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Functional restoration and remobilization of the affected limb is the most important goal of therapy for reflex sympathetic dystrophy (RSD). Any other treatments, such as drug therapy, or nerve blocks are instituted in order to reduce pain so that the patient can take advantage of intensive efforts to restore function. There are four components to functional rehabilitation: physical therapy, occupational therapy, recreational therapy, and vocational therapy. Treatment should begin as soon as possible after diagnosis of RSD. Restoration of function requires active participation from the patient, not passive cooperation. They must undertake to practice skills that they learn in various therapy settings and remain motivated to move to the next level of function under the watchful eye of the therapist even though it may cause a temporary increase in pain.

Each of these functional therapies involves helping the patient increase the range of motion, strength, and flexibility of the affected limb. Although the patient may find that exercises and tasks may cause an initial increase in pain, it is important to "stay the course" and work through the difficulty since for most patients the pain will dissipate and function will return.

Some of the components of functional rehabilitation include:

• Progression from gentle movements of the limb to bearing increasing weight
• Desensitization of the limb to sensory stimuli in order to "reprogram" or "reset" the way the nervous system processes this information

Adjunct treatments for pain control may be needed if the patient does not progress at a steady rate within a reasonable time frame. In general, professionals need to be flexible regarding when to consider the initiation of adjunct treatment as some patients may derive more benefit from rehabilitation if also offered adjunct therapy (including interventional therapy) early in the treatment process. Each success in rehabilitation therapy motivates the patient to continue working towards recovery even though it may be arduous and difficult. Adjunct therapy for coexisting conditions such as depression may need to be initiated at any stage of treatment because the patient's mental and emotional health has a significant impact on rehabilitation and recovery.

The information provided in this section is based primarily on informal guidelines published in the Clinical Journal of Pain in 2006 by RN Harden et al. For further information, please click on the following link: http://www.ncbi.nlm.nih.gov/pubmed/16772795

Physical Therapy

Physical therapy is considered a most important, first-line treatment for RSD and may be employed alone or in combination with other treatments such as nerve blocks and drug therapy. The primary goals of physical therapy include:

• Restore function of the affected limb
• Alleviate pain
• Strengthen muscles in the affected limb
• Reduce swelling and joint stiffness in the affected limb

The steps to achieve these goals include:

• Raising the awareness of and educating the patient regarding the need to use the limb despite the pain. The patient participates in the process by working with the physical therapist to set goals and a timetable of increasing demand and intensity.

• Educating the patient regarding avoidance of situations that will add stress to the affected limb. It is important for all physical therapy to take place at the patient's level of tolerance since more aggressive therapy can trigger more pain and increase inflammation. Patients should also be counseled to avoid inactivity of the limb, prolonged bed rest, prolonged use of cold compresses, and bathing in water that is too cold.