Will I ever be able to move how I want to again?
Disclaimer: This is an opinion blog. I may use clinical knowledge and experience as a Physiotherapist to develop this content. I will also cite resources where appropriate. However, this content does not replace nor seek to replace the consultation with a Physiotherapist or other healthcare professional for your health concerns.
Two years ago, when I started having low back pain during one of my clinical placements, I had a moment of hopelessness when I was talking to my Physiotherapist: “I could barely take a step without pain. I had to keep my back super straight, and even then, if I let go even an inch, the pain was excruciating! If my life continues to go on like this, will I ever become a Physiotherapist? Will I ever actually be able to DO my job, or will all the work that I put in be for nothing?!?”
For me, movement is freedom. Freedom to do whatever I want; however, I want, with my body being able to keep up with me. With an injury, sometimes that feeling is stripped away and replaced by a sense of dread. Something happens that steals that movement away from you and with it your freedom.
When you have an injury, why does that affect your ability to move aside from just pain? How do different types of injuries affect movement differently?
What stops movement?
Movement is the change in the position of an item. Last time, we talked about the pyramid to think about how the human body creates movement: the brain and spinal cord are at the top, and the rest of the body is closer to the bottom. We also talked about two-way communication in the body: the brain is in a black box and only knows what is happening, based on the information it receives from the body.
When thinking about an injury, I would like to layer on another analogy: let's imagine the hierarchy as a lamp and its connections.
The lamp and its connections
In the human body:
The brain/spinal cord = power source,
The wire = nerves
The bulb = parts of the body that send and receive information from the brain (i.e. muscle, joints, organs, etc.).
The lamp and its connections
I will speak from a muscle, joint, and brain perspective.
Think about an injury as though it happened at any one of these three areas. If that happens, it has different effects downstream. For example, if there is no power source, forget about the lamp bulb, nothing that plugs into the power source will work. If the wire is frayed, sometimes the electrical signal will get through, and other times it won’t, causing the bulb to turn on or off inconsistently. If the wire is fully cut, then no signal gets through. Lastly, if the bulb burns out, then it doesn’t matter if the power source is reliable or if the wire is made of the most robust material, the bulb will not turn on!
Now, let’s put this analogy into the context of the words that people created to describe the human body (anatomy). The brain and spinal cord are the power sources. One thing they are responsible for is holding movement patterns (1): remembering how to do something and how to tell different parts of the body to turn on, and in what order. An injury to the brain (e.g. a stroke) may turn off part of a movement pattern. The body then shows signs of forgetting the order in which to activate certain body parts to move. Sometimes the brain forgets that a particular part of the body exists. Recovery becomes about teaching the brain that the body part still exists and reteaching the brain how to move the body again and in what order.
The nerves are the wires: they send information to and from the brain. If something damages the nerves mildly, you can get tingling feeling or even sharp pains if the nerves that send information to the brain are affected. If the nerves that send information to the muscles are affected, they may not turn on as effectively. The more affected a nerve is, the less information can travel effectively between destinations. Recovery depends on the nerve's ability to regrow or for other nerves to sometimes take the job of ones that have been damaged.
The muscles and what attaches them to bone (tendons) are the bulb: they do whatever the brain tells them to do. But they also tell the brain what the body is doing, down to each nanosecond. When muscles/tendons are injured, they create the most well-known signs of injury: bruising, swelling, redness, and much more depending on the injury (2). Recovery here means giving the muscle/tendon time to regrow, and strengthening them so they can withstand forces like before the injury.
One of the things that limit the versatility of this lamp analogy is that unlike a lamp where you have the replace each of the components if they get damaged, the body, for the most part, is quite good at regenerating and relearning, WITH the right input. I love adages, and the one I would use here is “you get out what you put in.” If the daily tasks you can do are the output, then the high-quality movement you give the brain, and the spinal cord are the input.
This post was more technical, but I still hope it was readily digestible, and that it helped you learn about the body in a slightly new way. If so, I would love to hear it in the comments section!
Until next time!
[1] Think about a movement pattern like a dance move, “first your hips shimmy, then your left-hand goes up, to the side and down…” If you don’t do the dance move in the proper order, you will end up doing the chicken dance instead of the Renegade.
[2] One thing I want to point out is that even though we are the most familiar with the signs of this type of injury, see how many other injuries exist that are hard to see easily?