Disclaimer: The following neither contains medical or legal advice but is for Informational Purposes Only. Consult a medical professional or attorney for your unique situation.

Physical therapy and chiropractic care are two-way processes. It’s an interaction between the care provider and patient that changes over time depending on the nature of the health issue, and other factors such as a patient’s age, sex, body weight, comorbidities and recovery progression.

Treatment guidelines and therapists take into consideration all these factors when determining what is the best treatment protocol for each individual.^1,2,3,4

Immediately after the injury, the body’s repair mechanisms kick in and the process of inflammation, healing, repairing, and scarring begins. As mentioned above, the choice of treatment depends on which of these phases the patient is currently going through. If, for example, a sprained ankle is in the stage of acute injury, the treatment choice won’t be the same as if the treatment goal is to restore the function after an injury that took place one year ago.²

In this article, we will discuss how gaps in physical therapy and chiropractic care can hurt your chances of recovery.

Timing Is Crucial for Successful Rehabilitation

When it comes to physical rehabilitation, doing something at the wrong time does more harm than good. As we mentioned above, the process of healing goes through various stages.

Early after establishing the diagnosis and setting an indication for rehabilitation, the treatment goal is to limit the swelling, slow down muscle atrophy, and promote healing as much as possible. Most often, this includes PRICE acronym (protection, rest, ice, compression, elevation). Pushing too hard at this phase can result in suboptimal healing and excessive scarring. Although the problem might not be so apparent at the moment (because of pain and limited range of motion), it will become evident something went wrong when the rehabilitation moves to another phase. Gaps at early treatment can end up as permanent, severe or moderate reduction of function of an injured joint/ limb/ part of the body.⁵

Later, as the acute reaction to the injury fades away, reconditioning comes into place. The goal of this phase is to carefully and gradually increase the range of motion and muscle strength. Injured ligaments, tendons, and muscles after the prolonged period of rest lose some of their flexibility, tone, and range of movement. Gaps in this phase of rehabilitation not only slow down the progress with permanent consequences but can cause a re-injury and reset the entire rehabilitation process. Although the exercises and treatments within the physical and chiropractic practices might look like a pre-defined set of steps, they are not. Each session is tailored to each individual patient.⁶

Body movements are coordinated by multiple centers in the brain. The brain’s body schema is a kind of operating system; even when injured tissues heal, full restoration of their function involves the rearrangement and adaptation of body schema in the brain. Physical and chiropractic treatments take this fact into consideration as well, and some of them target this specific aspect of body movement.⁷

What’s the Price of Gaps in Physical Therapy or Chiropractic Care?

A large number of problems can emerge from incomplete or irregular rehabilitation. Some of them might be mild, limiting only extreme physical activities such as vigorous exercise, while others can severely interfere with quality of life. Due to a wide range of pathologies and body parts that can be affected, we will briefly mention only those that are the most frequent.

Pain

Pain can derive from many anatomical structures, and it’s never a part of the expected treatment outcome. The severity of it may vary, from unpleasant feeling during periods of exhaustion to throbbing pain that lowers quality of life. Treating it often requires the use of medicine with serious adverse side effects that can lead to further health deterioration.

Limited range of movement

Basically, the scarring process is what causes a limited range of movement in the joint. Sometimes the limitation is accompanied by pain, and sometimes it manifests only as a disability to reach a certain position amplitude of movement. Depending on the patient’s profession, it can reduce working ability, or cause early retirement.⁹

Degenerative changes in the musculoskeletal system

Reduced function of the soft tissues quite often requires compensation and adaptation of the skeletal structures around the injured joint or bone. In plain language, this means hardening of soft tissues. These problems can lead to painful conditions such as arthrosis, and sometimes require surgical intervention.

Back pain

Back pain is a well-known complication of suboptimal treatment outcomes (gaps in therapy) of injuries in the lower portions of the body. To maintain upright posture, the body needs a center of balance. Whenever this center is shifted (due to a dysfunctional knee joint, for example), the spinal column compensates the shift by bending to the opposite direction. The lower back is the most vulnerable to these changes and often a poorly healed knee results in chronic back pain within a couple years after the knee injury.⁸

Contractures

The process of healing, ideally, is finished with minimal scarring. Although a scar is a physiological repairing mechanism (not a pathological entity), the scar tissue has suboptimal performance compared to any other tissue (skin, ligaments, tendons, muscles). Because it has reduced flexibility, whenever it establishes in the area of joint connective and supportive tissues, it results in reduced range of motion. In some cases, it prevents the joint from taking its physiological position; when relaxed, a foot, knee, or a finger (or any other affected limb) bends which results in impaired function.^8,9

References

1. Anderson-Peacock E, Blouin JS, Bryans R, Danis N, Furlan A, Marcoux H, Potter B, Ruegg R, Gross Stein J, White E. Chiropractic clinical practice guideline: evidence-based treatment of adult neck pain not due to whiplash. JCCA J Can Chiropr Assoc. 2005;49:158–209.
2. Bono CM, Ghiselli G, Gilbert TJ, Kreiner DS, Reitman C, Summers JT, Baisden JL, Easa J, Fernand R, Lamer T, Matz PG, Mazanec DJ, Resnick DK, Shaffer WO, Sharma AK, Timmons RB, Toton JF. North American Spine S. An evidence-based clinical guideline for the diagnosis and treatment of cervical radiculopathy from degenerative disorders. Spine J. 2011;11:64–72. doi: 10.1016/j.spinee.2010.10.023.
3. Childs JD, Cleland JA, Elliott JM, Teyhen DS, Wainner RS, Whitman JM, Sopky BJ, Godges JJ, Flynn TW. American Physical Therapy A. Neck pain: clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2008;38:A1–A34.
4. Chou R, Huffman LH. American Pain S, American College of P. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007;147:492–504.
5. The Effectiveness of Physical Agents for Lower-Limb Soft Tissue Injuries: A Systematic Review. Yu H, Randhawa K, Côté P, Optima CollaborationJ Orthop Sports Phys Ther. 2016 Jul; 46(7):523-54.
6. The Relationship Between Training Load and Injury, Illness and Soreness: A Systematic and Literature Review. Drew MK, Finch CFSports Med. 2016 Jun; 46(6):861-83.
7. Takeuchi, N., Izumi, S. I., Ota, J., & Ueda, J. (2016). Neural Plasticity on Body Representations: Advancing Translational Rehabilitation. Neural plasticity, 2016, 9737569.
8. Shipton E. A. (2018). Physical Therapy Approaches in the Treatment of Low Back Pain. Pain and therapy, 7(2), 127–137.
9. Page P. (2012). Current concepts in muscle stretching for exercise and rehabilitation. International journal of sports physical therapy, 7(1), 109–119.

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