Selma and I were recording for our podcast last week (if you want to check out Isn’t This Enough) when she asked me about how to make the most of your time/ energy when you are in Physical Therapy.
What a wonderful question I had never considered!
Please note, in writing this list, I am referencing traditional physical therapy (not the preventative medicine that we are focused on in Practical Strength). In traditional therapy, you sustained an injury or underwent a surgery, or have been diagnosed with an underlying medical condition and you are seeing a physical therapist as a medical professional to help you with your rehabilitation.
1) Understand the role of a physical therapist is to help you improve your function (movement). (e.g. We can’t change how you feel!)
So often, when people come into physical therapy, their goal is only to reduce pain or feel better. We are going to look at (in topic number 2) how this is next to impossible for your provider. If you head to your PT, notice what you cannot currently do, that you miss doing or that you have a longing to do- I can no longer paddleboard because of my balance, I feel unsafe walking more than 3 miles. Keeping your goals based in movement and function will help establish a good frame work for what is meaningful to you and help guide you toward what you can achieve in PT.
I STRONGLY (how bout those caps for emphasis) so, so, strongly know that everyone who can (even folks in a wheelchair) need to be able to transfer up and down off the floor. If you cannot, why not make this a functional goal? Your PT can tie it into balance and strength - so rich.
2) When you are in pain, please understand that pain is a complex biopsychosocial experience- it cannot be reduced to a biologic condition, therefore no one can change it for you
Perhaps one of the biggest short comings in my profession, is that we don’t accurately provide information to patients about what our role is and what it isn't. A lot of that information is assumed.
My best orthopedic professor in PT (all the way back in 2003 at the beginning of pain science understanding) warned us not to create patient goals related to pain- because of how complex and nuanced pain is.
Don't get me wrong- in short term or acute pain, pain that has been lasting less than 3 months, we can be pretty effective in changing impairments that lead to pain. We can assess and reduce swelling in tissue, reduce stiffness in joint capsules or reduce fibrous muscle tissue or fascia. This can have the effect of making it seem like we are pulling some magical strings to influence how you feel. In reality, we are simply understanding your biological process and how to influence it.
Contrary to popular belief, we cannot make someone feel better. Our sense of feeling is co-created by our biological processes sure, in concert with our sociological belief structures and our psychological perspectives. Pain is a byproduct of our consciousness. What we as PTs can do is help you understand the habits or phase of healing you are in that influences tissue inflammation and help you create techniques to reduce it.
In physical therapy, we are (hopefully) experts at helping guide your biology toward healing- protecting your discs while they scar down after a herniation, building muscle after post-surgical atrophy, helping you build healthy biomechanics. We can help to teach you about the tissue that is challenged, and how to help that challenged tissue in the future. What might be a great question to pose to your therapist would be something like "What do you think are the main issues contributing to my impairments? How might I best change those factors?" (My heart would swell and I would hear Tchaikovsky if a patient actually asked me those questions!)
Changing biological factors (swelling, poor biomechanics, overloading tissues) can assist in the body sending fewer danger messages (and thereby creating less of a protective pain response), but notice how the biological healing differs from changing your sensation.
For those PTs who have been practicing for sometime, we have all experienced the complexity of pain with our patients who continue to feel crummy even when joints are mobile, soft tissue is repaired and strength is restored. We can help you change your biology, but changing pain is a broader intervention that requires you working with psychological and social factors you hold that influence your protective mechanism of pain. (p.s. we can help you with this too! It is through training and education).
Also, as a side note- did you know that there is at present (2024) only one university in the world that educates PTs and MDs in a semester long course on pain? One! (Mind blow emoji)
Please do not assume that just because your PT or MD talks with you about pain, and states they they treat pain, that they have more developed understanding in the causes of pain. I still encounter more clinicians in the outpatient setting attaching pain to the outdated, disproven biomedical model than I witness providers moving forward to embrace what we now know about pain science. Don't wait for your PT to become educated in pain science. Check out offerings from the NOI group to help educate yourself (I particularly love the books: Explain Pain, and the Knee Osteoarthritis Handbook).
3) Be ready for change. And if you are not, hold off (if you can) on going to PT until you are.
At the heart of every rehabilitation process is the notion that something needs to change. It’s called therapy for a reason! It requires effort and energy. This is also why it is not a good idea to start therapy the day before a vacation. Your presence is required. The most common aspects of movement I see adults need to make to improve their function:
1) Build more muscle mass safely to support the aging body
2) Maintain transfers (getting up and down off the ground, into and out of a chair)
3) Maintain strength in the muscles required for walking (the calf or gastrocnemius requires you to do 20 single leg heel lifts or so to support your body weight while walking). Most folks suffer orthopedically when they fall below the strength thresh holds for walking
4) Begin to understand that your body is bioplastic, and capable of amazing change. Your anatomy develops based on how you use it!
5) The mind is part of the body. How you move, what sensations you pay attention to, your beliefs about your body and health, your beliefs about your movement affect your outcomes.
As mentioned above, this includes mindset as well as cognitive understanding of biology, and movement patterning. When you enter into a rehabilitative process, you are changing many systems: cognitive and neurologic, musculoskeletal, immune responses. It is a full body and mind intervention.
When someone is unable to learn, for whatever reason, the rehabilitation process is stunted.
This can be because you have deeply set beliefs and struggle with change, it could be because you and your therapist don’t gel (and you should seek out a provider who you do fit with), or it could be that your therapist is providing information that is hard to hear (you might have confirmation bias and want a “yes person” for a PT). You might be raising a child as a single parent and have no time to do your home program.
When I am working with someone as a patient, what they do outside of the clinic is infinitely more important that what they do for the 2 hours a week inside. If people are not yet ready to take the messages learned in the clinic into the rest of their life, rehab doesn't really work. Whatever the reason, look into the causes. If you are not yet ready to make changes in your life for whatever reason, save yourself time and money and wait to go to PT until you are.
I hope this has been a helpful post.
You can let me know what has been helpful for you in your rehabilitation processes.
Happy Recovering Function!