Physical/Occupational Therapy for AMPS: Frequently Asked Questions

Getting your child moving again is a key part of therapy for amplified musculoskeletal pain syndrome (AMPS). Patients participating in AMPS treatment at Children’s Hospital of Philadelphia – whether outpatient or inpatient – will meet with physical therapy and/or occupational therapy for assessment and recommended exercises that focus on improving their strength and endurance so they can return to typical activities of daily living.

Below, we detail frequently asked questions about physical and occupational therapy as part of treatment for AMPS.

What exercises will my child perform?

All exercises performed as part of the AMPS program are individualized according to the needs of each child. Our therapists conduct formal evaluations on the day of admission to determine your child’s individual needs. Therapies will be adapted and modified throughout your child’s time in the program based on their progress towards functional goals.

Activities may include:

  • Timed activities: Your child will be expected to beat their previous best times each day until they “max out,” meaning your child has gone as fast as their therapist believes they can go and is able to do so consistently.
  • Specific activities to target areas of dysfunction
  • Aerobic/endurance activities
  • Desensitization techniques, such as rubbing, vibration and patting
  • Preparation to return to typical daily activities (such as school and sports)

Can the pain my child feels get worse or spread during treatment?

Yes. In addition to muscle soreness, it is common for AMPS pain to worsen once your child begins exercising. The AMPS pain may also spread to different locations in your child’s body. Increased pain and spreading pain are generally regarded as positive signs because this shows that the nerves in your child’s body are reconnecting and will soon function normally. Patients may also notice increased itchiness as their treatment progresses. We encourage patients to make the medical team aware of any changes in their pain levels and symptoms during treatment. The medical team evaluates each patient daily in the morning and as needed throughout the day.

What if my child is experiencing new pain or injury?

While we do not encourage patients to focus on or talk about their AMPS pain, we always encourage them to report any new or different pain to staff members. If new pain or injury is suspected or reported by patients, it will be assessed by AMPS program PT/OT or our medical team (physician assistant and attending physicians) as appropriate. Feedback is then given to patients and precautions are taken as necessary. When pain is determined to be AMPS-related, staff will explain their findings to patients to help them fully engage in activities and not worry about damaging their bodies. Our team will continue to monitor any new pain or symptoms throughout treatment.

My child says the therapists yell at them. What’s that all about?

PT and OT sessions are appropriately challenging for patients. Frequently the child will think that an activity is too difficult, so therapists must be firm and focused, but they do not yell at the child. Sometimes therapists will act as cheerleaders to encourage patients, and that can be interpreted as yelling.

For example, the therapist might say, “Go, go, go — you can do this — go faster! You can beat your time!” Everyone on the team is dedicated to providing the best care in a sensitive and caring way, but many patients procrastinate and need verbal reminders to correct their form or to get started on the next activity. Some children may interpret this as scolding. Patients are encouraged to talk openly with their physical and occupational therapists and other staff members if they have any concerns or questions.

What should I do if my child has a lot of pain at night after exercising in the AMPS Program?

Patients may be sore in the evenings after completing exercise, but they should remain active after therapies. Resting for a few minutes right after the program is allowed, but then continued activity is best. Patients should also stretch and/or take a hot shower or bath to keep their muscles from tightening up.

What are some strategies to help my child work through their muscle soreness?

Patients commonly experience muscle soreness, particularly during the first few days of AMPS Program treatment as they exercise harder and/or use muscles they have not used in a long time. To help with muscle soreness, patients are encouraged to drink a lot of water, take warm showers, stay active outside of treatment hours, and stretch at night. Additionally, it is important to maintain physical activity over the weekend to decrease muscle soreness the following program week – when more intensive program activities start again.

What happens if my child is not controlling their behavior or declines to participate in certain therapy activities?

Behavior modification programs are sometimes used to help your child meet their treatment goals. These programs are always used for younger patients in the intensive program and used on an as-needed basis for older patients.

Behavior modification programs are individualized, and typically privileges (free time at the end of a therapy session, doing a preferred activity in therapy, screen time at home, opportunity for fun activities, etc.) are earned when your child completes their goals.

Your child may lose privileges or receive consequences if their goals are not met. The psychologist is typically involved in helping your child understand the behavior program and identifying strategies to help them meet their goals. If patients continue to refuse to participate in required aspects of treatment, they may be discharged from the AMPS Program.

What if my child declines to participate in all activities?

Some children have difficulty participating in the AMPS Program because of significant coping deficits, severe depression or anxiety, and/or oppositional behavior. In these cases, we may refer children to an appropriate mental health provider.

Changing the treatment plan is always done with a lot of thought on the part of the team, child and family. We generally try to work with the child for several days before any final decisions are made. If the child is released from the AMPS Program, they may return to the program after psychological issues are addressed and insurance is re-authorized.

Support Services for AMPS

Learn more about other services offered to AMPS patients at CHOP: