PT Perspective: Dr. Christopher Ellis
So our next Hopeful Hippies guest is truly a hopeful hippie! Welcome to Dr. Christopher Ellis.
His story begin with a fall down an elevator shaft. Can you say, ouch?
Christopher catapulted four floors down and was fortunate that his fall was partially broken by wood which saved his life.
I'm hoping his feedback as a Physical Therapist and patient will help guide the recovery process for each of you. This is his story.
"After going through some pretty bad healthcare, I found physical therapy which brought me back to life. 8 months later I was in the best shape of my life, no cast, no surgery. Here I am at 44 years old with no pain, I play ice hockey, do Brazilian jiu-jitsu, and power lift. In the fall I fractured my pelvis, my wrist, and a vertebrae and was told basically I wouldn't be able to do any of that stuff. So I decided that physical therapy is the way to go.
Over the years, I think I've gotten very good at giving people permission to move. There is a narrative in mainstream medicine that teaches people to be afraid, to stop moving, stop activity, and I just disagree with it."
Check out his podcast to see how his background and philosophy has been molded from his experiences.
It sounds like you have an area of specialty in hip injuries and surgeries. Tell me about some of the benefits of that when helping people recover from hip surgeries such as hip arthroplasty.
I consider the hip joint to be my specialty. I originally became interested in it through SI dysfunction and got good at solving that. Then I became interested in hip impingement/FAI, mostly because there is just a lot of misunderstanding around it. When I was able to prevent surgery for a number of my patients, it became rewarding. Also, as I mentioned, I play ice hockey. A lot of hockey players develop FAI so I understand from both a sports and an orthopedic perspective.
THA is very easy to treat and recover from. Of all the joints to replace, the hip is kind of the easiest one. Treating a hip scope can be more tenuous and each person will have their individual differences so there is much more customization to a hip scope, whereas a THA can basically follow a protocol.
What is the best advice that you can give a patient leading up to an orthopedic surgery? What about after?
Keep moving, stay positive. The quality of your muscle going into the surgery will dictate their recovery, so the stronger the better. Eat protein, give your body the building blocks to heal. Same thing coming out of surgery. Go for walks when you are weight bearing to help mitigate swelling. Don't obsess about pain. Pain is just the body's way to tell you to alter something, it does not always mean tissue damage. If walking is too painful, biking is also great for swelling.
What are some things that a patient should make sure their PT understands if their PT is not well versed in rehabbing patients with FAI.
I would honestly seek out a PT that specializes in FAI, because a lot of schools don't even teach it. I would say issue number one is the hip flexor. Everyone blames the hip flexor for the pain, and although sometimes that is an issue, more often than not, it's not the hip flexor. And stretching the hip flexor can actually make it worse. You want to strengthen the hip flexor. There are a lot of structures in the front of the hip that are more likely the source of the pain. The hip flexor has a role in keeping the ball in the socket, and if it's overstretched, the ball can slide forward and make matters worse. Other than that, find a PT that can spend one on one time with you and is able to do a thorough evaluation.
Can you explain the current research on the human pain experience?
That is a huge topic, and to find out more, you can google pain science. Also look into Lorimer Mosely and Greg Lehman. There is a fantastic Ted talk on
The premise behind pain science goes as follows: When you do something repetitively and exceed the capacity of the tissue, there are changes that occur in the tissue, whether it's mechanical, thermal, or metabolic. The nerve endings in the tissue pick up on this and send a message to the brain. The brain produces a pain signal (yes, pain is actually experienced in the brain) to try to get you to alter what you are doing. Pain is a request to change. Pain usually precedes actual tissue damage besides acute, traumatic injury. So, if you take a golfer that doesn't have any back strengthening is his routine, and he goes out and plans 18 holes 5 days in a row, he will likely overuse some tissue. The nervous system will sense this and now there's pain. The approach is to desensitize the tissue, and prioritize pain free movement. Once the pain is resolved, you have to train the back so that it is more resilient and can tolerate 5 days straight of golf. It's all about dose. The right amount of stress (exercise), plus the right amount of recovery (proper sleep, nutrition, hydration) equals adaptation. The adaptation is whatever you set it to be, such as golf 5 days a week. You have to train for it to be pain free.
What is your belief on the mind-body connection in healing from orthopedic surgery? What about expectations - ie..patient expects success?
The mind-body connection is undervalued. We are complex, the brain is tied in intimately with the body, that's why it's called the neuromuscular system. We know that stress, both physical and mental, has a direct impact on recovery. And they tend to either upward or downward spiraling in a feedback loop. So it's easy to be in pain, then get depressed, and the depression puts you in more pain, and the cycle continues. This is how chronic pain develops. But the converse is true as well. Movement is medicine.
Additionally, we are finding out more and more just how important the gut is. Gut dysbiosis may be central to most of the diseases that afflict us, especially autoimmune disease. Alzheimer's is now known as Type 3 diabetes and the problems surrounding metabolic syndrome can literally travel into the brain via the valgus nerve and cause inflammation in the brain and lead to dementia.
What do you see as a PTs greatest contribution to helping a patient recover?
Patient expectation is vital. I don't know one patient that got better who didn't want to. Our role as therapists is to guide you to your own recovery, not to do it for you. It's important that the therapist is able to clearly communicate this message, as well as what to expect along the way. That there may be ebbs and flows to the process, there may be flare ups, and that's ok, it's part of the process.
What is one thing that can make the biggest impact on a patient's recovery? Conversation. Listening. Educating. We are here to guide you where you need it. To talk you off of the ledge when you need it. To give you permission to move when you need it. To scale it back sometimes when you need it. We have to meet the patient where they are, and progress them at their pace. Everyone is different, everyone progresses at different rates. Our job is to know when to push, and when to back off.
Conversely, what is one thing that can make the biggest impact on a patient NOT recovering?
That's a tough question. If I was to pick one thing, the relationship you have with your therapist. There has to be a comfortable and clear line of communication between the two of you. The patient and therapist's goals should be aligned. If there is a bad relationship, the rehab will not go smoothly.
What is your opinion about resilience and optimism as factors in successful recovery from an orthopedic surgery?
Resilience and optimism go hand in hand. You either buy into the narrative that we are weak, frail, and should avoid things that hurt and don't do too much. Or, you are optimistic about movement. Pain in life is normal. Some cultures even seek pain. If you work hard, there will be pain, but that can be managed. You want to seek resilience, which means building up your capacity. "A ship in harbor is safe - but that is not what ships are built for."