The musculoskeletal system is a complex and ever-changing system that sometimes can confuse and baffle even the most tuned-in and self-aware person. At these times, expert observation and intervention are what physical therapists can offer. We can help to re-establish the body’s balance and harmony which leads to healing.
There are any number of factors which can overwhelm one’s understanding of what is going on in their body and confuse us as to what to do about it.
Surgery
Although the goal of surgery is to correct pathology, the process is so alien to the realm of normal experience that it is difficult to interpret the tidal wave of sensations that are present postoperatively. Am I pushing myself too hard? Am I pushing myself hard enough? Is this pain normal? Am I doing harm to myself by doing this activity?
All these questions and many more go through the mind of the post-op patient and physical therapy can answer these questions and lead to a happy resolution so can enjoy the outcome of surgery.
Chronic Pain
We often think of an area of chronic pain as the tip of an iceberg. The 20% above the water (representing the area of pain) is maintained and perpetuated by the 80% below the water.
That 80% below the water is silent and unknown to most. The expert eye of the physical therapist can see areas to work on that aren’t obviously connected.
Injury
When the musculoskeletal system is injured (i.e. when you throw your back out or sprain your ankle), the body’s healing power begins its miraculous job. In most cases, time does heal all. There are two key words in the above sentence that warrant a response.
The first key word is “time”. If all we had to do was sit around and convalesce, all would be well, but the pressures of our life require us to get better sooner, rather than later. Physical therapy can usually speed up that process significantly.
The second key word is “most”. There are injuries that don’t respond to time and convalescence. These are the injuries that become chronic (greater than 6-8 weeks). Once again the physical therapist can become a problem-solver and seek to discover the non-obvious factors that are preventing the timely recovery of injury.
The title, physical therapist, says a lot. We provide help with physical problems. Problems of the MS system are our specialty at ABA Physical Therapy. Let us help you through the recovery process. Steve Anderson PT
At ABA Physical Therapy, we encourage regular exercise in all its forms, whether it be stretching, strengthening, or cardiovascular. The choices are many: Yoga,Tai Chi, Pilates, weightlifting, swimming, walking, running, biking, etc. How do you decide what’s best for you?
The first consideration is that it should be something that you enjoy doing! If you try to ride a stationary bike, but are bored, you’ll be much less likely to make it a regular routine. You should also take into consideration any pre-existing conditions or joint problems. If you have knee or back problems, swimming or biking may be a better choice than running. If you have shoulder issues, weightlifting or swimming could be problematic, or could be helpful if you do the appropriate exercises or choose the best swimming stroke for your particular problem. Your physical therapist can help you determine what type of regular exercise routine will be best for you.
Your PT can also give you guidance as to how to progress your program. Sometimes the best intentions lead us to over-do our workouts, only to aggravate an existing problem, or create a new one. When beginning a new routine, or returning to an old routine after a lay-off, progressing gradually is the best move to ensure you can maintain consistency, without re-injury.
Often when we consult a doctor or physical therapist we have a particular problem we are looking to address. There is always a medical history form to fill out and sometimes we fill it out as quickly as possible and omit things that we do not believe are related to the problem at hand. What difference does it make what’s happened to us in the past or what medications we are now taking? Providing a full picture of your health status gives the healthcare practitioner a better picture of your overall health so that he/she is able to help you more effectively.
Knee pain may be in your family but its sudden onset could be unclear. Understanding that you suffered an ankle sprain years ago, which may have influenced how you have walked ever since could more thoroughly help your recovery. Old rib injuries may have changed how your upper body now supports your neck. Previous surgical scars sometimes leave adhesions which act as barriers to full movement without you noticing. Our jobs, as physical therapists, is to restore motion in the most efficient and effective way. Sometimes that includes how other parts of the body are contributing to the problem site. When we see the connections of the whole body we see how miraculous it really is!
Have you ever seen an episode of “House” on TV? The main character uses a cane often because of a painful leg but, he holds the cane on the same side as that painful leg. His character does it to be cantankerous and it’s NOT the right way!
When a foot or leg is unable to bear weight fully and we need assistance from a cane or crutch the opposite hand should be utilizing that device. When you step forward with the affected leg, support for that leg should come from the opposite arm. Watch anyone walk any distance and you will notice how the upper body rotates to swing the opposite arm forward as a leg advances. This is called “cross pattern walking.” Walking by moving the same side arm and leg forward makes us look robotic and strange! Keep that same, natural cross pattern of movement happening even while you are getting help from a cane or crutch. Your balance will be better and you’ll feel much more stable.
Home Exercise is a vital adjunct to physical therapy treatment. Since we are primarily a manual therapy clinic, we spend a good part of every session trying to gain ease and movement where there is restriction. For example, a common postural tightness occurs in the front of the hips. We spend a great deal of every day sitting – at work, watching TV, reading. Long hours in a sitting position create a shortening at the front of the hip joints. Therefore, much of physical therapy treatment would be spent doing manual release for the psoas and quadriceps muscles to create a more effortless, upright posture.
However, we only see you for an hour or so weekly. It is very important that you carry through with exercises at home so that you don’t lose what you gain in a manual therapy session. Correct performance of exercise is not busy work. It’s a necessary continuation of corrections gained during our sessions with you. So Do Your Exercises!
Good balance depends on many different parts of our nervous system and musculoskeletal system working well together. For good balance we need muscular strength in the trunk and legs, good sensation in our feet and legs, good eyesight, a well functioning equilibrium system, and good reflexes.
If you have impairments in one area (for example; poor sensation in your feet due to Diabetes), you can become overly reliant on your other systems to help with your balance. A common example of this is “visual dependence”. Without even realizing it, you may become so reliant on your vision that you have more trouble in situations with low light, such as walking at night, or in a movie theater, or in places where there is a lot of visual distraction, such as a busy shopping mall.
Balance exercises that challenge you to use your other sensory systems more (sensation and the equilibrium system of the inner ear) can help. They work by requiring you to perform balance tasks with your eyes closed or with visual distraction such as turning your eyes and head, preventing you from focusing too long on a fixed object. This “forces” your other systems to work harder, so they become stronger and more efficient. When you find yourself in those visually challenging situations, your body will be able to rely more on all your systems to stay stable.
As physical therapists we often hear from patients that they have experienced a series of problems, seemingly unrelated. For example, someone with foot pain a few years earlier may now come for treatment of a hip or knee problem, sometimes without any specific incident of injury or onset. Or someone with an old wrist fracture may develop a shoulder problem. Are they related? They can be!
Even after pain resolves subtle changes in the way you move or walk following an injury can lead to “wear and tear” elsewhere in the chain of movement. Each joint is influenced by those above and below. This is why we will evaluate the movement and strength of your hip and ankle, even though your primary complaint is knee pain. Even if you haven’t had another injury or area of pain before, differences in the mobility or strength throughout the body can result in mechanical stresses being placed on some parts of the body more than others. Just like your tires will wear unevenly if your car alignment is “off “, your body can “wear” unevenly if you stand, sit or move too asymmetrically!
Paying attention to the whole chain of movement addresses the mechanical influences which create the problem, and can help minimize the chance that symptoms will return.
Several years ago, a colleague of mine did an informal study in her physical therapy practice to find out what region of the body most commonly had the severest restrictions. What she found was that the thoracic spine and rib cage were the areas she most frequently found restricted and that when these areas were worked on to gain more flexibility and muscle relaxation, neck or low back pain resolved much more speedily. (The thorax is defined as that part of the body between the base of the neck and the diaphragm or breathing muscle which is located in line with the lower ribs.)
This conclusion should not be surprising. The thoracic region is a cage of sorts with the purpose of protecting the vital and life giving organs of the heart and lungs within it. It has a structure that forms a foundation for some of the muscle attachment of the arms and neck. The respiratory diaphragm is a large muscle traversing horizontally across the floor of the thoracic cage. Piercing through and right behind this primary breathing muscle are: the aorta carrying blood from the heart to the rest of the body and the inferior vena cava returning blood to the heart. As the diaphragm rises and falls with breathing, it pumps the blood vessels which pass through and behind it. The esophagus also pierces the diaphragm.
An important muscle group starts at the spine, level with the bottom of the diaphragm and crosses the hip joint into the legs. This muscle is the Ilio-Psoas. The diaphragm itself attaches onto the lumbar spine. So structures from the thoracic region can affect leg and spine movement as well.
If movement is restricted in any part of the thorax, the ribs are no longer free to lift and descend with each breath; so respiration is shallower and requires more effort and the diaphragm cannot fully perform its function of expanding the lungs or pumping the large vessels to assist blood flow. We become more stiff and solid through the entire region. Physical therapy treats the muscles, joint and fascia which ‘hold together’ this protective cage while allowing it to move.
The thoracic cage is also integral in expression of emotion. We instinctively protect not only our physical being but our emotional vulnerability too. We respond to emotions such as fear, grief, shame and depression by a posture of drawing in and holding our breath. Try putting yourself into a posture of feeling depressed or fearful and see what happens to your breathing. These instinctive postures all involve the thorax.
The thorax is easily disposed to hold tension. As a result not only our movements but also some of our vital functions are restricted. This is why we often work on this area area using manual therapy techniques, even if the person presents with pain far distant from the thoracic region.
Our mothers, of course, are right! We need to sit and stand up straight. But why is this so important?
When we slouch, the spine curves forwards, the shoulders come towards the chest and the head pokes out in front of us. There is no place for the head to balance on top of the spine which is what it is supposed to do. When the head projects forwards the muscles of the neck have to work extra hard to support its weight. An average head weighs around 9 pounds.
Try adopting a slouched position and notice how the head moves forwards while the muscles of the neck become tense and uncomfortable. Especially affected are the two muscles, one on each side of the throat, called the Sterno-cleido –mastoid. The inferior (bottom) end of the muscles attach onto the sternum and clavicle (cleido) and the top end attaches on to the bone behind the ear, the mastoid process, which is part of the temporal bone. It is useful to note that muscles are named very often according to the places to which they attach.
When the Sterno-cleido-mastoid muscles are tight they tug on the temporal bone, and interfere with the position of the mandibular portion of the jaw joint as it rests in a delicate balance on the disc of its joint. Stress is put on the disc and the jaw does not slide as well over its disc.
Note also the back of the neck in the slouched position. There is compression at the base of the skull with the forwards head posture and this can lead to or compound headaches.
Now, get out of the slouched posture and you will feel much better! Make sure your feet are flat on the floor. Now roll the pelvis under you or bring your belly button forwards. This will straighten the lower part of your spine and the rest of the spine will follow, lastly the head will come back to rest naturally on top of the vertebrae stacked under it.
The mandible (lower jaw) will rest in a position which gives space to the disc so that the bone can slide easily over it. Space will also open up at the base of the skull to relieve compressed structures. And, you will be able to breathe more deeply! Can you feel what happens to your rib cage as you straighten up?
Feeling and being aware of these changes between tension and relaxation, compression and space in your body structures goes a long way to altering old habits.
