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  • Foto van schrijverPieter Derycke

Principles



Over the years, I've gathered a few core principles that I use in my profession of physical therapy. Some of them I've learned from others, some are the result of experimentation and experience. Some of them are more important than others, some are overlapping, some may be wrong, or at least not entirely true.

I use them to guide myself in my treatments, but I also use them quite a lot as short and sweet sentences for people to remember, probably ad nauseam… I'd like to share them today, and although they can be self-evident, I will elaborate a little bit on their meaning and use…

There is no change without change.

You're not happy with the situation you are in? Well, if you keep doing what you've always done, you will get what you've always gotten… Something needs to change. Luckily, small changes can make a big difference. Sometimes big changes have to be made…


There is no improvement without challenge/effort/stress.
There is no improvement without rest/safety.

Both principles are equally as important, they are two sides of the same coin, they are yin and yang. This interplay of opposites is necessary to grow and improve, but sometimes one aspect is already present, and the other needs to be added. Some people lack challenge, some people lack rest. Sometimes you need to relax first and challenge yourself later. Sometimes you need a kick in the ass and start putting in the effort.

This principle, by the way, does not only apply to exercise! It is true for all human capacities that can improve, and there are more of those than you would think.

Play to learn, learn to play.

Play is the mammalian learning mode, and all my patients need some kind of learning. I need to learn them to play, so they can play to learn. They can learn to be better moving humans, learn to cope with stressors and sudden change, learn to rest, learn to look for safety, learn to challenge themselves adequately, learn to overcome fear, learn to adapt, …


Fall on your butt, not on your face.

Sometimes genuine, outright play is too much. The wise thing to do here is careful exploration. But even then, you will fail once or twice and make mistakes. But if the risks are limited, the mistakes will be acceptable. So better to fall on your butt than on your face! And better a broken bone than a broken spirit, says Lady Allen of Hurtwood.

There is no mind without body. There is no body without mind.

There is nobody that minds this principle. But, oh boy, we can do so much better. In general, we need more mind stuff for body problems, and we need more body stuff for mind problems.


There is no you without tribe.

For us humans, the baseline expectation is to be surrounded by cooperative others, because nothing was more critical for our ancestors' survival and reproduction. We require people who have our best interests at heart. If we are alone, we feel threatened. If we are surrounded by bad people, we feel threatened. The people around us can make life great, or as Sartre knew, a hell on earth. Don’t measure your wealth by the extent of your possessions, but by the strength of your relationships.


There is no you without habitat.

The physical world you live in influences the way you live tremendously. The air you breathe, the sun on your skin, the water you drink, the food you eat, the microbes you interact with, … Environmental care is healthcare.


From a movement perspective, the environment you move and live in is shaping our behavior and health, in ways that we typically don’t think about. We have made our physical world too friendly, too energy efficient, too flat, too boring even. I suggest making our physical world a bit more varied, more three dimensional, more difficult, but more fun? See here for my thoughts on what I call ‘reverse ergonomics'.


Your tribe and your habitat could be considered part of your ‘long body’ (hat tip to Frank Forencich). You literally don’t exist without them. There’s also no clear border where ‘you’ end, and where ‘the rest’ of the world starts. Your microbiome is vitally important but does not share any DNA with your somatic cells. And your microbiome can only be alive through interactions with the world, both living and non-living.


You could also view your tribe and habitat as a home, a social and physical place to feel safe and at ease. A place to start your adventures from, a haven to come back to for recovery.


You have less control than you think.
You have more control than you think.

Our level of control changes how we respond to stress. When we have a sense of control, our alarm is quieter and easier to shut off. Unfortunately, we tend to control the things that are very difficult to control, or even beyond our control. Master Oogway, from Kung Fu Panda, advised us to ‘let go of the illusion of control’.


Luckily, in many instances, we can still exercise control over matters that are important and influentual enough to change a situation.


This principle really needs a longer and more thorough blogpost, maybe that’s something for a next time…


"Happiness and freedom begin with a clear understanding of one principle: Some things are within our control, and some things are not," said the Stoic philosopher Epictetus.


Learn to see the forest. Learn to see the tree.

As a therapist and as a patient, we need both the broad and narrow state of mind and we should know when to use them. A broad state of mind increases sensory information for perception, augments global attention and broad thinking, stimulates exploratory behavior, and creates a positive mood. So, seeing the forest is important.


When we’re focusing on the tree, our thinking becomes constrained, we tend to fall back on familiar choices and actions, and our mood sours. We tend to linger where we are, instead of exploring. This narrow state of mind appears, on the surface, to be rather negative, but some circumstances need this view. Know when to look for the tree...


A ship in the harbor is safe, but that is not what ships are built for.

Safety is important and a necessity, but most interesting and meaningful events happen out on the open sea. Learn to navigate the open sea, but know where the harbor is, and when to return. Another related sailor metaphor: "A smooth sea never made a skilled sailor."


Knowledge is only a rumor, until it is in the muscle.

I spend a lot of time talking, motivation, educating, stimulating. But none of this is really helpful, unless it is followed by action. The smallest deed is better than the greatest intention, says John Burroughs.


Information can be a good starting point, but in my experience, it is almost never enough to change behaviour, to learn, to truly understand. And quite often it is not even necessary. Words may be the inspiration, but you need the transpiration (the 99%, remember?).


Knowledge needs to be incorporated, which literally means: put into the body!



You do more than you think when you communicate.

The words we speak, are biologically active. And in a broader sense, our communication, verbal and non-verbal, can have significant impact on the treatment of our patients. Rudyard Kipling said: “Words are, of course, the most powerful drug used by mankind.” But we have to be careful, because, “though the tongue has no bones, it can break a spine."



You do more than you think when you touch.

Touch has since long been a therapeutic modality, but it most probably does more than you think. You think you are mobilizing a joint, or massaging a muscle, or pushing on a triggerpoint (and maybe you truly are doing that), but the positive effects can be the result of more than you’d think. Maybe you did some lymph work? Or you supplied the somatosensory cortex with some nice proprioceptive information? Or you sent the much-needed sensory information to the protective parts of the brain? Or maybe your touch had a social, almost grooming-like effect?


Don’t forget that these effects can be positive or negative, even if your intention is genuinely good. A painful stimulus can be safe for the tissue but can be too much for the central nervous system. A gentle trapezius massage that does wonders for one person, can be horrible for a person with a history of intimate partner violence.



You do more than you think when you prescribe an exercise.

Movement can be so much more than just exercises. And exercises often do more than the original reason why you prescribed them. Similar to the points made above, with touch, these additional effects of your exercise can be beneficial or detrimental.


Is your quardiceps strengthening exercise helping your patient through strengthening? Or through loaded joint mobilization? Or because of the proprioceptive feedback to the central nervous system? Or because of the confidence it creates in being able to use the knee?



You hear the tree fall, but you don't hear the forest grow

Bad is stronger than good, and sudden change is easier to detect than gradual change. Growth takes time. By the way, a fallen tree here and there is beneficial for the ecological health of the forest, as long as the storm (or humans) don’t fell too many trees at the same time…




Learn when to change the situation. Learn when to change yourself.

There’s a famous prayer that is very applicable here: “God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference. Jonathan Haidt (in ‘The Happiness Hypothesis) talks about this prayer: “Wise people are able to balance three responses to situations: adaptation (changing the self to fit the new environment), shaping (changing the environment), and selection (choosing to move to a new environment).”



The last two are rather self-explanatory:


Mood follows action.
You can learn nothing except by going from the known to the unknown.

Thanks for reading. Feel free to comment or ask question, or even better, to add some of your own guiding principles.


Cheers,



Pieter






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