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  • Dr. Jim Fisher PT, OCS

Lyme Disease and Physical Therapy

As the weather improves and our outdoor activity increases one issue we absolutely need to be aware of is Lyme Disease. Most commonly, it is transmitted through the bite of a deer tick; although it is possible to transmit to an unborn child in-utero. Most of us can think of at least one person that has been diagnosed with Lyme Disease and number of cases continues to rise.

Prevention is the key so proper attire, use of repellents and frequent tick “checks” of not only you and your family, but also our pets are all necessary. Having had multiple family members and pets diagnosed with Lyme Disease, our nightly tick checks are just routine now.

If you ever find a tick attached to your body remove it with use of a tick removal tool (which are readily available at your veterinarian office or local farm store) place it in a zip lock bag and save for testing if needed.

The next step is to call and or go to your Doctor’s office and let them know what has happened so that you can potentially start antibiotic treatment. Don’t wait for a bulls-eye rash to appear as it has been reported only to appear in as low as 30% of the confirmed cases. Some cases report other types of vague diffuse rash and some don’t see any rash at all. However, if you do see a bulls-eye rash you meet the criteria for a confirmed Lyme Disease case according to the Centers for Disease Control (CDC).

Common symptoms of Lyme disease infection include, but is not limited to:

·Flu-Like Illnesses (Fever, Chills, Sweats)

·Muscle Aches




·Joint Pain

·Skin Rash

If untreated, symptoms may develop and become more severe. It will result in:

·Loss of Ability to Move

·Severe Headaches

·Neck Stiffness

·Heart Palpitations

Common Misdiagnoses

  • Autism

  • Chronic Fatigue Syndrome

  • Colitis

  • Crohn’s Disease

  • Early ALS

  • Early Alzheimer Disease

  • Encephalitis

  • Fibromyalgia

  • Fifth Disease

  • Gastro-esophageal Disease

  • Infectious Arthritis

  • Irritable Bowel Syndrome

  • Juvenile Arthritis

  • Lupus

  • Meniere’s Disease

  • Multiple Sclerosis

  • Osteoarthritis

  • Prostatitis

  • Psoriatic Arthritis

  • Psychiatric disorders such as Bipolar and Depression

  • Raynaud Syndrome

  • Reactive Arthritis

  • Rheumatoid Arthritis

  • Scleroderma

  • Sjogren Syndrome

  • Sleep disorders

  • Thyroid disease

  • And other various illnesses

How can Physical Therapy help?

There are several potential treatments for Lyme disease through Physical Therapy. They are usually focused on the secondary symptoms and work in concert with the medical management of the condition. A Physical Therapy program may include:

·Manual Therapy includes massages, stretching and joint mobilization to improve alignment, mobility and range of motions, and to alleviate the pain of affected joints.

·Exercise Programs to help stretch and strengthen muscles to help assist weakened surrounding joints.

·Mechanical Modalities include ultrasounds, electrical stimulations, laser, ice and heat to decrease pain and inflammation.

·Gait and Balance Training as well as other forms of training to help improve movement techniques and reduce stress on joints caused by daily activities

Physical Activity Patients with Lyme disease are encouraged to exercise moderately, though not to overexert. Exercise is important not only to stimulate muscles and nerves, but also to help move the bacteria out of its hiding places in the heart and brain, and into the bloodstream where it may be detected and destroyed by the body's natural immune system. (

Exercise is an essential component of any Lyme disease treatment plan. “Despite antibiotic treatments, patients will NOT return to normal unless they exercise, so therefore an aggressive rehab program is absolutely necessary,” states Lyme specialist Dr. Joseph Burrascano, Jr. “It is a fact that a properly executed exercise program can actually go beyond the antibiotics in helping to clear the symptoms and to maintain a remission.”

Scientists don’t know for sure exactly why exercise makes such a difference, but Dr. Burrascano suggests several reasonable theories.

  • It is known that the Lyme Borrelia will die if exposed to even the tiniest oxygen concentrations and aggressive exercise can increase tissue perfusion and oxygen levels.

  • Borrelia is very heat sensitive and during aggressive exercise, the core body temperature can rise above 102 degrees.

  • Regular exercise can help mobilize lymph and enhance circulation.

  • An intermittent exercise program may help reset the HPA-axis more towards normal.

There is also evidence that exercise may benefit T-cell function if it is a carefully structured exercise program. T-cell function will be depressed for 12 to 24 or more hours after exercise, but then it will rebound. For this reason, it’s important not to exercise two days in a row. Dr. Burrascano recommends beginning with one day of exercise followed by three to five days of rest. As your stamina improves, fewer rest days will be needed between workouts. Because T-cell depression is more pronounced after aerobic exercise, Lyme patients are discouraged from doing any kind of aerobics, even the low-impact variety.

CAUTION: Check with your doctor before beginning any exercise program. Lyme can affect heart tissue so a cardiac stress test may be necessary first to ensure your safety.

Dr. Burrascano’s Exercise Protocol

Dr. Burrascano has developed a very specific “Lyme Rehab/Physical Therapy Prescription” for his patients. It begins with Physical Therapy

. Following are some of the key points he stresses:

  1. Teach correct exercise techniques, including proper warm-up, breathing, joint protection, body positioning, cool-down and stretching afterwards.

  2. Work one muscle group at a time. Perform extensive stretching to each muscle group after it is exercised before moving on to another muscle group.

  3. Aerobic exercises are NOT allowed – not even low-impact – until the patient has recovered.

  4. Work to improve strength and reverse the poor conditioning that results from Lyme.

  5. Use a whole-body exercise program that includes calisthenics and/or resistance training using light resistance and many repetitions.

  6. Each session should last one hour. Low intensity is preferable to a strenuous workout. If necessary decrease intensity so the patient can continue for the whole hour.

  7. Never exercise two days in a row. Initially patients may need to start by exercising every 4th or 5th day and increase the frequency as they are able, but never more often than every other day.

  8. Non-exercise days should be spent resting.

For a copy of Dr. Burrascano’s complete “Lyme Rehab/Physical Therapy Prescription,” see page 32 of his Advanced Topics in Lyme Disease monograph.

Most Lyme doctors agree with Dr. Burrascano’s recommendations, although some feel that light aerobics are permissible if the patient can tolerate it. Dr. Burrasano is adamant, however, that aerobics will do more harm than good. One point virtually all Lyme specialists agree on is that patients should start slowly and increase exercise incrementally. Pushing to the point of exhaustion, particularly when the exhaustion lasts for a day or more, is not beneficial.

NOTE: Dysautonomia, a malfunction of the autonomic nervous system which regulates all automatic bodily functions such as heart rate, blood pressure, respiration, etc., can accompany or be triggered by Lyme disease. One of the symptoms of dysautonomia is exercise intolerance. If you have or suspect you have dysautonomia, be sure to discuss this with your doctor before beginning any exercise program. (

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