We have to move from the concept of “management of disease” to that of “health promotion”.
Rehabilitation vs. Recovery
Did you go to PT, but it didn’t help? Did you have surgery and not fully recover? It’s not that uncommon. My patients often have a history of various surgeries and have received rehab treatment yet still feel like they never fully recovered. Quite often I hear, “I have tried physical therapy and it didn’t help.” My own husband has had 3 same sided knee surgeries, so I know the emotional and physical struggle of dealing with a limb that doesn’t feel or work like it used to. From a clinician’s view point, I have built my practice on helping people go from stuck to full recovery.
Whether you’ve had an ACL surgery, a joint replacement, spinal surgery, arthroscopic surgery, or a even a C-section there is quite a bit of recovery needed both emotionally and physically.
Here’s my view. Following the post-surgical protocol is necessary and good, but often it’s not complete. Traditional rehabilitation is meeting the mobility and strength goals necessary to return to normal daily life and improve upon any mechanical restrictions that might be standing in the way. Very necessary following surgery.
A more complete recovery process requires more time. Time to listen, discern, educate, and coach. It involves, 1) helping the patient understand the science behind pain 2) looking at the entire kinetic chain that has been affected by the surgery, because everything is connected, 3) looking beyond mechanical dysfunctions to address the neuromuscular and motor control components, and 4) educating the patient on the wellness cycle and how lifestyle factors play a significant role in recovery.
This is the reason I started my own cash-based physical therapy and wellness clinic; to help my patients get to the root cause.
Pain Science is Brain Science
First of all, did you know your brain holds a map of your entire body? It’s called the homunculus. The homunculus refers to the motor and sensory areas of the brain dedicated to each body part. Interestingly enough, the hands take up a large part of the homunculus because of how much sensation is needed through the touch receptors and how much movement happens daily through the hands. Here is a image of the homunculus, also known as the “little man”.
This is a Youtube video explaining more details into homunculus science. Why does this matter? Well, the brain is a pretty incredible organ. Especially when you begin to understand neuroplasticity, the brain’s ability to continue to form new neural connections throughout life. Scientific studies show that people with persistent or chronic pain, have what is referred to as “smudging” of the homunculus. This means that the parts of the brain map involved with the painful body part may be disrupted and have less acuity. The brain may also have a negative shift in the level of how it interprets sensory information coming from the body. This may lead to understanding why pain starts in one local area, like the low back but then spread to more diffuse regions of the body leading to more widespread pain.
A book I often lend to my patients is called, Why do I hurt? The author, Adriaan Louw, PT, PhD, CSMT writes in an easily understandable language explaining how living in chronic pain is often due to an extra-sensitive nervous system and the brain’s process of this stimuli. He describes how living with pain at the forefront of our mind is quite like having a vicious lion waiting outside your room while you frantically figure out how to stay safe. He reminds us that we have the power to view pain more as a kitty cat, present but not life threatening. It’s a powerful mindset shift in taking control of pain and your own life.
Pain science is such an important topic. NPR’s Invisiblia podcast has a recent episode about how pain has become the 5th vital sign. It’s worth a listen!
Another example of how the brain can influence the body’s pain response is by seeing pain as the alarm system on a house or car. If there is a real threat the alarm system will be triggered and alert the owner. Sometimes a harmless item like a child or small animal will trigger this alarm and this faulty sensor needs to be reset. Our nervous system can act in this same way. Often times the initial tissue injury is healed but the nervous system is still sending a pretty powerful alarm. Some ways to reduce this heightened sensitivity are getting more sound sleep, eating an anti-inflammatory diet, reducing stress, focusing on a healthy mindset, gentle movement that you enjoy, and breathwork. Each of these make up what the Wellness Cycle and I address that more in depth below.
The kinetic chain refers to the affect that one body part has on another. Everything is connected. For example, your great toe is important for the push off phase of gait. Having limited mobility in the great toe, affects the ankle range of motion, which then affects the hip and pelvis when swinging the leg through the gait cycle. Another explanation is to look at how many different body parts have to move in sync for someone to be able to appropriately squat. When you squat, your body moves from the neck down to the ankle.
I had a patient recently who wanted to be able to gain more flexibility in body. She felt stiff in her low back, hips, thighs, and knees. She had some minor back pain and a history of bilateral ACL repairs. She is an active female who was trying to exercise on her own. When I looked at her squat, she relied heavily on her quads and her lower back for mobility. Every time she attempted a lower squat she would lose her balance and almost fall backward. I noticed an extreme lack of mobility in her ankles and lower leg muscles.
By addressing her kinetic chain, specifically the ankle mobility, we were able to free up her complaints of stiffness and her lower back pain. Now she can squat without losing her balance and move more freely.
More Than Mechanical
Physical therapists are trained to notice and improve upon mechanical restrictions. A mechanical restriction could be due to poor functional movement of the joint or restrictions in the soft tissue and fascial structures. Manual Therapy and strength and mobility exercises can greatly resolve mechanical restrictions. Yet, I see a lot of people in my clinic who have tried “traditional physical therapy” and are still stuck. What else could be involved?
Back to the brain for a minute. Helping people move freely means going beyond traditional mobility and strength exercises. It means taking a bigger view yet more delicate approach to comprehending and facilitating the brain’s response to the muscle. Without brain we have no movement. The neuromuscular response cause the muscles to initiate and control the movement. So if you aren’t able to efficiently contract your transverse abdomens, rhomboids, gluteal muscles etc… then more reps and stronger load won’t help you get there. With my patients we slow down the movement, lessen the load, and call upon reciprocal patterns to help you get the connection and create a better response of the muscle. This is efficiency of movement and it can both reduce pain and enhance performance.
The Wellness Cycle
Lifestyle factors play a significant role in your recovery. It is important to understand how your breath affects your stress response; the stress response affects your sleep; sleep affects your daily movement; your amount of movement affects your nutritional choices and needs; your nutrition choices affect your mindset; and your mindset directly affects your breathing patterns. Each one correlating together to help your body function. I call this the wellness cycle.
You can take any one of the pieces in the cycle and change it to create a more positive feedback loop.
Diaphragmatic breathing is the simplest piece of the cycle you can incorporate to give you more control in creating positive health change. It is the main reason I am working on launching my Connected Breath workshops. I want to empower people to take control of their pain and their health.
If you’d like to learn more about when this workshop is launching, sign up here.
To learn more about the nutritional part of the wellness cycle, read my book, How To Tame Your Sweet Tooth: A Remedy
If you are local and want personalized help with learning how to breathe and move freely,
It doesn’t matter how long you have been stuck, there’s always a remedy.