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Space. Movement. Blood.

June 22, 2018 • Pain Science • Brian Freund

I can remember the day that I graduated from physical therapy school 20 years ago. I was clear in my goals for my career. I wanted to become an orthopedic manual therapist. I figured I would be able to “fix” everything that came into the clinic, and all of my patients would be extremely satisfied. Then that first day happened. I had a five o’clock new patient on that first day. When I walked up to the front of the clinic and picked up the chart, the diagnosis said fibromyalgia. I evaluated the patient that day, and the responses to my subjective questions are exactly what you would have thought.

I asked the following questions: What makes you better? Nothing.

What makes you worse? Everything.

Where do you hurt? Everywhere.

I could feel myself starting to sweat not really knowing what I was going to be able to do to help this patient. The one thing I did know was that I had no idea what mobilization or manipulation to perform for this patient.

Over the years that followed I realized I needed to open my perspective relative to treating patients. I realized that I could not put all patients into a silo and treat them all with only manual therapy. I realized that there was another system that I really had to pay attention to with regards to treatment interventions. I could no longer consider myself as only an orthopedic manual therapist but needed to broaden my horizon to include the nervous system.

I had to take on this beautiful living breathing organ.

I had to begin to have a better understanding of how this system plays into my patient presentation.

The rest is history. I was taught the nervous system in school as though it was three distinct and separate systems. I was taught the central nervous system, and then I had a test. I was taught the peripheral nervous system, and then I had a test. I was taught the autonomic nervous system, and the I had a test. I learned about this system in silos. My world has significantly changed since that time, and just coming back from the Align Conference in Denver further reinforced my thoughts around this wonderful system. The theme of the conference was peripheral neuropathic pain. Michel Coppieters and Michael Shacklock were at the Align Conference, and they were fantastic. It is amazing how far we have come in orthopedics relative to understanding the nervous system and more importantly what role this beautiful system plays in the world of orthopedics.

The nervous system is the body’s living breathing alarm system. There are 45 miles of nerves in the human body with 400 individual nerves. The entire system is connected much like a superhighway, and there is always a buzzing in the system.

Why? It tells us we are alive.

It works as a defense mechanism, and it works to protect us.The key thing to remember is we need to make sure this system remains healthy.The way to do this is to provide the nervous system what it wants.

The nervous system wants three things. Space. Movement. Blood.

So, as you are working in your outpatient orthopedic clinics today, make sure to keep in mind this beautiful living breathing alarm system and how it effects the orthopedic patients you treat.

Brian Freund

Brian is a physical therapist and clinic owner with 20 years of experience in outpatient orthopedics. Current Roles: Faculty, EIM Notable Accomplishments: Founding member of Midwest Spine Therapists (formerly ISPI and now EIM)

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