Although the research shows that early diagnosis and treatment is the most successful for complex regional pain syndrome (CRPS), what do you do if you have it and what can you expect at a physiotherapy session?
Research to date have found success with the following strategies:
- Progressive-loading exercises
- Desensitization exercises with tactile materials and proprioceptive input
- Cognitive-behavioral education motivating the pts to be more active and to use the painful limb in daily activities
- Graded Motor Imagery
- Pain coping strategies
- Relaxation exercises
- Connective tissue massage
- Pain reducing modalities such as TENS
- ROM Exercises
- Posture awareness Exercises
- Functional movement patterns
- Learning how to perform activities differently
- Device advice
So what does this mean?
What this mean is when you attend a physiotherapy session after being diagnosed with CRPS you can expect a number of things. First off your physiotherapist will talk with you and get a history of your injury. He or she will then look at the injured limb, see how it is moving, see what your pain tolerance is, see what your strength is and overall just get to know you and your goals. After a thorough assessment the physiotherapist will be able to determine your best treatment options, advise you on your goals, and determine how you will meet them.
If you cannot even tolerate gentle touch most likely your first few sessions with be desensitization exercises where the physiotherapist will use different materials such as a towel or silk or something more abrasive and he or she might rub the injured limb or have you do it yourself. The purpose of this is to reteach the nerves of you injured limb to identify different sensations.
Currently the nerves in your injured limb interpret all touch as painful. Another great option for treatment would be Graded Motor Imagery. Graded Motor Imagery actually has you looking into a special mirror and using your non-injured limb to do exercises. The purpose of this exercise is to re-train your brain. By looking through the mirror the eyes are tricked by the reflection and the brain thinks you are actually moving the injured limb versus the non-injured limb pain-free.
Other things to expect from physiotherapy would be education. Your physiotherapist will be able to advise you on how to perform everyday activities easier including:
- When it will be OK to push through pain and when you should not.
- When you should use a splint or brace and when you should not.
- When you should use pain control modalities such as TENS, ice and or heat, and when you should not.
The other thing a physiotherapist can advise you on is cross referrals. Complex Regional Pain syndrome did not get its name because it is simple to treat. A multidisciplinary approach will most likely be needed and your physiotherapist can help you to get in touch with occupational therapists, pain specialists and/or psychologists. Just ensure that all specialist have the same goal and that would be restoration of your function.
By Wendi Smith
BPE, BScEd, BScAT, MPT, MClSc