There are times in life when pain can be your friend.
Dr. Tom Roberts, an orthopedic surgeon in Conway with more than 28 years of experience, routinely takes the challenge of convincing his patients that handling pain will help them get better results. As Dr. Roberts explains it, overcoming the fear of pain is essential to recovering from injury.
Roberts and Physical Therapist Beth Milligan have spent 25 years together, building trust and helping patients over the challenges of physical rehabilitation.
They say communication is the key to overcoming pain. “As a therapist, you have to be a good communicator,” said Milligan. “Patients are afraid of pain, and you are going to have a certain level of pain during rehabilitation. Dr. Roberts and I explain what procedure was done, what the risks are, what a healthy level of pain is, and help them develop their goals for recovery.”
Roberts recalled an older patient who didn’t want to bend her fingers after surgery. He explained to her that “yes, it hurts to bend them but if you don’t you won’t be able to use them again. That’s a good pain; there is a huge psychological side to rehab,” said Roberts.
Roberts realized the importance of physical therapists to the healing process during his Sports Medicine Fellowship at Louisiana State University in the late 1980s. “We used to replace people’s knees and keep them still for a week; there were a lot of stiff knees,” he recalled.
As the orthopedic science progressed, attitudes toward rehabilitation and physical therapy began to change. “In the 90s, rehab accelerated and people got well sooner,” he said. “The basic principles are the same, but surgeons and therapists have a better understanding of how fast we can accelerate the rehabilitation process.”
New Therapy Techniques
A relatively new technique called blood flow restriction therapy allows patients to exercise at lower loads and achieve strength goals normally seen in higher intensity exercise. Certified therapists apply a special tourniquet system to surgically repaired or injured limbs during exercise. The technique was perfected by Johnny Owens, a therapist who later formed Owens Recovery Science in San Antonio. “It increases muscle fatigue and muscle size at a much lower intensity level,” explained Roberts. Milligan added, “It crosses all age groups and can be used with surgical patients as well as people with generalized weakness.
Therapists with Conway Regional Health System began using the FDA-approved Delphi blood flow restriction therapy six months ago.
“Medicine is always changing; that’s one of the things that make it fun,” said Roberts.
One of the biggest advances in orthopedics is in repair of injuries to articular cartilage. Articular cartilage is the smooth, white tissue that covers the ends of bones where they come together to form joints. Healthy cartilage in our joints makes it easier to move. It allows the bones to glide over each other with very little friction. Damaged articular cartilage can replaced by transplanting it from another area of the patient’s body or from a donor.
Cartilage is also being grown in orthobiological laboratories. In the future, Roberts predicts that labs will be able to enhance healing by using specially-modified cartilage grown in laboratories using stem cells, precursors and proteins.
Roberts and Milligan offer a few words of advice when it comes to recovery from orthopedic surgery and prevention of injury.
- Don’t compare your injury and recovery time to that of anyone else. “Every injury is somewhat different,” says Roberts. “You don’t want to set up inaccurate expectations of yourself.”
- Develop a clear understanding of personal goals for rehabilitation and understand limits. Those limits usually involve a time based component, i.e., how long to wear a brace. Roberts compares rehabilitation to baking a cake. “If you follow the instructions, it usually turns out fine,” he said.
- The most important part of a recovery plan is to trust the physician and the therapist and follow their advice.
Milligan says most injuries result from athletic or recreational sports, deterioration of physical health, and overall lack of mobility as we age. “A lot of injury prevention is understanding how lack of mobility leads to injury,” Milligan said. “A lot of us work at desks, sitting a majority of the day and don’t get the opportunity to be as mobile during the day. As we get older, muscles and joints stiffen and grow weaker if they are not used.
The best way to avoid future injuries is to make a plan to become more active by adding more activity to your day or engage in more vigorous exercise in something you enjoy.
Roberts added, “You have to make those changes with wisdom. A lot of times people injure themselves by pushing the envelope while they are trying to stay healthy.” For instance, an inactive person who tried to play basketball without warming up would be more likely to sustain an injury.
Tom Roberts, MD, is a graduate of the LSU School of Medicine. He completed a residency and internship in Orthopedics from UAMS. After completing a one-year fellowship in Sports Medicine from LSU, he taught orthopedic surgery and sports medicine at the University of Mississippi Medical Center in Jackson, MS. Since moving to Conway, he has practiced orthopedics and sports medicine for 28 years. Beth Milligan completed her Master’s Degree in Physical Therapy from the University of Central Arkansas in 1994 and has worked as a physical therapist for Conway Regional for 25 years. Together, they have led thousands of patients through successful orthopedic surgery and rehabilitation.