Getting Back to Baseline is Bullsh*t" - Why you should expect more from rehab.
I saw this quote the other day, and it has stuck with me since: “Getting back to baseline is bullshit.” Whenever you are rehabbing an injury or pain, the goal shouldn’t be just to get the pain to go away, but rather to help you understand why it happened in the first place (maybe?) and furthermore how to live your best, fit life.
Nearly every patient I see, we discuss if they are:
Doing everything they want to be doing in their life, or are physical abilities limiting that - beyond just the injury that brought them in.
Meeting the physical activity guidelines.
While I’d like to say it is shocking, how often we stop doing activities “the older we get,” it is more common than not. “Oh, I stopped skiing long ago because I was afraid of falling” or “I stopped doing pull-ups because my shoulders would hurt.” While these statements seem a bit like common sense, they also should sound alarms that we are losing strength or may be missing something in our training.
Here are some things we know:
Injuries often get better on their own - our bodies are resilient and heal (though I understand this might not be great marketing for a PT).
80% or more of our population does not meet the physical activity guidelines to sustain our health.
Most people do not know the physical activity guidelines (including healthcare providers).
Our healthspan is declining - meaning we are living long but with many years of poor health.
While we like to boast about prevention, there is no clear research that injuries can be prevented. It does appear the better prepared we are for activities, the less we get injured and/or the quicker we recover from a pain.
Here are some examples of how physical therapists, or those in medicine/rehab settings, should look and help with the whole picture.
A 14-year-old comes in with an ankle sprain. The ligaments of the ankle will likely heal well on their own over 4-8 weeks if it is a mild sprain. However, when assessing their movement, we see that they cannot squat on one leg, cannot balance on one leg (even the uninjured side). We also learn they often skip breakfast and lunch and eat a decent dinner. Their sleep habits are poor, staying up late to watch shows, do homework, or just catch up from a chaotic day. They play on three different teams and have very little rest or recovery time. The ankle is the least of my concerns in this scenario - we have a lot to unpack and a lot of education to be had to assist this individual in recognizing how to live a healthy life. Instead, most do some exercises and say, “Wow, the ankle is back to normal,” and back they go to playing, often to only get hurt again.
A 50-year-old comes in with back pain of unknown origin. Sure, there is some “weakness in their core,” and maybe some “McKenzie” movements help them feel better. But in conversations, we also find out work is absolutely exhausting; they are taking care of both their children and their parents. They want to exercise but every time they do, they get hurt - which then makes them worried because they do not want to stop exercising. Sleeping is a lost cause as their mind cannot be shut off at night. They can feel they put weight on. They’ve had MRIs and injections and “nothing seems to be helping.” No medical practitioner has sat down and asked about their goals - which used to be to run a marathon but is now to put their pants on without pain. I do not care what exercises I give this person - if we do not help them see the life they are currently living is not sustainable, their later years will be ridden with pain, disease, and loss of independence.
Too often in medicine, we are focusing on "the injury" and not "the person." We have fancy terms such as "evidence-based" and the "biopsychosocial model," but are we actually living this as practitioners? I know many amazing people who are, but truthfully, most are not or are in a work environment where they cannot.
When people finish a session or a program in rehab, we want them to “feel better than they ever have.” We want them to know that by hitting activity guidelines (30-60 minutes of huff and puff exercise a day, 2 days of resistance training, and reducing sedentary behaviors) they can greatly improve how they feel and extend their healthspan. We want them to understand the basics of eating well and hydrating (a dietitian can be consulted if more support is needed). We want them to understand rest and recovery for both the body and the mind (a psychologist can be consulted if needed). When people are in my walls, there is no better time to preach.
We want people to feel resilient and strong. Who doesn’t like feeling like a total bad-ass? The “gift of injury” is a real thing. Injuries can lead you to dark places, but with the right support system, they may be the gateway to you feeling the best you ever have and allowing you to sustain your health, fun, and independence for years and years to come.