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Can obesity hinder physical therapy?

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It is with all possible sensitivity that this article is written. Its purpose is to explore how obesity might affect movement assessment and corrective therapies. For the person of near-average weight experiencing musculoskeletal discomfort, there are numerous effective modalities to address their discomfort and/or ease their pain. But in the presence of excess adipose (fatty) tissue, as in the obese, the administration of soft-tissue therapy becomes a challenge and perhaps, less effective.

On the “Associated Bodywork and Massage Professionals” website, Liz Prato has written a comprehensive piece for massage therapists entitled “Working with Obese Clients” (1). Most of the article is written for the professional. It addresses special modifications in technique, and how to make the experience easier for the client. But within the article she covers some other interesting points. Among them:

  • Many obese clients report a constant, low-grade pain
  • The joints of the obese; shoulders, hips, knees, are prone to pain
  • Fluid retention, edema, can decrease the range of motion in the limbs
  • High blood pressure can be an issue
  • Sheer physics can put the body worker at a disadvantage, lessening the effectiveness of treatment

In looking at the list above, we can see that one or more of these conditions could make treatment challenging, or at least make a practitioner’s findings difficult. One of the first challenges would be in assessment.

Many physicians, therapists, and trainers use some form of postural or movement assessment to try to narrow down the reasons for a person’s pain. Among the simplest forms of these assessments is the Single-Leg Stance. To the therapist, it can reveal a great deal of information in a very short time. But as concluded in a study on the “PlosOne” website, “…Obese patients needed more attentional resources to control postural stability during unipedal [Single-leg] stance than non-obese participants.” (2) The findings mean that an inordinate amount of energy is spent by the individual in simply standing on one leg. In a clinical setting, it means that the therapist would need additional time to further assess whether an unstable single-leg stance is due to a muscular or joint problem or to the obese condition.

Findings from another study found “…Obese subjects were inferior to normals in ability to make sensory discriminations…” (3). (It must be noted that “normals” in this context is a scientific reference to the control group and does not imply that the obese are not normal). The proprioception of the obese group was found to be diminished. Proprioception is the body’s ability to determine where it is in space, and also the position of various limbs and joints relative to the body. Why is proprioception important in therapy?

In one of the more effective therapies, Neurokinetic Therapy™ (NKT™), manual muscle testing is used by the therapist in order to more accurately diagnose. An essential part of this muscle testing is that the therapist receives good feedback from the client, as they are an integral part of the therapy. Pain threshold and joint range of motion both factor into treatment. A person with chronic low-grade pain and diminished proprioception could still be effectively treated, but the diagnosis could be less accurate, or, at least, more time-consuming.

Corrective exercises are also utilized both in NKT™ and in other forms of therapy. Their purpose is to reinforce the work done in the clinic and to make the client’s improvement more permanent. Accuracy in these exercises is necessary. Without supervision, corrective exercises performed by a person with reduced proprioception can be detrimental, or, at the very least, ineffective.

There are absolutely cases of obesity that are not matters of lifestyle. But this piece was written for cases of obesity brought on by poor lifestyle choices, as if we needed to discourage the condition further. Carrying extra bodyweight puts unnecessary stresses on muscles and joints, causing dysfunctional movement, pain, and premature joint failure. So not only does obesity contribute to aches, pains, and a poorer quality of life, it would also seem to make correcting those conditions more difficult and costly.

References: (1) http://www.abmp.com/textonlymags/article.php?article=429

(2) http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0014387

(3) http://www.ncbi.nlm.nih.gov/pubmed/6664791

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