Addition By Subtraction

Patients often seek my care due to pain, or a limitation in their physical mobility. They are asking for help, and they want to know what they can do to improve their situation. One of the most common questions I receive is “What should I avoid doing for now?” This is an understandable question, and we typically have a conversation around it, however what if it is not the “what” but the “how”?

Many patients that I work with are very active in some capacity, and they want to know what else they can be doing to improve how they feel. Often, we tend to discuss doing a little less. Energy and the management of it has been a topic of this blog before, and for good reason. There is only so much of it to go around, we must be able to manage it not only in our day to day, but also within an exercise.

A lot of what I do with patients is teach them how to sense and manage their movements. We all develop strategies for moving within the world, and when those strategies work for long enough, they become subconscious. Only when we are unable to utilize that strategy does something grab our attention.

My job often entails coaching someone into a new strategy. This requires frequent repetition, time, and effort. The effort needed is very specific, and typically less is more. Moving in a different way feels odd, it grabs your attention and muscling your way through it feels like your only option. Once a patient has practiced a given exercise often enough, the amount of effort begins to diminish, and the movement patterns begin to change. New strategies develop, and pain or mobility tend to improve.

Austin Ulrich, Physical Therapist