Physical therapy, chronic pain and chronic illness: our expert’s answers
Published 6 Sep 2019 • Updated 10 Aug 2020 • By Louise Bollecker
François Perrin is a physical therapist in Paris. He explains how his practise can help patients with chronic diseases to better manage pain and regain their functional capacities, especially to move better and find an adapted physical activity.
Hello François, can you explain what physical therapy is all about?
Physical therapy is the treatment of physical and motor disabilities that result from injuries and diseases that can affect muscles, joints, bones, the neurological system (brain, nerves, spinal cord), the respiratory system (lungs), the circulatory system (blood vessels) and the heart system (heart).
Which chronic diseases can take advantage of this treatment?
There are many of them. Physical therapy is used in many medical specialities such as neurology (stroke, Parkinson's disease), traumatology, rheumatology, pulmonology, etc.
In rheumatology, for example, physical therapy is used as a long-term treatment for diseases such as MS, osteoarthritis, rheumatoid arthritis, ankylosing spondylitis or Lyme disease.
This year, the theme of the World Physical Therapy Day is chronic pain. How can this discipline fight chronic pain?
Physical therapy uses analgesic techniques to relieve the patient suffering from chronic pain. This is the case, for example, with massage, electrotherapy or balneotherapy, which have a real immediate effect on pain. To reduce pain in a sustainable way, these methods are often combined with exercises and body mobilizations.
When you are in pain, it is difficult to be enthusiastic about doing exercises. What would you say to our readers who are in this situation?
Some patients are afraid of movement because they fear their pain will increase. But it’s the opposite: seeing a physical therapist will allow them to cross this barrier in a very gentle and progressive way. This is the only way to regain functional abilities. The vicious circle of "I'm in pain, I'm not moving" must be avoided at all costs. The solution is to be progressive in the intensity and repetition of the movements you achieve. I often say that the body adapts to what you ask of it! If you don't challenge your body, then you’ll get used to doing nothing and your body will lose its skills. On the contrary, when you use your body, it will always respond positively and allows functional capacities to improve.
To fight pain on a daily basis, what simple exercises would you recommend patients to do at home?
I cannot answer this question because it depends on the patient's pathology. But in general, it is important to do simple movements that respect the body physiology. The exercises must be easy to do, so that they are done properly, with no risk of hurting yourself, and so that the patient can repeat them daily with pleasure!
Is it important to be physically active between physical therapy sessions?
It’s the physical therapist’s job to help you choose the best physical activity. Sometimes, it is better not to be physically active between two sessions: for example, if you are in the inflammatory phase of osteoarthritis of the knee, it is obvious that it is not advisable to do a jog! On the other hand, other situations require to do sport between sessions: for example, if you are trying to get back in shape after an ankle sprain, it is important to complete the re-education with adapted sports sessions.
Are there any new techniques developing in the field of physical therapy?
Yes, physical therapy is really growing and learning. There are many scientific studies that are being carried out and the way we do our job is changing. Physical therapists have a duty of keeping up with these innovations and it allows us to be up to date on the treatments we offer to our patients.
If you suffer from inflammatory rheumatism such as rheumatoid arthritis, can you go to see your physical therapist when you are in an attack?
Of course! The physical therapist will use analgesic techniques to reduce the pain induced by this inflammatory phase.
The WCPT (World Confederation for Physical Therapy) explains that cancer patients can also benefit from physical therapy, can you tell us more?
I am not an expert of oncology, but I know that physical therapy’s results for some cancers are very encouraging. For example, in colon cancer, the physical activity allows a "gastric emptying", which prevents the growth of metastases as they no longer have the nutrients necessary for their development.
Beyond physical exercise, does the physical therapist have a role to play in accompanying and advising patients so that they can learn to better manage their pain?
It seems to me that this is a very important point.
I think it is essential for a patient with chronic pain to be managed by a health professional such as a physical therapist. The follow-up can be weekly or even daily depending on the pathology: the physical therapist gets to know the patient very well. I can adapt the sessions according to my patients' pain, as I know them and I know what they can cope with, what their state of mind is, etc.
Are there any chronic pains or diseases for which the use of physical therapy is not recommended or not effective?
There are of course many pathologies for which it will not be useful. Always go to your GP for advice or to your specialist so they can tell you if physical therapy can do you good.
Have you ever tried physical therapy?
What have been the benefits of this practice on your mobility?
--
Meet our physical therapist expert
François Perrin is a masseur-physiotherapist in Paris. A former top-level sportsman, graduate of the Paris School of Physical Therapy (ADERF) and holder of a Master's degree in Sports Sciences (University of Paris Descartes V), François Perrin was trained at the Institut National du Sport (INSEP) and the Paris Saint Germain Training Centre (PSG) for several years. Specialized in sports traumatology, paediatrics (bronchiolitis), rheumatology, traumatology, neurology and pneumonia, he works in a multidisciplinary office that he shares with a general practitioner, a psychiatrist and a chiropractor.
Facebook
Twitter
10 comments
I've found that just doing something, like sewing on buttons (slowly !), small gluing repair jobs, small hobby things - however small - helps by taking your mind off the pain. Pain doesn't go away just 'melts' a bit: still hurts when you try to move or get up. However I can understand that making yourself move more would have a positive effect on the stiffness and perception of pain.
Yes and no to this type of help where indeed this type of help can crucial on recovery but not always successful. Since my radiotherapy I have had major damage to muscles and tissues in my neck. Killing part of my jaw bone and reducing blood vessels in my mouth causing issues of poor healing after tooth extraction. But where I feel physio would have benefitted is helping with the loss of muscle tissue in my neck as I suffer severe pain in my neck daily basis which has developed some years after treatment. The hospital do give help and advice for a short period but not long term help, despite the knowledge such conditions dog patients for the rest of their life. GP offerings are normally substandard due their lack of knowledge and limited help in the health authority.
My back issues of prolapsed discs is another issue where in theory physio and exercise do help patients. My two brothers felt that exercise was greatly beneficial and allowed them to continue an active work life. My sister opted for surgery in America as they do over there but now suffers years after the operation. But for me I did various physio courses over the years, even tried the quackery route of massage and chiropractor which did not work for me and caused more pain. I put this down to that I was one of the 10% of people where physio etc. does not work. My brother in Law who was a top surgeon, a specialist in this area told me never to go the surgery route as within ten years or so as arthritis sets in after the operation. I was relatively young at this time so did not opt for the surgery route but wished I had taken up the Botox injections for short term relief. But I did have multiple discs gone so I was always looking at eventually becoming disabled and my working career finished.
A cautionary warning of the quackery route rather than using your GP was the case of one of my brother's using a chiropractor. For years my brother attended a chiropractor privately for his back pain. In later life the GP threw the usual pain killers at him and he continued on listening to the quack chiropractor. After pain getting extreme he changed GP and quickly tested for various issues where one confirmed he had bone cancer. A treatable cancer that rarely kills if caught early but sadly it was all to late for him. He went on for two years with the all the usual cancer treatments and even some new ones but died in agony. Stay away from the quacks and seek a decent GP on long term issues, a major job these days with the state of the NHS, chiropractor's are just quackery.
Rob is very right. i wish I never had surgery for my prolapsed disc. I had no advice from any one. For 6 months I kept complaining of severe back pain. I was given Steroid injections in the Facet joint which did no good. Eventually was referred to a Neurologist as I had severe pins and needles in my leg, unable to walk stand or sit. Lying down was the only relief. i was not offered any physio. The Neurologist diagnosed me as having a proplapsed disc and said that the surgery was the only option. When I was opened up, it was discovered that I had the sciatic nerve solidly trapped between L4 and L5 which was freed and I had Hemi Laminectomies, of L4 and L5 bone graft and 2 cages to stabilize the spine. Within 6 months, I had to have another surgery as the surgeon had put one of the 4 screws into my nerve and compressed it. With the result, I had foot drop, pins and needles and constant pain. That was rectified. But alas within a few months my L4 prolapsed followed by L3 and I developed Scoliosis. So another surgery again. Once again, the surgeon did not stretch me enough during stretch test. and only put small rods instead of long ones, and i was twisted back facing the front, but not stood up straight and was still walking bent over to my knees. Yet another surgery to correct my posture. Thus ended up having 5 Spinal surgeries, 2 of which were due to surgeon's errors and I am now riddled with Osteoarthritis in my neck, spine, knees, fingers and wrists. Once you have had surgery to the spine, it is downward spiral from then on. If you can avoid the surgery and go the physical therapy route, one will have a better chance of recovery and normal life. I am now disabled, permanently bent from my back and walking with crutches for the past 6 years.
Hello, just wanted to say my doctor sent me to the physiotherapist a few weeks ago. When I was assessed they told me that how much my pain is I have to walk and get out of my wheelchair. Trouble is every time I walk I fall over and the pain gets worse. My arthritis and muscles react against each other to cause my falls. I do go swimming a lot as that’s the best pain relief I find. Trouble then I seem to cease up and can’t move the next day with the pain in my joints and muscles. I do use a tens machine then to try and help but it does not always help. When I get so severe I tend to sleep a lot which I know is not good for me. I do suffer with chronic depression and fatigue as well. The doctor took me of off tramadol painkillers and gave me paracetamol which does not help at all. I am trying to get to see a specialist for the medication but there is a long waiting list in our area. Hopefully I will see someone before the end of the year. Thank you for listening and reading my post.
The insistence that exercise is the answer to everything has caused me more pain than I can describe. For some reason the fact that I live alone and therefore do everything including the garden is apparently regarded as a sedentary life. Currently my feet are black with bruises from swelling during an extra busy day. To be told that my pain is purely a function of stress is so clearly ridiculous even though I work hard to keep positive and busy in society. Physical pain is not a weakness, it is often the symptom of an ongoing condition which in my case has been undiagnosed for decades and described as depression. If I had known what was wrong my life would have been so much more productive and balanced.
