When I was in training, they always talk about the aspect of relaying to the client the importance of getting back on the road to recovery. I think the most valuable thing that a therapist can experience the same thing that they treat. When my back went out last year, it was so bad that I couldn’t move or turn without a severe spasm of my core stabilizer muscles including my lower back and all my abdominal muscles. This lasted for about 3 weeks before I could even stand up. Having experienced this has dramatically altered the way that I approach treating a client. When I experienced the pain, the best thing for me at the time was all laying around, gentle pain free movements and ice ice ice ice. Spasm is like an alarm that continually goes off even when it isn’t necessary anymore, and the icing helps to reduce this unnecessary spasm by numbing the area. It’s helps the client to get over that hump so they can get back to being active slowly. I’m a big fan of ice over the A535/Tiger Balm and similar as a primary analgesic. The creams are good to a certain level but you need to get to the deep muscles and ice is the big one for getting that deep.
Once the severe spasm and flareups have reduced, then it is easier to get in and treat the cause. This all is only in the event of severe spasm. Less painful conditions can often be treated more directly and it is all assessed on a case by case basis.
Now that I’ve just had heart surgery, it has given me an appreciation for the aspect of returning to activity slowly. It is slow and you have to be patient. This isn’t something where you can dull the pain and fight through it because I literally get out of breath if I do something too rigorously.
When I tell a patient that they have to do this, it is good for them to hear that I have gone through it too whether it is back pain or returning from any injury. I suppose it is more likely that they will follow my advice if what I am suggesting worked best for me.
In respect to my back, I have made big changes to my posture and have dramatically reduced the precursors to my pain that I had a year ago. It took a while before my body adjusted to the point where the posture was automatic and I didn’t have to think about it. That too is experience that I am happy to pass on. Posture changes are not automatic and take time, but are very beneficial and your body will love you for it.
A lot of time when doing assessment for a clients condition, I pay close attention to what goes on from the feet up to the hip. Very often, this dictates what happens further on up the body. The positioning of the feet can affect the position of the knees that can affect the angle of the pelvis, and the pelvic angles are huge dictators of where the back and neck will be positioned. If there is a forward angle of the pelvis, the back muscles have to tighten to realign the upper back. If the pelvis is tilted back, then the back muscles are stretched and weakened and at risk of going into spasm. The peculiar thing is that the position of the upper body can also affect the pelvis so often it is a vicious circle. When it comes to rehabilitation, the emphasis will always be starting from the bottom and going up and includes some Core Stabilization exercises. And as I always preach, the most difficult part is retraining the brain so that it doesn’t pull itself back into the position that causes the problems, but that is another story.
It’s been exactly a month since my heart surgery. From a cardio point of view, it’s a slow but progressive effort to return to normal. It has been suggested that it is 3 months before a person feels like they are back to normal so I think that I am on my way there. I am considerably younger than most people that have the surgery so hopefully I can cut the time back a bit on the stats.
From a skeletal point of view, my sternum was split open to do the surgery so it is similar to any other complete bone break. They say that it is 4-6 weeks to healing, 8-10 weeks before I can go to work and 6 months before the bone completely heals.
I have chosen 8 weeks before I go to work part time. I can then get a good idea of how my body is reacting. My work will be part time and I’ll be taking it pretty easy. So mid September is the date that I will be returning back to work. So I hope to see you all there.
Something that has come up very often in my clinic are clients with headaches. Very often I have found myself looking not so much at the neck itself as the cause, but at the upper back, namely the area between the shoulder blades. This is an area of the spine that should be straight up and down vertically, but often I find that the upper back is tilted forward. When this occurs, the back of the neck muscles need to tighten dramatically to make sure the head is pulled up and level with the horizon. Naturally, I do work with the neck and spine to ensure that the tightness is reduced and the client has good natural movement in all directions but I also work with the client to make sure that the upper back is brought up into a more vertical position, so the neck doesn’t have to work so hard causing the headaches. Part of the problem exists as the back posture has become a postural habit and it is very difficult to pull out of. In my previous post, I discussed reduction of pain (headaches) as a signal for the body to pull itself out of the bad position. In this case, if the client has headaches at the end of each day, make a conscious effort to change to a good position for just one day. If there is no headache at the end of that day, then the reduced symptoms will override the bad postural habit that is causing the issues. If the cause is not reduced, the massage therapy will be good for maybe 3 days, then the headaches will return so emphasis on reducing the cause is as important as the treatment itself. So, as they say, if it hurts when you do it, then don’t do it. But sometimes you just need a little help not doing it.