Making Movement Possible
Much has been written about the value of exercise, especially corrective exercise and movement. My last client represents a principle that we, as massage therapists, need to keep in mind.
My person was a woman in her 50's who had been in debilitating pain for several years. Most of her pain was pelvic but, unlike most people with pelvic pain, her pain was suprapelvic. Her plight is a long story, but the bottom line is that she could hardly move without pain. Daily life was overwhelming. There were times when all she could do was be at home and on her couch.
It is important to remember that this person wanted nothing more than to resume her life as she had known it. She was previously quite active- this sedentary existence was not of her choosing. When I first saw her two months ago, she was understandably very frustrated. I saw her again today and she is now walking, cooking, serving at her church, going to conferences, and doing water walking and exercise at the YMCA. She is one very happy camper. There are still times that she hurts, but she can now use movement and activity to help alleviate her pain.
This is the important point. When I first saw her, every increase in activity was overwhelming and produced pain. This wasn't just kinesiophobia, she seriously hurt every time she challenged her musculature. She had tried every way possible to be active, to no avail. Exercise, as a way to rehabilitate herself out of this morass, was not helpful and made her plight worse. It is simply not possible to exercise when every movement or challenge is perceived as a threat or overwhelming obstacle by the nervous system. The frustrating aspect of this dilemma is that if you cannot move, getter better is highly unlikely; a fact that she knew all too well.
The real value of the PNMT work I did with her was to make movement possible again. After the first two sessions, she found herself doing more than she had previously. This increase in activity was largely not from her pushing herself through exercise, but finding herself being more active in daily life. She was walking more, standing longer at the stove, and was able to get groceries without collapsing on the couch as soon as she returned home. She would just put away the groceries like the rest of us does and then go about the next task on her list. The change was remarkable to her in that she was not pushing herself- this was more of an organic improvement.
Finding that she could move more, she decided to confer with her doctor about the possibility of more formal exercise. The doctor was enthusiastically supportive, and recommended water therapy to start. This was a great suggestion. She continues to slowly increase the activity level in both daily life and her exercise program with no ill effects.
One of the things she said today was that she had awakened one day last week to more pain than she was used to. Taking it slowly, she was able to go to the Y and do water walking. By the time she was finished, she felt fine and was fine for the rest of the day. This is an enormous victory. Descending inhibition, your brain's blunting of pain when activity is increased, was actually working for her. Now, instead of activity making her worse, activity makes her more comfortable.
The value of intelligent corrective exercise and movement is hard to over-state. Yet, it is also important to understand that PNMT made it possible to utilize this important therapeutic approach. All of us in health care have a role to play; we just need to be clear about what that role is and where it fits into the larger picture. I see PNMT as a way to open the door so that the movement work can happen. The movement and corrective exercise work is often the larger piece of the equation in the road to recovery. Our job is do do our craft so well that movement and corrective exercise therapists can do theirs.