Peripheral Arterial Disease: Benefits of Physical Therapy

Peripheral arterial disease (PAD) can be a devastating disease. Many people lose the ability to walk beyond one or two blocks, walk on family vacations, go shopping, or enjoy an evening stroll. PAD is more common than one might think. It is estimated that 10 million people in the U.S. are afflicted with PAD. Of these, only 1.25 million have been diagnosed and are receiving treatment.

PAD can have a large effect on one's lifestyle. Because of decreased walking ability, people with claudication (leg pain from PAD that occurs with walking but goes away quickly with resting) have a lot of difficulty in carrying out routine daily activities. Not only walking, but housecleaning chores, mowing the lawn, grocery shopping, community activities, and family vacations may be affected. Over time, decreased strength and lowerextremity decreased range of motion (the amount a person can move the leg, ankle, and foot joints) can cause simple activities such as climbing stairs or getting up from the floor to become extremely difficult, if not impossible. Many people become housebound or dependent on others. Physical therapy may help many people with PAD to increase their walking ability and, ultimately, to improve their quality of life.

How can physical therapy help people with PAD? First, a physical therapy evaluation needs to be performed. During the evaluation, the physical therapist measures many things that might affect physical ability. Over time, a lot of people with PAD exhibit decreased strength, decreased range of motion in the joints, balance problems, gait disturbances (ways of walking that are incorrect), decreased sensation (especially with diabetes), soft tissue tightness, decreased flexibility of the muscles, and poor posture. Careful consideration is given to the person's present physical condition, current medications, other diseases or medical problems, and past medical history. The physical therapist examines each of these in detail and decides upon a treatment plan which is specific for each person.

In someone with PAD, it is common to find a decrease in the strength of the lower extremities, especially in the hips and calves, as well as decreased flexibility. Balance is also often affected in the legs. Decreased balance may increase the risk of falls, which may lead to fractures in patients with osteoporosis. Changes in the gait, or walking pattern, can be present, making it more difficult to walk and increasing the energy used during walking. This causes a person to tire more quickly and shortens the distance that can be walked. Poor posture from a sedentary lifestyle can also make walking more difficult.

People also need a safe walking program that will help increase their walking distance. Patients who once were able to walk only one or two blocks can often double or triple their walking distance. A few have been able to work up to walking one or two miles with proper therapy, although such big improvements have not been supported in controlled scientific studies. A good walking program can dramatically decrease leg pain and increase the distance walked before the pain occurs. Here, a word of caution is needed: An individual should NEVER walk on a treadmill or start a walking program without knowing his or her heart status. Many people with PAD may have heart disease; indeed, the possibility of a heart attack is increased in this group. It is very important to check with one's doctor before beginning any walking or exercise program.

A physical therapist can work to resolve these problems and is highly qualified to help people start a safe, effective home exercise program. Many physical therapists see geriatric patients and are familiar with the symptoms and problems associated with PAD.

Typically, physical therapists use many "hands-on" techniques to correct soft tissue imbalances and to help loosen tight joints. These techniques help the patient reach the goals that were decided upon during the initial evaluation.

A team approach is optimal for the treatment of PAD. The vascular specialist, the physical therapist, and the patient all work together on a treatment plan. Medications and other medical problems may interfere with exercise, so it is essential to have a thorough medical history and physical examination prior to starting physical therapy. Reducing the patient's risks for cardiovascular disease should also be included in any treatment plan for PAD along with a regular exercise program.

Ask your doctor today if physical therapy can help you begin a walking and exercise program—it's never too late to start! Unfortunately, insurance and Medicare do not always cover these programs, so check with your insurance plan and doctor before starting the program.

About the Author: Janis Stradley, DPT, is a physical therapist at Performance Physical Therapy, Inc., in Redlands, California. Dr. Stradley has been treating patients with peripheral arterial disease and working with the vascular surgeons at Loma Linda University Medical Center in Loma Linda, California, for several years. She has evaluated over 200 patients with PAD.