Physical therapy wars against chik-V pain
Dr Bernadette Bryan-Frankson, Contributor
With an artillery of pain-relieving modalities, including heat ultrasound electrotherapy devices and magnetic field therapy, it's no wonder that at Physical Therapy Solutions we are seeing more patients recovering from the chikungunya virus.
With only two out of seven staff members chik-V free, we can more than empathise with individuals who have suffered the wrath of this unsuspecting illness.
On a daily basis, we now see patients returning for pains in the neck, lower back and joints. Some of these patients were previously treated for injury to these areas.
We are also seeing 'post chik-V' individuals with pain in their hands, wrists, shoulders and knees.
We decided to approach this in an evidence-based manner by first exploring the literature for answers and explanations on persisting pains in individuals who had contracted the chikungunya virus. Research articles from the National Institutes of Health library have been very enlightening.
A virus, as most people know by now, causes chikungunya, but they have little knowledge as to why they are still in pain after supposedly getting over the infection.
During the illness, deposits known as antigens are left in the lining of joints and also in the covering of tendons. Tendons connect muscles to bone and produce movement. When inflamed, movement produces pain. This is called tendonitis or tenosynovitis and is one of the commonest reasons for pain in the wrist and shoulder regions in the chik-V-infected individual.
The tendons that pass over a nerve can also become so swollen that it irritates the nerve, causing neurogenic pain. This explains why some chik-V patients are presenting with finger numbness, known as carpal tunnel syndrome.
Other patients present with joint pains that may occur either during movement, or at rest. They describe these joint pains awakening them at night and disrupting their sleep. They, quite often, had previous pains in these joints and possibly arthritic changes.
Pain in the majority will go away, but our concern is for those who are presently suffering and who may be developing secondary problems, such as muscle weakness due to lack of normal use of the limb. Weakness and joint stiffness can produce a vicious cycle of events that further complicate the existing pains, resulting in chronic problems.
The word 'chronic' refers in layman's terms to 'long-lasting' and, with chik-V, problems can extend from weeks to years.
It has been cited in the literature that the deposits that are made in the lining of the joints during the active phase of the illness can actually produce destructive changes over the long term. This may be interpreted as acceleration of the wear-and-tear changes that are normally taking place.
How can physiotherapy help? Several research publications have recommended physical therapy as a tool for managing chronic pain. Physiotherapy can be a stand-alone alternative to drugs or used in combination as a part of the management of joint, tendon and nerve-related pains.
Patients are evaluated, exploring the extent and location of pain and also how the pain has affected the strength and mobility of the joints involved.
Treatment includes the application of anti-inflammatory pain-relieving modalities. Exercise is commenced to safely preserve and restore strength.
Physiotherapists are trained to target specific muscle groups as well as to gauge the correct amount of repetitions and intensity of weights that can be applied in training.
Addressing muscle strength is a key factor to help support injured joints by taking the load from the joint.
We are not sure how Jamaica will be impacted in the long run by this giant of a virus. In countries that have been previously affected, there have been reports of long-term consequences that have impacted on quality of life.
As a nation, we should explore methods, like physiotherapy, that will have meaningful impact on improving quality of life, as we purpose to recover from the painful effects of chik-V.
Dr Bernadette Bryan-Frankson, PT DPT CLT, is a physiotherapist for more than 33 years and currently practises at Physical Therapy Solutions where she sees primarily musculoskeletal problems.