Uncomplicating Treatment
M Power Physical Therapy and Wellness is a cash based physical therapy clinic which offers strength and conditioning and wellness services.
One of my primary visions when creating M Power Physical Therapy and Wellness was to simply treatment.
Let’s think about musculoskeletal pain or injuries to a more common experience. If you are an adult I assume you have had some sort of cold, sinus infection, flu, stomach bug, or food poisoning at some point in your life. Generally you know that you need to rest, hydrate, eat as tolerated, maybe take some medications for some symptom relief, and maybe don’t go to work until you feel better. Rest generally means taking it easy but not necessarily total bed rest. Hydration can include soups, juices, ginger ale or lemon lime sodas, sports drinks etc. Eating can be a touchy issue when you are ill but you generally know to eat gentler simpler foods and may need to eat more frequently throughout the day in smaller quantities. As you recover you are slowly able to incorporate more foods and more activity. Sometimes you over estimate your recovery and feel worse for it. Examples include eating too much in one go and having to use the restroom quickly or having to leave work earlier than expected. However over time you progressively return to ‘normal’ with maybe some residual symptoms over a few weeks. Also to keep in mind that some of the bugs can last longer or have some lingering symptoms that take longer to resolve than expected.
Let’s compare this scenario substituting back pain. You injure your low back so you consider relative rest. You can stand for about 10 minutes comfortably and with some medication you can go for about 1 hour before you need to sit down. As time goes on you notice that you need medication less often and can stand for longer generally. You also notice your symptoms do better when you do some movement but not too much. You notice that eating a simpler diet emphasizing lean meats, fruits, and vegetables makes you feel better than a few alcoholic beverages and take out. Similar to another ‘bug’ back pain can improve progressively with some relative rest (not total bed rest), maintaining some activity levels, using medication to alleviate symptoms, and eating a health promoting diet.
Let’s use one more example and think about knee pain. Maybe it hurts to squat 225 pounds but anything under 200 is pain free. Do you need to stop squatting all together? Probably not. There is clearly some dysfunction/disconnect between these two weights so relative rest from 225 pounds until the issue is addressed. If running hurts but walking and biking do not it sounds like you can stay active despite your symptoms. If taking an over the counter medication (for a short period) means that you can perform the activity you love I do not seen an issue with it. The issue becomes when we ignore our symptoms and continue taking medication or never return to the previous load that previously been symptomatic. Just because I got food poisoning from eggs once does not mean I will avoid them for the rest of my life. So again, relativ rest, a health promoting diet, and medication as needed can improve our symptoms.
I bring up this example of comparing our musculoskeletal injuries to some common bugs because we need to remember we cant rush recovery. My mom had a saying. A cold treated with medication takes two weeks to recover from. A cold treated without medication takes 14 days to recover from.
Let’s talk about home exercise programs and musculoskeletal recovery now.
I would frequently be chastised, admonished, yelled at, etc for not providing patients with a print out of their home exercise program. My associates would provide their patients with 2-3 page programs totaling about 8-12 exercises. These patients would usually come back and say that they did not have the time or capability to perform all 12 exercises as written and would generally be anxious, disappointed, and ashamed they they were not able to do what was requested. Alternatively what I would also hear was that the paper was lost, washed, or that the patient did not know what to do from a priority order. Additionally, if the patient had done their exercises and demonstrated them the technique was usually poor. So I thought to myself what’s the point of giving a patient a home exercise program if they cannot complete it.
As an aside there has been a general critique of Physical Therapy that as a field we typically ‘underload’ patients. There is some reason to do so considering we do not want to flare up an injury, however, some loading is required to promote progress. These expectations need to be discussed with a patient. As a cash based physical therapy clinic that emphasizes one on one services we have the time to properly educate our patients properly.
Thus our motto of Simplicity, Efficiency, and Convenience. My goal for home programs are no more than 2-3 exercises that can be performed frequently, any time, and anywhere. This philosophy helps to cover a variety of physical therapy treatment concepts, though let’s focus on pain modulation, loading, and functional carry over.
The primary reason most people seek physical therapy services is pain. At M Power Physical Therapy and Wellness we seek to find a movement or other form of self treatment that you can do in many positions to relieve your symptoms Pain is a complicated experience and is not always tied to a specific structure. What we try and offer is a philosophy that permits you to find pain relief throughout your day without needing a therapist cue. One of the scenarios I like to give people is that of throwing a ball. We have a relative pattern that we use when we throw a ball. We know how hard to hold the ball, how much force we need to put in to it in order for it to reach our target, and when to let go. As a result there a variety of movement patterns that we have programmed over the years in order to achieve this result. When we have pain or other symptoms our body may limit or blur the lines between what patterns are efficient/effective for us at that time. Physical therapist can help create a new pattern or can help untangle the patterns so that you can access more patterns that either reduce or abolish your symptoms. These pattern adjustments can be temporary which leads us to the second point.
We emphasize the frequency of these movements to promote loading. Maybe your joint or body part cannot handle 20-30 minutes of continuous movement or exercise, but can handle 20-30 minutes of movement or exercise throughout the day. Maybe you get symptom relief for about 20-30 minutes from the movement pattern. A common trope in home exercise programs in that these exercises should be performed 2-3x a day. If you get symptom relief that lasts 20-30 minutes from completing an exercise why not complete it as needed for additional symptom relief. The movement patterns we practice with you to find symptom relief are based on finding frequent symptom relief and should not take long to complete in order to find relief. I think of this as competition between exercise and over the counter pain relievers. For myself a motrin or an aleve will generally make me feel better in 20-30 minutes. I want the exercise I provide to you to make you feel better faster than it takes for you to get the pills and water. Why? Because life does not always give us 20-30 minutes for us to start feeling better.
This brings us to functional integration. If we can provide to you a movement pattern that can be done anytime and anywhere it is not longer an exercise it is a part of life. If every time you go to lift something and you have practiced your pattern and your back does not hurt that is functional integration. If you practice your pattern and it does not hurt to turn your head while driving that is functional integration. If you can fold laundry because your shoulder does not hurt because you have practiced your pattern that is functional integration.
Our motto of Simplicity, Efficiency, and Convenience embodies what has been discussed. We find a pattern that requires minimal equipment or cueing (Simplicity), that improves your symptoms or capabilities (Efficiency), that can be done any time and anywhere (Convenience). These principles came to be because I too am a person and a patient. I know my life is busy and I cannot always find the time to do the things that I need or like to do. However, a few seconds of my time here and there are generally available to me. We’ve all stood around waiting for the water to get hot before we clean, we have all sat at a red light, we have all waited in line at a grocery store. These are the little moments that we can capture to try and incorporate the patterns that make us feel better so we can get back to doing the things we love most.
If you have any questions about our philosophy or how it can help your symptoms please feel free to reach out to us via our contact page.