Biggest Lesson Learned in 2017

So let me preface this first blog post by saying get used to pictures of my dogs in my posts and around the site. Since this is my site, my thoughts, I’ve decided I want dogs and thus, there.will.be.DOGS!

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As one of my dogs Charlotte (aka Charmu) is so eloquently tell-asking me, I actually did learn a ton of stuff in 2017. In fact, 2017 was one of the most accomplished years in recent recollection. I graduated with academic honors from Columbia University, moved into a great east side Manhattan apartment, treated full-time for 6 months in an out-of-network orthopedics clinic, created an LLC for my brand and met some amazing people and clinicians along the way.

I learned a ton about rehabilitation and fitness as well. As part of one of my biggest projects I have ever done in my life as well as for the Brookbush Institute, I authored a 42-page review of the adaptations that occur in the body from long-term high-velocity training (think plyometrics like jumping or intense activities like sprinting). Fascinating how our bodies just….do. They get it done.

I also began to become fascinated with blood flow occlusion training and its influence on our body with respect to increasing muscle mass, systematically reading all the research that has ever been published that I can get my hands on. I’m over 100 papers (and notes) in, and still have lots more to do. In short, blood flow occlusion training is cutting off some blood flow to create a pooling effect in your limbs. This pooling effect creates a stimulus in and of itself to maintain your muscle mass. This can have huge ramifications for rehabilitation after operations when you can’t move your arm or leg because of a cast or precautions from your physician. Now because your blood flow is restricted, new energy substrates (think sugar) cannot reach the muscle and so when movement (exercise) is added, you can exercise at a much lower intensity to improve your muscle mass than without blood flow occlusion. That’s the long and short of it, but I will be posting much more about it in future posts!

I’ll get it out for anyone whose reading right away – I live and breathe health and human performance. My brand, “The Human Performance Mechanic,” embodies who I envision myself as in the fitness and rehabilitation industries. Taken from my biography page:

“I’m fascinated by the human body, its unlimited potential, and its amazing ability to recover from injury. The human body is like a machine. Machines are most efficient and effective when they are in balance. When a machine is out of balance, it takes a skilled mechanic to diagnose the imbalance and provide the remedy. As a physical therapist, I see myself as a “human performance mechanic.” My goal is to keep my patients in perfect balance, have the skills to recognize asymmetries and help my patients enjoy the benefits of pain-free movement.”

Traditionally, “imbalances” and “remedys” provided in physical therapy are addressed with manual therapy. As taught in school as recently as last fall (2016), manual therapy can elicit tissue-specific effects which can include reducing the influence of adhesions, which to those unfamiliar, are supposedly areas in your muscles that become stuck together –either between the muscle and its fascial covering (which is like a sheath that has tons of complex functions, but in this case, is important in allowing movement of the muscles by allowing it to glide between surfaces–ie other muscles), the fascial covering and the skin, or any other type of combinations. In essence, I was taught that my hands could influence the relationship between the underlying tissues by working out these adhesions.

Taking a step back for a minute, I want to fill everyone in on why I actually got into physical therapy. I worked as an aide at a very upscale physical therapy clinic in Cos Cob, Connecticut for two years. It was there that I realized I could merge my love for fitness with my desire to help others. As someone who was always interested in fitness, I couldn’t believe how the physical therapists were able to alleviate someone’s shoulder pain within an hour session or help someone walk more efficiently and with less pain by releasing their hip flexor muscles. I was hooked. I thought that my hands could help heal people from their injuries the same way that the physical therapists who I worked for used their hands to almost instantly reduce someone’s sense of pain and discomfort. Manual therapy was my calling. Nothing was going to get in my way.

Fast forward to 2014-2016 at Columbia University. Anyone that asked me what my career ambitions were would hear two phrases – “Orthopedic Clinical Specialist/ Certified Orthopedic Manual Physical Therapist.” To me, those seemed like the pillar of orthopedic manual medicine. The titular titles I would earn after years of healing patients using my hands!

As a soon-to-be new graduate in late 2016, I felt that I should start to become more invested in networking and other adult-like endeavors. I decided that I would begin to put myself out there on Facebook to try to hone my skills and develop my craft. In particular, establishing a firmer foundation of my thoughts and beliefs as a future “Orthopedic Clinical Specialist” who specializes in “healing” and “manual therapy.” What better way to challenge my own beliefs than by interacting with other clinicians of various experiences and expertise? This was how I was going to learn more orthopedic manual medicine techniques! I imagined breaking them out during new patient evaluations to make them feel better instantaneously. The reactions I’d get from anyone who’d saw me. My hands were after all, novice, but eager to learn.

2017- Crashing. My belief system on manual medicine. The foundation for my profession. The reason why I chose physical therapy in the first place. Crashed.

Facebook has taught me one very important lesson. If you aren’t ever challenging yourself for what you believe in by throwing it up there for a wide audience to see, such as in a forum, you aren’t growing.

I can’t remember exactly when my thoughts dramatically changed, but I can say that it started with reading pain science articles by Butler, Moseley, and Louw and placebo-effect articles from Bialosky all the while interacting with experienced clinicians like Brent Brookbush, Greg Lehman, Jarrod Hall, Mark Powers, Karen Litzy, Scotty Butcher and research scientists like Andrew Vigotsky, Chris Beardsley and many others. Each of them have challenged me to think about my previously-held beliefs and to defend them with evidence.

As I began to look more and more into the evidence base, I became more and more certain that manual therapy does not “break up adhesions” as I had previously thought. Instead, I discovered something much more freeing and quite frankly, something that made much more sense.

In essence, everything we do in physical therapy revolves around modifying how the brain perceives the external and internal environment. Whereas before I thought that my hands were simply modifying the “stuck” peripheral tissues to change pain, I realized that the simple act of touching the skin changes the nervous system input to the brain. This very change in input can change the way the brain perceives pain. Pain – as it appears – can very easily be modulated by touch. Especially kind touching. Purposeful touching. Touching with reassurance from a confident practitioner. Even the treatment environment can influence how effective you perceive a manual therapy “touch.” This is not even talking about the internal determinants of pain such as stress (which is a whole other blog post).

After about a two-week period of panic, I realized all is not lost on my dreams. I still was armed with in-depth, expert-level knowledge in anatomy and kinesiology and a new understanding of how to approach patient care. A new foundation in which to build upon.

I believe that purposeful use of manual therapy in clinical practice is beneficial for modulation of pain and establishing a therapeutic alliance (a bond between practitioner and patient that helps improve outcomes). Nowhere do I ever tell the patient about “adhesions” or anything associated with a tissue-specific deficit in my treatments. Just five years ago, I wouldn’t have ever imagined I would feel so strongly in oppposition about a topic that I was so confident was my life’s calling.

While I have now been freed of the shackles of my past, I am excited to move into the future. A future that involves patient empowerment through exercise (which also has been shown to be analgesic), (the occasional) manual therapy and tons of social support!

The Human Performance Mechanic is the embodiment of all that I stand for in my clinical practice. After all, my goal is to help everyone experience “the joy of pain-free movement.” You know how I plan on making that happen? By moving!