In this, the third and final installment of "Holistic Approach to Injury," Paul discusses his system of prioritizing your approach to rehabilitation and revitalization of body/mind systems.
Movement that Matters
Today, there are many philosophical and mechanical approaches to treating injuries and developing exercise programs for health or performance. Unfortunately for the public, the majority of these approaches still operate on the illusion that the musculoskeletal system is an isolated system that runs all by itself. Since we know for absolute sure that this is far from the truth, prior to assessing a client or patient’s ability to move and perform general motor tasks, practitioners should have:
- Completed an investigation of diet, lifestyle factors, hormonal and visceral health within the framework of the six major classifications of stressors (see Figure 1 in Part 1).
- Looked for reptilian stressors that correlate with the patients symptom profile and behavior patterns (see Figure 2 in Part 1).
- Completed the survival totem pole assessment (Figure 4 in Part 2) to identify potential problems in any of the body’s major control centers, understanding that the hierarchical structure of neurological control allows for the sacrifice of subordinate structures on the totem pole. Included in the survival totem pole assessment is a very comprehensive assessment of length/tension relationships, joint motion, core stabilizer system function assessments and special testing for potential impingement of the CNS.
After gathering key systems information, the next step is to complete the Primal Pattern (PP) assessment. The PP assessment is based on research into human development. A study of the general evolution of species and the evolution of man suggests that we are what we are today because of the selective pressures of Nature. Through extensive clinical observation and empirical research, I have concluded that to survive in the wild (which was our home for greater than 99.9 percent of human evolution), humans would have had to have been proficient at the following movements while unsupported on our own feet:
- Twisting (such as throwing)
It became evident early in my career that athletes, laborers and people in general were commonly injured when forced by their environment to perform movement patterns they couldn’t perform well. I also noted that anyone who couldn’t perform a PP movement with good form was at greater risk of injury because PPs serve as a working foundation from which a plethora of other movements are built (i.e., throwing a ball, which is a lunge coupled with a twist and a push).
A typical example is the laborer who hurts his back while squatting down to pick up a heavy object (heavy being relative to the individual's level of conditioning). Upon consulting a physician or typical rehabilitation professional, he is told he shouldn’t squat because it is dangerous for the back, and he is told he should hereafter avoid squatting! This scenario presents a common problem in that squatting is a Primal Pattern. As an PP, it is almost impossible to escape the environmental demand to execute the movement. You squat to sit in a chair, get into a car, get on and off the toilet (which used to be on the ground), dress small children, pick up a five gallon bottle of water for the dispenser... we squat all the time!
With extensive knowledge of how to perform PP assessments and how to modify the assessment techniques to better suit each person’s specific work, sport or recreational environment, you will then gather relevant data. After completing the PP assessment, the next task is prioritizing the combined findings of the entire evaluation process.
Determine Your Physiological Load and Prioritize
Having completed a very thorough assessment of your client’s physical-emotional-mental and spiritual stressors in the format described previously, we will have gathered a significant amount of relevant data. While this information is critical for developing a coaching and treatment strategy, there is commonly much that needs to be corrected, and the client can become overwhelmed. It is also my experience that less experienced health care professionals can also become overwhelmed by the volume and diversity of challenges presented by most clients! It is for this reason that I developed the Physiological Load Assessment (PLA) form (see Figure 5 below). The PLA allows the practitioner the opportunity to empower a client/patient by letting him see what are usually obvious changes that need to be made to achieve function and vitality.
The process begins by listing all key stressors in their relevant columns. For example, any musculoskeletal complaints would be listed above the “Physical – Musculoskeletal” column, while any relevant visceral findings or hormonal findings would go above their columns respectively.
You then need to explain to the client that the body shares it’s stressors to protect it's self from accumulating too much energy in any given system or tissue, the result of which would be dis-ease! With this understanding, we can look at the number of stress inputs above each of the columns (represented by one of the sinks that are plumbed together) and collectively agree as to which system is potentially the greatest source of stress or aberrant energy.
After the client understands that body systems all share their stress, creating a total stress picture (see Figure 1 in Part 1 to appreciate how the body totals stressors), and they understand which system is under the greatest load, the practitioner must decide which self help options will most effectively alleviate the stressors loading the body systems. As the practitioner decides what self help methods will be most advantageous for the client’s specific needs, they are listed below each of the systems (sinks named after systems). Through this process, the patient usually begins to see a pattern emerge. For example, diet is commonly listed under each system sink as an important means of alleviating stress. Common options to alleviate stress include:
- Circadian rhythm management
- Self help courses for improved mental/emotional/spiritual understanding
- Exercise programs or exercise program modifications
- Specific therapies or specialists such as:
- Detoxification procedures
- Hormonal testing and balancing (Biohealth Diagnostics!)
- Tai Chi, Chi Gong or Yoga lessons
- Feldenkrais or Alexander lessons
- Body work options such as sports massage, Rolfing or trigger point therapy
- Breathing lessons from an expert (I often use voice coaches)
- Marriage or relationship counseling
- Financial planning
- Seeking council to overcome addiction
Don't Treat the Disease, Treat the Person!
While the current medical model is heavily slanted toward what I call "this for that" treatment, or the “Band-Aid Effect,” I think the current statistics on disease show that the model is failing drastically! As I often tell my patients, we evolved in the wild without drugs and doctors and we did so without near the prevalence of disease. Therefore, the greatest healer of all must be within us! The goal is always to coach the person with the disease, not treat the disease that has the person. Simply stated, disease is a symptom. It is not a cause.
When the clinician or therapist identifies which of the foundation principles are not being lived by, a structured plan should be built and agreed upon by the client to bring him into a resource state, balance or harmony. Foundation treatment principles include:
- Good diet
- Eating correctly for your metabolic type
- Eat organic foods
- Rotate foods on a four day cycle for food variety and decreased immune stress
- Adequate daily water intake
- Adequate exercise
- Work hard and rest hard!
- Working-out vs. working in
- Adequate rest and living in accordance with a natural sleep/wake cycle
- Live with a purpose! Have goals to improve:
- Physical health
- Emotional health
- Mental health
- Spiritual health
In conclusion, this system of assessment uses a holistic approach. This approach can help your clients achieve the ease and the life they’ve always wanted! All practitioners should carefully assess a client’s overall physiological load and identify any red flags that may require specific medical attention or tests. Implementing a personalized treatment plan to address stress, diet, exercise and related lifestyle factors flows out of the comprehensive assessment. Further, each client should be respected as a unique human being with unique challenges. There are no cookie-cutter approaches where you can try to fit the client into a standard mold. We use a careful system of assessment tools and questionnaires based upon interrelated physical, emotional, mental and spiritual systems of the human. This approach maximizes each client’s probability of achieving actual recovery leading to a state of vitality and well being.
It is the dream of all fitness professionals that their clients reach independence, becoming truly functional individuals as soon as possible. Using the principles described in this article series will help you to realize this dream!
- Connolly, Ceci. March 29, 2002. Pharmaceutical Spending Continues Steady Increase. Washington Post, p. A09.
- MacLean, Paul. (2002). The Evolutionary Neuroethology of Paul MacLean: Convergences and Frontiers. Ed: Gerald A Cory, Jr., and Russell Gardner, Jr. Praeger, Westport, Connecticut.
- Pearce, Joseph Chilton. (2002). The Biology of Transcendence: A Blueprint of the Human Spirit. Park Street Press.