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.