The Perils and Pitfalls of Physical Therapy
surfyogi@verizon.net
JonBurras.com
Jon Burras
Return to Nature:
"The Five Pillars of Healing"
The Spectator
founded 2004 by ron cruger
A place for intelligent writers
A place for intelligent readers

You have recently been in a severe car accident. Your body is bruised and battered. After the bruising goes away, your doctor recommends that you attend a series of physical therapy sessions in order to repair the damage. You agree and set off on the path of rehabilitation. Little do you know, you are heading down a road that may offer little or no actual healing to your body. Since you are uninformed and place your entire trust in your doctor, you agree to go ahead anyways.

When someone suffers from a traumatic accident what they are really looking for is relief from the pain and the ability of their body to once again function to its full capacity. They are often in a fearful place—not sure if they will ever walk again or get full functioning back of an arm or leg. They place their trust in a system of men and women who wear white lab coats and have stacks of certificates plastered on their walls. They seldom are in a place of getting a second or third opinion. Rarely do they question what is being offered to them.

Unfortunately, the world of physical therapy is full of many perils and pitfalls. What many consider as a life-saving tool can actually prevent one from healing. The politics and bureaucracy of the practice often limits the actual healing experience. Misguided ideas and profiteering sometimes come before helping people to get well.

There are many good physical therapists that have done a world of good for many people. Accident victims have been able to regain their life back with concerted effort and dedicated individuals who have not just physically helped them but have been their emotional backbones along the journey as well. We applaud those individuals.

However, others have not been so lucky. These individuals have been forced to live with a lifetime of reduced mobility and often agonizing pain. They have been the victims of a less than perfect system that does not always do what it says it does—rehabilitate injured people.

The term “physical therapy” is a catch all phrase that could mean many different things. Physical therapy could mean “rehab,” “re-education,” or “fitness.” There is not one type of physical therapy. Just the same, some of the best physical therapy does not necessarily come at the hands of physical therapists. Many others, like massage therapists, body workers, energy practitioners, chiropractors and movement specialists may also provide excellent forms of recovery and repair work for the body after a significant car accident or trauma. In fact, these skills might outshine the work of someone who calls himself a “physical therapist.”

When you begin a routine of physical therapy there are many aspects to consider and many more questions to ask. Most people go into a physical therapy situation blindly and will often be disappointed by the results. Here are some things to consider.

  1. Mechanistic View Versus Holistic View

“Physical therapy,” as most people know it, evolved in the United States from hospital-based treatments for polio patients and for wounded soldiers returning from World War Two. Procedures have continued to be developed, from treatments for children (pediatrics) to exercises for the elderly (geriatrics). Physical therapy has come a long way.

Traditional physical therapy follows a model based on Western scientific medicine. This model states that the body is a machine and the machine needs to be repaired. Under this premise, the body is treated as a collection of parts and seldom do emotions and energetic influences get addressed.

The mechanistic view of treatment often leaves one feeling like they were just a body and a “piece of meat.” The physical anatomy is usually what is addressed. Exercises and physical manipulation, along with high-tech machinery, are often the primary choice in this methodology. The physical therapist is more inclined to be a “technician” than anything else.

Example 1:

Ted was in a bicycle accident. Ted chose to get a prescription from his medical doctor for three months of physical therapy. In this traditional approach, Ted was instructed on how to use the weight machines in the facility, strengthen his core with the various equipment, apply heat and ice, use some of the high-tech equipment (like the muscle stimulating devices) and occasionally receive some deep tissue bodywork. Most of Ted’s treatment consisted of his individual workouts. For three sessions a week for the duration of three months, Ted received very little individual hands-on treatment.

After the three months had passed, Ted stopped any kind of treatment. He was not willing to spend any of his own money on therapy. While in therapy, Ted had hardened the areas around his injuries with strength training. After the therapy had ended, Ted felt stronger but also had “twinges” from time to time in his lower back. Ted was reluctant to get back on his bicycle and face his fears of competing with cars in traffic. He moved gingerly through life and always protected his back and joints.

Example 2:

Suzy was also in a bicycle accident.  She elected to see several holistic practitioners. All of Suzy’s expenses were paid from her own pocket. She did not seek out a disbursement from her insurance company for payments. Suzy had learned that the types of mechanistic treatments that her insurance company would approve of she was not interested in. She did not get a prescription from her medical doctor either as to what she should do. Suzy took responsibility for her health and well-being and did not fall victim to what others wanted her to do. Instead of working with “technicians” who primarily treat the body in a mechanistic fashion, Suzy was able to work with “healers” and “artists” who helped her reclaim all aspects of herself, (movement, emotions, energy release etc.).

The first step Suzy took was to begin working with a bodyworker who was able to release the frozen muscles and energy patterns that had lodged in her body. She knew that there was muscle memory imbedded from the fall that needed to be released or she would end up carrying it with her for the rest of her life. Through a series of various bodywork techniques, (Swedish massage, Connective Tissue Bodywork, cranial sacral therapy), Suzy’s body began to come back to life.

Suzy also began to see a holistic chiropractor for some minor adjustments and to begin releasing any emotional holding patterns. She chose a chiropractor who was skilled in a technique called NET (Neuro-Emotional Technique). Through these treatments, not only was she allowing her body to return to balance, but she was also erasing the fear that had lodged within her.

Finally, Suzy tried a few sessions with a movement educator who was skilled in the Feldenkrais approach. Here she learned to move various areas of her body to regain full and complete mobility once again. After three months of treatment, Suzy not only felt like the bicycle accident had never happened, but she felt better than she had felt in years. She had no fear about getting back on her bicycle and cherished every ride.

When you step out of the Western scientific box and try engaging with a holistic practitioner, (either physical therapist or other alternative healer), you are much more inclined to be treated as a whole person rather than just a group of body parts. A holistic practitioner might use many different body/mind approaches to help facilitate your healing. This method attempts to connect the beliefs, movements, emotions and patterns together to bring a more balanced sense of healing.

  1. War Model or Natural Model

Traditional physical therapy operates on a war model. The body is required to be hardened and tightened. The injury sight is often classified as being “weak” and thus must be strengthened. While this might be helpful for some people some of the time, this model is quite ineffective for most people most of the time.

This approach stems from several misconceptions about the body. The first misconception is that fitness and health have anything to do with each other. While these two terms are often found mixed together, they are very different experiences. Fitness was designed by scientists, celebrities, and corporations to sell products and to shape the body to look socially acceptable. Little does fitness have to do with health. Health is the vibrant and efficient functioning of all physical, emotional and energetic systems in the body.(See JonBurras.com/articles/Health or Fitness for more information).

The fitness model however, is the main focal point of most physical therapy. These treatments are designed to tighten, harden and stiffen the body. A misdiagnosis is often made claiming that the body is weak and needs to be strengthened. This approach is right out of the “training for war mentality.” Warriors will harden and tighten their bodies as they prepare for battle. Traditional physical therapy is not much different.

A natural model does not focus on strengthening the body. If strength training is utilized, it is prescribed as the last stage and not the first stage. Once the injury trauma has been removed and the muscles reeducated, it might be appropriate to add some strength.

A natural model will also apply techniques that offer full range of motion. The secret is to tell the muscles that it is now safe to move. During a trauma, muscles will hold the memory of the trauma and not feel safe to move again. A natural model emphasizes creating the ability for the muscles to let go of the memory of fear and replace it with a belief that it is now safe to move. If you continue to wrap hardened muscle around an injury then the release of fear will seldom happen.

  1. Physical Only or Multi-Disciplinary

Every injury to the body always has an emotional component somewhere. Most often during traditional physical therapy this is not addressed. The classic treatment follows the Western allopathic medical model. Disease is solely a biological event under this model. Your biology is “off” so your physical body needs to be rebalanced with physical tools. Hence, you will often see a swarm of technology in a physical therapist’s office. While these treatments can be effective for some people some of the time, they are relied on most often as the primary treatment choices. Other aspects of healing never take place. Science is the primary resource utilized. While scientific procedures can often be very useful, there is so much more available that is “non-scientific.” After all, what came first, science or nature?

There are many layers to an injury. First there is the trauma itself, followed by the emotional experience and then by the compensation patterns. In holistic recovery, the trauma is removed from many angles, not just from a physical one. Movement reeducation might be used along with bodywork or massage. This might include many different massage modalities, from cranial sacral therapy to connective tissue bodywork. During the release of trauma stage (or in tandem), the emotional factor is addressed. Why is the patient still frozen in PTSD (Post Traumatic Stress Disorder)?

 Holistic models address this. A physical only approach does not. (As everything is billed by insurance codes, there is no code for emotions or fear). Alternative practitioners specializing in body/mind healing are often utilized to release these old emotional patterns. This might include one trained in NET (Neuro Emotional Technique) or REMD (Rapid Eye Movement Desensitization).

The last part of the puzzle is compensation patterns. When someone is in a serious accident they will protect an area. This can be with either an emotional protection, (don’t move it), or with a physical protection, (building layers of muscle around an injury like a suit of armor). The traditional physical therapy model will primarily look at the injury sight alone and treat that. A holistic model will seek out the compensation patterns as well.

Example1:

Sally fell on her bathroom floor. She broke her arm. She was placed in a cast for six weeks and when the cast was taken off she completed a few sessions of physical therapy. While the treatments gave Sally her range of motion and strength back, Sally was petrified to return to her bathroom. In the back of her mind she continued to imagine herself falling again every time she entered. The traditional physical therapy model would not know how or why to address and heal this. The holistic model would find the emotional component just as important as placing one’s arm in a cast.

Example 2:

Joe was standing on a ladder when he slipped and fell. As he tried to catch himself with his hands he also used his right leg to try to make one last effort to remain upright. Joe fell on his arm and side. He was bruised and battered but did not break any bones.

When Joe went for his six weeks of physical therapy his arm was strengthened and his hips worked on, but no one ever looked at his ankle. Only the injury sights were addressed and if it was not painful at the time it was not an issue. A holistic model would have addressed his entire body as requiring balancing, not just the sights of pain.

  1. Assembly Line Model

        Sick and injured people make money for a system based on the medical industrial model. The first thing that one usually sees when he enters into a physical therapist’s office is an assembly line of strength training machines. One would think that he were at a gym. Physical therapists learned a long time ago that if they had to give personal attention to each patient they could not make much money. Instead, they brought in a series of strength training equipment. Here you can have eight or ten people using various pieces of equipment on their own or with little supervision. You can still bill the insurance company for a complete session, even though the patient spent all or most of the time by himself.

            This assembly line model is all about the money. A holistic model will be a one-on-one experience. For instance, Bill was in a skiing accident where he injured his left hip. First he went through his insurance and committed to three times a week for three weeks in physical therapy. He spent most of this time on the strength training equipment with little or no supervision. Occasionally, he would receive some personal attention for some stretching or deep tissue bodywork. After the insurance ran out he was still in pain and decided on a different path.

            Bill sought out a bodyworker for some personal hands-on treatment. Bill paid for six treatments out of his own pocket and received personal attention for the entire duration of those treatments. Connective tissue bodywork, Swedish massage and reeducation movement exercises were used to get the hip back to health.

            In the holistic model, every situation is unique and explored fully. Often old injuries will tie in with the recent trauma and overlap each other. In the traditional assembly line model, every injury has a diagnosis, insurance billing code and treatment based on the findings in a book. Therapists are more like technicians who are just treating the physical body.

  1. Insurance Approved

Most people enter physical therapy after receiving a prescription from their primary care doctor. Physical therapy is passed out like a pill from the pharmacy. It is often sterile, money driven and leaves one frustrated.

There is a strong correlation between healing and taking responsibility. It is often found that the people who only use their insurance money do not heal as fast or as completely as people who take responsibility for their health and pay for treatments out of their own pocket.

           When you allow an insurance company to be the guardian of your health you are saying that you have relinquished all responsibility. You are taking a back seat to an executive in an office building for whether or not you can be healed.

            On the other hand, a holistically-minded person will take matters into his own hands. Yes, he may choose to do physical therapy in the traditional manner. However, he will not stop treatments when a prescription runs out. He will utilize whatever resources he must and spend money from his own pockets in order to get better.

            Many of the best methods of healing are not insurance approved. Insurance companies follow a scientific Western medical approach and primarily reductionist treatments are approved. Natural healing techniques abound and natural healing therapists are numerous. Just because something is “insurance approved” does not necessarily make it the best choice. Insurance companies are often as sterile and backwards in their thinking as the traditional medical model. There are many choices in healing. Allowing an insurance company to decide for you will only set you back.

(See JonBurras.com/articles/Contract for Health Care).

  1. The Core Myth

The traditional physical therapy model works on an antiquated belief system. This system teaches that the body is a series of columns that need to be strengthened. These columns are the bones and muscles stacked on top of each other. There could be nothing farther from the truth.

The body is not a series of columns. Instead, the body is a collection of cables and pulleys that lift the body up and pull the bones away from each other. This is called “Tensegrity.” It is through the idea of tensegrity that the body is able to move and be propelled through life. Buildings are made of columns; human bodies are not. If you hadn’t noticed, buildings do not move while humans do.

Under the body as a column model the frequent treatment of many injuries, (especially back pain), is to strengthen the core. This is a complete misdiagnosis of the problem and a inaccurate treatment as well. If your back is in pain it is because your core muscles are already too tight. Why would you want to tighten them even more? While strengthening the core muscles might bring stability to an out of balance system, it does nothing to actually heal the body. (See JonBurras.com/articles/Backs do not just go out).

A better method to treat back pain would be to lengthen the cable system in the body. This would consist of bodywork treatments, movement therapy and yoga exercises. When you lengthen the muscles and corresponding connective tissue you are getting to the heart of the problem. When you continue to build strength around an injury you are just keeping the injury in place. Traditional physical therapy is akin to the United States’ foreign policy. If you can build a big army and be strong you can feel safe. A more holistic approach which relates to treating the body would be to develop meaningful relationships with all countries so you have nothing to fear. Translated to the body that would mean exploring all the relationships between the many parts and noticing how they respond to each other.

  1. Connective Tissue Versus Muscles

Muscular skeletal anatomy as we know it is several hundred years old. The traditional physical therapy model for the most part is using a very antiquated perspective of the body. Muscles are seen as physical machines that move joints. These muscles need to be strengthened under this premise.

The irony is that there are currently many ways to view anatomy, not all prioritizing muscles at the top of the list. For instance, there is energy anatomy. This approach sees the blockage of energy pathways as the source of much physical imbalance. A solution could be to utilize the ancient Chinese system of acupuncture to unblock the energy systems.

Another way to see the body is through connective tissue anatomy. Connective tissue is the most abundant tissue in the body. This tissue most often takes a back seat to muscular anatomy. However, patients could benefit greatly by addressing their connective tissue concerns over strengthening their muscles. This is seldom done in the traditional physical therapy setting. Very little respect is given to connective tissue from the Western allopathic medical system.

Traditional physical therapy, being mechanistic in nature, leans primarily on muscle health and ignores other key elements in healing. A holistic system would be quite different. Connective tissue bodywork, energy healing, acupuncture, yoga therapy and other systems would be used to bring balance back to the energy flow in the body.

There are many ways to envision anatomy of the body. Limiting oneself to just muscular skeletal anatomy will severely limit your choices.

Solutions

            There are many solutions to choose from to further your healing experience. While you may find a holistic and qualified physical therapist who offers a wonderful rehabilitation experience, there are many other professionals who are highly skilled who do not call themselves physical therapist. Do not allow yourself to be short-changed by insurance company billing codes or prehistoric healing modalities. If you truly choose to get better there are many tools and resources available. Here are some suggestions.

·        Acupuncture: American Association of Acupuncture and Oriental Medicine (aaaomonline.org)

Questions to ask

1.      How much treatment is dedicated to hands-on, one-on-one sessions?

2.     How much time is dedicated to strength training?

3.      What is the philosophy of the therapist?

4.     Can I get some telephone numbers from past patients to see if they were happy with their treatment?

5.     How holistic are the treatment sessions?

6.      Will I be strengthening my core?

7.     Are emotions addressed?

8.      Does my insurance cover alternative health care treatments?