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• Raising the tolerance level for touch and desensitizing the affected area by providing sensory stimulation of increasing intensity and duration. The patient's actual participation is important since it provides motivation for success of treatment.

• Increasing functional use of the limb through:

  • increasing flexibility with increased range of motion exercises
  • increasing muscle strength with isometric exercises
  • increasing strength and flexibility through weight bearing exercises
  • exercising on a mat which provides a non-weight bearing setting
  • improving posture and balance (for lower extremity RSD)
  • movement training to teach proper movement patterns
  • gait training (if a leg is involved)
  • treatment for myofascial pain of proximal joints (the membrane that surrounds muscle tissue which can become inflamed and very painful)
  • aquatic therapy (hydrotherapy) in a pool or whirlpool offers the advantage of added resistance during exercise (with or without weight bearing) but less stress to the joints. The compression of water may also help if the limb is edematous (swollen).
  • massage therapy to manage edema or myofascial pain
  • contrast baths in warmer and cooler temperatures to help increase blood circulation to the affected limb

Motion exercises are important for the whole limb, not just for the joint that is affected, since the movement increases blood circulation around the joints which provides nutrition for the cartilage and decreases the hypersensitivity of the area. This prevents or minimizes contracture of the limb.

As mentioned above, while undergoing physical therapy, some patients benefit from drug therapy and psychotherapy so that the pain of physical therapy does not discourage them from fully cooperating and carrying out the treatment plan. Current data has shown benefit from physical therapy for the short-term but long-term benefit has not yet been determined by clinical trials.

Occupational Therapy

The role of occupational therapy (OT) is to promote functional rehabilitation by managing edema, increasing activity of the affected limb by progressive desensitization, and initiating active movement of the limb.

Management of Edema

Edema is managed by the use of:

• Special compression garments- elasticized sleeves customized to fit the patient's arm or leg
• Manual lymph drainage (MLD) is a gentle manual treatment technique that is designed to stimulate the flow of lymph from the congested area where it has accumulated into more centrally located lymphatic vessels that eventually return the lymph back into the venous circulation.

Desensitization

Desensitization of the skin (to reverse allodynia) is achieved through progressive stimulation of the affected limb using different textures such as feathers, silk, terrycloth, other cloth materials, and environmental textures.

Initiating Active Movement

The occupational therapist initiates gentle, active movement and gradually increases the intensity with functional activities such as:

• Stress loading - motion of the extremity while bearing weight, for example by executing a scrubbing motion while holding a brush. The weight of the object being held is gradually increased.
• Carrying - holding objects of increasing weight while walking, progressing to carrying a bag with objects in it while walking. This is effective for upper and lower extremities.

• Exercise - structured exercises to encourage:

  • dexterity
  • increased range of motion