In the previous blog post, we introduced Jill and described her journey with back pain. Now we will discuss more specifically the approach we used to help her navigate this complex situation.
As the Wellness Station is a holistic practice, Jill’s plan of care was based on the biopsychosocial approach. This means that our care integrates factors related to biological/tissue structure and function, as well as psychological and social factors. Our approach is inspired by the Feldenkrais Method of somatic education, as well as therapeutic yoga, mindfulness, and traditional physical therapy.
(For further understanding of the biopsychosocial approach to pain, check out the following two previous blog posts: Does How You Think About Your Pain Affect Your Pain? & A Holistic Approach to Pain Science)
Bio
In collaboration with Jill’s referring provider, we made sure that Jill was managing pain most effectively with the lowest possible therapeutic doses of medications with the least potential for adverse effects. Jill’s goal was to get off medications for good, as she did not want to rely on them over the long term for pain management.
We also ensured that Jill was consuming a nutritious, whole-food diet to support an internal environment conducive to healing (she adopted an anti-inflammatory diet similar to the Mediterranean diet).
The bulk of our treatment approach focused on movement patterns that were likely putting additional strain on the injured tissues. Jill was extremely sensitive to bending movements, as well as prolonged sitting. Using biomechanical principles, we broke down patterns of spinal flexion and extension necessary to bending and lifting, and provided opportunities for neuromuscular learning- new strategies of bending that felt more comfortable, efficient, and less stressful on Jill’s back. This generally involved keeping Jill’s center of gravity over her base of support, sending her hips back to counterbalance her reach, and lifting objects with the strongest muscles of her core and legs.
Jill began to practice picking objects up in her daily life using new techniques, and eventually picked up her two year-old granddaughter in her new and improved way!
We also provided education about posture and the importance of changing position throughout the day, especially during prolonged sitting. Jill found that a children’s ball placed behind her back in her chair was incredibly helpful for back support, as well as performing small, regular movements of her pelvis, hips, and spine known as the pelvic clock.
See How Your Spine Moves Part I and How Your Spine Moves Part II for some ideas on what Jill learned here.
Psycho
Psychologically-informed care was necessary for Jill’s treatment approach. The grief from the loss of her husband was affecting her more than she cared to admit. She also recognized that a fear of aging and loss of confidence in her own body’s resilience contributed to a sense of hopelessness. Addressing these factors allowed Jill to further align with her goals, and she was able to instill a sense of self-compassion into the rhythms of her day. Combined with education on the psychology and neuroscience of chronic pain, as well as a daily practice of mindfulness meditation, Jill was able to insert a mindful influence on her pain. She recognized that by shifting the way she thought about her pain, her back, and the active role she could have in her own healing, she was able to take control of the situation more effectively. This helped her body and mind to begin to function more as one.
See Mindfulness and Movement for more of an idea on how we integrated mindfulness and self-compassion into Jill’s therapeutic care.
Social
Without others, we are lost. By creating a strong therapeutic alliance, Jill and I were able to work together on an even playing field. Unlike previous therapies she had been to in which an authoritarian figure prescribed what she should do for her back, Jill and I collaborated as a team, along with her physician. This feeling of support improved Jill’s confidence in her providers, as well as in herself as a necessary member of the team.
See Enhancing the Therapeutic Alliance for more information on the importance of the relationship between the patient and the provider.
We also addressed Jill’s social life and relationships with others. We encouraged her to seek support from her daughters and her friends. Jill began to feel more comfortable asking for help. She also began to go on regular walks with her friends, which she realized was very helpful for her back and much more enjoyable than walking alone.
A Whole New Jill
Clearly, Jill’s issues were not just in the tissues. The tissues in the back are part of a living, breathing, thinking, feeling, moving organism. Any persistent pain or mobility challenge is multifactorial. Throughout the healing process, the biopsychosocial approach was taken in order to holistically Jill’s issues.
As mentioned previously, Jill is now back to rowing, walking with her friends, strength training with weights, and playing on the floor with her grandchildren! This has further motivated her to continue to stay active and improve her life and her movement capabilities. She feels that she has gotten her life back!
“In the last eight months, I have shared my experiences with friends and shown them some of the simple movements. I have traveled, concerned I would re-herniate a disc. Not. That truly felt like success. I now know that this process takes time and patience but it is well worth the investment.”
Jill will occasionally experience instances of increased pain. However, these instances are drastically different from the flare ups of the past. They are far less frequent and less severe, and do not bother Jill as much emotionally. She also has much more clarity as to why the flare ups are happening, based on what she has or has not been doing.
Jill no longer sees pain as the enemy, but rather as an informant that helps to guide her actions. She recognizes that pain is inevitable for us all, but how we believe and behave relative to our pain can make all the difference.
Jill has the tools to manage and diagnose how to treat her pain, and she still does a monthly check in at The Wellness Station for support and for a review of movements and techniques.
Jill had an extremely active role in her healing journey, which will be a gift that keeps on giving for the rest of her life.
Written by Jacob Tyson, DPT - Physical Therapist, Yoga Instructor and The Wellness Station Team
Images:
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