The more knowledge I’ve acquired about the human body, the more I realize that most of the problems I have now are due to lack of muscle strength.
When I developed compartment syndrome at the age of seventeen, it was due to over-training for the spring track season (combined with the fact that I had an eating disorder, and was also starving myself).
But everything since then—that’s all been the indirect result of muscle weakness.
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I first learned about the concept of muscular atrophy when my friend fell in second grade gym class and broke her arm. I remember the gym teacher telling us then (after the ambulance had taken my friend away) that when she got her cast off in a few months, her arm would look small and shrunken compared to the other arm.
The teacher explained that when you don’t use a muscle at all for a very long time, your body lets it get weak because it doesn’t think you really need it. And that it can happen quickly– really quickly. That it would take my friend a lot longer to do these exercises to build her arm back up than it had taken for her muscles to get weak with the cast on.
That concept—atrophy—scared me so much when I first learned about it then.
But when it actually happened to me, following my leg injury, it was gradual. I didn’t really notice the rest of my body getting weak, because it was overshadowed by the pins and needles in my lower legs.
If I could go back in time, I would have worked out in a pool every day, so that I could I maintain all of the other muscles in my body I wasn’t really thinking about– back, shoulders, trunk/core– despite the fact that I couldn’t really use my legs.
I didn’t actually feel the atrophy as it happened. I felt like I was choosing not to use my body to do certain things because of the pain in my legs, not because of weakness.
But when I threw my back out, a month after my leg surgery—that probably wouldn’t have happened if I hadn’t come so weak.
And that, in turn, is when my nervous system really went crazy—which of course, started off its whole chain of problems, which of course my regular readers already know about.
But I’m coming full circle now.
I’ve addressed the pain—or, more specifically, learned how to address it. (This process of learning to manage chronic pain—it’s not something you do once and are done with. It’s about learning how to think. The knowledge that the more you feel you have control over what’s happening in your body, and that you truly understand what could be causing the pain—that’s an equilibrium that you must continually strive towards and re-create).
And now I see the underlying problem– that I am weak. Less now, of course, now that I’ve been working out in the pool for so long. But nowhere near as strong as your ordinary, average person who might not work out regularly, but has never had an extended period of time where they had to stop using their body.
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When I first started to voice my idea of becoming a physical therapist, there were actually quite a number of people who discouraged me.
“But it’s such a physically demanding career,” they would say. “Can you do that?”
And yes, I’ll be honest—sometimes that question makes me a bit nervous too.
But there’s no reason I can’t get strong again. I am lucky not to have anything wrong with me that is permanent. I just need knowledge.
When I took Kinesiology last summer, that was the point at which everything started to click for me. I learned about the motions each joint of the body can perform, and how the different muscles work together to produce that movement.
I started to understand why some of the exercises I’d been doing hadn’t helped that much, and I actually began to see holes in some of the exercise programs past physical therapists had given me.
I realized how specific muscles can be. Especially relevant to my case were the muscles of the back and shoulders. You can be doing two almost identical motions with your arm, but a ten degree difference in the angle your arm is at can completely change which back muscles are working.
I’d never known things were that specific. I’d always progressed through my back exercises based on my level of pain, doing the easiest, least painful exercises first, figuring I’d work up to doing the tougher ones after a few weeks. What I know now is that those easy exercises were never going to prepare me for the harder ones, because they simply weren’t working the same muscle groups (despite how similar they all seemed).
It’s frustrating– I’d always told my physical therapists what I was doing, and none of them ever warned me the plan might not work.
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Part of the problem, I believe, is the physical therapy model (at least, in the United States) where the therapist can only focus on one specific diagnosis or part of the body at a time. This means that your physical therapist has to send you back to your primary care doctor, to get a new prescription and a new insurance authorization, just to be able to answer a question about a different part of the body than what they were treating.
Now, all the PT’s I’ve seen haven’t been like that. But there were enough, over the years, that I’m sure it cost me a lot of potential progress.
All of my various diagnoses had the same underlying problem—I was weak and extremely out of shape. My whole body was the problem, not just one part. Treating each problem one by one wasn’t going to stop the next problem from developing.
I have a great physical therapist now, who is able to think abstractly, and answer all of my questions about strengthening various parts of my body. And that is the kind of physical therapist I would like to be for other people.
The type who understands that strength is important—overall strength. And that you aren’t really helping the patient if you help them strengthen one part of your body, but leave the rest totally weak.
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So now I’m strengthening everything.
The problem is not, primarily, my sacroiliac joint (although that’s obviously what causes me the most grief right now).
The problem is that my muscles are not strong enough to hold my sacroiliac joint securely into its proper alignment.
I’ve had to completely change how I think about my physical problems. When I work out in the pool, I’m not just focusing on fixing my SI joint, or my knees.
I’m troubleshooting.
I’m strengthening everything. Every major muscle group, and every major joint motion. (At least, as best as I can).
I’ve finally broken through the mysterious veil of pain that clouded everything I did, and made me afraid, and made all my physical therapists think I needed psychotherapy.
And now I’m back. I’m building myself up, back to the level of strength I should have had all along.
lifeinslowmotion
August 2, 2014 at 1:40 pmI think this is exactly the same for me – my SI Joint causes me sooo much pain, but I know it is the real underlying problem is likely because my muscles are so weak and unable to stabilize my SI joint to keep me aligned. BUT, the problem is that exercise is so painful for me, causes huge flares, and then results in huge setbacks. I have to increase my level of exercise by such minuscule amounts that it is so hard for me to make progress. Then when I finally do make progress, I will do something to flare up again, which for me, means starting from the beginning again. It is beyond frustrating.
sunlight in winter
August 2, 2014 at 2:00 pmI totally hear you. I don’t want to freak you out if a pool isn’t really an option for you, but in my case, I don’t think I would have gotten better if I didn’t start working out in water. Even now, when I have a flare up, the pool is really the only thing that allows me to feel better after exercise, not worse.
Specifically, the most important thing is to spend some time in deep water, using floatation devices to stabilize your arms/trunk while letting your legs hang beneath you. It’s the only way to take the compression forces off of the SI joint. Then you can do exercises in that position, to strengthen the muscles around the SI joint, without having a negative impact on the joint itself.
I know I say this to just about everyone. Hopefully I don’t sound like a broken record yet!
The other thing I would add is if a pool really isn’t an option for you, you could also ask a physical therapist about doing some isometric exercises. This is where you’re tensing your muscles without actually moving. I’ve found that when you’re really weak, this can be a more subtle way to start strengthening.
Hope that’s helpful!
lifeinslowmotion
August 2, 2014 at 2:04 pmThis is very interesting… I did use a pool for a long time, mostly to do walking in the water, and a few other easy exercises my PT suggested. I did not find it more helpful than the exercises I do on land. However, she strongly recommended that I not do the exercise you just suggested with using a flotation devise and letting my legs float. I can’t remember her reasoning, but she really did not want me to try it. Most of her advice has been extremely helpful, so I just took her word on it. But, I might give it a try hearing this from you.
sunlight in winter
August 3, 2014 at 10:29 pmHmm, that is strange. All I can say is that the two aquatic physical therapists I’ve seen, as well as my chiropractor, have been all about the “legs hanging” position.
Good luck, whatever you decide!
Rick Merriam (@RickMerriam)
August 3, 2014 at 1:58 pmI just stumbled upon your blog for the first time. After reading through this post, and your piece on the sacroiliac joint, I decided to provide you with some things that will help you with your journey.
If you think back to your Kinesiology class, at some point, the professor most likely went over the axes. Just in case it didn’t come up; an axis is an invisible line at which motion occurs at a joint. And for the most part, the axis is always perpendicular to the plane.
In order to have efficient motion of the pelvis, you first have to have stability throughout the lumbosacral joint (L-5 and S-1), the sacroiliac joint, and the hip joint.
Whenever the focus is *only* on the sacroiliac joint in rehab, it’s highly unlikely that you will ever have *efficient* motion throughout those joints.
This is due to the fact that ALL of those joints that I just mentioned have to move *together*.
We’re talking about a pelvis that has to move in three different planes, and three distinct joints. And all of those motions have to take place at the *right* time.
And if that isn’t enough complexity: Those same motions are supposed to be occurring every single time your foot comes in contact with the ground, e.g., walking .
In order to have efficient motion, there has to be a bunch of different muscles that cross a joint. Sound familiar?
This might come as a surprise, but there is an enormous disconnect between what is being said in a classroom, and what is actually occurring in reality. (And this is just one of the many things that you won’t hear about when you go through your training to become a Physical Therapist.)
Just because the Kinesiology books tell us that a muscle is always responsible for moving the bone(s) at the joint, doesn’t mean it will.
Example: There are a ton of different muscles that attach to the pelvis, but very often, many of those muscles are not receiving the neurological input to contract at the right time, in the right plane, or at the right joint.
Which means that any of the exercises that are designed to “strengthen”, are only going to irritate the under-performing muscles even more than they already were.
[Side Bar: As you might of already imagined; until the neurological input to the atrophied muscle(s) is restored, it will never go back to the size that it should be.
That being said, once you restore the input to the muscle(s), it will respond to any exercise that actually challenges the muscle with an outside force, i.e., a dumbbell.]
To say the same thing in a slightly different way, any of the muscles that are receiving the neurological input, will be forced to pull harder (and faster!) to accomplish the task. Why? Because this is their best attempt to make up for the under-performing muscles.
Those same muscles are most likely going to be labeled as “tight”. But they’re tight for a very good reason. They’re trying to protect the joints in question from going into a position(s) where the brain/muscles don’t sense stability.
Believe it or not, this scenario is occurring everyday in rehab (and prehab!). Meaning, the strong muscles are getting stronger, while the under-performing muscles remain weak.
Sure, the person feels stronger, but the reality is, they’re only relatively stronger.
And that is a HUGE problem! Because they’re ultimately going back into the game with a false sense of strength.
The only way to get the muscles that are responsible for eccentrically decelerating the pelvis and concentrically accelerating the pelvis back online: Address the attachments of the muscles with a circular/transverse friction massage. Then, the pelvis will be capable of going into positions that it hasn’t been able to. And not only that, the “tight” muscles will also relax. Why? Because they no longer have to play a role that they were never supposed to play in the first place.
I hope you find this to be helpful. 😀
sunlight in winter
August 3, 2014 at 10:10 pmThanks so much! Everything you said was really interesting.
I actually didn’t learn too much about the pelvis in my kinesiology class, because it was aimed more at future occupational therapists than PT’s. But I am definitely going to think about what you said, and try to teach myself a little bit more about the planes of motion in reference to the pelvis. Thanks again!
Lauren
August 4, 2014 at 5:28 amAny advice on how to start with exersize when it takes all of my energy just to look after myself and I can barely keep up with the housework.
I can’t afford a Physio to make a program so is heading to a pool to do laps not enough to build strength in most muscle groups and fitness initially?
I’d love some more specific advice!
sunlight in winter
August 5, 2014 at 1:12 pmHi Lauren,
Something I learned the hard way is that there’s a big difference between strength training and cardio/endurance training.
When you’re training for muscular strength, you want the motion you’re performing to be so difficult that you can’t perform more than 10-12 repetitions, at most. And you want to be completely exhausted at the end, like you really can’t perform another repetition.
Lap swimming, on the other hand, would help you develop muscular and cardiovascular endurance. Strength and endurance are equally important, so I think the lap swimming is a great idea to develop the latter.
However, I would try to find a way to perform some strength training movements in the water. There are lots of ways you can use floatation devices to create resistance. It’s hard to describe all the ways you could do this online, but you could check out articles like this: http://www.self.com/body/workouts/2010/08/get-toned-in-the-pool-slideshow/5
and this http://www.prevention.com/fitness/fitness-tips/cardio-and-strength-training-water-workout-pool (In this article, the exercises under “Circuit 1” are strength training. The “fat-zapping” ones aren’t).
There are also a lot of good videos on Youtube of pool workouts. I recommend all of the videos from Hydroworx. This one is my favorite. I think the exercises after the 2:30 mark (where she is using the “noodles” to float) are probably good for just about anyone. https://www.youtube.com/watch?v=B3HZMYioGNE
Hope that helps!
Lauren
August 5, 2014 at 7:57 pmThank you!
tlohuis
November 4, 2014 at 9:32 pmThat sure is a lot of great information. I am so weak from being in bed so much. I do get up, shower, get dressed and all that stuff us ladies have to do before leaving the house to go to my many appointments each week. If it weren’t for all my appointments, I’d really hate to see how weak I would be. At one time I did ask my doctor about physical therapy to strengthen my muscles and she agreed and I went and with all of my appointments I just couldn’t keep up with it, but I have been thinking about it a lot lately and I’m considering going back to PT. Thanks for sharing. I hope you’re doing well. 🙂