Deborah Howell (Host): Welcome to Stoughton Health Talk. I'm Deborah Howell and I invite you to listen as we find out how physical therapy can be an effective tool in managing arthritis pain. Joining me is Elizabeth Weihert, a Physical Therapist and Certified Athletic Trainer at Stoughton Health. It's such a pleasure to have you with us today.

Elizabeth Weihert, DPT, ATC: Thanks for having me.

Host: First of all, how has the interest in using physical therapy to manage arthritis pain evolved?

Elizabeth Weihert, DPT, ATC: Well, physical therapy has really been used for many years to help treat arthritis and help patients avoid things like surgery or reduce or eliminate their use of prescription medications. It's also been found to be quite cost effective and is usually covered by most insurances.

Host: Okay. And what are some of the key benefits of physical therapy for managing arthritis pain?

Elizabeth Weihert, DPT, ATC: There are quite a few different activities and techniques that physical therapy can use to help improve and restore the mobility of a joint, as well as increase the muscle strength to support the surrounding joints and improve a patient's overall fitness. And all those things can help the patient better tolerate activities and reduce their pain and their swelling.

Host: Can you give us an example of how you would do that? Say if somebody has knee, knee arthritis, and you would strengthen the muscles around the knee?

Elizabeth Weihert, DPT, ATC: In the clinic, we can use different machines, as well as bands or weights to help increase the muscle strength. And we can instruct the patient in doing some of those things at home too, using maybe some things they already have, or again, providing them with like a resistance band or just even using their own body weight.

Host: Okay. And that's all designed to take the pressure off the joint that's affected by arthritis, correct?

Elizabeth Weihert, DPT, ATC: Right, so if we strengthen the muscles around the joint, that helps give the joint more protection and stability.

Host: Got it. Is using physical therapy appropriate for all levels of arthritis and arthritis pain? In other words, is it beneficial for those who have severe arthritis as well as those with just minimal arthritis?

Elizabeth Weihert, DPT, ATC: Yes, you can definitely use physical therapy for varying degrees of arthritis? When a patient would first come in to a PT, they would likely start out with doing a thorough evaluation and assessment of the patient to determine what areas of attention that the joint might need to help improve.

And then based off of what the physical therapist is seeing and based off the goals the patient might have, then they can determine like a specific plan of care to help the patient reach those goals. And there are lots of different types of treatments and techniques the physical therapist might use.

So we talked a little bit about exercise. That's often an important one to work on the strength as well as the range of motion. But other things a physical therapist might do is help instruct the patient in proper posture and body mechanics with just within their daily activities, and that can help protect the joint.

So that would lessen their pain as well as let them tolerate more activities. The physical therapist might also instruct the patient in something such as the use of an assistive device, like a walker or a cane. Using those devices helps take some of the pressure off the joint. They may also recommend specific things the patient can do at home, not only just those exercises; but they might also recommend the patient try using ice or heat. And those things can help reduce pain and inflammation that an arthritic joint might have. It might also look at using a specific brace or a splint that can protect the joint. So, something they could wear when they're walking or, when they're you know, doing a sport or something that they enjoy.

 Sometimes even shoe inserts can be helpful. So, sometimes a physical therapist might work with the patient to create just an insert for their shoe that can give them a little bit more support.

Host: Yeah, and spinal alignment is very key to reducing pain, correct?

Elizabeth Weihert, DPT, ATC: It can be, yeah. Even when other joints might be involved besides just the spine, having things in alignment can be important in reducing pain and protecting the joint.

Host: I'm wondering if you could give us an example of someone who came to you with arthritis pain and the regimen you put them through and then maybe a happy ending.

Elizabeth Weihert, DPT, ATC: Yeah, so, patients with arthritis is kind of a daily occurrence in the clinic so again, on that first session with the patient, we're kind of assessing, you know, what's going on with them, you know, how long has it been going on? Getting a background of the types of things the person likes to do, maybe the things that they're not able to do right now and they want to be able to do in the future.

And we take measurements, so we have different tools that help us figure out how much range of motion and if there's swelling in the joint, as well as testing the strength of the muscles. We look at the, how the patient walks and how they move to kind of give us an idea too. And then based off what we're seeing, then typically we'll give some exercises for the patient to do.

So take them through those exercises, give them handouts or videos that they can look at so they're able to, to replicate that at home. As well as maybe doing some hands on techniques in the clinic too. Sometimes doing some massage or joint mobilizations can help lessen the pain and improve the motion. So sometimes we do that in the clinic the first day as well.

And then most often we're seeing these patients weekly, to kind of progress the exercises they might be doing at home, as well as do some of those hands on techniques. Most of the time, patients get some benefit out of doing a combination of all those things together.

Host: Absolutely. Now, do you have any other tips or advice for patients who are considering physical therapy for their arthritis pain?

Elizabeth Weihert, DPT, ATC: So, if a patient is considering physical therapy for arthritic pain, it's often good for them to start with a conversation with their medical team. They're going to see if PT is the right direction for them. Sometimes arthritis is severe enough that PT is not going to be the most effective tool.

They might need the see an orthopedic surgeon or, or someone that, you know, has another level of technique that can help them. So starting off with that conversation with their medical team, and depending on where the patient lives and what type of insurance they have, they might need an order to come to physical therapy.

 And so the doctor could provide them with that as well. It's also good for the patient to look into their type of insurance coverage and if they have co pays or co insurances.

Host: I was just gonna say, people are wondering how, how is this paid for?

Elizabeth Weihert, DPT, ATC: Yeah. So, most often physical therapy is covered by a patient's insurance, whether they have HMO type plan, or if they have Medicare, both of those types of insurances are typically cover physical therapy.

There might be a restriction in the number of visits that the insurance company allows in physical therapy. So often being aware of that is important to kind of gauge how often the patient's seen in the clinic. And then also talking just with family and friends to see what experiences they've had with PT, sometimes that can be helpful, to hear other people's successes.

Host: I've probably been to physical therapists probably 10 times in my life for 10 different reasons, mostly sports injuries. I've fallen in love with my physical therapist every single time and the whole team. I think they're angels on earth, honestly.

Elizabeth Weihert, DPT, ATC: Well, thank you.

Host: There's a real bond that takes place.

Elizabeth Weihert, DPT, ATC: That's one thing I've noticed in the years I've been a physical therapist is unique in the amount of time we get to spend with our patients. So it's not just five or 10 minutes quick, tell me a little bit of something and then we go on with our lives.

We have a half hour or an hour with, with patients and, you know, oftentimes on a weekly basis. So you really do get to know your patient and the things that are important to them and what they're trying to achieve. And, it is a special kind of bond to have and oftentimes a patient will see you for one thing and maybe a few years later down the road they come back to you because something else happened or they had surgery or whatever the case might be.

So it's kind of neat to, to have those relationships, and that person to trust you, you know, enough that they come back to you and they tell their friends and so it is, is very unique.

Host: And you really feel as a patient that they've got your back and they're really cheering for your recovery.

Elizabeth Weihert, DPT, ATC: Right. I mean, I think that's what drives a lot of physical therapists into the profession is they want to help people, and I've always felt that PT is such a way great way to educate. We have a lot of valuable information we can share and pass on to people who are wishing to receive that information. It's great to be a part of that.

Host: Yes, and I should amend my statement. I said recovery. Oftentimes it's not recovery, but it's pain management, correct?

Elizabeth Weihert, DPT, ATC: It can be both. In our clinic, we're seeing people after surgery. So yeah. They're, they're in that recovery phase, and sometimes people are coming in when they've had pain for five or 10 years and they're trying to avoid surgery or something like that. So we're, you know, in some ways just helping to manage their pain.

Host: Now, do you ever do physical therapy to prevent arthritis?

Elizabeth Weihert, DPT, ATC: So I think arthritis is a natural progression that just happens to everyone, you know, in varying degrees of what the research has shown is if they do an x-ray of people over the age of 40, it's going to show arthritis in the joints. Those people may or may not be having any pain or problems related to that, but it's just a natural thing that happens in our body. In a way, staying fit through exercise and activity to keep your, your joints and your muscles strong and maintain range of motion and balance, I mean, working on all those things can help slow the arthritis progression. There's no real way to completely prevent arthritis from happening, if that kind of answers your question.

Host: Yes, Yes, it absolutely does. Well, this has been just wonderful. Thank you so much for joining us today.

Elizabeth Weihert, DPT, ATC: Well, thank you for having me.

Host: And for more information, head on over to our website at stoughtonhealth.com. And that concludes this episode of Stoughton Health Talk. Please remember to subscribe, rate, and review this podcast and all the other Stoughton Hospital podcasts. I'm Deborah Howell. Have a terrific day.