Archive for proprioception

Physical Therapy

Movement and Posture

Therapy is a method of helping to bring one to a place of balance.  This place is not always a singular location.  In therapy, one may just come to a better understanding.  This understanding allows one to hopefully function at a better level.  Much of “Physical Therapy” is helping one come to better movement and posture.  It is usually focused on the physical aspect of our being and it does fit well with the preparations that are taught in many other sciences like yoga.

Premise

A basic concept we deal with in the science of physical therapy (and even in yoga), is that there is:

  • A complaint or problem which one wishes to change
  • There is a reason for this complaint or problem
  • There is a solution/therapy/or way to manage these problems
  • The solution or management is based on a proper method and practice

Movement Case Study

Take a generic example of someone complaining of knee pain when walking up stairs.  The medical evaluation to look for any disease, in this case, shows some degenerative changes in the left knee joint.  Typical explanation for the symptoms becomes defined by the associated disease state.  This assessment is incomplete for a problem noted with movement.  The medical definition is correctly defining the parameters of the disease.  One cannot jump to saying it is the cause of the pain and movement problem when going up stairs.

Evaluation

Since there is a complaint of knee pain that is aggravated by movement, one needs to do some type of movement evaluation. Physical Therapist properly trained are experts in movement dysfunction.  That means they can assess what is not working and suggest how to correct the dysfunction.  Once again they are not focused on the disease.  It is only noted as appropriate.  Too many people only look for the problem and the solution from a medical/disease model.

Local vs Regional relationships

We need to look at how the knee bone is connected with the hip bone, etc.  Actually movement observation of a person doing a functional task like the stairs is following the flow of forces throughout the whole body.  Really this is a wholistic viewpoint (though an over-worn phrase).  Sometimes we look only at the place causing the pain.  This is a local approach.  It can be “successful” in a limited way, ie reduction of the symptoms.  The cause of the symptoms are not necessarily treated.

Location of symptoms and cause of the complaint are not the same often.  Anytime you have a reoccurring or chronic complaint you definitely need to look elsewhere for what may be contributing.  The knee sits between the hip and ankle joint.  The leg and pelvis are force producers and transducers between the ground and the trunk.  Of course this model just continues through the whole body.  We are functioning system.

System Relationships

As a system, everything is related to everything.  Whew–that’s a lot of things!  But as everything is related, not all relationships are significant.  (hmmm reminds me of a few).   So now we need to skillfully work with all these relationships to quickly find which ones are having a difficult time maintain cordial connections.  This is where a skillful therapist can quickly screen a variety of key movements and determine where they need to look further.

Treatment

What is the best exercise for knee pain?  I have no idea.  So if one approaches a problem with an answer, you have to be a good guesser.  The best approach to a problem is to ask another question.  Once you have arrived at the most significant movement problems, that aren’t acutely painful, you can start helping to restore proper movement. Select  the movements that organize the system to correct itself and restore normalcy.  There should be no elevation of the pain.  In fact it should become less.

Let’s say you’ve evaluated some hip abductor weakness and stiffness in extension and rotation of the lower to middle thoracic spine.  You exercise and other treatments should immediately show some positive change in the systems movement patterns.  They may move farther, easier, faster, smoother, stronger with less symptoms now–something positively must change immediately upon proper/skillful treatment or you have not found the right movement dysfunction or you have not found a proper comparable retest.

Follow up

So evaluation and treatment are linked from a movement perspective.  We are looking not at the medical problem but how is that a person is functioning and yet maintaining their symptoms.  Changes for chronic problems often take time.  Doing something to a person is not the answer.  It is only part of the process.  Learning must be big part of the equation.

Awareness

In learning, one needs to not just do a corrective exercise.  One must develop an ability to sense and feel what needs to be done.  This body awareness needs coaching, both internally and externally.  I don’t know how many times in the past that I’ve shown someone “what to do”.  When they return to the office, I ask them to once again show me their home program.  After that, I wonder who was the idiot who taught them “that”.  Doing without understanding and feeling (proprioceptively and kinesthetically), gets the above result.  So take the time to work on ensuring what  and how they are feeling these movement changes.  This sensory feedback only enhances the motor pathways of changed movement patterns.

Postural Adaptation

Adapting to life through Posture

http://www.pbase.com/davidyuweb/rock_balancing

If you check out the above web site–you will see the work of Bill Dan.  A San Francisco artist that has a knack for balancing different shapes and sizes of rocks into an amazing display of “finding your center of gravity”.

This visual geometry of how you can show one segment finding it’s place of balance in relation to another segment makes me think of how we might organize our posture.  This sensory feedback of weight is critical.  It is not the only or possibly major feedback, but for this post it is the focus.  Also we are summating all the feedbacks dynamically in some integrated fashion.  Our maladaptive postures may actually be quite efficient for balancing ourselves at the moment.  Like the rocks in the picture–it is amazing we don’t fall over–or at least aren’t rushing to the Emergency Room more often.

It seems that we have posture defined statically and posture as in interim in our movement sequences.  In either case, we have a postural default that many of us keep coming back to.  (I know this is on interpretation of an observation, but continuing…).  When we evaluate someone or ourselves, we discover both movement and postural changes in and of  the structure and it’s relationships.  Say we have done a fair job and make some educated guesses on how to “improve” the system.  We look good for awhile–moments to hours and possibly (generously) for several days.  Usually in a short time our posture is back in that amazing rock balancing act.

Is this return to our “default” posture because we haven’t done the right exercise or done enough of it or what?  I’m sure this question becomes important.  I’m learning more all the time of what I don’t know (which is actually expanding faster as I know more–such an oddity is this inverse relationship of knowing less as you know more)  But forget the digression and let’s return to something solid like posture and rocks.

This postural alignment is maybe more fluid and interactive than just balancing out the mechanics of the musculoskeletal system.  The interactive nervous system must play a significant role here.  I’m wondering about how important should we be looking at emphasizing the sensory input of center of mass.  Working to highlight the awareness of this input and exercising to train the shifts of these different sensations may be significant for helping to change the “default” posture.  Of course doing all the re-balancing that “corrective” strategies gives is important.  But the emphasis of “what one is sensing proprioceptively and kinesthetically becomes important also.  How important and how to utilize this sensory training is one of my interests.

I think that correcting posture and then improving movement are great strategies.  I also find that spending time having a person develop the sensitivity to recognize say a balanced posture that allows for effective movement is extremely important.  Often I will have the person move in and out of their postural adaptations.  Spending time in each position until they “feel” and can more readily recognize the different sensations and adaptive postural changes.  I wonder if you are working in these ways.  I’m sure many are including this but clinically we might approach it differently and spend different amounts of time, etc.