A few months ago, I was talking to another PT in the staff office. She had asked for my ideas about how to work with patients with organ prolapse. One of the things I told her was a phrase that I use with all my patients: "It's not what you have, it's what you do with what you have that matters." As I was saying this, Cindy (the CEO of CTS) walked by and said, "That's awesome! You should write a newsletter article about that!" So, here it is!
What I mean by the phrase "It's not what you
have, it's what you
do with what you have that matters," is that body function is more important than body structure. The relative importance of function and structure is an age-old debate among and between different groups of health care providers, with physical therapists generally falling on the "function is more important" side. One example of this is back pain and diagnostic imaging (such as MRIs). When someone has back pain, it seems logical that something must be wrong with the structure of their back - they have some arthritis, or one of their discs is bulging, or one of their nerve roots is being pinched by the vertebrae. However, when people with back pain undergo imaging, the results are not consistent. Some people
do have structural problems, but some people
do not have structural problems. And even more interesting, some people
do have structural problems.
So what makes the difference? Well, pain science is complex, but in my experience, the difference is in how people function, or in other words, the way in which they use whatever structure they have. It's not the
what that is most important, but the
how. Returning to the prolapse example, body structure is important, because the ligaments and fascia that support the pelvic organs are there for a reason, but lack of structural integrity is only one factor that contributes to prolapse. The other factors are poor diaphragm/abdominopelvic coordination, poor posture, and poor abdominopelvic strength - all of which are "function" factors. What I have found is that in women with structural support problems, when we correct all of the functional factors, their prolapse symptoms resolve.
Functional factors can be corrected because of neuroplasticity, which is brain's ability to change (that was the subject of my last newsletter article!) The way we function and move is a result of what PTs call "motor control," or the patterns in which our brains activate our nerves, which activate our muscles. When you learn a new motor control pattern, for example, learning a new sports skill, you spend a lot of conscious effort on executing the movements in the correct order and with the correct timing. But with repeated practice, the skill becomes more and more automatic and requires less conscious effort. Unfortunately, injury or other imbalances in the body can cause faulty automatic motor control patterns that can contribute to pain and other symptoms of movement dysfunction. Physical therapists are specialists in identifying faulty automatic motor control patterns in the body. Under a PT's guidance, patients learn how to bring the faulty patterns into conscious awareness, then use conscious effort to learn correct motor control patterns, then use repeated practice to cause the new motor control patterns to become more and more automatic.
So remember, how your body functions is changeable, and is more important than what your body structure is.
In addition, over time, the body's structure can change (i.e. improve) in response to the functional demands placed upon it. (I might write a Part II about that!) For now, just remember that "what you
do with what you have" is the most important factor in the health of the movement system, and the body is truly amazing in its ability to overcome pain and dysfunction.
By Katherine Dahl, PT, MPT, CD(DONA)