Stuff I Wish My Patients Knew Ep 2: The Way You Move, Or Don't, Matters
The human Movement System is incredibly complex. It ultimately produces movement (go figure!), which is the result of a dynamic interaction of the nervous, muscular, skeletal, endocrine, pulmonary, and cardiovascular systems of the human body. Physical Therapists have many responsibilities and skills, but at the end of the day, we treat and enhance the Movement System. This system, while intricate, can be simplified in such a way that allows us to determine variables that are negatively impacting it. Careful observation of the motions, postures, and loads that a person is consistently subjected to paints a picture on how and why an individual may be experiencing pain. With this short blog, I’d like to present some daily tasks that can be manipulated to alter pain, and try to convince you that you have control over the way you move, and therefore YOU HAVE THE POWER TO CONTROL YOUR PAIN!
Sitting can be a pain in the butt (pun intended), or in the back. The study of ergonomics has come a long way toward reducing harmful stresses that we experience on a daily basis, but it is limited in its application. Even if we implement the most effective ergonomic designs into the workplace or home environment, there is no substitution for educating people about “proper” movement. I use quotation marks around proper because movement isn’t a one-size fits all deal. It’s unique to you, and that means it will take a thorough analysis of your anatomy, movement patterns, and current circumstances to make suggestions on what “proper” means for you.
Andrea’s back hurts after a long day at work, it never fails. After a physical examination, it is revealed that Andreas’s height (5’1”) and subsequent sitting posture are likely the source of her back pain. Because her legs are shorter than the average person’s, her legs do not fully rest on the ground, causing her hip flexors to contract and pull on her lumbar spine. A footstool is utilized at work, and Andrea’s pain drops from a 7/10 to a 2/10 within a week. Magic!
Standing is often one of the most painful activities for many individuals, which is unfortunate because many necessities in an independent life are contingent upon a person’s ability to stand and walk. I’ve found that many of my patients are baffled at the idea that they can change their standing posture to alleviate pain, but check out the patient scenario below to see how a small postural adjustment can make all the difference in the world.
Joan comes in to the clinic for low back and left hip pain that bother her during the day when she performs daily chores. While performing the physical examination, it is noticed that Joan prefers to stand with her spine rotated to the left. We alter Joan’s standing posture, and she is educated on how to perform her ADLs in a neutral spinal position versus left rotation. Within 2 days, Joan can perform her ADLs for an additional 2 hours before she experiences any pain in the back or hip. After 2 weeks, Joan only experiences low back/hip pain if she has a very busy day.
Walking can be the best, or worst, task for people. Walking satisfies the body systems need for movement, but it can be performed in such a way that is harmful to the body. It seems the common belief among my patients is that pain during walking is the result of degeneration- of the spine, hips, knees, etc. Check out this example of a middle-aged female with significant spinal degeneration that changed her pain while walking.
Betsy is a 65 year old female with significant spinal degeneration in her lower back: bulging discs, spinal stenosis, and arthritis. She has pain when walking her dogs more than a few blocks, and would like to get back to walking approximately 1 mile with her dogs like she did just a year ago. During the exam, it is noted that Betsy maintains an extended spine while ambulating, and
takes very large steps- further exacerbating her spinal extension. By teaching Betsy a more neutral alignment for her spine and demonstrating how to take slightly shorter steps during walking, Betsy is able to decrease her pain with walking within 3 days of starting therapy. By 4 weeks, she can walk one mile pain-free. And she still had the bulging discs, spinal stenosis, and arthritis.
As I’ve previously shown, you can have degeneration in your body and not have any pain symptoms. This is important information to know because it provides proof that you can modify the way you move in order to decrease the stress applied to your body, and consequently, the pain that you experience. Or if you’re not having pain, this is evidence that you should pay attention to the way you move, because there will be consequences down the road. With normal wear and tear on the body, certain forces that used to be tolerable may now exceed the body’s lowered threshold for pain.
I would encourage you to pay more attention to the positions and motions you perform on a daily basis. While seemingly innocuous, these positions and motions alter your anatomy and physiology slowly over time. A physical therapist can screen you annually to make sure that you are doing the best you can to maintain optimal movement patterns. Not only will you save yourself money in the long run and improve your quality of life, you’ll also be playing an active part in preserving your health- a responsibility that cannot be overstated.
Dr. William Richardson is a board member and program director for Work Out Help Out. As a licensed physical therapist, William has extensive knowledge about the human Movement System and is passionate about joining exercise and volunteer service to change the health of the nation.