wrist, and then up the arm
• Wrist arthritis: a general term that describes protective cartilage on the ends of bones in the wrist wearing away, usually either from osteoarthritis or rheumatoid arthritis; leads to pain and impaired wrist range of motion
• Ulnar tunnel syndrome (Guyon’s canal syndrome): similarly to carpal tunnel syndrome, this condition involves compression of the ulnar nerve and leads to a tingling sensation in the ring and little fingers; it’s particularly common in weightlifters and cyclists
• Dupuytren’s contracture: an abnormal thickening of tissue between the skin and tendons in the palm, which may limit the use of the fingers or eventually cause them to be pulled in towards the palm in a bent position

The use of physical therapy for elbow and wrist conditions is backed by research

Physical therapists can effectively treat these and many other painful conditions affecting the elbow and wrist. Most treatment programs will involve some combination of education, pain–relieving interventions, flexibility and strengthening exercises, manual (hands–on) techniques, and activity modification recommendations—particularly for repetitive strain injuries—but the specific contents of each plan will vary depending on the type and severity of the condition and the patient’s abilities and goals.

There is an abundance of research that supports physical therapy as effective solution for many of these conditions. For example, one long–term study of women with carpal tunnel syndrome found that there were no significant differences between patients that received manual therapy compared to those who underwent surgery both one and four years later. There were also no significant differences between groups in the rate of surgery over four years, and patient’s self–reported scores on their perceived improvements were similar. Other research has also found manual therapy to be capable of eliciting significant benefits in patients with carpal tunnel syndrome, while additional studies have shown that exercise therapy is effective for both tennis elbow and golfer’s elbow.

We hope this post series has opened your eyes to the wide array of benefits that physical therapy can provide for patients with nearly any musculoskeletal condition. And if you’re currently dealing with pain and have been putting off getting the care that you need, we strongly encourage you to see a physical therapist before your yearly benefits expire, as doing so now will help you get started on the right foot for the new year.

The knee is the next region of the body we’re going to examine, as it ranks up there with the back, neck, and shoulder as a hot spot for musculoskeletal pain. Knee pain is especially common in athletes of sports that involve lots of cutting motions and is the leading cause of disability in older adults. But sports and advanced age are far from the only factors that can increase the risk for knee problems.

The knee is the largest and one of the most complex joints in the body, and its complexity is one of the main reasons it’s so vulnerable to injury. The frequency with which it’s used also plays a significant role. The knee is a hinge joint that’s responsible for bearing weight and allowing the leg to extend and bend back and forth with minimal side–to–side motion. It primarily joins the thighbone (femur) to the shinbone (tibia), but also includes the kneecap (patella) and other lower leg bone (fibula). The patella is a small, triangle–shaped bone that sits in the front of the knee within the quadriceps muscle, and it’s lined with the thickest layer of cartilage in the body because of the massive forces it takes on.

Knee pain is the leading cause of disability in adults aged 65 years and older—with knee osteoarthritis being responsible in most of these cases—while various tears are more likely to occur in active individuals. Here’s a look at some of the most common conditions that physical therapists treat:

• Knee osteoarthritis: an extremely common disorder in which the cartilage on the ends of bones in the knee gradually wears away, which reduces its ability to absorb shock and increases the chances that bones will contact one another; usually leads to pain, stiffness, and swelling that makes it difficult to walk and move the knees normally
• ACL tear: the anterior cruciate ligament (ACL), which helps stabilize the upper leg bone to the knee, can be damaged or torn when an athlete suddenly cuts or changes direction; ACL tears are most often seen in football, basketball, and soccer, and sideline athletes for extended periods of time
• Meniscus tear: tears of the meniscus, a tough piece of cartilage that absorbs shock and stabilizes the knee, typically occur from twisting or turning too quickly on a bent knee, often when the foot is planted on the ground; degenerative meniscus tears may also occur in older adults; symptoms include pain, swelling, and difficulty extending the knee
• Patellofemoral pain syndrome: sometimes referred to as “runner’s knee,” this overuse injury results from repetitive movement of the kneecap against the thighbone, which can damage the tissue under the patella; as the name suggests, runner’s knee is most common in runners and other athletes

For knee pain that doesn’t improve with at–home exercises, see a physical therapist

If you find yourself dealing with knee pain, either from a traumatic incident or due to sustained damage over time, one of the first steps you can take is to try managing it on your own at home with some targeted exercises. These include stretching exercises like the quadriceps stretch, hamstring stretch, calf stretch, and knee range of motion exercise, and strengthening exercises like the wall sit, bridge exercise, single–leg heel raise, and partial lunge. If these exercises fail to produce notable improvements, the next step is to see a physical therapist, and preferably sooner rather than later.

Physical therapists frequently see patients with all types of knee–related conditions and are adept at creating personalized treatment plans based on the patient’s condition, abilities, and goals. A typical treatment program for knee pain will include the following:

• Strengthening exercises to build back up the weakened muscles of the leg
• Stretching and range of motion exercises to increase flexibility and regain normal mobility
• Plyometrics, or jump training (especially for patients recovering from ACL tears)
• Recommendations on how to modify activities to minimize the risk for future injuries
• Exercises to improve body awareness, balance, and neuromuscular control, which is the body’s ability to stay strong and stable during all movements
• Activity–specific training for athletes and active individuals

Research has shown that physical therapy can significantly improve patient outcomes and help them avoid knee surgery in certain cases. There is an abundance of evidence on physical therapy for meniscus injuries, including a powerful study called a randomized clinical trial, which found that physical therapy led to similar improvements in physical function when compared to surgery for patients with meniscus tears. Furthermore, a follow–up analysis of this trial showed that physical therapy is more cost–effective than surgery for meniscus tears, while a separate review of 6 studies found that although surgery led to some initial advantages over exercise therapy, there were no differences between groups 12 months later. A systematic review and meta–analysis of 14 studies also found that manual therapy, an important component of most knee treatment programs, is likely to be effective and safe for improving pain, stiffness, and physical function in patients with knee osteoarthritis.

In our next post, we’ll look at the injuries and conditions involving the wrist and elbow.

For the next installment of our post series, we’re focusing on shoulder pain, which can be extremely disabling. Whether or not you realize it, you use your shoulder almost constantly, as it permits practically any movement that involves your arms. This is why any issue that causes pain and prevents your shoulder from moving normally can be a major burden to your daily life.

After the back and neck, the shoulder ranks as the third most common site in the body for musculoskeletal pain, as about 67% of people will deal with it at least once in their lives. The primary reason is that the shoulder is the most flexible and mobile of all joints—and the only joint that can rotate a full 360°—but this extreme flexibility also makes it vulnerable to numerous injuries. Below is a summary of the most common shoulder–related conditions, many of which involve the rotator cuff, a group of four muscles and tendons that form a “cuff” and support the head of the upper arm bone:

• Shoulder impingement syndrome: involves any of the rotator tendons or other structures being trapped (or impinged) by two bones, which leads to shoulder pain, weakness, and difficulty reaching up behind the back
• Rotator cuff tendinitis (shoulder tendinitis): results from irritation or inflammation of a rotator cuff tendon, leading to pain and swelling in the front of the shoulder and side of the arm; most common cause of shoulder pain
• Rotator cuff tear: results when a rotator cuff tendon detaches from the bone, either partially or completely; can occur either traumatically or gradually, which is usually the case in older patients
• Shoulder bursitis: inflammation of a fluid–filled sac in the shoulder called the bursa, which occurs from regularly performing too many overhead activities; the most common symptom is pain at the top, front, and outside of the shoulder that gets worse with sleeping and overhead activity
• Frozen shoulder: a condition that occurs when scar tissue forms within the shoulder capsule, which causes the shoulder capsule to thicken and tighten around the shoulder joint; symptoms include pain and stiffness that makes it difficult to move the shoulder

Physical therapists use various interventions to facilitate recovery from shoulder pain

Regardless of what shoulder condition is present, in most cases, the best course of action is a comprehensive course of physical therapy. Physical therapists are movement experts whose goal is to guide patients back to full strength and function with an exercise–based approach. They accomplish this by first identifying the source of pain and any associated impairments and then by designing a personalized treatment program that targets these areas of weakness and teaches patients how to regain their abilities through movement.

Most treatment programs will involve some combination of pain–relieving interventions, stretching and strengthening exercises, manual (hands–on) techniques administered by the physical therapist, and education on how to avoid future shoulder issues. But the specific approach used will vary depending on the condition present, its severity, and the patient’s abilities and goals.

There is no shortage of research supporting physical therapy as effective solution for many shoulder–related disorders. One powerful study called a systematic review found that stretching exercises, strengthening exercises, and other physical therapy techniques reduced pain and improved range of motion in patients with frozen shoulder. Another systematic review published in 2018 identified moderately strong evidence to support exercise therapy for rotator cuff tears, while a long–term study found that surgery was no better than nonsurgical treatment for patients aged 55 and older with a rotator cuff tear up to five years later. Results from yet another systematic review and meta–analysis published in 2022 showed that exercises—both on their own and as part of a program—improved range of motion, function, disability, and pain in patients with frozen shoulder.

In our next post, we’ll look at the injuries and conditions involving the knee.

With the end of the year fast approaching, now is a great time to see a physical therapist it you’re trying to get the most out of your healthcare plan. We suggest you take a few minutes to review your health insurance policy and check on your benefit status as it pertains to your yearly maximums. If you’ve already met your deductible or out–of–pocket maximum for 2022, you will likely have a lower copay or no copay for the rest of the year before your deductible renews on January 1, 2023.

Seeing a physical therapist is perhaps the best decision you can make if you’re currently experiencing pain from any type of musculoskeletal disorder, as doing so is the safest, most effective, and least expensive route to less pain and greater function.

A musculoskeletal disorder is an injury or condition that involves the musculoskeletal system—which includes the bones, muscles, joints, ligaments, and tendons. These disorders are extremely common, with about 30% of Americans being currently affected. Musculoskeletal disorders can develop anywhere in the body, but the spine is by far the most common location, as low back pain and neck pain are among the leading causes of disability in the U.S. Other common musculoskeletal disorders include osteoarthritis, tendinitis, strains, sprains, fractures, and tears of ligaments and tendons.

Surgery vs nonsurgical treatment for musculoskeletal disorders

Patients with musculoskeletal disorders are faced with several potential options when determining how to address their condition, including surgery, which may be attractive to patients who believe it will lead to immediate relief. But the truth is that recovery from surgery requires effort, too, and the overall outcomes are often no better than those following nonsurgical interventions.

In a powerful study called a systematic review and meta–analysis, researchers reviewed the findings of 100 high–quality clinical trials on surgical versus nonsurgical interventions for various musculoskeletal conditions. These trials covered 28 different types of conditions at nine areas of the body, and in all studies that evaluated function, all studies that evaluated quality of life, and nearly all studies (9 of 13 [69.2%]) that evaluated pain, no clinically relevant differences were found between surgical and nonsurgical interventions.

These findings underscore why patients should strongly consider seeing a physical therapist before opting to undergo a surgical procedure. Surgery may have the appeal of being a “quick fix,” but it still requires extensive rehabilitation afterwards and is associated with several risks and extremely high costs. Physical therapy, on the other hand, is a cost–effective treatment option that is generally considered to be safe while providing similar outcomes to surgery in most cases.

To provide further context on the role of physical therapy for treating musculoskeletal conditions, we’re going to focus on the most common conditions in different regions of the body and provide evidence that shows how physical therapy can help.

Back and neck conditions most frequently seen by physical therapists

The spine is one of the most common locations in the body for musculoskeletal pain. Up to 50% of adults deal with neck pain each year, and up to 70% will encounter it at least once in their lifetime. The figures on back pain are even higher, as about 80% of Americans will experience an episode of low back pain at some point in their lives, making it the most common site for pain in the body. Many of the ailments that produce pain in the neck can also develop in the back, and vice versa. Here are some of the most prevalent conditions of the spine:

• Sprain: occurs when a ligament in the spine is pushed beyond its limits, which can cause it to be damaged or torn; typically leads to pain, discomfort, reduced range of motion, and possibly muscle cramping or spasms
• Strain: involves a tendon or muscle that supports the spine being twisted, pulled, or torn; as with sprains, neck and back pains usually lead to pain, discomfort, reduced range of motion, and possibly muscle cramping or spasms
  • Both sprains and strains can occur either from a single incident or due to repetitive stress over time, and these injuries are responsible for most cases of neck and back pain, particularly in younger patients
• Herniated disc: a condition in which the softer jelly–like substance of a disc in the spine pushes out through a crack in the tough exterior ring; a “bulging disc” means that the inner layer has protruded outwards, but the outer layer remains intact; a herniated disc is most likely to occur in the lower back, but they are also seen in the neck; common symptoms include arm or leg pain, numbness or tingling, and weakness
• Spinal stenosis: a condition in which the spinal canal—the space around the spinal cord filled with a fluid that bathes the nerves and nerve roots of the spine—narrows over time, which puts pressure on the spinal cord and spinal nerve roots; spinal stenosis is most common in the lower back and the neck and is typically only seen in older adults since it’s caused by age–related changes
• Degenerative disc disease: an age–related disorder in which one or more of the intervertebral discs deteriorates or breaks down, which can lead to a herniated disc or other related issues; degenerative disc disease is another one of the most common causes of low back and neck pain
• Osteoarthritis: involves the breakdown of protective cartilage that surrounds the ends of joints and discs in the spine; osteoarthritis can occur anywhere in the spine, and has been referred to as the most common cause of low back pain in people over the age of 50; patients typically experience pain and stiffness, as well as weakness or numbness in some cases

Evidence supporting physical therapy for neck and back pain

Physical therapists utilize a variety of interventions to address neck and back pain, including stretching and strengthening exercises, manual (hands–on) therapy techniques, pain–relieving modalities, functional training, education, and guidance on how to avoid further aggravation of pain. After adhering to these treatment recommendations, patients will eventually notice a marked reduction in their pain levels while gradually regaining the ability to move and function to levels similar to before the onset of their pain.

Research has shown that physical therapy can lead to a multitude of benefits for patients with back or neck pain, including less pain and disability, lower overall treatment costs, and a lower chance of needing additional treatments while avoiding both surgery and opioids. Other research has shown for patients with chronic neck pain, empowering patients with self–management strategies in addition to a comprehensive physical therapy program will lead to even greater overall benefits.

In our next post, we’ll look at the injuries and conditions involving the shoulder.

As we discussed in our first post, vertigo is the feeling that things are moving, rotating, rocking, or spinning when a person and their environment are completely still. It occurs when there is a problem with the vestibular system that interferes with communication between the brain and other areas of the body. This communication breakdown leads to the primary symptom of perceived motion, as well as other symptoms, which might include dizziness, nausea/vomiting, balance issues, and headache.

It’s difficult to establish firm figures on the prevalence of vestibular disorders, but it’s believed that millions of Americans experience vertigo and other related symptoms each year. One study reported that as many as 35% of adults over the age of 40—about 69 million—have dealt with a vestibular dysfunction at some point in their lives. There are several conditions that can cause vertigo, such as inner ear infections, migraines, stroke, surgery, and head injuries, but the two most common issues are vestibular neuritis and benign paroxysmal vertigo disorder (BPPV).

Vestibular neuritis results from inflammation within the inner ear, which consists of a system of fluid–filled sacs and tubes called the labyrinth. The main symptoms of vestibular neuritis are sudden and severe vertigo, as well as dizziness, balance difficulties, nausea and/or vomiting, and difficulties with concentration.

BPPV is the most common vestibular disorder and the leading cause of vertigo. It can affect people of any age, but is most common in adults over 60 years, at which point its prevalence is about 9%. BPPV occurs when tiny calcium crystals in the inner ear break off and move to another part of the inner ear, where they cause an unwanted flow of fluid. This tricks the brain into thinking that motion is occurring when things are at rest. In addition, when the head is moved in certain directions, it causes the crystals to stimulate nerve endings in the canal, which leads to dizziness. Other symptoms of BPPV include nausea, vomiting, lightheadedness, and a resulting loss of balance or unsteadiness.

The good news for patients is that BPPV and other causes of vertigo are very treatable. Physical therapy is regarded as one of the most effective vertigo treatments and it has been proven to significantly reduce symptoms. And best of all, many cases of vertigo can be completely resolved in just a few treatment sessions. The specific treatments used depends on what condition is present, but some of the most common interventions are listed below:

• Balance retraining exercises: these types of exercises will have the patient shift their body weight in various directions while standing to improve the way information is sent to the brain
• Gaze stabilization exercises: these are designed to keep vision steady while making rapid side–to–side head turns and focusing on an object, which will help the brain adapt to new signaling from the balance system
• Epley maneuver: an extremely effective technique for cases of BPPV involving the posterior canal of the ear that works by allowing the free–floating crystals to be relocated by gravity back to the utricle; has been found to resolve vertigo in approximately 90–95% of patients
• In another simple maneuver, your physical therapist will guide you through a series of 2–4 positions, each of which should be held for up to two minutes; as with the Epley maneuver, these position changes are designed to move the crystals from the semicircular canals back to the appropriate area of the inner ear
• Balance retraining exercises may be needed for some patients that continue to experience balance issues after the vertigo has subsided

Research supports physical therapy for vertigo

Several studies have shown that physical therapy is indeed effective for patients with vertigo. In one systematic review published in 2020, researchers reviewed 20 randomized and 2 non–randomized controlled trials that evaluated the effectiveness of physical therapy interventions for 1,876 older adults with vertigo, dizziness, or balance disorders. Moderate quality evidence showed that these interventions were superior to usual care for improving balance, mobility, and other related symptoms.

We hope this series of posts helped you better understand why physical therapy is such a valuable option for whatever physical problems you may be dealing with. If you’re interested in learning more about how we can help you or would like to schedule an appointment, contact us today.

There are 22 bones in the face and head, but the lower jawbone—or mandible—is the only one of these that can move. The mandible connects to the temporal bone of the skull at two points just in front of each ear through the temporomandibular joint (TMJ). And as we discussed in our last post, the TMJ is of interest not only because it allows us to move our jaw in multiple directions so we can talk, yawn, and chew, but also because it’s a common location of pain.

If a temporomandibular disorder (TMD) does occur, you may scramble to figure out what to do next. Numerous interventions are available for TMDs, but there is a general principle we strongly recommend when deciding how to proceed: less is often best. This means you should avoid expensive and irreversible interventions that are not often necessary and instead choosing minimally invasive, safe, low–risk treatment options that have been proven to work.

Physical therapy is a conservative (non–surgical) treatment option for TMDs that specifically fits these criteria. When treating patients with TMDs, physical therapists employ a variety of movement–based strategies designed to reduce pain levels, restore normal jaw movement, and lessen stress on the jaw. The techniques utilized are gentle and involve a combination of patients’ own movements and the therapist moving specific structures in a particular manner to increase range of motion.

Each physical therapy treatment program for TMDs varies depending on the severity of symptoms and the findings of the initial evaluation, but some of the most frequently used interventions include the following:

• Posture education: there are several postures that can contribute to or worsen a TMD, such as sitting with your head positioned too far forward, which stresses the muscles of the TMJ; therefore, if posture is identified as a possible cause, your therapist will teach you to become more aware of your posture and try changing the position of your jaw, head, neck, breastbone, and shoulder blades when you're sitting and walking
• Manual therapy: another common intervention is manual therapy, in which various hands–on techniques are applied to increase movement and relieve pain in tissues and joints; your therapist may use manual therapy such as massage or soft–tissue mobilization to stretch the jaw to restore normal flexibility or break up scar tissues that may have developed
• Stretching and strengthening exercises: your therapist will also teach you to perform a specific set of exercises that won’t exert a lot of pressure on your TMJ, but can strengthen the muscles of the jaw and restore a more natural, pain–free motion
• Pain–relieving modalities: for severe pain, your physical therapist may administer additional interventions to alleviate it, such as electrical stimulation or ultrasound

Research supports the role of physical therapy for treating TMDs

Physical therapy is also supported by numerous studies that have found it to be an effective treatment for TMDs. In one study published in 2021, 322 patients with TMD symptoms underwent a physical therapy program that included patient education, stretching exercises for the neck muscles, strengthening exercises for the jaw muscles, relaxation techniques, and manual therapy. Patients participated in three 60–minute sessions per week for three weeks and were also instructed to perform daily home exercises. After completing treatment, patients experienced significantly less pain and significantly better coordination of jaw movements.

Another study called a systematic review and meta–analysis—which collects and analyzes research on the same topic—had similar results. Six high–quality studies called randomized–controlled trials were included in this analysis, all of which compared exercise to other treatments or placebo for patients with TMDs. Results showed that patients who underwent exercise therapy experienced moderate short–term benefits of reduced pain and improved flexibility compared to other treatments, and a mixed approach to exercise therapy was likely associated with the best outcomes.

If your therapist suspects that your TMD is caused by teeth alignment problems, jaw clenching, or teeth grinding, he or she may refer you to a dentist who specializes in TMDs for additional care. Dentists can correct these issues with devices like bite guards, which create a natural resting position that will relax the TMJ, relieve pain, and improve jaw function.

In our next post, we’ll explore why physical therapy is effective is also recommended for vertigo symptoms that may or may not be related to TMDs.

The jaw is an area that doesn’t generally get much attention as some other parts of the body, but jaw problems are more common than you probably think. A class of jaw‐related issues called temporomandibular disorders affect millions of Americans each year, and the bothersome symptoms that result often require treatment.

The temporomandibular joint (TMJ) is a hinge joint that connects the part of the skull directly in front of the ears (temporal bone) to the lower jaw (mandible). It allows you move to your jaw up and down and from one side to the other, which is necessary for talking and chewing. The term “temporomandibular disorder,” or TMD, is used to describe a variety of conditions that cause pain and dysfunction in this joint and the facial muscles that surround it.

TMDs affect over 10 million Americans, with a much higher prevalence in women than men. The definite cause of TMDs is still unclear, but some theories suggest that they are caused by injury in that region, grinding or clenching teeth, osteoarthritis, or stress. TMD symptoms vary from patient to patient, but most report one or more of the following:

• Jaw pain or tenderness on one or both sides of the jaw
• Difficulty opening and closing the mouth
• Popping, clicking, or locking of the jaw
• Earaches or ringing in the ear

TMDs often occur with neck pain and headaches or vertigo

Another notable characteristic of TMDs is that many patients experience neck issues in addition to painful jaw symptoms. In some cases, neck‐related problems can manifest as headaches, and research has shown that up to 56% of patients who are treated for headaches also have a TMD. Experts believe that this relationship works in both directions, meaning that TMDs can contribute to the development of headaches, and vice versa. Neck issues and headaches can also mimic muscle pain in the jaw muscles, and it may therefore be difficult to distinguish the two conditions. Therefore, it’s often best to treat TMDs, neck pain, and headaches together.

TMDs have also been associated with vertigo, which is feeling a sense of rotation or movement when the body is stationary. Although the relationship between these disorders has been debated, some research has shown that those with a TMD have a stronger chance of experiencing vertigo than those without a TMD. This may be due to the proximity of the middle ear (which is likely involved in TMDs) and the inner ear (which is involved in vertigo). Common symptoms of vertigo include dizziness, nausea/vomiting, balance issues, headache, and fatigue.

Red flags for jaw pain, headaches, or vertigo

As movement experts trained to identify connections between various complications, physical therapists can effectively treat any of these potentially related issues. However, in some cases, care from another medical professional may be required if a more serious condition is present. Below are some important red flags related to jaw pain, headaches, and vertigo to be aware of:

• New onset hearing loss in only one ear
• Seeing double
• Facial or limb weakness
• New onset headache
• Abnormal eye movements
• Bowel or bladder dysfunction
• Extreme bruising, swelling, or throbbing pain
• Unexplained weight loss
• Symptoms arising after recent head or neck trauma

If any of these are present, it may be necessary to see your primary care physician or go to an urgent care center or the emergency department for a comprehensive evaluation. In most other cases, we encourage you to visit us to get started on a treatment program right away.

In our next post, we’ll explain how physical therapy can effectively treat TMDs.

October is National Physical Therapy Month, which is recognized and celebrated by physical therapists throughout the country every year. The goal of the campaign is to increase awareness of the important role physical therapists play in reducing pain, improving mobility, and encouraging a healthy lifestyle in patients. In honor of this important month, we’d like to educate our readers on some of the most important characteristics of our practice.

Physical therapists are experts in the way the body moves. When patients come to us with an injury or painful condition, we carefully identify the source of the problem and then create an individualized program that targets the patient’s impairments and limitations. Through this process, we help patients experience reductions in pain and gradually regain their ability to move and function similarly to original levels.

Although more people are now becoming aware of the numerous benefits afforded by physical therapy, several mistaken beliefs about the practice persist. Therefore, in honor of National Physical Therapy Month, here are seven common myths and misconceptions about physical therapy and the truths behind them.

7 common myths about physical therapy

1. You need a referral to see a physical therapist: A recent survey found that 70% of people think a referral or prescription is required to be evaluated by a physical therapist. In fact, all 50 states and Washington, D.C. allow an evaluation without a referral under what’s called direct access to physical therapy.
2. Physical therapy is painful: Physical therapists try to minimize your pain and discomfort—including chronic or long–term pain. They work within your pain threshold to help you heal, restoring your movement and function in the process. Although some pain will be part of the process, therapists will always work to keep this to a minimum.
3. Physical therapy is only for injuries and accidents: Physical therapy can effectively treat a wide range of conditions, many of which may not be due to a specific incident. It is also strongly recommended to condition the body and prevent future injuries.
4. Any healthcare professional can perform physical therapy: Physical therapy can only be performed by a licensed physical therapist. Current physical therapists complete a three–year post–graduate degree program in which they earn a doctorate in physical therapy.
5. Physical therapy isn't covered by insurance: Most insurance policies cover some amount of physical therapy, but beyond insurance coverage, physical therapy has proven to reduce costs by helping people avoid unnecessary imaging scans, surgery, and/or prescription drugs like opioids.
6. Surgery is my only option: Numerous studies have shown that physical therapy can be just as effective as surgery, and that it may therefore serve as an alternative for many conditions, including degenerative disc disease and meniscus tears.
7. I can do physical therapy myself: Although participation is key to a successful treatment plan, all patients need the expert care of a licensed physical therapist to guide them towards appropriate exercise and actions to address their problem.

The value of physical therapy over surgery and opioids

Physical therapy is not a magical cure–all that will immediately fix any physical problem, but it does have a vast range of applications and is appropriate for most painful conditions. Other popular treatment options for pain like surgery, injections, and pain medications (like opioids) may be tempting due to the prospect of immediate relief; however, research frequently shows that physical therapy often leads to similar—or better—outcomes while also saving patients money and time.

For example, one study showed that physical therapy was just as effective as surgery in the midterm and long term for reducing pain and improving function and flexibility in patients with various tendon disorders. Similarly, another study found only minimal differences after five years between patients treated surgically compared to those who had physical therapy for ACL tears. Surgery has great value that can often lead to positive outcomes, and it may be necessary in certain situations, but it does come with some potential downsides that should be acknowledged. These include high costs, long recovery times, and risks associated with the procedure. Physical therapy, on the other hand, is universally regarded as an affordable, safe intervention with minimal to no affiliated risks.

Physical therapy can also help patients avoid taking pain medications like opioids, which are a significant problem in the country today due to alarmingly high rates of addiction, overdose, and death. One study of 454 patients with low back pain found that those who participated in physical therapy had a lower chance of being prescribed opioids in the following year, while another found that those who saw a physical therapist early were 33% less likely to use narcotic analgesics like opioids and 50% less likely to receive non–surgical invasive procedures than patients who did not.

The earlier a patient sees a physical therapist, the more likely they are to experience positive outcomes with lower overall healthcare costs. This is exemplified in another study in which 308 patients with neck pain were divided into different groups depending on when they consulted a physical therapist: early (within 14 days), delayed (15–90 days), or late (91–364 days). Results showed that early physical therapy was associated with an average savings of $2,172 on healthcare costs over one year compared to late physical therapy, as well as a lower risk for patients being prescribed opioids, having a spinal injection, or undergoing an imaging test.

In our next three posts this month, we’ll continue to honor National Physical Therapy Month by showing you how physical therapy can serve as an important treatment tool for jaw pain, headaches, and vertigo, some less commonly reported conditions.

As we’ve shown over the last few posts, falls are one of the greatest dangers to the over–65 population, and suffering from just one fall can lead to an unfortunate cascade of consequences that will significantly impact one’s health status. But we’ve also explained that falling is far from inevitable in older age, because you have the power to reduce your personal risk by making lifestyle changes in and out of your home, learning safe walking and transferring techniques, and seeing a physical therapist for a personalized fall–prevention program.

Physical therapy prevention programs are typically designed to improve strength, flexibility, mobility, balance, and proprioception (how you sense the position and location of your body in space), all of which are inherently associated with staying steady on your feet. Many of these programs have been implemented for older adults in long–term care facilities, and they are generally classified into one of these groups:

• Single interventions: consists only of various exercises
• Multifactorial interventions: consists of a customized combination of various exercises and other interventions, such as reducing medication use, modifying one’s home environment, and managing low blood pressure
• Multiple component interventions: consists of a fixed combination of exercises and other interventions that are intended to promote mobility, prevent muscle loss, and improve muscle coordination during physical tasks

Research on the effectiveness of these types of programs for preventing falls in older adults is mixed, with some identifying benefits and others failing to do so. Therefore, a powerful study called a systematic review was conducted to evaluate the current evidence on various exercise–based programs for reducing falls in community–dwelling older adults.

Most studies support the use of exercise–based prevention programs

Researchers performed a comprehensive search of four major medical databases for high–quality studies that assessed the impact of exercise–based programs (single interventions, multifactorial interventions, or multiple component interventions) for preventing falls and fall risk in older adults. This search led to 34 studies fitting the necessary criteria for inclusion in the systematic review.

Twelve of the included studies were themselves systematic reviews that reported outcomes on the reduction of falls, and of these, 11 reviews concluded that exercise–based interventions significantly reduced the incidence of falls. In addition, 10 systematic reviews discussed fall risk factors as outcomes, and eight of these reviews concluded that there was a significant improvement in various risk factors, including balance, muscle strength, functional mobility, heart and lung health, gait speed, or fear of falling. Only six papers evaluated negative outcomes among patients, and most of these cases were minor, suggesting that these programs were generally safe. Further analysis revealed that the most effective exercise programs were those that accounted for the specific needs and risks of each participant with a personalized rather than a one–size–fits–all approach.

Based on these findings, it appears that various types of programs with single interventions, multifactorial interventions, or multiple component interventions that include light to moderate exercise training can reduce fall risk factors and the incidence of falls in older adults living in long–term care facilities. We therefore encourage you to contact us if you’re interested in learning more about our fall–prevention services for you or a loved one.