life is about participation; not avoidance

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By Dr. Sarah Greenwell, PT, DPT, CSMPT

​As clinicians, we should be saying “how”, not “no.”
How many times have I heard a patient tell me that they can never do ‘x’ again?

• "I had my knee replaced, and my surgeon told me never to kneel again"
• "I fractured my ankle a couple years ago and the doctor told me never to run again"
• "I herniated a disc in my back a few years back, and my chiropractor told me never lift anything over 20 lbs"
• "I have a labral tear in my shoulder, so my old PT told me not to play baseball with my kid anymore"

As healthcare professionals, we need to take a holistic approach to treating our patients. While these professionals may have been looking out for the physical interests of their patients, they neglected to remember that we are not a sum of our parts. Our mental and psychological health is equally important and intertwined. 

 ​When that patient was told never to kneel again, she refused to practice getting up and down from the ground with me in my clinic because she would not put weight on her knee in a half kneel position – even for the 10 second transition (and with hand support on a table). The surgery happened over 10 years ago; and she was now at a point where her balance was not good and she was afraid of falling. I was trying to show her in a controlled environment how to get up if the worst were to happen (sometimes the fear of falling is equally the fear of not being able to get back up).

Or the 65 y.o. patient who was told never to lift anything over 20 lbs... His 3-year-old grandson was 34 lbs and wanted to run into Papa’s arms. Rather than being taught to strengthen his core and learn good lifting mechanics, Papa just reminded the little guy that grandpa has a bad back and will settle for a high five.
​
In a world where the Paralympics continue to show us how resilient the mind and body are and how the once inconceivable are not only attained but gold medalists -why are we so willing to accept no as an answer?

As physical therapists, I would hope that my colleagues, as well as other professionals, start realizing the impact that what we say can have on an individual’s self-identity and future ambitions. 

The body is so amazing and was designed with the capacity to heal itself. Tissues heal. Chronic pain is usually brought on by an overactive nervous system that may have been conditioned under stress, conflicting medical opinions, fear of imaging results, ongoing legal battles, growing medical bills, and family pressures. Not always. Some things do result in life-long tissue damage- but this is more rare than we are led to believe.

As PTs, our goals are to

1. Help your tissues recover faster through education (knowing what is going on can significantly help reduce neural response), manual techniques to improve tissue mobility and circulation, and strategies to reduce further stress to the healing tissue.
2. Teach you ways to rebuild proper movement patterns and strengthen surrounding tissue to support return to normal activity without further risk of injury.

OR
    3. If severe trauma or a progressive condition causes a true inability to resume prior function at your previous capacity, then it is our job to show you modifications or tools to continue to allow you to perform within your current abilities.

​So.. to help preserve the longevity of a total knee replacement, you shouldn’t garden on your knees for 30 minutes at a time. But, you could use a low bench, planters, or a raised garden bed. If you had your knees replaced early so you can be more interactive with your grandkids, then use your knees to help lower and raise yourself from the ground to play with the legos.

If you are a runner who used to run 5 miles each morning to help improve mental focus for the workday ahead; or at the end of the day to help relieve anxiety -being told not not to run feels like give up the best mental health practice of the day. Some fractures are linked to increased risk for developing osteoarthritis, but what is the health risk from not exercising, losing the mental support of a running club, and turning to more passive stress relievers at the end of a long day (high sugary foods, alcohol, TV). Instead, maybe you start with a 2 mile hike in the morning and a 1 mile jog at the end of the day.

If your shoulder has a torn labrum, it might be irritated throwing consecutively for 20 minutes at a time. But you can start with 5-minute intervals while building up strength in your rotator cuff and doing daily mobility practices to make sure your shoulder moves freely without stressing the internal structures. Or you can be the batter and let your son practice fielding and running the ball back.
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Yes, your back might have a herniated disc. It might have more than one. But does it hurt all the time, or is it just fear of reinjury holding you back? Were you told you will need major surgery if you ever hurt it again? What if I told you that some disc herniations get reabsorbed over time (Altun & Yuksel, 2017).  Your deep abdominal muscles and spinal stabilizer muscles act like a weight belt at the gym. Instead of preventing abdominal hernias, when working properly, they support the internal spinal column and allow you to lift with very little risk of injury. 

​So if you have ever been told no, and you are sick of sitting on the sidelines in the game of life, I hope you can find a PT that tells you “how” instead.

Hint: you can come see us anytime at RecoverRx Performance Physical Therapy, where our motto is:

Reference: Lumbar herniated disc: spontaneous regression. Idiris Altun and Kasım Zafer Yüksel. Korean J Pain. 2017 Jan; 30(1): 44–50. 

Thanks for reading!
Dr. Sarah 

Email me if you have any questions about how we can get you back the things you love! sarah@recoverrxpt.com