Ask the Physical Therapist: Inversion tables, trigger points, and chronic pain management

The following is a transcript of a question-and-answer session, conducted over the FSH Society’s Facebook page, with Julie Hershberg, PT, DPT, NCS. Hershberg is a physical therapist who is a Board Certified Neurologic Specialist.  She practices at [re+active] physical therapy & wellness and is an instructor in Doctor of Physical Therapy program at USC.

I recently was examined by a physiatrist. Her report has recommended ongoing therapy plus she’s suggested an evaluation at a pain clinic and possible destroxe prolotherapy and/or trigger point injections. Do you know of any studies/reports about this type of treatment for someone with FSHD (or related conditions)?      Here’s the link to their website: http://www.bowlermedical.org/. The physician page and FAQ page provide information/articles relevant to their treatments.

First of all—so glad that you are working with a physiatrist and specialty clinic for pain—these are great steps toward better health.  There is not specific research regarding FSHD and trigger point or prolotherapy injections. However, there is also not evidence that either of these would be particularly detrimental to people with FSHD.  Trigger point injections are usually an anesthetic and therefore the mechanism of action is at the level of the nervous system rather than the muscle.  The prolotherapy injections are typically also not done directly into muscle and include concentrated dextrose and an anesthetic.   In regards to management of chronic pain, there is evidence that  biopyschosocial factors should be considered in the management of chronic pain for people with FSHD (Miro et al, 2009).  In fact, there is evidence for this approach for all people with chronic pain. I would recommend you inquire about incorporating addressing biopsychosocial factors  as part of your comprehensive pain management program. 

I’m watching a program on an inversion table. I was wondering if that would help or hurt us FSHers? It looks like a great way to twist and stretch the back out (which feels SO good) and helps with respiratory by opening the lungs up–which is hard to do by myself! Any idea if an inversion table would be good for us or have negative effects?

My first question is: have you tried one?  Most people either have a strong aversion or a love of the inversion table just based on personal preferences.   Inversion tables are a form of spinal traction.  Spinal traction most likely stretches the muscles around the spine and can temporarily relieve muscles spasm.  While spinal traction makes us temporarily feel very good, it does not provide long term relief (a Cochrane review in 2006 concluded that there was not evidence to recommend it for the treatment of low back pain).   There are some risks to be aware of with use of an inversion table:  it raises blood pressure, lowers heart rate and increases pressure in the eye.  It is recommended to not use an inversion table if you’re pregnant, have high BP, heart disease, glaucoma or any other eye disease. 

Overall I would recommend that you might try it with a physical therapist under supervision and incorporate it as part of a comprehensive program for low back pain.