The rambling and musing on 20 years as a PT continue….from Oahu

Aloha! Two hurricane watches and a delayed flight later the entire herd made it safely to Oahu. I feel the need to bring closure to my last post about my journey in physical therapy, where I am today and where the future may take me. It has been said the best way to stay secure in your knowledge is to not read. The more I read, the more I realize how much I don’t know. Medicine and health care are in the midst of great change with high quality research now debunking long held beliefs. On the continuum of heath care practitioners, you have two polar opposites: those that prescribe to the C.A.M. (Complementary Alternative Medicine) theories and the other end are those who do nothing until it is “evidence based” and backed my hard science. Large egos run rampant in each camp and here lies the problem. Like a weigh in before a heavy weight boxing match, there’s plenty of chest thumping, trash talking, and ultimately nothing gets done but both parties exit feeling as though something has been accomplished.

Personal soul searching has made me realize that I have one foot in each camp, a precarious position to be in. I read the evidence which sometimes challenges deeply held thoughts and beliefs that I often considered dogma. And although not fully recognized by the medical institution, acupuncture, meditation, energy medicine, and reiki can be powerful modalities that can lead to dramatic transformations in health and happiness. In quiet moments of reflections, I do know what I do manually can make a difference, but probably NOT for the reasons I thought. Rather than jettisoning my manual skill set, I find myself asking the difficult question of “what am I actually doing to make a difference with my clients”.

Every profession has its villains, the demonic source of all your pain and misery, and if we can free you from the clutches of this tyrant, all good in the world will be restored and global warming will be reversed! If you are a PT then you fight the evils of poor posture, muscle weakness, poor motor control and loss of range of motion, muscle tightness and other heinous maladies. Chiropractors will sell you a pillow, straighten out your crooked spine, put your joints “back in” and restore that lovely “normal” curve in your neck before it cripples you. Massage therapists will no doubt acquaint you with your psoas and you will wonder how you ever survived this long without someone making you cry as they “release” your psoas.

As a Physical Therapist, we have been conditioned to make poor posture, muscle tightness, loss of range of motion, and muscle weakness the prime suspects in the crime of pain, yet none of the above stated have been “proven” to be direct sources of pain. Take a very common example of someone who is experiencing mid back pain and happens to have an increase in their thoracic kyphosis (excessive curvature of the middle back, “hunched over’). In our quest to look for the “source” of pain, the easy answer is to look at someone’s kyphotic posture and make it the seed of all evil. Their kyphotic posture may be all or none of the problem since they may have had poor posture for years and the back pain only recently. First some basic definitions: An example of a retrospective study would look at a group of individuals that all have back pain and try to find the common characteristics and then go about solving them. Using the same lower back example, prospective studies are those that would follow a group of people that had NO back pain and evaluate them through the same physical therapy lenses and low and behold, would find many of the same issues that we thought were problems: muscle weakness, poor core strength, poor posture, etc. yet they have no back pain. Life was simpler when I didn’t read the literature.

So does this mean we throw out all previously held sacred tenants- muscle weakness, restricted motion, joint tightness, etc? I haven’t but I’m also humbled in my approach and have a greater appreciation for the complexity and wonder of the human body especially when someone asks me “well, what’s causing my pain”. Be wary of any practitioner who emphatically declares, without hesitation as to the cause of your chronic pain. Many people have described the body as an “amazing machine” a description that I completely disagree with. Pull the spark plug out of your car and see how the “machine” responds. To minimize the body to a “machine” is like saying Van Gogh was just a painter. My personal investigations of the human body and health lead me to further explore our amazing “biological capacity”. Each of us have an inert ability to maintain optimal health and the amount of “stress” our body can take depends on our “biological capacity”.

I believe that when our “biological capacity” is exhausted, we then become vulnerable and susceptible. This vulnerability or susceptibility can them come out in different ways depending on the individual: chronic pain, autoimmune conditions, chronic disease, cancers, digestive conditions, and depression are just a few examples. What I help people do is to increase their “biological capacity” through manual therapy, techniques to calm their nervous system, changing attitudes about their pain, helping them learn to love themselves, trying to focus on what you can do instead of what you can’t do and anything else that may come to me. So if our goal is to increase our “biological capacity” I might design a home exercise program that includes exercise, meditation, being nice to yourself instead of being critical, have a glass of wine, laugh a little with friends, and don’t sweat the small stuff. Thanks for reading my ramblings, I got a lot off my chest, and increased my biological capacity just a little bit,
Be safe,