Physical Therapy schooling is a grueling 3 year process that teaches you a lot about how the human body should work, and what to expect when you enter the real world. At the end of three years you get thrown into the fire and have to start treating a full case load.
At this point, you barely have any experience and have no idea what truly works and what doesn’t, often times you have to rely on the mentorship skills of your co-workers to have success early in your career.
To make matters more difficult, the first seminars I took coming out of PT school almost contradicted what I had previously been taught. By the time my first year was over, I had taken 8 different continuing ed courses, some of these pushing new ideas and research not covered in school.
Sifting through all this information and learning from some of the best minds in the industry I have started to create a philosophy that has allowed me to improve my skills as a Physical Therapist.
I am sure a year from now I will have 3 new takeaways, some of which will replace my current ideology. In an ever growing field that is starting to ask the right questions, who knows what the current trends in the field will be 1, 5 or 10 years from now.
Here are my 3 biggest takeaways since graduating that has shaped my understanding of rehabilitation, prehab and performance.
1. Mobility Before Stability Before Function
This one may seem like common sense, but this order is often skipped by most professionals and clients a like. We all tend to start at the “function” level, such as running a 5k, rather than ensuring our bodies have the necessary prerequisites to even begin said task. If you are 25 and never ran before, you should make sure you have such things as 70 + degrees of great toe extension as well as proper hip strength/stability to manage the demands of running.
I am guilty of mixing up this order myself, and have quickly realized the quickest way to get someone back from injury is to ensure first they have good mobility at a joint. Mobility here being determined by someone’s passive range of motion (PROM). If some one does not have the ability to achieve full PROM, building stability on top of this is hard-pressed.
Once somebody is able to achieve full motion at a joint, it is important to create stability. When thinking of stability we should be thinking about control of the motion, particularly at end range of motion.
Finally once you have control over the motion you can start to implement exercises for performance again focusing on creating good movement patterns while maintaining stability/tension throughout.
As a side note, these distinctions are not purely black and white. There is a lot of grey area and overlap between each stage. The point being don’t neglect one aspect versus another. Make sure everyone has the prerequisite movements for the task then add stability, strength and power to the mix.
2. Spend time on mobility everyday.
This takeaway was driven by 2 factors. The first was the Functional Range Conditioning (FRC) certification and the second was injuring my lower back.
Just before I took the FRC seminar I had injured my back. This put me on the shelf for about four months. I was unable to bend forward, stand up and barely could perform my job.
During the FRC seminar, I was re-taught the importance of daily movement and mobility training. Mobility training tends to get put on the back burner because we all want to go, go, go and not put in the work necessary to keep our bodies healthy.
Since then I have made it a priority to do Controlled Articular Rotations on a daily basis while targeting my weakest links with mobility exercises that build them up. The final result, no back pain and the ability to enjoy my time in the gym and in life.
3. It Takes Time to Make Tissue Change
This has been a big influence in the way I communicate with my patients and how I train myself.
Foam rolling, manual therapy, smashing muscles are all fine practices, but understanding what is happening is important. It takes roughly 2,000 pounds of force to make actual tissue change in one sitting. If any of the above things actually did that, they would cause much more harm than it would do good.
Understanding this, it takes consistent practice over time to make tissue change. Think of it like this, every time you foam roll, see your massage therapist/physical therapist, or do some mobility exercises you are simply opening up a window of opportunity within your nervous system.
If you stay consistent over time, the window will continue to grow and the mobility improvements will “stick”. Over the course of weeks, months, and years of consistent movement will give you more bodily control helping to decrease your risk of injury and improve your bodies awareness and performance.
I hope you guys enjoyed my 3 takeaways over the past year, and they help you take care of your own body or your patients/clients bodies.
Happy Rehabbing.
