I am a 57 year old physical therapist and I know that all of my chronic shoulder pain will not completely go away. I appreciate that the mild pain I feel at times reminds me of all the fun that I have had with this amazing complex joint. Impact traumas from skiing, softball 4 nights a week for many years, college baseball, throwing stones and footballs…the list goes on and is what my life was and to a large degree is still all about; being active and having fun doing it. We could go on with respect to my left hip and cervical spine, but why bother.
Using myself as a prime example in conjunction with the adult patients that I see on a daily basis, I appreciate that chronic musculoskeletal pain/impairment is a significant health problem, commonly resulting in negative effects on individuals’ lives. And because we live longer, sit more during the week and tend to overdo it on the weekend or on vacation, this issue is not going to go away.
Educate and Play Smarter…
I now fully appreciate and convey to the patients I see; that self-management strategies are essential to the management of persistent musculoskeletal disorders. I for instance, no longer do the same workout regimen at the health club that I did 30 years ago. None the less when I walk out of the club after exercising, I feel mentally and physically refreshed and rejuvenated. As well I don’t hurt and feel that I can physically take on the day without setbacks, appreciating that I have improved upon the quality of the “machine”. I am ensuring that I will be able to return to the health club for many years to come.
So what has changed in how I go about my weekly exercise? The following bullet points describe the content of my weekly workouts, noting day of rest in between.
My exercise is:
- Proactive: balance and coordination exercise is now a focus
- One of the highest origins of mortality in this country are complications following a hip fracture. Maintaining bony integrity while minimizing the risk of a fall can play a crucial role in one’s life quality and duration.
- Restorative: yoga and stretching now serve as a framework for the balance of my exercise routine
- Via yoga and stretching I appreciate the extremes of my functional mobility. I do not exercise outside of this realm.
- We do the same thing over and over resulting in functional mobility loss, then comes the weekend and physical overindulgence immediately followed by a week sitting at the office; repeat.
- When was the last time you climbed a tree, did jumping jacks or hung from the monkey bars?
- Functionally Expansive Strengthening: Postural and end range function strength
- Everyone is guilty of poor postural habits and these specific muscles have basically gone to sleep or tolerate only short periods of functioning before they tire.
- Recall what happens when you slip on the ice and grab onto a railing to save yourself… when your 20, and compare that to the classic outcome when you are 70.
Moving safe loads at a safe speed thru viable functional and safe realms of physical motion while progressively enhancing the three dimensional realm at which you can do this with progressive loads and speed is the key to maximizing physical function as well as one’s safety as an adult.
Looking Back
Compare this to my gym habits of 30 years ago when the focus of life was looking good in the mirror and hitting a softball a long way via moving a large weight through a confined space over a few repetitions.
I now appreciate fully that I will never feel as good and be as athletic as I was 30 years ago, but that is OK and I wouldn’t change a thing. I have now ventured into new and different options of exercise and appreciate that I am fully challenged, in good shape, and feel rewarded when I am done with that days effort. Best of all, the exercise for that given day is a “net positive” with respect to how I feel and perform.
To Summarize:
I have created for myself and convey to patients a personalized approach that focuses on self-management and a healthy lifestyle via restoring and maintaining maximal physical function which thus improves participation in the long term. The goal is to create a management plan instead of a cure. In this way, I and the patients I treat feel empowered and have the skills and knowledge to actively manage their condition, even after formal in-clinic care has ended.
The experts agree, in a recent article in the Journal of Orthopaedic and Sports Physical Therapy, Hutting etal. states: “Self-management fits the positive health concept (the ability to adapt and to self-manage, in the face of social, physical, and emotional challenges) as an overarching approach to prevent long-term disability from persistent musculoskeletal disorders.” The article defined self-management as “the ability to manage the symptoms, treatment, physical and psychosocial consequences, and lifestyle changes inherent in living with a chronic condition.”
The article goes on to say: “This kind of thinking reframes the expectation of a passive treatment approach that cures the condition (it doesn’t work) to that of an active approach (eg, self-management and exercise) as central to long-term management. Self-management strategies using passive approaches (medication, hot packs) increase the likelihood of pain behavior and disability, while active strategies, such as exercise, decrease the likelihood.”
For the opportunity to continue to ski, bike and run as an adult, an investment in oneself is required. The necessary self-management skills include:
- problem solving
- how can my brain be fulfilled without causing irreparable damage
- decision making
- how high do we set the exercise/activity bar while safely correlating the reality of the status of our bodies
- resource utilization
- What type of fitness facility/equipment/personal trainer is best suited for one’s goals
- Should I exercise with a friend to stay motivated
- action planning
- how intense and frequent are workouts
- self-tailoring
- what are appropriate restorative and maintenance measures does one need take to allow for progression to the next level of fitness
- self-monitoring
- What are the barriers to exercise
- Appreciating and documenting sx before and after exercise, are there underlying psycho-social issues that need to be addressed.
- Establish means of which to measure success
- creating a patient-health professional
partnership
- there is great value in proactive and not reactive medical care
- the professional can teach the client personalized skills to manage their situation
This is a big paradigm shift for most people and is not easy. Once accomplished however, people will feel empowered having the skills and knowledge to actively manage their condition thus enabling the enjoyment of exercise and/or sport and ultimately fulfillment on multiple levels.