State-of-the-art Physical Therapy and Rehabilitation

Physical therapy is an important treatment option for most back pain sufferers. A physical therapist is trained to carry out your doctor's orders to stretch, strengthen, and exercise your back in a safe and effective way. It is important that physical therapy is coupled with education, so that patients can be empowered to take charge of their own recovery.

Physical therapists are trained to give instruction on posture, educate patients about basic anatomy and physiology, and instruct patients in body mechanics, stretching, strengthening and conditioning exercises. The physical therapist also works with the physician to determine if other types of treatments including:

In order to improve results, physical therapists demand physical activity from their patients.  This may result in minor aches and pain at the beginning of the course of treatment, but has longer lasting therapeutic effects, strengthening the back and relieving pain in the long run. Treating patients with movement, exercise, strengthening and conditioning, encouraging gradual increase in activity, produces the best results.

In addition to emphasizing physical therapy, at the Miami Back Institute, we also encourage an educational program to better understand the mechanics of the spine. This may include back school, videos, or informational Newsletters.

Ultrasound
Value: Ultrasound is the application of sound waves above human hearing to tissue to increase healing in an area. Ultrasound that is applied to an injured area provides a "micro-massage", or a vibration at the cellular level. This treatment decreases pain, increases flexibility, and speeds the healing process. Ultrasound may also cause mild heating to occur in the area, depending on how it is applied.

Like exercise, each treatment of ultrasound builds on the previous session, so more than one treatment is necessary to gain the effects; usually 5 to 8 treatments are used at the minimum. Your treatment will last from 1 to 8 minutes, and you will need to be treated either daily or every other day. On occasion more extensive ultrasound treatments may be recommended, up to 4 to 6 weeks.

What you will feel: When properly applied, ultrasound will cause almost no sensation at all, although a mild warmth may be felt on the skin and sometimes deeper in the tissue. If at any time during the treatment you feel a burning or aching sensation, let you clinician know immediately; the intensity of the treatment may be more than it should.

Cold Therapy
Value: The use of cold in therapy, or cryotherapy, is often applied to a new injury or a recently re-injured old injury to decrease pain, muscle spasm, and swelling. Ice slows blood flow to the injured area and minimizes damage done by interrupted circulation. Ice is the safest and most effective way of treating sprains, strains, muscle spasm, and bruises. Health care practitioners frequently prescribe ice for a wide range of muscle and joint complaints.

What You Will Feel: When ice is properly applied, the following sensations will occur during a normal treatment:

The first time you apply ice, it can be very uncomfortable, but each treatment will get easier and easier as you get used to the ice application.

Home Application: The easiest, safest, and most effective way of applying ice at home is to use a plastic bag half filled with ice cubes and wrapped in a single layer of damp towel. The ice should be applied directly over the injury and left on for a period of twenty minutes. It can be reapplied a necessary so long as there is a 60 minute wait between applications to allow the temperature of the injured tissue to return to normal. Generally, the application of ice to a new or recently aggravated injury is most effective in the first 24 to 72 hours.

Another method of ice application at home is ice massage, which can be done with an ice cube or a paper cup filled with water then frozen. Application of ice massage should last no longer than 5 minutes and should be applied directly over the site of injury in a circular motion from the center of the injury out in an area no bigger than your hand.
If you have problems with circulation or decreased sensation in the injured area, talk to your therapist before beginning treatment.

Heat Therapy
Heat application helps relax tight muscles, and increases blood flow and nutrition to the area, which can help speed healing once the initial inflammation has subsided. It also helps the muscles and tendons respond better to being stretched and exercised. This treatment should feel like gentle warmth, never hot or burning.

If you use heat application at home, a treatment time of 20 minutes (no longer) is recommended. Leave the heat off for an hour or so between treatments.

NEVER use any kind of heat on a new (within 3 days) injury. Although the heat will probably feel good at the time, it actually slows the healing process and may cause increased aching and pain a few hours after treatment. For the first 2 to 3 days after an injury, ice is a better choice.

Moist hot packs are a convenient and effective way of treating with heat. Over the course of the 20-minute treatment, it may make you sweat, but it should never feel uncomfortably hot or burning. If it does feel too hot, let your clinician know immediately. At first you will barely feel the warmth, but it will gradually get warmer during the first 10 minutes. Your clinician will check on you periodically to make sure you are comfortable.
The advantage of moist heat over dry heat is that moist heat penetrates deeper, so generally moist heat is preferable except for people with arthritis.

Home Application: If you would like to treat yourself at home, you may use an electric heating pad only if it can be used with a moist towel. Do not use a heating pad alone, as it is a dry heat.

Warm whirlpool treatments can help relax tight muscles, increase blood flow and nutrition to the injured area which may help speed healing and allows you to exercise the joint against the resistance of the flow of the water without bearing weight on the area. The whirlpool's temperature is somewhere between 96° and 102° F. It will feel slightly warmer than a bath, and should never feel hot or burning. If at any time during the 15 to 20 minute treatment you feel light-headed, dizzy, or nauseous, let some one know as soon as possible so we may help you out of the whirlpool. Remember to have a clinician turn the jets on before you enter the whirlpool, and turn the jets off after you are out of the whirlpool to avoid the possibility of electrical shock.

Electric Muscle Stimulation (EMS)
Electric muscle stimulation is used for two main reasons; either to decrease pain, or to cause a muscle to contract.

When electric stimulation is used to decrease pain, the effect of the current is to encourage the body's natural pain-controlling mechanisms by either blocking a pain nerve's signal or by releasing opiates (endorphins, similar to those in "runner's high".)

If your clinician thinks it is appropriate for your condition, a muscle contraction may be caused by the electric muscle stimulation. This can range from a mild twitching sensation to a strong contraction.

The treatment you will be receiving may feel unusual at first, but should never feel painful or very uncomfortable. Many patients describe the sensation as tingling, like when your foot falls asleep. Your clinician will ask if the treatment is tolerable; if you are not comfortable, let them know immediately

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