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Occupational and Physical Therapy:  A consumers guide  Lois Copperman, PhD, O.T.R., Cinda Hugos, M.S.,P.T.  Oregon Health Sciences University 1. What are the differences between Occupational Therapy (O.T.)and Physical Therapy (P.T.)?  Both O.T. and P.T. require a physician’s referral. Check your insurance company regarding your coverage. O.T. - Upper body pain issues including stretching and strengthening exercises along with instruction in Spray and Stretch for home management of neck/shoulder/upper back pain. The O.T. also addresses modifying daily activities at home and work to decrease pain, posture and positioning issues, managing fatigue, compensating for cognitive problems and recommending equipment/positioning to decrease pain. P.T. - Lower body pain issues including stretching, strengthening and endurance exercises along with instruction in Spray and Stretch for home pain management. The P.T. also addresses equipment for exercise programs and corrective devices for walking problems/foot pain. Posture and positioning issues are also covered by the P.T.  - Lower body pain issues including stretching, strengthening and endurance exercises along with instruction in Spray and Stretch for home pain management. The P.T. also addresses equipment for exercise programs and corrective devices for walking problems/foot pain. Posture and positioning issues are also covered by the P.T.     2. Choosing your therapist All therapists are not the same. To improve the odds that you are getting effective treatment, try taking an active role in the selection of your therapist. To be a smart consumer, we suggest that: When your physician recommends a therapist, ask if the physician has sent other patients with fibromyalgia to that therapist. Did they have good results?  When calling to make your initial therapy appointment, ask for an appointment with the therapist who is the clinic’s "expert" in fibromyalgia treatment;  If you still have doubts, ask the therapist you are scheduled to see to call you OR at the first visit ask the following questions (These questions assume you are starting a new exercise program): a. Does the therapist emphasize techniques that you can use independently at home or does she/he use techniques that require that you see the therapist to gain pain relief? We feel the most effective long-term treatment emphasizes teaching you techniques that you can use independently in your daily life. Passive treatments -- where the therapist manipulates your muscles -- are good for short-term relief or when you are having a flare. However, over the long-term, treatments, which depend on therapy visits, are not cost effective or convenient. Your health insurance carrier is also unlikely to be willing to pay for "maintenance" therapy. b. How would the therapist start you on an exercise program? What sorts of aerobic exercise does the therapist usually recommend for fibromyalgia? How quickly do they recommend you begin a new exercise program? If the therapist recommends beginning impact exercise or recommends starting with 20-30 minutes a day of any new exercise, a warning flag should go up.  c. How would the therapist start you on stretching exercises? Does the therapist caution you to start with a minimal number of stretches, at a low intensity and for a short period? Or, do they recommend that you stretch as much as you can? Do they provide handouts or videos demonstrating the stretches for your home program? Generally, if a therapist does not caution you to begin very slowly with a minimal number of stretches for a short period, this should be another warning flag. If you don't have a stretching program and the therapist at the first visit asks you to do more than multiple repetitions of any stretch or exercise, DON'T do it! If a therapist starts your exercise program very aggressively, YOU are likely to hurt. If you hurt, you are not likely to develop a successful exercise program. Either ask for another therapist; jointly agree to reduce the number of repetitions, the positioning and/or the length of the exercise. Generally, you want to start stretching and aerobic exercise programs before a strengthening program.   3. Self management versus therapist management At OHSU, the O.T. and P.T. emphasize teaching you techniques to manage your pain. Although muscle mobilization, massage and other techniques may be provided for a short period - especially to help you get relief during a FM "flare"- we do not believe that therapy which requires you to continue to see the therapist for relief is very effective over the long-term. Our roles as therapists are to provide you with the information you need to manage your pain, fatigue and other issues. We emphasize teaching you techniques, exercise programs, Spray and Stretch and activity modifications which you then apply in your home and work settings. Together, we analyze the equipment you use at home and work and come up with recommendations for new office equipment, home seating, alternative positioning and other recommendations. If possible, we identify stores where you can try different alternatives and help connect you with resources to purchase equipment.  4. Number of Therapy Visits The number of visits you require will, of course, vary depending on your individual therapy needs. A therapist generally can develop an exercise program, analyze activities and recommend equipment in four to six visits. Once these basics are established, the therapist usually will want to see you again after one to two months to reevaluate your exercise program and check how you are doing. If changes are needed, additional visits can be scheduled. The goals of therapy are to help people with fibromyalgia learn to reduce pain, manage pain and maintain the activities, which are important to them.