Forwarded this in an email? Subscribe for all things bendy here:

Physical therapy is now widely recognized as a vital part of healing. The primary purpose of physical therapy, to restore strength and mobility to the point of injury, is essentially incontrovertible. However there is a secondary purpose to PT that is often overlooked and neglected, much to the detriment of the patient.

As I work through my knee pre-hab and prepare for surgery I can feel the way that daily strengthening and mobilization of the knee joint is reducing pain and swelling and improving my ability to move. Now, at 6.5 weeks post-injury I can walk, bend my knee to 90 degrees, and even do a cute little squat. None of this would be possible without doing all my knee exercises.

But knee function is only part of the physical therapy routine I have built for myself. There is another goal, equally as important, that takes up at least as much time and energy as the knee: dealing with compensatory movement.

Without working on the compensatory movement that inevitably develops as a result of injury we run a far greater risk of suffering some other injury or pain down the road. It is this additional piece that is often neglected, but when included transforms good PT into great PT.

While therapeutic movement has been around for thousands of years in many different cultures, physical therapy as we currently understand it first emerged in Europe in the mid 1800s. It didn’t gain a toehold in the United States until the polio epidemic in the 1920s-30s, then expanded as a way to treat soldiers returning from World War II, as medicine had improved enough to keep people alive even with grave injuries.

In the late 1950s physical therapy expanded beyond the hospital setting and was recognized as beneficial even for people who have not been gravely ill or injured. According to the United States Department of Labor's Bureau of Labor Statistics, there are now over 260,000 physical therapists practicing in the US.

It is likely that you, dear reader, have at least a second-hand experience with physical therapy. PT is now sought for all manner of injuries, aches, and pains with widely celebrated success. According to this study in the Orthopedic Review, PT is more effective than medication over the long term in reducing pain after an injury.

The first job of physical therapy is to stabilize, support, strengthen, and mobilize the area that was injured. If you tore, for example, your knee then a good physical therapy program would include exercises to strengthen the quads, hamstrings, calves, glutes, and adductors since all of those muscles affect knee function.

By the end of the course of PT the muscles should have remembered how to work together through the full range of motion so that you can go back to your life with a happy, functioning body bit. This is a clear benchmark of success.

The second goal of physical therapy is much easier to overlook because it is preventative.

The problem with injuries is that they don’t confine themselves to where they started. Whenever any part of our body is unable to perform its normal duties, other parts of the body kick in to compensate. Everything is connected, and when one area is restricted due to injury, our body will figure out ways to keep functioning anyway by creating weird new movement patterns.

This is why rotator cuff tears can lead to neck pain, sprained ankles can lead to toe pain, hamstring tears can lead to hip tightness, and a broken foot can lead to chronic back pain.

One of the most common reason that people seek me out for personal training is because they have chronic pain or tightness that they can’t seem to shake. I always start by asking questions about how their dilemma began, and it is very common to hear that they had been injured in a different part of the body and the chronic condition arose in the aftermath.

The secondary goal of physical therapy is to look at ways that the body is compensating for the injury and, while we are healing, strengthen and support the body so that those compensations heal along with the primary injury. This is vital even if the compensatory pattern is not causing us pain in the short term.

Even the best physical therapists are constrained by the systems in which they operate. My insurance offers my the chance to see my PT once every 2-3 weeks for 40 minutes at time. There is no way that she could offer me personalized, comprehensive, detailed physical therapy in that amount of time. If all I did were the exercises that she had given me I would be in a very different place than I am now.

This means that only people who can afford to pay for private physical therapy or have really superb health insurance have access to the kind of rehab routines that address compensatory patterns. Fewer and fewer of us are lucky enough to have that kind of access.

In next week’s post I will lay out some of the methods I used to design my own PT routines, both for the knee-hab and after my toe surgery. I am fortunate to have studied under and learned from a number of excellent physical therapists and trainers who have expanded my toolbox enough to have a decent idea of what my body needs right now.

If you are or were dealing with an injury and experienced some downstream consequences due to compensatory patterns I’d love to hear from you about your experience! Please email me back if you feel moved…

Stay safe out there my friends.

Happy Bendings,

Kristina