June 2012 Newsletter - Volume 3 by W. Patterson, MD

Helpful Ideas About Rehabilitation

The work is at the limit and not at the goal
People tend to be overeager to reestablish full function. This is very understandable but usually delays progress. The work of rehabilitation is always at the next step not at the end point. It's important to maintain goals, but nobody transforms their movement capacity from dysfunctional to perfectly capable in one exercise experience. Strong will is a very important resource. Using will in agreement with rehabilitation principles leads to the fastest recovery.

Don't overwhelm the affected body part
Many people do overwhelm themselves in their rehabilitation. The pain can be exhausting and incapacitating. Even with lesser levels of pain, people are forced to stop using the affected body part. Eventually the pain subsides and then the person wants to get back to their To Do list. After a varying amount of activity, pain can force them to stop once again. This typically happens in predictable cycles.
With self-examination, one sees that there is a pattern. When one is feeling better, one begins to attempt some level of activity. First comes a bit of fatigue, and then comes soreness and achiness. Next pain returns, and with continued activity severe pain can present. It is difficult to accept the idea of limitation and many people will finish their tasks in spite of the pain in an attempt to maintain their self-concept about their physical abilities.

In order to be able to do more and have less pain during the stages of rehabilitation, the following is necessary. If one stops during the fatigue level and releases that small amount of stress, then it typically takes minutes to recover back to baseline levels of pain. If one persists and goes into sore and achy levels, then it typically takes hours to recover. Persisting further into pain levels it can take hours to days to recover. Persisting further into severe pain, several days are typically required to recover back to baseline. The earlier one stops and resolves the fatigue, soreness, or pain even if the task is not finished, overall they will accomplish more and have less pain.

Beliefs and resentments
When someone has ongoing limitation, there is an inevitable change in self-concept. What we used to be capable of is no longer possible. The affected body part no longer serves us as it once did. Most people resent this as their movement wishes are thwarted. Later, a change in belief about movement possibility becomes established. This represents a psychological loss and people can become relatively depressed. A sense of I can changes to a well entrenched belief of I cannot or dare not. The body and the movement brain subsequently comply. The new belief can become a very well established new pattern of dysfunctional coordination. This can be reversed.

Anticipating pain guarantees pain
Most people with chronic dysfunctional patterns are convinced it's going to hurt the next time they move. After all, countless hundreds of such experiences are pretty convincing. The suggestion is to calm down completely, move slowly, and stop when the tension begins to build, before the pain increases.

Range of motion, coordination, and strength must be reestablished in that order
If the affected body part has normal or near normal anatomy, then it has normal or near normal movement possibility. First one must work through range of motion. This motion can still be sore or weak, but it is the first step. Then comes the task of improving coordination. Moving slowly with highly focused attention typically will improve coordination and a sense of reliability. Reestablishing coordination is usually when the sharp abrupt stabbing pains cease. Last comes strengthening. Trying to strengthen before range of motion and coordination are well-established only serves to further engrain dysfunctional coordination patterns and truly delays rehabilitation. The sequence of range of motion, coordination, and strengthening can be done at any level of range of motion that has already been established. For example, one can have good shoulder range of motion, coordination, and strength up to chest height. Regaining range of motion up to head level would be the next step and would require going through the same sequence of rehabilitation.

How to determine progress with pain
Most people report it still hurts in the same place. It's more helpful to think about does it hurt as intensely, as often, does it last as long and is it easier to get over? Are the associated referred pains as intense, frequent and enduring also? There is almost always an associated relationship to other stressors besides the pain. As these diminish, there is almost always a strong relationship to the overall levels of pain.

Consider these ideas frequently
Please refer to these pages often and think if your movement homework is guided by these ideas. Your rehabilitation will be much faster once you understand this completely.

 

 

 

 

 

 

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