You didn’t fail rehab, you just didn’t do the right rehab
You didn’t fail rehab, you just didn’t do the right rehab
𝗪𝗵𝘆 𝗺𝗼𝘀𝘁 𝗽𝗲𝗼𝗽𝗹𝗲 𝗳𝗮𝗶𝗹 𝗿𝗲𝗵𝗮𝗯 𝗮𝗻𝗱 𝘁𝗵𝗲 𝗹𝗶𝗸𝗲𝗹𝘆 reason 𝘆𝗼𝘂 𝗵𝗮𝘃𝗲
𝘕𝘰𝘸 𝘩𝘦𝘳𝘦’𝘴 𝘢 𝘵𝘳𝘪𝘨𝘨𝘦𝘳 𝘸𝘢𝘳𝘯𝘪𝘯𝘨. ❗️
Most people 𝗳𝗮𝗶𝗹 𝗿𝗲𝗵𝗮𝗯, it’s estimated around 𝟹𝟶% 𝘰𝘧 𝘤𝘭𝘪𝘦𝘯𝘵𝘴 𝘢𝘥𝘩𝘦𝘳𝘦 𝘵𝘰 𝘢 𝘱𝘩𝘺𝘴𝘪𝘰𝘵𝘩𝘦𝘳𝘢𝘱𝘪𝘴𝘵𝘴 𝘨𝘶𝘪𝘥𝘢𝘯𝘤𝘦 of prescribed exercises
From my experience personally and as a clinician I can break down why these numbers are so low, and how I manage to get my clients to engage to get long lasting results.
𝗙𝗶𝗿𝘀𝘁𝗹𝘆 𝘄𝗵𝘆 𝗽𝗲𝗼𝗽𝗹𝗲 𝗳𝗮𝗶𝗹 : q
- The assessments been too generic which has lead to basic exercises given
- The movements don’t hold value to the persons pain experience
- The exercises don’t fit the persons true lifestyle and options - 10 sets of exercises 3 x daily doesn’t cut it
- The therapist hasn’t found a meaningful change in the session to show the clients body it has the ability to move without pain
- There hasn’t been expectations set between therapist and client
- There is no structured plan for how the exercises are going to change in the persons real life goals
Now we 𝘀𝗲𝗲 𝘁𝗵𝗲 𝗽𝗿𝗼𝗯𝗹𝗲𝗺𝘀 𝘄𝗲 𝗰𝗮𝗻 𝗰𝗿𝗲𝗮𝘁𝗲 𝘀𝗼𝗹𝘂𝘁𝗶𝗼𝗻𝘀.
Overtime I have created 𝘀𝘆𝘀𝘁𝗲𝗺𝘀 to allow me to navigate these challenges
Using a 𝘮𝘰𝘷𝘦𝘮𝘦𝘯𝘵 𝘣𝘢𝘴𝘦𝘥 𝘴𝘺𝘴𝘵𝘦𝘮 combined with 𝘀𝗼𝘂𝗻𝗱 𝗿𝗲𝗮𝘀𝗼𝗻𝗶𝗻𝗴 it has allowed very simple strategy to give people actionable changes.
Step 1 𝗳𝗶𝗻𝗱𝗶𝗻𝗴 𝘁𝗵𝗲 𝗿𝗼𝗼𝘁 𝗰𝗮𝘂𝘀𝗲 :
Not just looking at the point of pain, but looking back in the persons movement history can show why they move the way they do.
This is then reinforced in a movement assessment to see objectively does it pair with their history
What lead to that area becoming sensitised
Now we have an idea as to the zoomed out picture we can look to treat.
Step 2 𝗽𝘂𝘁𝘁𝗶𝗻𝗴 𝗼𝘂𝘁 𝘁𝗵𝗲 𝗳𝗶𝗿𝗲 🔥 :
We then use whatever interventions best desensitise the painful area, whether it be a treatment of the local tissue, something for the nervous system or simply offloading that area
Step 3 𝗿𝗲𝗶𝗻𝘁𝗿𝗼𝗱𝘂𝗰𝗲 𝗽𝗼𝘀𝗶𝘁𝗶𝘃𝗲 𝗺𝗼𝘃𝗲𝗺𝗲𝗻𝘁 :
By this stage we should have made a simple win where movement doesn’t hurt like it did.
Now we use movement exercises or drills to reinforce to the persons body what movement options it needs or is missing.
We can then follow a structured programme of building from this to regain what the persons body is missing
And using graded exposure, strengthening and small wins it keeps the success frequent and gives obvious progress
Working with many clients who have failed traditionally therapy i commonly see step 1 and 3 completed poorly.
𝗧𝗵𝗮𝘁’𝘀 𝘄𝗵𝗲𝗿𝗲 𝘁𝗵𝗲 𝗺𝗮𝗴𝗶𝗰 𝗶𝘀
You can have the ingredients for a cake, but if you just chuck it all in a pan and hope it works it’s likely to come up short
You’re destined for failure.
There’s more to this game than just a couple generic exercises for knee pain, if it worked that easy then so many people wouldn’t fail.
𝗜𝘁’𝘀 𝗻𝗼𝘁 𝘁𝗵𝗮𝘁 𝗿𝗲𝗵𝗮𝗯 𝗱𝗶𝗱𝗻’𝘁 𝘄𝗼𝗿𝗸 𝗳𝗼𝗿 𝘆𝗼𝘂
𝗬𝗼𝘂 𝗷𝘂𝘀𝘁 𝗵𝗮𝘃𝗲𝗻’𝘁 𝗱𝗼𝗻𝗲 𝘁𝗵𝗲 𝗿𝗶𝗴𝗵𝘁 𝗿𝗲𝗵𝗮𝗯
Zoom out in order to zoom in
The reductionist viewpoint has always made life seem simpler, but what happens when it doesn’t ?
If we over simplify it can often lead to a diagnosis to a pain, however maybe doesn’t give the reasons why …
A common example I often use is one of a car.
‘If your car engine blows, you replace it because it 𝗻𝗲𝗲𝗱𝘀 𝗮𝗻 𝗲𝗻𝗴𝗶𝗻𝗲, but then the engine blows again,
𝗨𝗻𝗹𝘂𝗰𝗸𝘆 𝗿𝗶𝗴𝗵𝘁 ? Okay so you get a third engine, sh*t that one’s gone too.
So you look to see what’s 𝗰𝗮𝘂𝘀𝗶𝗻𝗴 𝘁𝗵𝗲 𝗲𝗻𝗴𝗶𝗻𝗲 𝘁𝗼 𝗯𝗹𝗼𝘄… 𝘴𝘰𝘮𝘦𝘰𝘯𝘦 𝘴𝘩𝘰𝘷𝘦𝘥 𝘢 𝘱𝘰𝘵𝘢𝘵𝘰 𝘶𝘱 𝘵𝘩𝘦 𝘦𝘹𝘩𝘢𝘶𝘴𝘵 🤦🏼♂️.
So you take the potato out, and the engine works like a dream.
We need to find your potato 🥔’
So if we zoom straight with *𝗶𝗻𝘀𝗲𝗿𝘁 𝗯𝗼𝗱𝘆 𝗽𝗮𝗿𝘁 𝗵𝗲𝗿𝗲* 𝗽𝗮𝗶𝗻 in the local tissue, tendon, joint might be where is being overloaded, but going back to the car analogy …
𝗠𝗮𝘆𝗯𝗲 𝘁𝗵𝗲 𝗳𝗮𝗰𝘁 𝘁𝗵𝗲 𝗽𝗲𝗹𝘃𝗶𝘀 𝗱𝗼𝗲𝘀𝗻𝘁 𝗹𝗶𝗸𝗲 𝘁𝗼 𝗺𝗼𝘃𝗲 𝗳𝗼𝗹𝗹𝗼𝘄𝗶𝗻𝗴 𝗮𝗻 𝗼𝗹𝗱 𝗳𝗮𝗹𝗹 , on an ankle is stiff and the knee is doing all the work
That’s why we need a bit of both,
At the end of the day the car needs an engine - like your body needs it’s parts to work
𝗕𝘂𝘁 𝗺𝗮𝘆𝗯𝗲 𝘇𝗼𝗼𝗺𝗶𝗻𝗴 𝗼𝘂𝘁 𝘄𝗲 𝘀𝗲𝗲 𝘄𝗵𝗮𝘁 𝗲𝗹𝘀𝗲 𝗶𝘀𝗻’𝘁 𝗱𝗼𝗶𝗻𝗴 𝗶𝘁’𝘀 𝗷𝗼𝗯 𝘄𝗲𝗹𝗹 𝗲𝗻𝗼𝘂𝗴𝗵 and we find the leak in the system.
That’s where global assessments for movement are so powerful, we see how someone moves as a whole person
Then that allows us to zoom in again to what we need to influence.
So if you have pain somewhere in the body and the direct treatment isn’t working
Remember 𝙁𝙞𝙣𝙙 𝙮𝙤𝙪𝙧 𝙥𝙤𝙩𝙖𝙩𝙤
Previous Experience Impacts Our Future Actions
Previous Experience impacts our future actions
Previous Experience impacts our future actions.
This is true in so many contexts, we learn from both our wins and losses, our beliefs, societal connections and exposures thus directing our thought processes to creating future decisions.
Whether that’s a good experience and we want to do it again there’s a science behind it all.
We like the feeling of feeling good so we will try and recreate it.
We don’t like the impact of feeling bad so we will try to avoid it. (Simple Right ?)
The feeling of a dopamine rush, is what makes us like to feel good, this neurotransmitter is also involved in reinforcement. That’s why, once we try one of those cookies, we might come back for another one (or two, or three). The darker side of dopamine is the intense feeling of reward people feel when they take drugs, such as heroin or cocaine, which can lead to addiction.
Dopamine also plays a role in these functions:
learning and attention
mood
movement
heart rate
kidney function
blood vessel function
sleep
pain processing
lactation
So since it impacts good functions we will look for it to relocate it.
On the other side of the coin, our brain does not like negative experiences, it will try to protect itself from further damage.
This is what plays key in the pain world.
An old c section scar - horizontal cut across 5 layers of muscle, a baby that you’ve grown, nurtured, created - taken from you after being stabbed (sounds heavy intense when put that way), but that’s a hugeeee trauma, but new mothers are just expected to get on move and bodies be normal after, even told they can do anything after just a couple of weeks without a solid rehabilitation plan.
A simple look of this - a large horizontal cut that feels like it will tear apart if it stretches - a painful experience and the body wants to protect it.
Now do a back bend and that area has to stretch - the feeling it doesn’t want;
Therefore the next time you try to do it you’ll find a new strategy that doesn’t stretch that area
dump the movement into the lower back, now we have a less efficient pattern however it isn’t the painful abdomens stretch that relates to the previous trauma
If you bent over and your back hurt, then bent over again - same thing happens, maybe the third time you’ll Bend your knees grab something and keep the back straight to not get the pain.
The brain remembers the painful experience and finds a new strategy, a less efficient way but again a new strategy.
These experiences are stored and create protective mechanisms, and over time dictate how we perceive movements for the future.
Following three simple rules
Do no harm
Don’t look stupid
Achieve the task
We find ways to move , interact , grow based on these principles, and the way we learn is by our previous experiences to them.
Whether positive or negative, we learn from previous experience.
So that knee that hurts might just be the effect of an old ankle injury that you protect and keep stiff, the poor knee taking the brunt of the load.
Teaching the ankle to move safely, without pain in positive ways can lead to a system that works in cohesion.
The key is in the details, finding the why is always the way in which we can create positive inputs to allow successful future outcomes.
Of course nothing comes without some failures, but that’s the way in which we learn.
Trust the process, our brains are smarter than we are.
BeTheDifference