6 Reasons Physical Therapy isn’t working and what you should do instead

Physical therapy serves as a conventional approach to rehabilitation from joint pain, yet it may not always meet individual needs comprehensively. As a Feldenkrais practitioner, I see clients every day who have been to PT and been disappointed with results. Here are some insights from the Feldenkrais Method that shed light on 

6 reasons why physical therapy might not yield chronic pain alleviation:

1. Problem isn’t local to one part of the body, and PT focuses on specific muscle groups

   Physical therapy often focuses on treating specific symptoms or areas of dysfunction without addressing the interconnectedness of the entire body. Without addressing these interdependencies, individuals may experience incomplete relief or persistent issues. 
   

   Sustainable treatment for neck pain, for instance, requires looking beyond the neck itself. Understanding how a person holds their chest and pelvis, how they balance their head on their spine are crucial in addressing the root causes of neck discomfort. Similarly, addressing shoulder issues effectively involves considering broader factors such as body weight distribution on the feet, the curvature of the spine, and even walking mechanics in ways that affect the shoulder's function. This holistic approach explains why exercises focused solely on neck or arm strengthening often provide only temporary relief and can sometimes exacerbate existing pain.

2.  Exercises hurt so you aren’t able to stick to the home practice program your physio provides

   In many physical therapy routines, exercises often involve repetitive movements intended to target specific muscle groups for strengthening or stretching. When our focus is solely on the repetition of these exercises, we tend to prioritize completing the prescribed repetitions quickly or forcefully. This mindset can make it difficult for us to be aware of any discomfort or strain during the exercise itself. Instead, we may only feel the effects after the session has ended, making it challenging to pinpoint what actions contributed to exacerbating our pain. It can lead to frustration and a reluctance to continue with the prescribed therapy regimen.

3. Pain isn’t muscular and that’s what your PT is trying to treat and connective tissues aren’t the PT’s specialty

   Physical therapy approaches often focus on addressing issues through a muscle-centric perspective. The underlying premise is that pain arises due to weakness in specific muscles, leading to instability or inadequate support. Consequently, therapists prescribe exercises aimed at strengthening these areas. While repetition can effectively reinforce positive habits, it may inadvertently worsen pain caused by poor body habits and compensatory movements. This idea of focussing on the muscles around the affected area perpetuates a fragmented thinking about what it takes to move well in our bodies. 

4. Limited mind-body Integration and PT might re-trigger a traumatic response or not be trauma-informed

   Effective rehabilitation encompasses not only physical aspects but also mental and emotional factors that influence movement and healing. Traditional physical therapy may sometimes neglect this dimension, potentially overlooking the impact of stress, emotions, or personal history on physical health. In this regard, physical therapy can feel very ‘physical’ not acknowledging the role of past history or trauma in perpetuating pain.

5. Lack of personalization in prescribed PT range of motion activities

   While physical therapy aims to provide tailored treatments, the effectiveness of these treatments can be limited by standardized approaches that may not sufficiently account for individual variations in biomechanics, movement patterns, and lifestyle factors. The lack of personalization in physical therapy can significantly impact pain management outcomes. When treatments fail to account for an individual's unique body habits and how these habits are influenced by their upbringing or cultural narratives, there's a missed opportunity to address underlying causes of pain. 

   Moreover, lifestyle factors such as daily activities, hobbies, and occupational demands play a crucial role in shaping physical health. A person's routine—whether they spend hours at a desk, engage in repetitive physical tasks, or participate in sports—can either support or undermine therapeutic efforts. Without considering these lifestyle aspects, physical therapy may overlook important contributors to pain and limit its effectiveness.

6. Disconnect from everyday life instead of working with your common movements

   Physical therapy often struggles to seamlessly integrate into everyday life activities, which can limit its effectiveness. While therapy sessions focus on specific exercises and techniques aimed at improving mobility, strength, there is sometimes a disconnect when it comes to applying these gains to real-life situations.

   For instance, exercises performed in a clinical setting may not directly translate to movements required during daily tasks like bending, lifting, or reaching. This lack of integration can leave patients feeling unsure of how to bridge the gap between what they do in therapy and what they encounter in their regular routines.

   Furthermore, physical therapy often emphasizes isolated muscle groups or joint movements, which may not adequately prepare individuals for the complex, coordinated movements needed in daily life like walking, climbing stairs, or carrying objects. These activities involve multiple muscle groups working together in a synchronized manner, requiring balance, coordination, and endurance that may not be fully addressed in traditional therapy approaches.

If PT isn’t working for you, here’s how the Feldenkrais Method could help:

The Feldenkrais Method offers a promising alternative for those seeking relief and improved functionality through a scientific and personalized approach. Here’s how it addresses the missing pieces in physical therapy:

1. Feldenkrais Method takes a Whole body Approach instead of muscular

   Feldenkrais practitioners understand the body as an interconnected system. They can pinpoint the body patterns causing strain by observing them in day to day activities relevant to the person’s discomfort, for example like walking, sitting, lifting things, climbing stairs, standing etc. The pain's source is rarely where it's felt. This holistic understanding allows for more effective treatment.

2. Gentle Movement reduces chances of getting hurt and increases the adoption of self-care with home practice

   In the Feldenkrais approach to healing, the role of body movement is to reprogram, not to strengthen. This reprogramming transfers to our physical movement abilities, mental thinking and emotional states. The verbally guided group classes start out with asking participants to make subtle, hardly noticeable movements, seeking out pleasant sensations of lightness and fluidity, while slicing away the instinct to perform or repeat. This invitation to move for one's own pleasure can seem like a paradigm shift for us as adults, but was the way that we learned to move as babies. As the person learns to move slowly, including various parts of themselves, the movement itself becomes enjoyable. When we repeat from this place, we are chasing after that pleasant sensation of ‘feel good’, not so much the mechanical act of repetition. This unique kind of repetition involves refinements that are made possible through the mediation of our motor cortex or ‘learning brain’.

   In a 1:1 session, the practitioner uses their listening skills, knowledge of human movement and anatomy  to guide the person in small but specific movements. The goal is to expand their range in ways that are consistent with improved functional quality and hence reducing and eliminating the pain over a single or a series of sessions.  

3. Feldenkrais Method is based in brain learning instead of physical muscle training

   Feldenkrais uses awareness as the currency for improvement. Instead of being repetitive, the movement explorations kindle your curiosity, helping your brain fill in the missing pieces of what it takes to move with ease and strength. The process enhances your self-image defined as the image that we have of ourselves in movement. This is different from self-esteem, how we feel about ourselves. We might be moving our knees or shoulders a tiny amount but we can fill in all the other parts of us that are involved - our hips, our back, chest and so on. This allows a person to discover fluid whole body movement where every part of us moves proportionately.

   Muscles have a role in facilitating the movement of our skeleton based on an intention to do something or go somewhere. Since there are so many muscles that are recruited in a cascading sequence, they are best recruited by using mental images about specific intentions (like reaching for the chocolate on the top shelf or turning to look behind you when reversing your car out of a driveway, getting up from your desk etc) and the awareness of how our skeleton moves to fulfill those intentions.

4. Feldenkrais practitioner helps you connect with your nervous system

   A Feldenkrais touch is a listening, calming touch. The practitioner takes genuine interest in a person's body habits. This creates a feeling of safety and an openness to change without being forced to do so. The ‘faulty body habits' are seen not as problems but as a person's resourcefulness with past circumstances. With touch and playful experimentation, they are invited to glean how some of those habits might’ve lost value and might be worth unlearning. The process itself is engaging and recruits them into relearning how to move in their bodies again. While there is no talk therapy about past trauma, it is natural for a person to have moments of relating their body habits to some particular events or interactions in their past. This kind of acknowledgment is very comforting and allows them to reevaluate their movement choices from a more informed place.

5. Customized to the person’s unique body patterns and lifestyle

   The Feldenkrais Method goes further by offering highly personalized sessions that adapt to the individual's specific needs and movement patterns. This personalized approach can uncover underlying causes that may be missed in more generalized physical therapy routines, enhancing the effectiveness of treatment.

6. Connect directly to everyday life instead of rote movement

   Feldenkrais body movements are inspired by functional movements that directly translate to improving day to day movements like walking, climbing, lifting, reaching, bending etc. Many of Feldenkrais' explorations are based on developmental movements that helped us learn basic movement skills as babies. Hence they are akin to movements that we make in our life. They are taught with much playfulness and have just the right sprinkling of visualization and analogies to help you learn to move well in ways that are pertinent to your health. 

In conclusion, while physical therapy can be beneficial for many, it might not always address the complexities of your unique body and movement patterns. The Feldenkrais Method offers a holistic, gentle, and personalized approach that focuses on awareness and the interconnectedness of the entire body. If you’ve found that traditional physical therapy hasn’t fully met your needs, consider exploring how the Feldenkrais treatment  can help you move with greater ease and comfort.

If you're interested in experiencing the benefits of the Feldenkrais Method, I invite you to schedule an appointment with me. Together, we can work towards uncovering the underlying causes of your discomfort and improving your overall movement and well-being.