Mental "Scar Tissue"

Two weeks ago I evaluated a patient who had recently undergone surgery to repair a ruptured quadriceps (above the knee) tendon.  It was readily apparent to me that despite his physical impairments, his biggest road block was fear.

"I'm scared as hell," he told me.

This patient came in with a strict protocol from his surgeon, which allows for a certain amount of knee flexion (bend) each week.  He is also required to wear a protective brace for a specified period of time, progressively "unlocking" it as he gains motion, bears more weight, and heals.

On the first day of treatment, my patient would hardly allow me to assess his leg.  Just this past Friday, after only three visits, he had achieved 40 degrees of knee flexion.  This was already pushing the limits of his protocol, so I shot his surgeon a quick email.  He authorized us to progress past the protocol based on my patient's current state, which we were both excited to hear.

My patient's physical progress and change in attitude in one week were profound.  I'm convinced that the the biggest reason wasn't because of the techniques I used or the exercises prescribed.  It was because I listened to his concerns, answered all of his questions, and provided a ton of assurance.

What is my point?  Your body is pretty darn good at knowing how to repair itself and adapt.  But don't underestimate the role you mind plays as a gatekeeper in the process.  While physical healing involves an amazing cascade of events, you can also simultaneously lay down mental "scar tissue" along the way.  It's simply about allaying fears through education.

When you go see your health care professional, demand to be heard as well as listened to.  In today's break neck pace of health care delivery, it's often a difficult task.  But remember, you are more than just a body part or a symptom.  You are a person with worries, fears and anxieties often overlaying your symptoms.  Just a little bit of compassion, patience and education will help pave your path towards wellness.  Everyone deserves that.

Lacrosse Ball for Knee Pain

In my opinion, the best way that I can help my patients is to educate them regarding their condition, and then provide a simple and realistic treatment plan for them to follow.  A KEY component of the plan is a home exercise program.  Effective home exercise programs must not only have to target the issue, but they also must be doable.  With simplicity in mind, I am also a big proponent of using as little equipment as possible.  One of the least expensive and most beneficial "tools" that I use in the clinic and encourage people to buy is a lacrosse ball.

Here is a quick demonstration of how this three dollar implement can be used to help treat a painful condition:

I hope you find this useful.  I plan on sharing more lax ball self-myofascial techniques in the future.

Normal vs. Unusual

This past week, I was struck by how often I was asked the following question by patients in the clinic:

"Is that normal?"

Most typically they are asking this regarding pain that they are experiencing.  It's a very logical question, whereby patients are seeking assurance or direction about their condition.  I've probably been asked this question hundreds of times over my 13 years practicing physical therapy.  Recently, I've been answering with the following response:

"No, it's not normal, but it's also not unusual."

What do I mean by that?  It may seem that I'm splitting hairs, but I believe there is a distinction between "normal" and "unusual".

I recently came across a simple definition that I think eloquently sums up physical therapy:  The restoration of painless, thoughtless movement.  By this simple description, pain is not "normal".  Most (not all) of the patients whom I see present with unilateral (one sided) complaints of pain and dysfunction.  That makes for a very simple testing approach.  If you can move one side freely without pain but not the other, then this is not normal.  Pain is a subjective symptom that is trying to get our attention for some reason, which may be directly related to tissue damage, or perhaps something even more complex.  It's not "normal" to be in pain.

But is it unusual?  When people ask me if their pain is normal, it's typically not during the first visit.  Rather, it's usually after a period of rehabilitation has gone by, and pain or swelling pops back up.  Unfortunately, progress in rehabilitation is not always linear.  You may go two steps forward, and occasionally one step back.  Or you may find that you have plateaued to some degree.  The reasons for this could be many, but a common one is that as folks progress, they become more active and/or perhaps less mindful, leading to slight set-backs.  It is those times when I'll explain to someone that what they are feeling is not normal, but it's also not unusual.

I find that most people are tough.  Sure, nobody wants to cope with the unpleasantness of a pain.  But in general, they are adept at coping and soldiering on.  What I do find that people are really seeking (along with pain relief) is assurances that they are taking the correct measures to allow for optimal healing and avoiding making matters worse.  It might not seem like much, but when you consider that one can experience pain for reasons far more complex than tissue damage, addressing the psychological component of pain is tremendously valuable.

***One final note on pain.  As I've written in the past, pain that wakes you an night, is unremitting, and does not respond to positional changes is a red flag.  This is certainly NOT NORMAL and requires a trip to your doctor to rule out anything systemic.

Interview With a Personal Trainer

One of the things I like about my job is the collaboration I get to do with other professionals in the rehabilitation and fitness world.  I'm always learning new things and expanding my knowledge base, sometimes shedding old ideas for new ones.  It keeps my job interesting, but most importantly, helps provide my patients with better outcomes.

Over the past several months, Johari Mayfield of Johari Fitness has been coming into the clinic for some hours of observation and collaboration.  A few weeks ago, Johari asked if I'd like to be interviewed for her website.  I thought it sounded like fun and was happy to participate.  Here's the clip below, in which I answer a few questions and offer some insights regarding movement skills, rehabilitation and collaboration:

http://vimeo.com/100241583