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Don’t Fix Your Own Brakes

As the owner of a “senior” vehicle, you’d think by now I’d be used to seeing large car repair bills, but I admit that I still sometimes get sticker shock by the cost of keeping that old Chevy on the roads. With car repair prices on the rise, it’s no surprise that many people try to do what they can to keep their car running without the cost of a professional mechanic. Changing wiper blades and fluid, spark plugs, and even your oil are simple tasks that can be safely done in your own home garage. However, I’d wager that almost none of us would ever attempt to fix our own brakes. Even though you could probably find a YouTube video on how to do it, or maybe you have a friend who is experienced with cars, most of us will still leave that kind of repair to the pros. Why is that? Because it doesn’t take much imagination to figure out the consequences of a home brake job gone wrong.

Rehabilitation is not that different from car repair. Some injuries (such as a minor sprain or a short-term episode of mild back pain) can be safely treated at home with gentle stretching and R.I.C.E. (Rest, Ice, Compression, and Elevation). More serious injuries (such as any long-term or severe pain or post-surgical rehab) should be rehabbed by a professional. Not only is the care of these types of conditions more complicated and specialized, the consequences of an improper or incomplete recovery are disastrous – continued pain, impaired function, lost independence, etc.

If you’ve just had a surgery, your doctor may tell you that you don’t need physical therapy. They might hand you a sheet with a few exercises and tell you to “just do them at home.” I don’t ever tell people to disagree with their doctor, but in this case I’ll make an exception: If your doctor says you don’t need physical therapy after a surgery, your doctor is wrong.

For an example, let’s use a surgically-repaired rotator cuff. Ideally you will be in physical therapy immediately (like the next day, not a week later, definitely not a month later) to begin the first of three stages of rotator cuff rehab. The first stage is the passive motion stage, and depending on your age, your other health issues, your body’s rate of healing, and your at-home compliance with your therapist’s instructions, this stage may last around six weeks. During this time, your shoulder won’t move on its own. Instead your therapist will guide it in passive motions (called “manual therapy”) designed to improve range of motion, regain flexibility, and prevent the buildup of scar tissue. This is a delicate stage that requires expertise to make sure your shoulder progresses without injuring fragile structures.

The next stage of rotator cuff rehab is called the active assistive stage. During this stage, which typically lasts two or three weeks (depending again on your individual rate of healing, other health complications, and adherence to your rehab program), you will begin to move your shoulder on its own, but you won’t be very good at it. You will have Weenie Arm Syndrome. And you will need a professional to guide you and help you relearn how to move your shoulder.

The final stage of rotator cuff rehab is the active motion with strengthening stage. Just as it sounds, during this final stage, you will begin to strengthen your shoulder in preparation for resuming your life and recreational activities as normal. Again, the expertise of a physical therapist is crucial to make sure that all strength and flexibility deficiencies are addressed in a specific fashion, that the exercises and weights are appropriate for your level of recovery at that time, and that you do not reinjure your shoulder. If all goes as planned, you can expect to be released from formal physical therapy about 12 weeks after your surgery (although you will continue with a home exercise program for several months).

On the flip side of our example is a patient whose doctor did not recommend physical therapy after rotator cuff surgery. This patient was sent home with a prescription for pain pills and a sheet of exercises. Instead of receiving expertly guided passive motion exercises for their shoulder, this patient sat around, their shoulder getting increasingly weaker and stiffer. They tried to do the exercises they were given, but the exercises were one-size-fits-all instructions that didn’t do anything to address this patient’s individual post-surgical needs, and so the exercises didn’t help at all. By the time the patient finally gets to a physical therapist’s office two months later, their shoulder is so stiff, painful, and weak that they are now facing a recovery period that’s three or four times longer (and a lot more painful) than it would’ve been if they’d began therapy right away.

Like fixing your own brakes, rehabbing severe injuries and post-surgical conditions is something that really can’t be done at home. I feel so strongly about this that I’ll tell you to just go see a physical therapist, even if it’s not me, if you’re facing this kind of recovery (after all, you always have a choice where to receive your PT). Get physical therapy, so you can get on with your life. Until next time, keep moving, my friends!

– Alan

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