Physical therapy, chronic pain and chronic illness: our expert’s answers
Published Sep 6, 2019 • Updated Aug 10, 2020 • By Louise Bollecker
François Perrin is a physical therapist in Paris. He explains how physical therapy can help individuals with chronic conditions better manage pain and regain functional capabilities, especially with moving better and discovering adaptations for physical activities.
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 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).
What type of chronic conditions can benefit from physical therapy?
There are many. Physical therapy is used in many medical specialities such as neurology (e.g. stroke, Parkinson's disease), traumatology and wound care, 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 for World Physical Therapy Day is chronic pain. How can this discipline help with chronic pain?
Physical therapy uses analgesic techniques to relieve the patient from 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 (functional and therapeutic) exercises and body mobilizations.
When you are in pain, it is difficult to be enthusiastic about participating in movement and 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 cycle of "I'm in pain, so I am not going to move" 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 ability. On the contrary, when you use your body, the bondy will always respond positively and allow for 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 a 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 ijury, and so that the patient can repeat them daily without discomfort!
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 sessions: for example, if you are in the inflammatory phase of osteoarthritis of the knee, it is obviously not advisable togo for a jog! On the other hand, other situations may require one to participate in exercises or sports 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 sport or exercise 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 provide to our patients.
If an individual suffers from an inflammatory rheumatic disorder such as rheumatoid arthritis, can he or she go to see their physical therapist when they are in a flare?
Of course! A physical therapist will be able to introduce analgesic techniques to reduce the pain induced from that 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 with some cancers are very encouraging. For example, in colon cancer, a physical therapy treatment allows a "gastric emptying", which prevents the growth of metastases as the cancers no longer have the nutrients necessary for development.
Beyond therapeutic exercises and treatments, does a 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 have come to know them and I know what they can cope with, what their state of mind is, etc.
Are there any chronic pains or conditions that physical therapy would not be recommended or effective?
There are of course many pathologies for which physical therapy may not be as useful. Always go to your GP for advice or to your specialist so they can tell you if physical therapy is good for you.
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 physical therapist 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.
Sources: know more about the World Confederation for Physical Therapy