Rehabilitation

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The “Magic” of Physical Therapy

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Physical therapy (PT) can deliver positive thoughts into motion when summoned. One popular aspect is when the beneficial outcome surrounding a successful PT encounter is mutually celebrated by all parties involved. However, sometimes there seems to be a general disconnect on the understanding of what makes a fruitful PT experience actually successful. After speaking with several patients and the general public, it seems that there’s an abundance of confusion as to what physical therapy actually is and how it tends to work its “magic.”

Throughout my frequent long days of working in an outpatient PT facility, I often hear patients erroneously utter the words “fix me” in various ways. Poor phrases tend to circulate the clinical atmosphere such as: “I need you to fix me.” “Thanks for fixing me.” “You fixed me, but I managed to screw it up again.” I hate to be the bearer of bad news, but love to be the presenter of truth. The truth is that the aforementioned sayings are all misnomers and highlight an unfortunate epidemic plaguing the world of physical rehabilitation. This epidemic primarily relates to passiveness of patients in their rehab process, as for people in alcohol rehab the use of services online is the best choice, click here to learn more. You should also keep in mind that mixing alcohol with meds could be deadly. If you’re wondering, paracetamol and alcohol how long to wait?The recommended wait time for taking paracetamol after moderate alcohol consumption is at least 24 hours.

Contrary to popular belief, physical therapists don’t really fix people. It’s not a therapist’s job to fix anyone, nor do therapists possess the superhuman qualities to fix anyone. What therapists actually do is coach. What we actually are, are coaches. We are health coaches, bio-mechanic coaches, musculo-skeletal coaches that develop a patient-specific plan of care consisting of various treatment techniques and therapeutic exercise to help restore functionality. The reason why it comes off as a “fix” is because when physical therapy is performed correctly to a treatable case, it allows for the augmentation of function and reduction/elimination of symptoms. We make people feel better, but we do not fix people. We provide the tools to help people fix themselves, whether it’s through physical therapy, or alternative methods like CBD and sleep. These tools allow patients to be active participants in their rehab process and not passive mummies that view PT to that of a spa treatment. We provide the program, we provide encouragement, we provide help. Work is required for both parties involved. That is the fix, that is the magic. However, magic only happens when each party owns up to their role in the game. It is through this format, that therapists afford patients the ability to help fix themselves.

Now, it is quite true that there are many useful techniques (manual, instrument-assisted, or modality treatment) employed by a PT that seem magical but are impossible to be duplicated by a patient. Although these therapist-applied treatments are beneficial, the true magic is formed when patients follow the therapist-scripted blueprint on how to keep those results attained from whatever the PT is solely capable of providing. What may feel like a fix will be disappointingly short-lived if active participation is neglected on the patient’s part. The true magic of physical therapy is centered around the human experience and not from any form of spellbinding magical PT prowess in any case. Physical therapy uses the skill of the therapist combined with the wants and needs of the patient to bring the best attainable results possible. Active engagement is 100% required for all. Physical therapy may seem magical, but only due to all the unspoken intangibles involved around when humans interact together positively. Great communication and being on the same page highlight the true magic of physical therapy. Physical therapy is individualistic. It’s altruistic. It’s an art. 

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The Power Of Manual Therapy

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Physical Therapists (PTs) use a number of different strategies to help restore an ailing client’s functionality. The three most popular restorative propellers are: manual techniques, modalities, and exercises. These three treatment resources are commonly combined into some fashion that aide in physical rehabilitation. As a passionate physical therapist, certain distinct things being practiced often bother me. For starters, it BLOWS my mind when a new client comes into my office for an evaluation with me, and tells me that they were treated in a previous PT facility that did little to no manual therapy. It also BLOWS my mind when referring medical doctors (MD’s) have prior conversations with patients strongly advocating the use of modalities as a major component in restoring functionality. Great… Thanks to that and their status on the hierarchy of the medical system, a nescient patient is now brain-washed into believing a passive, non-cerebral object is going to bring him/her to fame. Furthermore, I now have the pleasurable responsibility to try to convince otherwise; which, is more often than not, an impossible task. Concisely, manual therapy (hands-on treatment) is the driving force behind healing in physical rehabilitation. People who are addicted to drugs or alcohol need to be in an alcohol and drug-free environment with people who will hold them accountable for their goal of getting off drugs. You can find how much is a 28-day stay at the priory here.

Before I indulge in discussion about the preeminence of manual techniques, let’s define the term. Manual therapy can be defined as all the hands-on techniques that help reduce pain, increase mobility, increase muscle firing, increase strength, facilitate movement, increase function, decrease edema and/or reset or re-align anatomical segments. These techniques are provided by healthcare professionals in rehab such as: physical therapists, occupational therapists, chiropractors, osteopaths and the like. Manual therapy techniques include: joint mobilizations, soft tissue manipulations, deep tissue massages, rolfing, passive muscle stretching, muscle energy techniques, and proprioceptive neuromuscular facilitation to name a few. There are multiple reasons for the administration of manual treatment; moreover, the importance of manual work with injured patients is extensive.

For starters, it allows for an objective feel of the soft or bony tissue by the treating clinician. Clinicians can get an overall assessment of the static quality of the palpated tissues, as well as, the dynamic quantity and quality of movement. Moreover, certain manual techniques can deliver soothing sensations, which help patients feel better and puts them at ease. Most importantly, manual therapy can shorten the injured party’s convalescence by directly targeting the problematic source. Manual techniques can help a client move better, move faster, and restore proper movement mechanics by increasing a patient’s range of motion in a specific joint. For more on proper movement mechanics, check out last week’s blog titled “The Element Of Efficiency.”

On the other-hand, modalities are therapeutic agents, or machines mostly powered by electricity, that are designed to contribute to healing. These modalities include: electrical stimulation, moist heat, ice packs, ultrasound and the like. The inherent problem is that there is currently little to no scientific evidence in medical literature that advocate the rehabilitative efficacy of these said modalities.

Hands on techniques help develop a successful therapeutic relationship, which I’ll blog about on my next post. In my everyday practice, I employ hands-on techniques, and have developed great bonds with my clients. The fact of the matter is that the patient/client has to first trust you to allow you to touch them. It drives down insecurities and helps not only the physical rehabilitation process, but the never negligible mental rehabilitation process as well. Injury takes a toll on people’s body and psyche often equally. The warmness of your heart can be felt through your hands.

Bottom line: Passive modalities do NOT suffice. I know we are in the information age, and the trend is to believe that nearly all machines nowadays can take the place of humans, but this is not true for physical rehabilitation. For all patients and physical rehab clinicians out there, please know that the best way to tackle the issues head-on is hands-on.

Performing Numerous Manual Techniques Throughout Different Body Segments In My Practice

Performing Numerous Manual  Therapy Techniques Throughout Different Body Segments In My Everyday Practice

Disclaimer: These are my personal thoughts, and should never be misconstrued as biblical quotes from an imaginary medical bible. My blog posts should never take the place of what your MD advises. This is merely a personal rant that subjectively expresses my take on this topic.

The Art Of Practice

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The cliche, “practice makes perfect” is so overused and over-exemplified; however, it should never be overLOOKED. Indeed, it is very true that practice does make your efforts perfect. Why you ask? Well, it’s the result of a little scientific phenomenon known as Motor Learning. In a nutshell, motor learning is a concept that involves creating a new motor skill, a physical movement, applying it and mastering it. Motor Learning in humans began when we were all infants learning how to roll, crawl, cruise, and eventually walk. The concept also continues into adulthood when individuals learn new movement patterns that may be specific to a particular sport, dance, or movements necessary for everyday locomotion and activities of daily living. 

Image Courtesy Of Pinterest

Image Courtesy Of Pinterest

Here’s a basic science lesson:
Our human brain is known as the anatomical command center. It’s responsible for sending very regulated signals down the anatomical chain to create movement. In simplicity, our brain sends output down to the spinal cord for the majority of movements to occur. The signal then gets propagated down to nerve roots, which in turn travels down to the individual nerves that are responsible for innervating muscle fibers within muscles. The innervated muscles must have a harmonious contraction for the efficient production of the intended movement. Yes, this propagation of signaling happens in an instant. Amazing, I know.

The conceptual cliche,”Practice makes perfect,” involves the body’s neuromuscular system developing a familiarity with a motor skill(s) after it is rehearsed frequently. After continuous attempts, your brain and body finally get adapted to whatever movement you are trying to master. There are 3 known stages of motor learning: 1) the cognitive stage, (2) associative stage, and (3) autonomous stage.

The Three Stages Of Motor Learning

The Three Stages Of Motor Learning — Image Courtesy of HumanKinetics.com

These are 3 proposed stages in which we learn, create mastery, and eventual automaticity of a motor skill. The aforementioned cliche is best correlated with the 2nd stage of the 3 stages of motor learning: the associative stage. First, we go through the cognitive stage: why and how to perform a skill; then, the associative stage is  where we practice to learn exactly how to perform the skill. The last stage (automatic) is when we have practiced enough that the skill becomes automatic like second nature. 

My point behind this blog is not to bombard and bore you with a condensed version of complex science, but rather to stress the importance of the 3 “C’s”: compliance, commitment, and consistency. In order to be successful, one must apply all three “C’s” when learning a new motor skill. Whether it’s learning how to walk appropriately with your physical therapist, learning the correct shooting mechanics with your basketball coach, or how to squat with proper body mechanics with your fitness trainer (I happen to teach all 3 by the way), you must practice, practice, practice to develop mastery. Don’t expect to get it the minute you are introduced to it with your respective source of influence. It takes multiple repetitions to train/retrain your body’s neuromuscular system for motor learning/re-learning to occur. What is practiced and repeated continuously becomes learned, and each subsequent repetition becomes easier. Moreover, research has shown that varied practice is best for long-term retention of skills. I will probably save that discussion for a later post.  

 

Me Performing Gait Training With A Patient To Foster Motor Learning

Gait Training With A Patient To Foster Motor Learning On Proper Walking Mechanics

Practice makes perfect guys. Numerous trial-and-error attempts are needed for the acquisition of skill. DO NOT think you’re underqualified. DO NOT be frustrated when you have failed a bunch of times. Frustration has the propensity to act as a big deterrent to new movement skill acquisition. Lastly, DO NOT give up. Keep pushing. As a fitness specialist, physical therapist, and basketball coach, trust and believe I know the importance of skill practice. More importantly, I know the practice of PATIENCE. Exercise patience with skill learning and you will master your target skill in no time.