why pt rehab isn’t about exercise
As a kinesiologist, I see so many patients forget this one thing.
I came across a meme yesterday of someone drowning while swimming in knee-deep water. The caption read, “Why am I still in pain? I’m doing all my rehab exercises!”. Other text bubbles surrounded the image such as ‘sleeps 4 hours per night’, and ‘eats poorly and is chronically dehydrated’. The premise is that exercise is only a tiny piece of the rehab story, even when done consistently as prescribed.
It’s hard to argue that adherence to a rehab plan is a bad thing, but it can often mask the other areas of life that are being neglected. This can essentially cancel out the benefits of the efforts being made, often leaving individuals even more frustrated and confused than before
While I believe that we should never be insensitive or condemn those who are going through genuine struggles, these matters shouldn’t be swept under the rug either. Life is complex. It gets messy. To pretend that completing a simple exercise therapy program will heal years of chronic pain caused by various factors is wishful thinking.
The image of drowning in water is powerful one because we have the tools to learn how to swim but often don’t know how to use them.
Keeping Your Head Above Water
As a kinesiologist and personal trainer, I’ve come across virtually every type of client/patient in my years of work. Each one comes in with their own story, injury, pain, and burdens. Most also come in with their biases and learned behavior around movement and rehab. When starting my career, I thought that 90% of my job would be exercise prescription. I thought that my knowledge of exercise physiology, biomechanics, and anatomy would automatically heal these people who were hurting.
How I was wrong.
The more I work with people, the more I feel like a life coach. Sure, things still revolve around the application of movement as therapy, but there’s a deeper element to it. I call it an embrace of the human condition.
I’m a firm believer that training is less about curls and burpees, and more about embracing a devoted, intricate conversation that happens to involve exercise.
Those who are willing to understand that pain and injury have multiple contributing factors have the best results hands down. Not only do these individuals heal faster, but they’re more satisfied with the rehab process and have an elevated sense of agency from start to end.
Just think about it this way. One-dimensional physical therapy is like placing a bandaid on a deep wound. On the other hand, holistic therapy heals your tissues from the inside out. Therapy through exercise will only benefit you fully once you’ve built the foundation of addressing the other aspects of your health and wellness.
I would be remiss if I didn’t mention of few of the other barriers that get in the way:
catastrophization around movement
sleeplessness
poor social support
lack of occupational satisfaction
anxiety/stress
trauma
lackluster diet
overtraining
etc…
To get the most out of your rehab, move beyond your exercise regime and embrace your human condition.
While reflecting on all of this, I thought of one of my clients in my earlier days of training. To inspire you to lean into the ‘human side’ of physical therapy and view things from a more holistic lens, I want to share a bit of her story.
Fighting the Monster
A few years ago I had the pleasure of training with a lady with multiple sclerosis. Suzie has Primary Progressive M.S., a rare form of the disorder that grips on to just 10% of patients. PPMS is not only incredibly hard to diagnose, but its onset is ten years later than other versions of the M.S. Upon our first meeting, Suzie detailedly described her life being ripped away at forty, with no indication of what was going on.
Thanks to her journey of coming to grips with her condition, she’s incredibly in tune with her body. Her primary symptoms are instability with walking and fine motor control, along with spasticity and range of motion difficulties throughout her right arm and shoulder.
There is not a moment that goes by when her body doesn’t remind her of what she has to deal with.
This would be enough to defeat most people and drive them into fear, shame, and isolation. Fortunately, Suzie is a fighter by nature. From the moment we started training, she’s had her boxing gloves on. She also happened to have of of the most beautiful perspectives on life — both in the deepest struggles and best triumphs. She fights back with positivity and optimism.
Suzie refers to her specific condition as ‘The Monster’. The first time I met her, she requested that we do everything in our power to fight The Monster and take back control. I was in.
Boy does she fight. Suzie didn’t let a day go by where she didn’t get her right arm over her head or walk across the clinic without any assistance. She’s armed with powerful weapons, ones that we should all equip to become more resilient, hopeful human beings.
During our countless hours of training together, including sweat, tears, and many laughs, there were three main lessons I learned from her. Three ways to fight back, if you will. While everyone’s approach to rehab will (and should) be different, I think we can all benefit from leaning into these principles.
1) create a healthy distance between you and your pain.
The thing I like about Suzie calling her M.S. ‘The Monster’ is that she’s labeling it as something outside of her. Too often I find that we allow a diagnosis to seep into our identity — letting it defeat us. When the physical symptoms arise, they seep into the very core of our hearts, soul, and mind.
“I’m not feeling ok. But I know that I’m still ok”.
By Suzie creating separation from her and the M.S., she’s able to recognize that it doesn’t define her. Even when The Monster rages on her bad days, she can say, “I’m not feeling ok. But I know that I’m still ok”.
2) Be vulnerable with others who are struggling.
If you want to feel better, stop isolating yourself. We are built to be together. Suzie has taken this to heart, as she’s constantly surrounding herself with supportive people, and intentionally connecting with them on an intimate level. She has a handful of trainers and specialists, a yoga group, and an online support team that she meets with weekly. Through community, she can hold on to hope because she’s actively moving towards a goal and doing it with people she deeply cares about and trusts.
3) Seek out things that spark joy and give back.
It seems that every week we train, Suzie has another legendary story of how her dogs got stuck under the house or almost hit by fireworks. I realized early on that these pups were Suzie’s medication. Not only did they spark joy every day, but they were something that she had control of.
Being the head of the household, these pets keep Suzie accountable for being a leader. Furthermore, they offer her an opportunity to invest in another life, even when she feels defeated. There is nothing more energizing or empowering than being selfless and thoughtful when you are struggling. It instantly puts things back in perspective.
All of these tips allow the self to worry less and focus on ability rather than dysfunction. The moment you can overcome the fear around your battle is the moment you take back control and start moving in the right direction. This alone can catalyze a full, successful rehab.
“He who fears he will suffer already suffers because he fears”. — Michel De Montaigne.
In Closing,
Experiencing pain and injury is never easy, but you have the strength to keep your head above water. Just like Suzie, you too can fight the monster and win the battle. Just remember that exercise therapy is a small part of the story and approaching your wellness with a holistic lens is the true recipe for success. Most importantly, give yourself grace and remember that you’re human. There will be bumps in the road, but as long as you care for your whole self, you’ll be moving in the right direction.
You got this.
-DavidLiira.Kin
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