Perhaps the most important thing to realize as the practitioner is that there is always limited ability to help somebody. The path to recovery from an injury is not entirely in the hands of the therapist, rather, it is a journey that the therapist and client must take together. The goal is for the two people to put their heads together to successfully diagnose the problem, find the cause and intervene in a way that changes the symptoms of pain or dysfunction.
Sometimes this is hard to understand from the clients’ point of view. To some, the idea of coming to a professional and paying their hard-earned money should represent a purchase of “improvement”. It seems simple. I come to you. I pay you money. You fix me.
And of course, on the occasion, it can be as simple as that.
But more often than not it’s just not that simple.
The therapist must understand the behaviours of the client. In this case, the behaviours refer to the movements of the body for work, rest, sports, leisure and play.
A thorough understanding of all these movements includes what they do, how they do it and how often it’s done.
At the point of understanding the behaviours of the client, the therapist is in a great position to advise “WHAT NOT TO DO”, but also to educate the client as to WHY there is a problem.
I like to break it down to LOAD and CAPACITY of the body to accept that LOAD.
Let’s take a look at the diagram above. It explains things in simple terms. That is, if you’re doing something that OVERLOADS the body part in question, it will eventually result in injury. If not immediately it will eventually happen in time. This is important to know because the client must understand this FUNDAMENTAL concept. Without this understanding, the mind tends to forget that there is a limit to what the body can do. And every time there is an OVERLOAD there needs to be time to recover.
An OVERLOAD may be evident as the client experiences periods of increased pain and weakness, pain at rest or in the mornings. What often happens is the process of OVERLOAD and RECOVER becomes a process that results in confusion. The injury feels good, then it feels bad again. And so on and so on.
This is where the problem becomes complicated for the therapist and the client. The therapist has performed the correct manual therapy, and given some complimentary exercises for strengthening/lengthening, however the OVERLOAD due to behaviours from day to day, has resulted in the issue not improving.
SO HOW DO WE LOOK AT CHANGING THE DIAGRAM?
Well, we have three options.
Option 1 – unload the structure
Option 2 – increase the capacity of the structure (to accept that load)
Option 3 – both options 1 and 2 together
And there we have it!
Once the total load for the structure is decreased, and the capacity of that structure to take that load is increased, we have a new presentation. One where the body part is quite comfortable doing what it is you ask of it.
NOW it may just be that this requires some terrible inconvenience. BUT, the rule still applies. For example, it may just be that the structure that needs unloading is the foot. And it may just be that this means that you cannot walk. AT ALL. On that foot.
And this is certainly inconvenient. BUT the rule still applies. That is, if you have not unloaded it enough to meet the requirements, it’s a pretty good chance you will continually have problems.
So keep in mind this basic concept of physics with the terms “LOAD” and “CAPACITY” because I’m afraid to say that us humans are no exclusion to the rules of physics. We will break if put under enough tension/load/stress BUT thankfully, we (most) often will heal if given the right environment to do so.