A WEIRD THING HAPPENED AFTER SEEING TWO DOCTORS FOR UNEXPLAINED KNEE PAIN AND GETTING A REFERRAL TO PHYSICAL THERAPY: My physical therapist recommended a whole bunch of exercises to strengthen my hamstrings and glutes, seemingly far away from the source of the pain.
“What physical therapy usually does is that we try to learn how patients move,” says physical therapist Hyeri Jung. “We try to think: How did they even injure themselves in the first place? From there, we think about how to change their movement pattern and prevent reinjury.”
To that end, Jung has spent hours coaching me on how to walk up or down the stairs, hips bent slightly, relearning how to do this daily activity pain-free. It’s not that I was doing it wrong before, she says, but that our bodies compensate for weak areas, and we can teach our muscles new habits that don’t stress the painful parts. I’m working in slow motion on a four-inch baby step, but I like to think it’s not wholly different than Steph Curry, star Golden State Warriors point guard, whose NBA career at one time looked limited by repeat ankle injuries. He kept spraining his ankles and missing games, until a trainer in 2013 saw that he was turning all wrong – relying on his ankles, instead of his more powerful hips. “We wanted to teach Steph how to load his hips to help unload his ankles,” trainer Keke Lyles told ESPN.
At Monterey Spine & Joint, Jung takes a similar approach to new patients, watching them walk, jog, then pokes and prods to see where the pain might be originating. “When a patient comes in with knee pain, I look at the hip first and I try to address the hip,” she says. “Then I look down the chain and see if the foot is contributing. The knee compensates, and then you feel unstable in the knee.” Part of the process is also a patient interview that feels more like conversation – about your daily routine, and what exacerbates or relieves the pain.
At Balance Physical Therapy, based in Salinas and with clinics also in Prunedale and Monterey (and a fourth location set to open on Jan. 24), the message is also about how physical therapy should be a first stop for patients who might typically spend weeks waiting for referrals. Balance does reverse referrals, offering 20-minute free screenings; if they see signs of an injury that should be addressed by an MD, they refer patients out – but lots of pain is best treated with exercise, says CEO John Farahmand.
In a video, Farahmand talks about reviewing new patients’ MRIs and X-rays, and then finding that their treatment plan may have nothing to do with what those images show. “You are not your MRI. You are not your X-ray,” he says. “You are far more complex than those things… If you’re over age 30, and have positive signs of degenerative change, congratulations: You’re a normal human.”
How to be a normal human with minimal pain – that’s where PT comes in. Farahmand uses the metaphor of banking: “Invest in your health care bank account, so when you take a withdrawal, you have a positive balance,” he says. “If you can move and do everything you want to do physically without pain, life’s beautiful.”
The underlying idea of PT is to help patients learn to maintain flexibility and strength so they can do activities without injuring themselves – and just be normal, over-30 people in the world. “As you age, things stiffen up,” Jung says. “If you don’t use it, you lose it. I tell people to incorporate stretching into daily life so you don’t hurt yourself.”