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  • Jeffrey T. Stenback, DPT, OCS

Mindfulness and Physical Therapy

What is “Mindfulness” in Physical Therapy?

How does the concept of “mindfulness” factor into physical therapy? I use the concept to help patients focus on becoming conscious of changes in their posture or function and help them to better integrate movement and exercise into their daily lives. Originally, the term “mindfulness” was heard mostly in yoga circles, new age and self-help publications—more “Eastern philosophy-oriented” materials. But the concept has become mainstream and is used much more widely in many different areas. Mindfulness is the conscious “paying attention” to what is occurring all around us in the present moment. It is an active focus on what is happening or what we are feeling within ourselves right now. So how does this work in physical therapy? We can break “mindfulness” down into 3 important, but inter-related areas. First, we need to create an awareness of our current situation—questions like, “what do I need to accomplish?”, “what do I need to focus on?” or “what is the problem that I need to address?” fall into this area. When you come to physical therapy, you receive an evaluation with questions and hands-on assessments to better uncover the issues which you need to address. These may be postural, flexibility or strength-related, muscle recruitment issues, functional endurance problems, etc, and the job of the physical therapist is to help you identify the primary issues that will need to be addressed. We can then work together to help you prioritize these issues and achieve improved function (i.e. greater flexibility, specific strength needs, decreased pain, etc). Becoming aware is a critical first step in your ability to become more mindful and directed towards your improved health and function. This awareness will remain a necessary component in your mindfulness training as you progress your program. The specific focus of your awareness will most likely change as you improve and your physical therapist will help you continue to prioritize this shift. Without an awareness or focus on what needs to be changed, it is very easy to ignore your signs and symptoms. It is easy to slide back into old habits or postures that actually work against our goals to help get you better. Learning to be aware of the need to change positions or postures is a good example. If we sit for too long behind our computers, we often miss signs that we need to get up out of our chair or incorporate a simple stretch or two. This awareness helps us actively intervene in our current situation to hopefully keep signs and symptoms at bay. We want to try and prevent pain and dysfunction that will continue to occur again and again if we don’t make a few changes.

The second area of mindfulness involves intention. Intention means that we have a plan of action and are doing something to change how our bodies are moving or experiencing our current activities. Having an intention to move means that we are focusing our awareness on our body’s need for movement and then actually doing something (an exercise or movement) that helps us refocus on more efficient movement. The body is a wonderful organism and your soft tissues and joints get their nutrition through full range movement. When there is dysfunction, our bodies tend to not want to move as well and we substitute altered movement patterns for more efficient ones. Our bodies allow us to keep functioning even though we may not be remembering to move or the movements we are doing are inadequate or actually contributing to our symptoms. Our musculoskeletal system makes changes (i.e. tightening up a muscle here; allowing weakness to be reinforced there; stressing certain tissues over others…) that may allow us to continue functioning for awhile. But when these changes reach a point where they no longer work and no further changes can be tolerated, we begin to experience pain or more obvious dysfunction. Sometimes this process occurs quickly (like in an accident or a fall) or these changes may occur over a very long period of time (with a series of many adaptations). Either way, the changes made are always at our expense. Becoming aware of the shift in function our bodies have made and the need for change is important, but when we add the intention of applying a specific improved pattern of movement or a directed stretch to specifically address the dysfunction, we are working against older, less efficient movements and replacing them with more efficient and “posture stable” movements. Having a plan of action or intention is the second part of mindfulness and helps direct our focus towards a specific purpose or goal(s) in mind. Your physical therapist will help you identify musculoskeletal dysfunction (the stuff that isn’t working like it should) and then give you exercises, movements and activities to reinforce improved movements/activities to help you regain more efficient movement with less symptoms.

The third area of mindfulness is consistency. We can focus our attention on our problems and have a plan of action to makes positive changes in our movement, but if we don’t follow through consistently with those intentions, we won’t see much of a difference. All of our patterns of movement are reinforced by repetition. Movements that are practiced regularly (whether they are good or bad movements) are learned and reinforced through this repetition. The movement patterns are familiar and are our “go to” or default movements. It requires a focused approach (awareness) with a plan in place (intention) that is repeated enough (consistency) in or order to make a new movement pattern the new normal or “familiar”. Regular repetition is often the reason your physical therapist wants you to repeat your program at least a few times per day (randomly throughout the day is even better). It has been said, “what is practiced is what is allowed to grow” and this is definitely true in physical therapy. It may not be necessary to repeat your program on the hour, but in order to overcome a dysfunction, it is necessary to remind your body of the new/improved movement(s) you are hoping to adopt. Consistency is the key to strengthening both your awareness and intention.

We have discussed the practice of mindfulness and its application to physical therapy. Certainly, also addressing your diet, sleep habits, stress, proper footwear or seating, as examples, are important discussion areas as well. Breath control is also important. Your physical therapist should also be addressing these areas, but we’ll save these for discussion at another time. Identifying your functional problems (awareness), creating a plan to address those functional problems (intention) and then implementing that plan (consistency) is how you can make a significant difference in your life and really take control of your symptoms—rather than your symptoms controlling you. Mindfulness is a functional concept that works very well in physical therapy and is a tool that helps us help you in achieving improved health and well-being.

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