H. Hooshmand, M.D.
Neurological Associate Pain Management Center
1255 37th Street, Suite B
Vero Beach, FL 32960
The best physical therapy for the patient
is alternating resting and activity without exhausting themselves. The patient
should be taught that in CRPS/RSD, no pain is all gain. This is just a sharp
contrast to the somatic pain where no pain is no gain. The patient should learn
to listen to their body, and the moment they start having pain because of
prolonged sitting or standing, or prolonged bed rest, or prolonged activity, the
patient should change position and stop the activity that is generating the
The general rule of thumb is sitting for
15-20 minutes, standing for 10-15 minutes, walking for 10-15 minutes, and lying
down at least every few hours.
The patient should understand that resting
for long hours is going to be as much if not more harmful than doing too much
If the patient wakes up in the middle of
the night because of pain or discomfort, he or she should not just lay in bed.
The patient should get out of bed and walk around. The patient will be surprised
how soon the pain improves by walking after long periods of rest.
Anytime the patient is doing physical
therapy or hydrotherapy, all the activities should be on both sides. The patient
should not apply the treatment only on the side of the body that is painful. The
main reason being that the nerves for temperature control of the body start from
the central nervous system and go all the way down to the spinal cord. So, if
the patient has a lateralized pain, spasm, or limitation of motion, the
exercises should be done on both sides, otherwise there would be a temperature
asymmetry causing improvement to temperature on one side at the expense of the
other side becoming colder. This type of bilateral exercise also prevents spread
Physical Therapy For The Upper
The patient should use all different kinds
of devices such as a tennis ball, rubber ball, silly putty, playdoh, springs,
stress ball, a warm paraffin bar in the sink for the patient to tear the bar up
into little pieces, and soaking the hands up to the forearms in the sink
containing Epsom salt and warm water.
One of the biggest risk in CRPS is frozen
should, also known as shoulder hand syndrome (The International Association for
the Study of Pain- IASP- defines shoulder-hand syndrome as a manifestation of
sympathetic nervous system dysfunction).
What is important for prevention of any
frozen shoulder is to instruct the patient to make big circles with their arm
and shoulder without flexing the wrist or elbow, and the circle should be a
large circle with the patient starting with the hand pointed to the floor, and
the reaching as far as he or she can to the ceiling and to complete the circle.
This exercise should be done at least 15-20 times, 2-3 times a day ideally.
The physical therapist should apply
hydrotherapy as well as active and passive motions of the extremities
On CRPS patients, the treating team should
realize that there is a big difference between Functional Capacity Evaluation (FCE)
and physiotherapy for the treatment of CRPS. FCE is a requirement for
occupational therapy after the patient has reached maximum medical improvement.
This is only a requirement for employment, and it is too traumatic for a CRPS
patient in the process of recovery.
Hydrotherapy is quite effective,
especially because of the fact that immersing the body in the swimming pool
reduces the effective weight of the patient by 50%. Obviously, suddenly changing
the weight from 140 pounds to 70 pounds, helps with mobilization and reduction
If the patient is intolerant of weight
bearing, he or she should be instructed to stand and walk on towels at the
bottom of the swimming pool at the shallow part of the pool. Exercise in the
pool is one of the best forms of treatment. What is important is the temperature
of the water. Ideally, the temperature of the water should be over 90º
F. Hydrotherapy in a
Jacuzzi is very effective, but the patient should drink a lot of fruit juices
before and during treatment in the Jacuzzi.
Hyperosmolar therapy refers to the fact
that some chemicals such as magnesium sulfate (Epsom salt) reduce the
neuroinflammation, swelling, as well as flexor spasm of the small joints. This
is achieved by the patient taking an Epsom salt bath in the bathtub or taking
Milk of Magnesia, no more than 1-2 ounces a day. The magnesium being a calcium
channel blocker as well as a very strong osmotic chemical extracts the calcium
and facilitates the inflow of calcium through the skin. This form of treatment
is very effective to counteract the neuroinflammatory edema of CRPS, as well as
relieving the pain.