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Rehabilitation is the art of returning the injured to a state of optimal function. One must always explore the cause of injury before embarking on a particular treatment approach. Does an imbalance of the muscles around the shoulder girdle exist, predisposing one to impingement? Were the muscles of the spine and pelvic girdle functioning improperly, causing the pinched nerve when you bent over to pick up a sock? Are the mechanics of your foot and ankle creating excessive strain at the knee or hip, resulting in chronic tendonitis or bursitis when you run? Rehabilitation should not just treat the symptoms of the current problem, but should look for the factors predisposing you to injury in the first place.
Most people, in order to function at their full potential must be habilitated, or brought to a state far superior to their pre-injury state. The ultimate goal is to foster a profound understanding between a client and their body. Take some time to watch how people sit, stand and move. Common findings that are easy to see include forward head posture, rounded shoulders, loss of the lumbar curve in sitting, excessive toe-out of the lower extremities. These postures as well as many others create muscle imbalances, resulting in abnormal functioning of joints, and eventual pain syndromes. Detachment from our internal sensors that tell us what our bodies are doing in space is a primary cause of injury, and re-establishing the often long-forgotten connections is a major component of rehab.
For the treatment of any given problem, there is a logical progression to rehabilitation. The acute phase, or immediately after an injury, involves activity adjustment to protect the injured area as well as scar tissue modification. Appropriate exercises are introduced during each phase of healing to speed progression and prevent range of motion deficits and muscle imbalances. The factors that predisposed you to injury should also be explored, and correction should be intertwined in your treatment. The skilled practitioner will teach you how to create the optimal environment for healing.
The longer a person has lived with an unresolved injury, the greater the challenge to effectively rehabilitate. Rehab from an injury that is more than six months old is usually quite extensive. Adaptive changes occur throughout the entire body. Chronic pain can be very debilitating both mentally and physically, and is challenging for both patient and practitioner. Frequently rehabilitation of people with chronic pain is like peeling back the layers of an onion. When the structural problems that are present on initial evaluation resolve, different problems may present as the patient is taken on a journey back through the different adaptations that the body had assumed between injury and initial treatment.
Also of note is that treatment usually needs to be multifaceted. Successful treatment of chronic problems needs to address the muscles, joints and nerves. Education is critical to help patients understand the reasons for their pain, and to help them re-create an environment that allows balance and free flowing motion. This is the challenge and the art of rehabilitation. It is assisting the body to self-heal by creating the optimal environment.
Sources: Julie Edelman, MPT, Boulder CO and Erik Hansen, CMT.
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