This conversation come up whilst I was taking a patient of mine through a strength based rehab session. They have fully recovered from a lumbar disc injury, a neck and shoulder injury as well as post operative recovery following surgery for bowel cancer. We were high-fiving because he had got through a couple of crazy days of physical work at a vineyard and had no hints of back pain or shoulder issues at all and was feeling great despite the strain and effort he put himself through. He made the comment that his training was "really working for him" which prompted me to go into a bit of a monologue about what that phrase means to me 🙂 It went something like this:

The whole point of physical therapy and all of it's different branches and sub types is to create meaningful changes to your life and wellbeing. Initially, the biggest change most people want to see is to their pain; they want to feel better and move more freely. Beyond this the goal is to not have that pain return...but this is where the industry is letting people (you) down!

When folks jump on to google and search "physio near me", "myotherapist geelong" and all of the various terms that lead them to find a therapist that they hope can help them, most commonly it's with the goal of finding relief to an issue like back pain, neck pain or shoulder issues that have been lingering for a little while. There are a lot of therapists out there who are quite good at helping people feel less pain, which is fantastic. After their consult they may be sent away with some cream, taping or some advice on how to avoid aggravating their pain so that it can further settle.

If that remains the treatment focus or is the limit of the treatment provided then that is what we call an "avoidance approach". All it involves is figuring out what's aggravating your pain and telling you to stop doing that thing. The problem here is that trying to avoid moving in certain ways, sitting in certain positions or lifting things with a certain technique is simply not possible all of the time. For example, if you aggravated your shoulder by reaching to the back seat it is fair to advise you that you'll need to avoid that movement TEMPORARILY to allow the injured structures to settle and heal. However, to leave the advice there and expect you to avoid that movement for the rest of your life is just bad practice and misses the broader point of treatment altogether.

The goal of your therapist should be to help you overcome pain but to then help you get to a point where you can do whatever it was that caused your pain in the first place but without the risk of pain or injury developing again. This means that your care needs to be relevant and applicable to your life outside of what happens in the treatment room or with your rehab exercises. Finding exercises that challenge an injured body part to heal fully is critical to a full recovery. But finding exercises that allow you to learn and feel new, different or 'better' ways of moving is also critical.

For this patient, when I first met him he tended to move with excessive stiffness and bracing in his lower back and 'core' muscles. This is what he'd been taught by a physio who took a clinical pilates based approach to his care which, unfortunately, ended up causing him more pain and discomfort. This lead to a habit of focusing his effort into tightening those muscles whenever he was lifting and carrying things (and often even when he wasn't). This is an issue I phrase as "putting tension on top of tension". So a big part of our work has been to help him learn how to spread that effort over more muscles and more body areas so that the strain isn't so focused into his lower back. Now he can feel that his hips and hamstrings can do a lot of the work when doing those same tasks, which allows him to ease off the effort in his lower back. This means his back muscles don't get as fatigued, the joints in his back aren't getting the same amount of compressive strain and his overall endurance and tolerance for movements that were previously painful is sky high.

This is one of many example of how we can make a rehab plan meaningful to the life you live outside of the treatment room and outside of the gym. The drills, exercises and techniques you learn in your care can set you up for a life of progress or a journey of stagnation if they aren't specific to YOUR needs. To put it simply; if nothing changes then nothing changes.

If that ramble didn't make sense in written word, just trust that it made sense face to face! Hahaha

As always, have fun, train smart and expect more!

Carey