Mechanotherapy is what you are looking for, you just don't know it yet!
You have water in your row boat. What’s the best solution: find the hole and fix it or bail the water out? This is the classic question of treating the symptom versus treating the source of the problem.
What causes pain?
If you have pain, is it chemical or mechanical? Mechanical pain is overwhelmingly more frequent than chemical pain. Something stiff or something weak will cause pain. The chemical reaction or some say “inflammation” is the consequence of the mechanical problem failing. Ultrasound, dry needles, electricity, lasers, are some of the examples of what we might use to treat a mechanical problem with chemical means. There are no double blinded, good studies to show any of those things are any better than a placebo. Clinical experience shows they don’t help.
Mechanical fixes (mechanotherapy) are joint “mobilization” and muscle and tendon “progressive loading.” (both described below) What is unfortunate is the American Physical Therapy Association doesn't even recognize mechanotherapy as a possible treatment option. We as a profession cannot agree on what is best for patients so we end up losing patients to other professions because we don’t address the real problem. Managed care doesn't want LESS things to bill for they want MORE. The equipment used to treat chemical problems cost lots of money. Expensive buckets to remove the water spilling into the boat.
Mechanotransduction (The scientific word for mechanotherapy) is defined by Khan and Scott as “the physiological process where cells sense and respond to mechanical loads.” These mechanical loads induce stress on the tissues to which they are applied, and this stress induces a response in the tissue to create a stronger structure in order to withstand that stress in the future. One of the most common examples of this concept being applied is through Wolff’s Law. Wolff’s Law states that “bone grows and remodels in response to the forces placed on it.” In other words, weight-bearing bones, such as femurs and tibias, are made stronger in loaded, weight-bearing positions--think squatting with a barbell. Not only are you squatting your body weight, but you are also squatting the additional weight of a heavy bar. Your bones thrive on this type of stress and they thank you.
Wolff’s Law is often only associated with loading bones to prevent conditions such as osteoporosis. However, it can be applied to other tissues as well, such as tendon, muscle, and cartilage. Therefore, another way of looking at this concept is that the application of Wolff’s Law to the entire musculoskeletal system is mechanotransduction. By utilizing a great enough stress to drive cells to respond in order to build and develop stronger tissues, we can create a progressive loading program through which the body trains to adapt to increased forces.
Mobilization is a form of stretching that changes the amount of range of motion of the joint as opposed to the flexibility of the soft tissue around the joint. Allowing for flexibility through stretching and not stabilizing the joint causes a temporary change in pain that requires more attention.
Stabilizing the joint through progressive loading then, once the joint is working better, loading the joint with heavy loads is how the hole in the row boat is patched. Low load-high rep exercises will cause the connective tissue to grow. Low rep-high load exercises require sound connective tissue integrity. This will improve the body’s ability to tolerate activities of daily living as well as the ground reaction force of running, lifting, or sports.
Restoring high level activities cannot be performed by chemical means, it must be done using mechanical means like loading. Squatting, deadlifting, and push press are key to a body that can tolerate some force. Here at MVPT, we do not use any modalities to treat your mechanical problem. We do a thorough evaluation, find the stiffnesses or weaknesses and then put a plan together to help you correct the abnormalities in joint position or weakness. Call 702-998-2900 to make an appointment today!
Want to read up?
Khan, K. M., & Scott, A. (2009). Mechanotherapy: How physical therapists’ prescription of exercise promotes tissue repair. British Journal of Sports Medicine, 43(4), 247–252. https://doi.org/10.1136/bjsm.2008.054239
How Wolff's Law Is Used During Fracture Rehab in PT. (2018). Retrieved from https://www.verywellhealth.com/wolffs-law-in-physical-therapy-2696151