There’s a fascinating phenomenon that exists within the world of recreational circus arts and, depending on the background of the artist, it sometimes happens beyond the recreational level: people “do their PT (physical therapy) exercises” before they train. I realize that on the surface of it, that may not sound particularly fascinating, but there is an element to this phenomenon that I find somewhat troubling.
You see, even when they are not currently injured or actively rehabbing an injury, people still “do their PT”.
“Oh, I got these exercises from my PT a decade and a half ago when I had this shoulder issue…”
Obviously, there is a bit of a tongue-in-cheek bit there, but nonetheless, my question is this: if you are not currently injured or actively rehabbing an injury, why are you “doing PT”?
Why are you still “doing PT”?
Perhaps it would be helpful to frame this question:
First and foremost, physical therapy—as we know it—is what you do when you’re injured and looking to recover. Physical therapy—based on the way that it seems most people view it and use it—is designed to return your body to the state it was in just prior to the moment your injury occurred.
This is where things get tricky, so let’s take a step back:
[alert type=”info” close=”false”] Actually, things get tricky on two fronts. One is a matter of means and accessibility. Please read about that here. The other…starts with a step back: [/alert]
Let’s talk about how injuries happen
Load > Capacity = Injury
In the simplest sense, an injury occurs when somewhere over the course of your training, a tissue of the body (a muscle or tendon, let’s say) encounters a load (an external force) that is greater than its capacity to withstand. This can happen all at once (acutely) or gradually, over the course of time (“overuse injuries”, which I suspect are the most commonly followed path to injury town).
There are a variety of factors that influence a tissue’s capacity, increasing or decreasing it. Faulty movement, for example, can mean a tissue bears more load than it should. Endurance plays a role (injuries are more likely to happen when we’re fatigued) and, of course, so does strength.
I would be remiss if I didn’t also mention that sleep and recovery and stress and nutrition all add to the mix of overlapping and interacting factors that determine a tissue’s capacity.
However it came to pass, your tissue encountered a load that exceeded its capacity and an injury resulted.
Load ≤ Capacity = Rehab
Next, let’s say you went to see an orthopedist and they diagnosed your injury and sent you to see a physical therapist. In your initial assessment with your PT, they will seek to gain a clearer picture of what hurts and, most importantly, why.
From there, your PT will begin the process of guiding the healing of the injured tissue so that you can eventually begin building it back up—
—now, this “building it back up” idea is an interesting one because it raises the question build it back up to where? And that’s a really important question to consider.
Again, thanks to the way that we approach healthcare, the majority of cases are going to unfold like this:
Tissue healing: The adventure begins with controlling pain and swelling. (Initially, this might not even be happening under medical supervision…because, you know circus artists: if it hurts, you have to practically drag them to the doctor’s office). The length of time you spend in this phase depends greatly on the extent and severity of the tissue damage (injury). This is generally where you’re going to have fun with the PT doing manual therapy and other modalities (ultrasound, laser, etc.). Low-level isometrics can work here as well.
Get it moving: Basically, as pain and swelling get under control, it’s time to begin moving the joint(s) nearest to the affected tissue. Depending on the injury, this begins with passive range of motion exercise (where your PT moves it for you) and progresses to increasingly active range of motion exercise.
Get it moving well: It is often the case that your PT has noticed some faulty movement patterns that may have played a role in predisposing you to injury. This is where the process of improving how you move begins. This usually also means that something in the kinetic chain was/is weak and your collection of therabands will increase as you begin to strengthen the weak link(s) in the chain.
Recall that the rehab equation—
Load ≤ Capacity = Rehab
—involves loads that are less than or equal to the tissue capacity.
And this is where a lot of rehab comes to an end. You are “back to 100%”… right back to where you were just before you were injured.
Actually, that might not be entirely accurate to say. Let’s use an example:
Say you found yourself in rehab because you had some impingement pain that turned into rotator cuff tendinitis.
In the process of calming the inflamed tissue, the PT recognizes that your lower traps are weak and not sufficiently contributing to scapular upward rotation. When you bring your arms overhead, poor scapular positioning means more impingement. This is probably what ultimately caused your rotator cuff to get all angry.
Continuing with my simplified example, your PT teaches you how to get your lower traps to do their job and you end up with a series of exercises designed to strengthen those lower traps.
An example would be the “Y with theraband”:
After you learn the movement, perhaps you start with a yellow band for resistance. Eventually, it’s graduation time and you’re using a green band. (It could be a darker color, but green therabands seem to be everywhere! We’ve even got several in our closet at home!)
And, depending on your PT, the clinic you went to and, unfortunately, the parameters (restrictions) placed on how long you can be in physical therapy by your health insurance, your rehab may even include revisiting some circus-specific movements.
So this is where we can say that you came out of physical therapy a little stronger than when you went in.
And then, it’s back to circus.
Sure, it’s a “gradual” return—whatever that means—where you “don’t do anything that causes sharp pain” at first, but eventually, it’s just back to business as usual.
Except that now you have your “PT exercises”…
…that you will continue to do…with that same green theraband…for the rest of your life so that you avoid re-injuring your ________ …
…because you just know that if you stop “doing your PT exercises”, you’re surely going to get hurt.
And so it goes…”injury prevention”
The thing is, words matter and, as I mentioned earlier, the current dominant perspective on physical therapy is that it’s what you do after you’ve been injured.
And thus, we arrive at “doing your PT exercises” to prevent injury.
And don’t get me wrong: I am totally in favor of preventing injury. Or, perhaps more accurately, reducing the likelihood and/or severity of injuries.
Part one of my question is essentially at what point—if ever—do you stop “recovering from injury”?
Because there is another way.
At this point, I’m hoping that the alternative is pretty obvious. There’s a third “equation” that we can look at to illustrate my point—next week, in part two.