The True Role of PT for Rehab.

I recently sustained injuries to both my shoulders, probably as a result of overuse and chronic trauma (apparently, throwing someone on top of you instead of over you via Morote Seoi hurts your shoulders).  Over the past couple of months, I’ve managed to nurse at least one shoulder back to health, with the other well on the way.

Some of my classmates and clients are amazed that I’ve been able to do this without going to physical therapy.  But it’s really not a mystery.  What did I do?  Liberal application of ice, heat, and meaningful (read: heavy enough to challenge) exercise for the support muscles of the shoulder.

When you sustain an injury, the first impulse you have is to rest it.  You’d avoid movements that hurt in attempts to give the injury enough time to get better, hoping that things will work out at some point.  Well, while it’s important to manage pain, decrease swelling, and allow enough time for your body to repair itself, the reality is that you can’t avoid usage of your joints (at least, not unless you plan on consigning yourself to complete bed rest).

Problem #1: By avoiding usage of the joint, you impair the joint’s function.

Problem #2: By impairing the joint’s function, you allow the joint to get weaker.

Problem #3:  A weaker joint is less capable.  So you end up either using it less (see problem #1) or continuing on as if nothing happened and risking further damage to the joint (see problem #2).

In physical therapy literature, this sequence is referred to as “the downward spiral of pain” – by limiting function as a response to pain, a patient gets worse and worse until he’s virtually non-functionally.  Interestingly enough, the only way to interrupt this cycle is to perform corrective exercise to strengthen the muscles surrounding the injury site.

The true role of PT in rehab is to strengthen the muscles that support the damaged joint. All the bells and whistles that are done to you as a patient (modalities) serve to decrease inflammation and pain, either pre-emptively (so you can exercise) or post-emptively (so as to control additional pain and swelling resulting from exercising the injured area).  You can see the sense in this – without icing a swollen joint, for example, you’d have very little active motion in the joint (not to mention tons of pain when you do try to move it).  Bring down the swelling, turn the volume down on the pain, and you can meaningfully exercise.

Unfortunately, this isn’t what most people go to PT for.  They’re in it for the modalities: A little stim to ease lower back pain; an ice massage for patellofemoral syndrome; some wet heat for a sore neck.  There’s nothing wrong in seeking relief from pain.  What ultimately matters, however, is obtaining pain relief for the long-term, and that’s only going to happen if you progressively improve strength.

Am I saying to eschew the services of a professional when you’re hurt?  To take matters into your own hands and treat yourself?  No.  But what I hope to point out (to those of you who are engaged in some sort of rehab program, anyway) is that the yardstick for improvement is still the same – if you’re not getting stronger, you’re not improving.  Do what’s necessary to make it possible for you to strengthen the injured area via corrective exercise, but remember that the corrective exercise is the keystone your recovery hinges upon.