When evaluating patients that are in pain, one of the priorities our Physical Therapists have is to “stage” where the patient is in their recovery and subsequently prescribe the appropriate interventions to promote healing. For example: If a patient comes in with an acutely strained hamstring, it would not be appropriate to initially prescribe ballistic stretching the injured tissue (hamstring). This would just inflame and irritate the hamstring. Tissue healing is what the body is innately designed to do and given the right environment, the right conditions, the right time.
When referencing the continuum of healing, we (PTA) subscribe to the concept of the “3 R’s”. These have been popularized by a well-known Physical Therapist and Movement expert named Gray Cook. Reset – Reinforce – Reload. These are referenced this this blog: https://graycook.com/?p=1553. Please check out this article for further background on the “3 R’s” as this concept is well-explained in this write up.
When speaking about “passive” treatments, we are referring to what Gray calls, Resets. These are techniques or treatments provided for the patient to elicit a change in status i.e. pain reduction, stretch, joint mobility, spasm reduction. We use resets every day in clinic and we are good at them! An example might be performing soft tissue release to address restrictions in the muscle with the intent of allowing muscle fibers to glide more easily to decrease pulling in the hamstring. Another might be a manipulation performed to the lower lumbar spine to regulate nerve tension into the sciatic nerve that might contribute to pseudo-hamstring pain. These techniques are great to address initial impairments and if you find a skilled Physical Therapist to perform them, you should get a great start to your rehab. However, most passive techniques (treatments that are done for you) are only shown to provide short-term changes (30 minutes to 3 hours). That is why some patients that receive passive-only treatments feel good for a short time after treatment, but the complaints tend to return within hours of leaving the clinic.
If you have neck stiffness and pain and you get a massage, it will probably make the neck feel better. If you have neck pain every day from your 8 to 5 computer job, only having massage might not fix the underlying driver of the pain. Therefore, you have to keep getting massage to keep getting relief. This is where we transition to talk about reinforcement. If someone has a forward head posture and sits for 8 hours a day, they probably have some consistent complaints: neck stiffness, headaches, general upper back and neck pain. An evaluation by our licensed Physical Therapists can uncover impairments such as: postural deficits, joint or soft tissue dysfunctions, or muscle imbalance. Once these are defined by an evaluation and treated with resets (above), it is necessary to introduce reinforcements such as: strengthening, muscle re-education, training correct movement patterns. Treatments focused on retraining the way the body moves are imperative to make permanent changes for posture, mobility, and pain reduction. An example of reinforcement would be teaching a patient with low back pain to be able to appropriately brace the core while moving arms or legs.
Re-loading involves the next phase of the movement continuum that challenges the patient to be able to utilize the strategies learned in the reinforcement phase while performing a functional task. An example would be the progression of the above patient with low back pain that you train to brace the core and move through the hips while lifting a suitcase from the ground.
It is important that you first start any treatment program with a baseline evaluation. We use standardized evaluation procedures that give us great starting point for rehab. In order to change the way you move, you have to train your body to move in the appropriate sequences. This is how we utilize the 3 R’s to make lasting changes. If you have read this blog and realize that you are dependent on passive treatments for relief, it may be that you are not using that “window of opportunity” to make changes in the way you move. If you are ready to get treatment that allows for lasting improvements, please contact our office to schedule your appointment to help you Get Better Faster!