To begin, yesterday, I had just finished my training session when Eric walked up to me and said, “you’re 12:30 eval is here; she’s waiting in the office.” Oops – twenty minutes early. I head over to the stereo to turn-off the Wu-Tang (not exactly a great first impression when M.E.T.H.O.D Man is blaring through the speakers), pound my protein shake, and change shirts really quickly before I head out to greet Paula.
Upon quickly glancing at her health history, I notice something that jumps out and grabs my attention – she noted that she had been suffering from a chronic hamstring strain for the better part of the last two years. Hmmm, interesting. Almost immediately a light bulb goes off in my head and I start to stroke my evil strength coach beard (but more on that in a bit).
Anyways, whenever a new client walks into the facility, we always try to sit down for 5-10 minutes to better ascertain what it is (s)he is looking to do. Generally speaking, this is the time where we try to dig a little deeper, discuss training background, goals, injury history, etc. The form sitting in front of me was otherwise blank, so without even blinking an eye, I ask about the hamstring.
Paula smiled, took a deep breath and let it rip. Without going into too many details, she explained how she had always been an athlete (she was a sprinter in college) and had always lead an active lifestyle – she even did some personal training on the side a few years ago, and really enjoyed it. For all intents and purposes – she’s the epitome of a fitness junkie.
Giving full disclosure, however, she openly admitted that she’s her own worst enemy, and sometimes has a knack for not knowing when to hold herself back. When she first hurt her hamstring, she waited a few weeks, and once it started feeling better, she hightailed it to the track and did some sprints – only to re-injure herself, again, and again, and again.
After what was seemingly her umpteenth hamstring strain, she finally decided to seek some professional expertise and visited a local physical therapist near her hometown. And for many of you, I think you know where this story is going.
To say that a ham sandwich could have done a better job than this physical therapist would be the understatement of the century. Based off of what Paula told me, this therapist did nothing other than give her ultrasound and electric stimulation for a few weeks and then sent her on her way. Incidentally, there was no real formal assessment of her movement quality. Basically, Paula walked in, said “my hamstring hurts,” and the therapist treated the hamstring.
I guess in the grand scheme of things, this isn’t necessarily wrong. For instance, when one of our baseball guys shows up and says his shoulder hurts, as traditionalists, we usually end up looking at the shoulder first and work out way out crossing things off as we go: things like, scapular positioning, thoracic mobility, contralateral hip mobility, soft tissue restrictions, to name a few.
But there’s the rub – WE DON’T JUST LOOK AT THE SHOULDER.
And this is where I feel this particular physical therapist (and the countless other health professionals whom Paula visited) missed the boat entirely.
Leaky Roof Syndrome strikes again!!
It’s akin to someone complaining about a leaky roof in their house, and hiring someone to come in and place a patch over the leak itself – when in fact, the root cause of the leak is coming from somewhere else entirely. Placing a patch over it is just a temporary fix in the long run, and will do nothing but delay the inevitable.
So, fast forward to yesterday and Paula getting visiably emotional while telling her story. Who could blame her? I mean, up until this point, no one had really taken the time to listen and to actually offer any concrete resolution to her problem. All she’s been told is that she has “tight hamstrings,” (which, as I’ve noted in the past, is a bullshit excuse more often than not), and that she just “needs to take it easy.”
All this great advice for a $25 co-pay? Sign me up!
Bringing this to a close, here are a few points of interest from yesterday that I found:
- By and large, whenever someone mentions the word “strain,” you can usually (not always) chalk it up to something called Synergistic Dominance. Translating for the non-nerds out there, Synergistic Dominance is defined as a condition when a muscle in a group of muscles, that share similar actions, become more dominant and in turn, another less dominant.
- In Paula’s case, during her assessment, I found that she had little (if any) ability to activate her glutes, which is kind of a problem – especially given they’re a very powerful hip extensor. If her glutes are unable to fire, then that means her hamstrings (also hip extensors) have to work overtime to pick up the slack. And, when you put two and two together (poor glute function paired with hamstrings throwing you the middle finger), you get chronic strains.
- Furthermore, after taking her through some more tests, I found that she had very little ankle dorsiflexion. Actually, that’s just being nice. She had NO ankle dorsiflexion. She lives in planar flexion from wearing high heels all the time. Is it any wonder, then, that whenever she tries to sprint, she ends up hurting herself?
- And finally, as I alluded to above, all the therapy in the world won’t make a bit of difference if people continue to move like shit. Renowned physical therapist, Gray Cook, has popular saying
“fix the pattern, and the muscles take care of themselves.”
- It’s so simple, that it’s brilliant. I took Paula through some basic movement drills, and it was readily apparent that her lunge pattern needed some work – her foot externally rotated and knee caved in on each step, and even worse, her hip would collapse; all indicative of really poor hip stability. Sorry, but ultrasound isn’t going to fix that.
In closing, it’s things like this that make my job so awesome – cause here’s a woman that came to us as a last resort, and she left yesterday feeling hopeful that we’d be able to help.
This isn’t to say that we don’t hava a lot of work to do – we do! On top of building some basic strength, and correcting some motor patterns, she’s going to need quite a bit of soft tissue work done. I gotta say, though, that it definitely frustrates me when I hear stories like this, and do nothing but show how “broken” our primary care system is (at times) in this country. And,let me just say that this post wasn’t meant as a “dig” to all physical therapists, chiropractors, physicians, or orthopedic surgeons out there that may be reading.
I understand that with any profession, there are those that do their job very well, and others that, well, don’t. And I am in no way saying that what I found is altogether right or wrong. I But this is one instance where I was pretty fired up about the lack of “giving a shit” this physical therapist had. We can do better than that!
PS: If you found this article useful, or just liked it’s general awesomeness, please do me a favor and “like” it, or maybe re-tweet it. Any way to get the word out there is very much appreciated!
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