Anorexia & Bulimia
How can physical therapy help?
Anorexia and bulimia are devastating disorders that severely compromise the physical, emotional and spiritual health of those affected. Considering the complexity of these illnesses, effective treatment involves the united efforts of medical and mental health professionals: dieticians, psychologists, psychotherapists, physicians, psychiatrists, expressive therapists...The list continues. As an extension of such multidisciplinary treatment, skilled physical therapy intervention complements the therapies traditionally provided by the multidisciplinary team and helps to enhance recovery yet further.
Tish Kettler uses a variety of physical therapy interventions to address the cardiac, musculoskeletal and neurological complications of eating disorders. One-on-one, 60 minute sessions ensure the highest quality care and sensitive attention to the clinical needs of each client.
"Tish developed individualized physical therapy programs that allowed each patient a gentle and safe re-building of her physical body. This area of treatment, which she addressed with enormous skill and sensitivity, was a significant factor in the recovery of our clients... successfully guiding them toward healthier body image, physical restoration, and self-care." --Caroline H. Leibman, M.A.Ed., ADTR
Massage/Soft Tissue Techniques
Due to malnutrition, compulsive exercise behaviors, body image distortion and many other factors, exaggerated muscle imbalances are often associated with anorexia or bulimia. As a result, eating disordered individuals are exceptionally vulnerable to musculoskeletal pain and injury.
In order to provide relief, Tish often uses soothing, manual techniques, such as massage, myofascial release, craniosacral therapy, and manual stretching (for clients who are comfortable with hands-on intervention).
Decreasing the pain not only dimishes the client's physical suffering but allows them to focus more fully on the psychological, experiential and education components of their eating disorder treatment. Such healing touch methods also help to rebuild the mind-body connection, restore interpersonal trust and encourage self-nurturance.
Therapeutic Exercise
Each client's exercise program is designed specifically for him or her based on nutritional, medical, cardiac and musculoskeletal status. When clinically appropriate, therapeutic exercise begins with nonaerobic postural and flexibility exercises designed to address the specific muscle imbalances of each client. As the client's nutritional status improves, functional strengthening and/or light resistance work can be introduced to address strength deficits and bone loss.
Cardiac Rehabilitation
Due to the extensive cardiac complications associated with anorexia and bulimia, cardiac rehab is a vital yet closely monitored component of the client's rehabilitation program. After formal testing is performed to ensure that cardiac response is appropriate, leisure walks are usually initiated. Cardiac rehab is then progressed gently, with a therapeutic goal. This allows the heart to strengthen gradulally and promotes safe re-entry into "normal" levels of physical activity.
Education Topics
Client education includes a variety of topics: general principles of healthy exercise, detrimental affects of compulsive exercise, recognizing exercise behaviors that are actually a caloric or emotional purge, osteoporosis, the role of fats in the body's structure and function, common misconceptions of the "ideal body", etc.
Please note: Tish requires that her eating disorder clients be medically stable (with physician verification). Additionally, all eating disorder clients seeking physical therapy need to be actively engaged in eating disorder treatment with a dietician, primary therapist and physician (M.D., D.O.). If you are uncertain where to seek help, Tish will be happy to speak with you and provide a list of St. Louis eating disorder professionals so that you may begin the recovery process.
Anorexia and Bulimia: Tish S. Kettler, MSPT
Tish served as the physical therapist at La Montagne, a residential treatment facility for women and adolescent girls with anorexia and bulimia, from 2001 to 2004 (Crystal City, MO). As a member of La Montagne's multidisciplinary treatment team, Tish contributed to program development and worked closely with other clinical team members to help La Montagne clients recover from these devastating illnesses. In private practice, she continues to work in conjunction with St. Louis eating disorder professionals, providing physical therapy services to individuals struggling with anorexia and bulimia. "Contributing to the recovery process has been an invaluable experience for me as a clinician and as a person. Seeing our eating disordered clients' wellbeing and sense of self-worth gradually restored is very rewarding."
In addition to her specialized work within the eating disorder field, Tish has dedicated much of her career to helping individuals overcome musculoskeletal pain, orthopedic injury and many other painful conditions within the outpatient orthopedic setting.