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.
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.
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.
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.
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 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.