You decide you have to change the paint color on your bedroom wall. YOU HAVE TO. You cannot spend one more day looking at the putrid green that the previous homeowner chose. You skip home from the hardware store in glee. You have found the perfect hue and you are ready to paint the day away. You won’t stop until every inch of the puke-green is gone. You wake up the next morning basking in the soft-yellow glow that is now your bedroom. You stretch your arms overhead and – oh man! Your elbow is messed up! The pain continues over several days prompting a trip to your primary care doctor. They send you to see a physical therapist for treatment of your painting injury. You’re back in ship-shape in less than a month!
This is a common way that a person might be sent to physical therapy. You strain a muscle, you talk to a doc, they send you to PT, you heal, and bing-bang-boom you’re done! Unfortunately, if you are reading my blog this story is probably not you. Often times those suffering with more mysterious onset or vague symptoms are not so quickly sent to physical therapy for treatment. In this post I want to highlight a few diagnoses that many people may suffer from but have no idea that physical therapy could help with including facial pain, pelvic pain, bowel/bladder dysfunction and Lyme disease. Note: you need to be diligent with your research, as these conditions should be treated by a physical therapist with specific training in these specialty areas.
Much (but not all) of my research on the conditions below did not list physical therapy as a possible treatment option. Let’s get the word out there and don’t be afraid to ask because…
YES! Physical therapy can help with that.
1. Facial pain
Facial pain describes a grouping of disorders that can be caused by pain in the muscles or connective tissues of the face, dysfunction in the joints of the jaw or neck, nerve irritation, or a combination of these factors. There are many conditions that fall under the umbrella term of “facial pain” but I would like to highlight a few that can be successfully helped by a physical therapist as part of a well-rounded, and multi-disciplinary treatment course.
Temporomandibular Joint Syndrome (also known as TMJ disorder) 
You can find your temporomandibular joint (TMJ) by placing two fingers on your cheek just in front of the opening of your ear and then slowly opening and closing your mouth.
The cause of TMJ pain can vary widely. Pain may occur after prolonged positioning of your jaw in an open position such as during an extensive dental procedure. Pain may be due to chronic age-related changes meaning your jaw, like any other joint, can get arthritis too. Stress is another big culprit here- it can lead to teeth grinding, either while awake or when sleeping, also known as Bruxism. This can cause strain and abnormal tension in the muscles of the jaw. Dysfunction could occur from overuse including frequently chewing gum or eating tough foods such as red meat or dense breads. Pain may start after a direct trauma to the face. As with many other chronic conditions, sometimes the cause is unclear.
TMJ disorders often manifest as pain, clicking and/or popping in the jaw exacerbated by activities such as talking, yawning or eating and can prevent people from adequately opening their mouth. Pain most often occurs on one side, but dysfunction is on both.
If you are diagnosed with TMJ disorder, a referral to a physical therapist may be indicated. Your PT will perform a detailed evaluation of your jaw as well as surrounding areas such as your neck and shoulders. Your PT treatments may include hands-on techniques performed by the PT to normalize the motion of your TMJ and release tight muscles that surround the joint, and use of modalities such as ultrasound to reduce pain and promote healing. You can also expect a whole lot of education regarding activity modification including changes to your diet and techniques to assist with stress management.
Most people have experienced a headache during their life but for some, headaches can become a nearly constant and debilitating problem.
There are many possible causes of headaches which make them very difficult to specifically diagnose and even more difficult to treat. Often the cause is multi-factorial. Note that headaches can also be result from TMJ disorders (see above!). Some headaches can be due to issues such as high blood pressure, hormone imbalances or a sinus infection so a doctor should always evaluate you first.
The exact presentation of a headache can vary greatly depending on the cause but generally encompasses pain in any area of the head.
Like many other chronic conditions the amount of resources to support physical therapy as a treatment for headaches is underwhelming, but once a medical doctor has ruled out a more serious condition, physical therapy is definitely worth a try.
For those suffering from cervicogenic, tension or even migraine headaches, physical therapy can provide enormous relief. Often those with headaches present with some form of neck, shoulder, or jaw dysfunction and benefit from a comprehensive plan to strengthen weak muscles in the shoulder or neck, release muscles that may be in spasm, and address any abnormalities in posture.
It is not unusual for a particularly tight spot in a muscle (called a “trigger point”) to reproduce headache pain when palpated by a PT. These trigger points may be in your back and neck or sometimes nowhere close to where your pain is occurring, and believe me they hurt more than you would think! Those properly trained in trigger point release can have a huge impact for treatment of chronic headaches.
Trigeminal Neuralgia (also known as Tic Douloureux and other names) 
Trigeminal Neuralgia is caused by irritation or inflammation of Cranial Nerve V, called (you guessed it) the Trigeminal Nerve.
The exact cause is unknown but the disorder has been linked to other diagnoses such as depression and multiple sclerosis and other disorders that effect the nervous system.
Pain occurs on one side of the face with pain that can radiate from above the ear to your temple, cheek and down your jaw. Onset of pain is sudden and can be severe, lasting up to several minutes at a time. This pain can be triggered multiple times per day. It can also cause spasms of the facial muscles resulting in involuntary twitches or “tics” in the face. The pain can be triggered by various (and often difficult to avoid) activities including brushing teeth, talking or even a cold breeze on the face.
This condition is often managed medically and there is very limited evidence for treatment of this condition via physical therapy. However, if medication fails to solve the problem, physical therapy may be indicated with treatment including pain-relieving modalities (use of Transcutaneous Electrical Nerve Stimulation, TENS, to calm painful nerves), application of moist heat to neck and shoulder musculature to reduce tension, gentle neck strengthening exercises, nerve desensitization techniques and education regarding activity modification and pain management strategies .
Persistent Idiopathic Facial Pain
Of course there is a category of facial pain that doesn’t quite fit the diagnostic criteria of any particular disorder. Again, as with Trigeminal Neuralgia, if conservative medical management fails and your doctor has ruled out a more serious medical condition, physical therapy is worth a try.
2. Pelvic pain and bowel/bladder dysfunction
This category covers a whole gamut of different disorders and I plan to cover them more specifically and in much greater detail in future posts. A physical therapist’s main role in this area is to assess and treat dysfunction of the pelvic floor (and maybe the rectal floor as well), which are the muscles at the base of our pelvis that are involved in bowel and bladder control and supporting our internal organs. Like any other muscle in the body your pelvic floor can be tight and in spasm, weak and undertrained, or both. This can cause an array of issues that you may not realize are actually a muscular problem.
As stated above, this category covers a wide variety of disorders all with different symptoms. For now, know that pelvic pain describes the area where the lowest part of your abdomen meets your hip joints, also known as the pelvis. Pain can vary greatly in location and type. I have additionally listed bowel and bladder dysfunction, which can include incontinence (loss of control) and urgency (having to go too much), among other issues.
Physical therapy can be immensely helpful for treatment of variety of causes of pelvic pain and other problems that involve the bowel and bladder, both of which can occur at the same time.
Many issues can be improved by daily activity and diet modifications. Your PT will additionally perform any manual work to address tight muscles and instruct you on stretches and strengthening exercises based on your diagnosis and presentation. Knowledge is power and I guarantee one trip to a PT for this type of condition will change the way you view your diagnosis.
Pelvic pain and bowel and bladder dysfunction are extremely common problems that few people are talking about and even fewer are seeking treatment for. Of course, it is understandable why. No one really wants to talk about the time they lost control of their bodily functions or their inability to enjoy sex due to pain. If you’d like to read about my struggles and triumphs with pelvic pain, find it here.
These are uncomfortable topics, sure, but with the right physical therapist I can assure that you will feel comforted, vindicated and empowered with tools to make real positive changes in your life.
3. Lyme disease 
Lyme disease is quickly becoming a more prevalent health concern, but appropriate diagnostics and treatments remain a challenge. Many of us know that we should be wary of a tick bite that results in a bull’s-eye shaped rash.
Unfortunately, this distinctive rash does not always occur (or goes unnoticed) and the diagnostics for this disease like many others are not 100% reliable. This is a difficult problem to diagnose definitively and people may therefore suffer from the repercussions of this disease for months before any treatment is initiated. In the United States this disease is most common in the North East and portions of the upper Mid West.
Lyme Disease is an infectious disease that is transmitted by ticks (Ew!).
Common symptoms of Lyme disease include: rash (that may or may not take on bull’s-eye appearance), fever, headache, neck stiffness, generalized muscle and joint aches and swelling. There are many other symptoms that can result as well including: arthritis with joint pain, facial palsy, pain in tendons, muscles, joints and bones, irregular heart beat, dizziness, shortness of breath, nerve pain, abnormal sensations or numbness/tingling in the hands or feet, and difficulty with short term memory . Yikes!
Typically when properly diagnosed Lyme can be successfully treated with antibiotics. If antibiotic treatment fails and/or symptoms persist or worsen it can lead to disorders known as post-treatment Lyme disease (PTLDS) or chronic Lyme disease (CLD). This is generally the time those suffering from Lyme disease may be sent to PT.
As seen above, Lyme disease can cause a variety of problems. Evidence shows that physical therapy can be of great help for the musculoskeletal problems involved including treatments such as: gentle strengthening and stretching program to improve deconditioned or underused muscles, hands on techniques to reduce tension and pain in muscles or connective tissue, and modalities such as ultrasound to reduce pain and promote healing.
My doctor thinks I may need PT, now what?
Your doctor may know of a particular clinic nearby that is well versed in the area you need help with so make sure you ask— this is certainly the most reliable route and best first step.
Another great resource is the website for the American Physical Therapy Association (APTA). They have a search engine to assist you called “Find a PT”. Here you can search a directory of PT’s by the region you are living in.
In more rural areas you may need to consider traveling a further distance to find a physical therapist who specializes in what you are seeking treatment for. You can then further filter your search by practice area.
To find a PT for treatment of pelvic pain or bowel/bladder dysfunction, search for a therapist who specializes in “Women’s Health”.
Finding a therapist who is well trained in treatment of certain facial pain diagnoses or Lyme disease may be trickier. A general Internet search can be helpful after which you should reach out to the clinic directly to ask them if they are able to accommodate your needs. If they are not, hopefully they know who the experts in the area are!
Seeking help for a chronic condition is never easy, but I hope that by following the guidance outlined in this article the process will be a little easier.
- See a doctor to rule out a more serious medical condition.
- Ask if they believe a physical therapy referral may be indicated in your case.
- Seek out a physical therapist well trained in the area you need help with.
- Stay positive and commit to the program prescribed by your PT.
1. TMJ (Temporomandibular Joint and Muscle Disorders). Last updated: February 2018. Retrieved from: https://www.nidcr.nih.gov/health-info/tmj/more-info
2. Trigeminal Neuralgia Fact Sheet. Last updated: May 10, 2017. Retrieved from: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Trigeminal-Neuralgia-Fact-Sheet
3. Khanal D, Khatri SM and Anap D (2014) Is there Any Role of Physiotherapy in Fothergill’s Disease? J Yoga Phys Ther 4: 162. Doi: 10.41722157- 7595.1000162
4. Lyme Disease. Last updated: January 19, 2018. Retrieved from: https://www.cdc.gov/lyme/index.html
5. Signs and Symptoms of Untreated Lyme Disease. Last updated: October 26, 2016. Retrieved from: https://www.cdc.gov/lyme/signs_symptoms/index.html