As a therapist I want to be giving my clients RESULTS. When it comes down to it, when you are working with pain you want to get results. Without results, it is very difficult to convince someone that you are achieving significant change and also, keep them continuing with a treatment protocol or timeline. It's an aim I have - to provide a treatment protocol and definitive time frame that lets us both know what our expectations can be.
By this I mean a step by step plan that you can bank on which logically leads to a reduction in pain. Now for each individual, that path is going to be different according to what symptoms are presenting, how long the injury has been in place for and what compensating factors have been developed in dealing with that injury. The Plan is there to give you (the client) measuring points. By setting out A, B, C, D - a client and therapist have clear indicators of steps that should be mastered and achieved along the way. It keeps both parties accountable. If I hit step A, you need to take responsibility to make sure I can hit step B by doing the exercises I prescribe. It also means that you may be more likely to do step D if you can see A, B and C being achieved. It's a win/win.
An injury that has recently occurred is a lot easier to manage back to health. It's fresh, its malleable, it's able to be coerced into being the length or tonality of what it was before. A long term injury is different. One of the first things you have to deal with here are the compensations that have occurred to deal with the injury. This misalignment, difference between muscle tone on bilateral sides, the change in posture that may have been developed so that you can be able to do simple actions such as walk or run without pain is often the first thing that has to be addressed before you can start to manage the actual injury. After all, PAIN is what you have to address first. I know that the pain in the neck may be coming from the hip, but if I don't make that neck pain feel significantly better, then my client isn't going to be getting those signals of 'inspiration' that he/she needs to trust in the protocol. Hence the trust is broken and the inspiration is lost.
So what are the Steps of Recovery? I like to identify them as five distinct phases
1. Inflammation - reducing any inflammation in the tissue
2. Length/Space - creating more joint space via reducing adhesions or restrictions in tissues/structures
3. Postural - identifying postural influences in an action and addressing biomechanical issues
4. Stability - find stability for the action
5. Strength -reinforce the stability and biomechanics of the action to make it stronger than previously.
You can see in this process there may be steps which are not relevant to certain injuries. It may be apparent that after getting length in a tissue, the pain is gone and movement is restored. But what of the contributing influences? What was it that caused this adhesions or 'strain' on the muscle in the first place? Why were the biomechanics compromised? This is where one must look further afield and start to bring into play, assessment beyond the symptom. This usually involves looking further down the chain of an action.
If there is one thing I took from my Applied Kinesiology (that's the skeleton in action) it is that stability for an action is the primary point of focus. The platform against which you push, jump, lunge, lift - if this isn't stable, there is going to be consequent contraction elsewhere to find that stability and the body will find it by hook or by crook. This is perhaps the final 3 stages of the Rehab Circle. This is where the client begins to take more responsibility as it is usually remedial exercise or physiology that needs to happen to 'train' the body back into its alignment and correct biomechanics. Otherwise, we will be seeing you again in 4 weeks time.
If I am able to work on someone who has been struggling with pain or injury for some time and has been to see specialist after specialist without any change in their condition, then maybe they may see me as divine and start genuflecting on the spot? Wouldn't that be great for my ego! But as with any individual achievement there is always a TEAM behind it. No person wins a grand slam tennis tournament on their own. A Formula 1 driver doesn't make it across the finish line without a pit crew. No one person can be all parts of the team. In certain stages a massage therapist may need to consult with an exercise therapist or a dry needler. Perhaps even a Sports GP, osteopath, acupuncturist or a remedial yoga therapist. Everyone has their own area of expertise and speciality and it is rare to find the one person who can achieve all these things. That is why the TEAM is important.
Injury rehabilitation is exactly that. Everyone, including the client is involved in the Team and EVERYONE has their own job to do. Even if that team is 2 people, the team has to work together to achieve a result. So inspiration may be necessary to enable someone to continue to achieve, but there is nothing divine about a therapist, as much as it is nice to be called a 'god' or even a 'demon'. It's about working together to achieve the result. Establishing a timeline and a protocol that has distinct markers that have to be hit or achieved before progressing onto the next one. Building the relationship of trust and each person contributing to the end result. That's the crux of an approach to Injury Rehabilitation and management.
