Physical therapist Beth Winkler-Schmit, a
fellow in the American Academy of Manual Physical Therapy, discusses rehabilitation
philosophies and techniques she employs at Wellnessworks Advanced Physical Therapy
(990 N. Corporate Drive, Harahan, 733-0254).
Q: Does physical rehabilitation include helping patients recover from any
kind of injury, including those suffered as a result of sports, accidents, surgery
or stroke?
A: Yes. I do mostly motor vehicle accidents and sports injuries. Mostly,
unfortunately, motor vehicle accidents.
Q: What is your approach to rehabilitation?
A: It's really starting slow, to their pain tolerance. The old philosophy
of "No pain, no gain" doesn't apply to physical rehabilitation. It's hard to
get patients to understand that. If you push the tissues too much, you'll either
stay in the same place, or they'll regress.
Q: Do you do nutrition counseling and lifestyle work with patients?
A: Definitely lifestyle work and changes, depending on what their occupation
is. If they're sitting at a desk all day, we'll change where their keyboard
is or their chair ... make things ergonomically correct. If they work where
they're bending and lifting a lot, we'll have to modify that as well if they're
irritating [their injury]. Nutrition is a whole other ballgame; we're not licensed
to give nutritional advice.
Q: Are a lot of sports injuries caused by people over-exerting themselves
when they're out of shape?
A: Exactly. It's usually overuse. I see a lot of younger kids, high
schoolers, with swimming injuries, rotator cup injuries from overuse, a lot
of throwing inuuries: baseball, javelin or football. Also from backpacks. Kids
come in with these backpacks, where they have to lean over all the way to carry
all the books. Then there's contact sports such as football; you can leave to
your imagination how they injure themselves there.
Q: What is the No. 1 thing that sends people into rehabilitation at your
clinic?
A: Motor vehicle accidents. It's mosly lower back pain and whiplash.
Whiplash is very real; it's usually from being hit from behind. Usually, the
people being hit are the ones who complain of pain.
Q: Is that because they brace themselves and tighten up their muscles?
A: There's still an argument over whether it's worse to brace yourself
or not to know [the impact] is coming.
Q: How many of the physical problems result from excess weight?
A: I would say mostly hip and knee problems. Our knees, because when
we walk one knee (at a time) has to withstand the total weight of our body when
we take a step.
Q: What do you do for that?
A: A lot of it is trying to heal the tissue and trying to get the knee
muscles stronger to withstand the weight of the body. We have a treadmill un-weighting
system where the person gets on a treadmill and there's a compressor that takes
some of the weight of the body off their knees while they exercise. That really
helps. A lot of times, they want to lose weight so their knees get better, but
it hurts when they exercise. We also use aquatic exercises in a pool; that's
really good as well.
Q: What's the key to successful physical rehabilitation?
A: Compliance, getting them in here and then getting them to do some
things at home. Once they see the benefits of what exercise can do, they're
more likely to continue. You have to be kind of a sales person to get them to
believe in their mind and heart that they can get better.
Q: What circumstances can make success more difficult?
A: Negative attitude. Thinking that "nothing can help me and I'm never
going to get better." I think I might see that more in patients who have been
sent to [some other physical therapy center] and haven't been helped. I'm sometimes
considered the last resort before surgery or something else. People put a lot
of faith in me, but if they have faith in themselves they do really well. It's
a team effort.
Q: Dispell some misconceptions for us. Is it best to put ice on sprains,
heat on sore muscles and soak swollen feet in Epsom Salts?
A: Usually, the first 24 hours after an injury is ice, then heat is
after that. That is very arguable, though. If you talk to five different therapists,
they may tell you something different. This is my personal preference. Another
common misconception of physical therapists is that we just do massage or just
do exercise, but we incorporate everything into it: massage, joint mobilization,
you have to analyze people's gait to determine what muscle imbalances they have,
and set up a physical therapy program.
Q: Do you deal with children?
A: For orthopedic disorders, anything going on in the joints, yes.
If they're developmentally delayed, that's a whole different realm.
