Here is what you should expect when you have physical therapy at Beyond Physical Therapy. I will always treat your dysfunction, however your dysfunction(s) may not necessarily be where you are feeling symptoms. Sometimes the primary dysfunctions are quite remote or tangential from the symptomatic area(s). This has to do with the fact that we are organisms, not mechanical beings.
What to Expect with Physical Therapy:
When you come in for a visit, I conduct an exam and spend time getting to know you. My exam will consider your life history (now to birth) and your body (head to toe). Because of my training and work experience, My history taking and exam is designed to screen for a variety of conditions and to consider whether there is something going on that may have been missed and may need MD follow up.
I treat with a variety of gentle hands on manual techniques. The sensation is usually about 5 grams of pressure or about the weight of a coin. Sometimes deeper pressure is used for deeper tissues (please see related pages on treatments with links for more information).
My treatment style is unique. With treatment you may feel nothing at first, or you may feel throbbing, pulsing, warmth or even real heat release. You may also feel twitching, almost like the involuntary little muscle twitches you may get when you are relaxed, zoning out like watching TV or just before falling asleep.
A small percentage of people early on may experience a worsening of symptoms even though the things that I can measure poke and prod at stay stable or even improve. Please note that treatment is very gentle so if you are experiencing increased pain, the first thing to keep in mind is that hurt is not always harm. Also pain can be tricky; it can come and go often in unpredictable ways without defined triggers or aggravating postures or activities. You may not able to put your finger on what brings about an exacerbation, so consider that if you are experiencing increased symptoms after a treatment session, it may or may not be related to the treatment; it may be correlated but it may not be causal/ cause and effect. However, even if you think that any symptoms you experience are treatment induced, as the treatment is extremely gentle-look at it inside out- it may indicate we are on the right track.
If you do experience some flaring of symptoms, know that these occurrences are short lived, usually only in the beginning of the episode of care. Don’t let any initial pain you have cause you stop before you start or are underway. Don’t prematurely self -discharge as you may expect the duration, frequency and intensity of any flare-ups to diminish and then resolve with continued treatment.
This treatment introduction is “one size fits all” -not all of this may apply to you.
Our bodies map and signal pain in unique and sometimes overlapping or confusing ways. The deeper the tissue, the less demarcated the pain pattern may be. Pain is an indicator, but not always a reliable indicator. This is because there is such a thing as “referred pain”. So while your pain is real, it may not be coming from where you think, even as convinced as you may be of its origins and/or despite what you may have been told or how you have been diagnosed or labeled. Diagnoses are labels that let our medical structure communicate in terms that describe aspects of anatomy and physiology. They are useful for understanding, and for claims and billing, but they may not tell the whole story. Often, I see patients who have seen several providers in ongoing pursuit and hope of having their condition recognized and effectively treated; but who have been unable to get relief under the existing medical care model. For example, they may have seen an MD who has diagnosed a tendonitis, then another who diagnoses a bursitis, then another who diagnoses a neuritis or some other syndrome. This can be confusing and frustrating for patients. But think of a chicken leg, when you take it apart, you pull the skin from the meat (muscle), there is some tissue holding that together that you separate (fascia), near the meat you can see blood vessels and bone, all very close together, touching each other, hard to demarcate or differentiate. The same is true with our diagnostic process. The truth is, it is often not one thing that is going on; you may have a tendonitis and bursitis and even a neuritis, it’s because the tissues touch each other and are connected. This doesn’t necessarily mean that if you have been provided all of these diagnoses that you are worse than if you had been provided only one diagnosis; really it is more like each clinician is looking at what and how you present, with one choosing one description, while another may choose a similar but slightly different description, and still another, another. A label or diagnosis is helpful for understanding and can provide a name, and some hope that your condition is known and therefore treatable. However, when patients go through a diagnostic process, are (sometimes multiply) diagnosed, even if/when such diagnoses are accompanied by confirmatory findings on MRI, Xray or other testing, but they have limited success with treatment, experiencing continued pain and dysfunction, and are unable to find relief, often they start to lose hope. It is frequently these patients, that I have been able to help. All of your diagnoses are probably all representative, describing in part the symptoms and some of the dysfunction; but despite how it seems when total knees and hips are advertised, we are not simply mechanistic, like cars that can have a part rebuilt and put back together again; instead, we are organisms and very interconnected. The trick is to look more holistically. Sometimes this means looking at one end of the spine to treat the other, or at one end of one or more of the extremities to treat the spine; or vice versa.
What follows, is an introduction to human anatomy, as a basis for understanding some of the ways pain can be mechanically referred and treated.
Fasciae is a connective tissue in your body that is elastic, supportive and even conductive. Fasciae is described by anatomists as “contiguous”, meaning interconnected, figuratively from your toe to your ear and back again (and almost literally so).
In some places fascia is thick and fibrous and in other places it is wispy like a spider web.
Fasciae lines muscles, lines individual muscle fibers, and while called different things in different locations, still of the same embryologic origin, also lines the bones, blood vessels, nerves and organs (so they don’t friction on each other). Fasciae creates natural divisions within the body that aide in the different physiologic processes (for example by the appropriate alignment and tension exerted on the thoracic diaphragms creating a sub-atmospheric pressure in the thoracic cavity that assists with non-conscious breathing).
Some of the major fasciae areas in the core body running horizontally are at the levels of: the base of the skull, the throat, the collarbone, the lower ribcage, ~the underwear line (in support of the abdominal organs), and at the pelvic floor from tailbone to front (in support of the reproductive organs). Some of the major fasciae areas of the main body oriented longitudinally are at the cranium, lining the skull and brain tissue, then running the length of the spine lining the central cord and the exiting nerve roots, then attaching at the tailbone. Some of the main fasciae areas in the upper extremity are at the forearm, and the wrist, (carpal tunnel). Some of the main fasciae areas in the lower extremity are at the outside of the hip running down the outer thigh (iliotibial band) to attach to the patella (knee cap), at the outer leg bone, at the front and back muscle compartments of the calf, at the Achilles’ tendon (heel cord), and supporting the arches of the foot.
When fasciae soft tissue is healthy it is sort of like cotton candy. When it is unhealthy it’s sort of like where you took a bite of cotton candy; it gets hard, bound down, crystallized and stuck.
Now, in just that overview you may start to see that one area can tether and pull on another area, and on another, and another, such that with a dysfunction or injury you may end up with a kinetic chain of dysfunctions, some originating possibly quite remote from where you are experiencing symptoms. Here the fasciae system was described and gives one view of the body, but again it is not the whole story. We have not even touched upon the skeletal system, muscular system, nervous system, circulatory system, lymphatic system, visceral system or craniosacral system and an effective therapeutic approach rightly considers and addresses the needs of all such systems.
Yet, considering the traditional systems is again, still not the whole story. This fascial system, which is a component part of the other systems and part of the interstitium, has also been shown to be energetic. As such, there are treatment considerations related to the neurophysiology of pain and referred pain patterns that are beyond the mechanical; that need to be considered and which are explored next.
I consider and approach the body as a physical, emotional and spiritual entity because I believe it is all one in the same. I will give you some science as to this treatment rationale. Have you ever heard the term endorphins? Many people have, I did my honors thesis on endorphins. Endorphins actually means endogenous opiates, it means opiate like substances created by our body for our body.
Endorphins and their related neurotransmitters enkephalins were discovered in the early 1970’s by Candace Pert, a very highly credentialed biochemist. Dr. Pert did some interesting studies that demonstrated that women ahead of labor and delivery have an increase of endorphins in their bloodstream. She also showed that this increase occurs when you twist your face up into a smile, even when you don’t feel like smiling. This strikes me as very interesting reverse engineering. Other studies have shown aerobic activity increases endorphins in the bloodstream (the “runner’s high”). We have a mechanism within our body for a natural “high”. I have found this design intriguing, powerful, AND intentional.
Candace Pert’s findings were ground-breaking in their day and she was considered the guru of this type of neuro-transmitter medicine/science. Highly regarded, in the late 1970’s/ early 1980’s, Dr. Pert was actively recruited by and worked for the National Institute of Health where she conducted research on emotional memory. In her first study, that was dry, empirical science that her colleagues were able to repeat (and is since being taught in some medical schools) she determined that emotional memories are stored at the molecular level.
As a means of illustration, let’s imagine you are walking around the block and you smell a cook-out, and for you it brings back fond memories of childhood because every Sunday in summer when you were a kid you had a cook-out. In this example of an emotional memory (or whatever is actually relevant for you) you can probably buy into the idea that there is such thing as an emotional memory; and if Candace Pert says that it is stored at the molecular level, you can probably buy into some storage mechanism, atomic, molecular, bionic-whatever-the point is it was stored in some fashion and brought up in some fashion; makes sense, a memory storage and retrieval mechanism.
I tell you about this first study as an introduction. In Candace Pert’s second study, which again was dry empirical science that her colleagues were able to repeat (and is since being taught in some medical schools) she traced these so-called “molecules of emotion”. I have read the studies and they seem to go every which way, it can make your head spin – what’s the point?- until you come to understand that that is the conclusion, that is the point. In her second study Candace Pert demonstrated that emotional memories are not just stored in brain tissue, but potentially in ANY tissue of the body. What this means is that if you have stored emotional memories in an area that represents as a physiologic dysfunction (pain, spasm, limited motion, dysfunctional alignment), that in addition to experiencing positive physiologic changes from treatment (decreased pain, inflammation & spasm, improved mobility, alignment and function), if you have stored emotional memories in that same area, you may also as a result of treatment, experience a somatoemotional response/release. This release/feeling could run the gamut from potentially feeling giddy and elated, as if you have wings on your heels and you could just fly out and about, to potentially feeling very, very energized, almost in a manic way but it’s all good, to potentially feeling very sad or tearful for no new or good apparent reason but the floodgates are open, and even to potentially feeling angry. Sometimes it’s just a mish-mash of emotions that you can’t quite put your finger on.
As we are emotional beings, and life goes on outside of treatment, it is hard to be at all definitive in regard to such experiences, and it is usually only in retrospect and via patterning that we might be able to correlate any emotional responses that occur outside a session to a specific treatment/session. In any case, it is really not necessary to make such determinations. What is important is to educate and equip you to know that should you experience any emotions and relate them to treatment, that a somatoemotional release is a positive therapeutic event. The experience should be treated like a wave at the beach, don’t run away from it like a little kid running away from a wave, and don’t dive into it either, just try to surf it and when you come out on the other side you are going to feel better for it.
My unique and foundational treatment approach doesn’t figuratively cut your head off at your neck with the scarlet letter type thinking that your pain is in your head, with the negative connotation that it is your fault, you’re crazy.
My approach is more integrated and goes deep, it is one that looks for resonance in the tissues and promotes healing at multiple levels.
It is an approach that honors our design.