Physical rehabilitation is an important part of medicine. When I was on the stroke team on my Neurology clerkship, the main goal of our team (after we identified and localized the stroke) was to make sure our patients were medically cleared so they could go to rehab (The second I wrote that I heard the Amy Winehouse song “Rehab” in my head- I’m sorry if I’m responsible for putting this earworm in your head too!).
Physical rehabilitation was also a significant portion of patient care on my surgical trauma clerkship. Indeed, one of the tasks of the med students was to do “PT rounds”, in which we tracked down our patients’ charts (yes, our hospital still uses paper charts) and checked for progress in their therapy. This became quite time consuming when our list grew to 40 patients, including 1 on almost every floor of the hospital! Each afternoon, as we tracked down charts, we would pore over the PT/OT (Physical therapy/Occupational therapy) notes. This was challenging not only because of the almost illegible handwriting of some of the therapists, but also because of the litany of abbreviations and symbols that they utilize (though with time, their interpretation became much easier). Over the weeks we would track the range of motion of our patients’ various joints, and the relative amount of assistance needed to go from lying to sitting and from sitting to standing. We would see how far they could walk (and with what type of assistance) and how many stairs they could climb up and down. The process- both the types of movements done and the assistance that is provided- is very delineated and mechanistic.
Meanwhile, in a seemingly totally different world…
Last weekend I attended a MovNat one-day workshop in Central Park. I’ve been aware of MovNat for a while now (I can’t remember my original introduction, but the name, and the general concept of ‘natural human movement’, is definitely something I came across as part of my journey in evolutionary health and wellness), but it’s something I’ve been interested in for a while, and I was enthusiastic to attend the workshop.
For those that are not familiar, MovNat is a concept of fitness based on the full range of natural human movements. It is the pursuit of fitness based on “man in the wild” not “man in the zoo”.
Through the day, we talked about and practiced 7 of the 13 MovNat movement skills. People do some interesting things in Central Park, but we definitely drew interesting looks as we explored different ways of walking, running, balancing, jumping, crawling, climbing, and lifting (the remaining 5 skills of swimming, carrying, throwing, catching, striking, and grappling were left for another day…). Many of the movements we explored were familiar, if not as things that we do on a regular basis now, then perhaps more reminiscent of a day outside as a child. Running around barefoot, tumbling in the grass, trying to nimbly walk along curbs and park benches: these skills weren’t exactly new, they were just things we needed to rediscover.
Throughout the day, the emphasis for these movements was not one of rigorous perfection, but more one of practice and experimentation. Through a variety of positions and movements, we explored our balance and flexibility, all with a focus of being mindful, both of our body and mind, and also of the environment around us. Through this practice, one could recognize the efficiency of natural movement and the (at least to me) instinctive nature of basic human movements.
As I mentioned above, many of the things we explored were not really “new”, but instead were a reawakening of movements and skills of childhood. It is great to watch a child play and realize that (at least to my rather untrained eye) they have great form in almost everything they do. Watch a child squat, pick up a rock, and play with it. Watch them as they stand up, carry, and run around with it- they don’t have to be taught how to do these movements correctly, they learn it through a process of trial and error- figuring out how do it as efficiently as possible.
Rediscovering these movements, with the help of guidance and tips from an instructor, is (at least from my take) what MovNat is all about (at least for the basic skills of balancing, walking, running, and lifting… I’d be a bit concerned if I was impressed with the grappling skills of a small child!).
So where does rehabilitation tie into all this?
As I mentioned above, the process by which people receive physical therapy in our medical system is (at least from my experience) rather rigid and mechanized. Could the instinctive and practical elements of a “natural movement” regime (such as MovNat) offer a new approach to rehabilitation?
MovNat has gained respect from many in the fitness world and beyond. Indeed the founder of MovNat, Erwan Le Corre, has given a talk on the subject at NASA. The emphasis I have seen thus far has been of general fitness and wellbeing for “normal” humans as well as athletes, but could a return to “natural human movements” be an appropriate approach to rehab? Would it help those who have lost their knowledge of how to move like a human, such as those who have suffered a stroke or a traumatic brain injury? When someone has well-and-truly forgotten how to move like a human (versus those of us who might just need to dust off those skills from childhood), can rebuilding this knowledge from an evolutionary and adaptive approach bring more success than a purely mechanistic approach? And what of those who are recovering from a long period of convalescence? Would a program that focused on the evolutionary “natural” movement of humans have greater success at returning appropriate balance and strength?
I definitely don’t have any solid answers, but it’s an interesting idea to ponder…
principleintopractice 
I wish I could remember where I read this, but when some fellow’s dad had a devastating stroke, he reasoned that the brain could be re-configured beginning with “baby” movements. So he started with movements like lying on the back and kicking, followed by lying on the stomach and raising the head etc, working up to crawling around the house. Ultimately, the stroke victim regained all his lost motion. Of course, this would not be considered cool in the medical establishment. But he got his father back!
Yeah- sometimes it’s not the latest-and-greatest “sexiest” treatment and therapy that is most effective… Perhaps we need to find a new high-tech name for crawling? “Active-assisted quadrupedal rehabilitation therapy”?
While exploring different bases of support rolling around on the ground I realized that patients might be really missing out by going directly from rehab in a bed (where it’s soft and where the transfer of weight and center of balance is quite different than on a hard surface) to sitting off the side of the bed and then standing on solid ground. I really think that working with people’s balance and weight transfer from solid ground (while lying, kneeling, seated, whatever) would give them a much stronger basis for moving to standing exercises.
Thanks for the comment!
[…] Victoria presents Natural movement and thoughts on rehab posted at Principle Into Practice, saying, “The idea of practicing natural, human, movement, has become increasingly popular in the fitness world through programs such as MovNat. Could the world of physical rehabilitation benefit from considering evolutionary and instinctive movements as well?” […]
Excellent post. Your unique perspective is more of what mainstream medicine needs.
When I completed the Mov Nat course in Thailand I had a lot of similar questions about it’s therapeutic applications. If you are interested, here is a post I wrote on the topic:
http://www.activebodystillmind.com/holistic-fitness/if-it’s-physical-it’s-therapy/
“If it’s physical, it’s therapy”. Good point- need to make sure it’s quality stuff!
Nice post and good thoughts! I wrote about my MovNat experience as a physical therapist here:
http://movnat.com/movnat-a-physical-therapists-perspective/
I had the same feelings as you regarding using the MovNat principles in rehab and I utilize a lot of what I’ve learned in MovNat with my patients now in outpatient rehab.
Inpatient rehab is a horse of a different color in many ways, though. The primary objective of physical therapy in inpatient rehab (because of insurance restrictions, etc) is to get the patients as independent as possible, so that they can be discharged to home and begin outpatient rehab. When I worked in a rehab hospital, we had to focus on bed mobility, transfers, ambulation, and stairs because those were the objective, measurable goals to determine if the patients were making progress and how that translated to their ability to return to their home, or go to a short term nursing facility. It is unfortunate that once patients can get out of bed and into a car they are usually discharged from inpatient rehab. The focus is purely function.
The real magic with retraining movement happens in outpatient therapy – that’s where we get to “play” and retrain more efficient, effective ways of moving. I would encourage you to do a short stint in outpatient rehab if you can! I think you would enjoy it.
Cheers,
Ann
Thanks for your thoughts, and I will definitely try and get some time in an outpatient setting. The inpatient functionality-focus seems to have the same effect on medical care as “no child left behind” has on our education system… All focus on passing specfic requirements, but of limited use in the real world!
Hi,
I have a quick question about your blog, do you think you could e-mail me?
Jillian
We have actually implemented just this approach for the rehabilitation of injured endurance athletes in Ireland and Britain with our technical director Tony Riddle over the last 6 months. We look at the specifics skills/movements essential to the sport and fix the technical aspect over an initial 2 day weekend workshop. Then we progress people to there to a point where they can, for example, run for 1 hour. Then we progress them to 2 hours and from there a traditional performance-based cardiovascular training programme can take effect. The original methodology was developed by Tony Riddle for us and we have helped shape it into a model that can blend seamlessly over into performance-focus afterwards. Rehab coach and performance coach working in tandem so to speak.
From my vantage point as an athletics coach, this is the only proper route to deal with chronic injuries and we foresee a great future for the programme. For the wider health related questions, we apply the perspective of evolutionary medicine to understand the true root causes of ailments.
Check out Gray Cook – he is a PT who has looked at and developed programming based on developmental patterns, so rolling, quadraped, half kneeling, kneeling, etc. I’m a PT and while it is not always possible to do these things in an inpatient setting, as the PT above noted, generally we try to incorporate natural movement into rehab. Or, I should say, we should! Unfortunately, as mentioned above, insurance looks at function, not quality of movement, so if a person can transfer or walk, no matter how poorly, they tend to not want to cover PT that would address improving the quality of the function. Great post!