Mirror Therapy in the Orthopedic Population

"How is my leg doing that?"
"This is so weird."
​"It feels like my stronger knee."

These are common comments I hear from patients when using Mirror Therapy in my Orthopedic practice. The beauty of using the mirror is that we are tricking the brain, and both the patient and I know it! I tell patients before we begin a session, "we both know your uninvolved leg is doing the movement, but it will feel look like your involved leg, and it will work!"

How to Perform

To perform Mirror Therapy, patients place their intact/uninvolved extremity in front of a mirror. Doing this visually super-imposes the hidden/involved extremity (Ramachandran et al 1996). In the video to the left, the woman has chronic right knee pain. Therefore, the mirror faces the left knee (super-imposing the involved right knee.) 

What is Mirror Therapy?

Mirror Therapy has been used in the neurological population for quite some time. Fortunately due to a deeper understanding of pain science, we have also been able to transfer this intervention into the chronic pain population. Through the use of a mirror, this rehabilitation technique creates illusory visual feedback of the involved extremity (Sathian et al 2000). From the cortical level, we are identifying and correcting any misinformation between our visual and proprioceptive systems. In other words, we are reorganizing how the brain perceives the movement! 

​Watch the video below from David Butler which explains mirror therapy in greater detail.

Conclusion

Mirror Therapy is not an isolated intervention. Other graded motor imagery exercises and graded exposure to sensitize stimuli is also important. When performing Mirror Therapy, be dynamic! Change the environment- sounds, clinic environment, light, etc... Additionally, be patient and progress slowly! Chronic pain does not develop overnight. Typically multiple sessions and hours of retraining is required to retrain the brain. 
​-Jim Heafner PT, DPT, OCS