Physical Therapy vs Opioids: When to Choose Physical Therapy for Pain Management


According to the Centers for Disease Control and Prevention (CDC), sales of prescription opioids have quadrupled in the United States, even though “there has not been an overall change in the amount of pain that Americans report.”

In response to a growing opioid epidemic, the CDC released opioid prescription guidelines in March 2016. The guidelines recognize that prescription opioids are appropriate in certain cases, including cancer treatment, palliative care, and end-of-life care, and also in certain acute care situations, if properly dosed.

But for other pain management, the CDC recommends non-opioid approaches including physical therapy.

Patients should choose physical therapy when …

  • … The risks of opioid use outweigh the rewards.
    Potential side effects of opioids include depression, overdose, and addiction, plus withdrawal symptoms when stopping opioid use. Because of these risks, “experts agreed that opioids should not be considered firstline or routine therapy for chronic pain,” the CDC guidelines state. Even in cases when evidence on the long-term benefits of non-opioid therapies is limited, “risks are much lower” with non-opioid treatment plans.
  • … Patients want to do more than mask the pain.
    Opioids reduce the sensation of pain by interrupting pain signals to the brain. Physical therapists treat pain through movement while partnering with patients to improve or maintain their mobility and quality of life.
  • … Pain or function problems are related to low back pain, hip or knee osteoarthritis, or fibromyalgia.
    The CDC cites “high-quality evidence” supporting exercise as part of a physical therapy treatment plan for those familiar conditions.
  • … Opioids are prescribed for pain. 
    Even in situations when opioids are prescribed, the CDC recommends that patients should receive “the lowest effective dosage,” and opioids “should be combined” with nonopioid therapies, such as physical therapy.
  • … Pain lasts 90 days.
    At this point, the pain is considered “chronic,” and the risks for continued opioid use increase. An estimated 116 million Americans have chronic pain each year. The CDC guidelines note that nonopioid therapies are “preferred” for chronic pain and that “clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient.”

Before you agree to a prescription for opioids, consult with a physical therapist to discuss options for nonopioid treatment.

“Given the substantial evidence gaps on opioids, uncertain benefits of long-term use and potential for serious harm, patient education and discussion before starting opioid therapy are critical so that patient preferences and values can be understood and used to inform clinical decisions,” the CDC states.

Physical therapists can play a valuable role in the patient education process, including setting realistic expectations for recovery with or without opioids.

Compliments of Move Forward: Physical Therapy Brings Motion to Life

Tips to Prevent Skiing-Related Knee Injuries

The most common injuries in skiing happen to the lower limb, most commonly the knee. The introduction of releasable bindings has decreased the rate of leg fractures by 90% in the past 30 years, but knee sprains (including ACL and/or MCL tears) are on the rise accounting for about 30% of all skiing injuries.

The most common injury is the medial collateral ligament (MCL) tear, which is typically treated without surgery.  In skiing, the MCL is often torn when the ski tips are pointed toward one another in a snowplow position (the common slow or stop position) and the skier falls down the hill. MCL tears are more common among beginning and intermediate skiers than advanced and elite skiers.  When skiing you may prevent an MCL tear by:

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6 Tips to Shovel Snow Safely

Snow shoveling is a repetitive activity that can cause muscle strain to the lower back and shoulders. Back injuries due to snow shoveling are more likely to happen to people who may not know that they are out of condition. Following these tips can help you avoid injuries:

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Family Tips For an Active Lifestyle

Making a commitment to be physically active is one of the best ways families can prevent or combat obesity and its consequences. Physical therapists support the Department of Health and Human Services’ Physical Activity Guidelines, which states:

  • Children should get 1 hour or more of physical activity a day.
  • Adults should do 2 hours and 30 minutes a week of moderate-intensity, or 1 hour and 15 minutes a week of vigorous-intensity aerobic physical activity.

The following tips were designed by physical therapists to help families stay active and incorporate physical activities into their daily lives:

“Smart Moves” for Families

  • Plan weekend family activities involving physical activity, such as hiking, swimming, bicycling, mini-golf, tennis, or bowling.
  • Help your child plan physical activities with friends and neighbors, such as skating or softball.
  • Have your kids brainstorm a “rainy day” game plan of indoor activities involving fitness games such as Wii Fit or Dance Dance Revolution.
  • Remember that your family does not need to join a health club or buy fancy equipment to be active. Walking isn’t costly and it’s easy. So is designing a backyard obstacle course. Weights can be made from soda or detergent bottles filled with sand or water!
  • Provide positive rewards for your child when he or she engages in physical activities, such as workout clothes, a new basketball, or an evening of roller-skating.
  • Provide positive feedback about your child’s lifestyle changes. Remember not to focus on the scale (for you or your child).
  • Be your child’s “exercise buddy.” Plan daily walks or bike rides and set goals together for increasing physical activity rather than for losing weight. It’s also great “bonding” time!
  • As you schedule your child’s extracurricular activities, remember to plan time for exercise and activity as a priority for the entire family. Don’t just “squeeze it in.”
  • Encourage children to try individualized sports such as tennis and swimming. Studies show such activities are the basis of lifelong fitness habits.
  • Parents and children can do exercises while watching television (or at least during commercials), such as sit-ups, push-ups, or running in place. Discourage snacking or eating meals while watching.

Compliments of Move Forward PT: Physical Therapy Brings Motion to Life

Physical Therapists’ extensive knowledge of pre-existing conditions (such as type 2 diabetes and obesity) allows them to help people of all ages and abilities establish life-long patterns of physical activity. For those who already are obese, physical therapists can devise safe exercise programs that reduce pain, restore flexibility, and increase strength and cardiovascular endurance. For people with type 2 diabetes, they can design and supervise exercise programs that reduce the need for medications, lower the risk of heart disease and stroke, and help manage glucose levels, among other benefits.

Physical Therapist’s Guide to Knee Pain

Knee pain can be caused by disease or injury. Among American adults, approximately 25% have experienced knee pain affecting the function of the knee. The prevalence of knee pain has increased over the past 20 years, with osteoarthritis being the most common cause in individuals over the age of 50. Knee pain that is caused by injury is most often associated with knee cartilage tears. Knee injuries can occur as the result of a direct blow or sudden movement that strains the knee beyond its normal range of movement. Knee pain can cause difficulty performing activities such as walking, rising from a chair, climbing stairs, or playing sports. Physical therapists are specially trained to help diagnose and treat knee pain, and help individuals return to their normal activities without pain or limitation.

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Soreness vs. Pain: What’s the Difference?

There are many benefits to exercise, including the potential for improved physical and mental wellbeing. However, there may also be some physical discomfort associated with these activities due to the stresses placed on the body.

When experiencing discomfort, it is important to understand the difference between exercise-related muscular soreness and pain. Muscular soreness is a healthy and expected result of exercise. Pain is an unhealthy and abnormal response. Experiencing pain may be indicative of injury.

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