CRPS is a neurologic condition characterized by prolonged and excessive pain in an area of the body that was previously injured. Sometimes the initial injury is more severe, such as a broken bone, while other times it could be a very minor injury. The pain caused by CRPS is out of proportion with the level of tissue injury existing at the moment and persists even after the original injury is healed. CRPS can occur anywhere in the body but is most common in the hand, arm, foot and leg. Common symptoms of CRPS include:

• Changes in skin temperature and skin color near the involved site
• Swelling near the involved site
• Pain that is unprovoked or spontaneous and that can worsen with activity and improve with rest. It can also spread to a larger area of the limb over time
• Symptoms that may be described at burning, pins and needles or squeezing in the area
• Changes in skin texture
• Alterations in nail and hair growth in the area
• Changes in sweating patterns in the area
• Stiffness, loss of strength and muscle wasting in the involved site

CRPS can occur in anyone but is most likely to occur in teenagers or adults 40 years of age and below. It is thought that older adults who experience less inflammation after injury may be more protected from this condition as are children who tend to heal very quickly. It is unclear why some people develop this condition while others do not, but one thing that is evident is that in cases of CRPS, damage and inflammation around the unprotected sensory and autonomic nerve fibers is involved. While inflammation or injury to a nerve may constitute the first step of developing CRPS, over time, the areas of the brain that are mapped for sensory and motor information for the involved body site can become “smudged” and the nervous system can become hypersensitized which results in pain and discomfort as a result of normally non painful movements or stimuli.

The outcomes of CRPS are highly variable and many individuals can experience frustration while looking for a solution to their symptoms. Most cases are mild and resolve over the course of a few months to years as the involved nerve continues to heal, but for those with a more severe case, a multimodal approach is often needed to manage symptoms and improve function. One of the most important factors to promote recovery from CRPS is addressing lifestyle and health factors that impair nerve health like smoking, nutrition, and diabetes. In addition to managing health factors, working with a knowledgeable physical therapist is an important tool as well.

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If you decide to work with a physical therapist to help with CRPS related issues, your entire treatment plan could consist of around 8-20+ different physical therapy sessions that will each last 60-90 minutes. Once you complete your customized physical therapy treatment plan, you will be able to continue to do the prescribed stretches and exercises utilized during your PT sessions yet in the comfort of your own home.

PHYSICAL THERAPY INTERVENTIONS FOR CRPS

As mentioned above, treating CRPS involves a multimodal approach and your physical therapist will address several key areas like those listed below, to help improve your symptoms and your level of function:

• Perception and understanding of pain
• Changes in the sensory and motor cortices of the brain
• Impairments in functional activities that require use of the involved body area
• Strength, coordination and range of motion in the involved area

Treatments for CRPS will always be individualized but several physical therapy interventions have been shown to be helpful in the management of CRPS:

Pain science education: Under normal circumstances, the sensation of pain is intended to alert you about tissue injury. In cases of chronic pain or painful conditions like CRPS, the body is experiencing pain even though the tissue injury has healed. This type of pain can have profound effects on mental and physical health and create a fear of movement. PTs help educate their patients on the science of pain to help ease their fears and allow them to begin moving normally again.

Graded Motor Imagery, Laterality Training and Mirror Box Therapy: Graded motor imagery provides a way to introduce more comfortable and pain-free movement in the setting of CRPS. When movement is imagined, the motor cortex will activate in the same way it does in response to actual movement but it does so without pain. By providing the brain with a chance to activate these areas without the coupled experience of pain and discomfort, we can help desensitize the nervous system and retrain more normal movements. Laterality training involves looking at a series of images of the involved area to determine which is a right and left limb, for example. This skill becomes impaired in many cases of CRPS likely due to the reorganization of the brain cortices and these activities help to reverse this. Finally, mirror box therapy which is carried out by placing the painful limb inside a mirrored box, can also help to reorganize the brain and lessen pain.

Range of motion, manual therapy and strength training: Disuse, pain and changes in localized nerve function can result in joint stiffness, muscle weakness and atrophy. Physical therapy aims to find tolerable ways to incorporate hands-on-manual techniques, range of motion and stretching and strengthening exercises to combat these symptoms.

Functional activities and movement retraining: gradually reintroducing comfortable movements and functional activities is a main goal of rehabilitation for CRPS. It will begin with simple activities that may be affected and work toward bigger and more complex movements that are required for every day function.

Living with CRPS can be overwhelming but a knowledgeable physical therapist can help guide you through the journey of lessening your symptoms and improving the function of the involved body area. If you are dealing with CRPS, call Evolve today to learn more about how we can help.

Call to Schedule a Consultation! 1-718-258-3300