Pain is inevitable. Suffering is optional.
-Buddhist proverb
First of all, I have a passion for my hip healing. I am tired of these damn hips talking to me and I have so many other things that I want to focus on. I have been invited to participate in a 200-hour yoga training in the city in June (aka San Fran). I would love to write a children’s book or a book about the inspirational story of my best friend who has dealt with real life and death drama. Who wants to be focused on their hips, unless, of course, they are the foundation for a great pair of jeans? But, there are many people out there who focus on hips (and other joints) as their life’s work. So let me introduce Physical Therapist, Dr. Jacob Templar.
Jacob is a PT who is also trained in Mechanical Diagnosis and Therapy (MDT) which is a technique used by Physical Therapists to assess and treat spine and other extremity orthopedic issues. He works in Rochester, NY as a PT and also works for The Strength Guys helping
with “injury management and load management”. Jacob was first drawn to PT as he had “been there done that” with his own injury in high school.
This Hopeful Hippie follows Dr. Templar on Instagram and I routinely see his excitement about pain science and helping his patients get back to moving! One of his light bulb moments in his career was when he was being mentored by Physical Therapists, Justin Murray and Erik Nassif, in the area of MDT. Jacob said that with this technique he had, “never seen such rapid changes in someone's pain and function, all while using an active approach and trying to teach a patient how to care for themselves”.
Jacob works with many types of orthopedic patients but does have experience with our hippie population ranging from replacement to resurfacing to labral repair and normal overuse problems. He does also see a lot of patients who have a double whammy of having their symptoms being driven by a combination of dysfunction of the lumbar spine and hip joint.
Jacob sees his PT role primarily as a team member. Essentially, he sees himself as “being a teacher and a coach versus a fixer.” He knows the importance of being a “guide [to] someone on their journey.” He knows how important his listening skills can play into his patient’s recovery. He believes that “by listening to [his patients he] can uncover which strategies may help them the most and what approaches to use. Ultimately it is their journey and [he] needs to facilitate the recovery and not get in the way by creating negative thoughts and association with movements or beliefs about our bodies that are unfounded based on our current understanding of the human pain experience.”
And as I mentioned before in another blog post, my biggest ‘ah ha’ moment when dealing with my own pain was learning that the pain I felt did not necessarily equal a similarly intense level of damage in my hip joint. Jacob explains that “the current understanding of the human pain experience is vastly different than what most of us learned growing up. We now know that tissue damage does not always lead to pain and having pain doesn’t mean there is tissue damage. We all have had bruises or cuts that we didn’t know how we got them. We know the body is always weighing information in situations we are in and saying to itself ‘How safe am I and does the sense of safety outweigh the danger in this?’ Lorimer Moseley calls this our protectometer. Pain is our bodies best guess at interpreting a scenario [and determining safety versus threat]. We also know if people learn about modern pain concepts, they have better sense of self efficacy and are more likely to partake in active approaches to improve their functional abilities that the pain has limited."
So, in essence, Jacob is saying the more a patient understands pain and what it represents in your nervous system the better outcomes you may have. If you are interested in understanding this pain concept, I know I have previously provided a link to Greg Lehman’s patient pain workbook and to Lorimer Mosely’s video and here they are again!
Jacob also has some additional resources that can help ease you into more manageable pain through your hip journey. The best resources he suggests for people with pain are Lorimer Moseley videos on Youtube. Mosely strongly believes that “pain is not an accurate measure of tissue health.” Jacob also recommends checking Mosely out at Tamethebeast.org. Adriaan Louw also has patient education books. Jacob also recommends checking out Knowpain.org from the UK which also has some great information to help you in your journey.
Although we all have real pain and hip issues, recovery is a process. I know that sometimes my blog posts ooze with optimism and hope. I know I sometimes can make it sound easy, but I want to make sure that you see me as a real person who does struggle even with my “Hopeful Hippie” persona. Some days, she is NOT on that path to hope and I can’t get her back, but overall I do feel that optimism and resilience have helped me.
Jacob also shares that the “literature supports that resilience and optimism has a big impact on recovery from any injury. Our expectations and thought process has a determinant of recovery. Adriaan Louw has done several studies explaining how pain works in the body and setting expectations around surgeries versus simply explaining anatomy and bio-mechanics and found significant improvement in people's coping with symptoms. Since we know that surgery may remove what we call nociception (response to painful stimuli) or tissue problems but does not impact our nervous system, adaptations [around pain perception] will still need to be changed. This then helps people perform activities that will help improve their function."
This inquiring mind also asked Jacob what his thoughts were with the mind-body connection and recovery. He stated that the “mind body connection is huge because we can't separate the two. A surgery may fix a tissue problem if one exists, but does not rewire a nervous system that has been trained to produce pain with less activity or to be more protective of your body. So, while a tissue may be fine, we need to encourage movement and activity and retrain the system to accept and tolerate that because it's no longer getting the offensive stimulus from that tissue.”
In prepping for surgery and beyond, obviously understanding your anatomy, pain and “nociception” and valuing the mind-body connection is important, but Jacob also recommends doing the “the best you can to strengthen around that joint and improve your range of motion (within reason) [because] the stronger and more active you are with better motion [will] lead to better outcome after the surgery.” And what about beyond the surgery? Jacob says, “get moving again as quickly as possible (within surgical precautions). Even if you aren't supposed to have weight on that leg use your other leg, your upper body and in general continue to use your body. This will influence your recovery and help to mitigate changes to your entire body that can impact recovery.” This Hopeful Hippie will also second that but add a more specific warning phrase. “Follow the protocol!” Most hip surgeons have a very specific protocol designed based on their experience, your needs and your particular surgery. Always first get input from your surgeon and PT.
Jacob travels with his patients through this journey and one of the biggest areas that he tries to incorporate with his practice is this whole idea of “mind set and readiness to change. [He believes it is his] job to recognize where someone is in their readiness to change and make behavior changes and meet them at that spot to optimize their long-term success. [He realizes] some people are just not ready to make a change or have prior beliefs about something challenged and things don't work out. But our willingness to change behaviors and beliefs about the body influences things negatively and positively.” He also says that he “always put the blame on [himself] first because it’s [his] job to frame things in a way someone can understand and [help] elicit change.” He also understands how hard it is to make changes, but he is always willing to walk on that journey with his patients.
So, Hopeful Hippies, dig into this information. Understanding your pain may help to better manage it and, in turn, will help in your recovery so you can go on your merry way with a distant rear view mirror vision of painful hips!