Therapeutic Physical Care

Therapeutic Physical Care

Paradigm Overview


The goal of this paper is to present and discuss a therapeutic paradigm that recognizes and aims to fill a gap between medical physical therapy and fitness. Therapeutic Physical Care (TPC) is a conceptual framework that is of value to all practitioners of the physical arts. It recognizes the unseen internal (psyche) and the physical worlds as a union, rather than a combination. The union of the psyche with the physical, in the language of TPC is referred to as "psychephysical". This distinction helps the provider understand that psychephysical is two parts of the same whole, not a link between separate things.

Bringing this latent awareness to the forefront will enhance care and recovery programs. TPC discipline can be applied in numerous disciplines, such as martial arts, pilates, yoga, physical education, nursing, psychology and personal training. All these professional services require a knowledge of basic anatomy and physiology in a highly interpersonal setting. Anyone in these disciplines can benefit from this paper. It is an effort to bring new perspectives to old knowledge.

There is a gap between physical therapy and fitness that lacks acknowledgement. Physical therapy focuses on recovery from acute trauma and/or surgery in order to regain function necessary for Activities of Daily Living (ALD). This discipline aims to get clients back to their homes and ideally back to work following significant injury. At the other end of the physical wellness spectrum there is fitness training. Fitness training serves individuals who have no issues with ALD and instead can focus their goals around improving strength, vitality, and even achieving a certain aesthetic. Physical therapy focuses on basic function while fitness training is a high level challenge that does not address basic dysfunction. Both disciplines largely focus on the physical body with little to no emphasis put on mental health. Thus, there is need for a product on the wellness spectrum that focuses on the physical body, basic function and mental health.

This psychephysical perspective is relevant to all methods that combine the manual therapeutic processes with deeper consideration for the individual. Providers must not fail to focus efforts only on the parts that are injured but embrace the client as a whole in order to provide the highest standard of care. It is important to emphasize immediate relief from the injury, but it should be followed by discovery and elimination of the root cause of dysfunction when possible.

When greeting a patient or client you must listen thoroughly. Their experience and understanding of the process which they have engaged in. The practitioner starts with a blank slate and no predefined intended path. We, unlike most healing practitioners, are not concentrated on methods. You are expected to be the master of all methods and apply strategies based on the need of the individual in front of you. When it is apparent clients are in intense emotional distress, this must first be addressed before any other progress can be achieved. The focus of your work should be the most apparent need of the individual to achieve their goals.

The rehabilitative process begins by addressing the immediate physical issues but the journey to recovery continues with discovery and elimination of the root cause of dysfunction. Coaches, trainers, therapists and practitioners of numerous movement arts are the frontline professionals for healing and amplifying human potential. Intimate relationships built on trust are fundamental to helping others learn and grow to ensure that the best care possible is provided. This includes acknowledging and nurturing the limits of possibility are far greater than commonly known. Any coach or trainer can learn to administer TPC, by adopting the tenets presented in this paper. Frontline educators have the role of amplifying human potential. It is our mantle to grab, arguably a duty to ensure people find paths back to strength and to nurture those facing the limits of possibility.

The Tenets of TPC

In summary, TPC is a set of protocols to optimize care to individuals with treatment-resistant chronic pain and ease the physical and psychological burden of their traumatic event(s). The following are principles, tenets, and points of emphasis that have proven invaluable over years of practice:

  1. Correction and prevention of physical dysfunction and pain is central to TPC. This is accomplished through the Manual Therapy Triad: condition-specific physical movement patterns, assisted mobility, and in concurrence with aggressive bodywork strategies.
  2. TPC recognizes that we are a psychephysical union. All action is relevant to its intention. Technique and method are secondary to the awakening of aware intention. Successful application of technique requires awareness and intention along with focused commitment.
  3. Central focus of TPC is attention to each individual and their immediate needs and goals. It includes finding ways to start from an imperfect point and rebuilding the body without causing further injury.Central focus of TPC is attention to each individual and their immediate needs and goals. It includes finding ways to start from an imperfect point and rebuilding the body without causing further injury.
  4. Practice of TPC requires a commitment to self awareness and growing beyond bias. It is required to achieve the objectivity necessary to see the needs and desires of the individual seeking help. This separation from personal intention is necessary to select the most appropriate ministrations and plan for progression.
  5. TPC holds that mastery of elemental movements is necessary in order to develop deep kinetic re-learning. To correct unconscious aberrant maladaptive patterns all compound movements must be distilled to their elemental parts and corrected before reassembly into accurate compound movements. Elemental movements are building blocks, a strong frame requires all elements of the structure to be exact.
  6. A practitioner must first create hope, without creating hope you won't keep the person involved in order to move them forward.
  7. The natural growth process in tissues can be guided and coaxed by body work and intentional active contraction.
  8. Neural change precedes physical change.
  9. The more thoroughly aberrations are neutralized, the more a self-sustaining neutral pattern can be established and perpetuated.
  10. TPC recognizes that compassion is required to optimize care when addressing treatment resistant chronic pain.
  11. TPC is an empowering tool to recovery, focused on tangible goals rather than a hyperbolic hope. This provides motivation to the client and keeps them invested in their recovery.
  12. TPC seeks to develop therapeutic regimens that best serve an individual toward a more comfortable, functional, and fulfilling life first. Recreation comes second, athletics third.
  13. A TPC practitioner never stops working to motivate a client that remains engaged.
  14. Technical skill, once achieved, requires focus and commitment to wield it.
  15. TPC presumes adequate nutrition until determined otherwise.
  16. Focus on the present and anticipate moving forward.
  17. Too many people suffering trauma are left to idle by themselves without guidance. Pain affects the ability to work, socialize, and participate in life, TPC seeks to make this reality a thing of the past.
  18. No person is a "lost cause". No injury is untreatable. TPC emphasizes that no one is too weak or too injured. It starts with basic function and grows with the client.
  19. It is through the mastery of the elemental and the understanding the value of the elemental and always starting with the basics.
  20. Listen to the person, feel the person, know you're dealing with and approach through the most open path

Message To Practitioners:

The foundations of physical restoration are rooted first and foremost in one physical principle - the phenomenon of atrophy and hypertrophy of tissues. Referred to colloquially as "use it or lose it". Atrophy - hypertrophy is accepted as a biological constant especially in musculoskeletal tissues.

Everyone is aware of the concept of "use it or lose it" on some level - if you stop running, you lose the capacity to run, same with lifting and bending. What folks are less aware of is that this decrease in function is the result of the body's energy conservation principles. A physical body will not maintain living tissue mass that does not have a demand placed on it. When the body does not use a system, it does not maintain that system.

With long term kinetic hygiene practices in place for a lifetime, future generations of humans will live more complete lives with a great overall reduction in pain and suffering related to postural degeneration and disuse, and dramatic increases in functional longevity.

Physical degeneration and restoration is the modulation of atrophy and hypertrophy. It is universally accepted that the tissues of the body are constantly renewing themselves. It is less commonly known that this process can be altered intentionally by an informed individual. This is underpinned by an irrefutable principle. Atrophy/hypertrophy cycles operate at all levels of the body from the microscopic cellular level to the gross anatomical systems. The pace and depth of this process can be modulated through therapeutic intervention. Growth cycles vary across different types of tissues based on genetic propensity, acute demand, and response to blood supply volume.

It is the intention of TPC to raise awareness in the population of medicine, rehabilitators, and the general population on how to optimize this ability. Society understands these principles well with regard to fitness and athletics but seems often to not fully realize they apply to all of us regardless of our current physical state. We will benefit from expanding our awareness of the body's ability to rebuild.

When faced with tissue injuries and dysfunction there are two paths. One, the individual can choose to do nothing, this is the "lose it" path. This will result in collagenous damage, fibrous scar tissue development and eventually calcification as well as loss of bone density. Overall, there will be an expected decrease in physical function. The alternative is the "use it" proposition and to actively engage in a therapeutic process. This will promote restoration of contractile muscle tissue and reduce post-event scar tissue. This option will result in re-structuring of collagenous tissues to an active, more functional state, and will enhance integrity of tendons, ligaments, fascia and bone strength.

This second option is ideal, however it is not always easily achieved and for many reasons health and well-being does not just involve the physical body. The body operates in unison with the mind.

It is important to be aware modern healthcare is rooted in dualism often ignoring this symbiosis. This leads to an under-appreciation of the body's ability to maintain and heal itself. "Unusual recovery" is often seen as a mysterious aberration of the familiar, rather than a mysterious manifestation of the unexplained. More often than not, these "unusual recoveries" can be explained by the symbiotic nature of the psyche and will upon the physical matter of the body.

Thus, it is necessary to thoroughly consider the entire person and their complete situation, not only the chief complaint and immediate external physical and mental stresses. Upon gaining a deeper understanding of the client, a more rigorous process can be created which will be amenable to the recipient. This will allow for small successes which will show the viability to maintain persistence on recovery goals. For individuals who have suffered injury, serious trauma, or debilitating physical degeneration, there is often a long journey to recovery and maintaining motivation is key and are the result of cumulative work.

Starting with a strong foundation can seem unnecessary to a novice client and professional athlete alike. It may be difficult to grasp the value of recreating primal anatomical patterns to a suggested ideal and retraining kinetic chains with surgical detail. However, upon recognizing the value of rebuilding physical capacity, an individual may see apply a strong foundation to more difficult hurdles. It can take a time for a client to see the value of rudimentary exercises which is why having a supportive therapist is crucial. This therapist will provide the steadfast bedrock and stability for a person to anchor on, allowing them to overcome hurdles and maintain faith, belief and significant motivation.

As an instructor, it is critical to understand the depth and power of human intention but more important to focus on simplicity. What is the first most tangible element to be addressed. When coaching someone where do you begin? Tending to anatomical aberration, Motivation, education, which comes first? It will be forever different from person to person. The goal is providing immediate tangible results and setting the stage for ongoing incremental progression.

If I have been successful, you have gained insight from reading this paper that will permeate your thinking. I hope you see value in concepts presented in this paper as tools to ease suffering and human loss from physical trauma.

An Example:

Early in my career, I was hit with the first of many waves of clients with hip pain. I was young and cocky with a great track record for a few years uninterrupted. I was running on autopilot during this time, I was systemically just applying a process that I was adept at without consideration to the individual. This is a very easy cycle to fall into especially when we are also running a whole practice. Moreover it is the place where most practitioners reside, learn a method or process, spend a career applying and refining that method or process

In the midst of this mindset, I had one initial interview that woke me up from my trance. The interview started like any other consultation and her answers were the same as any other client with hip pain. I was nodding and thinking, "this will be another quick and easy fix" Already thinking forward to getting to work. Rather than continue, we jumped into exercises assuming I could get her feeling better with the time remaining. But I was wrong.

I went at things as I always did with bodywork for the hips and pelvis. The client was not having it, she would buck and fight every hand placement. Not only was I getting frustrated because she was not allowing me to do the work, but she was getting frustrated with me since I was causing her more pain than good. The whole mood of our relationship and the appointment shifted, the anxiety became palpable. I knew my standard mode of operation was not going to help this Woman the way she needed to be helped. I realized that I needed to come at things differently.

She was kind enough to give me a second chance and at the next appointment, we continued our consultation. But unlike the week before, I was present. I wasn't simply nodding through it. I was engaging in her story and being a part of the dialogue. I learned that my client was the victim of abuse which complicated matters creating profound sensitivities to touch and pressure. I learned that there was a lot of traumatic burden within this person that needed to be addressed in conjunction with the physical in order to see her through this. After this Re-consultation our treatment plan changed. I was no longer forcefully addressing the issue, but instead we were addressing her foundational strength and balance and respecting her unseen pain, this eventually built into hip exercises and improved general strength. Mental and emotional space was providing a safe space to share and explore vulnerabilities.

I can say with confidence that if I didn't take the time to listen and hear this person more completely, I would have never been able to help her, I may even have written it off as her incapability, not a failure of mine. Which in my philosophy of practice it would have been because I would have failed to properly modulate the knowledge in a manner that served her, a fundamental premise of the work.

In this example, one can see the application of TPC and its multiple disciplines of bodywork, movement and mobility integrated to create a very broad approach path to any individual. It is why worship of process and method is fundamentally limited, because the method is about method not the subject. In this example of youthful folly I let my focus shift from immediate site-specific relief to an awareness of this entire person and it was life-changing for this client. There is no need to rush to the finish line. Each client will get there at their own pace and it is your job to watch from the sidelines, cheer them on and give them appropriate nudges.

You are not expected to be the master of all rehabilitative sciences. I did not undertake any particular psych-therapy treatment for my client, but I was there for her. I knew that she needed an outlet for all her pain and I provided a space for it. When it is apparent clients are in intense emotional distress, this must first be addressed before physical progress can be achieved. It is this Person Centric focus and the secondary application of broad knowledge to find answers that distinguishes TPC from programs that are Method Centric approaches that attempt to impart the method equally upon all comers.

About the author:

Mark St. Peter coined the term Therapeutic Physical Care in 1999. After years of lived experience, education, professional practice he was aware that it was necessary to transcend the dualistic thinking that has plagued dialog for centuries and to create a modern framework to discuss the midbody union that includes; awareness of psyche as multi-organ system, influence of environment on persona and organic factors.

"It is the main focus of my waking hours". TPC is the result of personal and professional experiences. It was born from a personal life-altering injury and fortified by a study of kinesiology, psychology, and competitive athletics. As a professional coach, trainer, and therapist working with clients living with severe injuries and treatment-resistant chronic pain, I began to see commonalities in cases of optimal recovery which inspired TPC.

TPC is not a single solution to therapeutic practice, but it does seek to impart an understanding of the universal essence that exists in all physical arts and center them through the lens of each individual seeking help.

Thank you for reading, Mark St. Peter B.S., B.A.

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