Physical therapy for CRPS: a guide for Veterans

Before your appointment

For a Veteran whose hand pain makes fastening a shirt difficult, or whose foot pain limits walking to appointments, a useful first question is: what can we work toward, and how will we adjust if symptoms increase?

What should happen before exercises begin?

Start with an assessment. CRPS can involve persistent regional pain alongside changes in sensitivity, swelling, skin temperature or color, movement, and other features. Those symptoms need clinical evaluation, including consideration of other explanations. A video or checklist cannot establish the diagnosis. CRPS diagnostic and treatment guidelines.

Bring a brief account of when symptoms began, what changed after an injury or procedure, and what previous treatment helped or aggravated. Include any restrictions your surgical or medical team has given you. Identify one daily task you want to improve so the therapist can connect the plan to something you value.

What might CRPS rehabilitation include?

Physical and occupational therapy have related roles. A physical therapist may focus on movement and mobility; an occupational therapist may help with tasks such as dressing, cooking, or returning to work. The exact division depends on your needs and the team. NINDS overview of CRPS care.

Possible elements include:

• Gradually building comfortable movement and use of the limb.
• Sensory approaches, with the intensity adjusted to your response.
• Education about pain and ways to pace activities.
• Graded motor imagery or mirror feedback when the clinician considers it appropriate.

These options appear in rehabilitation guidance, but they aren't a prescription for every person with CRPS. AAPM&R treatment overview, updated 2024.

In her 2015 RSDSA talk, physical therapist Tracey Shannon emphasizes patient-directed progression and a coordinated team. Her experience described in the talk is largely pediatric. The practical questions here adapt those themes for adult Veterans; the talk does not establish outcomes in Veterans. Pacing and progression, around 21:13; team care, around 30:48.

Should I push through increasing pain?

Ask your therapist for specific instructions about symptom changes. Overly vigorous exercise can aggravate CRPS, so the plan needs a clinician experienced with the condition. Do not assume that a worsening response means you should increase the intensity. NHS CRPS treatment guidance.

Before leaving an appointment, clarify what response is expected, what means modifying or stopping a task, and whom to contact. If an activity causes a substantial increase, report what you did, how soon symptoms changed, and how long the change lasted. New or rapidly changing symptoms need medical advice rather than being automatically labeled a familiar flare.

A written flare-up plan can keep those instructions together. Progress should be reviewed in terms of daily function and tolerability as well as pain scores.

How strong is the evidence?

Rehabilitation is commonly recommended as part of CRPS care, but that does not make every technique equally well supported. A 2022 Cochrane review judged the evidence for physiotherapy's effects on pain and disability to be very uncertain. Many studies were small, and unwanted effects were rarely reported. Cochrane review.

That uncertainty makes a monitored plan important. Agree on a goal and a review point. If the approach isn't helping, ask what should change and whether another assessment or service is needed. A promised cure or a fixed recovery timetable goes beyond what these sources support.

How can Veterans ask for care?

Ask your VA care team whether physical therapy, occupational therapy, or a pain or rehabilitation specialist is the right next step. Mention travel limits, accessibility needs, and difficulties practicing at home. Ask which appointments require an in-person assessment and what follow-up is available.

If Community Care is being considered, VA must approve the referral before you schedule routine care with a community provider. Check the authorized provider, services, and time period. A general inquiry to Valor does not establish coverage. VA referral instructions and the Valor referral checklist can help you prepare.

Can I use an online CRPS exercise program instead?

Ask your treating clinician to review it first. A generic video cannot account for your diagnosis, sensation changes, restrictions, or response to activity. Get an individualized plan and follow-up rather than copying the speaker's practice schedule.

About the source

Based on Tracey Shannon, PT, DPT's Non-Pharmacological Interventions for Chronic Pain, uploaded August 24, 2015, with the adult evidence linked above. Review covered the complete available automatic transcript and selected video frames, not the full audiovisual presentation. Veteran care-navigation questions are editorial additions. This educational guide has not received clinician review.