As pelvic floor therapists, we find it to be very important to assess our patients…
Typical of the winter weather season, we have had significant ups and downs in our beloved Kansas City weather. Like I always heard growing up: If you don’t like the weather here in Kansas City, wait a day, it will change.”
Our weather never seems to hit a plateau and stay the same, but we cannot say that about our bodies. Many of us participating in physical therapy or any fitness endeavor have experienced a plateau. A plateau is when things stay the same after initial signs of improvement. Healing is never linear, and we naturally will see times of improvement alternated with bouts of no change. Sometimes we can even experience a flare-up of our original pain or issue (which is content for another blog post). When we work so hard and then experience a plateau, we feel as if we are not making progress. We then either want to quit (as we feel we are at our highest level achievable) or we want to back down from PT and work on our own to strengthen for a while. I had an interesting visit with a patient recently that illustrates how a percieved plateau can actually be something entirely different.
This patient needed to take a month off PT due to a crazy job schedule, and was a diligent patient, working regularly on her exercises. When she returned after her month off from PT, told me she was at a plateau and wanted to work on her own indefinitely. She had made good initial progress with some lingering symptoms. During her session, I checked her form and made some corrections to faulty movement patterns that had sneaked back into her current home exercise program. I found she had reverted to movement strategies that had been originally causing her pain and urinary issues. Since she had been working in PT for a while, it was easy for her, once I pointed them out, to recognize and re-establish the new patterns using some self-feedback strategies we worked on in the clinic. As soon as we made these changes, she immediately had a resolution of her knee and back pain. She had not been experiencing a plateau, after all. Instead, she had reverted to the movement patterns that originally caused her problems. This issue calls for external feedback and education on how to change these patterns. Now she can go back to doing her home program feeling and functioning much better with the new modifications. This knowledge led to us increasing her PT session frequency so she can have feedback and a faster progression toward her goals.
Her need was currently not strengthening over time for muscle growth, but rather a strengthening of her neural connections to a new motor pattern through repetitions with some sort of feedback. Pain and urinary issues in physical therapy are usually due to faulty movement strategies and habits. The best way to identify these is to have a trusted eye on you and someone who can tweak your program or, if needed, give you an entirely new program.
Our body’s muscle memory, even for movement patterns that don’t serve us, is strong. We can be doing our best with our home program and still not be making the stellar changes as quickly as we could if we get regular monitoring from a trained professional. This patient could have stayed with the same program for years thinking “I just need to work harder and longer” when her real need was a few tweaks from a very experienced eye. Now she can do her beloved squats without knee pain and control her bladder even better after a one-hour follow-up session.
If you do the math, the cost of a PT session could save you time and money over months and years, not to mention the frustration of working so hard on your exercises without progressing any further. We often feel we are doing things right because we had some instruction (even from our PT). The fact is, it is so easy to fall back on old muscle memory. It feels comfortable and “right” because it is familiar to us. Over time and with feedback, we can change these patterns and make them part of our normal daily movements, but time alone does not do the trick, and a skilled eye and training are sometimes needed. That is what we are here for.
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