by Jason Schexnayder, PT, DPT, CMTPT, Kishan Shah, PT, DPT, CMTPT, & Christian Bourgeois, PT, DPT, MTC, OCS, FAAOMPT, CMTPT, MEd

Muddy Water…

We know, the medical field can be a big and confusing place for many people. To be honest, it’s confusing for us physical therapists at times as well. To help clear the water, we want to tell you about our philosophy at Bourgeois Physical Therapy & Sports Rehab.

Let us introduce…The Amazing Human Body!!!

Unfortunately, many of us develop pain and/or dysfunction. We all know what pain is, but what about dysfunction? Dysfunction simply is when our bodies, or a part of our bodies, don’t operate like they should. Dysfunction can set in from a multitude of causes: traumatic injury, overuse, poor habitual movements, poor diet, lack of physical activity, etc. Like most human beings, we tend to think, “If I just give it some time, it’ll get better.” However, this isn’t always the case!

The human body is meant to heal itself, and in a lot of cases, it’s great at doing so. There are many short-lived pains, dysfunction, and/or injuries that the human body is capable of handling on its own. The human body truly is incredibly complex and resilient. Unfortunately, many people don’t realize this, and instead, they think the body is more frail than it really is. Certainly, we don’t give the human body the credit it deserves.

With that being said, there are times when our amazing body just can’t handle everything on its own. It’s at these times that the body needs a little help to resolve the issue…and it’s NOT the kind of help most people think of.

“Motion is Lotion”

Our bodies are meant to move, to move efficiently, and to move in many different ways. When we begin to experience aches and pains, most of us believe it’s best to do less and move less. And to a certain extent, this may be true; however, becoming completely sedentary can actually make a condition/dysfunction worse. Don’t get me wrong, rest is important, but getting appropriate rest and being sedentary are two VERY different things. Below are some examples of why staying mobile is best…or as we like to say, why “motion is lotion.”

  • Example 1
    • Commonly, people with arthritis experience pain in the morning or after long periods of rest (not always, but often). They also tend to report that they feel better after moving around a little bit. As you move, your joints become lubricated with a fluid called synovia. Synovial fluid is one of the slickest materials in the world. It helps reduce the friction (viscosity) inside your joints. Basically, it’s oil for your joints. As you move, this fluid builds up in the joints, INCREASING joint space and allowing for a more fluid, efficient movement. TOO MUCH REST, on the other hand, reduces the amount of synovial fluid present in your joints and makes the synovial fluid that is there thicker (more viscous) consequently making you feel stiffer and making you hurt more.
  • Example 2
    • In our clinic, we see many post-surgical patients and many kids that have been immobilized for several weeks with a brace, boot, or cast. Surprisingly, some of our kids have come in with up to 1-inch of atrophy (loss of muscle size due to degeneration of the muscle) after just 2 weeks of immobilization…and that’s ONLY after 2 weeks. The lack of movement prevented by these braces, boots, and casts often cause the muscles to break down and get smaller. In this case, the phrase “use it or lose it” LITERALLY applies. These braces and casts are necessary for certain conditions, but the atrophy that often accompanies them is a prime example of why you need to stay active. Your muscles and soft tissues need movement and exercise to promote the blood flow  that supplies them with the oxygen and the vital nutrients they need to maintain their function, improve their health, and get them stronger.
      • In a study by Dirks et. al along with the American Diabetes Association, results showed that 5 days of bed rest, disuse, or inactivity can lead to a 4% decline in muscle mass and a 9% decline in muscle strength. We can lose as much muscle in 1 week of inactivity as we can gain in 12 weeks of intense exercise. That’s alarming!

Regular Exercise as a PRIMARY treatment…

There’s a reason that we promote movement and exercise so much at our physical therapy clinic. Research has consistently shown that regular exercise has a plethora of health benefits with very few negatives, if any at all. If you’re interested in seeing exercise recommendations, check out the activity guidelines from Health.gov. (for just the guidelines skip to pages 6 – 10). Read the entire article to get a good understanding of all things related to the recommendations. Among the plethora of benefits of exercise, pain reduction is often one of them. Here are just a few studies showing the benefit of regular exercise…

  1. Physical Activity and Knee/Hip Osteoarthritis
  2. Exercise and Musculoskeletal Pain

Pain and staying active…

A little bit of pain with your activities isn’t dangerous, BUT, that old notion of “no pain, no gain” isn’t a smart way to live. Too often, this notion of “no pain, no gain” is how people end up with chronic pain, dysfunction, and disability. If an activity is increasing your level of pain, then you should pay attention to it. Then, modify the activity in some way that decreases the pain. For example, walk for less time, lift less weight, reduce how far you go down in a squat, etc. HOWEVER, if the modification doesn’t decrease the pain, then consider stopping that activity for the day. If an activity reduces your pain, then by all means, keep on going! The point is you should stay active and pay attention to what your body is telling you while you’re active. 

The BIG Problem with commonly prescribed treatment…

Too often, medical professionals recommend prescription medication, injections, or surgery as the first course of treatment for pain. Yes, these forms of treatment are necessary and important in certain situations, BUT they should almost never should the first form of treatment. We firmly believe that conservative treatment (like physical therapy) should be the first form of treatment for most musculoskeletal disorders…and NO, prescription medication IS NOT a conservative treatment.

Conservative treatment can reduce healthcare costs and can prevent the unnecessary prescription of strong drugs (opioids) or unnecessary surgeries. A recent study commissioned by the Alliance for Physical Therapy Quality and Innovation (APTQI) showed:

  • As an initial intervention, the average total medical cost when physical therapy was used first was $3,992
    • 19% lower than total average costs when injections were used first = $4,905
    • 75% lower than the total average costs for the surgery-first group = $16,195

Remember, there’s a reason why opioid addiction and prescription drug abuse is a major issue around the world. Surprisingly, some surgeries and injections, like cortisone injections, can actually have a negative impact on your body. We’ll cover the topic of cortisone injections more in a later blog post.

So the next time your medical provider offers prescription medication, injections, or surgery, don’t be afraid to ask detailed questions. They have good intentions for their recommendation; however, it’s still important to know the pros and cons of all treatments and the “why” behind their recommendation.

Last but not least…Annual Physicals

We know, most of us hear the word “physicals” and alarm bells start going off in our heads. However, we aren’t talking about the normal physical you get from your primary care physician. We’re talking about an annual check-up by your physical therapist. Just because you aren’t in pain, doesn’t mean you shouldn’t see a physical therapist. Many of the issues we see in our clinic happen over time. Like most human beings, we tend to push things off to the side or simply don’t notice an issue developing. So the notion that “I have to be in pain in order to go to physical therapy” is NOT true, and honestly, it’s not the best way to go about things.

Physicals & Injury Risk Reduction

Many medical professionals talk about or recommend “injury prevention” programs. The problem is that injury prevention doesn’t truly exist, at least not yet. A better term is “injury risk reduction,” and there are definitely things you can do to reduce your risk of injury and/or developing dysfunction. We believe that one of the ways you can help reduce your chances of injury, developing aches and pains, etc. is by having an annual physical therapy physical (that’s a lot of physical in 3 words 😳).

Finding impairments like reduced overhead shoulder range of motion or poor quadriceps (front thigh muscle) strength could help reduce your chances of developing shoulder pain or arthritis in your knee. The physical you undergo with your primary care physician is meant for more sinister conditions like cancer, heart problems, high blood pressure, diabetes, etc. And by the way, a medical physical and a physical therapy physical are both vital to your health!!!

What would it involve?

In contrast to the physical performed by your primary care physician, the physical we would perform would actually be more PHYSICAL in nature. We would assess your strength, range of motion, balance, quality of movement, etc. Then, we would discuss our findings with you and provide you with a plan to address any problems we may find. It could include such things as a home exercise program, good postural tips, healthy back habits, joining a gym, further physical therapy treatment, or a referral to another medical professional if indicated. The goal of the physical is to reduce your chance of developing pain, dysfunction, and physical limitations in the future. Just as the APTA says…

According to the American Physical Therapy Association (APTA)
  • “Physical therapists have the education, experience, and expertise necessary to provide a broad health screening to allow tracking the patient’s health status over time. It may also lead to a referral for a physical therapist evaluation and treatment plan or to another health care professional for potential problems identified during the checkup.”