The Therapeutic Mindset
Physical therapists (PT) are considered the “movement scientist” of the healthcare profession. Although a PT’s primary area of influence is the musculoskeletal system, it is not the only system they can affect nor should it be. I often see PTs taking a biomedical approach to their care chasing their patient’s symptoms with sole focus on the musculoskeletal system. This approach works about 80% of the time, but what about the other 20% of patients. I find the biopsychosocial model to be of use. This model considers all systems of the patient and allows them to be considered a person at whole and not just a collection of symptoms. Let us examine these models further before we make the connection to rehabilitation.
Keeping this comparison in mind, I find that the rehabilitation process to be integrative. Physical therapy intricately combines the studies of neurology, anatomy, kinesiology, and psychology. But let me take this one step further and say that I believe neuro- controls orthopedics. All afferent input matters and must be considered to understand why patients are presenting with their respective outputs: pain, postural tension, loss of balance, etc. We must understand this process to effectively approach our patients with a biopsychosocial model. Consider the two illustrations to better conceptualize what I am saying.
We can see that input initially comes from our environmental interactions as well as from our tissues. This afferent input is then processed in our brain where an output is generated. This output then becomes a new input to our system where it is then re-evaluated by the brain to determine if the appropriate output was generated. This cycle will continue until our system returns to a balanced state.
Sometime we as clinicians cannot fully change all necessary input to our patients’ systems and we need to collaborate or seek integration with other healthcare professionals. This takes both humility as well as knowledge about how our body systems interact and can influence one another. This is why I like to work with both a Neuro-Behavioral Optometrist as well as a Dentist. If integration is necessary, my purpose then becomes to keep a patient posturally neutral. My how is to provide afferent input to my patient’s system in order to allow them to have reciprocal and alternating movement within the cranium (sphenoid), thorax (sternum), and pelvis (sacrum). When working in an interdisciplinary team, keeping a patient in this state of “neutrality” gives the other members of the team greater potential to effectively influence the patient’s input to change output and resolve their medical needs.
Ultimately our goal should be to get our patients into an OPTIMAL situation to facilitate their recovery and sometimes that means integration.
References:
Neuro Orthopaedic Institute: Explain Pain.
Postural Restoration Institute: Myokinematic Restoration, Postural Respiration, and Pelvis Restoration.
