Physical Therapy Can Help You Avoid Opioids When Joint Pain Strikes

Physical Therapy Can Help You Avoid Opioids When Joint Pain Strikes

People who get prompt physical therapy for pain in the knee, shoulder or lower back may have less need for opioid painkillers, new research suggests.

The study, of nearly 89,000 U.S. patients, found that people given physical therapy for their pain were 7 percent to 16 percent less likely to fill a prescription for an opioid.

The researchers said the findings suggest that early physical therapy is one way to reduce Americans’ use of the risky, potentially addictive painkillers.

“For people dealing with these types of musculoskeletal pain, it may really be worth considering physical therapy — and suggesting that your health care provider give you a referral,” said lead researcher Dr. Eric Sun. He is an assistant professor of anesthesiology, perioperative and pain medicine at Stanford University.

Dr. Houman Danesh, a pain management specialist who was not involved in the study, agreed.

“This study shows how important physical therapy can be,” said Danesh, who directs the division of integrative pain management at Mount Sinai Hospital, in New York City.

Physical therapy does require a much bigger investment than taking pain medication — and, he said, patients may have to travel to find a therapist who is the best fit for them.

“Physical therapy is highly variable,” Danesh said. “Not all physical therapists are equal — just like not all doctors are.”

But the effort can be worth it, according to Danesh, because unlike painkillers, physical therapy can help people get at the root of their pain — such as imbalances in muscle strength.

“You can take an opioid for a month, but if you don’t get at the underlying issue [for the pain], you’ll go back to where you started,” he explained.

The findings, published online Dec. 14 in JAMA Network Open, come amid a growing national opioid epidemic. While many people who abuse opioids are hooked on illegal versions — like heroin and illicitly manufactured fentanyl — prescription opioid abuse remains a major concern.

Medical guidelines, from groups like the American College of Physicians, now urge doctors to first offer non-drug options for muscle and joint pain. Opioids, such as Vicodin and OxyContin, should be reserved as a last resort.

The new findings support those guidelines, according to Sun’s team.

The results are based on insurance records from nearly 89,000 Americans who were diagnosed with pain affecting the lower back, knee, shoulder or neck.

All of the patients had a second doctor visit within a month of the diagnosis, and an opioid prescription within 90 days. So the group included only people with significant pain, the researchers said.

Overall, 29 percent of the patients started physical therapy within 90 days of being diagnosed. Compared with those who did not have physical therapy, the therapy patients were 7 percent to 16 percent less likely to fill an opioid prescription — depending on the type of pain they had.

And when physical therapy patients did use opioids, they tended to use a little less — about 10 percent less, on average, the researchers found.

The findings do not prove that physical therapy directly prevented some opioid use.

Sun explained that, “since physical therapy is more work than simply taking an opioid, patients who are willing to try physical therapy may be patients who are more motivated in general to reduce opioid use.”

But his team did account for some other factors — such as a patient’s age and any chronic medical conditions. And physical therapy was still linked to less opioid use.

While this study focused on physical therapy, Danesh said, there are other opioid alternatives with evidence to support them.

Depending on the cause of the pain, he said, people may find relief from acupuncture; exercises to strengthen particular muscle groups; injections of anti-inflammatory steroids or other medications; platelet-rich plasma — where a patient’s own platelets (a type of blood cell) are injected into an injured tendon or cartilage; and nerve ablation, where precisely controlled heat is used to temporarily disable nerves causing the pain.

It’s also possible that some simple lifestyle adjustments will help, Danesh pointed out. An old worn-out mattress could be part of your back pain woes, for instance. Ill-fitting, non-supportive or worn shoes could be feeding your knee pain.

What’s important, Danesh said, is to get at the underlying issues.

“We have to match patients with the right treatment for them,” he said.

More information

The U.S. National Center for Complementary and Integrative Health has more on managing pain.

SOURCES: Eric Sun, M.D., Ph.D., assistant professor, anesthesiology, perioperative and pain medicine, Stanford University School of Medicine, Stanford, Calif.; Houman Danesh, M.D., assistant professor, anesthesiology, perioperative and pain medicine, and director, division of integrative pain management, Mount Sinai Hospital, New York City; Dec. 14, 2018, JAMA Network Open, online

5 Physical Therapy Exercises for Neck Pain

5 Physical Therapy Exercises for Neck Pain

Non-invasive treatments should be your first line of defense against neck pain.

Workouts, sports, and even sitting at a desk all day can put strain on the neck, leading to pain and discomfort. While some conditions may require orthopedic surgery, non-invasive treatments often lead to better long-term outcomes, and should generally be the first line of defense against neck pain.

A qualified physical therapist can help you create an appropriate plan for chronic neck pain, which is defined as pain that lasts for more than a few weeks. With a physical therapy plan tailored to your needs, you can safely gain strength and flexibility, as well as lower your chance of developing a future neck injury.

If you’re suffering from neck pain and looking to find relief, your physical therapist might suggest some of the following exercises.

1. SHOULDER AND HEAD ROLLS

These stretches are a good warm-up to start with before attempting other exercises. For a shoulder roll, keep your arms relaxed at your sides, and with your head upright, simply lift and roll your shoulders. Relax briefly between each roll. Do ten rolls forward, and ten back.

Before you try a head roll, stretch the neck. Make sure your shoulder blades are relaxed, and that your head is not tilted forward but sits directly over your neck. Start by dipping your chin slowly toward your chest, and hold for several breaths (if you are unable to dip your chin, or if it causes an increase in pain, stop and contact your doctor). Next, lift your head and lower your left ear toward your left shoulder, and hold. Repeat this movement on the right side, then do a similar stretch with your head tilted back.

After stretching your neck, you can roll your head slowly in sections, from tucked in front or tilted back toward each side, five times each. Avoid doing a full head roll, which can actually strain the neck.

2. SEATED NECK STRETCH

Deceptively simple, this exercise can even be performed at your desk. For a seated stretch, sit upright in your chair with your feet flat on the ground. Extend your right arm along your right side and place your left hand on the top of your head. Tilt your head to the left, applying pressure with your hand to gently intensify the stretch. Hold for 30 seconds, then repeat for the right side. You will feel this stretch in the levator scapula muscles in the sides of the neck.

3. WALL PUSH-UP

This exercise can help strengthen your shoulders and support your neck muscles, without causing as much stress as typical push-ups. Stand facing a wall, with two to three feet of space in front of you and your feet shoulder-width apart. Place your hands against the wall, just below shoulder level. Start with straight arms, and bend your elbows slowly to bring your body closer to the wall. Repeat this 10 times for one or two sets.

4. AQUATIC EXERCISES

While high-impact sports can be hard on the neck, low-impact sports like swimming, walking, or recumbent biking may help you avoid strain. If you have neck pain, many physical therapists recommend that you hit the pool for your aerobic exercises in order to increase blood flow to the neck.

While in the water, you can attempt neck flexibility stretches like the “clock” exercise. Repeat the following on both sides:

  • Stand in a lunge position, with both arms at shoulder height. While the right foot and hand are forward at a 12 o’clock position, sweep the left hand back to 6 o’clock, following with the head and body. Repeat five times.
  • Keep the left hand sweeping to 6 o’clock, while the head moves only to 9 o’clock, for five repetitions.
  • For the last set of five, the head remains at 12 o’clock while the arm sweeps to 6 o’clock.

5. PRONE ROWS

This exercise strengthens the muscles that pull the shoulder blades together. You’ll want to lie facedown on a bed or similar surface, angled so that your face is in a corner, and you can dangle your arms off each side. Row upward, bending the elbows and squeezing the shoulder blades together without moving your head. Try about 20 repetitions for one or two sets. You can add light weights to this exercise if it is too easy.

EXERCISES TO AVOID

While adding these exercises to your routine, you should be careful to avoid workouts that may impede your progress. Don’t do sit-ups or crunches, as these can strain your neck vertebrae. In weightlifting, both the military press and lat pulldown put pressure on the vertebrae, and should be avoided.

The five exercises above can get you started on the road to recovery, although for best results, we recommend working with a physical therapist. If these exercises don’t relieve your pain, or cause pain that shoots into your shoulders or arms, contact a doctor as soon as possible. The orthopedic specialists at Comprehensive Orthopaedics can help you develop a personalized treatment plan and get back to the activities you love.