There Is Never a Manuscript

Starting my career as a fulltime physical therapist, the feedback I've received is not what I expected. The good news is: I think I am where I should be.

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In the first six months of this new career, I have worked with middle school athletes experiencing acute injuries, to seasoned retirees navigating chronic illness. I have had the pleasure of helping patients return to swimming or running, tennis or basketball, in a matter of weeks. I have shared the heartbreak of learning about a recent relapse in symptoms, a recent fall, another set back.

In my experiences, the proverbial saying is true: joy shared is doubled, sorrow shared is halved. (So get yourself a physical therapist that empowers you and maybe a therapist for your brain too--I don't think you'll regret it.)

If only physical therapy practice were more explicitly reflective of mental health obstacles and the challenges of life, it may be possible for more people to feel empowered in navigating adversity. (Stay with me on this...)

In the first weeks of treatment, a patient is not able to pinpoint their objective progress -- the degrees of range they've regained in the hip is not nearly as noticeable as not being able to walk the same distance on the trail that's become so familiar. (Yes, nerds, MCID.) The body that has once permitted miles of running on end, is now not allowing them to walk -- so what's the hype about getting a little more mobile. Fortunately for us both, they decided to trust in the prescribed movements.

Within months, the same patient is deadlifting, squatting, lifting weight with athleticism. They've been walking without issue for many weeks, and they've been hopping, jumping, and getting around without any issue. They're on their way back to running and it feels like magic.

In reality, it was far from magic. After trying targeted exercise, learning about body mechanics, collecting tools for warm up and how to approach workouts, gaining insight on how to ease in to running... the very thing that caused the injury was not necessarily the activity itself. When preparing for the activity and utilizing a smarter back-to-run program is done, returning to do the very thing they love to do seems inevitable.

This patient reflected and confessed how much they considered hip surgery within the first weeks of the injury. Surgery is likely to have been able to repair the damage, and is likely to have impacted other structures. Alternative modes of treatment could have had similar or different outcomes. There is always a possibility of an alternative solution working both better or worse. There is something innately human to question our ability--it is an easy trek down a familiar path that's built upon fear and protectiveness. Physically, it is common to fear injury/reinjury, aging, pain, immobility. People commonly gravitate to things that feel familiar, movement patterns that feel sensible, and recognize set backs as the truth of aging and deteriorating (which is an entire issue not for this blog post). On top of this, there is uncertainty in what success the opposite long, unfamiliar road may bring. This may be the crossroads of surgery or medication and conservative management, seeking treatment or resting, avoiding the sport or movement entirely, or otherwise. Metally, maybe this shows up in avoiding uncertainty altogether, or maybe it's paralysis by analysis. How then, does this not sound like mental health?

Oversimplified: Musculoskeletal tissue responds well to the stress you put on it. Putting bodies through too much stress for too long, or too much at once, is damaging. The damage can sometimes be resolved with targeted intervention, or sometimes the body recoils into sedentary protectiveness.

It sounds familiar because our minds work similarly. Hold too much stress for too long, and the likelihood of a sequela of symptoms, detrimental to the mind and body, fester. Take on a tremendous stressor at one time, and it can be harmful, too. Targeted intervention can help heal the mind and thought processes, and increase the quality of life.

In the last weeks of working in a new city, I was asked: how do you have such good bedside manner? I know you learn it but how is it that exceptional? (Ridiculous. But trust me, I know colleagues who get sung higher praise.) The truth is that the best physical therapists I know are not solely experts in their specialization or in the practice; they center their practice in putting people first. To find out what someone truly cares about, what they hope to get back to doing or have yet to do, drives the part of this career that makes it most fun.

There isn't a manuscript for how to live this life purposefully, but I believe deeply that to live this life in service of others makes it all worthwhile. I believe I have nothing to lose if I care about what I do and do it with love. Corny. No one pays me to be a sap.

Going into my next role will have more growth opportunities to offer and connections with a new patient population -- not to mention the joy of windows and waterfront property. What is more exciting is the feeling that maybe I can make a difference in the role, and maybe if I stop and listen to the feedback, I'll be reminded of who I am and why I do this at all.

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Comment, like, or leave a message. Happy to connect and share stories over the years!

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Written by:

Judith Wang

Founder, Project Green Beard PT, DPT, CSCS and UCSC Banana Slug