What to expect and not to expect from physical therapy

Are you wondering what you should expect from physical therapy? Or maybe what you should not expect? As a physical therapist for the past 12 years and as a movement specialist for the past 24 years, I can confidently share what you deserve in physical therapy.

Rather watch or listen? 

What you should expect from physical therapy

1. Thorough evaluation

You deserve a thorough evaluation, no matter what you are reaching out to physical therapists for, whether that’s movement issues, chronic pain, acute pain, vestibular, balance issues, post surgery, pre surgery, or any other reason.

That means not only a physical therapist should be looking at your current symptom (s), but they are looking to figure out why they happened in the first place, even during post-surgical cases. A thorough evaluation includes looking at a detailed movement assessment, where your compensation patterns lie, what might be driving some of the issues you’ve had, and all of your modifiable lifestyle factors. How is your sleep? How is your nutrition? How are your relationships? How is your stress management? If your therapist is missing these details, they are missing a huge element of helping you heal.

2.  Practicing what they preach

You deserve a physical therapist who practices what they preach, whether that’s movement, balance, or exercise. They should be a health leader, educator, and movement specialist, and because of that, they have an obligation to be able to do the things that they are recommending that you should do.

3. 1-on-1 care

It is hard to find 1-on-1 care in today’s healthcare environment. I worked in the outpatient practice for eight years, so I understand a busy outpatient setting, and unfortunately, the demands of insurance companies are dictating this. However, you deserve to be able to be the only person in the room, to be listened to, and to have your therapist understand your diagnosis, prognosis, underlying causes, current concerns, goals, and plan of care without being pulled in a million directions. One-on-one care is extremely important, whether that’s 30-minute sessions or 60-minute sessions.

4. Someone who will look at you as a whole person

You should expect someone who listens to your story and understands that you are not a “shoulder problem,” you are not a “hip injury,” and that you are a person; you are human with a story and emotions and thoughts and all the things that make you wonderful. So, make sure that someone is looking at you as a human with a beautiful story, not just an injury.

5. Mindful and intentional movement

You should expect a therapist to help you perform mindful, intentional movement to help guide you to move with interoception, internal awareness of self, to be able to understand movement quality, as opposed to high-volume exercises with poor form.  As movement educators, one of the greatest gifts we can share with you is to help you move your body the way it was intended to so that you can continue to do the things you love.

What you shouldn’t expect from physical therapy

What are some of the things that you should not expect from physical therapy? This is equally as important.

1. You should not be on things that will not help you get well

You should not be on hot packs, cold packs, electrical stimulation, ultrasounds, or other modalities that aren’t helping you get well. They are sometimes time-savers for the therapist, but they are not actually creating better movement in your body. They’re not getting to the root of your issue. They are not moving you forward, and you want to be able to maximize your time spent in physical therapy.

2. You shouldn’t be warming up on machines

You don’t want to get to physical therapy and go on the treadmill or bike to warm up for 10 or 15 minutes. You want to learn how to move your body. Every minute counts!

3. You shouldn’t be on tons of band exercises

You should not be going through tons and tons of band exercises with poor form without guidance. Especially when you feel like you are going through the motions and you could do this at home.

If you feel like you could do that at home, that’s your first sign that this is not a good fit.

I want everyone to believe in physical therapy. We have an amazing opportunity to share with you the gift of movement.

In summary, when you think physical therapy is a waste of time, you’re put on machines and lots of modalities, and you feel like you are competing for your PT’s attention, you deserve better.

Please make sure to find a great physical therapist in your area who does one-on-one care, that looks at you as the whole person, that addresses potential root causes of your injury or your pain or any other issue that you might be experiencing.

If you need help, please reach out to us, we do virtual and in-person care, and we perform holistic physical therapy. Schedule your evaluation here: https://p.bttr.to/3qHXz8i

If it was helpful, give it a like, share it, and subscribe to our YouTube channel, The Movement Paradigm, for weekly tips on mindset, nutrition, and movement.

Other things that might interest you:

3 ways to treat your acute low back pain

Pelvic floor–Gut Connection

A neck exercise that really works

HOW TO TEST YOUR VAGUS NERVE | Polyvagal Theory

Did you know that you can test your vagal nerve function, and not only can you test it, but you can begin to tap into the healing power of the vagus nerve? Your vagus nerve is responsible for the regulation of internal organs such as digestion, heart rate, respiratory rate and impacts certain reflex actions like coughing, sneezing, and swallowing. It is critical to optimal health and you can tap into it-but first, find out what state you’re in.

The Polyvagal Theory

Before we jump into how you can assess the vagal nerve, let’s talk a little bit about the autonomic nervous system. We used to think of the autonomic nervous system as simply fight or flight or rest and digest. However, Dr. Steven Porges’s work shows us that there’s much more to it and there are actually three circuits of our autonomic nervous system. This is referred to as the polyvagal theory.

Essentially we have our fight or flight state, which is also considered our sympathetic spinal activation. We also have our dorsal vagal state, referring to the most primitive vagal nerve, and indicates we are in a freeze state. This means we are shut down and feel hopeless. We are disassociated from ourselves and other people.

Lastly, we have the ventral vagal circuit, which means we are in a state of social engagement-a state of safety. This means we are connected to the greater world. We’re connected to ourselves. We are joyful and mindful. All three of these are critical and during the day we go through all of these different circuits, but most often we don’t even recognize that we do because we go through them so quickly. However, we can get stuck in these. We can get stuck in a fight or flight stress response where we’re constantly worried, anxious, frustrated, or irritated. It’s also easy to remain in a shut-down mode. We of course could be mindful and joyful. We’re constantly fluctuating.

polyvygal chart
Adapted by Ruby Jo Walker

Check out our previous blog on “How to Map your Nervous System” here.

Breaking that down a little further, let’s speak about the ventral vagal nerve. This originates from the brainstem just as the dorsal vagal nerve does. This innervates most of the muscles of the throat, such as the larynx, pharynx, uvular muscles as well as the levator palatini muscles in the back of the throat. Whereas our dorsal vagal nerve, which is more subdiaphragmatic, innervates the muscles of the stomach, liver, and digestive system. It also does innervate the muscles of the heart and lungs. Just a reminder, the dorsal vagal nerve is impacting that freeze state, shutdown mode, whereas the ventral vagal is eliciting that sense of inner calm and relaxation and is associated with our state of safety or state of social engagement.

Testing Ventral Vagal Function

You may need a partner for this. This is a really powerful technique that can have a profound impact on how you address your body. Remembering where all the powerful neural innervations are, one of the innervations of the ventral vagus nerve is the throat.

  • Grab a partner and a flashlight.
  • Have your partner look at the inside of the mouth at the back of the throat at the uvula that drops down right in the center.
  • Now, perform an “ah, ah, ah” sound.
  • When you open your mouth, you can use a tongue depressor or your fingers to push down your tongue so the uvula and soft palate can be more visible.
  • The examiner is going to look at the uvula to see if there is a deviation to one side.  
three mouths anatomy
Adapted from Stanley Rosenberg’s Healing Power of the Vagus Nerve

What you’re looking for, specifically, is if there’s any deviation from one side to the other. If the uvula pulls over to one side, then that is indicative of ventral vagal nerve dysfunction. If it moves up symmetrically, then that means that you are in that state of social engagement. So, if you have the soft palate moving up on one side, let’s say it’s moving up on the left side, and not moving up on the right side, then that would be indicative of a dysfunction of the pharyngeal branch of the ventral vagal nerve.

Now, that you’ve tested let’s move into how to stimulate the vagus nerve.

Vagus Nerve stimulation: The basic exercise

If your test indicated that you had a ventral vagal nerve dysfunction, perform the basic exercise for vagus nerve stimulation.

  • Lie on your back on the ground.
  • Interlace your fingers and bring them behind your head- right at the base of the skull
  • Look with your eyes to the right until you sigh, swallow, or yawn, and then repeat on the other side.
  • You may blink during the exercise.

Now that you’ve stimulated it, retest your vagal nerve and see if there was a change.

This is just one way to measure your autonomic nervous system function. This is also just one way out of many to stimulate your vagus nerve. However, recognize there are so many ways to become more aware, more in tune, and map your nervous system. You are completely in control of what’s happening in your life.

I want to give a huge thank you to Dr. Steven Porges for all of his amazing work in this area, as well as Stanley Rosenberg, for their contributions to this area of life-changing research. Make sure to check out the book, Accessing the Healing Power of the Vagus Nerve, by Stanley Rosenberg.

If you’d like to schedule a free 15-minute virtual discovery session, please email drarianne@themovementparadigm.com or text 302-373-2394 to schedule. We’d love to help you get healthy again!

For more content, make sure to subscribe to our YouTube channel here.

Why you should stop “stretching” your hip | HIP PAIN

Do you have hip pain that you are continually trying to stretch, roll, or smash, and nothing seems to get better?  Before we get into the role of the psoas, one of your key hip flexors, let’s speak about the local stabilizers and global stabilizers of the body. This is important to understand how you are going to treat your hip flexors and hip pain.

Think of the local stabilizers as being muscles that are close to the joint. They create more of an isometric contraction versus concentric (shortening) or eccentric (lengthening) contraction. They control the joint centration which means keeping the joint centered in its axis. It’s also independent of the activity of motion so if you raise your arm overhead, the deep stabilizers in my spine are going to activate before your arm goes overhead. Essentially these local stabilizers are imperative for stabilization in the body so that we can have proper movement.

Our global stabilizers are equally as important. However, they have a different role, so they have more of an eccentric contraction. They decelerate the range of motion, are continuous with motion, and are farther away from the joint.

Now getting back to the psoas, which is what everyone wants to stretch when they have hip pain.  The posterior or the back of the psoas is a local stabilizer. Think of it as one of our deep core muscles that is helping to stabilize the spine and also prevent the femur, our leg bone, from shifting forward in the hip joint. The anterior or front of the psoas serves as a global stabilizer. So, it is necessary to think of the psoas muscle as a stabilizer. Not only is it a stabilizer but it works in an integrated unit with all of the other muscles, including the pelvic floor, diaphragm, multifidus, the deep five rotators in the hip, and the transverse abdominus. All of these have to work together, and once again in this integrated fashion to be able to stabilize the low back and the pelvis during any kind of movement.

For example, if you performed a chest press with 30 pound in each hand on a bench and then transitioned into doing that on a stability ball, your weight would naturally go down. Why? Because you now have an unstable platform to work from and therefore can not generate as much force.

There are a lot of different hip pathologies that we won’t get into today, but when you have hip pain it typically happens from losing the deep stability of the hip. There are two common muscle imbalances that will exist. One is the TFL(tensor fascia latae) muscle, which is right in the front lateral side of the hip, can get tight, especially with increased sitting. Based on this attachment, it will pull the hip forward, and that will therefore inhibit or shut down the psoas. The other common muscle imbalance is the hamstring muscles, which can get tight for various reasons, inhibiting the glute muscles. The hamstrings can push the femur forward and that also leads us to lose that optimal position on the hip joint. Overtime if we have these muscle imbalances, instead of the hip being centered in the axis, it will start to shift forward and up. This will cause all types of pain issues and pathologies. Whether that’s a labral tear, hip impingement, tendinopathy, bursitis, and so on. So, it is important to get the hip stabilized and centered in the joint in order to decrease pain and ultimately improve function.

You can begin to do this through a four-step process. This is a great way to begin to address your pain, as well as any kind of movement compensation, and most importantly, integrate your foot with your core, in a very integrated manner. First is inhibiting the tissue, in this case we inhibited the TFL muscle that typically pulls the hip joint forward and creates that inhibition of the psoas as a deep stabilizer. Then, mobilize the hip joint to center the hip joint. Remember that when it is not in that center position it’s shifting forward enough so we’re shifting it back to the center position. Next, stabilize it by activating the deep stabilizers, such as our diaphragm, pelvic floor, etc. Then we’re integrating it with the ground. This is super important because the foot is part of the core and they work as an integrated unit. To get those deep stabilizers of the hip firing, short foot, i.e. foot to core sequencing, allows us to do that in a very integrated fashion.

4 Steps

1. Inhibition

For the TFL release, place the ball right on the outside of the hip. When you lie down, you’ll naturally rotate the hip in, which will expose the TFL muscle. With the other leg, anchor it up at a 90-degree angle and come down to your forearms. Holding that position your leg will be nice and long, naturally rotated in, and breathing throughout the exercise trying to relax into it.

2. Mobilization

For the hip mobilization with a band, you’ll place the band high up in the groin. You’ll have it back at a 45-degree angle away from you. You’ll start in a table position rocking forward 15 times, making sure your spine stays nice and long, and you’re breathing. Then rock away from the band, so to the opposite side, once again about 15 times, making sure you’re breathing throughout the exercise.

3. Activation

Now it’s time to activate the deep core, so you can do this by diaphragmatic breathing. Inhale, breathing into the abdomen and into the base of the pelvis allowing the abdomen to expand 360 degrees. Exhaling, letting the abdomen contract and the belly button in towards the spine. Once you feel like you have this established, then on your inhale allow the pelvic floor to relax, so you can exhale and gently lift the pelvic floor about 20% contraction to get a deeper integration. You want to think of this as a rhythmical balance, so nice and fluid. Inhaling to the base of the pelvis and exhaling gently lifting the pelvic floor.

4. Integration

Lastly, it’s time for integration. This is to be done with short foot. Standing on one leg, sitting the hips back, knees slightly bent, taking a breath in, while your foot relaxes then exhale and gently root the tips of the toes into the ground. That will naturally lift the arch and lift the metatarsal heads or ball of the foot.

So whether you have hip pain or hip tightness and are constantly stretching your hips, hopefully, this video will give you a little bit of insight to allow you to think about your hip differently and recognize that it is part of an integrated unit. It is really important to understand how that works as it relates to stabilization and movement

If you’d like to schedule a free 15 minute virtual discovery session, please email drarianne@themovementparadigm.com or text 302-373-2394 to schdule. We’d love to help you get healthy again!

For more content, make sure to subscribe to our YouTube channel here.