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Is Prehab The Solution To Today’s Physical Health Problems?

How familiar does this sound to you?

“Deshaun Watson is out for the season with a torn ACL.”

The injury occurred during a routine practice drill. The injury was non-contact. Deshaun Watson underwent surgery on November 8th, 2017; he is projected to be out for the season. Many Houston Texans fans are very disappointed. Fantasy players are scrambling to pick up a replacement from the waiver wire. Deshaun Watson himself has to look forward to many months of intensive therapy and rehabilitation, and wonders if he will ever be at his peak again.

Figure 1: An injured athlete. Was his injury non-contact? Was it preventable? [1]

Your uncle has a bad back. It started out with mild pain 20 years ago. At the time, he didn’t know that it was the early symptoms of a slipped disk. After surgeries, pain medications, and physical therapy, today, he can stand for 30 minutes at a time before the pain becomes unbearable.

Your 13 year old niece sprained her ankle playing tennis. She had just made the Varsity team. Thankfully, she only has to go on crutches for two weeks and to rehab for two months. But her season is over.

And lately, you’ve been having shoulder and neck pains that won’t go away. Some days are better than others, but they’re a constant, always nagging dull ache. You’ve changed pillows. You’ve gotten massages. Nothing has worked so far.

Physical health: how we feel as we move

Each of these cases is an example of issues with somebody’s physical health and wellness. Physical health and wellness is the condition of our body’s musculoskeletal system and its proper biomechanical functioning. Physical health is not the same as fitness; it is not looking at how fast you run, how much you lift, or how much you weigh. Rather, in a nutshell, it’s a reflection of how well we can move and how we feel as we move.

Poor physical health is all too common in today’s world. You have all know of at least several people for whom one of these scenarios is applicable right now. And it doesn’t seem to matter whether you can bench press 200 lbs, or run a 5k at a 7-min/mile pace. It affects us with little discrimination.

The importance of physical health

Many of us have lived with aches and pains our entire lives. Because of that, as a society, we have become desensitized to them, and often view them as necessary parts of our path to improved physical condition. “Pain is weakness leaving the body.”

While it’s a worthwhile motto, it’s also important to note that not all pain is created equal. Some pain is the result of lactic acid buildup and torn muscle fibers, ready to be built back stronger, after a tough workout. Some pain, however, is the symptom of improper movement patterns: of joints, ligaments, bones, cartilage, straining to move you the way you want to.

Unfortunately, too often, this latter type of pain is what is most prevalent. As a former NCAA D1 athlete, I realize that competitive athletes very rarely feel at 100% physically. We all constantly struggling with minor pains, small strains, etc.

These improper movement patterns are the result of years of bad posture, improper form, and habits that have shaped our muscles and neurological pathways to undertake very specific muscle activation patterns to accomplish a certain movement. These improper movement patterns can then push our bodies into positions that are unstable and put suboptimal stress on our joints, from a physics perspective. It is because of these improper stresses on our joints, tendons, ligaments, and muscles that injuries and pain frequently occur [1].

Figure 2: Beware the chute. From poor movement patterns to pain and injury. [EuMotus]

As a result, the impact of this condition isn’t just decreased performance on the field. It’s much more severe and widespread than that. For athletes, the prevalence of improper movement patterns can mean season- and career-ending injuries. Each year, 9MM injuries in youth sports require hospitalization, 50% of which are non contact (i.e. due to improper biomechanics) [2]. 70% of all college athletes will experience at least one “severe” injury [3]. Longer-term, it can mean chronic pain from overuse that will impact their standard of living for the rest of their lives.

For the everyday person, improper biomechanics can have a devastating effect in our daily lives that too often goes hidden. That neck pain, that backache, that knee problem, can quickly evolve into something that takes over your life. 1 in 3 Americans suffer from chronic pain, leading to $300 Billion in medical spending and an additional estimated $300 Billion in lost productivity [4].

Lastly, it has been well researched that mobility is directly correlated with morbidity at a higher age [5]. Poor balance and motor control can lead to painful, or even disabling falls. The better our geriatric population can move, the more comfortable they are in staying active, improving both their bodies and minds, the longer and happier lives they will lead.

Our current approach to physical health is reactive.

As a society, we have been able to increase the awareness of the benefits of physical activity. Gym memberships have steadily increased over the years. New ways to be active and new experiences such as Crossfit, SoulCycle, and Spartan Race, have kept people motivated.

The effort to improve our biomechanics and instill proper movement patterns, however, feels like it hasn’t changed in decades. Coaches and trainers guide with their eyes, hands, and experience. Sometimes, we compare videos of movements to highlight, frame by frame, a movement progression, but still ultimately with our eyes and experience. Frameworks to systematize movement analysis, such as the FMS, still rely on subjective individual observation. Meanwhile, marker based motion capture is expensive and time-consuming, and therefore, not applicable to society as a whole.

As a result, we live with our improper biomechanics, our bad posture, until they erupt into injury or pain that is unmanageable.

Only at that point, once we’re injured, once we’re in pain, will we go to the experts in human movement, the physical therapist and the chiropractor.

The physical therapist or chiropractor will assess our physical health, our movement patterns. He or she will identify our deficiencies, our imbalances, and our compensation mechanisms that were the source of the pain or injury, and will attempt to correct them.

However, too frequently, we never fully manage to correct the underlying biomechanical deficiencies, for two reasons:

  1. As patients, we are focused on the pain or the injury that brought us to the professional in the first place. Once the pain or injury improves, we have less direct incentive to improve our deficiencies.

  2. Insurance companies, for the most part, focus on treating the immediate problem: the pain incidence or the injury. From what we hear in the world of physical therapy and chiropractic care, they may not always offer coverage for the additional treatment sessions required to fully correct improper movement patterns.

Figure 3: Functional health paths to avoid over time. [EuMotus]As a result, the treatment we undergo still leaves us open to repeat injuries, repeat pain incidences. We then find ourselves in a never-ending vicious cycle.

Avoid injury and pain in the first place by being proactive

There is hope to break this vicious cycle. A recent movement in the physical health and wellness space is the concept of “Prehab” – a series of visits to a physical therapist or chiropractor when we’re not injured or in pain. Prehab is specifically focused on measuring, analyzing, and improving our biomechanics, helping us become more efficient and more stable in our movement patterns.

Prehab has been shown to be tremendously effective in reducing injuries in a variety of settings [6]. And logically, it makes sense. Let’s tackle the problem before it erupts into something that cripples us.

Proactive (or preventative) treatment is widely accepted and acknowledged as prudent and cost effective access to the healthcare system.

For example, we go to the dentist twice a year to make sure we don’t get surprised by a cavity. We visit the doctor annually to make sure our vitals and our blood metrics are in line and not taking us down an unhealthy path. Many of us go to the gym, run, and watch what we eat, to manage our cardiovascular health and avoid dangerous and costly complications.

Our physical health is something we feel every day of our lives, from when we get out of bed to when we fall asleep. We owe it to ourselves to be proactive about such a significant part of our lives.

Technology is empowering physical health professionals to be proactive, faster, more accurately than ever before

Today, it is easier than ever to take charge of our physical health and wellness. More physical therapy and chiropractic practices are offering prehab programs. Many gyms are even bringing physical health professionals in house to better serve you.

Recent technological progress is also making prehab easier and more powerful. Look beyond fitness trackers that are tracking “fitness” metrics, like steps walked and heat rate. Breakthrough developments by companies, such as EuMotus, in markerless motion capture systems and machine-learning based analytics have made it easy and efficient for physical health professionals to capture accurate and meaningful biomechanical data and actionable insights into your physical health.

With such technology, physical therapists, chiropractors, and athletic trainers, can get objective and trackable measures of your movement patterns, your muscle imbalances, your injury risks, and more, faster and more easily than ever before. At the end, we all benefit from our ability to lead healthier, pain-free, injury-free lives.

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