mind over movement

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Physical therapists are body mechanics who deal in the nuts and bolts of human movement.

After taking a medical history, we hunt specific impairments in strength, flexibility,  balance, etc. We replicate the pain or problem using combinations of motions, posture, and loads. We may also give attention to environmental conditions such as work demands, equipment and tools, footwear, and body mechanics.

And so it begins. Unload inflamed tissues. Stretch, mobilize, or manipulate what needs to be stretched. Strengthen what needs to be strengthened. Correct faulty movement patterns. Attend to equipment needs. Prescribe a realistic home exercise program that bears in mind the original problem.

A few weeks later, we send clients out the door throwing braces to the wind, tossing medications in the trash, and clicking heels together as they go tell all nations the good news of physical therapy. We thump a fist to our chest and shout, "This. Is. P. T."

Except when we don't.

It doesn't always end well. Some people don't improve much or for long. They need medicine or surgery or something else. Many of those people go on to fail at other treatments. Trust no health care provider, PT or otherwise, who fails to acknowledge that they are one part of team and the fact that they can't help everyone.

The complexity of human movement seems like simple modernism next to the entire realm of psychological and social factors. It seems that ethereal fluff like attitudes, beliefs, and expectations trump the logic bound stuff of biomechanics.

"Okay Mr. Smith, today we're going to work on mobilizing that attitude."

Stress, social support, job satisfaction, expectation of recovery, and fear of re-injury have all been identified as important variables in the recovery of physical function. It's no light or indirect association. Numerous examples abound.
  • Recovery from an episode of low back pain has more to do with mental health, whether or not you're suffering anxiety or depression, than it does with any specific measure of back flexibility or core muscle strength. 
  • The correlation between physical function and degenerative findings in diagnostic imaging (X-ray, MRI) is low at best.
  • A persons perception of the physical demands of work is a better predictor of disability than are actual measurements of forces, weights, and other physical demands of job tasks. 
  • Several studies have shown that a patients perception of the severity of their musculoskeletal problem is depends on, above many physical factors, whether their doctor advised them to rest or not go to work. 
  • Don't imagine that health care providers are exempt. Research shows that many health care providers choose treatment interventions based less upon actual clinical presentation of their patients and more so on their own attitudes and beliefs regarding pain behavior.
Neither health care providers nor patients can afford to underestimate the psychosocial factors in the development and treatment of musculoskeletal problems. Move, work, move, carry on, move, and hustle, truly to the best of your ability. Try to see the bright side, and try to be treated by people who do likewise (I know this sounds ridiculous for those suffering clinical depression, but it needs to be stated).

Mutual trust and respect helps providers truly advocate for patients, and helps patients trust, learn, and self-manage to the best of their ability. This is real help, not just fluff. And it's not going to happen with a 7-minute office visit. In physical therapy, it doesn't happen when physical therapy techs herd patients through exercise protocols.

Have you received treatment  of a physical problem with or without a side order of mind fluff?

*References/further reading available. Didn't feel like typing it out but yeah, let me know.
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