I’m in the weight room at the Y. Focused in. Feeling my shoulders work, then my hips and knees and always my core. It is 8 a.m., quiet and only a few people here. I am in my zone. I love the exertion and the movement.
I am an old jock—an aging one. Both vocation and play have put a lot of wear on my body over the years. And, I have struggled to follow through on what I know I need to do to take care of myself. I want to keep working as a physical therapist without damaging my repaired shoulder. I love feeling strong when I’m trucking up the hill to the maple grove on 15 year-old replaced knees. I look forward to the refueling energy that comes of long hours in my vegetable garden.
It is not by accident that I have stayed committed to this new routine for more than two months now. Finally, I have developed a routine that works for me. First, I am a person of routine. Same days, same time of day. Routines ground me. Second, I need structure. Going to the Y, working parts of my program for time, counting a certain number of repetitions and sets for others and beginning and ending with Tai Chi all create structure for me. Finally, it is doable. I am an early morning person and I come here on the days I start work a bit later. So it fits the rhythm of my day.
I think a lot about the practice of physical therapy. The science of physical therapy has informed how I work on strengthening my body, but it is the art that has gotten me to a place where I can experience success. Art, for me, is the creativity, imagination and skill involved in producing an result that is meaningful and has its own beauty. I feel stronger and I am more engaged in a process that moves me towards my goals. As my friend Ray says, “That’s a beautiful thing.”
There is much that could be said about the art in evaluating and diagnosing a patient’s problem and about the art of knowing where to begin in addressing the major dysfunction. Or, the art of knowing which treatment technique to use at what point. But the question I ask today is, how do I help my patients be successful?
How am I going to help this person get to where they need and want to be? How am I going to facilitate change that will keep them moving forward long after they are done with physical therapy?
It starts with the first part of the initial evaluation, when we are “taking the history.” What brings them to PT? What is their primary concern? What is the mechanism of injury? How does their issue limit them? What is functionally impacted? Can they describe the pain? What makes it worse or better? What medications are they taking? What past medical history is important to understand? What is their work, activity level and social support?
Underneath this, I am asking myself, “Who is this person?” I am listening. What is important to them? What do they care about? What is going on in their life? How have they related to their body in the past and how do they relate to it now? What other issues or concerns do they bring that will impact how I work with them? What is the path that brought them here? What has been the impact of their condition on their life and where do they want to go? As I listen to each person’s story, I can start to understand and start to develop a connection that allows us to work as a team.
As I start to develop a person’s home program (the work they will need to do in this healing process), I need to appreciate what is on their plate. Do they have work demands that make it difficult to decrease overuse? Are they in the midst of a major life transition? Are they taking care of a family member, and is that responsibility physically and emotionally stressful? Is this a chronic condition that has taken a toll? Is there a history of trauma resulting from an accident, injury or something earlier in life?
These stories impact the body differently. They can contribute to tension and protective body responses. They can lead to high levels of anxiety or a to a person feeling disconnected from their body or from the injured part. We may need to incorporate breathing techniques, relaxation techniques or movement patterns to facilitate easier movement. At the same time, we are starting the process of muscular recruitment, strengthening or stretching they need. It has to be doable: something they can fit into their day, that they can do and are willing to do.
While the science may define the most effective exercises for strength of a certain muscle, for example, the art says you have to consider different personalities and interests. Is this a hard-pushing person who needs to be held back? Is this a person who needs a cattle prod? Does this person have a history of being active and wants several exercises or is this a person who has been more sedentary and needs to learn how to feel their body move and would do best with a simple plan? And, how do you connect with them? Does humor work? Do they need a lot of listening and empathy? Or, do they do best with a really straight forward approach?
Above all, I may know where they need to go in terms of strength, changing old patterns of gait, regaining balance to keep them safe or learning new movement patterns to stop an overuse and get them to their goals, but it has to work for them. And from the get-go, I tell everyone they know more about their bodies and themselves than I do, so they need to give me feedback about what is working and what is not. It requires creativity, communication, connection and skill. We are human beings with complexity, not robots with moving parts. We need to practice the art of physical therapy to help our patients be successful.
~ Julie Dewdney PT