Friday, February 12, 2016

What is PT, really?

What follows is a side conversation on a Facebook thread, about acupuncture.
Bronnie Thompson said,
My main worry about acupuncture is that even if it helped with pain unless the person can learn to do it themselves there is an ongoing need for seeing a clinician, taking time out for appointments and the person will not have a chance to think about no longer being a patient. The opportunity to learn to be confident to self manage pain gets lost when people receive ongoing treatments.
A few replies later, Bronnie added,

Thanks guys. I used to believe there was no good from hands on therapy, but revised my opinion after meeting you lot and the like minded people on here. Now I can see that hands on has a place but it's that old thing about deciding when to stop seeking a pain reduction approach. At some point life is limited more by the ongoing pursuit of treatment than learning how to live well despite the pain. There's no easy way to work it out but my research found that people need to know their pain will remain before they're ready to get on with life and I worry that people lose opportunities for quality of life and fulfilment because healthcare providers don't want to talk about the reality that pain is not always completely removed. Tough questions to ask!
I replied,

I think our hands on works well (confirmation bias) but is usually short-lived. Behaviour that contributes must be uncovered and challenged (gently) for long term comfort in one's own physicality.
>> I see you sit with your right leg crossed. Do you ever sit with your left leg crossed? [Hmmnn. I don't know. I've never thought about it.] Would you like to see how it feels to cross the other leg, just to find out? [OK.] (Patient crosses left leg.. funny look appears on her face) How does it feel to you? [Weird.] Go back and forth a few times. Check how it feels to you, on the inside, each time. (Patient goes back and forth, a couple times each side.) Is there one leg that when it's crossed makes you feel more "at home" in your body than the other? [Definitely the right leg feels "right" and the left leg feels weird.] Like you have to work a lot harder to relax? [Yeah, kind of.]Note: psychotherapists are the worst for this! smile emoticon

And so on. 
You can still use your well trained biomechanically nit-picky eyeballs. But you can convert them over from spotting "biomechanical defects" into spotting motor output stasis habits that put diagonal shears into the peripheral neurovascular tree (metacognition?). 
Habits. Default resting positions. They are detrimental. A small force over a lifetime can be just as annoying to a nervous system as a big force over a short period of time. 
You can help people become aware of their habits. Then you can invite them to change them. 
Homework is simple - ask them to consider watching themselves (metacognition?) and intervening every time, to practice the exact same behaviour on the other side of themselves (just a few minutes at a time) (graded exposure), until it feels just as easy and natural to them as the habit does. They can symmetricalize themselves with way fewer visits, way less expenditure, and stop or at least cut way back on irritating their own peripheral nervous systems. 
How long does it take to feel comfy doing an unfamiliar yet easy motor output task? Surprisingly, not very long, maybe 3 or 4 days, same length of time it takes for receptor turnover. Like any kind of learning slope, it should be as low-angle as possible.
I call that a kind of cognitive behavioural therapy. I don't know that it would count as such, academically, but it's the kind I've cobbled up over a lifespan.
She replied,
That is exactly CBT to me. And some people think PTs are working out of scope if they "do CBT"?!!
I replied,

Bronnie, those people must not have a very broad understanding of what PT is really about! To me, that is what it's supposed to be about - helping people learn how not to be patients, and avoid useless surgery by learning how to be in a body better. Of course it will involve teaching and learning. Doesn't everything involve teaching and learning? I was so ecstatic when pain science came along, because it helped me make sense of my entire profession. Not everyone in my profession agrees this is what it's about though! They think it's an industry in which they can pop stuff or poke holes in people and hand them "pain education" in a pamphlet! OK, rant over.

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