RSD Puzzle #006

H. Hooshmand, M. D.

DIPLOMATE AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY

BOARD CERTIFIED IN ELECTROENCEPHOLOGRAPHY

BOARD CERTIFIED IN ELECTROMYOGRAPHY

BOARD CERTIFIED IN AMERICAN BOARD OF ELECTODIAGNOSTIC MEDICINE

INTRACTABLE NEUROLOGY

EPILEPSY, PAIN, MS

An International Referral Center dedicated to Treatment, Education and Research

RSD PUZZLE #6
Physical Therapy

"There have been references in the literature that physical therapy can aggravate pain and RSD. Yet in every outline of treatment for RSD, the use of physical therapy is emphasized. These two statements seem to be contradictory."

Both statements are absolutely true. Excessive exercise and physical therapy that causes fatigue, pain, and distress to any part of the body, only flares-up and aggravates the inflammation and pain of RSD. On the other hand, the commonest aggravators of RSD are bed rest, inactivity, application of ice, and the use of assistive devices. In RSD, the best treatment is eustress not distress.

Distress refers to the stress of prolonged bed rest and inactivity. Like any other machine, prolonged idling of the body is distressful and causes damage to the body. Especially in RSD, the prolonged bed rest results in aggravation of pain and insomnia. The RSD patients suffer from severe, chronic insomnia due to the constant allodynic pain as well as due to the aggravation of constriction of blood vessels secondary to inactivity. One of the earliest signs of RSD is a restless night with the patient constantly being fidgety and changing position all night as well as having to get up and walk to get some relief.

The second form of distress is too much exercise, prolonged physical therapy.

The RSD patient has to learn that they will have pain with too much exercise, and the patient will have more pain without exercise. The patient will have to find a happy medium. The patient will have to rest and exercise frequently. Three days a week in the P.T. Department is not enough. The RSD patient should continue the instructions of the physical therapist from morning to night with equal periods of rest and exercise. The patient should learn from the human heart which beats approximately once a second for 80 to 90 years without taking a vacation. The reason is the heart beats half a second and rests half a second. The same principle should apply to physical therapy in RSD.

H. Hooshmand, M.D.

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