Physical Therapy: There Are No Safe Spaces on the Savanna

[Mark Rippetoe]

Physical Therapy: There Are No “Safe Spaces” on the Savanna | Mark Rippetoe

[Chiaki Nitya]

"“stress” that does not require recovery is not actually stress, and cannot produce an adaptation toward returning function."

Brilliantly worded. Also, in my particular situation, this is a perfectly timed article. Thanks Mark!

[Jdcuth]

A phenomenon often ignored in medicine. We used to advocate graded physical therapy for chronic fatigue syndrome. Essentially gradually increasing your daily workload under supervision. Although this was often done badly, the theory obviously made sense- at present you have a sick phenotype, a healthy one exists for you and gradually taking advantage of the stress/recovery/adaptation cycle gets you there.

However experts got involved (many of whom never had their hands on these patients) and actually used the term barbaric to describe this practice and instead used "pacing" as a tool to get there, advising often totally sedentary patients to rest more to get healthy.

So if a patient with CFS came to me and actually said "I'm sick of feeling like this, what can I actually do?" I would be vilified to use the term graded physical therapy. I therefore need to tell them to lie more still or tell them to do ungraded physical therapy which is a total mess of bullshit. And we end up with these people in wheelchairs.

The reason why the guidelines changed was, in my opinion, because people with CFS associated being told to do graded physical therapy with the insinuation their condition is due to laziness. And we cannot make patients feel bad, ever.

I have no doubt this condition is real. I have had company CEO's and former military leaders struck down with incapacitating fatigue -- but they all benefited from, over many weeks and months, gradually increasing their physical exertion under supervision because there is no other way to do it

Glad I escaped this mess.

[JFord]

Very well written. I’m aware of the concept but have never heard it expressed so cogently.

The paradigm is changing for the better though. Years ago, as a “hospitalist”, I was rounding on one of my patients who had just had his chest cracked for open heart surgery late in the afternoon of the previous day.

That morning when I came into the patient’s room, the ICU nurse was getting the patient out of bed to walk him after well under 24 hours post-op. The patient was bitching vociferously and I asked the nurse why she was doing this. She just smiled and said that that was the surgeon’s order.

I was amazed and what started off as indignation turned into admiration.

Numerous studies have validated immediate ambulation of almost all patients in the hospital, including the vast majority of post-op patients. This has been demonstrated to improve a broad range of clinically significant metrics.

The principle has many applications in medicine for a wide variety of conditions. In fact, there are very few medical conditions that convincingly benefit from rest.

Even doctors can learn from the savanna.

[Mark Rippetoe]

Tell your colleagues to read the piece, Thanks John.

[JFord]

Tell your colleagues to read the piece, Thanks John.

Will do.